Noelle Swan

Author Archive

, , , , , , , ,

Weighing New Prescription for Doctor/Patient Communication

In Healthcare on December 20, 2011 at 7:52 pm

This article first was published by New England Post on December 20, 2011.

Every day countless people see their primary care physician for sick visits, routine physicals, and to follow up on chronic conditions. On average, patients spend 8-15 minutes face-to-face with their doctors. Doctors have checklists that they need to push through in addition to any concerns that the patients may have. Appointments fly by and patients often feel they have just spun out of a revolving door.

What if after appointments patients could go online and review the their primary care physicians’ notes? What if they could share them with their family and caregivers?

Researchers at the Beth Israel Deaconess Medical Center (BIDMC) in Boston have done just that. For one year, patients were granted access to the doctors’ note section of the hospital’s existing online patient portal—a secure website where patients can access lab results and medication lists. Study authors released a preliminary report of the trial today in the Annals of Internal Medicine detailing physicians’ and patients’ expectations for the program.

Jan Walker, R.N., M.B.A.

“Knowledge is power. If patients understand more and have more knowledge about what the doctor is thinking, they’ll be more empowered to make better decisions,” said Jan Walker, RN, MBA, member of the research team at BIDMC and Harvard Medical School and the study’s lead author.

By law, patients are entitled to these notes and can obtain them from hospital records offices by jumping through a few bureaucratic hoops and possibly paying a fee. Unsurprisingly, few seek hard copies of their records.

Participating patients at BIDMC, as well as at participating hospitals in rural Pennsylvania and suburban Washington overwhelmingly embraced the idea with 90% of patients reporting that the notes would put them more in control of their health. Half of them said they thought they would take their medication better if they understood more about why they were taking it.

Tom L. Delbanco, M.D.

Michael Meltsner, a 74-year-old patient of the study’s senior author, Tom L. Delbanco, M.D. said in an interview that he enthusiastically agreed to participate in the study. “It’s not as if we didn’t have an open relationship before,” he said of his interactions with Delbanco. He added that the notes not only reminded him about what was said during his appointment but prompted additional follow up questions. “It’s as if I was being presented with a potential checklist so I could write him back in an email,” he said.

Walker hopes that the notes can improve communication between family members and caregivers as well. “If you’re an elderly patient and your adult children are in another city, this is a way to share information about your health,” she said.

As a licensed marriage and family therapist, Meltsner said that he sees tremendous potential in this possibility as well. “Healthcare is often a family event as well as an individual event. An appointment doesn’t involve the family.” As a husband and father, he found that sharing his own notes with his family prompted additional questions for his doctor and ultimately a better understanding of his health.

Most patients and many doctors see this added layer of communication between doctor and patient as a step forward. However, some doctors expressed reservations and worried that harmful effects would outweigh any benefits.

Doctors participating in the survey process of the study but not in the actual trial expressed concerns around confusing, upsetting, and frightening patients. Some said that they would not be comfortable taking candid notes if they knew that their patients could read them.

Meltsner brushed away these concerns and said that he is prepared to read whatever his doctor writes about him. “All too often, the professional has an image of the patient as someone who is going to dissolve if they’re told something difficult,” he said.

Instead, he says that notes come in especially handy in such situations. “When something tense or difficult comes up in a doctor appointment the patient often has selective amnesia, having something to refer back to is extremely valuable.”

Walker pointed to anecdotal evidence that difficult news delivered in written form can be a vital reinforcement. She said that one patient reported that she had been able to ignore her doctors annual urging to lose weight, but when she saw the word “obese” in black and white, something hit home. Many patients tune out their doctors recommendations to lose weight, quit smoking, lower their cholesterol. Perhaps doctors’ notes hold the key to put the physical symptoms into the context of habitual choices.

An additional concern raised by many non-participating doctors was how to address issues of mental health and substance abuse.

“When you talk to mental health professionals, the waters part,” said Delbanco. “Half think the idea is nuts, the other half like it.” He added that his personal philosophy is, if a doctor thinks his patient has mental health or substance abuse issues, the patient should be the first person to know.

Delbanco does not deny that some people could become upset by what they read. “Think about it like a new medicine. We think it’s going to be good for the vast number of people and it’s going to hurt a few people. We also have to learn how and when to use it and so do patients.”

, , , , , , , , , , ,

Second Test Confirms Neutrinos Breaking Light-speed; Physicists Respond

In Uncategorized on November 29, 2011 at 7:46 pm

This article first was published by New England Post on November 29, 2011 under the headline Speedy Neutrinos Shine New Light on Einstein’s Theories; What do Harvard Scientists Say.

