TIME medicine

Who’s Better at Baby Talk, Mom or Dad?

ULTRA.F—Getty Images

The latest research shows that moms and dads use baby talk in different ways, and that boys and girls respond to them differently too

In the latest research on how babies first pick up language, it turns out that gender makes a difference.

Reporting in the journal Pediatrics, Dr. Betty Vohr and her colleagues decided to look at how both moms and dads talk to their young babies. Much research has focused on how mothers engage infants, even before they can speak, but fewer studies have focused on the male side of the equation.

Taking advantage of a small recording device called LENA, which they attached to the babies on a vest for 16 hours, Vohr’s team analyzed all of the verbal interactions a group of 33 babies had (none of the babies were born premature). The recordings occurred just after they were born, while the infants were still in the hospital, and again at 44 weeks and seven months. The last two sessions were recorded on days when both the babies’ parents were home.

MORE: How to Improve a Baby’s Language Skills Before They Start to Talk

From more than 3, 000 hours of recordings, the scientists got a good snapshot of the babies’ verbal environments. And the results were both expected and surprising. When babies made sounds, moms were more likely to respond to them verbally than fathers were — “Oooo, sweetie pie, you’re talking this morning.” Mothers responded 88% to 94% of the time to the babies vocalizations, while dads responded only 27% to 33% of the time.

Perhaps because of the increased responsiveness, or because of other reasons, both boys and girls were also more likely to respond to their mothers’ or female voices than they were to male voices.

Vohr says it’s possible that mothers may use more mother-ese — the higher pitched, sing song-y conversational tone that women, more than men, tend to adopt with infants. Mothers may also pair their vocal interactions with more eye contact with the baby, encouraging them to respond more when they hear their mothers’ voices.

“It seems to me that adults talking to children is absolutely the most cost effective intervention a family could do to improve children’s language,” says Vohr, professor of pediatrics at Alpert Medical School at Brown University.

She also found other intriguing gender-based differences. When she compared mothers of girls to mothers of boys, she found that mothers of girls responded more frequently to their babies’ sounds than mothers of boys did to theirs. The same trend occurred for dads; those who had boys tended to respond more frequently to their infants than those who had girls.

“We’re not certain why that is, but the important thing here is knowing that of critical importance in early language development is the need to encourage both parents,” says Vohr. “The more we learn about it, the more we can inform parents of the power they have in just talking and interacting with their infants to improve the long term outcomes for their child and their school readiness.”

Previous studies have documented that the amount of verbal interaction, or “conversations” babies are exposed to even before they can speak, can predict their later language skills and even academic performance in school.


This Flu Shot Is Not Like the Others

Some people may get a new flu shot that’s made with dog cells instead of chicken eggs

This year Novartis shipped its first full batch of Flucelvax, a new vaccine that was only approved by the Food and Drug Administration in 2012. The company made a limited amount of the shot last year, but there are more doses to go around this flu season. And for the first time, the doses were made at the company’s newly approved U.S. plant in Holly Springs, North Carolina.

The vaccine is made without growing the influenza virus in chicken eggs, which is the way that flu shots were made for more than four decades. Instead, Flucelvax is grown in kidney cells from dogs. The technology means that the shot can be made in less time than a traditional flu shot—enough virus can be churned out in about 65 hours to 75 hours, compared to the six months or so it takes to grow in chicken eggs. It also means that people who are allergic to eggs now have another option for getting immunized against the flu.

MORE: Pregnant Women and the Flu: Why Influenza Is More Dangerous for Expectant Moms

In studies that the FDA reviewed before approving the vaccine, the shot was 84% effective in preventing flu among adults who were vaccinated compared to those who received a placebo. People getting Flucelvax produced around the same amount of antibodies to the influenza virus as those who were immunized with a chicken egg-based flu vaccine.

Using animal cells instead of chicken eggs, say Novartis officials, allows them to have more control over the purity of the final vaccine. How well influenza grows in the chicken eggs is variable—some eggs or batches of eggs help the virus grow, while others aren’t as conducive to producing large amounts of influenza.

