TIME Infectious Disease

A Patient Is Being Tested for Ebola at a California Hospital

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The hospital has not divulged details of the patient or stated if the patient has recently been in West Africa, the disease's epicenter

An unnamed patient has been admitted to a hospital in Sacramento over possible exposure to the Ebola virus, the San Francisco Chronicle reports.

“We are working with the Sacramento County Division of Public Health regarding a patient admitted to the Kaiser Permanente South Sacramento Medical Center who may have been exposed to the Ebola virus,” Dr. Stephen M. Parodi, an infectious-diseases specialist and director of the hospital’s operations, said in a statement.

He said patient samples had already been collected and sent to the Centers for Disease Control and Prevention for further testing. The hospital has also taken the necessary precautions to protect other patients, staff and doctors.

“This includes isolation of the patient in a specially equipped negative pressure room and the use of personal protective equipment by trained staff, coordinated with infectious disease specialists,” said Parodi.

The hospital did not give details about the patient, state when the patient was admitted, or say if the patient had recently been in West Africa, the Chronicle reported.

The world’s worst-ever Ebola outbreak has swept through several countries in West Africa and has killed more than 1,200 people since the first case was reported in Guinea in December of last year.

Two American aid workers, who contracted the disease in Liberia, returned to the U.S. for treatment earlier this month.

[San Francisco Chronicle]

TIME Liberia

Liberia President Declares Ebola Curfew

Liberia says escaped Ebola patients returned to quarantine
Liberian nurses retrieve a looted generator stolen from the M V Massaquoi Elementary school that was used as an Ebola isolation unit in West Point, Monrovia, Liberia, Aug. 19, 2014. Ahmed Jallanzo—EPA

(MONROVIA, Liberia) — Liberia’s president has declared a curfew and is imposing a quarantine of a major slum in the capital Monrovia as the death toll mounts from Ebola.

President Ellen Johnson Sirleaf announced late Tuesday that movements now would be restricted between 9 p.m. and 6 a.m.

The country is already under a state of emergency, and the latest action also will block all movement in and out of West Point, home to at least 50,000 people.

Over the weekend, residents angered over the placement of an Ebola center in West Point looted the facility and 37 patients left who were supposed to be under surveillance. Health officials said that all of those later returned.

At least 466 people have died from Ebola in Liberia, and panic already has led to social unrest.

TIME sleep

Find Out Which Cities Get the Most Sleep

There's no city that never sleeps

+ READ ARTICLE

Is your city getting enough sleep?

The Wall Street Journal recently published a list revealing the cities that get the most and least sleep based off a one year dataset provided by Jawbone. Jawbone makes a digital wristband called UP that tracks when its wearers are awake or asleep and how many steps they take within a day.

The Journal reports that this is not a representative study of the general population, and rather a representation of how UP users sleep across the world.

[Wall Street Journal]

TIME Exercise/Fitness

Exercise Makes Kids’ Brains More Efficient

Brain
Science Photo Library/Corbis

For the first time, there’s evidence that being fit can improve the speed and connectivity of brain neurons

There’s plenty of evidence that suggests that children who are more physically active do better in school. But what’s contributing to the boost in brain power?

In a study, published in the journal Frontiers in Human Neuroscience, researchers led by Laura Chaddock-Heyman, a research associate in psychology at the University of Illinois at Urbana-Champaign, report that children who are more fit have more white matter in their brains than those who aren’t as fit. The areas of the brain where more white matter was observed are important for attention and memory, and are critical for linking different parts of the brain together.

The study is the first to find a connection between exercise and white matter. Previous studies focused on specific structures of the brain, such as the hippocampus, which is involved in memory, and how exercise affected their size and volume. In the current study, however, Chaddock-Heyman and her colleagues show that the improved fitness that comes with exercise may lead to other beneficial changes in the brain as well, such as improving the way signals are sent around the brain via the white matter.