Throughout the world, physicists are peeking out from their customary obscurity in a hasty scramble to explain recent challenges to Einstein’s theory of special relativity.

The scientists are reacting to a second round of experiments at CERN, the European Organization for Nuclear Research, that measured infinitesimal particles called neutrinos traveling at speeds faster than light. Initial findings in September stunned the scientific world and met skepticism, even among the CERN researchers themselves. So they repeated the experiment, shooting neutrinos through nearly 500 miles of rock between Geneva, Switzerland and central Italy, to check the accuracy of their work.

Many physicists have bristled at the claim by members of CERN’s OPERA experiment, which calls into question one of the basic tenets of modern physics. Others have set new eyes on interpretations of relativity, searching for flexibility that could accommodate these speedy particles.

Harvard physicist Gary Feldman says that while the second experiment improved the precision of the measurement, he remains doubtful that the results are accurate. Feldman says that they have addressed just one piece of the possible error. “The difficult part of the experiment is to get all of the time delays that they measure the time with. In other words they have to do a series of corrections for time of flight because they measure through electronics, through cables, and so forth.”

It takes light one nanosecond, or a billionth of a second, to travel one foot. Calculations that incorporate fractions of a blink of an eye over hundreds of miles traveled require extremely precise measurements.

Giles Barr, Oxford University

Oxford professor Giles Barr agrees with Feldman and points out that the CERN scientists are skeptical of their own results. “They are saying, ‘We want some other groups to go out and test this thoroughly.’ ”

Barr works with the only two facilities in the world capable of checking the timing sequence. The Fermi National Accelerator Laboratory (Fermilab) in Chicago can send neutrinos to the MINOS detector 450 miles away in northern Minnesota. Japan’s T2K experiment sends neutrinos from Tokai to Kamioka, Japan, about 175 miles away.

The OPERA, MINOS, and T2K experiments were designed to observe the bizarre tendency of neutrinos to alter their state, not to measure speeds faster than light. Scientists working on these projects have not thoroughly examined their previous data with that possibility in mind.

Boston University physicist Andrew Cohen says that T2K has existing data that could confirm or negate CERN’s results. “They don’t have to record any new neutrino event…. They recorded all the information they need, they just have to do the analysis.”

Alec Habig, University of Minnesota

Physicists at MINOS also are analyzing their previously collected data. Fermilab physicist Alec Habig said that an experiment in 2007 hinted at similar results but the researchers doubted their findings, citing probable equipment shortcomings. The experiment’s intent was to determine the mass of neutrinos. While their speed factored into calculations, researchers designed the experiment under the assumption that they would travel slower than light.

“No one had ever expected that there’d be a need for precision on the fast side,” Habig said. “We just published what we had and went on figuring that eventually we would go back and try to do a better job.”

Likewise, scientists at Fermilab are refining data collected in 2007 and preparing to run their own experiment to test CERN’s claim.

This process takes time. Habig says that Fermilab cannot simply replicate the OPERA experiment right down to the equipment. “You want to go about solving the problem as independently as you can, so that you don’t make the same mistakes,” Habig said. “If we do it independently, when people compare our results to theirs, they’re more likely to believe the combination of the results.”

While Feldman and Barr both believe that OPERA’s readings will be proven wrong, others are willing to entertain the possibility of an exception to Einstein’s theory.

Andrew Cohen, Boston University

At BU, Cohen and Nobel Prize-winning physicist Sheldon Glashow have been contemplating ways to expand the theory of relativity to accommodate faster-than-light neutrinos.

“You can’t just say relativity is wrong and now all of a sudden nothing works anymore,” said Cohen. “You have to extend the theory to accommodate the results without disturbing all the old ones that work.”

Theoretical physicists have attempted to simply stretch the theory of relativity to allow for particles that move a tiny bit faster than light. Cohen and Glashow have published a paper highlighting a contradiction in this accommodation.

According to Cohen and Glashow, if the neutrinos actually travelled faster than the speed of light, they should have lost energy on the way and not reached their final destination. Researchers working on another project known as ICARUS at Gran Sasso National Laboratory, confirmed that the neutrinos observed by OPERA did not lose energy in the way predicted by Cohen and Glashow.

Cohen insists that while his paper refutes theorists’ one attempt to make room for the OPERA results, it does not prove OPERA definitively wrong. “Someone needs to come up with some other way to modify our existing ideas to allow for superluminal [faster-than-light] neutrinos.” He says that while the majority of physicists suspect that cannot be done, “Physicists are creative. If the OPERA experiment is confirmed by MINOS, then we’ll all be trying to do it.”

