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killkarichildcare · 2 days ago

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The Fourth Trimester: Your Essential Guide to Newborn Care After Delivery

The moment you meet your newborn is pure magic. But once you leave the hospital or birthing center, reality sets in: you’re now fully responsible for this tiny, fragile human. Post-delivery newborn care – often called the "fourth trimester" – is a whirlwind of feeding, sleeping, crying, and learning. Here’s your roadmap to navigate those crucial first weeks with confidence.

The First 24-72 Hours: Getting Started 1.The Golden Hour & Immediate Bonding: * Skin-to-skin contact right after birth regulates baby’s temperature, heart rate, and breathing, and encourages breastfeeding initiation. * Don’t rush it – savor this time! 2.Hospital/Birthing Center Essentials: * Vital Checks: APGAR scores, weight, length, head circumference. * Vitamin K Shot: Crucial for blood clotting (prevents rare bleeding disorders). * Eye Ointment (Erythromycin): Prevents eye infections from bacteria in the birth canal. * Newborn Screening Tests: Heel prick test for metabolic disorders (done before discharge). * Hearing Screening: Usually done before you go home. 3. First Feedings: * Breastfeeding: Offer the breast within the first hour if possible. Colostrum (early milk) is liquid gold! Expect frequent cluster feeding. * Formula Feeding: Follow instructions carefully for preparation and sterilization. Hold baby semi-upright. * Signs of Hunger: Rooting, lip-smacking, hands to mouth (crying is a late sign!). Bringing Baby Home: Core Care Pillars 1. Feeding: Fueling Growth * Frequency: Newborns eat 8-12 times per 24 hours (every 2-3 hours), on demand. Wake a sleepy baby if needed. * Breastfeeding: * Focus on good latch (wide mouth, chin to breast, no pain). * Watch for swallowing (jaw movement, soft "kuh" sound). * Wet/Dirty Diapers: Best indicator of intake (see chart below) * Formula Feeding: * Use iron-fortified formula. * Sterilize bottles/nipples initially; wash thoroughly with hot soapy water after. * Hold bottle horizontally to avoid overfeeding. Burping: Essential! Burp halfway through and after feeds (over shoulder, sitting on lap, or face-down on your lap). 2. Sleeping: Safe & Sound Safe Sleep ABCs (Non-Negotiable!): * A lone (in their own safe sleep space – bassinet/crib). * B ack (always place baby on their back). * C rib (firm mattress, fitted sheet ONLY – no pillows, blankets, bumpers, toys).

Room Sharing: Keep baby in your room (but not in your bed) for at least 6 months. Patterns: Newborns sleep 14-17 hours per day in short stretches (2-4 hours). Day/night confusion is normal initially.

Diapering & Hygiene Frequency: Change diapers every 2-3 hours or immediately after pooping (prevents rash). Technique: Wipe front-to-back (especially girls). Clean thoroughly, allow skin to air dry. Use diaper cream if skin is red. Umbilical Cord Care:

Keep it clean and dry (sponge baths only). * Fold diaper below the stump. * Let it fall off naturally (usually 1-3 weeks). Watch for redness, swelling, foul odor (signs of infection). Bathing: * Sponge baths until cord falls off & circumcision heals (if applicable). * Then, 2-3 short (5-10 min) tub baths per week is plenty. Use mild, fragrance-free soap. Support head/neck.

Soothing & Understanding CuesWhy They Cry: Hunger, wet/dirty diaper, tired, cold/hot, gas, overstimulation, need for comfort. Soothing Techniques: * The 5 S's (Swaddle, Side/Stomach position, Shush, Swing, Suck). * (Only for soothing,) *never for sleep - always place on back! * Skin-to-skin contact, gentle rocking, babywearing, white noise. Learn Their Signals: Yawning = tired. Turning away = overstimulated. Fussing/rooting = hungry.

Health Monitoring & Doctor Visits First Pediatrician Visit: Usually within 2-5 days after discharge (to check weight, jaundice, feeding). Danger Signs (Seek IMMEDIATE Medical Attention):

Fever (100.4°F/38°C rectally in a newborn < 2 months). * Difficulty breathing (grunting, flaring nostrils, ribs pulling in). * No wet diapers for >12 hours. * Lethargy (hard to wake), extreme floppiness. * Forceful vomiting (not just spit-up). * Jaundice (yellow skin) spreading to arms/legs or worsening. Common Concerns:

Jaundice: Mild yellowing is common. Feed often to flush bilirubin. Phototherapy may be needed if levels rise. * Baby Acne/Milia: Harmless, usually clears on its own. * Cradle Cap: Gentle washing, soft brush, mineral oil if needed. Wet/Dirty Diaper Tracking (Key Indicator!): Day of Life Wet Diapers Dirty Diapers (Stool) Day 1 1–2Thick, black/green (meconium) Day 2 2–3 Dark green/brown (transitional) Day 3 3–5 Green/brown/yellow, softer Day 4+ 6+ Yellow (breastfed: seedy/mustardy; formula: tan/pasty), 3–4+ per day

Caring for YOU to Care for THEM

Rest: Sleep when baby sleeps (seriously!). Delegate chores.

Nourishment: Eat regularly & stay hydrated (especially if breastfeeding).

Support: Ask for & accept help (feeding, cooking, cleaning).

Emotional Health: Baby blues (mood swings, weepiness) are common for 1-2 weeks. If feelings of sadness/anxiety persist or intensify, seek help for possible Postpartum Depression/Anxiety (PPD/PPA). You matter too.

The Takeaway: Trust Your Instincts (and Your Village). Newborn care is a steep learning curve filled with trial and error. There’s no "perfect." Focus on the essentials – feeding, safe sleep, hygiene, and responding with love – and the rest will follow.

Trust your instincts. If something feels "off," call your pediatrician. Don’t hesitate to lean on your partner, family, friends, or a postpartum doula. This intense, beautiful phase is temporary. You are learning, and so is your baby. Be gentle with yourselves.

What’s one newborn care tip you wish someone had told you? Share your wisdom in the comments below!

(Disclaimer: This blog provides general information. Always consult your pediatrician or healthcare provider for personalized advice regarding your newborn's health and care.)

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humbleworksstandingdesk · 5 years ago

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The ABCs Of Illness Due To A Sedentary Lifestyle

Have you ever thought about how you sit for a prolonged time and still don’t realize it, let alone realize the effects it has on your body?

Studies suggest that the average office worker spends75% of their day sitting down at their standing desk. And if you are a sedentary worker, if you’re not stuck at the office glued to the screen, you’re, you’re swiping or scrolling through your cell phone—which frankly, is just an extension of prolonged sitting.

Sitting down for long periods of time at an office desk (or anywhere else for that matter) is detrimental to our health in a number of ways—but the crazy thing is, most people don’t know it.

The concept of sitting in moderation is a concept that has been lost.Good posture is essential to a healthy, happy life—as is standing up more—and we’re going to explain why.

We’re not designed to sit but to stand and to move and as much as sitting can bring more comfort or relief to your body, just like too much sugar, too much of it will have its consequences.

So, to help you on your way to a healthier, happier existence, we’re going to give you a peek into the ABCs of the health issues caused by a super sedentary lifestyle.

