jeudi 30 avril 2015

Team Of MGH Doctors And Nurses Headed To Nepal To Treat Earthquake Victims

Team Of MGH Doctors And Nurses Headed To Nepal To Treat Earthquake Victims

Members of the MGH medical team headed to Nepal to help care for the more than 10,000 people injured in last weekend's earthquake attend a last-minute briefing Thursday morning at MGH's Center for Global Health. (Courtesy MGH)

Members of the MGH medical team headed to Nepal to help care for the more than 10,000 people injured in last weekend’s earthquake attend a last-minute briefing Thursday morning at MGH’s Center for Global Health. (Courtesy MGH)

As the death toll following a massive earthquake last Saturday in Nepal continues to rise, and more than 10,000 injured men, women and children await treatment, a group of nurses and physicians from Massachusetts General Hospital will join those working to keep survivors alive.

They plan to arrive in Kathmandu on Saturday, with all the basic equipment. Each person will carry their own tent, sleeping bag, mosquito net and basic medical supplies, hopefully in a carry-on so they’ll have a place to sleep if luggage is lost in the chaos.

At a last-minute training Thursday morning, members of the team acknowledged that they can’t prepare for the emotional impact of arriving in a city where rain and a shortage of wood is making it difficult to dispose of the nearly 6,000 bodies recovered so far.

Nepalese relatives carry the body of an earthquake victim for cremation as Indian rescue workers, left in background, carry on their work in Kathmandu Tuesday. (Manish Swarup/AP)

Nepalese relatives carry the body of an earthquake victim for cremation as Indian rescue workers, left in background, carry on their work in Kathmandu Tuesday. (Manish Swarup/AP)

“We cremate our dead,” said Dr. Bijay Acharya, who is from Nepal, explaining that the country follows Hindu customs. “They’ve run out of wood, so bodies are piling up in hospitals.”

Most of the doctors and nurses on this trip have either been to Nepal or traveled to other medical disaster zones. But Dr. Hilarie Cranmer, director of disaster response for MGH’s Center for Global Health, says the devastation in Nepal may still be shocking.

“You’re going to see things that you’ve never seen before,” Cranmer said, “but I challenge you and I ask you and I require you .. to make sure that you are caring for yourself, so that you may care for others.”

Cranmer pulled together the briefing for the Nepal team. One person lists the shots these volunteers need to get in the next 24 hours, another explains how they’ll be paid while away. A physician who has spent time in Nepal describes altitude sickness. There are tips on safety and security.

Dr. Acharya says some villagers confronted a group of doctors delivering medical supplies Wednesday and demanded tents.

“There was a very tense situation and a little bit of chaos,” Acharya said. “It’s raining and people are outside, sleeping outside, and people are desperate for relief, even in Kathmandu.”

Medicine and medical tools are in short supply as well, especially the material needed for orthopedic care and surgery, Acharya said. Three orthopedic surgeons may join their MGH colleagues next week if the backlog of supplies lifts.

Team leader Dr. Miriam Aschkenasy says the nurses and physicians traveling to Nepal have to adopt a public health rather than individual approach to medicine. In a disaster zone, she said, doctors don’t have the time or resources to try and save every patient, but letting a patient die, instead of going all out, is difficult.

It’s a lesson Aschkenasy learned the hard way after the 2010 earthquake in Haiti, while treating an 8-day-old baby girl. The baby had a severe infection that might have been treatable in Boston but was not given the conditions and resources in Haiti. Still, doctors and nurses were doing everything they could to bring their Boston training and mindset to the tiny girl on the table in front of them. Aschkenasy remembers making the decision to stop.

“We have very few resources, and to continue to use them up on a child that has absolutely no chance of survival,” Aschkenasy paused, “I can’t, I just can’t, because we need those resources for a child that we might be able to save.”

Aschkenasy and her team are working now to make sure their own children understand why they are leaving for three weeks and to persuade colleagues to cover their shifts at the hospital. But no one had to persuade them to go.

“For physicians, doing this kind of work reinforces the essence of why many of us went into medicine in the first place,” said Dr. David Lawlor, “because the need is so great.”

The MGH medical team will join a nonprofit group, International Medical Corps, that has teams across the country.

Outpouring On Beloved Prouty Garden Continues: Traumatized Kids Need It

Outpouring On Beloved Prouty Garden Continues: Traumatized Kids Need It

The fountain in Prouty Garden at Boston Children’s Hospital (Jesse Costa/WBUR)

The fountain in Prouty Garden at Boston Children’s Hospital (Jesse Costa/WBUR)

News this week that the Prouty Garden at Boston Children’s Hospital can be bulldozed continues to draw impassioned pleas to reconsider the garden’s fate. Here, Dr. Elliott B. Martin, Jr. a psychiatrist at Newton-Wellesley Hospital and Assistant Clinical Professor of Psychiatry Tufts University School of Medicine adds his thoughts. (This is the second powerful letter we’ve received from defenders of the garden. We also welcome letters from the other side.)

I am writing in hopes of continuing the narrative around the fate of the Prouty Garden at Boston Children’s Hospital. I have been involved now for several months in the effort to save the therapeutic space, and the letter yesterday from Ms. Ellen Gilliam has inspired me to build upon her story, in hopes that others will add their own chapters.

I, too, have worked at Boston Children’s Hospital, as a physician, specifically as a psychiatrist. Until recently, the best kept secret at Children’s Hospital had been that there is in fact an inpatient psychiatric unit there. At any given time the hospital cares for some of the most grievously traumatized children you can imagine. These are kids, ranging from seven to seventeen years old, who have suffered ungodly physical and sexual abuse, at times since infancy. These are kids who have suffered from neglect, at times to near death. These are kids with profound depression, who have tried to commit suicide, very often many times over.

Therapeutic options in such cases are extremely limited, often amounting to time, containment, support, and most importantly, love. Many, if not most, of the physically ill children at the hospital at the very least know the love of their families. For the psychically wounded there is precious little love. As we would often observe on the inpatient unit, very few people sent get well cards to the psychically ill. The clowns never came there. The celebrities, on their visits to sick children, were carefully shuttled past the double-locked doors designed to be disinviting.

In this environment two therapeutic modalities stood out as having had immediately tangible, positive effects on these children. The first was the weekly visit from the therapy dog, and the second were the daily supervised excursions to the Prouty Garden. For kids otherwise confined day and night to a tiny, cordoned off piece of hospital property these fifteen to thirty minute trips were their only connection to the greater world, the ‘world outside’, as one horrifically abused seven year old boy once described it to me. To see these kids playing in the garden one might even mistake them for “normal’ kids. To see them interact with children in wheelchairs, with children wheeling IV poles, with children sentenced to die and whose parents had nowhere else to cry, one might think they were even more than normal, that they were, at least for a few minutes, special.