But whether the bulkier white matter actually translates into higher IQ or better school grades isn’t clear yet. Chaddock-Heyman says the study did not track the students’ cognitive abilities, though previous, smaller studies have linked white matter to better math scores, for example. “It’s possible that white matter differences as a function of fitness are driving the cognitive differences we see in the brain,” she says. “But that that’s speculation at this point.”

What the results do show, however, is that physical activity may be an important part of keeping children’s brains active and open to learning. Physical education class and recess may be just as important to doing well in school as time spent in a classroom. “We are hoping our work encourages more support of physically active lifestyles,” says Chaddock-Heyman. She and her colleagues are continuing their work with a five year trial in which children are randomly assigned to an aerobic fitness program or not, so their white matter changes and their academic performance can be tracked.

“More schools are contributing to our more sedentary lifestyle by eliminating or reducing physical activity during the school day,” says Chaddock-Heyman, “and we know that aerobic fitness is related to the size of brain structures as well as their function.”

TIME Infectious Disease

Doctors Without Borders Opens New Ebola Ward in Liberia

Liberia Battles Spreading Ebola Epidemic
A Doctors Without Borders staffer supervises as construction workers complete the new Ebola treatment center on August 17, 2014 near Monrovia, Liberia. John Moore—Getty Images

Doctors Without Borders just opened a new ward in Monrovia, Liberia to care for the growing number of patients suffering from the virus

In its latest move to combat a growing outbreak of the deadly Ebola virus in West Africa, Doctors Without Borders/Médecins Sans Frontières (MSF) opened a new ward in Liberia this week to accept more people confirmed or suspected to be infected with the disease.

“There are some really urgent needs here, and much more needs to be done,” says Tim Shenk, lead field communications officer for MSF, speaking to TIME from nearby the new ward.

The new Ebola management center, called ELWA 3, took just two weeks to build, with the help of MSF staff members and local workers hired by the organization. It opened on Aug. 17, and as of Tuesday, it had 32 patients. MSF’s plan is to gradually increase the number of patients in the facility, as the ward is using a novice staff. MSF will slowly accept more patients as the workers get used to the procedures they must go through to protect themselves from contracting the Ebola virus.

The ward has 120 beds, and its layout is meant to reduce risk of exposure to other victims and those treating them. There’s a low-risk area where physicians and workers put on their protective equipment. After that, they can move on to the high-risk area, which is separated into two parts. Each side has four tents with 15 beds each. One side is for suspected cases, and the other is for confirmed cases. The ward is staffed by some of the MSF’s international staff members as well as local health care workers. The new facility has two doctors, with a third on the way.

The new facility’s first batch of patients are people with suspected Ebola who could not be admitted to a facility run by the Ministry of Health due to lack of space. Liberia has 834 confirmed cases of Ebola, with 466 deaths, per the World Health Organization. Worldwide, there have been 2,240 cases with 1,229 deaths.

“The needs of Ebola patients are greater than our capacity and it’s likely it will remain that way for quite some time,” says Shenk. “That’s why the center was constructed, and it’s certainly the case that there are few places where people can be admitted as Ebola patients in this city.”

Over the weekend, reports came out of Monrovia that patients in a temporary holding and quarantine center were missing as members of the community raided the facility. Shenk says that’s not the type of reaction they are experiencing, but that the event proves there needs to be more international support for educating and sensitizing communities on what Ebola is and how it can be prevented.

“Now, not only do we need to contain the outbreak, but we need to respond to the urgent needs of people affected, like kids,” says Shenk. “Schools have shut down, family members have died. These are very urgent social needs. It’s a disaster, and it’s in need of a greater response.”

TIME Infectious Disease

Hospital Says It’s Unlikely Berlin Woman Has Ebola

Suspected case of Ebola in Berlin
People at the main entrance to Campus Virchow Hospital where a woman suspected of being infected by the Ebola virus is being treated in Berlin, Germany, 19 August 2014. Paul Zinken—EPA

A woman displaying symptoms of infectious disease is being treated at a hospital in Berlin and being tested for Ebola

A female patient in Berlin is currently awaiting tests to determine whether she has Ebola, but spokespeople from the Charité hospital where she is being treated say it is unlikely she has the virus.