A – Ageing

A pivotalstudy shows that a sedentary lifestyle accelerates ageing. When Telomere (a nucleotide sequence of DNA) of two different lifestyles (one active and the other inactive) were compared and repeatedly recorded, the active one had longer telomere, while the inactive one had a shorter telomere (this had shortened with every recording, showing slow degeneration). Since telomere is a marker for a person’s biological age, it’s clear that inactivity accelerates ageing. Also, the health issues caused by sitting indirectly impact the ageing process.

B – Blood pressure

Immobility and lack of physical activity of the body results in hypertension or high blood pressure as it goes unregulated. If you move more and invest in a standing desk while at work, you will stand a far greater chance of keeping your blood pressure at a safe level.

C – Cholesterol

It’s no secret:Too much-sitting results in weight gain, but when that weight starts showing around the hips and waist, you are at an increased risk of high cholesterol levels which can lead to serious heart conditions.

D – Deep Vein Thrombosis (DVT)

Immobility in the body reduces blood circulation. The blood pools in certain parts of the body causing blood clots which can lead to issues like DVT. This is a serious health issue where long-term effects can result in the inability to walk properly or worse, lose the ability to walk completely.

H – Heart problems

When we sit for a long period, our body’s fat-burning ability is drastically reduced, resulting in poor blood circulation as well as a build-up of fatty acids. When these acids have nowhere to go they settle in the arteries, blocking the entry and exit of blood to the heart—a recipe for disaster.

I – Inactivity

The human body’s purpose is to move and we are structured to stand, not sit. Every time we sit for a prolonged period, we invite a new health problem that has short and long term repercussions. Inactivity does harm to your body more than you may think. By improving your posture at work and moving more, you can avoid this plethora of health issues.

M – Mental health issues like depression and anxiety

Sitting not only causes physical but also mental health issues—those that typically go unnoticed. When you sit for too long, you can lose the motivation to do anything. When you lose motivation, you tend to go outdoors less that will deprive your brain of fresh air, vitamin D or social interaction, thus creating feelings of loneliness, anxiety and depression.

N – Nerve damage

Too much sitting can numb the whole body while creating a series of blood clusters. Similarly, sitting also numbs the nerves, which bears a lot of pressure and can lead to chronic damage.

O – Obesity

Sitting for longer periods has strong links to weight gain. This happens as a result of decreased lipoprotein lipase activity which creates a negative impact on the body’s ability to burn fat. When the fat burning process slows down, the body burns carbohydrates instead of fat which means that weight is not lost at all. Even if you follow a low-calorie diet, sitting for extended periods will significantly reduce your body’s ability to burn fat.

P – Poor posture

We slouch all the time and sitting elevates the effects of slouching, causing neck, back, shoulder and hip pain in the process. Poor posture often leads to a variety of chronic health and mobility problems which naturally, will have a negative impact on your quality of life—so keeping tabs on it is incredibly important.

S – Sugar

Inactivity puts stress on the cells to produce insulin which spikes blood sugar with too much pressure. Both of these factors combined can become a big contributing factor in diabetes.

T – Type 2 Diabetes

People with a sedentary lifestyle are at a significantly increased risk of Type 2 Diabetes.Inactivity tends to weaken the muscles that result in lower insulin sensitivity which, in turn, raises the chances of contracting diabetes.

V – Varicose veins

When you’re immobile for a long time, your blood circulation slows down to the point that blood starts collecting in various parts of your body, giving rise to spiderweb-like networks called varicose veins. These result in swollen legs, calves, and ankles. Though it’s possible to treat this condition, ignoring varicose veins can lead to more serious conditions like blood clots and Deep Vein Thrombosis (DVT).

W – Weak legs and glutes/muscles

Being idle stops the muscles from getting any form of workout. So, instead of making them flexible, we loosen them up. Loose muscles are unable to help us stand or support our body properly, thus weakening the legs and glutes. You might think that exercising will compensate for your continuous sitting habits, but it won’t undo the damage sitting has already done to your body internally. As such, standing up at work and commitment to moving more frequently is essential if you want to avoid the health issues mentioned here.

Now that you know the many hidden side effects of sitting too much, you can make a change for the better. In addition to eating and sleeping better, getting more exercise, and improving your general posture and perhaps investing in the right standing desk will improve your lifestyle tp no end.

Explore our selection of specialist standing desks and make a change for the better, today.

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itsmareecheatham · 5 years ago

Text

The ABCs Of Illness Due To A Sedentary Lifestyle

Have you ever thought about how you sit for a prolonged time and still don’t realize it, let alone realize the effects it has on your body?

Sitting down for long periods of time at an office desk (or anywhere else for that matter) is detrimental to our health in a number of ways—but the crazy thing is, most people don’t know it.

The concept of sitting in moderation is a concept that has been lost.Good posture is essential to a healthy, happy life—as is standing up more—and we’re going to explain why.

We’re not designed to sit but to stand and to move and as much as sitting can bring more comfort or relief to your body, just like too much sugar, too much of it will have its consequences.

So, to help you on your way to a healthier, happier existence, we’re going to give you a peek into the ABCs of the health issues caused by a super sedentary lifestyle.

A – Ageing

B – Blood pressure

C – Cholesterol

D – Deep Vein Thrombosis (DVT)

H – Heart problems

I – Inactivity

M – Mental health issues like depression and anxiety

N – Nerve damage

Too much sitting can numb the whole body while creating a series of blood clusters. Similarly, sitting also numbs the nerves, which bears a lot of pressure and can lead to chronic damage.

O – Obesity

P – Poor posture

S – Sugar

Inactivity puts stress on the cells to produce insulin which spikes blood sugar with too much pressure. Both of these factors combined can become a big contributing factor in diabetes.

T – Type 2 Diabetes

V – Varicose veins

W – Weak legs and glutes/muscles

Explore our selection of specialist standing desks and make a change for the better, today.

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getfastestnews · 5 years ago

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Trump criticised for leaving hospital to greet supporters

US President Donald Trump sparked an angry backlash from the medical community on Sunday with a protocol-breaking visit to his supporters outside the hospital where he is being treated for the highly infectious, potentially deadly new coronavirus.

He was masked as he waved from inside his bulletproof vehicle during the short trip outside Walter Reed military medical centre near Washington, which appeared designed to take back the narrative on his improving health after a weekend of muddled messaging from his doctors.

The last-minute limousine outing came with Trump's doctors satisfied enough about his progress to suggest the possibility of his being discharged on Monday.

But experts complained that the outing broke his own government's public health guidelines requiring patients to isolate while they are in treatment and still shedding virus — and endangered his Secret Service protection.

Trump, who has been repeatedly rebuked for flouting public health guidelines and spreading misinformation on the pandemic, said in a video that dropped on Twitter just before the appearance that he had “learned a lot about Covid” by “really going to school” as he has battled the virus.

But health experts took to the airwaves and social media to criticise the “stunt”, which they said demonstrated that he had learned nothing at all.

“Every single person in the vehicle during that completely unnecessary presidential 'drive-by' just now has to be quarantined for 14 days,” said James Phillips, chief of disaster medicine at George Washington University.

“They might get sick. They may die. For political theatre. Commanded by Trump to put their lives at risk for theatre. This is insanity.”

White House spokesman Judd Deere said “appropriate” precautions had been taken to protect Trump and his support staff, including protective gear.

“The movement was cleared by the medical team as safe to do,” he added.

But Zeke Emanuel, chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania and regular TV pundit, described the appearance as “shameful”.