When given the opportunity, no one is more accepting, more compassionate, more empathic than a traumatized kid. There are countless stories of the therapeutic miracles of Prouty Garden among physically ill children and their parents. But the Garden has also helped, and continues to help, those kids without a voice, those kids who, without the Garden, will have lost all connection to the outside world. On behalf of the kids who will never have a walk or a marathon or a drive dedicated to their benefit, please allow them at least their fifteen minutes of daily humanity. Bulldozing the garden will directly affect the care and well-being of these children. I cannot imagine Ms. Prouty, a woman who struggled with her own mental health issues as a child, would have wanted this any other way.

mercredi 29 avril 2015

Grandmother’s Last-Ditch Plea: Save The Garden At Children’s Hospital

Grandmother’s Last-Ditch Plea: Save The Garden At Children’s Hospital
The author's son-in-law and grandson take in a quiet moment in the Prouty Garden, August 2014. (Courtesy)

In response to the Boston Landmarks Commission’s vote to reject landmark status for a much-loved garden at Boston Children’s Hospital, Ellen Gilliam — a librarian in Portland, Me., and the grandmother of a child recently treated at Children’s — sent in this poignant and powerful letter:

Last summer, my newborn grandson was a patient for several months at Children’s — first in the neonatal intensive care unit, then on a surgical inpatient floor. Fortunately, with the help of the knowledge, skill, expertise, experience and dedication of the medical and support staff there, he was able to recover from surgeries and infections in the aftermath of a serious birth defect and to ultimately go home from the hospital on the day before his three month birthday.

My family and I certainly know the confines of the NICU there. In fact, we experienced the contrast between the spacious patient and family accommodations at Mass General’s NICU, where my grandson received his initial post-surgical intensive care in a private room with sleeping space for multiple parents, and the much tighter and less convenient NICU quarters at Children’s, as described in a recent Boston Globe article by Andrew Ryan.

That said, I must also add that were it not for the Prouty Garden, we might have lost our sanity while our little guy was fighting for his life. Family caregivers are on their own at Children’s Hospital when it comes to managing the abject anxiety and heartache that accompanies a child’s illness. Indeed, I was surprised by the paucity of organized or informal options for helping family members cope with the stress. The medical staff is compassionate, but their jobs are to tend to the science and medicine of healing the patients. Rightfully so.

The author's son-in-law and grandson take in a quiet moment in the Prouty Garden, August 2014. (Courtesy)

The author’s son-in-law and grandson take in a quiet moment in the Prouty Garden, August 2014. (Courtesy)

Meanwhile, the one oasis for family was the Prouty Garden. Stepping into the cool, fresh-air of the garden, with its blooming roses and hydrangeas, its paths meandering by a water fountain and under spreading trees, one could finally exhale the pent-up terror and feel the lightness of human connection with the good earth.

When the baby was well enough to be moved to a room on the surgical floor, one of the first goals was to get him out into the fresh air of the Prouty Garden. We sat under the trees with him in a stroller, his IV pole supporting his infusions into his central line, and we had ice cream and basked in the warm sunshine. My son-in-law let himself stretch out and kick a ball around with a child who spoke no English, the sibling of another patient whose mother was quietly tending to what looked to be other siblings on a blanket on the grass. On the anxious night before a big surgery, we sat out under a Prouty Garden umbrella with a bottle of wine and reflected on how lucky we were to be in Boston, where the little guy could get the care he needs to survive and hopefully have a normal life.

I understand that the hospital finds itself between the proverbial rock and hard place on this question. But I hope there is still a way that the Prouty Garden can be preserved. Yes, it is critical to be able to meet increased demand from the many children and families who need help from across the world, but it is also essential to acknowledge the unique opportunity for healing that the Prouty Garden provides

Ellen Gilliam is a librarian in Portland, Maine.

Related: Beloved Garden At Center Of Children’s Hospital Building Dispute

Why To Exercise Today: Train Now To Shovel More Safely Next Winter

Why To Exercise Today: Train Now To Shovel More Safely Next Winter

By Rick Discipio
Guest contributor

Over 100 inches of snow fell in the Boston area this past winter, and tons of the heavy, wet stuff had to be shoveled out of driveways and walkways — not just a pain in the neck, but a potential pain in many other parts of the body as well. Nationwide, an average of 11,500 snow shoveling injuries occur annually, including damage to muscles, ligaments, tendons, and other soft tissues. Lower back injuries are the most common.

So what can you do to avoid injury in winters to come if, as some predict, heavy snow becomes more common? To handle the stresses that snow-shoveling places on the body, you need a year-round exercise program. Consult with your doctor before undertaking any exercise program, of course, but here are my starter suggestions:

Begin with a basic total-body strength training program two or three times a week. Improving your strength will make daily routines (such as shoveling) less taxing and help with injury prevention. Strength training is any type of resistance training that includes free-weights, tubing or strength machines. The focus should be on strengthening the legs, hips, shoulders, abs, and lower back.

Basic strength training routine:

Screen shot 2015-04-24 at 2.57.27 PM

Stability ball squats: You can begin with just your bodyweight but to increase muscle tension, hold a pair of dumbbells by your side. Placing a stability ball behind your mid-back will engage your abs. Squat down to 90 degrees and keep chest up and hips back. This exercise will help strengthen the legs, hips and abs. Perform two sets, 12 repetitions each.


Screen shot 2015-04-24 at 2.57.37 PMSquat and Press: Grab a pair of light dumbbells and hold at shoulder level. Go into a squat position, keeping your chest up and hips back. Once you return to an upright position, tighten your abdominal muscles and then press a pair of dumbbells overhead. Repeat for 2 sets, 12 reps. This exercise will strengthen your legs, hips, glutes and shoulders.


Screen shot 2015-04-24 at 2.57.47 PM

Hip lifts: This exercise is a great way to work the glutes, hamstrings and the lower back. This exercise can either be done on the stability ball or on the floor. Bend your knees at 90 degrees and place your feet on the ball or floor. Tighten your glutes, push down into the ball or floor with your feet and then lift the hips up until the body is in a straight line. Keep the hands on the floor for more balance if needed. Perform 2 sets of 12-15 reps.