, , , , , ,

MIT Researchers Operate Unmanned Helicopter Via iPhone

In Uncategorized on November 16, 2011 at 7:44 pm

This article first was published by New England Post on November 16, 2011.

Imagine a soldier deep in enemy territory at the foot of a hill. The objective of his mission lies on the other side of that hill, but so might enemy forces. Or consider a fire chief coordinating containment of a forest fire. He needs information about what is happening inside the blaze, but sending in firefighters would put much-needed personnel at risk. What if that soldier and that fire chief could send in a small, lightweight helicopter to scope out the scene without risking any human life?

Turns out, there is an app for that.

Researchers at Massachusetts Institute of Technology have been working in conjunction with Boeing for the last two years to cultivate an iPhone application to remotely control “micro aerial vehicles”—or small-scale helicopters, about 20-inches long with 8-inch rotor diameter. In the last year the program application has undergone several successful trials testing its ability to function in a real-world outdoor environment, the capability of remotely controlling vehicles over long distances, and the accessibility of the controls to an unskilled operator.

MIT master’s candidate Kimberly Jackson and three other students working on this project conducted the first outdoor test of the technology last January in Arizona. “We had operators, literally pulled off the street. We handed them an iPhone, gave them three minutes of training, and said, ”Okay, now fly around this area, find an eye chart and read it to me, and find an image of a person and tell me who this person is. Out of 12 people, 11 were able to find those targets….”

“A lot of work we do draws on concepts that people are familiar with from video games,” said Jackson. “You interact with the iPhone through tilting movements, pinching movements, swiping movements. We wanted to take the motions that people are familiar with in terms of interacting with the smartphone and translate them into intuitive controls for the micro aerial vehicle.”

Engineers at Boeing, which is funding the program, see tremendous potential in the kind of user-friendly interface created by Jackson and the rest of the MIT team. “Training has been something that consumes a lot of effort in the past,” said Ramzy Boutros, manager of Boeing’s Research and Technology Human Factors Technology Group. “By making these vehicles significantly more autonomous, we’re able to reduce the expertise of the operator to reduce the training so that people who have a need to can operate in the field very quickly.”

This simplicity means that soldiers would not have to wait for skilled personnel or remote intelligence to alert them to what awaits on the other side of that hill. A fire chief could efficiently delegate his firefighters however he needed and select anyone to operate the helicopter while he continued to coordinate firefighting efforts.

Just how far can this technology take us?

“We’ve all seen the Jetsons,” said Professor Mary “Missy” Cummings, who oversees and advises the student-run project at MIT. “I suspect that one day, and the question is what day, we will all be flying around in effectively unmanned air vehicles.”

Boutros said that he is not aware of any Boeing-sponsored projects that would bring this technology to full-sized aircraft.

Cummings insists that the technology is there. “Our iPhone app can control a small plane but it can control a commercial-sized airliner as well. We’d have to make some regulatory inroads for it to happen, but the technical issues have fundamentally been solved.”

She predicts that in 5 to 10 years, unmanned aircraft will be transporting cargo. “That’s a foregone conclusion,” said Cummings. “It’s not going to happen in this country first, because we have so many regulatory problems. I suspect that Australia’s going to beat us to the punch, and very soon they’re going to start flying their packages overnight with no pilot on board.”

Cummings added that implementation of unmanned ground transport will not likely come as soon. “It’s actually harder to make a robotic car than a robotic plane. That takes a lot of people by surprise.”

She explained more external factors must be accounted for on the road than in the air. Pedestrians cross the street when they are not supposed to, weather changes the way the vehicle interacts with the road, and construction alters routes that must be navigated. Ground vehicles must be able to react to these changes very quickly. In the sky, adjustments are much more subtle and reaction times are more forgiving.

It looks like for now, the sky is the limit.

,

Study Links Food Container Toxins to Emotional and Behavioral Problems in Young Girls; Researchers from Harvard and BU Weigh-in on the Issue

In Healthcare on October 26, 2011 at 3:13 pm

This article first was published by New England Post on October 26, 2011.

Beth Santoro of Billerica thought she did all the right things during her pregnancy. “I didn’t eat cold cuts for the listeria. I didn’t have caffeine. I avoided quite a few things,” said the stay at home mom and former preschool teacher.

According to a recent study published by the journal Pediatrics, Santoro may have unknowingly exposed her unborn daughter to bisphenol-A, or BPA, a chemical found in a variety of plastics. BPA became a household term in 2008 when the compound made the news with reports that it could be leaching into the contents of water bottles. The new study suggests that other types of containers deliver BPA into the body as well. The report links aggression, depression, and anxiety in very young girls to their exposure in utero.

