Sloan Kettering Executive Turns Over

Sloan Kettering Executive Turns Over Windfall Stake in Biotech Start-Up

This article was reported and written during a collaboration with ProPublica, the nonprofit journalism organization.

A vice-chairman of Memorial Sloan Kettering Cancer Center has got to turn over to the hospital nearly $1.4 million of a windfall stake during a biotech company, in light of a series of for-profit deals and industry conflicts at the cancer center that has forced it to reexamine its corporate relationships.

The vice president, Dr. Gregory Raskin, oversees the hospital ventures with for-profit companies.

As compensation for representing the hospital on the biotech company’s board, Dr. Raskin received stock options whose value soared when the start-up went public a little over a week ago.

The move handy over his stake is one among several steps now underway because of the cancer

the center tries to contain a crisis that has already led to the resignation of its chief medical officer and a review of its conflict-of-interest policies.

Several board members and some executives of the nonprofit institution have maintained close ties to the health and drug industries at a time when stunning cancer breakthroughs are generating excitement among investors and spawning a flurry of biotech start-ups.

At other cancer centers and research institutions, employees are barred from accepting personal compensation once they represent their institution on corporate boards. But Memorial Sloan Kettering had no such prohibition so far.

Dr. Raskin has been involved in the start-up, Y-mAbs Therapeutics, since 2015 when he signed off on the effect Memorial Sloan Kettering, where the company’s experimental treatments for children with cancer have been developed.

His vested stock options are worth about $675,000, at least on paper.

Stock options which will vest within the future are worth about $616,000 more. In addition, shares he had personally purchased earlier at a discounted price are now worth about $106,000 quite he purchased them.

After The NY Times and ProPublica asked about Dr. Raskin’s compensation, Memorial Sloan Kettering said it might change its policy in the order that he and other employees in similar roles wouldn't profit personally from such arrangements, which all proceeds would revert to the hospital and its research.

The hospital itself has an equity stake within the company of 8.45 percent, which is worth $73 million.

On Friday, the Manhattan-based cancer center issued a memo to thousands of employees, announcing that it might restrict some interactions with for-profit companies.

It said it had been imposing a moratorium on board members investing in or holding board positions in start-ups that originated with Memorial Sloan Kettering.

For now, the moratorium on board investments only applies to new deals, the hospital said.

It might not affect the exclusive deal the hospital made with a man-made intelligence the company, Paige.AI, to license digital images of 25 million tissue slides.

Three insiders, including a member of Memorial Sloan Kettering’s executive the board, were company cofounders, and three other board members were investors.

Staff turmoil over the deal caused Dr. David Klimstra, the chairman of the pathology the department, to announce that he would divest his equity stake in Paige.AI.

Memorial Sloan Kettering said within the memo, “We have determined that when profits emerge through the monetization of our research, financial payments to M.S.K.- designated board members should be used for the advantage of the institution.

”The proposed policies stopped in need of barring the hospital executives from receiving compensation for his or her work on outside boards, although officials have said that's a move they are considering.

Dr. Craig B. Thompson, the cancer center’s chief executive sits on the board of the drugmaker Merck.

Dr. José Baselga, the chief medical officer who resigned under attack this month after a piece of writing within the Times and ProPublica about his undisclosed industry ties sat on the board of the drug maker Bristol-Myers Squibb and Varian Medical Systems, a manufacturer of radiation equipment.

He resigned both positions after he stepped down from his role at the hospital.

In an email, Dr. Raskin said that each one of his compensation for work with Y-mAbs “is being

committed to Memorial Sloan Kettering and therefore the amazing work we do.”

He said he “couldn’t be prouder of the work we’ve accomplished at Y-mAbs in extending children’s lives.

I'm grateful that I even have the chance to lend my expertise in the biotech business development and licensing property to bring M.S.K.’s unique and important discoveries to cancer patients.”

Christine Hickey, a spokeswoman for Memorial Sloan Kettering said Dr. Raskin brought the matter to hospital leadership on Sept. 21, the same day that Y-mAbs began trading publicly and each day after the article about Paige.

AI was published online. She said he had fully disclosed his ties to the corporate, as needed by the hospital.