The cell-based technology is also a plus during a flu pandemic, since the platform can produce more doses quickly to control an outbreak as a particular influenza virus spreads among a population. The kidney cells are frozen and can be thawed quickly to begin growing virus. The company has produced doses of pandemic flu vaccine against H5N1 using the cell technology, and it’s keeping them in deep freeze as part of the U.S. government stockpile in the event of a pandemic.

The FDA has approved seven different types of flu shots—in addition to Flucelvax and the standard vaccine made from chicken eggs that protects against three strains of influenza, there is also a shot that protects against four strains of flu; for the needle-phobic, one with a microneedle injects just into the skin and doesn’t penetrate into the muscle, making it less painful; for the elderly who need more protection, there is a high-dose vaccine; for younger children there is a nasal spray; and for those allergic to eggs, there’s a shot made from bits of influenza proteins grown in insect cells. Not every doctor’s office or clinic carries every shot, so if you prefer one over the others, call your health care provider to find out if it will be available.

TIME ebola

Here’s What Scientists Know About Ebola in Sierra Leone

An Ebola screening tent outside the Kenema government hospital in Kenema, Sierra Leone, Aug. 6, 2014.
Tommy Trenchard—Redux/The New York Times An Ebola screening tent outside the Kenema government hospital in Kenema, Sierra Leone, Aug. 6, 2014.

Rare, reliable data about Ebola from inside a treatment center in Sierra Leone

Everything we know about Ebola since the disease’s two dozen or so outbreaks since 1976 comes not from a rich, deep database of scientific evidence that’s been carefully collected and recorded. With few formal health care systems in the areas hardest hit by the disease, there were no medical records, no charts and no standardized ways to document patients’ symptoms, vital signs, treatment regimens and whether or not they survived. Instead, much of our knowledge comes from the haphazard scrawl of doctors’ notes and their recollections about treatment and survival rates.

But for the past 10 years at Kenema Government Hospital in Sierra Leone, the country’s Ministry of Health has been working with a group of international researchers to establish a meticulous medical records system—originally for patients with Lassa fever, another common infection in the region. So when the first Ebola patient walked through the door on May 25, the same procedures for documenting vital signs and treatment information stayed in place. Now, for the first time, doctors have a robust record of the first Ebola patients in the current outbreak treated at Kenema beginning in May—and the results of that record-keeping appear in the New England Journal of Medicine.

MORE: Ebola Tests Fast Tracked By FDA

The new records were a challenge to collect, since infection control rules meant that the paper charts could not be transferred back and forth between the ward where patients were treated and other areas of the hospital. “The nurses’ station was separated from the patient rooms by essentially a chicken wire window, so the nurses would talk to each other through the chicken wire—the nurse inside, in personal protective equipment, would tell the nurse outside what to write down,” says paper co-author Dr. John Schieffelin, an assistant professor of clinical pediatrics and internal medicine at Tulane University who has been serving stints at the hospital for the last four and a half years. Even that rudimentary system was state of the art for the region, where most health clinics do not keep medical records. “In most of Sierra Leone, the hospital chart is one of those little composition books that we used to write essays in during high school,” says Schieffelin. “There was no structure to it; the physician would just write daily notes and most hospitals don’t have a charting system.”

MORE: See How Ebola Drugs Grow In Tobacco Leaves

The new documents confirm what previous health workers knew about Ebola from experience. Of 106 patients with Ebola, 44 had complete medical charts in paper form (the rest were destroyed because health officials feared they had been contaminated with the virus), and the findings supported some basic tenets of Ebola infection: that the incubation period for Ebola virus is about six to 12 days, that 74% of those infected died, that younger patients were more likely to survive infection than those over age 45, and that people with less virus in their blood when diagnosed were more likely to survive.