“Making his Secret Service agents drive with a Covid-19 patient, with windows up no less, put them needlessly at risk for infection. And for what? A PR stunt,” he tweeted.

Confused messaging

The episode came hours after a briefing by Trump's medical team, who said he had “continued to improve” and could be returned to the White House, which has the facilities to treat and isolate the president, as early as Monday.

The president was flown to Walter Reed with a high fever on Friday after a “rapid progression” of his illness, with his oxygen levels dropping worryingly low, Trump's physician Sean Conley said in a Sunday briefing.

Health experts have complained that the messaging from the administration — and particularly Trump's medical team — has caused widespread confusion.

Conley admitted on Sunday that he had kept from the public the fact that the president had been given extra oxygen, in a bid to reflect an “upbeat attitude”.

And he gave a rosy account of Trump's progress on Saturday, only for White House chief of staff Mark Meadows to tell reporters immediately after that Trump's condition had been “very concerning” and that he was “still not on a clear path to a full recovery”.

'White House Cluster'

With his tough reelection campaign in its final month against Democratic rival Joe Biden, Trump's diagnosis and hospitalisation have left him sidelined from what he does best — campaigning.

Meanwhile, Biden — who announced on Sunday his latest negative test for the virus — will start the week with a trip on Monday to key swing state Florida.

But Trump and his advisers have done their best to project a sense of continuity.

His deputy campaign manager Jason Miller told ABC on Sunday he had spoken to Trump for a half and hour on Saturday and that the president was “cracking jokes”.

But controversy has been mounting over the possibility that Trump might have exposed numerous others to Covid-19 even after a close aide tested positive.

A timeline provided by his advisers and doctors suggested he met more than 30 donors on Thursday in Bedminster, New Jersey, even after learning that Hope Hicks had the virus — and just hours before he announced his own positive test.

There were more than 200 people at the fundraiser, and a contact tracing operation under way in New Jersey was looking at potentially thousands of people who may have been exposed.

All this came in a week when a Wall Street Journal/NBC poll — taken in the two days after a bruising presidential debate with Biden but before news emerged of Trump's illness — gave Biden a significant 53-39 per cent lead among registered voters.

As well as Trump and Hicks, numerous White House insiders and at least three Republican senators have contracted Covid-19, along with First Lady Melania Trump, who has not experienced severe symptoms.

Public health experts have expressed alarm at the “White House cluster” that has been linked to the September 26 Rose Garden celebration of conservative judge Amy Coney Barrett's nomination to the Supreme Court.