Before joining Memorial Sloan Kettering in 2012, Dr. Raskin was vice president of the venture capital arm of AllianceBernstein, focusing on biotechnology.

He now leads the cancer center’s Office of Technology Development.

Hospitals and universities have long assisted researchers with tasks like registering patents, but Dr. Raskin’s field — referred to as technology transfer — has expanded in recent years.

Technology transfer offices became increasingly involved in helping to line up 2 pages, 0.03 MB companies, said Stephen Susalka, the chief executive of the Association of University Technology Managers.

More than 1,000 start-ups originated at universities, hospitals or research institutions in 2017, consistent with his group, up from about 550 in 2007.

Research institutions have varying policies when it involves allowing employees to represent them on the boards of companies.

Some, like the Cleveland Clinic and the University of Texas MD Anderson Cancer Center, permit employees to represent the hospital on company boards, while others, just like The University of Utah, do not.

The Cleveland Clinic said it prohibits employees from personally profiting once they are representing the interests of the institution.

A spokeswoman for MD Anderson said that its head of technology transfer serves on one corporate board as a hospital representative, but that position is uncompensated.

Ebola Likely to Spread From Congo to

Ebola Likely to Spread From Congo to Uganda, W.H.O. Says

The risk of Ebola escaping from the Democratic Republic of Congo is now “very high,” and the outbreak already is nearing Uganda, the planet Health Organization said on Thursday.

The W.H.O. raised its official alert level due to violence by local militias, which has slowed efforts to contain the outbreak and population movements in eastern Congo, where the latest outbreak erupted in August.

But the danger of Ebola spreading globally remains low, the agency said.

Since 2000, Uganda has had three Ebola outbreaks, with a complete of about 600 cases.

Although it's a poor country, its health care system is comparatively well organized, and its the health ministry said it might start a vaccination campaign if it detected cases there.

Inside Congo, the response to the outbreak has been hampered by fighting and by small numbers of victims leaving or refusing to travel to treatment centers, spreading the virus to new areas.

Also, local politicians exploiting the fear and confusion before December elections were encouraging people to distrust the national government’s efforts, Dr. Peter Salama, the W.H.O.’s head of emergency response said at a press conference in Geneva, Reuters reported.

In the coming weeks, problems like those could “create a possible perfect storm,” Dr. Salama said.

As of Friday, there are 155 confirmed or probable cases within the Ebola outbreak. Some 102 patients have died, and 45 cured patients are released.

In a video statement, Congo’s health minister, Dr. Oly Ilunga Kalenga said the outbreak was now 3 times the dimensions of the one this summer within the central Equateur Province. He blamed several factors.

More people sleep in the affected area, and that they are more mobile because they're mostly traders rather than farmers. The region has better roads and water connections, but is more dangerous because many militias operate in it.

Nearly 12,000 doctors and contacts of known victims are vaccinated.

Although cases of Ebola continued to say no and only about 10 new ones are detected each week, the W.H.O. expressed alarm that one had turned up for the primary time in Thomas, a fishing town across Lake Albert from Uganda.

Refugees often flee across the lake; just this year, 75,000 Congolese crossed it into Uganda to flee fighting in Ituri province, of which Tshomia maybe apart, consistent with a report from the European Commission’s humanitarian aid organization.

Officials in Ituri said the case was a lady who had attended the funeral of an early Ebola victim in Beni, where the present outbreak began.

She was being followed as a case contact, but she refused to be vaccinated, slipped away in between visits from medical workers, and traveled about 75 miles north before falling ill. She visited a standard healer and a rural clinic before ultimately dying within the Tshomia regional hospital on Sept. 20.

More than 100 people in touch together with her are now being vaccinated, and therefore the mud-walled the local clinic she visited had to be decontaminated.

Although doctors haven't been targeted, 21 people were killed last week in Beni.

An Islamic fundamentalist militia referred to as the Allied Democratic Forces was blamed.

The group features a history of cross-border fighting with the Ugandan army, attacks on United Nations peacekeepers and massacres of civilians.

After the killings, medical staff were told to prevent working for 48 hours; they are subsequent efforts were hampered by a four-day mourning period declared by local officials, the W.H.O. said.