“It affirms our understanding of how to treat Ebola patients,” says Schieffelin. “We need to treat them aggressively with IV fluids and monitor their blood chemistries. The study also gives us a good solid baseline for understanding the disease, so we can build on it in a lot of different ways. It’s a foundation for doing further studies for optimizing treatment. It provides a great foundation for studies looking at novel treatment methods. Now that we understand how Ebola affects patients, can we improve symptoms and outcomes with novel therapies? We can start to ask and answer those questions.”

MORE: 12 Answers to Ebola’s Hard Questions

Turning those answers into new treatment strategies, however, might be a daunting task—especially in the context of the current outbreak. On most days, the Kenema hospital would see about 90 Ebola-related patients, some of whom were suspected to have the disease but still needed to be tested, and others with confirmed infections who needed to be immediately assigned to a bed and given IV fluids. “There are a lot of confused Ebola patients,” says Schieffelin. “These people are wandering around the ward, often going from one bed to the next, and they are scared so often not very cooperative. To top that off, a lot of people didn’t speak English, so that made it even more challenging.”

He admits to often tossing patient confidentiality concerns aside by asking other patients who were feeling well to translate critical information to their peers, who either didn’t need to be in the hospital any longer because they tested negative, or needed to be immediately transferred to another ward if they were infected.

MORE: Learning From Past Viral Epidemics, Asia Readies for Possible Ebola Outbreak

At Kenema, the health care workers did not use the full-coverage hazmat suits that Medecins Sans Frontieres uses in its clinics. Instead, they wore Tyvek suits that covered their front and back, a mask, face shield, double gloves and a head covering. That left some skin in the front and back of the neck exposed. The reason was partly for practical reasons—Schieffelin was often the only health care worker on his part of the ward where patients were triaged, and frequently had to spend four to four and a half hours at a time suited up. The full coverage suits become uncomfortable and unbearable after about 45 minutes.

“But I was personally okay with our equipment,” he says. “Because my biggest concern was getting a needle stick. My mucous membranes—my eyes, nose and mouth—were pretty well covered.”

After about four hours, he and whoever else was working on the wards with the infected patients would get sprayed with a bleach solution from the shoulders down, in order to avoid splashing any potentially contaminated material onto their face and neck. Then they would take each piece of equipment off and wash their hands in bleach after each step. After a break of an hour or so, they would suit up again.

MORE: Ebola Quarantines ‘Not Grounded on Science,’ Say Leading Health Groups

When Schieffelin returned from his work in Sierra Leone in August, he was told by the World Health Organization, U.S. Centers for Disease Control and the Louisiana state health department (he lives in the state) to monitor his temperature twice a day for 21 days, which he did. He was also told not to use mass transportation. He worked at home for a couple days, only because he was exhausted after his trip, and when he returned to work he didn’t see patients for a few weeks—mostly out of a scheduling coincidence, not intentionally.

Given public concerns about Ebola potentially coming to the U.S. and spreading here, however, he says, “Perhaps we should say that in terms of physicians and nurses, maybe direct patient care for a couple of weeks would not be in anyone’s best interest.”

But while he recognizes that hospital organizations and the general pubic have legitimate concerns about being protected against an agent as deadly as Ebola, Schieffelin is against mandatory self-isolation or quarantine, measures the states of New York and New Jersey recently decided to require for all health care workers returning from the three countries affected by Ebola. “I think self-isolation is completely unnecessary if you are not symptomatic. In my mind, that enhances hysteria. I have young children. If their dad were in self isolation away from everybody for three weeks, that would adversely affect them and would be telling the community and the schools the wrong message: that I need to be a pariah and an outcast for three weeks,” he says. “In my mind, that’s not the right message. If I have no symptoms, I am not a threat to anybody—I’m not a threat to my children, nor are my children a threat to other children at their school.” Such mandatory quarantines could also deter health workers from contributing to the effort to control the epidemic, and that will only prolong it, he says.

