The Nursing Homes of Boston: Three Years of Inspections

by Kat Hemming and Judith Lavelle

This week, we experimented with the GoogleDocs tool called Fusion Tables.  We found a data set on ProPublica that detailed the number of penalties and deficiencies in nursing homes across the country in the past three years.  Since this data set was so large, we decided to use only the nursing homes in Boston for our map.  While we had some difficulty cutting down the data and figuring out how the Fusion Table worked, we were able to figure it out and ended up happy with our result.

Click the on the map below for an interactive look at Boston’s nursing homes.

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Population Control: Not Ebola… But Not Science Fiction Either

Yesterday, The New York Times took an interesting angle on the recent, media-consuming Ebola epidemic. After continuously consulting the experts and the people on the scene, the Times decided to review the “fringe” interpretation of the tragedy in an article aptly titled, “The Ebola Conspiracy Theories.” The dominant theory, echoed in the Liberian newspaper The Daily Observer and on Chris Brown’s Twitter account, is that the epidemic is an intentional incidence of population control–making the virus itself a bioweapon intended to carryout a massive genocide.

Just to be clear: like many journalists, experts, politicians, victims and casual observers, I don’t buy into this theory. But I am a bit discouraged by the diction some have used to dismiss it–Politico even labeled it “crazy.” While a sophisticated analysis reveals that Ebola would make a poor choice for a bioweapon (it spreads inefficiently and is difficult to produce in a lab setting), generally categorizing all paranoia about population control as batty borders on the offensive. Various groups have been subjected to government-sanctioned depopulation through medical means, and you don’t have too look far back in U.S. history (let alone world history) to find them.

A Politico article identifies some "crazy" theories on Ebola's origin and implications.

A Politico article identifies some “crazy” theories on Ebola’s origin and implications.

In colonial America, British settlers at Fort Pitt took advantage of the Native Americans’ lack of immunity to smallpox by offering the blankets and handkerchiefs of smallpox patients to visiting chiefs in 1763. Historians debate how widespread the practice of intentionally distributing smallpox-exposed materials to Native American populations was, but correspondence between British officials reveal that the intent to harm was certainly there. Said one British commander to a colonel: “You will Do well to try to Innoculate the Indians by means of Blanketts as well as to try Every other method that can serve to Extirpate this Execrable Race.”

The United States also has a long history of controlling certain populations through forced sterilizations. As recently as the 1970s, laws at the state level allowed some medical and penal institutions to sterilize those under their care considered to have disabilities or criminal characteristics that could undesirably enter the gene pool. In 1926, this practice was deemed constitutional in the Supreme Court case, Buck v. BellAnd though this seems horrific enough, some people assert that proponents of forced sterilization targeted not only the disabled and incarcerated but also racial minorities. Even today, some victims of this practice are still advocating for visibility and reparations.

Emma (right) and Carrie Buck (left) lost a Supreme Court case that upheld Virginia's right to authorize Carrie's forced sterilization because of her mental disability.

Emma (right) and Carrie Buck (left) lost a Supreme Court case that upheld Virginia’s right to authorize Carrie’s forced sterilization because of her mental disability.

So while Ebola is more than likely off the hook as a means of population control, the historical context certainly gives credence to why some fear the idea in the first place. As New Jersey City University English professor James F. Broderick told The New York Times, “Conspiracies against the powerless tend to be effective [theories] because the masses often feel that way.” And it’s important to remember that, for “the powerless,” that feeling is often pretty justified.

Tru(vada) Love Conquers All

By Judith Lavelle

Some argue that the stigma behind preexposure prophylaxis is fading. But how does it work?

Let’s talk about a little pill that makes many people’s sex life a bit less nerve-racking. It’s most effective in its protection when taken everyday, but in certain doses, it can do the trick up to 72 hours after unprotected sex. Insurance companies are begrudgingly changing their policies to cover it is as a preventative therapy, and while some ethicists and cultural critics worry it will only encourage promiscuity, others hail it as incredibly empowering.