Many rumors about Ebola are circulating and must be debunked, consistent with the health ministry’s Twitter feed.

They include reports that prisoners with Ebola had escaped from the Beni prison, that children were being vaccinated without their parents’ consent, and that schoolgirls who had their menstrual periods were being forced into treatment centers.

Four Ebola treatment centers have now been built, and a treatment team has arrived in Thomas.

In the Nursing Home, Empty Beds and Quiet

In the Nursing Home, Empty Beds and Quiet

For quite 40 years, Morningside Ministries operated a home in San Antonio, caring for as many as 113 elderly residents. The facility, called Chandler Estate added a small independent living building within the 1980s and a good smaller assisted living center in the 90s, all on an equivalent four-acre campus.

The whole complex stands empty now. Like many skilled nursing facilities in recent years, Chandler Estate had seen its occupancy rate drop.

“Every year, it seemed a touch worse,” said Patrick Crump, chief executive of the nonprofit the organization, supported by several Protestant groups. “We were running at about 80 percent.”

Staff at the Chandler Estate took pride in its five-star rating on Medicare’s home Compare website.

But by the time the board of directors decided it had to shut the the property, only 80 of its beds were occupied about 70 percent.

Revenue from independent and assisted living couldn’t catch up on the losses incurred by the nursing home.

In February, the last resident was moved out. Morningside Ministries operate two other retirement communities within the San Antonio area; they took within the independent living and assisted living residents and about 30 home patients, absorbing most of the staff as well.

But quite 40 older people had to relocate to other nursing facilities or move out of town closer to family, and 30 staff members lost their jobs.

“There was some real sadness, tears, frustration,” Mr. Crump said. “It’s hard knowing you won’t be providing services to those older folks.”

At least the organization has the consolation of knowing that nursing homes across the country is grappling with the same problem.

The most recent quarterly survey from the National Investment Center for Seniors Housing and Care reported that almost one home bed in five now goes unused.

Occupancy has reached 81.7 percent, rock bottom level since the research organization began tracking this data in 2011, when it had been nearly 87 percent.

“It’s a big drop,” said Bill Kauffman, senior principal in the middle. “The industry as a whole is struggling, and a few operators are having difficulty.” Such national statistics mask considerable local differences.

“The best facilities still have one hundred pc occupancy and waiting lists — that’s how you know they’re good,” said Nicholas Castle, a health policy researcher at the University of Pittsburgh.

But in 2015, the National Center for Health Statistics reported that quite a 3rd of beds were empty in some states, including Illinois, Iowa, Nebraska, Oklahoma, and Utah. 

Texas wasn’t far behind. Nationally, “200 to 300 nursing homes close annually,” Dr. Castle said. The number of residents keeps shrinking, too, from 1.48 million in 2000 to 1.36 million in 2015, according to federal data.

Given an aging population, you’d think nursing homes would be dealing with the other problem — surging demand for their services.

But they also face growing financial strains and regulatory requirements intended to control costs, Mr. Kauffman pointed out.

Under the Affordable Care Act, as an example, hospitals face financial penalties for readmissions and a few have responded by designating patients as “under observation,” rather than admitting them as inpatients. After discharge, Medicare won’t cover skilled nursing care for these patients.

(Generally, Medicare pays for short-term rehabilitative care in nursing homes following a hospital stay; however, Medicaid, administered by the states, covers long-term care.) Moreover, “certain surgeries are migrating from inpatient to outpatient surgical centers,” Mr. Kauffman said. Medicare won’t cover skilled nursing for those patients, either.

The growth of Medicare Advantage plans, which now cover a third of Medicare beneficiaries also play a role.

“They have a keen interest in lowering costs, so maybe they divert people from skilled nursing to home care,” Mr. Kauffman said. “If you are doing to attend a nursing facility, rather than a 30-day stay, maybe the plan wants the patient to call at 17 days.”

At an equivalent time, nursing homes face stiffening competition. As their operators sometimes say themselves, they’re selling a product nobody wants to shop for.