Schieffelin says that if he had recorded a fever at any point during this 21 day monitoring period, he would have immediately reported to the Louisiana health department and gone into isolation. He knows how deadly Ebola can be from personal and professional experience: seven of Schieffelin’s co-authors on the paper have died of Ebola infection since the data were collected over the summer.

TIME ebola

Ebola Tests Fast Tracked By FDA

Two new tests that can rapidly detect Ebola are now being shipped to hospitals around the country

The Food and Drug Administration (FDA) approved two new diagnostic tests that can detect Ebola from blood, urine or saliva samples in as little as an hour. The tests are made by BioFire Defense, a Salt Lake City-based company, and can be used in the company’s FilmArray machine, a device that can look for Ebola virus genes in the blood. In the U.S., 300 hospitals already use the machine to detect a range of infectious agents.

One test is designed for commercial use in hospitals and laboratories, while the other is approved only for labs designated by the Department of Defense.

The company said it sent a FilmArray machine with the newly approved Ebola kit to Bellevue Hospital, where Dr. Craig Spencer, the fourth person to be diagnosed with Ebola in the U.S., is being treated. But because the approval came so quickly, and the device was rushed to the hospital at the FDA’s request, proper New York city and state regulations have not been met yet, so the machine is still not in use. The company says the paperwork should be completed soon. “We are working through the process of being able to deliver [it] to Bellevue Hospital and hope that happens soon,” says Kirk Ririe, CEO of BioFire Defense, which worked with the U.S. military to develop the Ebola test kit. “We just got out ahead of ourselves.”

MORE: Ebola Quarantines ‘Not Grounded on Science,’ Say Leading Health Groups

The two tests were approved under the agency’s Emergency Use Authorization powers, which allows the FDA to permit use of unapproved tools or drugs to be used to diagnose, treat or prevent “serious or life-threatening diseases or conditions caused by [chemical, biological, radiological or nuclear] threat agents when there are no adequate, approved and available alternatives.”

While quick diagnosis of Ebola is critical to identifying patients infected with the virus and providing them with health care that can save their lives, officials at Doctors Without Borders (Medecins Sans Frontieres, or MSF) say that the BioFire tests do come with some disadvantages in the field. Currently, lab technicians use a gene-based assay to pick up genetic fingerprints of the Ebola virus. The test takes four hours, but the current technologies can run multiple samples from different patients at the same time, allowing clinics like MSF to test up to 70 people a day. While the BioFire platform can spit out results in one hour, it can only run one sample at a time, so to maintain the high volume of testing at outbreak centers, says Erwan Piriou, laboratory advisor at MSF, “we would need multiple devices to reach the same throughout in a day. I feel in that sense the device doesn’t solve everything.”

That could be tricky in the resource-poor settings where Ebola typically emerges. Each machine costs around $39,000, and the price of each test is about $189.

MORE: WHO: Ebola Cases Exceed 10,000 Worldwide

The big advantage to the BioFire platform, however, is that it requires less handling of the samples that could potentially be infectious. At field clinics in West Africa, testing currently occurs in small tents or facilities outside of the Ebola treatment areas. Ebola treatment areas require health care workers to don full personal protective equipment that reveals no skin that could potentially be exposed to virus. Health care workers draw blood and sterilize the outside of the vial with chlorine to kill any virus that may have contaminated it. The vial is then brought to the testing area, where technicians work in glove boxes—transparent, sealed boxes with built-in gloves so that technicians can destroy the virus. Once the virus is deactivated, the sample is put through a molecular process to amplify the viral genes and then analyzed for presence of Ebola RNA.

The BioFire platform, while welcome, is also a bit of overkill for the immediate needs of the Ebola health care community in West Africa. It was designed to test for an array of pathogens—from malaria to anthrax—so the cost includes the ability to test for all of those agents, which isn’t urgently needed in West Africa.

