TIME Infectious Disease

5 Reasons We May Never Know Ebola’s True Impact

Liberia Battles Spreading Ebola Epidemic
A Liberian burial team wearing protective clothing retrieves the body of a 60-year-old Ebola victim from his home on Aug. 17, 2014 near Monrovia. John Moore—Getty Images

In this unprecedented Ebola outbreak, measuring and predicting the virus' true impact is nearly impossible

The U.S. Centers for Disease Control and Prevention (CDC) published a report in mid-September estimating that if current trends in the Ebola outbreak continue without a ramped up effort, then Ebola cases in West Africa would double every 20 days. In that situation, Ebola cases could reach up 1.4 million by January.

It’s a worst-case scenario estimate, but that’s only one caveat behind the 1.4 million figure, which remains muddled by research limitations and assumptions. While health experts and a CDC official told TIME that it’s common in public health surveillance projects to report overestimates, the fact that this is the worst Ebola outbreak in history adds additional levels of uncertainty in forecasting an unprecedented epidemic.

Here are five reasons why we may never know Ebola’s true impact, despite health experts’ best efforts to fully understand the virus’ deadly potential:

1. Most Ebola cases aren’t reported

CDC researchers believe that for every 1 reported case of Ebola, there are 1.5 additional cases that go unreported. They estimated that without additional intervention, 550,000 Ebola cases will be reported by January, a lower bound that doesn’t account for the cases that go unreported. By correcting for underreporting, they arrived at the upper bound of 1.4 million.

“Underreporting is always an issue with communicable diseases,” says Thomas Gift, an economist at the CDC. “We believe the actual incidence of disease is higher than what shows up in case reports.”

In West Africa, a lack of on-the-ground healthcare resources has meant that many Ebola patients haven’t been treated by doctors, or, in some instances, they have been turned away by doctors, which has resulted in an incomplete headcount of afflicted people.

2. Adjusting the projected numbers accurately is extremely difficult.

“It’s always difficult with these models to try to capture what’s really going on on the ground,” says Dr. Eden Wells, an epidemiology professor at the University of Michigan. “Given the data they used, it’s the best projection they could get at the time.”

The projections were based on data from only one day in only one country—Liberia—Gift said. Researchers used a model to predict the number of beds in use in Liberia on Aug. 28, 2014—the occupied beds were a measure of reported cases. They then surveyed experts at Ebola treatment clinics in Liberia to estimate the actual number of beds in use, weighing that estimate by the proportion of those who stay at home (and are therefore “unreported” cases) who eventually arrive in hospitals: a measure of both reported and unreported cases.

Gift added that while on-the-ground conditions made it difficult to collect more frequent data, there was also an urgency in releasing information about the outbreak. “Why didn’t [researchers] do more to get a range of confidence? Partially because this was designed to provide a tool to be used by people to assess the potential impact of intervention while the outbreak is going on,” Gift says.

3. The projection, based on a slice of data from Liberia, was applied to all of West Africa.

Liberia has been the most hard-hit country in the Ebola outbreak, with more than 1,800 deaths and 3,400 confirmed cases, according to the CDC. Sierra Leone and Guinea have suffered significant death tolls as well, though far fewer than Liberia. “Notable regional differences in underreporting might mean that using one [assumption] across an entire country is inappropriate,” the report said. This could, in theory, result in an overestimate.

“The 2.5 correction factor”—meaning that for every one reported case, there are potentially 1.5 unreported cases, according to the CDC’s modeling—”seems to have been correct for that day,” Gift says. “But [that] might change over time.”

Still, the fact that an Ebola outbreak has never been this widespread—and thus never modeled so extensively—allows the study some liberty in deciding its parameters, the report said.

“The purpose is to show that this epidemic was not going to show signs of peaking on its own. In historic outbreaks, there were a few hundred cases, and the epidemic diminished. That didn’t happen this time,” Gift says.

4. Much of the data coming from West Africa is likely inaccurate or incomplete.

A recent World Health Organization report said that in Liberia, “data were being reported from 4 different and uncoordinated streams, resulting in several overlaps and duplicated numbers.” The report added that many deaths were not being properly documented.

Last week, the New York Times similarly reported a discrepancy between the number of reported deaths in Sierra Leone and the number of buried victims, a fact that further complicates researchers’ efforts to measure Ebola’s true impact.