“You have increased alternatives, like assisted living, and other ways for people to remain at home,” said Ruth Katz, senior vice chairman of public policy at Leading Age, which represents nonprofit senior service providers.

“When people find community alternatives, they use them whenever possible.”

Federal policy has helped propel this shift. For years, advocates protested that Medicaid covered care in nursing homes but not within the places people much preferred to measure. Congress paid attention and passed legislation in 2005.

Thirty years ago, 90 percent of Medicaid dollars for long-term care flowed to institutions and only 10 percent to home- and community-based services. Now, the proportions have flipped, and nursing homes get only 43 percent of Medicaid’s long-term care expenditures.

A report from the federal Accountability Office earlier this year acknowledged, for example, that Medicaid covers assisted living for 330,000 people. A demonstration the program called Money Follows the Person has moved quite 75,000 residents out of nursing homes and back into community settings.

It’s good news for consumers — but not so good for nursing homes.

The 31 largest metropolitan markets have 13,586 fewer home beds now than in late 2005, the investment center reports.

This could prove a temporary crisis. When the baby boomers enter their 80s and wish residential care, occupancy could pick up again.

Even now, nursing homes can turn a profit with lower occupancy by attracting more patients for short-term rehab. Medicare reimburses for those stays at higher rates than Medicaid pays for long-term care.

(About 80 percent of yank nursing homes are forprofit.) Facilities are bracing for a few tough years ahead, nonetheless. In casting about for additional revenue, they’re trying tactics like opening pharmacies and residential care agencies, and accepting sicker patients, including those on ventilators, at higher reimbursement rates.

Not All Women Have a Clear Answer

Expecting Women to Describe How Sexual Assault Affected Them Creates Barriers to Reporting It

“Can you tell us what impact the events had on you?” Senator Dianne Feinstein asked Christine Blasey Ford during Thursday’s Senate Judiciary Committee hearing.

It was the primary of several questions aimed toward getting Dr. Blasey to outline the toll on her life of sexual abuse that she testified involved Judge Brett M. Kavanaugh.

Many people who add the world of trauma found her answers, including “anxiety, phobia and PTSD-like symptoms,” familiar and credible. But they said it’s important to remember something Dr. Blasey, a research psychologist drew attention to during her testimony.

“I think the sequelae of sexual abuse varies per person,” Dr. Blasey told the committee, using a scientific term for aftereffects.

Sometimes those effects are difficult to discern or articulate, one among many reasons that women often fail to report sexual assaults to authorities — or maybe discuss the incident with loved ones, researchers say.

“There is a large amount of research showing the survivors cope in many various ways, but there does seem to be a societal image of how they have to act — and if not they're not believed,” Antonia Abbey, the editor of the journal, Psychology of Violence said in an email.

Kevin Michael Swartout, a psychology professor at Georgia State University who studies sexual violence agreed.

“Research indicates that folks are less likely to believe a victim’s account and believe the assault was less severe when the assault and victim’s response doesn’t follow people’s scripts.”

During Thursday’s hearing, Dr. Blasey was asked by Rachel Mitchell, the prosecutor hired by the committee to question her and Judge Kavanaugh, how she might be certain that the PTSD and anxiety she experienced was caused by the assault she described.

Though she appeared certain that the solution was yes, for several victims, the consequences are murkier, researchers said. Reinforcing the thought that one must be ready to clearly outline the concrete effects of trauma within the sort of poor grades, broken relationships or days spent weeping so as to be believed, they said, can do more harm than good.

“This is one among the explanations survivors don't report their assaults to police immediately after,” said Dr. Swartout.

This phenomenon can also push a lady to attenuate the incident for herself. She may feel like her own experience wasn't deserve documentation or discussion because she didn't observe an equivalent effect other victims mention.

“I think we intuitively understand that if a gun was forced into your mouth or put to your head, you'd be traumatized,” said Neil Malamuth, a scientist at UCLA who studies sexual violence.

But within the realm of sexual abuse, many people’s view of the crime continues to be shaped more by the response of the victim than by the actions of the perpetrator, he said.

