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Tuesday, June 23, 2015

6 ways LGBT patients can get the most out of their health care

IMAGE: JETTA PRODUCTIONS/BLEND IMAGES/CORBIS

Visiting the doctor can be a high-anxiety experience for any patient, but those who identify asLGBT are especially prone to discomfort.

Standard interactions with medical professionals often revolve around the assumption that a patient is straight, causing distress for members of the LGBT community during even the most routine checkups.

SEE ALSO: 10 meaningful ways you can celebrate LGBT Pride Month

There's also the fear of gender-based discrimination that transgender people face when visiting a health professional. Medical records can "out" trans people when name and pronoun changes aren't accounted for in bookkeeping. But even willingly coming out to a doctor exposes trans patients to the possibility of being both medically misunderstood and a victim of violence.

The anticipation of encountering an intolerant doctor is enough to make LGBT patients want to cancel all of their checkups. And a lot of them do.

While 17% of straight individuals report delays in seeking medical care, 29% of LGBT individualssay they put off their doctor visits. Yet LGBT people are more likely to need care addressing emotional health, suicide ideation, substance abuse, HIV/AIDS care and cancer treatments.

While the Affordable Care Act provided some protections for LGBT individuals seeking medical care, there are still no national laws banning discrimination on the basis of gender identity and sexual orientation. A number of states have instituted non-discrimination laws on their own, which mostly protect patients on the basis of sexual orientation, and some clinics have anti-discrimination clauses in their practice policies. But the lack of nationwide protection is still a very real issue LGBT people face.

Navigating a health care system that is not designed with your needs in mind is daunting, and educating your doctor on your identity can be frustrating. But Barbara Warren, Psy.D., the director of LGBT Programs and Policies for the Mount Sinai Health System in New York, says confronting uninformed medical professionals is necessary in our current health care climate.

“My belief is that the onus should be on the health system and not on the patient," Warren tellsMashable. "But the reality right now is that we are not quite there yet in terms of LGBT issues. Hopefully we can empower patients to say who they are and ask for what they need.”

To get the most out of your health care, and to receive the most complete care possible, read this guide to being a more empowered LGBT patient.

1. Do your research.

Don't feel compelled to go to the same health care provider your family has gone to for generations if it isn't the safest space for you. Researching your options — even if they seem insignificant — will help you pick the best provider for your needs.

“I always tell people, 'Be a shopper,'” Warren says. “Before you go there, check it out.”

Shop around for a clinic that’s sensitive and inclusive, and promotes it. If the clinic’s LGBT patient values aren’t apparent on its website, dig deeper with a preliminary phone call. A clinic you want in charge of your health will answer any and all questions you have about its policies and practice.

The best place for you may be a clinic that’s farther away than the office down the street, but it's worth the travel for competent care.

2. Know what issues may arise, and think about the best ways to address them.

If you are a member of the LGBT community, you probably have a mental list of uncomfortable moments that always arise at the doctor's office. Maybe that includes questions about sex that assume you're with someone of the opposite sex, or assumptions about your gender identity that aren't quite on-point with how you identify.

Whatever the case, instead of just brushing these moments off as inevitably uncomfortable, think of how you would address them before stepping into the doctor's office. For example, your doctor is always going to ask some form of, “Are you sexually active?” It’s standard on intake forms and some need-to-know medical information. But, if your medical provider assumes you're straight, he may not consider what your answer implies about your sexual health and potential health risks.

In that situation, it’s best to clarify what he is trying to ask. Does he want to know if you have had sex within the past six months with a person with a penis? Is he wondering if you could be pregnant? Or maybe you’ll want to just offer straightforward information about your identity by saying, “I currently have one sexual partner and she’s a woman.”

Make a list of questions you may encounter, and have a plan for addressing them.

3. No matter how you do it, bring up your identity.

While coming out is always a personal decision, it's important to weigh that personal choice with the necessity of health care tailored to your complete self. Warren believes it’s essential to be open with your identity to receive the most relevant, competent care.

“That is my personal opinion. That is my strategic opinion. That is also my social justice opinion,” Warren says.

In some cases, it might be helpful to request a preliminary chat with your doctor to address your identity. However you bring up your sexuality or gender, do so honestly and openly. If you need some support, bring someone with you who can serve as an advocate in possibly tough moments.

Coming out is the only way to receive care tailored to your specific needs as someone of a marginalized gender or sexuality — and it's also the only way to know if your health care provider will be an unwavering supporter of you as a patient.

4. Call out problematic moments.

If you are in the middle of an appointment and even the smallest microaggression occurs, call it out — if you're comfortable to do so. Feel empowered to challenge your provider's missteps. Ultimately, challenging their assumptions, language and biases will help them provide you and others with more inclusive care.