5. Projecting all the way to January is difficult.

“It’s a bit like weather prediction,” says Marisa Eisenberg, an epidemiology professor at the University of Michigan. “There’s a lot more uncertainty if you’re going all the way out to January versus the end of October.”

The obvious difficulty is that the report is based on the assumption of no significant additional intervention, which, with each passing week, is changing. A shorter-term projection of Ebola cases was provided by the WHO in a report published last week in the New England Journal of Medicine. The projection’s limited time span indicates a more realistic prediction of Ebola cases, even though it also assumes “no change in the control measures for this epidemic.” If Ebola cases were to double every 20 days without additional measures, as the CDC reported, then the WHO’s estimate indicates that there will be about 150,000 cases by January, a markedly more conservative figure.

Still, experts believe there is value in examining the CDC’s “worst-case scenario” of 1.4 million cases. Overestimation offers a safety net in ensuring adequate assistance is provided. If anything, it also adds an urgency to prove wrong the study’s chilling caveat: that this is what could happen if no additional resources are used to battle the deadly disease.

“[The researchers] are trying to cover their bases, and make sure they don’t under-deploy resources,” Eisenberg says. “If you’re going to be wrong in one direction or the other, it’s better safe than sorry.”

TIME medicine

Soon You Can Send Your Expired Painkillers Through the Mail

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The DEA has a new way to get rid of extra meds

How to get rid of leftover medication is a tricky question—keep it around and it can get into the wrong hands, but dispose of it improperly and you risk contaminating the environment.

That’s why in the past, the U.S. Drug Enforcement Administration (DEA) has held National Prescription Drug Take-Back Day. Last April, the DEA reported that it collected 780,000 pounds of prescription drugs, and during the event on Sept. 27, a single county in Virginia dropped off 1,200 pounds of drugs. But even though half a ton of drugs for one county is certainly a coup, it was the last event of its kind—because soon, through an innovative new program, Americans will be able to safely abandon their unused pills at any time.

The DEA first recognized the leftover pill problem because the Controlled Substances Act had no outlined provisions for how people could get rid of their unused or expired prescription drugs. According to the DEA, people would keep them in their medicine cabinets (which made it possible for them them to be abused), toss them in the trash or flush them down the toilet. The latter method was discovered to contaminate water supplies.

In 2010, the Drug Disposal Act gave the DEA the authority to create a framework for how the general public and facilities could dispose of prescription pills properly and safely. On Sept. 9 the regulations were approved, and the DEA says it will start implementing the plan in early October. The new regulations allow Americans to get rid of their excess drugs at pharmacies or police departments with drop-off receptacles. Patients will also be able to grab envelopes from places like hospitals that they can use to mail their pills to authorized collectors, who will make sure the pills are properly incinerated. “It will be more convenient because once these rules are implemented, then people can do it all the time,” a DEA spokesperson told TIME.

The number of Americans abusing prescription drugs has dropped in the last couple years, but the DEA says the 6.5 million people who reportedly abused prescription drugs in 2013 is double the number of people who use hard drugs like cocaine, heroin, LSD and Ecstasy combined.

TIME medicine

For Back Pain or Headache, Painkillers Do More Harm than Good

Blue pills
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For the first time, a major medical organization takes a stand on rampant overuse of opioids for treating back pain, headaches and migraines

Powerful painkillers do little to improve patients’ daily functioning, finds the American Academy of Neurology in a new position statement on opioid painkillers for chronic pain not related to cancer. Written by Dr. Gary Franklin, research professor in the departments of occupational and environmental health sciences and neurology, the paper outlines the growing epidemic of overdose deaths—most of them unintentional—linked to opioid use. It concludes that in the majority of these cases, pain killers may ease some pain but fall short of truly improving patients’ health. Coupled with the potential hazards of addiction and overdose, the Academy says that doctors should be looking for other ways to help these patients manage their pain.

“This is the first position paper by a major American specialty society saying that there is a real problem here, and the risk might not be worth the benefit for certain conditions,” says Franklin.

MORE: Stopping America’s Hidden Overdose Crisis

The statement traces the rise of the opioid prescribing epidemic to loosening of previously strict regulations put in place in the 1940s, when opioid-based opium and heroin gained popularity as narcotic drugs of abuse. Recognizing the potential for addiction and overdose, states implemented rigorous controls over who could prescribe opioids and how much of the medications were dispensed; violating the rules meant doctors could lose their medical licenses or face criminal prosecution. Therefore, most physicians shied away from the drugs, leading to under-treatment of chronic pain, particularly among the growing number of cancer patients.