“We’re primarily exposed through the diet because BPA is used for a lot of food contact material and processes,” said Joseph Braun, an environmental health researcher at Harvard School of Public Health and a co-author of the study.  The chemical can be found in food storage containers and in the tin cans’ linings used to prevent spoilage. He said that pregnant women should consider reducing consumption of canned or packaged foods.

“In my head I’ve always said, ‘It’s water bottles,’ ” said Santoro. “That’s what they were drilling into your head.” She was careful not to use old water bottles and to look for the BPA-free label. She said she was shocked to learn she had likely been exposing her unborn baby to BPA.

Santoro said she would have done things differently if she had had that information a year ago. “I would have probably bought the big jar of applesauce instead of the little prepackaged ones.” She said she looks back to all the yogurt, hummus, and applesauce she ate out of plastic containers.

However, Santoro said she does not generally eat many canned goods. “I do a lot of frozen vegetables rather than canned vegetables,” she said.

For many families, canned vegetables and beans represent a large portion of their diet. Braun recognizes that canned goods represent an affordable way to incorporate healthy food into the family diet. “So don’t get rid of those and start eating French fries and milk shakes.”

David Ozonoff, an environmental health professor at Boston University School of Public Health, said in a telephone interview that low-income families frequently are exposed to greater levels of pollutants. Ozonoff knew of no income-specific data relating to BPA, but he said it is highly probable that children in low-income families are exposed to higher levels of BPA both in utero and in early life.

Both Braun and Ozonoff pointed to cash register receipts as an unexpected yet significant source of BPA exposure. Braun suggested that the BPA can be absorbed through the skin when handling receipts. “They get thrown in landfills and get into the water and the environment, ” Ozonoff added.

Joseph Braun

Scientists have long suspected that BPA disrupts the body’s endocrine system, according to Ozonoff. “When the fetus is developing, especially the nervous system, there is a delicate choreography from one cell to another. In order to do this in a coordinated way, they have to talk to each other. One of the main ways they talk to each other is through chemical signaling—that’s the endocrine system,” he said.

He offered this example. “Imagine you go with friends to a crowded bar, and you’re sitting at a table trying to talk about something, but the band is playing. You’re not going to hear anything.” Endocrine disruptors create static-like noise that can lead to distortion and miscommunication and affect development, he said.

Braun said the study found that prenatal BPA exposure appeared to affect the development of “executive functioning” in the brain. “So when you sit down and you know you have to write a story, you have steps in your head, and you are able to plan how to carry them out,” he explained. “People with good executive function can manage those steps and know the order they should take. People with poor executive function can’t manage those types of tasks from start to finish.”

David Ozonoff

Some of the effects of BPA cited by Braun and his colleagues resemble the symptoms of Attention Deficit Hyperactivity Disorder, or ADHD. “Children with ADHD have difficulty in executive function. They are hyperactive, and they don’t know how to react in situations,” he said. He added, that the majority of the children in the BPA study had not been diagnosed with ADHD.

Braun’s study followed children from the womb through their third birthdays. The researchers have continued to track their development and are in the process of completing their fifth-year assessments. Braun expects to publish those findings in the next 18 months.

Ozonoff finds good reason to trust the results of this study. He was not affiliated with this research but is familiar with the work of the scientists collaborating on the study. “These are really good, experienced scientists who really know what they are doing and how to interpret the data.”

Ozonoff believes policymakers and regulators should not wait for additional research but should ban BPA now. He adds, “If it turns out it’s okay, we can always let it back in the environment.”

European Scientists Claim They Have Broken Einstein’s Theory; Harvard Physicist Says Think Again

In Uncategorized on October 24, 2011 at 2:39 pm

This article was first published by New England Post on October 24, 2011.

Italian and Swiss scientists recently observed particles moving faster than the speed of light, which is a phenomenon that violates Albert Einstein’s special theory of relativity.

However, Harvard physics professor Gary Feldman is not yet ready to give up on Einstein.

It’s now up to Feldman to find out whether the fundamental law of physics—that nothing moves faster than the speed of light—is wrong.

The findings released by the European Organization for Nuclear Research (CERN) have rocked the scientific community. Eugenie Reich, writer for the journal Nature, said that “readers’ appetite for this story has been insatiable.”

“The findings are likely wrong,” Feldman told a dozen members of the New England Science Writers Association last week in a classroom at Harvard University’s Jefferson Laboratory.

“They don’t believe it either,” he said of scientists who published the study online last month. “This is what they measured, they’ve got to tell the world about it, but they hope other people will do the measurements and see if they get the same result or not.”