#International News

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jaketapper · 8 years ago

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Dartmouth Commencement 2017

President Hanlon, Board of Trustees, distinguished faculty, fellow honorees; Magnificent alumni including and especially my dad, Class of 1961; My wife, Jennifer ... and with her in mind ... Members of the admissions committee for the Dartmouth Classes of 2029 and 2032, who are right now for the first time hearing the names Alice Tapper, age 9, and Jack Tapper, age 7; Friends of mine from the Class of 1991—Hillman, Scully, Haber, Kessler, Miller, Groq, Barts, Edison—most of whom I met 30 years ago this fall in the Choates, which I’m still not convinced is not a psychological experiment by Dartmouth Housing. They are here today, because if you want it to happen, friendships formed here can last for the rest of your lives; Rejoicing families; And most importantly, you—glorious, brilliant, ambitious, determined members of the Dartmouth College Class of 2017. A proud member of the class of 1925 once wrote: “The more that you read The more things you will know The more that you learn The more places you’ll go.” This is from a book that probably all of you have received as a gift this week. And it’s true that the more that you read and the more that you learn, the more places you may very well go. But while I revere Dr. Seuss, by necessity he left a few things out. He didn’t tell you that there are a lot of unread and uninquisitive – but well-connected – heathen going very far and doing very well. In the real world, not only is the Lorax still battling the Once-ler—he also has to deal with the Once-ler's Super PAC. And his nasty, nasty tweets. Dr. Seuss often depicted the world as he wished it, with endings that were just and lessons that were learned. But that is not the world you are about to enter. The world outside of Hanover can be cold. Not “walking from the River Cluster to Dartmouth Hall in February to make a 7:45 a.m. language drill” cold, but cold. It has been said, “He who stays the longest learns the most.” Actually, that wasn’t actually said by anyone; it was once carved on the wall in the basement bathroom of Alpha Chi. But it is true! Though no doubt some of you after all are way smarter than I am – many of you, probably – especially you with the glasses in the third row—I have picked up a few things along the way. “He who stays the longest learns the most.” Wise words from someone who probably had his pants down. I wonder if whoever took that little knife and carved that into the Alpha Chi basement bathroom wall ever imagined that one day it would be invoked in a commencement address? Whatever the case, it has truth. It speaks to the wisdom one accrues merely by continuing to exist and paying a modicum of attention. So, what tangible advice do I have to share, having departed from this campus 26 years ago? First, let me offer the quick and easy stuff. OK? Always write thank-you notes. Be a big tipper. Always split Aces and Eights. Floss. Call your folks. Invest in a good mattress. Shine your shoes. Don’t tweet, post, Instagram, or email anything you wouldn’t feel comfortable seeing on the front page of The New York Times. Be nice to seniors. Be nice to children. Remember birthdays. Never miss an opportunity to charge an electronic device. Use two-step verification. Shake it off. Shake it off. Stretch before exercising. Stretch after exercising. Exercise. Never play keno. Never drink airplane coffee. Never pay $200 for a pair of jeans. Never wear jean shorts; and No one has ever had fun on a paddleboat. You can get that from YouTube later. Those are the easy ones. But there are a few harder-fought lessons into which I would like to delve a bit further. The first one is about you, right now. For you, my dearest Class of 2017. Even if you have jobs or grad school lined up, you are no doubt stressing a bit about the question: What are you going to do with the rest of your life? And my first serious bit of advice to you is: Do not worry if you do not know what you want to do with the rest of your life; it is OK if you take years to figure it out. Wall Street, Silicon Valley, law school—they ain’t going anywhere. I did not become a full-time journalist until I was almost 29. It took me a little time to figure out where my particular qualities of annoying persistence, uncomfortable observations, and curiously rooted self-regard might best be suited. Now, our society worships the prodigies. The Mozarts. To paraphrase Tom Lehrer, it is a sobering thought to consider that when Mozart was my age he had been dead for twelve years. But to measure success by how old you are when you achieve it is silly. The Adventures of Tom Sawyer wasn’t published until Mark Twain was 41. Do not stress if you have no idea what you want to do with the rest of your life. View these years, where your responsibilities are relatively few, as a journey, as an adventure. Adventures are not seamless trips from point A to point B; they have ups and downs and obstacles. And every crappy internship, every rude boss, every remedial chore that makes you wonder, “Why did I bother working so hard to get into Dartmouth and graduate from Dartmouth?”—it is all part of this voyage. Every step of my trip to this stage today taught me something and guided me to here. The fall after graduation, I went to film school. I could not have been more unhappy. Flash forward a few years, more misery in Washington, DC, as the worst public relations flunky in the history of relating to the public. These were periods of ennui, angst, sturm undt drang, and many other words only the Europeans could have come up with. I felt like a complete and utter failure. All part of the adventure. Do not take these moments that you will someday soon experience as failings or even as wrong turns. Public relations and my ineptitude in it steered me away from the world of spin, but it also showed me how PR executives spin, which gave me insight into how to cut through it. And, more importantly, it was while supporting myself as a PR flunky that I began writing freelance newspaper stories. And that led me to my first full-time job as a reporter at Washington City Paper, a tiny free weekly newspaper, with an editor who was like a one-man journalism school, who saw in me a young man who did not take mistakes and errors seriously enough and browbeat that attitude out of me. If I had not worked under that man at that free weekly newspaper, I would not be on this stage right now. At the risk of sounding like Oprah, embrace this adventure. Throw yourself into it. Now. How to get started? You know how your parents used say when you were younger that the world doesn’t revolve around you? You’re about to find out what they meant. Because, believe it or not, until now, crudely speaking, the academic worlds in which you’ve been safely ensconced have been all about you—your teachers and your coaches, professors and advisers, from UGAs to President Hanlon—they have been focused on not only your education but your experience and your personal growth. You are about to leave a warm and nutritious womb. Freshman trips, freshman groups, sophomore summer, tea at Sanborn, the Phys Ed requirement, all the rest... this incredible support system, these teams of people whose job it has been to turn you into an adult with skills and smarts and tools – caring about your mixers, about your happiness, about your comfort, about your birth control needs, about whether or not you drink responsibly, whether you’re doing okay, making sure you go to the dentist. I'm sorry to say, that ends tomorrow. You now have to do that for yourselves, and for each other. Now, my little baby birds, you are expected to fly. Coach. Last row, middle seat. There will be no UGA down the hall in your first apartment, and if there is one, that's not really a UGA; that's just a creepy dude trying to get on your Wi-Fi. Now I’m not saying you should be scared about what tomorrow might bring. The real world's a cool place. There are plenty of nice and kind people. There's live music, fresh juices, hotels that don’t charge for the minibar. But the real world, unlike what you've experienced here, is a place of transaction. What does that mean? Practically speaking, it means you can no longer rely on people in positions of power to do things for you because they care about you. The people you’re going to meet whom you need to help you get a job, or an apartment, or a loan, or advice—the people to whom later you will point to and say, “Hey, she gave me my first break!”—those people are looking for something in return. What is that something? It can be tricky to figure out. It might be your loyalty, your respectability, that you have a diploma from Dartmouth, your brains, your cleverness, or your politeness. Different people are going to want you for different reasons, but your first boss and every boss you ever will have will want something very simple: your hard work and your good attitude. Now, the transactional nature of the world might sound harsh but it isn’t necessarily. Put it this way: A screenwriter sells her idea to a studio. The studio wants to make her movie. They start conducting screen tests. In this parable you're, say, Vin Diesel. You audition. You have to. No one is going to give you that job out of the kindness of their hearts. They need to have confidence that you will be Fast and Furious. So they can sell $380 million worth of movie tickets. But here is the exquisite bit of good news, for those of you paying attention: Now you know this; now you know that it all comes down to you figuring out what you can offer them. It's a lesson it took me several years to learn—maybe even more than that, maybe a decade or two—but once I did it was invaluable. I joined ABC News in 2003. In the 2004 presidential race, I was not assigned a candidate to cover. I can still list the reporters who were, by the way. I remember every one of them. I got nothing. So I did the only thing I could do. Complain? No. I worked so hard in those intervening years to establish myself as a good and tireless political reporter, so hard they HAD to assign me a candidate in 2008, for their own good. It worked, and in 2008 I was finally assigned a candidate. My goal then became to be the White House correspondent. And I knew, again, there was only one way I would get that job. I had to be so skilled and tough and industrious and vigilant that, if my bosses at ABC News made anyone else the White House correspondent, they would look like idiots. I had to force them to give it to me out of their own best interests. Now, I've come up with a lot of bad strategies and made a lot of bad decisions in my life. I’ve made enough bad decisions to fill five other commencement addresses. But this was a good one. Have something that they want. And show it to them—over and over, every day. Make them need you. Work twice as hard as the job requires. Make sure they know that you will show up and act like a professional, that you don't feel entitled to anything. Make them hire you for their own good, not yours. Now, a word on the inevitable rejections that may soon shower upon you like a monsoon. Dr. Seuss’s first book, And to Think That I Saw It on Mulberry Street, was rejected 27 times before he found a publisher. As a young man, Robert Frost, class of 1896, received a rejection letter from the poetry editor of the Atlantic Monthly with the note: “Our magazine has no room for your vigorous verse.” In other words: Not every expert is expert. Quite a few of them are going to be wrong about you. Some of them will be downright idiots. When my classmate Shonda Rhimes first pitched Grey’s Anatomy to a room full of older men, they told her that nobody was going to watch a show about a woman who has casual sex and threw a guy out the night before her first day of work—that that was completely unrealistic and that nobody wanted to know that woman. Shonda sat in that pitch meeting and thought, “Wow they don’t know anything about what’s going on in the world right now.” Forgetting the critical, financial, and popular success of the show for a moment, Shonda can't even keep track of how many young women have told her that they were inspired to become doctors because of Grey’s Anatomy. Keep going. There might be a lot of rejection. Most of it you should not take personally. People making decisions are often wrong. Even the faculty of Dartmouth can get it wrong! Connie Britton, Class of ‘89, perhaps the best known and most critically acclaimed actress to have ever graduated from Dartmouth College, was not able to convince the Drama Department here to sponsor her to send to the League Auditions. David Benioff, Class of ‘92, acclaimed novelist and screenwriter and co-creator of HBO’s Game of Thrones, he didn't get into English 80—three times. But some of the rejection you should take personally. Some of it will be because of things you could be doing better. Try to figure out what those things are. Because you always can be doing something better. To be honest, this never ends. The best and most successful people are constantly striving to be better. If you think that at 48 I think I’ve got it all figured out, kindly allow me to disabuse you of that notion. And I can provide multiple sources for that scoop. And I can do that because I know it's important to surround yourself with people who love you and respect you enough to tell you the truth. And it is important to listen to them. Many people you will see rise to a level of success on which it becomes difficult to find people to challenge them and their ideas. And whether politicians or generals, news anchors, or CEOs, that inevitably leads to their downfall. Look at what's going on in Washington, DC, right now. Tell me there aren’t people you can think of whose own careers would not be improved if they heeded the suggestions of a tough but loving staff of critics willing to share hard truths. At my job at CNN, I am lucky enough to be surrounded by people who challenge me every day. From the top, to the side, to the bottom of the ladder. They make me better by sanding away my worst impulses. Class of 2017, get people like that around you. No matter how high you rise, do not get rid of them. You're going to have friends who are willing to criticize you, and maybe you don’t want to hear it, and your impulse may be to show them the door; but if you spend the rest of your twenties amidst only the sycophantic and the shallow, you will wake up at 30 with a friendship hangover worse than a month of Jägermeister shots. You know, it’s funny what sticks to your brain. I haven’t looked at the autographs in my high school yearbook since they were written in 1987, but I know that there’s one in there from a girl named Kate. She praised me for my cutting wit, but she also cautioned me to be careful about how I wielded that particular blade. And though I spent much of the next 20 years ignoring that lesson, much to my own detriment, I still remember that advice 30 years later because she was right. Advice can sting. Ted Koppel once pulled me into his office after seeing an embarrassing TV pilot I was part of and told me that it was OK to tell my bosses “No.” Charlie Gibson once told me to stop sending such pointed emails, that I would get a lot farther if I didn’t share every critical thought I had every moment I had it. These were not easy criticisms to hear. But they were right. These were important people investing their time to try to make me better. These kinds of lessons aren’t fun. No one enjoys hearing about how much of a jerk they are. So let me also say while I prepare you for those moments: Absorb the lessons. Adapt accordingly. But do not be too hard on yourself. And listen to yourself, follow the better angel we all have in us steering us toward ways to be our best selves. On October 3, 2009, I was sitting in my wife’s recovery room at a hospital in Washington, DC, holding our newborn son. On TV I saw a news story: That day, an outpost containing just fifty-odd US troops had been attacked by up to 400 insurgents. Combat Outpost Keating was built at the bottom of three steep mountains, the reporter said, in a particularly rough corner of Afghanistan just 14 miles from the Pakistan border. It was an ugly and brutal battle. The deadliest for the US that year. Eight American soldiers were killed. And as I sat in the room that day holding my son, hearing about these eight other sons taken from their parents, from their wives, I wanted to know why. Why would anyone put an outpost in a such a dangerous place? And more importantly, who were these people that were risking so much and sacrificing everything – people to whom I really didn't pay all that much attention, to be honest. Sure, I covered debates over troop levels—ten thousand, forty thousand—but those were statistics; those weren't people. So, against the advice of a lot of people I knew, I decided to write a book about the men who fought and suffered and prevailed and died in that battle, about Combat Outpost Keating. Writing that book was a long slog. Many doubters; many skeptics. And yet I felt compelled to tell the story of these troops and their families, people part of a world unfamiliar to me at the time, the world of the US military, of duty and sacrifice. In some cases, the ultimate sacrifice. Hearing the stories firsthand of these men and women made me realize how little I had accomplished in the service of anyone other than myself. “My God,” I told my wife one afternoon after I had been visiting with two Cavalry officers, Dave and Alex. “My God, these guys are amazing, and I am nothing. I have risked nothing and sacrificed nothing compared with these men.” “But honey,” she said, “you can tell their stories. You can tell their stories.” The book I wrote, The Outpost, remains the professional work I am proudest of. It is not what has resulted in the most Twitter memes, but it is the most meaningful. It was the one least about me; and it may be one professional achievement, maybe, perhaps, that has a chance of outlasting me. That which you end up doing in the service of something greater than you – even if it means that you feel lesser, humbler, even worthless by comparison – by honoring the humanity of others, that will allow you to get in closer touch with your own. And this is the most important thing I can tell you today, Class of 2017. Don’t just work hard at your job; work hard at everything. Work hard at being a friend. Work hard at being a partner, at being a son or a daughter, at being a grandchild, at being a steward in your community, at caring about people who have never had a day like the one you’re having today. At being the best YOU that you can be, Class of 2017, all of you, A to Z, from the best Alexander Abate to the best Jonathan Zuttah. There are going to be moments like this one – a celebration of hard work well done, surrounded by family and friends. And then there are going to be moments when you feel alone and adrift, misunderstood, and hopeless. Maybe right now it looks to you like someone like me effortlessly went from your seat to this stage. Let me assure you, there was effort. There was effort and there was pain and embarrassment and rejection and humiliation. False starts and false turns and mistake after mistake after mistake. But that's OK. That's all part of the adventure, and yours starts now. Members of the Dartmouth College class of 2017 – you are already great. Now it’s up to you to become even greater. Be bold. Be smart. Be brave. Be true. Go forth and rock. God bless you; God bless your families; God bless Dartmouth College of Hanover, New Hampshire; God bless the memory of EBA’s; and God bless the United States of America. Thank you for the honor of a lifetime.