To address that trend, advocacy groups and pharmaceutical makers of opioids lobbied to change state laws to remove sanctions against doctors prescribing them—and ended up making them too lenient, says Franklin. “The language in Washington state, for example, said that no doctor shall be sanctioned for any amount of opioids written. So even if a doctor is handing out bags of opioids, it made it hard for the medical board or disciplinary board of the state to do anything about that doctor.”

MORE: FDA Approves New Pain Pill Designed To Be Hard to Abuse

That push to begin treating pain more aggressively began with cancer patients and those who were terminally ill, but drug makers saw another opportunity in people with chronic pain. The problem, say experts, is that for most such chronic pain, including low back pain, headaches and fibromyalgia, there is little evidence to support the idea that opiates are effective, and even less data suggesting that escalating doses and keeping patients on opioids for months or even years to treat persistent pain would benefit them. Most studies only followed patients for about a month on average.

Some in the pain community called out a red flag when they saw that a growing proportion of pain patients were still taking opioids but not reporting any improvements. In 2003, Dr. Jane Ballantyne and Dr. Jianren Mao, then at Massachusetts General Hospital and Harvard Medical School, published a review of the existing data on opioid use for chronic pain in the New England Journal of Medicine. It was among the first studies to highlight the fact that the skyrocketing number of prescriptions was doing little to actually reduce reports of chronic pain. “The real problem is physicians who are practicing with the best intentions and not understanding what the limited role of opiates is,” says Ballantyne, now a professor of anesthesiology and pain medicine at the University of Washington. “For 20 years they have been taught that everybody deserves an opiate, because they really don’t know what else to do. It’s a cultural thing and it’s hard to reverse that.”

The result, Franklin notes, is that since the 1990s, more than 100,000 people have died from opioid overdoses – more than the total number of American soldiers who lost their lives in the Vietnam War. In addition, studies have linked opioid use to serious health problems, from changes in hormone levels that can contribute to infertility, abnormal immune function, heart problems, and even worsening of pain symptoms.

MORE: Viewpoint: FDA Approval of Overdose Antidote Leaves Lives on the Table

Ballantyne says that the opioids can backfire in excessive doses; in the same way that neurons become over-sensitized to pain and hyper-reactive, high doses of opioids could prime some nerves to respond more intensely to pain signals, rather than helping them to modulate their reaction. “The idea is that we have the answer to all chronic pain, and that is to give opiates. That’s simply not true,” she says. “A lot of chronic pain isn’t appropriate for opiates.”

To stop the epidemic of deaths by opioids, Franklin says, states have to reinstate stricter oversight over doctors who prescribe these medications and implement guidelines that call for clear limits to opioid use that both doctor and patient agree upon, particularly for chronic conditions outside of cancer or terminal care. A handful of states and the Centers for Disease Control, for example, have already instituted so-called yellow-flag warning doses that require providers to get additional opinions if a patient reaches daily opioid doses of 80 mg to 120 mg and continues to complain of pain.

MORE: FDA Expands Access to Overdose Antidote to Stem Opiate Addiction Epidemic

But perhaps the best way to move the needle in the epidemic is to reset expectations that doctors and the public have about pain treatment. “In this country we expect everything to be fixed, and that doctors have the answer and can take pain away,” says Ballantyne. Yet many of the first strategies for alleviating pain might start with patients and their lifestyles rather than a prescription. Exercise and a healthy weight can ease much of the chronic pain associated with the back and joints, for instance. “We shouldn’t be resorting to pills as a first resort; they should very much be a last resort,” she says.

Alternative approaches to managing pain, including cognitive behavioral therapy, should also be given strong consideration. The Academy is urging insurers to step in and cover more such pain management approaches so that drug therapy doesn’t continue to be the default. “The important message is that we should not use opioids chronically for most people because they don’t work,” he says. “But at the same time we ought to be paying for things that do work.”

TIME Obesity

Antibiotics Before Age 2 Increase Risk of Childhood Obesity

A potential unintended consequence of the broad-spectrum drugs

Antibiotics, the most commonly prescribed medications in the first two years of life, might come with the unintended consequence of childhood obesity.