And, no, I’m not talking about birth control.

by Flickr user "torbakhopper HE DEAD."

by Flickr user “torbakhopper HE DEAD.”

Preexposure prophylaxis–or PrEP, as it’s being called–is just hitting its stride and becoming more widely embraced as a method to prevent the spread of HIV. Some suggest that the drug may help couples bridge the “viral divide” (allowing HIV-positive and HIV-negative lovers maintain a sexual relationship with less anxiety about contracting the virus), the promise dissipates fear left and right, users are starting to get vocal, and and this month, The Advocate is spreading the word about the therapy through its “31 Days of PrEP” campaign. But how does PrEP add to the (ideally) already-utilized, low-tech methods of condoms, communication and routine status testing?

For the the most common formulation, under the trade name Truvada, the secret lies in two active ingredients, emtricitabine and tenofovir disoproxil fumarate.

Emtricitabine, one component of Truvada.

Emtricitabine, one component of Truvada.

Tenofovir disoproxil fumarate, one component of Truvada.

Tenofovir disoproxil fumarate, one component of Truvada.

Even though the buzz surrounding Truvada is still hot, emtricitabine and tenofovir disporoxil fumarate aren’t new players in the fight against AIDS. Both have been used in combination therapies–the “AIDS cocktail” for HIV-positive patients–since the mid-nineties. What’s new is the practice of regularly taking the medications before being exposed to HIV.

And despite their different structures, the two chemicals do essentially the same thing: throw a wrench in an important piece of the human immunodeficiency virus’s machinery–reverse transcriptase.

In an unhindered attack, HIV uses this enzyme to convert the genetic material it injects into a human cell, the viral RNA, into DNA. That DNA then highjacks the cell’s resources to do the virus’s bidding–turning cells into virus-production factories and allowing the disease to spread throughout the body.

But given the complex and so-far irreversible nature of AIDS, even emtricitabine and tenofovir disporoxil fumarate–which very effectively halt the conversion of viral RNA to DNA by thwarting the efforts of reverse transcriptase–can only slow the spread of the virus instead of rid it from a person who has already been infected. So Truvada and its counterparts are not a miracle cure for AIDS, the disease that ensues when HIV takes hold of a person’s entire system.

Even with that limitation, the drugs are particularly useful for getting in and doing their job as early as possible–which is why they’re showing such promising effectiveness (some say up to 90% of the time) stepping in when the virus is new to the body. But since this isn’t perfect, that comparison to hormonal birth control applies here too. Reducing the risk comes down to being safe in as many ways as possible–so barrier methods, regular testing and education are still powerful tools in protecting against HIV.

by Flickr user "torbakhopper HE DEAD."

by Flickr user “torbakhopper HE DEAD.”

Overcoming the Ick Factor

by Judith Lavelle

A new treatment reminds us that pushing past squeamishness can be a medical necessity.

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Over the past few days, a good amount of Twitter users, a few of my Facebook friends and apparently NPR have embraced the charming phrase “frozen poop pills” to describe a promising new treatment for Clostridium difficile infections. The capsules, which indeed contain frozen human feces, have helped a small sample of patients overcome the chronic diarrhea that can prove fatal to many C. diff sufferers and that has become increasingly difficult to manage with antibiotics.

As exciting as this progress is, hope and excitement haven’t exactly been the only reactions people have had. When The New York Times reported the story, I was struck by what one C. diff patient, identified simply as “Deirdre,” had to say about the life-saving cure:

“If this is a treatment that was 90 percent effective and you can get over the gross factor, it seems to be kind of a no-brainer.”

— “A Promising Pill, Not So Hard to Swallow” by Pam Belluck

Well put. In some ways, this new pill represents an interesting set back for an evolved response. Most human beings are disgusted by certain bodily fluids and creepy insects because that revulsion keeps us safe. Were we to normally sample human waste or even let disease-carrying rodents dwell in our homes, we would be more likely to pick up nasty germs. In this case, modern medicine has turned the tables: let your revulsion call the shots, and those germs might get the best of you. But are these “frozen poop pills” alone? Not at all. Patients and doctors have had to employ their higher faculties and push past squeamishness throughout the history of medicine.