Screen shot 2015-04-24 at 2.57.56 PM

Side planks: Lie on your side with your body straight, one foot on top of the other, your upper arm directly under your shoulder, your hand and forearm placed on the ground and pointing directly in front of you. Push up so that your elbow is bent at 90 degrees and only your left foot, hand and forearm are in contact with the floor. Keep your body tight with your torso, hips and legs in alignment. Hold this position for 30-60 sec, switch sides, and repeat for 2 sets each side. Do not hold your breath. Side planks strengthen the side muscles of your waist.

Screen shot 2015-04-24 at 2.58.04 PM
Planks: Start by lying face down on the floor. Place your forearms on the floor with your shoulders aligned directly over your elbows clasping your hands in front of you. Extend your legs behind you and rest on your toes, as if you are going to do a pushup. You should look to attain a straight line between your shoulders and toes. Tighten your abdominal muscles to help you hold the position correctly. Perform two sets for about 30-60 seconds. Do not hold your breath. This is a great exercise to help strengthen your abs.

In addition to beginning an exercise program, you can commit these shoveling tips to memory, to reduce the risk of future injury:
• Use your legs and bend at the knees to lift snow, and avoid excessive twisting and throwing.
• To reduce pressure on your back, try pushing snow to the side instead of lifting snow and throwing it.
• Take frequent breaks so you do not overload your muscles, ligaments, and tendons.
• Drink plenty of water to keep hydrated.
• Warm up your muscles before shoveling by stretching your back, legs, and shoulders.
• Choose an ergonomically designed shovel that can help reduce the amount of bending you have to do.
• Eat a small snack for energy before you shovel snow, but avoid heavy meals.
• Avoid caffeine or nicotine before beginning. These are stimulants, which may increase your heart rate and cause your blood vessels to constrict. This puts extra stress on the heart.
• Dress appropriately — wear snow boots to avoid slipping, a hat to prevent heat loss, and dress in layers to keep your muscles warm and lessen blood vessel constriction.

Readers, any personal tips to add? And do you have any fitness questions you’d like Rick to address in future posts?

Rick Discipio is the assistant director of fitness at Boston University’s Fitness and Recreation Center, better known as the FitRec. He has experience in training and conditioning athletes, designing post-rehab programs for special populations, and creating employee wellness programs. He’s a former competitive powerlifter who won the Mass. State and New England States Bench Press and Powerlifting Championships.


Beth Israel Doctors Travel To Nepal To Aid Relief Efforts

Beth Israel Doctors Travel To Nepal To Aid Relief Efforts

Villagers wait in the rain as an aid relief helicopter lands at their remote mountain village of Gumda, near the epicenter of Saturday's massive earthquake in the Gorkha District of Nepal on Wednesday. (Wally Santana/AP)

Villagers wait in the rain Wednesday as an aid relief helicopter lands at their remote mountain village of Gumda, near the epicenter of Saturday’s massive earthquake in the Gorkha District of Nepal. (Wally Santana/AP)

A team of doctors from Boston’s Beth Israel Deaconess Medical Center is heading to Nepal Wednesday to aid with earthquake relief efforts.

As of Tuesday, more than 5,000 people were confirmed dead and nearly 11,000 injured from Saturday’s 7.8-magnitude earthquake that hit just outside the capital city of Kathmandu.

Beth Israel Disaster Medicine Fellowship Director Greg Ciottone says the team will set up a base at a hospital 30 kilometers southeast of Kathmandu. He said the doctors will essentially function as “a mobile emergency department,” but will not be performing complex surgeries.

According to Ciottone, the group is planning to work in areas with little to no drinking water, power or communication infrastructure.

“We have to take all of that into account,” he told WBUR’s newscast unit. “So we take our redundant communication systems with us. We take all the personal items and necessities for water, food, shelter.”

He said the doctors are also preparing to face wet and somewhat cold conditions.


Globe: Panel Says Beloved Garden At Children’s Hospital Can Be Bulldozed

Globe: Panel Says Beloved Garden At Children’s Hospital Can Be Bulldozed

Prouty Garden at Boston Children's Hospital (Jesse Costa/WBUR)

Prouty Garden at Boston Children’s Hospital (Jesse Costa/WBUR)

Andrew Ryan of The Boston Globe reports here:

Prouty Garden, long a refuge at Boston Children’s Hospital for ailing youngsters and their families, can be bulldozed to make way for an expansion that includes a new neonatal intensive-care unit after a key city commission voted Tuesday night to reject pleas to protect the space as a landmark.

After an emotional hour of public comment, the Boston Landmarks Commission voted 7 to 1 to deny landmark status, effectively allowing the hospital expansion to proceed. Commissioners acknowledged they had grappled to find the greater good in a dispute in which the goal of both sides was to heal and comfort sick children.

WBUR’s Deborah Becker and Lynn Jolicoeur reported on the long-running fight over the garden’s fate back in 2013 here. The report begins:

Noise from traffic, construction and sirens dominates this neighborhood of some of the nation’s premier hospitals — but not in one spot tucked among the buildings of Boston Children’s Hospital.

The space many refer to as an oasis is called Prouty Garden, a half acre of grass, mature trees, flowers and fountains. It’s been a sanctuary for stressed families, sick children and hospital staff since 1956, when a patron created and endowed it. A Scientific American article last year called it “one of the most successful hospital gardens in the country.” That same article quotes research showing the benefits of hospital gardens in reducing anxiety, pain and blood pressure.

But now, citing a desperate need to expand, Children’s Hospital has developed plans to build a 10-story, 500,000-square-foot building on the site of the garden. The decision is not final. But many patients’ families are distraught.

The Globe reports that Anne Gamble, who led the charge to preserve the garden, said after the Tuesday evening vote that she “needed time to consider the next course of action.”

mardi 28 avril 2015

Seeking Patients’ Stories, Ann Romney Launches #50MillionFaces Campaign

Seeking Patients’ Stories, Ann Romney Launches #50MillionFaces Campaign

Ann Romney in 2013. (AP)

Ann Romney in 2013. (AP)

Ann Romney would see them at almost every rally along the campaign trail when her husband was running for president: a few men and women who arrived hours in advance to secure a spot up front, against the police barricade.

“When I would get there, there would be people at the front of the lines hanging on,” Romney recalled, “and I knew who they were, they were people with MS. They’d been there for hours and hours, waiting just to say thank you to me for being an example for them.”

Romney recalls men and women collapsing after they saw her, exhausted from the wait.

“And it’s now time for me to be a strength for them,” Romney said Tuesday as she launched a social media campaign to capture and share the stories of 50 million patients around the world, and their families, who have multiple sclerosis or other neurological diseases.

Romney told an audience at a Partners HealthCare forum that she does not want patients to repeat the experience of her diagnosis, when 16 years ago a doctor told Romney she had MS and to come back when she got more sick.