Feldman works on one of two projects in the world capable of checking these measurements. Fermilab’s MINOS experiment is equipped to analyze a neutrino beam about 500 miles between laboratories in Illinois and Minnesota. This is almost the exact distance between CERN’s Swiss laboratory and the Gran Sasso Laboratory in Italy, making it an ideal location to replicate the experiment. Japan has a third neutrino beam that is about half the length of the MINOS and CERN experiments.

MINOS collaborators at the University of North Carolina had tried to secure funding for similar experiments from the Department of Energy previously but were turned down, said Feldman. CERN’s findings violate the laws of relativity and nearly every theory for the past century hinges on Einstein’s assumptions. This claim that relativity has been discounted has reanimated interest in the MINOS Experiment and Feldman expects funding to follow.

Einstein’s theory of special relativity states that the speed of light is constant regardless of observer and inertial frame—think back to middle school math problems with balls rolling at two miles an hour down the aisle of a train that is moving at 60 miles per hour. This has been widely tested and universally accepted.

Feldman said that we see proofs of relativity constantly in our everyday lives. “If Einstein’s theory of relativity is inaccurate, our GPS systems would not work,” he said.

Feldman respects the integrity of the experimental methods used by CERN scientists and says that they did “a very good job.” All data was double checked with at least two different methods of measurement, the margin of error was small, and data analysis was blind. Still, he cannot accept the findings.

In lieu of evidence to discredit the experiment, Feldman turned to historical evidence that appears to refute the findings.

In 1987, a supernova exploded millions of miles away, collapsing in on itself, sending particles hurtling through space. Neutrinos arrived on Earth three hours before the light given off by the supernova. The difference in the speed of the neutrinos observed by Grand Sasso’s OPERA detector was greater than the speed of the supernova’s neutrinos. “If OPERA was correct, these neutrinos should have preceded the light by four years,” said Feldman.

Feldman explained that these neutrinos essentially had a head start. Because of their negligible mass, neutrinos can pass through matter more easily than protons carrying light. In the case of the supernova, he said, the neutrinos escaped from the center of the explosion faster and began their journey through space first.

Feldman pointed out that CERN scientists also had difficulty reconciling their data with the observations from the 1987 supernova. They mentioned it on the first page of their paper.

When questioned about where the CERN experiment could have gone wrong, Feldman pointed to technological limitations. He said that 10 billion neutrinos are produced in a few millionths of a second and there is no way to tell when in that period one given neutrino was produced. That may seem like an insignificant amount of time, but when you are talking about a particle no bigger than a millionth of the size of an electron, fractions of nanoseconds matter.

Further, Feldman explained that the experiment has several segments, each with its own technological limitations and margin of error. “This chain of timing is a long chain,” he said. “The most likely thing is that they made a mistake somewhere in that chain.”

Massachusetts Tries to Revive Lobster Industry

In Uncategorized on October 6, 2011 at 2:34 pm

This article was first published by New England Post on October 6, 2011.

Lobster fishing isn’t a young man’s game. The average age for a lobsterman is 57 years old. “If a younger fella tries to get in this business, there’s an awful lot of overhead,” said 58-year-old lobsterman, Steve Holler. “You have to have some years and experience under your belt to take the losses.”

In an industry accustomed to rocky economic waters, this year has been exceptionally treacherous with warming seas and intense competition from out of state fisheries.

“What is killing us right now is up in Maine, they’re having a year that’s gonna go down in the record books,” said Holler. “They’re catching thousands of pounds a day. We’re having a tough time making expenses, and people are falling by the wayside.”

Holler and the state’s lobstermen hope that the public’s appetite for local products and new recognition from the state will give the industry a needed boost.

The Department of Agricultural Resources (DAR) announced at the recent Boston Local Food Festival that it would extend the Commonwealth Quality Program (CQP) to include lobstermen. The CQP is an established designation for local farms, forestry, and aquaculture.

The majority of the world’s lobster passes through Massachusetts before being distributed throughout the country by dealers. Massachusetts’s restaurants and markets have access to lobsters from Maine and from foreign fisheries. With no basis for comparison, price wins out.

DAR Commissioner Scott Soares said the program could help level the playing field. The CQP seal will tell consumers that not only was the lobster caught by local lobstermen, but also it was caught with sustainable and environmentally sound practices. “Harvesters are seeing a lot of product that come from other countries that are not held to the same environmental standards,” said Soares.

Many Massachusetts lobstermen have employed environmentally responsible practices for years, Soares said. “This is not designed as a regulation. There are already plenty of state regulations. This is a voluntary program to provide the opportunity to put out there that they are employing these practices.”