“If you're too upset, you're crazy,” said Mary Koss, a professor at the University of Arizona who has published numerous studies on sexual abuse, in an email. “If you are not upset enough, people don’t believe you were raped. So you have to be just the right degree of upset, whatever that is.”

In Rare Bipartisan Accord, House and

In Rare Bipartisan Accord, House and Senate Reach Compromise on Opioid Bill

WASHINGTON — The House and Senate have reached agreement on an enormous package of measures to address the opioid epidemic.

The legislation, backed by leaders of both parties may be a rare bipartisan achievement that lawmakers are wanting to have in hand when they go home to campaign for the midterm elections.

The 653-page bill contains a mixture of enforcement and public health measures, including one that aims to dam deadly fentanyl from being imported through the mail and one that will allow more nurses to prescribe medication for opioid addiction.

Another provision could make it easier for Medicaid recipients to get inpatient care for substance abuse over the next five years.

“While there is more work to be done, this bipartisan legislation takes an important step forward and can save lives,” a gaggle of Republican and Democratic committee leaders said in a statement.

But addiction experts say that while many of the measures will help incrementally, the investment remains meager and scattershot compared with what's needed, and with what the govt spent to stem the tide of AIDS-related deaths within the 1990s.

With 72,000 overdose deaths in 2017, including nearly 50,000 involving opioids, members of Congress are wanting to wield the bill as a substantive policy achievement amid the drama surrounding Fates of Judge Brett Kavanaugh, President Trump’s Supreme Court nominee, and Rod Rosenstein, his deputy attorney general.

Both chambers still need to vote on the compromise bill.

The House could vote as soon like Wednesday night, before its members adjourn to hit the campaign trail and the Senate could take it up next week.

The Congressional Budget Office has yet to attain the new bill and estimate its cost, but an earlier Senate version would have cost an estimated $8 billion over five years.

Improved access to treatment One of the foremost expensive provisions — which had been a detail between the two chambers — will repeal an obscure rule that blocks states from spending federal Medicaid dollars on residential addiction treatment at centers with quite 16 beds.

The rule was originally intended to discourage warehousing of individuals with mental illnesses in psychiatric hospitals, which was much more common when it had been written in 1965.

More recently, the rule has limited the number of beds available for low income patients affected by addiction, although there have been several ways for states to circumvent it.

Some addiction specialists worry that the bill’s expansion of inpatient care will eclipse the importance of longer-term outpatient programs that focus on medication-assisted treatment, which researchers consider the gold standard for treating opioid addiction.

Many residential programs for opioid addiction still don’t offer such treatment as a part of their protocol, and therefore the bill does nothing to deal with that.

“The evidence for residential stays is extremely thin in terms of science,” said Dr. Ken Duckworth, medical director for behavioral health at Blue Cross Blue Shield of Massachusetts.

“I’m not against the residential model, but the linchpin is that with it, you have to have exposure to medication-assisted treatment.”

The opioids bill that the House passed in June limited the expansion of inpatient treatment only to patients with cocaine and opioid addiction; the Senate version left the the old rule in place.

The compromise bill lifts the rule for all substance use disorders for residential treatment lasting up to 30 days.

The bill also permanently allows nurse practitioners and physician assistants to prescribe buprenorphine, an anti-addiction medication that needs a special license and additional training.

Only about 5 percent of the nation’s doctors are licensed to prescribe it, and shortages are especially acute in rural regions.

The bill further aims to increase access to the medication by allowing nurse anesthetists, nurse midwives and clinical nurse specialists to prescribe buprenorphine for the subsequent five years.

Blocking mail orders of illegal drugs The bill includes a provision to assist stop the flow of illicit opioids into the country by mail, especially synthetic fentanyl and its analogs, which are fueling the increase in overdose deaths.

The supply was pushed by Senator Rob Portman, Republican of Ohio, whose the state has been especially hammered by the opioid epidemic.

It will require us a mail to start out collecting information on international mail shipments, even as private carriers like Fed Ex and DHL has already got to do.

By the end of this year, the Postal Service will need to provide the name and address of the sender and therefore the contents of the package, as described by the sender, for a minimum of 70 percent of all international packages, including all of these from China. It will have to provide the knowledge on all such shipments by the top of 2020.