“That was shocking to me,” Romney said with a laugh. “I thought, wait a minute, someone’s got to give me a pill here? I can’t just walk out because I’m so sick.”

Romney found a physician at Brigham and Women’s Hospital who offered hope. The treatment — intravenous steroids — stopped the progression of MS for Romney. But she wanted a better long-term plan.

“I was very frightened,” Romney said. “Even though the answers were not good answers, I had to figure everything out myself.”

Romney learned through trial and error what works for her. It’s lots of sleep, exercise, often on her horse, and what she calls clean eating: no sugar, no alcohol, very little bread and a green juice of spinach, kale and ginger. She does drink Diet Coke. The 66-year-old says acupuncture and reflexology, treatments that aren’t typically recommended by doctors, have helped her as well.

She is reaching out through Twitter, Facebook and Tumblr for stories from other patients who will help doctors understand the connections between Alzheimers, ALS, Parkinson’s, MS and brain tumors.

“Let’s share what helps you feel better. It might not be the same for all of us, but these stories will hopefully bring awareness, which brings cures,” Romney said.

Romney joins a growing effort to gather information from patients online.

Romney says she hopes the stories will help researchers figure out, for example, why more women than men are diagnosed with neurological ailments.

“That is the first thing I have to get out there,” Romney said. “I don’t think women are aware that they have a much higher risk for Alzheimer’s, much higher risk for MS.”

Dr. Howard Weiner, who is Romney’s physician and co-director of the Ann Romney Center for Neurological Disease, says the prevalence of MS in women is an important clue about how the disease works.

“I think it relates to hormones. I think it relates to the immune system, and we’re trying to understand that,” Weiner said.

Are women more susceptible for some reason, and should the treatment be different? Those are just a few of the key questions for researchers.

Romney’s MS is in remission and she’s not on any medication right now. But she lives with the fear that the disease will reassert itself again at any moment. And when people say, “Oh, you look great,” Romney knows she’s masking the effects of the disease.

“Even when you’re in remission you have to deal with fatigue and you have to adapt your lifestyle to accommodate that, and sometimes I gripe about it and Mitt will say, ‘Oh it’s not your MS, you’re just getting old,’ which we are,” she said, laughing.

But this mother of five and grandmother of 23 is busy. She’s writing a book about her experience with MS and raising money for the center that she launched at Brigham and Women’s, where she goes now just for check-ups.

Bomber Trial: How Do You Talk To Children About The Death Penalty?

Bomber Trial: How Do You Talk To Children About The Death Penalty?

In this courtroom sketch, Assistant U.S. Attorney Aloke Chakravarty points to defendant Dzhokhar Tsarnaev, right, during closing arguments in Tsarnaev's federal death penalty trial Monday. (Jane Flavell Collins/AP)

In this courtroom sketch, Assistant U.S. Attorney Aloke Chakravarty points to defendant Dzhokhar Tsarnaev, right, during closing arguments in Tsarnaev’s federal death penalty trial Monday. (Jane Flavell Collins/AP)

Killing is the ultimate bad, right? That’s what we teach our children. So how do we talk to them about the very real possibility, splattered across our screens and newspapers, that we may put a young man to death for his crimes?

“I think he should die,” said my nine-year-old child when I raised the question leading the news this week: Whether Boston Marathon bomber Dzhokhar Tsarnaev should be sentenced to death or life in prison. “If he killed [four] people and injured hundreds and ran from it he should have a very serious consequence.”

“Life in prison is worse,” said my older daughter.

The conversation then turned to what kinds of people commit crimes and why, and by the end, my young daughter was not so sure about the death penalty. Needless to say, it’s complicated.

Earlier this month, Tsarnaev, 21, was convicted on all 30 counts against him and was found  responsible for the deaths of three spectators at the 2013 Marathon as well as the fatal shooting of an MIT police officer.

Today, defense lawyers are making the case for life in prison for Tsarnaev, rather than the death penalty. The public, is seems, is also leaning in that direction: a WBUR poll found that only 31 percent of Boston area residents say they support the death penalty for Tsarnaev.

So how do we talk to our kids about all of this?

Shamaila Khan, Ph.D., is Director of Behavioral Health at the Massachusetts Resiliency Center, a program of Boston Medical Center, and has been attending the Tsarnaev trial regularly, providing support for survivors at the courthouse. She was a responder on the day of the Marathon in 2013 working with families and individuals brought to BMC. She has also worked closely with families affected by the bombing and its aftermath, including people in Watertown who were impacted by the hunt for the Tsarnaev brothers days after the bombings.

I spoke with Khan about how to help parents talk about these tough issues — life and death, justice and punishment and revenge — with children.

Here, edited, is some of our conversation:

RZ: So, as a parent, how do you begin to talk to children about these complex issues?

SK: This is a very controversial topic. It’s hard enough for adults to talk about it, let alone children. Children respond differently based on their developmental level — depending on what age they are and where they are developmentally. But there are three basic things to consider:  listening, protecting and connecting.

RZ: OK, can you give some more detail please?

So, first, listen. Ask the children if they’ve heard about this, and what they know. With social media, there’s so much information available and often children know more than parents think.  If they have heard about this, listen to what they have to say. Often, our tendency as adults is to start explaining — first let the children tell you what they know.  Once you know that, you can figure out how to answer their questions, and find out what they are curious about.  If they are expressing opinions at one end of the spectrum — [like my daughter] offer them another point of view, maybe something like, ‘Who knows why this person did this?’ and give them more information.  Help them to think about it in a more complex way, highlighting the variation on the spectrum. But remember, sometimes not telling the whole truth is important.

Like if a child, say up to 12 years old, asks how exactly does the death penalty get carried out, you might want to explain it in a way that demonstrated how it’s done with the individual experiencing the least amount of pain. You can be kind of vague and abstract. I’ve given examples of a pet that needs to be put to sleep: it happens in a way that doesn’t hurt them. So, a little abstract and not giving all the graphic detail unless asked. You can explain the death penalty by saying, for example, there’s a process in place, and different ways that it can be done. They try to figure out the least painful method, maybe medication or an injection. They used to do worse things but they don’t do that any more. Just keep it simple and abstract.

So you also said “protecting” is important. How does that work in this context?

Children, no matter what you’re talking about, they think about their own self and safety: Where is this person? Can this person get out of prison and hurt me? Is he in the same town where we live? Is he chained up? What kind of person does this and can there be anyone else around to do this to me? So the child’s own sense of safety is triggered.  As parents you want to make sure the kids are feeling protected and safe. So just reassuring them is important.