“The patient suspected of having Ebola has arrived at the Charité. The Charité experts do not assume at this time that they are dealing with a case of Ebola. The patient has not stayed in one of the affected regions. The physicians are leaning more toward an infectious gastrointestinal disease. Of course, in order to formally rule out Ebola, a blood analysis will be carried out,” Manuela Zingl, a spokeswoman for the Berlin Charité hospital where the patient is being treated, said in a statement sent to TIME.

The woman had recently returned from West Africa when she collapsed at her workplace. About 60 police, medics and firefighters were sent to the office, which was put under a lockdown, the Wall Street Journal wrote. A reported 600 people were involved in the quarantine.

If any hospital in Germany is prepared to take in a patient with Ebola or suspected Ebola, it’s the Charité hospital. The hospital recently underwent drills—which you can see in TIME’s coverage—in order to prepare for the possibility, though Dr. Florian Steiner, an infectious disease physician at Charité hospital told TIME he thought the likelihood they would get a patient was slim. In the photos, the physicians wear intensive full body suits, which Dr. Steiner acknowledges is conservative, given that Ebola is not an airborne illness and not easily transmitted. You can read more about their prep here, and see the photos below.

 

TIME medicine

When Will I Die? How I Decided Whether to Test for Early-Onset Alzheimer’s

The author bakes cookies with his 3-year-old twins
The author bakes cookies with his 3-year-old twins Courtesy Matthew Thomas

The disease killed my father. At 39, I had to choose how much I wanted to know about my own fate

People ask me all the time if I want to find out how and when I’m going to die. But that’s not exactly how they ask it. What they ask is whether I’m going to get tested for the gene associated with early-onset Alzheimer’s disease. It’s hard, though, to miss the subtext in the question: How morbidly curious are you? How much terror can you withstand?

I don’t blame them. These friends know I’m 39 and that my father started showing symptoms of Alzheimer’s in his early fifties (and possibly earlier). They know that after a handful of difficult years my father was diagnosed when I was a freshman in college and that he died less than a decade later. They wonder if I’m going to take advantage of the remarkable opportunity science affords us to uncover our genetic destinies and plan accordingly.

Modern life is all about making us forget we’re capable of dying. We love to feel in control of our mortality, even if we understand that that control is only an illusion. Alzheimer’s disease is the opposite of modern life. It’s the ascendancy of entropy and chaos.

My father’s disease had a devastating effect on our family. It didn’t just take away our time with him and his with us. It also took away his time with the not yet conceived children who would populate the family in his absence. He would have been in his 70s now, surrounded by three grandchildren through my sister and two through my wife and me. It’s painful to know what a resource he would have been for them and how much they’ve lost. He will live, faintly grasped, if at all, only in stories.

When he was still living, we tried to make the best of the situation. When my sister got married, my mother brought my father’s tux to the nursing home and had the staff dress him in it. After the ceremony, while everyone else headed to the reception, two limos carrying my immediate family took a detour to the nursing home for photos.

When I look at the framed shot of us huddled around my father in his wheelchair, I see how hard my sister is trying to keep her emotions in. She’s smiling big, but tears are streaming down her face. We are all smiling hard, though there’s no driving off the pain and awkwardness of the moment. Everyone’s looking at the camera except my father, who is gazing vacantly the other way, his mouth hanging open. Moments later we drove to the reception, leaving him behind, feeling terrible for doing so. I wanted him not to understand a thing that was happening in that scene, but you never knew what he knew.

For most of my youth, my father seemed to know everything. A universe of information swirled around in his brain. I could hardly put a question to him that he couldn’t answer. The rare times he came up short, he pulled me into his study, took a book off the shelf, lay it on the desk and stood flipping through it with me. I think sometimes he pretended not to know things just so that we could look them up together.

Once, when I was about 10 and my sister about 14, we were walking with my father on the outskirts of his old neighborhood. He stopped in front of a town house and told us Winston Churchill’s mother was born there.