Warren says this is more than warranted, and sometimes absolutely necessary for people of marginalized genders and sexualities.

“It’s absolutely OK for you to say, ‘My preferred name is Jane, it’s also my legal name. My gender pronoun is 'she' and that’s what you need to be calling me,’” Warren says.

If your provider isn’t complying with your requests or has a harsh reaction, consider filing a formal complaint against the practitioner and the clinic. Warren recommends knowing the proper channels to file a complaint before you even step into a doctor's office.

5. Take control of your own health care.

Taking ownership of your health is the best thing you can do for your well-being. Warren recommends having a relationship with your doctor in which you are open to share your needs and questions without judgment.

“[It’s] OK to go to your provider and ask questions and make certain demands,” she says. “We’ve sort of had this hierarchical system where the doctor's the expert — and they are usually white, male, cisgender and straight — and the patient's an idiot.”

Instead of prescribing to that hierarchy, challenge it. A doctor may be an expert in medicine, but you are the expert on yourself. Use your knowledge of your identity to discern what you need from your health care. Then, advocate for those needs.

6. Practice self care.

Navigating even the most standard doctor visit with a queered sexuality or gender expression can be frustrating, difficult and draining. During the process, it’s important to keep track of your own well-being to ensure you're not only getting the best treatment possible, but also taking care of yourself.

If you're in a situation with your doctor that feels dangerous, uncomfortable or out-of-line, call off the appointment — even if it’s in the middle of a physical while you’re wearing an ill-fitting medical gown.

Always feel empowered to end a consultation if your needs are not being adequately addressed, especially if you are being disrespected. When it comes to your health, your needs should come before everything else.

Sunday, June 21, 2015

Blind Americans can now ‘see’ with a device that uses their tongues

The three-part device BrainPort V100 will cost about $10,000.

IMAGE: WICAB VIA BLOOMBERG

MICHELLE CORTEZ for Bloomberg Business

1 day ago

A new device that helps the blind "see" by using their tongues has been approved by the U.S.Food and Drug Administration.

The BrainPort V100, cleared for 250,000 profoundly blind Americans without sensitivity to light, will cost about $10,000, said Robert Beckman, chief executive officer of closely held Wicab Inc.The three-part device captures images with a camera mounted on sunglasses, routes them through a hand-held controller and sends them to a 1-inch square device containing 400 electrical stimulation points that rests on the user's tongue.

"People are able to learn to interpret these patterns of bubbles or stimulation on their tongue to know what object is in front of them," Beckman said. "We don't want to create false hopes," he said. "They need to learn the technology and practice with it. It's more akin to learning a new language than it is to ordinary perception."

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People using the BrainPort for the first time can often walk around an oval track, staying within the white lines without assistance, Beckman said. With additional training, they can navigate hallways, read short words such as EXIT, tell the difference between a ball and a banana, and eventually play darts, he said. The BrainPort was approved for use in Europe in 2013, according to the company's website.

"Medical device innovations like this have the potential to help millions of people," said William Maisel, deputy director for science at the U.S. Food and Drug Administration. "It is important we continue advancing device technology to help blind Americans live better, more independent lives."

Brain stimulation

Studies show that people who are blind perceive the electrical stimulation in their visual cortex, the part of the brain responsible for sight. People using the BrainPort who aren't visually impaired process it as tactile information, Beckman said.

Google Inc. and the U.S. Department of Defense helped fund the device's development. Wicab, based in Middleton, Wisconsin, licensed a patent on the device from the Wisconsin Alumni Research Foundation, a nonprofit patent and licensing organization for the University of Wisconsin at Madison.

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The company hopes to gain insurance reimbursement for the device, though it acknowledges that adoption of the technology may be slow going, especially at first.

"The reality is that most people who are profoundly blind are also quite poor," Beckman said. "It will take off slowly just because of blind people being so impoverished."

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Injectable implants could help crack the brain’s codes

A micrograph shows neurons (whose nuclei are stained blue) integrated with a flexible nanoelectronic mesh (green) inside a mouse brain.

IMAGE: MIT TECHNOLOGY REVIEW

MIKE ORCUTT for MIT Technology Review

2 days ago

Understanding how the brain works — or doesn't, as the case may be — depends on deciphering the patterns of electrical signals its neurons produce. Recording them requires inserting electrodes into the tissue. But the rigid devices traditionally used to record these signals, or to therapeutically stimulate certain regions, can damage the brain and elicit an immune response, and they tend not to work for very long.

Now researchers have shown that a new type of flexible electronic device, which can be delivered via injection, could be a gentler alternative.