And “connection” — where does that come in?

Connection is about making sure their support system is in place. You make it clear that you are there as a parent or parents, and other people are around, teachers, family members, and others. You make sure there are other people and systems in place and say, ‘If you ever want to talk, there are people around to talk to.’ Often children stay curious, and if talking is not what they want, offer them activities that give them other ways to address their feelings: write a letter — What would you say to this person? — write in a journal, create a drawing…

I’ve worked in different disaster settings with children and I was in Pakistan after the school shooting in December. Many children drew pictures about it — it was much easier for them to talk about the drawings and express their feelings and thoughts about their drawings. Sometimes it’s easier to project onto something else rather than your own self.

With regards to the Tsarnaev case, how do you frame basic moral questions about the death penalty? How can parents address this?

o, you can talk about the different debates on this topic — some people think this and some people think about it in another way. Try to show them some of the complexities but in as simple a way as possible. The other things to remember with kids are: how they feel, how they think, how they act. So if a child raises the issue of life in prison, you can say, that’s what you think but how do you feel about it and what would you do? What would be a different way of handling it? Shifting between domains like this is important. Optimal functioning entails being healthy emotionally, cognitively and behaviorally. Sometimes people are caught in their emotions and don’t really think things through; sometimes they may be acting out but not recognizing where the feeling is coming from, so you want to make sure their feelings, thoughts and actions are connected. Especially when people are traumatized, they often disassociate, or detach.

All this might take time, I imagine.

Yes, it’s not a linear process. There’s an ebb and flow to it.  The psychological impact for people doesn’t always surface immediately, there can be secondary trauma for people who listen to all this graphic material. You need to let them know there are people around to help and answer their questions.

It does takes time. And it’s important not to expect that you will explain everything perfectly all at once or that they will understand perfectly. It requires being comfortable with being uncomfortable.

For more information, Khan recommends the National Child Traumatic Stress Network, a resource for parents that explains child stress and how it can play out for children of all ages.



lundi 27 avril 2015

‘The Checkup’ Podcast On Kinds Of Anxiety: High, Parental And Hormonal

‘The Checkup’ Podcast On Kinds Of Anxiety: High, Parental And Hormonal

Screen shot 2013-08-01 at 9.39.48 AM

[Listen on SoundCloud]

Extra, extra, get your hot-off-the-presses new episode of The Checkup, the health podcast that WBUR produces in partnership with Slate, here! It explores three different aspects of that incredibly common (especially among CommonHealth co-hosts) psychiatric disorder: anxiety.

First, we get into Rachel’s fear of flying and how she (sort of) overcame it. For a fuller story, she wrote about it here, but the saga continues.

Then, we speak with Harvard Medical School’s Mohammed Milad about his research on an intriguing hormone-based hypothesis that might help explain why so many more women suffer from fear and anxiety disorders than men. For more, see Rachel’s full interview with him: “Why Do So Many Women Have Anxiety Disorders? A Hormone Hypothesis“.

And finally, we talk about parental anxiety and how we can try to manage it better through mindfulness techniques, featuring a recent book on the topic — “The Mindful Way Through Anxiety” — by Suffolk University professor Sue Orsillo. For more, the book’s website is here, a sample chapter is here, and please stay tuned for a post with the full interview.

Each episode, The Checkup features a different topic — previous episodes focused on college mental health, sex problems, the Insanity workout and vaccine issues.

And in case you missed our most recent episodes: “Grossology” included a look at the first stool bank in the nation and research on the benefits of “bacterial schmears” from a mother’s birth canal — you can listen here. And “Sexual Reality Checks” busted myths about penis size, aging and female sexuality — it’s here.

If you listen and like it, won’t you please let our podcasting partner, Slate, know? You can email them at

vendredi 24 avril 2015

Out Soon: First Official Consumer Guide To ‘The Bible Of Psychiatry’

Out Soon: First Official Consumer Guide To ‘The Bible Of Psychiatry’

The DSM-5, widely known as the "bible of psychiatry," is close to 1,000 pages and not exactly user-friendly. (Photo: Wikimedia Commons)

The DSM-5, widely known as the “bible of psychiatry,” is close to 1,000 pages and not exactly user-friendly. (Photo: Wikimedia Commons)

On average, says Dr. Paul Summergrad, the outgoing president of the American Psychiatric Association, he gets three or four calls a week that go something like this: “Hi, I’d love to chat — we haven’t talked in a while — but I’m calling about a personal problem — I’m worried.”

Almost always, Summergrad says, “It’s about a parent, an aunt, an uncle, a brother, a sister, a child — usually an adolescent or young adult who’s at the age of onset of these conditions, and they’re trying to figure out what to do.”

Summergrad, who’s also psychiatrist-in-chief at Tufts Medical Center, doesn’t mind a bit. “It’s actually the best job that I have, taking those calls,” he says. “That’s one of the most important things I ever do, because I’m trying to get people to the right sources of help.”

Now he has one more source to recommend: On May 1, the American Psychiatric Association is officially releasing its first-ever consumer guide to the DSM-5, the compendium of mental disorders that’s referred to in virtually every news story ever written about it — including this one, now —  as “the bible of psychiatry.” The new consumer-oriented book is called “Understanding Mental Disorders: Your Guide To The DSM-5.”

The new consumer guide to the DSM-5 (Courtesy APA.)

The new consumer guide to the DSM-5 (Courtesy APA.)

The DSM-5 — DSM stands for Diagnostic and Statistical Manual — took more than a dozen years to develop and sparked controversies over some psychiatric disorders as it was compiled, drawing criticism both within the field and from without. But it was finally published in 2013 — the latest version of the go-to reference on psychiatric diagnosis and treatment.

No one would call it user-friendly, though; it’s a thick tome of 991 pages in the paperback edition, and written for clinicians and researchers, not laypeople.

So the new consumer guide, Summergrad says, “is a way of trying to provide some help and guidance and understanding for either the individuals themselves, for their family members, or for other caregivers.”

It’s also intended for tables in the offices of primary care doctors, psychiatrists and psychologists, he says, to explain diagnoses in language for laypeople.

As one of those laypeople myself, I felt a little confused. The consumer guide, like the DSM itself, is organized in categories of diagnoses: psychotic disorders, bipolar disorders, anxiety disorders, and more.

That would mean that in order to use it, I’d need to already have a diagnosis, right? But if I were like one of Dr. Summergrad’s callers, worried about a loved one and needing guidance on what could be wrong, could a book that explains diagnoses help me?