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mitchbattros · 6 years ago

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Tornadoes Kill at Least 23 in Alabama, Official Says

The first tornado warning in central Alabama went out around 1 p.m. Sunday. In the hours that followed, a cluster of storms ripped through the Southeast, spawning multiple tornadoes, killing at least 23 and leaving a trail of rubble.

As the storms pushed east, the tornadoes would leave a path of destruction that stretched from Alabama into Florida and Georgia. The reported deaths were all in Lee County, Ala., where two tornadoes — one at least a half-mile wide — wrecked homes and uprooted trees. It was unclear Sunday night whether the deaths had occurred in various locations or all in one place. Dozens of people were sent to hospitals. As darkness came, rescue workers searched for survivors, and more victims, often with little more than a flashlight or the lights of their vehicles to aid them. More than 150 people were part of the search-and-rescue operations near the Lee County communities of Smiths Station and Beauregard, which is about 60 miles east of Montgomery, said Rita Smith, a spokeswoman for the county’s emergency management agency. Sheriff Jay Jones of Lee County told reporters that 23 people had been killed. The East Alabama Medical Center in Opelika, Ala., had received more than 60 patients as of Sunday night, said John Atkinson, a spokesman for the center. He said the conditions of the patients varied.

In Georgia, Booker T. Gainor, the mayor of Cairo, told The Tallahassee Democrat that a tornado had hit just south of downtown, damaging dozens of homes and businesses. “We have a lot of trees down, debris and power lines,” he told The Democrat. “We have trees completely through houses. You would think a hurricane came after this, the way it looks.” President Trump said in a tweet on Sunday night that people in and around Alabama should “be careful and safe.” “Tornadoes and storms were truly violent and more could be coming,” he said. “To the families and friends of the victims, and to the injured, God bless you all!”

Alex Miller, 27, was driving with two passengers from Savannah, Ga., to his home in Birmingham, Ala., on Sunday evening when they were alerted on their cellphones that tornadoes might be incoming. They stopped at a gas station in Columbus, Ga., to let one wave of the storm pass, and continued to head north, hoping to break through the worst of the weather during the lull. As they neared Smiths Station, Ala., they passed a gas station with a billboard toppled over. They then passed a police blockade diverting southbound traffic off the main roads. The skies darkened, the rain grew stronger — “all the ominous signs,” Mr. Miller said. “The plan quickly pivoted from ‘We need to drive north’ to ‘We need to pull over and seek shelter immediately,’” he said. Mr. Miller pulled into a gas station in Smiths Station and sheltered in a hallway in the back with about 10 other people, including children, and a dog. The power was out inside and the light outside continued to dim. It was “post-sunset dark,” Mr. Miller said. The wind whipped outside, in what appeared to be one of the tornadoes to hit the Lee County area. “The energy was pretty tense,” he said. After the worst weather abated, Mr. Miller said, he got into the car and drove north, past debris strewn around the roads. Within 15 minutes, he saw sunshine. David McBride, the owner of Buck Wild Saloon in Smiths Station, told The Ledger-Enquirer that he had ridden out the tornado inside his truck as it was pelted with debris, watching as the winds tore his saloon apart. “We can replace all this, can get a new truck, we can get a building down the road,” he said. “Thank you, Jesus, I’m still here.” Chief Byron Prather of the Opelika Fire Department told the television station WSFA 12 that several mobile homes and houses had been destroyed in Lee County. “There’s debris laying everywhere,” he said. “There was a mobile home frame in the middle of the road at one time. There’s personal belongings in the trees. There’s insulation, there’s building material in the trees.” Meredith Wyatt, a meteorologist with the National Weather Service in Birmingham, Ala., said the office had issued its first of at least six tornado warnings of the day for Lowndes and Montgomery Counties. The warnings were based on winds, radar patterns of flying debris, and live feeds from storm chasers on the ground. “And it went full swing after that,” she said. Between three and five tornadoes probably touched down in central southeastern Alabama, she said. The Weather Service confirmed that a tornado at least a half-mile wide with 136 to 165 m.p.h. winds — or an EF-3 tornado on the Enhanced Fujita scale — had touched down in the southern part of Lee County. The service will send teams on Monday to survey the damage to determine the path of the tornadoes, their intensity and how long they stayed on the ground. Nearly eight years after a tornado outbreak that devastated major cities and small towns alike, Alabama remains wary of severe weather and the menace of tornadoes. After the 2011 outbreak, which spawned more than 60 tornadoes in Alabama and led to more than 230 fatalities in the state, some communities ordered upgrades to storm shelters, and residents became extraordinarily sensitive about even the threat of poor weather. Sunday’s weather was a “fairly classic” pattern for March, where colder air mixes with warmer air, said James Spann, the chief meteorologist for WBMA television, the local ABC affiliate. Tornadoes are common this time of year in “Dixie alley,” the nickname given to the Southern states vulnerable to severe weather, he said. “This is clearly the biggest loss of life we’ve had in my state in a while,” he said. “In fact, we had more deaths in Lee County, Ala., today than the entire United States last year.” In 2018, 10 people were killed by tornadoes in the United States. “It’s been very quiet,” Mr. Spann said. “We knew it’s been too quiet for too long.” Read the full article