A diagnostic that can quickly detect Ebola—or rule it out in cases of diseases like malaria—is critical for containing the outbreak and maintaining strong health care in the region, even as the outbreak peters out in coming months and years. “It’s the malaria season now, and what is happening is that some non-Ebola cases need to be treated as well,” says Dr. Arlene Chua, policy advisor on diagnostics for MSF, citing patients with undefined fever or post-partum bleeding. “Health care workers are afraid they might have Ebola, so we need to a test to exclude Ebola quickly so we can take care of non-Ebola cases.”

MORE: Study: Current Aid Promises Won’t Contain Liberia’s Ebola Outbreak

WHO is soliciting submissions from companies interested in receiving expedited approval from WHO for their diagnostics; some have been in development for years but have stalled because of lack of funding. From MSF’s perspective, top priorities in an Ebola test would include a device that can take smaller samples of blood—such as from a finger stick rather than a blood draw, which exposes health care workers to more risk of infection—or samples of saliva. Also helpful would be a device that remains completely contained that does not require technicians performing the test to wear personal protective equipment, and lower power requirements, such as a battery, that can be recharged so the test can be used anywhere and under any conditions.

Those are tall orders, but such a dream diagnostic should be possible, says Piriou. “The BioFire technology is amazing technology for sure. So the technology is there,” he says. “It’s not more or less difficult than developing a test for any other disease. There is no reason it can’t happen.”

TIME Cancer

This Mammogram Saves Lives and Money

Dubin Breast Center Of The Tisch Cancer Institute At The Mount Sinai Medical Center Ribbon Cutting & Opening
Gary Gershoff—Getty Images A 3D mammogram machine at the Tisch Cancer Institute at Mount Sinai Hospital in New York City

A screening combo may be worth it for women with dense breasts

More hospitals are offering women the latest technology in mammography: machines that can recreate breast tissue in 3D to help doctors better detect the earliest cancers. But it’s still not clear whether these screens, which cost more than digital mammograms, are worth the money.

In a study published in the journal Radiology, researchers led by Dr. Christoph Lee at the University of Washington found that for women with dense breasts, who often need repeat mammograms, adding on 3D screening—called tomosynthesis—to a traditional digital mammogram actually costs less in the long run.

MORE: High-Tech 3D Mammograms Probably Saved This Woman’s Life

Women with dense breasts are at moderate to high risk of developing breast cancer because of the volume of breast cells in their tissue, and Lee’s team created a model for these patients to compare the cost effectiveness of digital mammography every other year to digital mammography with 3D screening every other year. Using data from the National Cancer Institute’s Breast Cancer Surveillance Consortium, the researchers calculated breast cancer rates and deaths using both screening methods, and found that for every 2,000 women with dense tissue who were screened, the 3D and digital test avoided one additional death from breast cancer compared to the digital mammography alone.

Just as importantly, says Lee, the model predicted that the two screening methods together averted 810 false positive readings. Fewer false positives means that women won’t get as many repeat scans and will be less likely to have biopsies and other procedures to learn more about any suspicious growths.

“The savings represented by 810 fewer false positives are a huge savings in anxiety, diagnostic workup and resource utilization in the health care system,” says Lee. “The decrease in false positives is what is driving cost effectiveness and showing that the benefits of adding tomosynthesis outweigh the added costs of the technology.”

The findings support a study published earlier this year that showed for the first time that 3D mammography detected more cancers, while reducing the false positive rate in a broader group of women even without dense breast tissue.

TIME ebola

Ebola Quarantines ‘Not Grounded on Science,’ Say Leading Health Groups

Doctors Without Borders (Medecins Sans Frontieres) and other major medical groups voice opposition to mandatory quarantines imposed by New York and New Jersey on health workers returning from the Ebola epidemic

Doctors Without Borders, also known as MSF for Medecins Sans Frontieres, joined a growing number of professional medical groups that are critical of the mandatory quarantines both New York and New Jersey put into place on Oct. 24. Those orders required any returning health care workers who have had contact with Ebola-infected patients in west Africa into a mandatory quarantine for 21 days. The first nurse held under the new rule, Kaci Hickox, was brought to an isolation tent at Newark University Hospital, and held there for two and a half days despite having no symptoms of the disease.