“I think we’ll find out exactly how people use it, but it is intended as a supplement to professional care, not a substitute,” Summergrad says. Oftentimes, family members speak first with a primary care doctor or pediatrician — a good place to start — or, in this Internet age, they may find possible diagnoses online that they want to explore.

Dr. Paul Summergrad (Courtesy APA)

Dr. Paul Summergrad (Courtesy APA)

“We’ll find out what’s useful and not useful,” he says, “and get important feedback from patients and families and others.”

Some initial feedback from Lisa Halpern, director of recovery services at Vinfen, a Cambridge, Mass. nonprofit that offers psychiatric and other support services, who kindly agreed to review a copy:  Indeed, she says, in this Google-driven age of self-diagnosis, it could be a real challenge for readers to keep in mind that the book is not intended for generating a diagnosis, but rather as a companion to professional care.

A positive note: The book uses personal vignettes as illustrations, and “It’s not one-size-fits all. I thought this was the right message,” says Halpern, whose background includes Duke, Harvard and a schizophrenia diagnosis. “Diagnosing people is an art and a science, and each person is unique. The DSM-5 is very much about science but the art piece comes with the personal vignettes. That spoke to me.”

Her only major criticism, Halpern says, is that the chapter on “treatment essentials” spends six pages on medication and just one page on humor, friendship and peer support. “I thought there should have been more of a balance between the two,” she says.

Overall, she says, the book is a strong companion guide: “The DSM-5 by itself can be very overwhelming to people, and anything that helps break down those barriers, break down the silos between psychiatrists and persons seeking help, can be helpful.”

The guide’s publication reflects the broader trend of growing public discussion about issues of mental health, Summergrad says, and greater recognition of psychiatric challenges — from speeches at this year’s Academy Awards to President Obama’s remarks honoring a veteran who committed suicide at a White House ceremony at which he signed a bill aimed at preventing such suicides.

Among the book’s goals, Summergrad says, is to demystify psychiatry.

Sigmund Freud said the goal of psychiatry was “to turn hysterical misery into ordinary unhappiness,” he says. “You know, there’s enough ordinary unhappiness and suffering in life; not everything that’s suffering is a mental disorder. But there are things that are. So the goal here is not to medicalize everyday life. The goal is to help people get guidance about something they’re worried about.”

Readers, thoughts? If you get a copy, please share your reactions.

jeudi 23 avril 2015

Why Do So Many Women Have Anxiety Disorders? A Hormone Hypothesis

Why Do So Many Women Have Anxiety Disorders? A Hormone Hypothesis

Stuart Anthony/flickr

Stuart Anthony/flickr

Why do so many women suffer from anxiety? Is it something inherent in being female, are we more attuned to our moods? Or is that breath-clenching feeling of impending doom hard-wired?

According to the National Institute of Mental Health, women are 60% more likely than men to experience an anxiety disorder over their lifetime. (Obviously, men are not immune: taken together, anxiety disorders are among the most common mental health conditions — they affect about 40 million men and women age 18 and older, or about 18 percent of the U.S. population.)

Mohammed Milad is an Associate Professor of Psychiatry at Harvard Medical School and Director of the Behavioral Neuroscience Program at Massachusetts General Hospital. He studies the complex interplay of gender, fear and anxiety. More specifically, he’s looking at how hormones, notably estrogen, might play a role in the fear response and our ability to extinguish fear and anxiety.

I spoke with him about his work. Here, edited, is some of our conversation:

RZ: OK, can you just clearly explain the difference between fear and anxiety? Sometimes it’s a fine line indeed.

MM: I was thinking about taking my kids camping over the summer, and I was reading about bears and potential bear encounters, and considerations for taking cover and putting your food this distance away from your camping site, etc. Anxiety is when you’re camping and you have that heightened awareness — hyper-vigilance  — that’s anxiety, it’s sustained, it’s continuous, but it’s not at the point where it makes you run or look for cover. Fear is when you see the bear; fear is intense, it’s immediate, it’s right there in front of you.

RZ: Thanks for that. But I’m curious, how did you start studying how men and women are different when it comes to fear and anxiety?

MM: When I was in grad school we used to host kids from middle and elementary school…showing our lab to them, showing them the rats, and one kid, maybe 10, 12 years old, asked, are they male or female rats and I said they’re all male rats, and he asked, why, what about the female rats? And I didn’t know the answer, so I went to my mentor and asked, why don’t we study the females? And the answer, simply put, was they’re complicated.

RZ: So the female rats were just too complicated. I get that. But considering far more women than men suffer from anxiety disorders, the fact that you were studying only male rats wasn’t such a great approach, was it?

MM: No, so I think that’s not an acceptable answer now.

RZ: In your experiments on rats and humans, you and your team use Pavlovian conditioning, as in Pavlov’s dogs, who were famously conditioned into drooling every time they heard a bell because they associated that sound with food. So, in these studies you repeatedly showed a blue light on a screen to men and women who would then receive a mild shock, until they came to expect — and fear — a shock every time they saw the blue light. Then, you stopped giving shocks when the blue light came on, to teach the subjects not to fear it. That’s “fear extinction.” And the next day, the men and women were tested to see if they still had a fear response to the blue light.

The results in these studies were all over the place, but most of the variance in fear response was among women in the experiment, right? The men were much more consistent. Why might that be?

MM: That’s what got me into beginning to think about hormones, because what could account for that other than maybe some women that we’re bringing in to the lab were at a particular phase of their menstrual cycle? And when we did that study we found that women who came in when their estrogen is elevated, they had their [fear] extinction capacity much better, in other words, they were able to control their fear, or express much less fear, compared to the women that came in in the early phase of their cycle… when they had low estrogen.

RZ: So just to be clear, high estrogen was linked to better control of fear, and low estrogen meant more potent and longer lasting fear?

MM: Right.

RZ: Ok, so if estrogen helps with fear extinction, and women typically have more estrogen than men, then why aren’t men gripped with fear and anxiety all the time?

MM: As our initial hypothesis, we thought that men would behave very much like women with low estrogen, but when we got the data, I was puzzled because men behaved very much like women with high estrogen, and only low-estrogen women showed deficits in the fear extinction. What we have learned is that testosterone in men, in the brain gets converted to estrogen by an enzyme called aromatase. So we think that a lot of the benefit that men get is due to this conversion of testosterone to estrogen.

RZ: It’s cool to think that a hormone often thought of as “female,” could be so crucial to a characteristic often thought of as “male”…But you also conducted some research involving women on birth control pills, which, of course, interfere with the body’s normal production of estrogen. How does that affect the fear response?