Holler said he did not have to alter his harvesting practices in order to qualify for certification. “We have to adhere to strict guidelines to the state anyway, as far as handling egg-bearing lobsters, short lobsters, and how we keep them in the tank,” said Holler. In fact, the DAR sought out Holler and other local lobstermen to find out what best practices were already established, like using ropes that sink to connect traps connected together in a daisy chain to avoid snaring endangered right whales.

But will consumers pay a premium for feel-good lobster? Fewer people have been buying lobster at all during the latest economic crunch. Those that have may be looking more closely at price.

While Holler doubts certification will boost his prices this year. Massachusetts lobster already sells for premium prices compared to Maine’s. And according to Bob Glenn, an aquatic biologist with the Massachusetts Department of Marine Fisheries, yields in the southern New England fishery may continue to decline as lobsters move north for colder waters.

“The southern New England fishery is in a state of collapse,” Glenn said. “Southern New England stock is suffering from a lot of stress that has to do with climate change.” In the last 10 to 20 years, water temperatures have increased, he explains. Water temperatures above 68 degrees affect lobsters’ reproductive cycles, migration patterns, and growth, as well as the overall health of fisheries.

“In the past five or six years has been a tremendous attrition in the fishery,” said Glenn. “We’ve seen anywhere from 40 to 50 percent attrition in the number of guys who simply couldn’t make it.”

So far, it remains unclear whether adding the word “Massachusetts” to those little elastic bands around lobster claws will increase local sales or not. The program is new and many retailers are unfamiliar with it. The Stop & Shop Supermarket Company declined to comment, saying that it did not have enough information to answer any questions.

Liz Ventura of North End Fish Market said she had read about the program but was not sure how much choice she would have when purchasing lobster from her distributors. “Of course we’d like to try to buy from those guys, but I don’t know how it will work yet.”

Invasive Plant Finds Fertile Ground in Allston-Brighton

In Uncategorized on October 4, 2011 at 12:33 pm
This article was first printed in The Allston-Brighton TAB on September 23, 2011 and online on October 4, 2011.

The plant first appeared in Massachusetts in the late 19th century when it escaped from a Cambridge garden. In recent years, it has staged a hostile take over of the state’s parks, yards, meadows, and woodlands. This year, many towns have begun to take aggressive action to control it.

Boston — There’s a new creep in town.

It has been weaving itself through fences and hedges in Allston-Brighton all summer long, plaguing homeowners, gardeners, and landscaper. It goes by the name black swallow-wort.

The plant first appeared in Massachusetts in the late 19th century when it escaped from a Cambridge garden. In recent years, it has staged a hostile take over of the state’s parks, yards, meadows, and woodlands. This year, many towns have begun to take aggressive action to control it.

In many areas of Massachusetts, black swallow-wort threatens the local ecosystem. By sending out runners, or long underground stems, the vine is able to spread over large areas and can quickly overtake a yard or meadow. It produces a crop of green pods that, when mature, turn brown and burst open to release several little brown seeds with white tufts of fuzz that catch the breeze, spreading the plant over long distances. In areas with intact ecosystems, the infestation can be a real problem, upsetting the balance of plants, insects, and even birds.

This summer, in Cambridge, there has been an active campaign to eradicate the plant. Resident volunteers of the “Pod Patrol” scour the city collecting bright green seedpods to either burn or dispose of in a landfill. In Belmont, the Massachusetts Audubon Society’s Habitat Wildlife Sanctuary acquired a meadow completely overrun with black swallow-wort and other invasive plants. The sanctuary attempted to eradicate the weeds by bringing in hungry sheep and goats. Unfortunately, even the animals found the plant distasteful.

In Allston-Brighton the plant poses more of an aesthetic concern than an ecological threat.

“I’m not sure that you can say that there are any native ecosystems in Allston. I wouldn’t know where to look for them,” says Peter Del Tredici, senior research scientist at the Arnold Arboretum and an expert on wild, urban plants.

Del Tredici notes that the major green spaces in Allston and Brighton are planned parks designed to bring nature into the city. “Have you walked along the Charles River?” Del Tredici asks. “There’s nothing native about the vegetation… There are a few native species, but a lot of that was planted. It’s totally a managed landscape.”

For Allston-Brighton, perspectives of the plant as a problem varies widely. “We’re not talking displacing native species here, we’re talking about chain link fences,” Del Tredici says. But he doesn’t hesitate to add that he hates black swallow-wort and aggressively tears it up in his own yard. The best time to pull it is in the spring, he explains. Once it becomes established, it can be difficult to remove. Yanking mature vines does little to affect the overall plant. Individual limbs easily break off the runner, which responds by producing more shoots. Removing the plant this time of year requires some exploratory digging with a trowel or shovel to uncover the entire root system.