By age 2, an astonishing 1 in 10 kids are obese, weighing about 36 pounds. Childhood obesity isn’t a problem with a single cause, but according to a new study published in JAMA Pediatrics, some of it could start at the doctor’s office. Researchers looked at the health records of more than 64,000 children from 2001-2013 and found that using antibiotics before age 2 was associated with an increased risk of obesity by age 5. Almost 70% of the children in the study had taken antibiotics before age 2, with an average of 2.3 courses of the drugs per child. The link was especially strong in children who took four or more courses.

MORE: This Is How Much Childhood Obesity Costs Over a Lifetime

Not all antibiotics had the same effect, however. The association was only significant with broad-spectrum antibiotics—those that wipe out different kinds of bacteria all over the body—but not narrow-spectrum antibiotics, which target only certain families of bacteria. Of the kids in the sample, 41% took broad-spectrum antibiotics at some point.

Doctors prescribe antibiotics for a host of common infections ranging from the mild, like sinus and ear infections, to the more severe, like pneumonia. Broad-spectrum antibiotics are generally recommended only when the narrow-spectrum kind won’t work, like if an infection won’t respond or if the patient has an allergy. But in practice, broad-spectrum antibiotics are being prescribed for a lot of typical childhood infections that might not even need an antibiotic at all, says study author Charles Bailey, MD, PhD of the Children’s Hospital of Philadelphia.

MORE: Antibiotics Overload Is Endangering Our Children

When parents visit the pediatrician with a sick child, they often request antibiotics to help the child feel better faster, Bailey says. “There are these non-medical pressures to use some of the broader-spectrum drugs,” he says. “But if we use broad-spectrum antibiotics a lot of the time, are we creating unintended effects down the road that we didn’t appreciate when we were sitting in the office?”

MORE: Gut Bugs—A Hidden Trigger of Obesity

One of those unintended consequences might be killing off certain kinds of beneficial bacteria in the guts of young kids at an age when their collection of bacteria—or microbiome—is thought to be especially sensitive. Studies have shown that feeding antibiotics to mice around birth alters the kind of microbes that colonize their guts, which in turn changes how they digest food, how many calories they get from their diet and how they extract energy, Bailey says. “Our worry is that we may be seeing some of the same things going on with people.”

Though obesity in early life puts a child at greater risk for obesity in adulthood, it’s still early enough to intervene, Bailey says. “Our hope is that we can find out what the risk factors are in early childhood and do a better job not just at preventing this, but of identifying the kids…who then can change their path by changing their lifestyle and changing the healthcare they get.”

TIME Diet/Nutrition

Gov’t to Put Up $52 Million to Help Farmers Market Their Produce

Wheat
Sean Gallup—Getty Images

A total of $30 million a year will go towards promotion for local food and farmer's markets

The United States Department of Agriculture (USDA) is to put $52 million toward local and organic farming through farmers markets and organic research.

Local farmers are having difficulty marketing their produce, even though there’s increasingly high consumer demand for it. According to the New York Times, the funding is part of the Farm Bill signed by President Obama in February.

The $52 million is being distributed to the industry through five grant programs that were authorized through the Farm Bill. The grants will be distributed annually.

Agriculture Secretary Tom Vilsack announced the funding at the Virginia State Fair, where farmer and business owner M. James Faison of Milton’s Local Harvest won a grant to help farmers producing pork and beef products market their goods more effectively.

According to the Times, the organic business sector will be getting $125 million over the next five years for research as well as $50 million for conservation. The USDA will also be allocating $30 million each year to marketing for local food and farmer’s markets. Another $70 million will go toward researching fruits and vegetables.

In an interview, Agriculture Secretary Tom Vilsack said funding local food systems are good business for the government since they generate new employment.

TIME Sex/Relationships

Doctors Advise IUD Use as Best Birth Control Method for Teenagers

A copper IUD
A copper IUD B. Boissonnet—BSIP/Corbis

A boost for a little-used but widely effective method of contraception

A leading medical group on Monday recommended implantable rods and intrauterine devices (IUDs) as the best form of birth control for teenage girls other than abstinence.