A maggot illustration from the "The Boston Medical and Surgical Journal" (1858).

A maggot illustration from the “The Boston Medical and Surgical Journal” (1858).

Granted, some treatments–like urine baths for bad skin or consuming rotten mice to stop bedwetting–have fallen out of favor for being unsubstantiated as well as unsavory. But other “gross” treatments are very much in use. For example, doctors sometimes prescribe “fecal transplants” for particularly stubborn cases of antibiotic-resistant C. diff. Just like the pills, these enemas of donated fecal matter help restore healthy gut bacteria… but they don’t make for good table conversation.

Likewise, the medicinal properties of some creepy crawly animals may be able to step in when more traditional cures fall short. Maggots can be surprisingly adept at clearing dead, infection-prone tissue from healing wounds, and with antibiotic resistance on the rise, perhaps we’ll be seeing more of them. Leeches, too, can be useful; in rare but demonstrated cases, surgeons employ them to suck on the area of operation, and the leeches’ natural secretions prevent blood clots from forming.

"Leech dance." by Flickr user Thejaswi

“Leech dance.” by Flickr user Thejaswi

Even if you find anti-clotting leeches or “frozen poop pills” unbelievably disgusting or even darkly amusing, I think you have to agree they’re a testament to the medical community’s commitment and creativity. And after all–it’s a give and take. Sure, feces capsules might turn your stomach… but they might save your life.

Iron Chef Veteran Talks Science, Taste and Transformations

by Judith Lavelle

Science and cooking converge for a Harvard University lecture series.

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Christopher Bleidorn (left) and Dominique Crenn (right) of Atelier Crenn in San Fransisco reveal their recipe for “carrot jerky.”

Last night, I attended the seventh lecture in Harvard University’s 2014 Science and Cooking Lecture Series entitled, “The Metamorphosis of Taste.” The series is a weekly academic collaboration between Professor Michael Brenner of the School of Engineering and Applied Science and the chefs he invites to discuss the science behind their craft. This week, Brenner introduced Dominique Crenn of Food Network’s Iron Chef and Christopher Bleidorn, the chef de cuisine at Crenn’s highly acclaimed modernist restaurant, Atelier Crenn in San Francisco. Fitting with the series’ scientific slant, the pair discussed how their recipes use taste to evoke memories and applied science to transform raw ingredients into five star dishes.

"The Metamorphosis of Taste" on Monday, October 13th at 7pm at the Harvard University Science Center

“The Metamorphosis of Taste” on Monday, October 13th at 7pm at the Harvard University Science Center

Crenn began with an overview of her philosophy on food: it should be organic, sustainable and transport the diner to another, imaginative space or time. That last facet seemed most important, citing how one dish’s crisp flavors were inspired by walking in the woods. “When we bring a dish to the table,” Crenn explained, “we want to trigger memory.” Incidentally, our brains (even those of us who aren’t culinary geniuses) are adept at performing the opposite because the brain regions that process taste and smell are intimately connected to memory. Hence, some of us feel warm and fuzzy about mom’s tomato soup recipe but will never touch tequila again.

Cooked to a precise 64 degrees Celcius,

Cooked to a precise 64 degrees Celcius, Bleidorn and Crenn say these yolks are the perfect consistency.

Once she had established her goals for her recipes, Crenn acknowledged that experimentation is a necessity to get them right. “The best recipes come from failure,” she said. “Cooking is science.”

For the details of that science and the precise techniques that make the memory-evoking food at Atelier Crenn a reality, Crenn turned things over to Bleidorn, who narrated two video presentations of kitchen transformations: raw eggs to a versatile “glass egg yolk sheet” and freshly plucked carrots to unique and spicy “carrot jerky.”

Both recipes were deceptively complex. The eggs were cooked to a precise 64 degrees Celcius, when the heat could denature the perfect proportion of proteins for the optimum consistency. Bleidorn then described how the yolks were separated and mashed into a puree, pasteurized through another two-hour cooking process, pressed into a thin “sheet” between two pieces of plastic and cooked again to create the filmy finished product.