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mhsn033 · 5 years ago

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Best health At least 3 dozen states have reported coronavirus cases on college campuses

Best health

Classes have not even started on the College of the Holy Sinful, in Worcester, Massachusetts, but there are rising considerations over the college students’ push aside of coronavirus security protocols. Over the weekend, campus police busted a clean birthday party at an off-campus house rented by Holy Sinful college students, eliciting rising considerations that such gatherings may perhaps flip into coronavirus clean-spreader events.

“No longer only did the selection of of us in attendance exceed the negate limit on the selection of of us at a gathering, but attendees had been no longer wearing masks or adhering to bodily distancing guidelines,” acknowledged faculty directors in a letter to the neighborhood, calling the behavior “extremely irresponsible.”

According to the college, the birthday party has ended in a likely cluster of infections, and if such behavior continues, the comfort of the student physique may perhaps be unable to achieve to campus, later this year.

Equally, only eight days into the semester, Notre Dame changed into compelled to slay in-particular person classes for 2 weeks, after seeing a “dramatic invent bigger” in determined coronavirus, with 336 college students contaminated as of Friday. Most infections contain stemmed from off-campus gatherings, according to the University’s contact tracing prognosis.

“Students contaminated at these gatherings cross it on to others, who in flip, cross the virus on to an extra team, ensuing within the determined cases now we contain considered,” stated Notre Dame President Rev. John I. Jenkins on Tuesday, in a stern message to the neighborhood.

Though the college had at the initiating begun crafting plans to ship undergraduate college students dwelling, for the time being, he acknowledged, he would allow college students to live on campus, and transfer all undergraduate classes to a long way-off instruction for 2 weeks. However, Rev. Jenkins warned failure to follow smartly being protocols may perhaps result in sending college students dwelling.

Such scenes are a long way from remoted incidents, and are examples of the many challenges confronting universities and colleges as they reopen.

A mountainous selection of movies of packed events on campuses all the procedure during the nation had been broadly shared on social media, time and another time with no social distancing or face masks, indispensable to the alarm of college directors and public officers alike.

Syracuse University Vice Chancellor J. Michael Haynie severely admonished first-year college students who had gathered on the college’s quad, calling their behavior “selfish and unsettling,” and stating, “Rating no mistake, there changed into no longer a single student who gathered on the Quad final evening who failed to know and realize that it changed into unsuitable to originate so.”

No no longer as much as three dozen states, to this level, contain reported coronavirus cases on faculty campuses.

At Oklahoma Sigh University, over 20 cases had been confirmed in a single sorority dwelling.

Iowa Sigh University directors issued a stern warning that a failure to abide by the college’s solutions and persevering with partying may perhaps result in a long way-off instruction, after over 175 college students examined determined for the virus.

Some colleges are already acting snappy, and harmful disciplinary actions against college students who originate abide by the role protocols.

Purdue University has suspended 36 college students, together with of us that had hosted a celebration and of us that had attended the gathering in violation of social distancing insurance policies.

Duke University is investigating seven cases of “flagrant misconduct and protracted non-compliance” with COVID-19 solutions by college students or groups of college students, and if realized responsible, college students and organizations may perhaps face a broad selection of that you can perhaps have faith in sanctions, together with disciplinary probation, suspension, or eternal dismissal.

23 college students from Syracuse received period in-between suspensions following their on-campus birthday party.

Drake University in Iowa barred 14 college students from campus for 2 weeks for partying, and a couple of alternative University of Connecticut college students had been evicted from on-campus student housing after movies of dorm-room events emerged Monday evening. On Wednesday, the college announced eight on-campus college students, and three commuter college students, had examined determined for COVID-19.

Colleges and universities that contain opted either to reopen, or allow college students to dwell to articulate the story the premises, are relying heavily on college students to abide by the precautions and behavioral expectations outlined by the college.

But some specialists inquire whether or no longer it’s that you can perhaps have faith in to inquire of 18 to 23 years-venerable to stare, enjoy, and dwell in shut quarters, all whereas acting responsibly and maturely ample to sacrifice quite so much of the social interactions and traditions linked with faculty life.

“They’re going to want to birthday party, they may be able to want to drink, they may be able to want to hold around either on-campus or off-campus dorms or in interior most residences. They’re at an age the place they give thought to themselves to be invulnerable,” Dr. Paul Offit, director of the Vaccine Training Heart at Kid’s Sanatorium of Philadelphia, knowledgeable ABC Files.

“I believe you’re inquiring for something, that is no longer going to happen,” he acknowledged, adding this may occasionally be extremely sophisticated to safe college students to achieve that here’s a life and demise disaster.

Offended University of North Carolina at Chapel Hill college students agreed, calling the disaster a ��clusterf—” after in-particular person classes barely lasted a week into the autumn semester forward of being halted when four COVID-19 clusters surfaced, with 130 college students testing determined and the positivity charge on campus surging from 2.8% to merely about 13.6%.

In a scorching editorial within the student newspaper The Day after day Tar Heel, college students wrote, “All of us seen this coming … University leadership must contain anticipated college students, loads of whom are indubitably residing on their very contain for the first time, to be reckless. Reports of events all the procedure during the weekend attain as no surprise.”

Gazing the fastidiously crafted COVID-19 reopening plans by top universities without discover unravel, some colleges are already reassessing their very contain tumble plans. Dozens of colleges that had beforehand dedicated to a hybrid machine for the autumn, contain now reversed direction and decided to behavior classes remotely.

Ithaca College, in upstate Original York, knowledgeable its 5,500 college students on Tuesday that it can perhaps no longer be welcoming them reduction to campus this tumble. “Now we contain realized from watching varied communities how brilliant this equilibrium is, and how snappy it will most likely be disrupted,” wrote President Shirley M. Collado in a message to the neighborhood.

Equally, at Michigan Sigh University, which planned to reopen on Sept. 2, classes are indubitably going to be a long way-off, asking college students who planned to dwell to articulate the story campus, to cease dwelling.