The mail could block or destroy shipments that the knowledge isn't provided.

Cancer Center Switches Focus on Fund-Raising as Problems Mount

This article was reportable and written during a collaboration with ProPublica, the noncommercial journalism organization.

Memorial Sloan applied scientist Cancer Center has suddenly modified the main target of AN annual drive amid a widening crisis that has already crystal rectifier to the resignation of its chief medical man and a sweeping re-examination of its policies.

The campaign, at first titled “Harnessing massive information,” was to possess centered on the cancer center’s analysis into the utilization of computer science in cancer treatment, per a leaflet on Memorial Sloan Kettering’s website.

The move follows a writing Thursday by The NY Times ANd ProPublica concerning an exclusive deal that Memorial Sloan applied scientists created with a man-made intelligence start-up to use digital pictures of twenty-five million tissue slides analyzed over decades.

The corporate, Paige.AI, was based by 3 hospital insiders, and conjointly concerned investors UN agency were Memorial Sloan applied scientist board members.

Pathologists at the hospital complained that their work was being commercial for personal gain which patients weren't being conversant that pictures of their tissue slides were being shared with a doors company.

The hospital and its officers aforesaid they did nothing wrong, however, acknowledged that they might have communicated higher.

Kenneth Manotti, the cancer center’s senior VP and chief development officer, created a relation to the article in AN email sent Fri to board members of the Society of MSK, the hospital’s volunteer fund-raising arm, ANd a related committee.

It aforesaid the effort, which might have accelerated the center’s analysis on computer science, would be deferred “under these circumstances, as we have a tendency to navigate through the problems at  hand.”

An interpreter for Memorial Sloan applied scientist aforesaid weekday that the Society of MSK would instead concentrate on patient care and would proceed.

The society’s annual campaign generally raises funds starting from roughly $800,000 to $1 million for the hospital, she said. Overall, the society raised over $20 million a year for Memorial Sloan applied scientists, per its annual reports.

The amendment highlights the fund-raising challenges Janus faced by Memorial Sloan applied scientist, that is one amongst the nation’s most prestigious cancer centers and recently completed a $3.5 billion multiyear fund-raising effort.

Earlier this month, the hospital’s chief medical man, Dr. Jose Baselga, resigned under attack when writing by the days, and ProPublica unconcealed that he had did not disclose his intensive business ties in dozens of medical journal articles in recent years.

At conferences and in online forums, patients and employees members have expressed concern concerning the establishment and therefore the manner within which it interacts with the health and pharmaceutical industries.

The hospital has proclaimed a task force to check its conflict-of-interest policies and aforesaid weekday during a note to the employees that it'd rent an out of doors business firm to conduct a “focused review” of any old considerations that had been raised internally. The leaders aforesaid they believed the considerations were while not advantage.

That uneasiness was mirrored at an employees meeting on Thursday once a pediatric brain doctor told the leaders that she was a bit embarrassed concerning the establishment despite the fact that she could be an interpreter for Cycle for Survival, a Memorial Sloan applied scientist charity that raises cash for analysis. She asked for a recommendation on a way to go, per many attendees.

Dr. Craig B. Thompson, the hospital’s chief govt, responded that it absolutely was necessary to concentrate on the cancer center’s dedication to treating cancer, together with the rare cancers that area unit the main target of Cycle for Survival, per the attendees. Cycle for Survival raised $39 million this year.

The hospital interpreter, Christine Hickey, aforesaid the 2019 Cycle for Survival event was already planned and would proceed.

The fallout has crystal rectifier medical and tutorial consultants to imply tighter revealing rules on potential conflicts of interest within the cancer analysis fields and among major non-commercial organizations.

Dr. Thompson and Dr. Lisa DeAngelis, acting physician-in-chief, acknowledged the problem of low morale in AN email to the employees on Monday.

“We and our board area unit terribly awake to the frustration and distress that several of you're experiencing when recent events at our center,” they aforesaid within the memorandum, that was obtained from hospital employees members.

“We share these considerations and area unit deeply sorry that you simply feel upset. As your leaders, we have a tendency to acknowledge that nothing is a lot of necessary than maintaining the integrity and name of MSK and its employees.”