In the near term, the technology could yield valuable insights about how the electrical activity of certain circuits, or networks of neurons, is related to discrete functions, like the creation of a lasting memory. It could also shed light on the brain's dysfunctions, like schizophrenia or Parkinson's disease (see "Cracking the Brain's Codes" and "Shining a Light on Madness"). Further down the road, the concept could lead to a better way to deliver therapeutic stimulation to address neurodegenerative diseases, or a stable brain-computer interface that might help disabled people do things their condition usually wouldn't allow them to do, like move prosthetic limbs or communicate (see "The Thought Experiment").

One current therapeutic use of implanted electronics is called deep brain stimulation, which is FDA-approved and used to treat Parkinson's disease. The therapy involves inserting electrodes into certain regions of the brain and producing electrical pulses meant to regulate abnormal ones. This approach is also being studied as a treatment for other disorders, such as epilepsy.

Today's technology is limited, not by the electronics, which are already "really powerful," but because the interface between the brain tissue and the electronics is far from ideal, saysCharles Lieber, a professor of chemistry and chemical biology at Harvard University. Existing implantable electrodes are too large and rigid, and this "mechanical mismatch" leads to tissue damage and immune response, he says.

Over time the devices tend to lose their ability to record or stimulate the area of interest. Researchers can only record for a matter of days or weeks. Implants for deep brain stimulation often must be repositioned or have their settings adjusted, and usually don't last for more than a few years.

In recent years, a lot of progress has been made in research labs toward designing new kinds of implantable electronic devices made of more flexible and biocompatible materials (see "Wireless Micro LEDs Control Mouse Behavior"), but none have overcome this problem, Lieber says.

The new nanoelectronic "mesh" structure that Lieber's group has designed is much more like the biological tissue it is meant to interface with

The new nanoelectronic "mesh" structure that Lieber's group has designed is much more like the biological tissue it is meant to interface with, he says. Its features are the size of cells or smaller, and, according to the researchers, the mesh is several orders of magnitude more flexible than any previous implantable electronic device.

The group originally conceived of the design a few years ago with tissue engineering in mind. They developed a scaffold-like structure that could support the growth of cells in three dimensions, similar to how it happens in the body, and also house electronic sensors for taking measurements from those cells. That demonstration suggested that the technology was potentially useful for measuring cellular activity.

Now they've shown that they can use a syringe to inject the mesh scaffold into targeted areas in the brains of live mice. They also demonstrated the ability to record signals from the injected implants by attaching a wire to a section of the mesh that remains outside the body. Tests indicate very little harmful tissue response, suggesting that the technology offers "substantial promise" for long-term brain activity mapping.

Made using conventional photolithography techniques, the mesh is composed of nanoscale metal wires and polymers. Tiny electronic devices, such as sensors and electrode stimulators, can be built into it. A scaffold that is a centimeter and a half in width can fold into a size small enough to be injectable through a needle whose diameter is just a few hundred micrometers. Once inside the body, it unfolds to conform to its 3-D environment. When it encounters a ventricular cavity in the brain, for example, it can unfold to fill in the space, bridging the two sides. Over time, neurons integrate with the mesh, providing the opportunity to record from or stimulate many single cells in a given region. The cells and the mesh have a "very positive interaction," says Lieber, and the neurons "seem happy, at least over a month's timescale."

Lieber says his group has observed in unpublished experiments that it is possible to record for several months, from the same specific neurons, without signal degradation. He says the goal now is to demonstrate the same over six months to a year in mice before moving on to primates and, eventually, human trials.

Have something to add to this story? Share it in the comments.

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This article originally published at MIT Technology Review here

Saturday, June 20, 2015

A single pinprick test could detect hundreds of viruses

Mature HIV virus infection and budding release of HIV in human lymphatic tissue.

IMAGE: CORBIS DENNIS KUNKEL MICROSCOPY, INC./VISUALS UNLIMITED

JESSE EMSPAK for LiveScience

Jun 10, 2015

Doctors often don't have a complete picture of their patients' health histories — they only know about past illnesses that a patient remembers and tells them about, and patients may not know whether they've been exposed to certain diseases.

But now, researchers at Brigham and Women's Hospital in Boston say they have created a tool that could reveal many of the viruses that have infected a person in the past. Called VirScan, the test looks for hundreds of viruses at once, and does so at a fraction of the cost of traditional tests, and with smaller samples of blood, according to the researchers.

"We could use a lot less blood [than traditional tests]," said Tomasz Kula, one of the co-authors of the new research and a graduate student at Harvard Medical School. "It could be a pinprick."