“The iconic English statesman of the century!” he said. “A mother from Brooklyn!” He gave us a look almost wild with the significance of what he was about to say. “The wit!” he said. “The chutzpah! That was the Brooklyn in him!”

Three decades later, I can still remember the moment, bathed in that ethereal light that we reserve for our happiest memories. Why do I remember it, though? How did such a quotidian moment burrow its way into my consciousness and survive? Was it the juxtaposition of incongruous worlds, England and Brooklyn? I don’t think so. I think it was the joy my father took in sharing his knowledge with us.

My father would have loved my twin children. They’re 3 years old and full of vitality and personality. My son is unusually strong for such a skinny kid, and remarkably agile. He climbs whatever is available, with a monkey’s speed. When he sits at the piano and pounds the keys, it sounds as if he’s playing a real song. My daughter is a sensitive cuddler who remembers everything. “Daddy, is this from the hotel we stayed at?” she asked the other day, handing me a pad from a Marriott where we stayed six months ago.

Recently my daughter came into our bed in the early morning, lying between my wife and me, and started in on iguanas. “Iguanas are baby alligators,” she said, and I chuckled at the powers of observation of a developing mind. “Can iguanas learn to open doors?” she asked, and after I offered the opinion that they couldn’t, I pulled her close, gave her kisses and began to choke up.

Maybe when my twins are older, science will have caught up to this disease. We have the best scientific minds working on the problem of Alzheimer’s. Much like the search for the cure for cancer, there is a massive payout at the end of the rainbow for anyone who comes up with a solution. If there’s anything to put one’s faith in in the health care system, it’s that the confluence of genius and capital will, in this case, produce the outcome if the outcome is producible. And I do believe it’s producible. But if it isn’t produced in time, no amount of awareness of my fate, if it is to be my fate, is going to forestall its unfolding on me.

My wife and I have little battles over my forgetfulness. She asked me to fix the kink in the hose that runs from the humidifier in our basement to the French drain. A few days later, she gave up and fixed it herself. We had a grill delivered for our backyard, and the flame kept going out on it as soon as we lit it. I was supposed to call about it the next morning, but I’d more or less forgotten that we’d bought a grill in the first place when I heard my wife on the phone with the store. These aren’t terrifying signs in themselves — everyone is a little forgetful occasionally — but they make me pause enough to wonder if the worst is coming.

I’m built like my father, I sound like him, and if I have a genetic mutation in one of three genes that are all variations of the apolipoprotein E gene, then I will likely develop early-onset Alzheimer’s like him. These genes are rare, accounting for only 1% to 5% of all Alzheimer’s cases. But if I inherited the mutation from my father, then I will probably get the disease.

My grandfather — my father’s father — died relatively young of other causes, so there’s no saying whether he would have gotten early-onset Alzheimer’s. No one else in the family had it that we know of. I have as good a chance of getting familial Alzheimer’s as I have of avoiding it. Genetic testing would settle the question for good.

But what would I gain by knowing I was getting Alzheimer’s? I wouldn’t gain another day with my family. I wouldn’t gain a leg up on planning. My wife and I have taken care of practical considerations. We have wills. My wife has a durable power of attorney that enables her to make decisions on my behalf. Every policy, every asset, is in both our names. We opened college savings accounts for the kids. I’m working hard on my next book. How much more could I prepare?

After some deliberation, I’ve decided not to get genetic testing done. Instead, I’m going to try to live every day as if I know that I’m dying. The fact is, we are all dying. If I try to wring the most I can out of every moment, if I set aside time every day that my wife and I keep as inviolate as possible, if I give my wife and children quality interactions whenever we’re in the same room, if I leave the smartphone on the counter and realize there is no information more important than the information I get in my interactions with my loved ones, then how different is any of that from what I’d do if I knew I was getting Alzheimer’s?