Fund-raising will quickly dampen once charities sustain a reputational hit, aforesaid Sophia Shaw, the co-founder and managing partner of fruit Advisors, advises nonprofits.

“They’re precisely like investors during a for-profit company,” Ms. Shaw aforesaid of donors. however, instead of expecting a come-on investment, donors expect a come-on charity’s mission.

“If the donor doesn’t feel that their cash is furthering that mission, then they might be reluctant to present it away at that point.”

Consultants for nonprofits aforesaid major donors were unlikely to be simply flustered by news reports, however, that would amendment betting on what happens next and the way the hospital responds.

“Individual funders — and conjointly foundations and companies — don’t like unhealthy news,” aforesaid Richard Mittenthal, president and chief govt of the TCC cluster, that advises nonprofits. “And once there’s unhealthy news, there’s continually a matter of — is there to any extent further unhealthy news?”

They Say Sexual Assault, Kavanaugh Says

They Say Sexual Assault, Kavanaugh Says It Never Happened: Sifting Truth From Memory

When Judge Brett M. Kavanaugh and Christine Blasey Ford present their vastly different recollections to the Senate on Thursday, the standard and reliability of memory itself will be on trial.

Judge Kavanaugh has emphatically denied allegations from Dr. Blasey that he tried to rape her once they were teenagers or ever committed sexual abuse against anyone. Dr. Blasey and another accuser, Deborah Ramirez, have recounted their alleged incidents with both precise detail and gaping holes.

Could Judge Kavanaugh’s accusers be mistaken about his identity? Could he somehow have erased the experiences they allege from his memory? Or, even, could all be telling what they genuinely believe is the truth?

The biology of memory, while still far away from figuring out , helps to elucidate how vastly different accounts can emerge from a shared experience.

Memory, by its nature and necessity, is selective, its details subject to revision and dissipation.

From the dizzying stream of incoming perceptions, the brain stores, or “encodes,” the sights, sounds, sensations, and emotions that it deems important or novel.

The quality of preservation may depend not only on the intensity of emotion within the moment an occasion occurs but on the mechanics of how that event is recorded and retrieved — in some cases, decades later.

“Recollection is typically a reconstruction, to some extent — it’s not a videotape that preserves every detail,” said Richard J. McNally, a professor of psychology at Harvard University and therefore the author of “Remembering Trauma.” “The details are often filled in later, or dismissed, and guessing may become a part of the memory.”

For a trauma victim, this encoding combines mortal fear and heart-racing panic with crystalline fragments of detail: the make of the gun, the color of the attacker’s eyes.

The emotion is so strong that the fragments can become untethered from time and place.

They may continue memory whilst other relevant details—the exact date, the conversation just before the attack, who else was within the room — fall out of reach.

“In situations of high arousal, the brain is flooded with hormones that strengthen those things you’re listening to,” said Daniela Schiller, a neuroscientist at the Icahn School of Medicine at Mount Sinai. “But other details are less accessible.”

Conversely, experts suggest, there are scenarios during which someone could have committed an assault and yet even have almost no memory of it. If an assailant attaches little significance to an assault—for instance, if he doesn’t consider it an assault — his brain may only weakly encode details of the encounter.

Symptoms of dengue virus

Dengue fever overview

Dengue (DENG-gey) fever may be a mosquito-borne disease that happens in tropical and subtropical areas of the world. Mild dengue causes a high fever, rash, and muscle and joint pain. A severe sort of dengue also called dengue hemorrhagic fever, can cause severe bleeding, a sudden drop in vital signs (shock), and death.

Millions of cases of dengue infection occur worldwide annually. Dengue fever is most common in Southeast Asia and therefore the western Pacific islands, but the disease has been increasing rapidly in Latin America and the Caribbean.

Researchers are working on dengue fever vaccines. For now, the best prevention is to reduce mosquito habitats in areas where dengue is common.

Symptoms

Many people, especially children, and teenagers may experience no signs or symptoms during a mild case of dengue fever. When symptoms do occur, they typically begin four to seven days after you're bitten by an infected mosquito.