MM: We did an initial study that made us concerned — we recruited women on birth control, and what we found is that women on birth control pills act like women with low estrogen. In other words, birth control seemed to impair women’s ability to control or extinguish fear.

(Editor’s Note: Lots of caveats here; Milad says all of these findings need to be replicated and tested on a much larger scale and are in no way conclusive at this point.)

RZ: After childbirth, that post-partum period is a time when many women have dramatic mood swings, depression, anxiety. Might that be related to the extreme hormonal changes that occur after birth, specifically the drop in estrogen?

MM: Yes, we think it’s that drop that perhaps may make women more vulnerable to anxiety disorders.

RZ: And what about the anti-anxiety drugs we’re all prescribed now? You did a study on fear extinction and SSRI’s, specifically using the generic version of Prozac, fluoxetine. These drugs aren’t prescribed with any thought about how hormones come into play…

MM: Right, they are not tailored to the different genders, everyone is taking the same thing. We did a study in female rats with fluoxetine, and what we found is that it’s most effective in reducing fear in the female rat only when the rat was in the estrous phase, which is the low estrogen state…So it doesn’t always work. And that could provide some data into why aren’t all women responding, for example, to Prozac or other medications for anxiety, why there’s a huge difference in how people respond.

RZ: So what’s next on your research agenda?

MM: We have applied for funding for a study to recruit women with PTSD; we want to pair prolonged exposure therapy with an estrogen pill to see if that helps with fear extinction.

R: Fascinating, and great if that worked. But tell me: what ever happened to that camping trip with your kids?

MM: Yeah, I was thinking about the bear thing…I would be anxious if I was in that park alone with my kids.

R: So did you end up going camping?

MM: No, of course not. I’m highly anxious.

For more on this and related news on anxiety, subscribe to our podcast, The Checkup, a joint venture with Slate. Our next episode, High Anxiety, will come out on Monday.

mercredi 22 avril 2015

Report Finds Stark Gaps In Mass. Substance Abuse Care

Report Finds Stark Gaps In Mass. Substance Abuse Care

The math is simple and starkly clear.

There are 868 detox beds in Massachusetts, where patients go to break the cycle of addiction. They stay on average one week. Coming out they hit one of the many hurdles explained in a report out this week from the Center for Health Information and Analysis on access to substance abuse treatment in the state.

There are only 297 beds in facilities where patients can have two weeks to become stable. There are 331 beds in four week programs.

As the table below shows, there are almost four times as many men and women coming out of detox as there are from a two or four week program.

From the CHIA report on Access to Substance Use Disorder Treatment in Massachusetts

From the CHIA report on Access to Substance Use Disorder Treatment in Massachusetts

Patients who can’t get into a residential program right away describe a spin cycle, where they detox and relapse, detox and relapse. Some seek programs in other states with shorter wait times.

Health insurers will tell you that not everyone needs a two or four week program. They point to research that shows medications — methadone, in particular — which are distributed by out-patient clinics, are effective in helping patients avoid a relapse. But many addiction patients say they need more than one residential stay before they can sustain a recovery, with or without medication.

“This world is complicated for patients and providers to navigate,” says Aron Boros, director of the Center for Health Information and Analysis, the agency that wrote the report. “The immense complexity of the system is the number one thing that comes out of this report.”

If you’re a provider, Boros says, you’re dealing with 10 to 20 different payers who may all have different rules. If you’re a patient, it’s hard to figure out which program is the best fit for young adults, those who are homeless or who are also trying to manage hepatitis C or HIV.

Boros says there are things the state could do to simplify the system. The report goes to the Health Policy Commission, which will use it to make recommended changes.

And a report from Gov. Baker’s task force is due out next month.

“Governor Baker considers the opioid epidemic a top priority and the working group he named earlier this year has heard many of the same concerns raised in this report from individuals and families across the Commonwealth,” said Rhonda Mann, spokesperson for the state’s Department of Health and Human Services. “The administration looks forward to reviewing the Opioid Working Group’s recommendations that are due back next month and taking tangible action to address, treat and prevent the impact of addiction on Massachusetts’ families.”

With one in 10 residents suffering from substance abuse disorder and two to three people dying from an overdose every day, a plan to stop this epidemic can’t come too soon.

Elmo’s Buddy, The Surgeon General, And Other Health Chiefs Urge Vaccines

Elmo’s Buddy, The Surgeon General, And Other Health Chiefs Urge Vaccines
[Watch on YouTube]


Vivek H. Murthy, video star and Friend of Elmo. Who’d have thought, back when Dr. Murthy’s appointment to be the U.S. surgeon general was facing political fire, that this would be the sequel? But there he is in a popular new video, cavorting with Elmo. Okay, not cavorting, but rather working nicely together with Elmo to help promote vaccinations while the recent Disneyland measles outbreak is still fresh in memory.

And Dr. Murthy’s big-city colleagues are also going visual to promote vaccinations: Public health chiefs from Los Angeles County to Boston are just out with a series of videos in which they personally urge their residents to get their kids immunized. See the full collection here, including Boston’s Huy Nguyen (below). The videos, part of the Big Cities Health Coalition, are aimed at health districts with a combined population of 14 million.

Recent history: When President Obama proposed Dr. Murthy, then at Brigham and Women’s Hospital, as surgeon general in late 2013, colleagues showered him with praise and said they expected him to be a progressive and visible leader. Then, last year, opposition from gun groups — Dr. Murthy had expressed support for gun control in the wake of the Newtown shootings — held up and threatened to scuttle his confirmation. But in December, in a squeaker vote, he got the nod.

And now here he is, living up to predictions that he would be “visible” — and on Sesame Street, no less. After Elmo gets his vaccination in the video above, he (it?) says, “That was so easy! Why doesn’t everyone get a vaccination?” Dr. Murthy strokes his chin: “That’s a good question, Elmo, that’s a good question…”

[Watch on YouTube]

mardi 21 avril 2015

Last But Not Least: Man With Muscular Dystrophy Finishes Marathon At 5 A.M.

Last But Not Least: Man With Muscular Dystrophy Finishes Marathon At 5 A.M.

An inspirational Venezuelan man has become the last finisher of this year’s Boston Marathon, crossing the finish line about 20 hours after he started.

Maickel Melamed finished at about 5 a.m. Tuesday, after battling torrential downpours and thunderstorms for the last few miles.

The 39-year-old Melamed has a form of muscular dystrophy which severely impairs his mobility.

He was accompanied along the race by volunteers and was met at the finish line by dozens of cheering friends and supporters.

Melamed has previously participated in marathons in Chicago, New York, Berlin and Tokyo, but said Boston is special because it’s the city where his parents brought him as a child for treatment.