Scientific studies suggest that my children are at just the age when they can begin to form lasting memories of their experiences. If I’m aware that I’m going to be gone someday and I consider it possible that that day will come far sooner than I’d like, then I want them to grow up not only knowing their father well but also knowing that they are well loved. I want to get in better shape for them, because I’d like them to see what a truly vital father looks like. And I’ve decided to read to them whenever they ask, if I possibly can. I don’t have any memory of my father telling me, “No more books” at bedtime. I will forever picture him with an arm around me, holding a book out before me, showing me the world.

Thomas is the author of the debut novel, We Are Not Ourselves, out today.

TIME Research

What Kids’ Drawings Say About Their Intelligence

Here are examples of children's drawings. Scores are from left to right: Top: 6,10,6; Bottom: 6,10,7. Twins Early Development Study, King's College London

The number of features a child draws into their sketch of a person may say a little something about their intelligence

A large and long-term new study shows the way a 4-year-old draws a person not only says something about their level of intelligence as a toddler but is also predictive of their intelligence 10 years down the line.

A team of researchers at King’s College London had 7,752 pairs of identical and non-identical 4-year-old twins draw a picture of a child. Every sketch was rated on a scale from 0 to 12 based on the presence of features, like legs, arms, and facial features. The kids also underwent verbal and nonverbal intelligence measurement tests.

When the kids turned 14, the researchers once again tested their intelligence. They found that a higher score on their drawing was moderately associated with the child’s intelligence both at age four and at age 14. The researchers expected to see a connection at age 4, but for the results to have consistency a decade later was surprising.

The researchers also found that the drawings of identical twins were more similar than the drawings of non-identical twins, suggesting that a genetic link was involved in drawing, though its exact mechanism was unknown. For instance the kids could be predisposed (or trained) to pay attention to detail well or hold their pencil in a specific way, the researchers say.

“The correlation is moderate, so our findings are interesting but it does not mean that parents should worry if their child draws badly,” said study author Dr. Rosalind Arden, the lead author of the paper in a statement. “Drawing ability does not determine intelligence, there are countless factors, both genetic and environmental, which affect intelligence in later life.”

The study was published Tuesday in the journal Psychological Science.

TIME Healthcare

One Patient, Too Many Doctors: The Terrible Expense of Overspecialization

Doctored, by Sandeep Jauhar
Doctored, by Sandeep Jauhar Courtesy Farrar, Straus and Giroux

As physicians become more specialized, our health care system becomes increasingly costly, sloppy and disorganized

Not long ago, a primary-care physician called me about a patient with a right-lung “consolidation” — probably pneumonia, though a tumor could not be excluded — that a lung specialist had decided to biopsy. My colleague wanted me to provide “cardiac clearance” for the procedure.

“Sure, I’ll see him,” I said, sitting in my office. “How old is he?”

“Ninety-two.”

I stopped what I was doing. “Ninety-two? And they want to do a biopsy?”

My colleague, who is from Nigeria, started laughing. “What can I tell you? In my country we would leave him alone, but this is America, my friend.”

Though accurate data is lacking, the overuse of health care services in this country probably costs hundreds of billions of dollars each year out of the $3 trillion that Americans spend on health. This overuse is driven by many forces: “defensive” medicine by doctors trying to avoid lawsuits, a reluctance on the part of doctors and patients to accept diagnostic uncertainty (thus leading to more tests), lack of consensus about which treatments are effective, and the pervading belief that newer, more expensive drugs and technology are better. However, perhaps the most important factor is the overspecialization of the American physician workforce and the high frequency with which these specialists are called by primary-care physicians for help.

The past half-century has witnessed great changes in American medicine. One of the biggest shifts is the rise of specialists. In 1940, three-quarters of America’s physicians were general practitioners. By 1960 specialists outnumbered generalists, and by 1970 only a quarter of doctors counted themselves general practitioners. This increase paralleled an equally dramatic rise in medical expenses, from $3 billion in 1940 to $75 billion in 1970.

Specialist-driven care has now become a fact of medical practice. In the past decade, the probability that a visit to a physician resulted in a referral to a specialist has nearly doubled, from 5% to more than 9%. Referral rates to specialists are estimated to be at least twice as high in the U.S. as in Britain.