In MSF’s first statement about the quarantine rules, the group says the forced quarantine, regardless of whether the health workers are have symptoms, “is not grounded on scientific evidence and could undermine efforts to curb the epidemic at its source.”

The group already has strict policies for its returning staff, which includes self-monitoring for 21 days for fever, one of the earliest signs of infection with Ebola. “We need to be guided by science and not political agendas,” said Dr. Joanne Liu, international president of MSF. “The best way to reduce the risk of Ebola spreading outside West Africa is to fight it there. Policies that undermine this course of action, or deter skilled personnel from offering their help, are short sighted. We need to look beyond our own borders to stem this epidemic.”

Liu says that the quarantine policy has already caused some volunteers to reduce their tours in the hardest hit countries of Guinea, Liberia and Sierra Leone. And because the humanitarian aid organization relies on health professionals to volunteer their time to curbing the epidemic, such disincentives could lead to fewer people willing to take the time and effort that are critically needed to curb the outbreak. Currently, MSF has 270 international staff members in the three Ebola-stricken countries, and oversees an additional 3000 local staff members.

The group’s criticism of the stricter quarantine rules are echoed by others in the medical community and even the White House; an official told the Wall Street Journal “We have let the governors of New York, New Jersey and other states know that we have concerns with the unintended consequences… [that quarantine] policies not grounded in science may have on efforts to combat Ebola at its source.”

Here’s what other health groups are saying about the quarantines:

Dr. Robert Wah, president of the American Medical Association (AMA):

“It is critical that we respect and support U.S. health professionals who are volunteering to help bring this epidemic under control in West Africa. The AMA’s Code of Medical Ethics emphasizes that decisions related to quarantine or isolation be based on scientifically sound information. In the case of Ebola infection, relevant scientific evidence indicates that the virus is spread only through contact with the body fluids of symptomatic individuals.”

The Infectious Diseases Society of America:

“IDSA does not support mandatory involuntary quarantine of asymptomatic healthcare workers returning from Ebola-affected areas. This approach carries unintended negative consequences without significant additional benefits.”

Association for Professionals in Infection Control and Epidemiology:

“While we understand public concerns, APIC does not support mandatory quarantine of healthcare providers with no symptoms of Ebola who have treated patients with EVD.

APIC believes that quarantining healthcare professionals returning from caring for Ebola patients in West Africa will deter potential healthcare volunteers and lead to increased difficulty in assembling care teams in West Africa and the U.S. Forced quarantines of healthcare workers with no symptoms of Ebola who have risked their lives to protect others, are unnecessarily harsh and are not aligned with scientific evidence. Quarantines may affect the healthcare worker’s ability to make a living and may also have negative emotional and social consequences as a result of being stigmatized for their service.”

AIDS activists, doctors and researchers in a letter to Governor Andrew Cuomo:

“[The quarantines are] not supported by scientific evidence” and “may have consequences that are the antithesis of effective public health policy.”

On Monday, New Jersey Governor Chris Christie released Hickox from quarantine.

TIME ebola

Doctors Without Borders Responds to New York Ebola Case

Doctor Quarantined At NYC's Bellevue Hospital After Showing Symptoms Of Ebola
Bryan Thomas—Getty Images A New York City Police officer stands at the entrance to Bellevue Hospital October 23, 2014 in New York City.

"Extremely strict procedures are in place"

Doctors Without Borders/Medecins Sans Frontieres (MSF) confirmed Friday that one its staff members tested positive for Ebola in New York City this week. While the patient’s identity, Dr. Craig Spencer, has been made public, MSF declined to provide further details about his him, citing privacy reasons.

Spencer had recently returned from Guinea, where he was part of the humanitarian aid group’s efforts to treat the Ebola epidemic there. MSF had strict procedures requiring members returning from Ebola-stricken areas to monitor themselves by taking their temperature twice a day for potential signs of a fever, an early sign of the virus. When Spencer found his temperature was high on Thursday morning, he immediately called MSF, which then contacted the New York City Department of Health & Mental Hygiene.