Carrots are stored in salt and sugar in order to dehydrate them for a unique vegetable jerky.

Carrots are stored in salt and sugar in order to dehydrate them for a unique vegetable jerky.

To create their “carrot jerky,” Bleidorn explained, the Atelier Crenn crew stores fresh carrots in a mixture of salt and sugar for three days. As the video atop the speakers showed, the salt and sugar draw out so much of the carrots’ water that the once-dry mixture looks soupy at the end of a long weekend. For flavor, the carrots are then soaked in salty ginger tea–a process called “brining” that again extracts moisture from the vegetable to finish off the dehydration necessary for producing a good, tough jerky.

By the time the carrots are finished, brushed with cayenne pepper and garnished with orange rinds, they’ll shrink to 60 percent their original size. “The result becomes a very chewy carrot,” Bleidorn says, miming the floppiness with his hand, “kind of playful.”

Before the audience headed home with a little more background on the science of cooking and a major case of food envy, Crenn and Bleidorn invited us up for a sample of the carrot jerky. I decided not to brave the long line, but a quick Google search revealed that their whole tasting menu is just a flight to San Francisco and a mere $195 away.

I’ll have to get on that…

While You Wait

by Judith Lavelle

Wait time is pivotal in emergency medicine.

"Pronto Soccorso" by Michele Federico.

“Pronto Soccorso” by Michele Federico.

I live in Boston, a city saturated with universities and flush with hospitals, so being able to access state-of-the-art medical treatment rarely worries me. Still, it should concern all of us that hospitals around the US are closing their emergency departments (citing large overhead costs) even though, as the The New York Times reports, patient demand is on the rise.

Last Monday, I was one of those patients. I’m doing fine now, but feeling poorly then, I landed in the emergency department waiting room at Beth Israel Deaconess Medical Center in Brookline. The staff was attentive, and my wait was under an hour. While Brookline is better off than many communities with heavily-burdened ERs, my experience got me thinking about how some departments speed up their response times and why some do better than others.

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A Chicago emergency room in the 1910s

First, my inevitable history lesson: while there were a whopping 129.8 million ER visits in 2010, emergency medicine as a medical speciality is relatively new. Emergency rooms began appearing with the onset of stricter standards for hospital care at the turn of the century, and the first emergency medicine residency programs were established as recently as the 1960s and 70s. Before that, patients who were lucky enough to receive immediate medical care were likely to have their doctors come to them during a house call. Now, hospitals have revived the let-us-come-to-you strategy within their ER waiting rooms.

When patients arrive in the ER, they are quickly examined by triage nurses, who determine when the patient will be seen based on the severity of their condition. If patients have to hang tight for a bit, many ERs will begin the diagnosis or treatment process right in the waiting room. If they didn’t already take care of it in triage, hospital staff will collect a patient’s blood and urine samples and take his vital signs (like blood pressure, temperature and heart rate). This way, when a bed finally opens out or a physician becomes available, the staff will already have the results of the tests to refer to. If doctors are available but beds or exam rooms are not, patients may also be evaluated in the waiting room by doctors who can prescribe painkillers and other time-sensitive medications before the staff can provide more intensive treatment.

A poster in a southern CA hospital estimates wait times for common diagnostic tests. "Taking a friend to the ER No. 2" by Jason Tester Guerrilla Futures.

A poster in a southern CA hospital estimates wait times for common diagnostic tests. “Taking a friend to the ER No. 2” by Jason Tester Guerrilla Futures.

The CDC reported in 2010 that a quarter of ER patients are seen in under 15 minutes, and data from ProPublica states that the average national wait time is 28 minutes–but this reflects a wide range of patients appearing at various times of the day with all kinds of conditions. Nonetheless, the data reveals that you may wait the longest to receive care in Washington, D.C. but spend only a short time in a Wyoming ER waiting room. To get a better sense of how long patients wait in specific areas of the country, you can check out ProPublica’s news app, which lets you search for average waiting times in local ERs:

See how long you might wait in the ER

Audience Laughs Then Learns At Ig Informal Lectures

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by Judith Lavelle

Originally posted Sept. 22, 2014 on trackingtheadvocate.wordpress.com.