In a letter to college students, Michigan Sigh president, Dr. Samuel Stanley, underscored, in particular, the challenges considered “at varied institutions as they re-populate their campus communities,” writing further that “it has became evident to me that, despite our only efforts and steady planning, it’s no longer truly we can prevent frequent transmission of COVID-19 between college students if our undergraduates return to campus.”

Just final week, huge-title universities akin to Stanford, Brown and the University of Pennsylvania all announced their determination to reduction college students at dwelling.

The mountainous challenges of welcoming college students reduction to campus all during the pandemic are turning into extra and further extra obvious to college officers and public smartly being specialists.

“I believe it’s too indispensable to ask stunning now,” Dr. Offit knowledgeable ABC Files. Campuses are appropriate “another breeding ground for straightforward transmission.”

The college students’ behavior is additionally a source of immense disaster to the communities around the colleges and colleges, fearing that this may occasionally place them at likelihood for coronavirus. In Massachusetts, native residents expressed their terror after the Holy Sinful birthday party, whereas Somerville and Medford residents held a negate originate air the Tufts University president’s dwelling Wednesday, over plans to bring college students reduction to campus.

Boston College is hiring a police detail to interrupt up weekend events that grow too clean.

In Alabama, Tuscaloosa Mayor Walt Maddox tweeted an image of a clean crowd of mostly unmasked University of Alabama college students, gathered downtown, announcing that “we are desperately attempting to guard” town.

Students too are anxious and pissed off regarding the chaos, with some feeling that college officers contain failed them.

“We’re offended — and we’re unnerved,” wrote the UNC college students. “We’re bored with the gaslighting, bored with the secrecy, bored with being handled admire money cows by a University with such blatant push aside for our lives.”

But within the ruin, all of it boils down to interior most selections, according to Penn Sigh President Eric Barron. “I ask college students flaunting the college’s smartly being and security expectations a easy inquire: Pause you utilize to want to be the actual person responsible for sending all individuals dwelling?”

“I need you to achieve stunning now and extremely clearly that now we contain one shot to invent this happen. The realm is watching, and they inquire of you to fail. Uncover them unsuitable. Be better. Be adults,” concluded Syracuse’s Vice Chancellor Haynie.

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kristablogs · 5 years ago

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Florida’s new COVID cases are outpacing entire continents

Wearing a mask, washing your hands, and keeping your distance is more important now than ever. (Max Bender on Unsplash/)

Stay-at-home orders and mask mandates have finally helped to quell COVID-19 cases in the New York area. But testing data shows that while NYC may have been the first pandemic hotspot in the US, it certainly won’t be the last.

How bad is COVID-19 in the US right now?

According to a case tracker managed by Johns Hopkins University, more than 3.3 million people have been diagnosed with the novel coronavirus in the United States so far. Nearly 135,000 of those patients have died.

More troubling than the case counts themselves is the fact that cases are climbing upward in large chunks of the country. A huge outbreak that started in New York City in March has been largely squashed thanks to measures like mask-wearing mandates and the closures of theaters and bars. Cases are still rising in 39 states, as well as in Puerto Rico, Washington, DC and in the US Virgin Islands. Researchers at the Harvard Global Health Institute estimate that a mere 14 states are actually testing enough people to recognize the depth of the problem.

On Sunday, Florida broke a record for the most COVID-19 cases reported by any single state in a one-day period. At a total of 15,300 cases, Florida outranked the new case count for the entire European continent by 16 patients. As the virus spreads, hospitalization and death rates continue to rise. Meanwhile, Disney World has reopened its gates.

Once case counts start to spike, it takes weeks for hospitalizations and fatalities to follow suit.A disease has to spread for a while in a community before enough people catch it and unknowingly pass it around for some individuals to get seriously sick. But there are already signs of ICU crowding and increased deaths in the country’s newest hotspots, and things will only get worse.

“We do expect deaths to go up,” Brett Giroir, an assistant secretary with the Health and Human Services department, told ABC. “If you have more cases, more hospitalizations, we do expect to see that over the next two or three weeks before this turns around.”

Why is COVID-19 still spreading?

In general, states that have reopened bars, restaurants, and retail are seeing a bigger uptick in cases than states that have encouraged people to stay home. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, recently pointed out to Five Thirty Eight that the behavior of individuals also matters. While some states truly opened too quickly, he said, others tried to slowly and responsibly reopen a few businesses—only for citizens to throw caution, along with their social distancing practices and masks, to the wind.

“Many of the citizenry said, ‘You know, well, I’m either going to be locked down or I’m going to let it all rip,’” Fauci said.

Cell phone data also suggests that more people traveled for July 4 than for Memorial Day, which likely contributed to case surges. Parties are a particularly dangerous activity when it comes to COVID transmission. Private summer gatherings—as well as bars and clubs in reopened states —have been traced to new COVID-19 clusters, particularly among young people.

## What can I do to keep from getting or spreading COVID-19?

At the beginning of the COVID pandemic, evidence was spotty on how best to prevent its spread. Now it’s become clear that wearing masks is key to lowering transmission and perhaps preventing deadly cases. Public health experts resoundingly recommend wearing face coverings whenever you leave the house or interact with people from outside your household. Here’s our latest guide to understanding how masks keep you and other people safe, and instructions for making your own mask at home—with or without a sewing machine.

Social distancing is also crucial. Maintaining a distance of six feet or more from people outside your household drastically reduces your risk of transmitting COVID. Even if you stay far away from people, it’s best to wear a mask and play it safe since neither method is a complete guarantee against spreading the virus.

The third tool in the anti-coronavirus trifecta is proper hand washing. If you wash your hands thoroughly and frequently, wear a mask whenever going out, and keep your distance from other people, your risk of catching or spreading COVID-19 is basically nill. But any sloppiness makes your risk go up: Sitting in a bar full of strangers is dangerous, even if you keep a mask on when you’re not sipping. Going for a walk without your mask is still risky, even if you try to avoid all passersby. Coming back inside and forgetting to wash your hands leaves you more vulnerable than if you immediately gave them a good scrub.

How bad is COVID-19 globally right now?

While some countries—New Zealand in particular—have managed to crush COVID for now, cases are still rising globally.

“Let me be blunt, too many countries are headed in the wrong direction,” WHO Director General Tedros Adhanom Ghebreyesus said at a briefing on Monday. “The virus remains public enemy number one.”

Tedros added that there would “be no return to the old normal for the foreseeable future,” and that he expected the pandemic to get even worse before things improve.

The virus, which first emerged in Wuhan, China in late 2019, has infected around 13 million people worldwide and killed more than 569,000.

How do I know if I have COVID-19?

Many people with COVID-19 have few symptoms, if any. So it’s important to wear a mask and practice social distancing even if you feel fine. But even if you’re already being careful, you should still look out for symptoms. According to the Centers for Disease Control, known COVID-19 symptoms now include fever or chills, coughing, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, a sudden loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea. If you have an existing condition that causes some of these symptoms, such as seasonal allergies or a gastrointestinal disorder, take note of what is normal for you. If you suddenly begin to experience worse than average symptoms, they may be due to COVID. The context of you and your household’s behavior is also important: a bit of a cough after weeks of careful social distancing is less worrisome than one developed just days after going out to a restaurant.

If you find out that someone you’ve recently been in close contact with has been diagnosed with COVID-19, you should operate under the assumption that you have it.