MORE: Ebola in New York: How Worried Should the City Be?

“Extremely strict procedures are in place for staff dispatched to Ebola affected countries before, during, and after their assignments,” Sophie Delaunay, executive director of MSF said in a statement. “Despite the strict protocols, risk cannot be completely eliminated. However, close post-assignment monitoring allows for early detection of cases and for swift isolation and medical management.”

According to the group, three MSF members and 21 locally employed staff have been infected with Ebola; thirteen have died. MSF has 3,000 employees working in West Africa to treat Ebola patients; more than 700 international staff from around the world have spent varying amounts of time in the region battling the epidemic.

TIME ebola

Ebola in New York: How Worried Should the City Be?

A doctor diagnosed in New York City raises public health questions in one of the world's most densely populated urban areas

Dr. Craig Spencer, 33, of New York was diagnosed with Ebola Thursday night after he was isolated at Bellevue Hospital. Before he was rushed to Bellevue in Manhattan earlier Thursday afternoon, the Medecins Sans Frontiers (MSF) MD took a subway to Brooklyn on Wednesday night where he spent a few hours at a bowling alley, and then took an Uber car back home. Health officials say that he was not symptomatic—and therefore not contagious—at the time. The next morning, he took his temperature and reported that it was 103F, and immediately reported it to MSF, which then notified the state and city health departments. (New York Gov. Andrew Cuomo said Friday morning the doctor’s temperature had been 100.3F, not 103F as previously reported.)

The diagnosis has raised concerns about how quickly Ebola could spread in a city as densely packed and populated as New York. But in a late night press conference, the mayor and governor of New York, as well as the city and state health commissioners were quick to assure the public that New York was prepared for such a case, and that everything had gone according to plan in identifying, isolating and bringing Spencer to Bellevue. “We are as ready as one could be for this circumstance,” said Cuomo. “What happened in Dallas was the exact opposite. Dallas unfortunately was caught before they could really prepare, before they knew what they were dealing with. We had the advantage of learning from the Dallas experience.”

President Barack Obama meanwhile spoke on the phone Thursday night with Cuomo and, separately, with New York City Mayor Bill de Blasio, offering any additional federal support necessary in terms of patient care, the maintenance of safety protocols for healthcare workers, and the identifying of any of Spencer’s contacts who might be at risk of exposure.

The public has been assured that riders of the subway, and even residents of Spencer’s apartment building, are at very low risk of getting infected. “There is no reason for New Yorkers to be alarmed,” said de Blasio. “Ebola is an extremely hard disease to contract.”

As sobering as the Dallas experience was for that city, widespread cases in New York are unlikely, they said, because Spencer was asymptomatic when he was in public places, and because Ebola is only spread from person-to-person when two conditions are met.

First, the infected person must be symptomatic, meaning he has a fever, is feeling nauseous, has a headache or is otherwise feeling ill; and there must be direct contact with his body fluids — saliva, sweat, blood, urine, vomit or feces — at this time with another person’s mucous membranes such as in the eyes, nose or mouth, or with an open wound.

City health commissioner Dr. Mary Travis Bassett said that Spencer had gone for a three mile jog, and that the night he visited the bowling alley, also strolled along an outdoor area in downtown Manhattan where he ate at a restaurant. He was taking his temperature twice a day since leaving from Guinea on Oct. 14 and did not have a fever until the morning of Oct. 23, the night after he visited the bowling alley and after his other excursions. Bassett said that since Spencer was a doctor and fully aware of his risk of having been infected with Ebola, he had been limiting his contact with others since arriving back in the U.S. once Oct. 17.

And because Spencer was alone in his apartment when he began feeling ill, with a fever and some gastrointestinal problems, the number of people who may have had direct contact with him when he started becoming contagious is small. New York City health officials said on Thursday that Spencer’s fiancee was in isolation at a hospital, two of his friends and the driver of the Uber car he rode were being monitored.