Scientists responsible for 2014’s most unexpected research gave short presentations on their findings and fielded an audience’s questions from a packed auditorium at the Ig Informal Lectures at the Massachusetts Institute of Technology on Saturday afternoon. The event was presented by Improbable Research, Inc. and sponsored by the MIT Press.

The lectures followed the 24th Annual Ig Nobel Prize Ceremony, held at Harvard University on Sept. 18, where research teams from around the world—from the U.S. to the Czech Republic—were awarded for unusual accomplishments in medicine, biology, physics, and more.

The stadium fills

The auditorium in MIT’s Building 26 fills with onlookers at the Ig Nobel Informal Lectures on September 20, 2014.

Marc Abrahams, founder of the Ig Nobel Prize and “Chief Airhead” at the Annals of Improbable Research, presided over the nearly three-hour event, beginning with his explanation of why the featured scientists would present both entertaining and important work. “[The research] is funny when you first heart about it,” Abrahams told the crowd, “then a week later, it’s still bouncing around in your head.”

The lectures unfolded as each of the present scientists shared a five-minute presentation on their research. Ig Nobel Laureate in physics, Dr. Kiyoshi Mabuchi, started things off by serenading the audience as a slideshow on his research—an investigation into why banana peels are so slippery—cycled on screen.

During the question and answer period that followed, Abrahams asked the crowd if anyone could translate the audience’s questions to Mabuchi’s native tongue, Japanese. Tomo Soejima, an MIT student studying chemistry and physics, spontaneously volunteered.

After the lectures concluded, Soejima said he had not expected to participate in the event when he found out about them through posters around MIT’s campus. “I was surprised,” laughed the 19-year-old sophomore.

Tomo Soj (19) translates for Dr. Something

MIT sophomore Tomo Soejima (19) takes the stage to translate for Ig Nobel Laureate Dr. Kiyoshi Mabuchi.

Other speakers presented on the neuroscience behind seeing Jesus on a piece of toast, the ability of cured pork to stop nosebleeds, and the response of reindeer when researchers disguise themselves as polar bears.

So, far a Japanese man sang a song about banana peels, and we’ve talked about seeing Jesus on toast. Strong start. Now I’m hungry. #IgNobel — Julia Sklar (@jfsklar) September 20, 2014

Midway between the award-winners’ presentations, Abrahams introduced the keynote speaker at this year’s Ig Nobel Ceremony held at Harvard University last Thursday. In 2005, he won an Ig Nobel in nutrition.

NakaMats, as he is informally known, took advantage of his allotted time at the Ig Informal Lectures to present a slide show of some of his inventions (of which there are over 3300), including the floppy disk, a popular brand of aphrodisiac, and a state-of-the-art golf putter.

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This year’s Ig Nobel Ceremony keynote speaker, Sir Dr. Yoshiro NakaMats, presents some of his over 3300 inventions.

Abrahams hailed NakaMats’s eccentricity and prolific life’s work, calling the Japanese inventor the world’s “possibly greatest human.” After his five minutes of presentation ran before he finished, the audience cheered for an encore, and Abrahams allowed him another minute.

“He’s the only Ig Nobel winner in history to receive an extra minute,” said Abrahams.

The crowd at the 2014 Ig Informal Lectures applauds Dr. NakaMats.

The crowd at the 2014 Ig Informal Lectures applauds keynote speaker, Dr. NakaMats.

After the presentations ended and before the audience was dismissed, Abrahams and David Kessler, General Manager of Improbable Research, Inc., made a plug for subscribing to the Annals of Improbable Research and for next year’s 25th Annual Ig Nobel Prize Ceremony.

“It’ll be big,” Kessler told the crowd, “and you’ll want to be there.”