The new guidance from the American Academy of Pediatrics (AAP), published Monday in the group’s Pediatrics journal, touts birth control methods not commonly used in the U.S. despite widespread agreement about their effectiveness. The AAP says pediatricians, who teens consider “a highly trusted source of sexual health information,” should recommend, in decreasing order of effectiveness, progestin implants, IUDs, injectable contraception, and oral contraception for use among adolescents.

(MORE: The best form of birth control is the one nobody is using)

The doctors call oral contraceptives the least effective options for teens because many fail to use them properly and consistently. About 18% of women experience an unintended pregnancy when using male condoms, compared to 0.8% who experience unintended pregnancy while utilizing a Copper T IUD. Though IUDs are expensive at the outset, the AAP says the long-term cost is less than the cost of over-the-counter oral contraceptives.

TIME Addiction

Big Tobacco Is Ramming Home the Message About the Dangers of E-Cigarettes

World Health Organisation Calls For Regulation Of Ecigarettes
In this photo illustration, a woman smokes an E-Cigarette at the V-Revolution E-Cigarette shop in Covent Garden on August 27, 2014 in London, England. Dan Kitwood—Getty Images

Think of it as corporate image enhancement

When it comes to e-cigarettes, large tobacco companies are suddenly stepping up warnings about their own products, the New York Times reports.

“Nicotine is addictive and habit forming, and is very toxic by inhalation, in contact with the skin, or if swallowed,” reads a warning on packets of e-cigarette made by Altria, the company that manufactures Marlboro cigarettes.

Industry experts and critics say the warnings are serving as a legal safeguard or a corporate image-enhancer.

“Is this part of a noble effort for the betterment of public health, or a cynical business strategy? I suspect the latter,” said Dr. Robert K. Jackler, a professor and researcher on e-cigarette advertising at the Stanford School of Medicine.

MarkTen, a prominent e-cigarette brand, features a 100-word warning that, among other things, reiterates that e-cigarettes are not a way to wean oneself off cigarettes. This warning also appears on Reynolds American’s Vuse e-cigarettes.

According to Altria spokesman William Phelps, the MarkTen warning is created with a “a goal to openly and honestly communicate about health effects.”

“Why wouldn’t you warn about ‘very toxic’ nicotine on your cigarettes, when you do so on e-cigarettes?” is Jackler’s only question.

According to the Times, experts say the strategy is low-risk for the big tobacco companies because many people don’t read the warnings anyway.

[NYT]

TIME neuroscience

This Curry Spice Might Help the Brain Heal Itself

A chemical commonly found in turmeric was shown to encourage nerve-cell growth in rats

A spice commonly used to make curry could help the brain heal itself by encouraging the growth of nerve cells, according to a new study.

Researchers at the Institute of Neuroscience and Medicine in Julich, Germany, found that rats injected with aromatic-turmerone, a compound found naturally in turmeric, showed increased activity in parts of the brain associated with nerve-cell growth.

The compound could encourage the proliferation of brain cells, researchers said — though it was unclear whether it could be used to help stall or reverse the symptoms of degenerative-brain diseases like Alzheimer’s or dementia in human beings.

A separate trial by the same research group found that rodent neural stem cells grew when they were bathed in a solution of aromatic-turmerone. The cells bathed in the turmeric compound also appeared to specialize into certain types of brain cells more rapidly.

“It is interesting that it might be possible to boost the effectiveness of the stem cells with aromatic-turmerone,” Maria Adele Rueger, a researcher on the team, told the BBC. “And it is possible this in turn can help boost repair in the brain.”

An outside researcher said it was unclear whether the findings would be applicable to people, and whether it could help people with Alzheimer’s.

Turmeric was already known for its potential health-giving properties. One 2009 study found that one of its component chemicals — curcumin — killed off cancer cells.

TIME

14 Ways to Be a Happier Person

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Billboard-worthy news: It's possible to amp up your bliss every single day with these simple, unexpected strategies

Sometime this morning, during your shower or at breakfast, you probably did a mental run-through of your day. You decided when you’d tackle various tasks and errands. Perhaps you vowed to hit the gym at lunchtime. Maybe you even plotted to get out of something. The one thing you forgot to plan for: happiness.

With all the books on bliss and the mood-boosting technology that does everything for us but laugh, we expect happiness to show up on our doorstep, like a pizza. But we have to make it happen.