On Thursday night, Uber issued a statement saying they had confirmed with both CDC and New York health officials that “neither our driver partner nor any of his subsequent passengers are at risk.” The statement added, “Our thoughts are with the patient and his loved ones.”

Spencer’s apartment is cordoned off, and officials will likely sterilize or incinerate all of its contents, as they did with the apartment in which Dallas Ebola patient Thomas Eric Duncan lived, and with the apartment of Nina Pham, one of the nurses whom Duncan infected.

New York State has designated eight hospitals to care for Ebola patients, including Bellevue. While all 200 are prepared to isolate and initially handle anyone who might come in with suspected Ebola, if they test positive they will be transferred to one of the eight hospitals that are designed to treat patients with staff that has drilled in the proper protocols for protective equipment and handling and removal of waste. At Bellevue, for example, the lab for testing blood samples is contained within the isolation unit so samples from infected patients are not mingled with those of other patients.

Given the mistakes made in Dallas, in which one patient infected with Ebola transmitted the virus to two health care workers, New York City is on alert. However, in a press conference late Thursday night, Mayor Bill de Blasio assured the city that Bellevue had been drilling for this possibility for months.

With additional reporting by Zeke Miller

TIME Cancer

Here’s How Well Your Genes Can Predict Your Breast Cancer Risk

Researchers say genetic sequencing can predict breast cancer risk better than previously thought

Your genes have a lot to say about who you are and how healthy you are. But for certain diseases, including cancer, so many genes are likely involved that it’s hard for doctors to come up with a useful, reliable way to turn your DNA information into a precise risk score.

But in a paper published in the journal Cancer Epidemiology, Biomarkers & Prevention, researchers say that combining the known genetic players in breast cancer can predict with much higher accuracy a newborn girl’s theoretical risk of developing the disease.

MORE: Angelina Jolie’s Surgery May Have Doubled Genetic Testing Rates at One Clinic

Alice Whittemore, a professor of epidemiology and biostatistics at Stanford University School and Medicine, and her colleagues included 86 known genetic variants that have been associated with breast cancer—including BRCA1 and BRCA2, which are relatively rare but confer a very high risk of disease compared to those that have a smaller contribution—and created a computer model that took into account the rates of breast cancer among women who had these genetic variants.

This model served as a predictor for breast cancer based on womens’ genetic makeup. When researchers looked at the top 25% of risk scores, they found that these would account for about half of breast cancer cases in the future. Using previous models, genetic variants could account for only 35% of future cancer cases.

“Our results are more optimistic than those that have been previously published,” says Whittemore, “because we took 86 known genetic variants associated with breast cancer, and took what was in the world’s literature about how common those variants are, and by how much a factor they increase risk. And the more genetic variants that are identified, the better we will get at this.”

MORE: BRCA Gene Can Be A Cancer Triple Whammy, Study Finds

Since the paper was submitted, several new genetic variants have been linked to breast cancer, and adding those to the model, says Whittemore, could make it more effective.

But just because a woman may have been born with a high genetic risk for breast cancer doesn’t mean that she can’t change that risk. The model found that lifestyle factors, which are in a woman’s control, can generally lower that genetic risk as well. And the higher a woman’s genetic risk, the more she can reduce it with healthy behaviors.

“The news is that even if you are at high genetic risk of developing breast cancer, it’s all the more reason to do what you can to modify your lifestyle to lower your risk by changeable factors even if your genes aren’t changeable,” says Whittemore.

TIME ebola

How Worried Are You About Ebola?

Electron micrograph of Ebola virus

As the Ebola epidemic continues in West Africa, the U.S. and other countries could also see cases of the disease in coming weeks and months.

Tell us how you feel about the U.S.’s efforts to contain Ebola in this 10 question survey, and see how other responders rate the country’s preparedness.

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