The consequences for patients are troubling. Besides high costs, having too many consultants leads to sloppiness and disorganization. As Drs. Donald Berwick and Allan Detsky recently wrote in the Journal of the American Medical Association, inpatient care at hospitals has become a relay race for physicians and consultants, and patients are the batons.

I remember a 50-year-old patient of my Nigerian colleague who was admitted to the hospital with shortness of breath. During his monthlong stay, which probably cost upward of $100,000, he was seen by a hematologist; an endocrinologist; a kidney specialist; a podiatrist; two cardiologists; a cardiac electrophysiologist; an infectious-disease specialist; a pulmonologist; an ear, nose and throat specialist; a urologist; a gastroenterologist; a neurologist; a nutritionist; a general surgeon; a thoracic surgeon; and a pain specialist. The man underwent 12 procedures, including cardiac catheterization, a pacemaker implant and a bone-marrow biopsy (to investigate only mild anemia). Every day he was in the hospital, his insurance company probably got billed nearly $1,000 for doctor visits alone. When he was discharged (with only minimal improvement in his shortness of breath), follow-up visits were scheduled for him with seven specialists.

This case — in which expert consultations sprouted with little rhyme, reason or coordination — reinforced a lesson I learned many times in my first year as an attending physician: in our health care system, if you have a slew of specialists and a willing patient, almost any sort of terrible excess can occur.

What to do about this overspecialization? One option is accountable-care organizations, an idea put forward by the Affordable Care Act, in which teams of doctors would be responsible (and paid accordingly) for their patients’ clinical outcomes. This would force specialists to coordinate care. Unfortunately, most doctors, notoriously independent and already smothered in paperwork, have generally performed poorly in this regard.

Reforms will also have to focus on patient education. Medical specialty societies recently released lists of tests and procedures that are not beneficial to patients. By using these lists, cardiologists have been able to decrease their use of imaging tests by 20%. Better-informed patients might be the most potent restraint on overspecialized care. A large percentage of health care costs is a consequence of induced demand — that is, physicians persuading patients to consume services they would not have chosen had they been better educated. If patients were more involved in medical decisionmaking, there would be more constraints on doctors’ behavior, decreasing the possibility of unnecessary testing. This could serve as a potent check on what the doctor ordered.

Today roughly 1 of 6 dollars spent in America goes toward health care. If we do not succeed in controlling these costs, they will gradually crowd out other necessary societal expenditures. Improving health literacy will be critical to these efforts. Without a better understanding of what doctors are actually doing, one may end up like the patient who had 17 consultants and 12 procedures and who reinforced a further lesson I have learned many times since entering practice: when too many specialists are involved in a case, the result too often is waste, disorganization and overload.

Jauhar is a cardiologist and the author of Intern: A Doctor’s Initiation and the new memoir, out today, Doctored: The Disillusionment of an American Physician

TIME Infectious Disease

WHO: Ebola Casualties Top 1,200

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

Another 84 deaths reported in just three days

The World Health Organization has tallied another 84 deaths from confirmed or probable cases of Ebola virus over the past three days, bringing the death toll in West Africa to 1,229 people.

The WHO released the updated figures on Tuesday and announced an increase in food and aid shipments to roughly 1 million people living within the quarantined areas of Guinea, Liberia and Sierra Leone.

“It is essential that people in those zones have access to food, water, good sanitation and other basic supplies,” the WHO said in a statement, adding that it had partnered with the United Nations World Food Programme to scale up its aide shipments to affected areas and target its deliveries to hospitals and quarantined homes. “Providing regular food supplies is a potent means of limiting unnecessary movement,” the organization said.

Liberia’s information minister said Tuesday that three Ebola-stricken African doctors who were treated with a regimen of the experimental drug, ZMapp have shown “remarkable signs of improvement,” Reuters reports. The minister also confirmed that 17 Ebola patients who escaped from a quarantine center in Monrovia had been found and transferred to a treatment center.

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