“When you’re young, other people orchestrate your enjoyment of life,” notes Barbara Fredrickson, PhD, a social psychologist, director of the Positive Emotions and Psychophysiology Lab at the University of North Carolina at Chapel Hill and author of Positivity. “Your parents keep you entertained, and in college your friends make sure you’re OK. But after that, the scaffolding of having a good day is taken away, and nobody is telling you how to provide that for yourself.”

HEALTH.COM: 18 Habits of the Happiest Families

Also tricky: keeping the glee going when you have work to do, kids to raise, bills to pay and more work to do. Mercifully, big, costly, splashy events are not the ultimate bliss bringers. As people get older, they tend to find ordinary treats—such as a latte or a manicure—just as joy-inducing as extraordinary ones like an around-the-world cruise, found a 2014 study by researchers at Dartmouth and the University of Pennsylvania. With age, the authors speculate, we’re more aware of how fleeting time is, so we’re particularly likely to relish everyday bright spots.

What you won’t find here: a step-by-step happiness guide. How draining would that be? Instead, we tapped top positive psychologists for easy ways to infuse your days with more pleasure. Consider this a pick-and-choose list; even doing just a few will help. Ready for more joy? Plan on it!

First up: Make it your goal

Although increasing happiness levels shouldn’t feel like work, having a can-do mindset really comes in handy. In a study published in the Journal of Positive Psychology, people who were told to listen to music and attempt to feel happier had a greater boost in bliss over a two-week period than those instructed only to relax as they listened to the same upbeat tunes. It comes down to motivation: You can transform into more of a glass-half-full type.

While researchers believe that genetics are behind about 50 percent of the variation in happiness levels among you and your neighbors and that life circumstances account for maybe 10 percent, you’re fully in charge of the rest. “A lot of people think you can’t control happiness—you either have it or you don’t—which is totally not true,” stresses Sonja Lyubomirsky, PhD, professor of psychology at University of California, Riverside, and author of The Myths of Happiness. “It’s like controlling your health. First you need to believe that you can do it before you take those first steps.”

Know your own bliss

When was the last time you mulled over what truly brings you pleasure, aside from biggies like your partner and the kids? “A key to steering your own happiness is reflecting on the things that make you come alive,” Fredrickson says. Perhaps it’s been so long since you’ve done some of them that they’ve fallen off your radar. Make a list, if it helps. “Think back to what gave you joy in your younger years,” says psychiatrist Stuart Brown, MD, founder of the National Institute for Play in Carmel Valley, Calif., and author of Play. Maybe you’re not jamming on a guitar in your bedroom anymore, but “you can recall the carefree state,” Dr. Brown says, “in which the outcome wasn’t as important as what you were experiencing.” You want to find what does that for you now and…

…Prioritize it

Sigh if this sounds familiar: You make a major effort to avoid future stress—say, staying up late to finish laundry so tomorrow will be a better day—only to suck your evening dry of all fun. Happiness researcher Robert Biswas-Diener, PhD, founder and managing director of the consulting firm Positive Acorn in Milwaukie, Ore., knows this treadmill effect well. He delivers a lecture regularly at Portland State University: “I give the students an hour off and tell them to do anything they want that’s legal that will make them happy. Some have a hard time with it—they even do homework! What they say is, ‘I’d be stressed if I didn’t get that task done.’ People think that working toward less stress will make them happier. That’s a minor form of insanity.”

HEALTH.COM: 13 Ways to Beat Stress in 15 Minutes or Less

In a get-stuff-done world, it’s hard to avoid our efficiency instinct. The answer, then, is to focus on enjoyable stuff, along with the must-dos. “Don’t fit joyful activities into your days—fit your days around them,” Biswas-Diener urges. “Do you ever hear devoted church attendees say, ‘Can we reschedule church because something came up?’ You need to have that church mentality about whatever it is that gives you pleasure. If you say that your weeks are full, find the next blank spot in your calendar.” Protect that sacred time from “nibblers” (otherwise known as your family), adds productivity consultant Julie Morgenstern, author of Time Management from the Inside Out:“Announce to everyone that it’s your time to recharge your batteries.” Tap a friend to make sure you use that time strictly for fun.