To make the test, the researchers used the DNA codes of 206 viruses whose genomes had previously been sequenced. The researchers focused on the part of the viral DNA that codes for the proteins that appear on the virus' surfaces, and engineered new viruses to have these surface proteins.

SEE ALSO: The 9 deadliest viruses on Earth

The VirScan test uses these engineered viruses to look for antibodies to each of these viruses in a sample of a person's blood. Antibodies are immune system molecules that zero in on the proteins of a virus's coat and stick to it, flagging the virus as a foreign invader and alerting other parts of the immune system to kill or neutralize the virus.

In experiments, the researchers ran the test on nearly 600 people living on four continents. They found that the study participants had antibodies to an average of 10 virus species. In two people, they found antibodies to 84 virus species.

To see how well the scan could work as a test, the group ran the scan on people known to be infected with hepatitis C and HIV. VirScan detected the viruses 95% of the time.

The researchers were surprised to find that widely separated groups of people, more often than not, showed antibodies to the same or similar viruses. "We thought it would be a lot more individual than that," Kula said. "Maybe antibodies have more similarity than we've been thinking."

SEE ALSO: 5 viruses that are scarier than Ebola

Kula said this finding showcased one of the big advantages of this method of testing for a person's viral infection history: The VirScan allows researchers to see similarities and differences in large populations.

This could be helpful in studying conditions — for example, chronic fatigue syndrome — that researchers suspect may be caused by a virus but haven't proven for sure to have a viral origin. Current methods of testing for hundreds of viruses at are time-consuming and expensive, but the new test could make such an analysis feasible, the researchers said.

"We could also see if individual viruses are correlated to other diseases, or try to figure out why only a fraction of patients" are helped by certain cancer treatments, Kula said.

Because the new test is relatively cheap — Kula noted the chemicals necessary are a few dollars per person, or perhaps even less — it could also help doctors and patients by detecting their exposure to a virus they weren't aware of. Hepatitis C, Kula said, is often not detected for months or years, because few people think to ask about it.

But there are limits to what VirScan can do. It won't work on newly discovered viruses, or any other virus that researchers have not yet sequenced. Also, viruses with small genomes may be harder for the test to find, Kula said.

The study was funded by the Howard Hughes Medical Institute, and appeared on June 4 in the journal Science.

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4 debunked myths about allergies

IMAGE: CORBIS ARMAN ZHENIKEYEV

SALLY BLOOMFIELD, HONORARY PROFESSOR AT LONDON SCHOOL OF HYGIENE & TROPICAL MEDICINE for The Conversation

Jun 07, 2015

Allergies are on the rise across the developed world, and hay fever and eczema have trebled in the last 30 years. Yet allergies are an area of much confusion and concern. Although 40% of people report having a food allergy, in fact only 1-5% do, and allergists commonly report spending most of their consultations refuting firmly held beliefs that have no scientific foundation.

Theories about allergy — some from medical research and some from lifestyle "gurus" — have led to conflicting information, making it hard to know what to believe. Because of this, Sense About Science worked with me and a number of allergists, immunologists, respiratory scientists and pharmacists to produce Making Sense of Allergies, a guide tackling the many myths and misconceptions about allergies. One common myth — something that I work on — is the link between allergies and exposure to microbes.

So here is a hygiene and allergy reality fact check:

How to use your local park for a kickass workout

IMAGE: MASHABLE/LILI SAMS

BY KATHLEEN WONGJUN 11, 2015

Your gym is cold and poorly lit. The great outdoors is your playground.

Mashable followed fitness trainer and founder of New York-based boot camp Trooper Fitnessand FL2 ambassador, Prince Brathwaite, around Union Square, New York to learn a high-intensity interval training (HIIT) circuit routine. It only require objects easily found in your local park, and maybe even your backyard. No purchase necessary.

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Complete this set about three to five times, which should take you about 15 to 30 minutes, depending on your fitness level. And don't forget your sunscreen.

1. Power step-ups

Snag an empty bench to use for jumping step-ups. Do 20 of these, alternating your legs.

2. 180 degree staggered jump squat

To take things up a notch, rotate your body 180 degrees with each step-up jump. Do 10 and then switch sides to do 10 more.

3. Inverted mountain climbers

Remember mountain climbers from gym class? Take it to the next level by inverting them against a tree. Climb upwards slowly to get into position. Then carefully kick off, alternating legs for 20 reps.

4. Inverted half-squat thrust

Staying with your feet against the tree, you're going to kick both legs off into an inverted squat. Then lower them to the ground and thrust them back against the tree. Do this 10 times.

5. Wall sit

Finish off the routine with a wall sit against a tree for one minute, keeping your arms crossed against your chest or straight out.