Dengue fever causes a high fever — 104 F degrees — and a minimum of two the subsequent

symptoms:

• Headache
• Muscle, bone, and joint pain
• Nausea
• Vomiting
• Pain behind the eyes
• Swollen glands
• Rash

Most people recover within a week or so. In some cases, symptoms worsen and can become life-threatening. Blood vessels often become damaged and leaky. And the number of clot-forming cells (platelets) in your bloodstream drops. This can cause a severe form of dengue fever called dengue hemorrhagic fever, severe dengue, or dengue shock syndrome.

Signs and symptoms of dengue hemorrhagic fever or severe dengue - a life-threatening emergency - include:

• Severe abdominal pain
• Persistent vomiting
• Bleeding from your gums or nose
• Blood in your urine, stools, or vomit
• Bleeding under the skin, which could appear as if bruising
• Difficult or rapid breathing
• Cold or clammy skin (shock)
• Fatigue
• Irritability or restlessness

When to see a doctor

Call 911 or go to the nearest emergency room if you've recently visited a region in which dengue fever is understood to occur and you develop emergency symptoms, like severe abdominal pain, vomiting, difficulty breathing, or blood in your nose, gums, vomit, or stools.

If you develop a fever and milder symptoms common to dengue, call your doctor.

Causes

Dengue fever is caused by anybody of 4 sorts of dengue viruses spread by mosquitoes that thrive in and near human lodgings. When a mosquito bites an individual infected with a dengue virus, the virus enters the mosquito. When the infected mosquito then bites another person, the virus enters that person's bloodstream.

After you've recovered from dengue, you've got immunity to the sort of virus that infected you — but to not the opposite three dengue virus types. The risk of developing severe dengue also referred to as dengue hemorrhagic fever actually increases if you're infected a second, third, or fourth time.

Risk factors

Factors that put you at greater risk of developing dengue or a more severe sort of the disease include:

• Living or traveling in tropical areas. 

Being in tropical and subtropical areas increases your risk of exposure to the virus that causes dengue. Especially high-risk areas are Southeast Asia, the western Pacific islands, Latin America, and the Caribbean.

• Prior infection with a dengue fever virus.

Previous infection with a dengue fever virus increases your risk of getting severe symptoms if you're infected again.

Complications

If severe, dengue can damage the lungs, liver, or heart. Blood pressure can drop to dangerous levels, causing shock and, in some cases, death.

Prevention

One dengue vaccine, Dengvaxia, is currently approved to be used in those ages 9 to 45 who sleep in areas with a high incidence of dengue. The vaccine is given in three doses over the course of 12 months. Dengvaxia prevents dengue infections slightly more than half the time.

The vaccine is approved only for older children because younger vaccinated children appear to be at increased risk of severe dengue and hospitalization two years after receiving the vaccine.

The World Health Organization stresses that the vaccine isn't an efficient tool, on its own, to scale back dengue in areas where the illness is common. Controlling the mosquito population and human exposure remains the foremost critical part of prevention efforts.

So for now, if you're living or traveling in a neighborhood where dengue is understood to be, the

The best thanks to avoid dengue are to avoid being bitten by mosquitoes that carry the disease.

If you're living or traveling in tropical areas where dengue is common, the following pointers

may help reduce your risk of mosquito bites:

• Stay in air-conditioned or well-screened housing. 

The mosquitoes that carry the dengue viruses are most active from dawn to dusk, but they will also bite in the dark.

• Wear protective clothing.

When you go into mosquito-infested areas, wear a long-sleeved shirt, long pants, socks, and shoes.

• Use mosquito repellent. 

Permethrin can be applied to your clothing, shoes, camping gear, and bed netting. You can also buy clothing made with permethrin already in it.

For your skin, use a repellent containing a minimum of ten percent the concentration of DEET.

• Reduce mosquito habitat.

The mosquitoes that carry the dengue virus typically live in and around houses, breeding in standing water which will collect in such things as used automobile tires.

You can help lower mosquito populations by eliminating habitats where they lay their eggs. At least once a week, empty and clean containers that hold standing water, like planting containers, animal dishes, and flower vases. Keep standing water containers covered between cleanings.