Smell the shower gel

The act of savoring—mining pleasant moments for their joy—is a proven happiness booster. In one study published in The Journal of Positive Psychology, 101 men and women kept diaries for a month, recording positive activities they participated in and how much they did or didn’t savor them. Those who tended to enjoy a good thing—and share their delight with others—maintained high levels of happiness no matter what the day brought, whereas nonappreciators needed positive events to get into a good mood. Savoring is a no-brainer—just tune in to your senses. Inhale that pinot grigio, feel the soft rug under your bare feet. “I leave a little time in the morning to savor my showers,” Lyubomirsky says. “I go out of my way to buy gels with the best scents.” You can even find ways to relish tasks; try running YouTube as you delete junk email. (Why hasn’t anyone yet studied the happiness powers of panda videos?!)

Ration your time

Gold, natural gas and your attention: They’re all scarce resources. Allocate wisely so you can max out time for pleasure, recommends Paul Dolan, PhD, in his new book Happiness By Design. “Every tweet, text or email distracts us from the good experiences and people in our lives,” he says. Some research shows that heavy social media users are less merry than others. One study published in the scientific journal Plos One found that the more people went on Facebook, the more their life satisfaction levels declined. (Click: dis-like.)

HEALTH.COM: 12 Reasons to Stop Multitasking Now

Experts widely recommend electronic time-outs; shut off your phone for a couple of hours a night or do email-free Saturdays or Sundays. You also want to dump any activity that “should” make you happy but in reality doesn’t, like the book club that picks crappy reads or an overly earnest yoga class. It’s hard to walk away, Dolan acknowledges, “but you probably haven’t regretted breaking joyless commitments in the past. Remember: Lost happiness is lost forever.”

Think perky thoughts

On those days when you barely have time to breathe, recall something that made you happy and you can get a boost. In one study from Michigan State University, bus drivers who smiled as a result of thinking about a positive event, such as a child’s recital, were in more upbeat moods than workers who fake-smiled. Science suggests that a full, genuine grin—one that involves facial muscles around the eyes—sparks a change in brain activity related to a good mood. So, yep: Say cheese.

Buy some happy

As any woman who has ever bought a trendy, overpriced accessory knows, the kick we get out of purchases wears off fast. However, spending on experiences (like tickets to a Broadway show) rather than things (another black sweater) creates lasting contentment—with one new caveat. A study co-authored by Ryan T. Howell, PhD, associate professor at San Francisco State University and director of its Personality and Well-Being Lab, found that people fail to get pleasure from objects or experiences if they’re acquiring them mainly for bragging rights. That is, if you’re more of a local-Thai-restaurant person and you plan a 40th-birthday blowout at Le Fancy Schmancy Bistro, you may get admiration on Facebook but miss out on feeling personal delight.

Play around in love

If the words Honey, take out the trash! are your idea of foreplay, you know that running our domestic lives sometimes saps the fun out of relationships. “Playfulness energizes both of you and gets your brains in sync,” says Vagdevi Meunier, PsyD, a relationship therapist certified by the Gottman Institute in Seattle and founder of The Center for Relationships in Austin, Texas. “It also lightens the vibe of a relationship and helps us manage the business of our lives—otherwise it’s too much about dishes and bills.” She likes to tell couples she works with, “I can help you fight better, but that’s not nearly as effective as if I help you play better.” One recent suggestion to busy parents of three: Zap each other more playful texts. “They’d send links to funny sites. Or he would text her at work, suggesting she imagine him naked,” Meunier says. “The couple started looking forward to coming home instead of being grumpy. And they’d talk about the texts.”

HEALTH.COM: 10 Ways to Improve Your Relationship Instantly

Have a bad-day backup plan

You have backup in case your electricity goes out, even if it’s just a stockpile of flashlights. Time to come up with one in case your mood fails. Michele Phillips, a performance coach in Piermont, N.Y., and author of Happiness Is a Habit, has a group of friends who’ve dubbed themselves the Village. “I can call them anytime my day is going badly, and they will change my frame of mind,” she says. She recalls sitting in a bar in Colorado after her divorce, feeling lonely and, she says, “like I had loser written on my forehead.” She called a Village friend, “and she said, ‘Look around: You’re in Vail, skiing!’ She helped me shift the thinking from ‘poor me’ to ‘lucky me.'”