Not everyone is interested in evicting the black swallow-wort, though.

“I think it’s kind of pretty,” says Melissa Copeland. The vine has woven a tapestry all over a chain link fence in the backyard of her ranch-style duplex in Brighton’s Aberdeen neighborhood. She says she originally left the vine alone because she thought it could be poisonous and induce a rash, but has since grown to like it.

Is the Current Healthcare System Driving the Nation to Economic Collapse?

In Healthcare on September 23, 2011 at 2:26 pm

This article was first published by New England Post on September 23, 2011.

“Healthcare costs are destroying our American prosperity and even beginning to destroy the American dream,” Dr. Atul Gawande told the Harvard Institute for Learning in Retirement, Wednesday in a lecture entitled “The Battle for the Soul of Medicine.”

Gawunde is a surgeon at Brigham and Women’s Hospital, associate professor at Harvard School of Public Health, and regular contributor to The New Yorker. He is the author of three books including The Checklist Manifesto in which he prescribes a 19-item checklist for surgical teams to address before each surgery. He has been presenting his “Battle for the Soul of Medicine” lecture around the country for a year warning of impending economic medical collapse if healthcare costs are not reigned in within the decade.

These concerns are nothing new to Boston area medical and public health professionals. Dr. Alan Sager, Boston University professor of public health and management and director of BU’s Health Reform Program has been weighing these problems for a decade and testified before Congress about such matters.

In a telephone interview following Gawunde’s lecture, Sager confirms Gawunde’s concerns. “We’re already there,” he said. “There are huge signs of that already,” and cited individual state struggles to cover ever rising Medicare costs.

Gawunde, however, remained optimistic.

“The answer is right in front of us. We can rediscover our American ability to solve problems,” he said and offered his checklists as one solution.

Gawunde advocated medical culture that looks beyond providing individuals the best training and hospitals the best technology to a system where individual doctors work in concert. “We’ve trained all of our physicians to be cowboys when we need pit crews,” Gawunde said. It used to be that individual doctors could “do it all,” he explained.

But medicine has changed.

“We now understand there are 13,600 different ways that the human body can fail. There are 6000 drugs that I can legally prescribe and 4,000 medical and surgical procedures to choose from,” Gawunde said. Where doctors once prescribed an aspirin, they now might recommend a knee replacement. A knee replacement requires a lot more doctors than an aspirin and those doctors need to work together he said, then added “cowboys aren’t even cowboys anymore. They drive in teams and have specific protocols that they follow…checklists.” ”

However, even cowboys and pit crews need a leader, someone to coordinate efforts and reduce redundancy.

Sager said he sees primary care physicians as the key to unlocking the healthcare crisis. A shortage of primary care doctors means that full time physicians care for 1500 to 4000 patients, he said. He said an increase of 300,000, full-time equivalent primary care doctors would bring the doctor to patient ratio down to 1 doctor for 1000 patients. He predicted this would improve the overall quality of primary and secondary care and reduce reliance on expensive hospitals for routine care.

Dr. Gregg Meyer, primary care physician and vice president of quality and safety at Mass General Hospital agreed in a telephone interview that there is much to be gained from an investment in primary care doctors.

“I think there is strong evidence to say that if we invested more in primary care and we did it in the right way, that we could make a dent in health care costs,” said Meyer. However, primary care is not an attractive field to medical students, he qualified. He added that primary care doctors are often overworked and underpaid.

American cultural norms contribute to excessive medical costs, as well. Dr. Karen Thomas, cardiologist at Beth Israel Deaconess Medical Center and Mount Auburn Hospital said in a telephone interview that she often felt trapped as a physician by cultural expectations.

“Americans think they should be able to live forever and they should be able to spend millions and millions of dollars to do so at no personal cost to themselves,” says Thomas. “We just don’t have $50,000 to be putting a preventative device in a 90 year old.” Still families want their loved ones to receive every medical advantage possible, and Medicare will readily pay for it.

Sager suggested that physicians benefit from over providing. More tests mean more visits and more visits mean more fees. “Financial incentives to over-serve and fear of being sued come together as two mighty rivers and lead to a flood of over-care.”

Thomas admitted to ordering tests that she knew were probably not necessary in order to avoid a potential lawsuit. Meyer said that this is a problem throughout the United States and should be a major subject in the national healthcare dialogue.

Gawunde called the identification of these problems as the first step. His checklists are one idea for addressing the problem of errors. As Doctors Sager, Meyer, and Thomas pointed out, problems abound in the current medical system. Only time will tell how these problems will be addressed.