Please check back for an update today from WBUR’s Fred Thys, who’s covering the press conference at which Boston Mayor Marty Walsh awards Maickel Melamed a medal.

lundi 20 avril 2015

Blankets And Broth: Hypothermia The Main Medical Issue At 2015 Boston Marathon

Blankets And Broth: Hypothermia The Main Medical Issue At 2015 Boston Marathon

Lauri Perry, of Austin, Texas, is used to getting really hot when she runs. She thought she was being cautious ahead of Monday’s Boston Marathon, when she added a layer over her running top.

“I started out with something on and I threw it away at mile six cause it was warmer, then the rain started at about mile 10 or so and then the wind got worse,” Perry said, her voice trailing off.

By the time Perry crossed the finish line on Boylston Street she was soaking wet, numb, blue and shaking.

“Uncontrollable shaking,” Perry repeated with emphasis. “I couldn’t even hold my drink because it was splashing out.”

Lauri Perry, of Austin, Texas, went into the medical tent to warm up after finishing the Boston Marathon Monday. (Martha Bebinger/WBUR)

Lauri Perry, of Austin, Texas, went into the medical tent to warm up after finishing the Boston Marathon Monday. (Martha Bebinger/WBUR)

Perry has run the Boston Marathon five times and notes with some pride that she has never needed medical assistance after the race. But Monday, when a member of the medical team asked if she wanted to step inside the big white tent, she gave in.

“I would normally say no,” Perry said, looking disappointed. “I’m a pretty strong person but I knew that I would not be able to walk all the way back to my hotel in the condition I was in.”

Perry and hundreds of runners on Monday fell victim to hypothermia, a condition where despite a runner’s hyper-exertion, their body temperature drops dangerously low. Inside a medical tent at the finish line, Perry peeled off her wet clothes and shoes and sat wrapped in multiple Mylar and cotton blankets, drinking warm fluids. But some runners needed more active warming.

“We use what’s called a ‘bear hugger,’ where you have this air flow system that goes around and warms them,” explained Dr. Pierre d’Hemecourt, co-medical director of the Boston Marathon.

Across the vast medical tent Monday afternoon there where signs of the standard post-race issues — some of the runners need fluids or help with cramping. But for most the issue was standard hypothermia, with the body temperature of some runners falling into the low 90s.

“It’s interesting, we’re seeing more people than normal but far less acute,” d’Hemecourt said.
“It’s basically just babysitting and getting them warmed up.”

One of the medical tents filled up and had to close at one point Monday afternoon. The overflow of shivering runners were loaded onto buses to warm up. As of 5:30 p.m., 1,310 runners had been treated in the medical tents and 36 transported to area hospitals.

For d’Hemecourt, who’s been co-medical director since 2007, Monday was a first.

“I’ve never quite seen as many cold people come in at one time,” he said. “It just goes to show, every year you show up here you see something different.”

But on balance, the medical team says cold is easier on the body than heat.

rails validation on belongs_to variable

The following class

class Condition
  belongs_to client


class Client
  attr_accessible :client_code

requires a validation whereby upon action Create for Condition, the condition's form submission params[:condition][:client_code] must belong to an existing client.

How can this be created?

Cancer-inflammation 'vicious cycle' detailed in new study

New findings hidden within the complex machinery behind the chronic inflammation-cancer feedback loop have been discerned.
Cancer-inflammation 'vicious cycle' detailed in new study

Oral milk thistle extract stops colorectal cancer stem cells from growing tumors

A new study shows that orally administering the chemical silibinin, purified from milk thistle, slows the ability of colorectal cancer stem cells to grow the disease. When stem cells from tumors grown in silibinin-fed conditions were re-injected into new models, the cells failed to develop equally aggressive tumors even in the absence of silibinin.
Oral milk thistle extract stops colorectal cancer stem cells from growing tumors

How to get a list of readOnly fields from a JsonSchema in Java

I am trying to validate a JSON input against a schema using the json-schema-validator library: The validation works fine. However, one of my requirement is to make sure that the input doesn't contain any readonly fields. I have marked the fields as readonly in the json schema but there's no good way to know which fields are readonly in the java code.

Here's an example schema:

{ "type": "object", "$schema": "", "id": "", "required":false, "properties": { "partId": { "type": "string", "final":true, "minLength": 1, "maxLength": 36 }, "name": { "type": "string", "required": true }, "forSaleDate": { "type":"string", "format":"date", "final":true, "readOnly":true
} } }

Here's the code I used for validation:

JsonNode jsonSchemaNode = null;
try {
jsonSchemaNode = JsonLoader.fromString(schemaString);
} catch (JsonProcessingException e) {
log.error("Invalid JSON schema");
throw e;
JsonSchema jsonSchema = factory.fromSchema(jsonSchemaNode);
JsonNode json = null;
try {
json = mapper.readTree(example);
} catch (JsonProcessingException e) {
log.error("Invalid JSON string");
if (json != null) {
ValidationReport validationReport = jsonSchema.validate(json);

The last field in my schema "forSaleDate" is a readonly field. In my validation code, the JSON input will get parsed into a JsonNode and I can call the "has(fieldName)" method on that JsonNode to see if it contains a particular field. The idea is to do this for all the final fields. However, the tricky part is to figure out which fields are final. The schema in the above code is represented as JsonSchema and it does not have a method that would return all the final fields. Did anyone come across this sort of validation? If yes, what was your approach?

Extending natalizumab up to 8 weeks shown safe and effective in patients with MS, report says

Extending the dose of natalizumab from four weeks up to eight weeks was shown to be well-tolerated and effective in patients, and resulted in no cases of the potentially fatal side effect progressive multifocal leukoencephalopathy, researchers report.
Extending natalizumab up to 8 weeks shown safe and effective in patients with MS, report says

New drug combination shows promise for breaking breast cancer resistance

A new combination of drugs has been developed that may overcome treatment resistance and relapse in breast cancer. While most women initially respond well to hormonal treatment with drugs such as tamoxifen, many go on to develop resistance and relapse. There is evidence that this is often due to activation of the Wnt signalling pathway, a gene involved in development which fuels the growth of the tumor.
New drug combination shows promise for breaking breast cancer resistance

Frequent indoor tanning among teens shows correlation with smoking, social media use

More than a third of New Jersey high school students who engage in indoor tanning do so frequently and many would find it hard to stop the practice. Investigators also found that frequent indoor tanners were more likely to smoke and to engage in social media activities related to indoor tanning.
Frequent indoor tanning among teens shows correlation with smoking, social media use