Find purpose in pleasure

For total happiness, you need a mix of activities that give you joy and a sense of meaning, what Dolan calls the pleasure-purpose principle. “If happiness were only about pleasure, what would be the point of having kids or helping others?” he says. “To be truly happy, we need feelings of purpose, too.” Think volunteer work or taking a cooking class. The positive feelings that come from these sorts of activities can help train the brain’s neurons to overcome its negativity bias. As neuropsychologist Rick Hanson, PhD, explains in his book Hardwiring Happiness, the brain is all too good at remembering adverse experiences, which he traces to ancestors who had to focus on threats like predators in order to survive. But when you rack up feel-good experiences that give you a sense of achievement, they can serve as a buffer against the disappointing ones.

Think less “me” time, more “we” time

Truly sunny people have one thing in common, and it’s got nothing to do with their paychecks, IQs or gender, Biswas-Diener says: They have plenty of good social relationships. These include interactions that psychologists refer to as social snacking—little ways of connecting with other human beings, including strangers. In one 2014 study by Nicholas Epley, PhD, professor of behavioral science at the University of Chicago Booth School of Business and author of Mindwise: How We Understand What Others Think, Believe, Feel and Want, participants heading to work by train either refrained from engaging with fellow passengers or made conversation. Chatty commuters—both introverts and extroverts alike—reported having the most pleasant commute. In another recent study co-authored by Elizabeth Dunn, PhD, at the University of British Columbia, people kept a running tab of social interactions with folks with whom they had either a strong or weak tie. Regardless of the type of person they connected with, they consistently felt more chipper on days when they mingled.

Yes, camaraderie is comforting—that feeling that we’re all in this crazy world together. “But when you talk with strangers, there’s also the pleasant surprise of finding stuff in common and sometimes the exhilaration of their opening up your world when they tell you something interesting you didn’t know,” Epley says. Surprisingly, having conversations with new people can even keep things upbeat at home. As Dunn puts it, “Trying to be pleasant and cheerful ends up improving your mood in ways you can’t foresee.”

Go off the grid

Weekend getaways continue to trend; cruise lines are even creating shorter jaunts for time-crunched travelers. And yet for deeper joy, you can’t beat a long trip. “One of the biggest deterrents to happiness is that we adapt to our situations—you buy your house and it has a beautiful view, but at some point you stop deriving pleasure from it,” Howell says. When you take only a quick journey, the elation spike is brief. How high you go! How quickly you return to reality! An extended vacation—even to somewhere familiar like a beach town three hours away from home—may create more impactful, lasting memories. And having a bank of them to tap into can add to happiness, research shows. So try to budget for a two-week trip. Even just planning gives you a boost: One study from the Netherlands indicated that the bliss of a trip can start months before it begins, owing to the anticipation.

Be nicer

Nobody is calling you evil, but committing to a few do-good gestures a day can increase your general level of contentment. “I’ve found that when people are told to try to do three to five acts of kindness a week, they get happier,” Lyubomirsky reports. “It does not have to be a grand gesture, given that women are already doing so much caregiving. At the store, let someone get in line ahead of you. Give a compliment. Smile at someone.” Or simply do something thoughtful for your significant other, she continues: “We just finished a study in which we asked someone to choose a person in her life to make happier, like her husband, three times a week. It also made the giver significantly happier.”

Make Sunday future-fun day

One enjoyable thing you should do every weekend: Make plans for the next one. “The anticipation powers you through the workweek,” Morgenstern says. The tactic also helps you avoid making passive, meh plans, like accepting the Saturday dinner invite from that couple you don’t totally like just because you have nothing better on tap. Morgenstern has a formula for a blissful weekend: PEP (physical, escape, people). In other words, a mix of physical activities that energize you, escapist activities that relax you and people who inspire you. “It’s a good framework for putting together weekends that leave you happy,” she says. Not to mention entire happier weeks.

This article originally appeared on Health.com.

TIME Infectious Disease

NIH to Care For US Doctor Exposed to Ebola Virus

Ebola virus
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WASHINGTON — The National Institutes of Health is preparing to care for an American doctor who was exposed to the Ebola virus while volunteering in Sierra Leone.

As early as Sunday, the physician is expected to be admitted to the special isolation unit at NIH’s hospital out of what the agency called “an abundance of caution,” for observation.

NIH infectious disease chief Dr. Anthony Fauci wouldn’t discuss details about the patient but said that in general, an exposure to Ebola doesn’t necessarily mean someone will become sick.

Four other American aid workers who were infected with Ebola while volunteering in the West African outbreak have been treated at hospitals in Georgia and Nebraska. One remains hospitalized while the rest have recovered.

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