Will the Buffalo Roam?

In Uncategorized on September 8, 2011 at 4:50 pm

The Kansas State song, and anthem of the American West, “Home on the Range,” brought the longing for “a home where the buffalo roam” to the hearts and lips of nearly every cowboy to sit in a saddle and settler to drive a wagon. Unfortunately, by the time the American settlement of the Plains was complete, and all those cowboys and settlers found their home the American buffalo–or more accurately, bison–was nearly wiped out.

But, recent efforts just might bring the buffalo back to the plains of Montana.

Montana Fish, Wildlife, and Parks has proposed establishing herds of bison in several areas around the state. The creation of herds of 40 to 50 animals would permit managed hunting. Ranchers are skeptical of the state’s assurances that these bison would be disease-free. They fear that wild bison living so close to their homes would pose a threat to their cattle herds. Bison are potential carriers of brucellosis, a disease that can lead to miscarriages.

Today, protected herds of bison already thrive in Yellowstone National Park and on Native American reservations. Yellowstone officials maintain that brucellosis has been effectively managed and controlled within the park.

Bison migrating north of Yellowstone have created a sustained appetite for bison hunts in the area. The area surrounding the towns of West Yellowstone and Gardiner make up some 720 square miles of wildlife habitat. In 2005, the Montana legislature ended a  15-year moratorium on bison hunting with 50 hunting permits. Since, the number of permits issued has increased to 140. The hunts are just as controversial as the current proposal to establish additional herds in other areas of the state, predominantly for the same brucellosis concerns.

Bison and limited bison hunts regularly occur in Utah, Arizona, South Dakota, Alaska, and Wyoming and the Montana officials are quick to point out that such controversy has not arisen in those states.

Yet attitudes toward introducing bison in Montana remain negative. Bison that have migrated away from the protected realm of Yellowstone  often hazed–driven back into the park–or outright slaughtered. As opposed to hunting within a restricted quota and using the meat and skins in a sustainable way, carcasses are left lying on the plains, a scenario reminiscent of the original American settlers’ nearly catastrophic hunting. This persistent problem has resulted in a significant drop in the park’s bison population.

A new iPhone app, Buffalo Haze was released last month, is designed to foster empathy for the modern-day wooly mammoths. The app is a video game in which players “haze” wayward buffalo until they return to Yellowstone. Before playing the game, players are given a brief history of bison and their current plight. Critics say the game makes light of a serious issue and reinforces the notion that the bison belong within the confines of the park.

In the end, it remains to be seen if the buffalo will be free to roam.

, , , , , , ,

Fireworks Blamed for Arkansas Blackbird Deaths, Cause of Fish Kill Still Unknown

In Uncategorized on January 27, 2011 at 4:59 pm

New Year's Eve fireworks are thought to have spooked thousands of red-winged blackbirds, sending them to fly blind into the dark night.

Nearly a month after Arkansas residents found thousands of dead red-winged blackbirds and tens of thousands of dead drum fish, half the mystery remains unsolved.

The 4,000-5,000 red-winged blackbirds that fell from the sky this New Year’s died as a result of blunt trauma, according to tests conducted by several state and federal agencies, announced the Arkansas Game and Fish Commission on Wednesday. Weather radar confirmed the theory that dense swarms of the birds took off together during New Year’s Eve fireworks celebrations. Unaccustomed to flying at night, the birds have poor night vision and are thought to have crashed into buildings, trees, and other stationary objects.

The bizarre event occurred less than 24 hours after 80,000 drum fish washed up on the banks of the Arkansas River. The Game and Fish Commission has conducted similar tests on the fish, but has been unable to find any conclusive cause.

Tests of the river water revealed normal minerals, nutrients, and metals and did not find any toxins. Infections and parasites have been ruled out as well. AGFC Chief of Fisheries, Chris Racey is quick to reassure consumers that fish caught in the river are still safe to eat.

Coupled with the blackbird event, the riverbanks strewn with fish have drawn a lot of national media attention, but fish kills are not uncommon. While pollution and other human interference can occasionally lead to fish kill, in many areas of the nation, these events are simply a natural phenomenon. In Massachusetts, MassWildlife receives so many calls from residents disturbed by riverbanks dotted with dead fish, that they have a web page devoted to reassuring the public that fish kill is often a natural process. This is a seasonal occurrence and can be triggered by many different factors, from diseases to oxygen levels in the water.

Arkansas rarely sees fish kill of this size, but it does experience this type of event annually. “Unfortunately, we probably will never know exactly what killed these fish,” conceded Racey.