What should I do if I think I’ve been exposed to COVID-19?

If you have symptoms of COVID or have recently been exposed to someone with COVID, you should get tested. Confirming your infection will allow those who’ve come into close contact with you to take necessary precautions. It will also help doctors keep tab on your symptoms in case your illness starts to take a turn for the worse.

If you experience trouble breathing, persistent chest pain or pressure, bluish lips or face, an unusual level of confusion, or an inability to wake or stay awake, the CDC says to seek immediate medical attention.

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scootoaster · 5 years ago

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Florida’s new COVID cases are outpacing entire continents

Wearing a mask, washing your hands, and keeping your distance is more important now than ever. (Max Bender on Unsplash/)

How bad is COVID-19 in the US right now?

Why is COVID-19 still spreading?

“Many of the citizenry said, ‘You know, well, I’m either going to be locked down or I’m going to let it all rip,’” Fauci said.

What can I do to keep from getting or spreading COVID-19?

How bad is COVID-19 globally right now?

While some countries—New Zealand in particular—have managed to crush COVID for now, cases are still rising globally.

Tedros added that there would “be no return to the old normal for the foreseeable future,” and that he expected the pandemic to get even worse before things improve.

The virus, which first emerged in Wuhan, China in late 2019, has infected around 13 million people worldwide and killed more than 569,000.

How do I know if I have COVID-19?

If you find out that someone you’ve recently been in close contact with has been diagnosed with COVID-19, you should operate under the assumption that you have it.

What should I do if I think I’ve been exposed to COVID-19?

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jobsearchtips02 · 5 years ago

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Bolton Attacks Trump Leadership Ahead of Book Launch

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In a video interview with ABC News, former U.S. National Security Adviser John Bolton criticized President Trump’s handling of foreign policy issues, alleging that Mr. Trump lacked basic knowledge of issues he had to deal with. Mr. Bolton’s new book is a scathing account of his 17 months working for the president. Photo: Saul Loeb/Agence France-Presse/Getty Images

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brajeshupadhyay · 5 years ago

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As coronavirus deaths near 100,000, Trump, others head outdoors

Preparing to celebrate Memorial Day, Americans flocked to beaches and parks on Sunday, with many ignoring disease precautions even as the nation’s coronavirus-related deaths approached the bleak milepost of 100,000.

As public health experts made a fresh round of appeals for physical distancing and face coverings, President Trump visited his Virginia golf property for a second straight day. He delivered an upbeat message while heading for the links, despite both the death count and predictions that double-digit U.S. unemployment would drag on into the early winter — past the November election — possibly coinciding with a second wave of infections.

“Cases, numbers and deaths are going down all over the Country!” Trump tweeted from the motorcade en route to his club.

Although the outbreak has eased in many areas, dangerous hot spots remain, including Greater Los Angeles, Chicago and Washington D.C., with spikes in some less populated places as well.

“This isn’t contained, and it’s still continuing to spread,” former Food and Drug Administration Commissioner Scott Gottlieb said Sunday on CBS’ “Face the Nation.” He cited rising hospitalizations in “many states: Florida, Georgia, Virginia, Maryland, Minnesota, Wisconsin, Ohio, Arizona.”

After weeks of restrictions meant to fight the spread of COVID-19, the disease caused by the virus, every state is in some stage of reopening. Many, though, have failed to meet U.S. Centers for Disease Control and Prevention guidelines for a safe return to public life.

One of the country’s leading virus experts, Deborah Birx, the director of Trump’s coronavirus task force, warns that even in the open air, physical distancing and, when in close proximity, face coverings are essential.

“Out of respect for each other, as Americans that care for each other, we need to be wearing masks in public when we cannot social-distance,” Birx said on “Fox News Sunday.

That message was echoed in sharper terms by Tom Bossert, Trump’s former White House Homeland Security advisor, who has at times been critical of the administration’s pandemic response.

“Wear a mask — it’s common decency,” he said, citing the theme of respect and remembrance that underpins Memorial Day. “Pray and think about those that passed in our former wars … but also about those that passed in the last three months.”

His former boss, however, was characteristically mask-free on Saturday and Sunday as he came and went from the White House and his club.

With the three-day holiday weekend in full swing, news reports and social media featured many images of people clustering tightly at waterfronts, in swimming pools and in al fresco bars and restaurants without wearing masks. However, despite Trump’s insistence on Friday that states allow places of worship to reopen, Americans did not seem to be filling pews on Sunday; even conservative congregations were largely closed, offering prayer fellowship online or in parking lots.

Tens of thousands more Americans have died in the pandemic than in Vietnam and all of the country’s conflicts since, combined. On Sunday, the New York Times memorialized the dead with a striking gesture, devoting the entire front page and several inside ones to listing 1,000 names — just 1% of the total deceased — with short but vivid snippets of their lives culled from obituaries.

“Incalculable loss,” the headline read.

Birx, who is often at pains to avoid disagreements with Trump, was asked in the Fox interview about the president’s refusal to wear a face covering in public. Trump told reporters he had worn a mask for part of a factory tour in Michigan last week but that he did not want to give journalists the “pleasure” of seeing him in it.

“I’m not with him every day and every moment, so I don’t know if he can maintain social distance,” said Birx. “I’ve asked everybody independently to really make sure that you’re wearing a mask if you can’t maintain the six feet. I’m assuming that in a majority of cases he’s able to maintain that six-feet distance.”

Bossert was more acerbic, telling ABC in response to a question about Trump and face masks: “’Do as I say, not as I do’ isn’t very useful.”

At a White House briefing last week, prior to Trump’s weekend golf outings, Birx said she well understood the public’s need for outdoor recreation, especially over a long holiday weekend. “You can go out. You can be outside. You can play golf. You can play tennis with marked balls. You can go to the beaches if you stay six feet apart,” she said then.

Although many people are flouting distancing and masking recommendations while outdoors, Birx told ABC, “I think that’s our job to continue to communicate.”

While overall White House messaging, and certainly Trump’s, has focused on a robust economic recovery beginning soon, a senior Trump advisor said Sunday that joblessness would continue to rise this month and next, after reaching nearly 40 million claims last week.

“The unemployment rate will be higher in June than in May, but then after that, it should start to trend down,” advisor Kevin Hassett said on CNN’s “State of the Union.”

Asked if he thought the jobless rate would still be in the double digits in November, when the election is held, Hassett said: “Yes, I do.” But he also predicted that signs of a larger economic recovery would be “raging everywhere” by then.

The Trump administration has weathered widespread criticism for its handling of the pandemic, but the president has often called restrictions he imposed on travel from China — and later Europe — as policy triumphs. On Sunday, the White House announced that Trump was suspending U.S. entry by foreign nationals who had been in hard-hit Brazil in the preceding 14 days.

Public health experts have predicted that, by late fall, the United States could be in the grip of a heavy second wave of infections, but Trump said last week that the country, and the economy, would stay open in any event. Birx, asked about the likelihood of new lockdowns, said “it’s difficult to tell” what measures might be taken if the outbreak took on a new ferocity.

Gottlieb, in his CBS interview, said Americans should not be lulled into complacency if infections and deaths eased somewhat in the summer season.

“We’re likely to have this slow burn through the summer, and then face renewed risk in the fall that we’re going to have bigger outbreaks and potentially epidemics in certain states and cities,” he said. “That’s what we need to be focused on right now, getting the tools in place to prevent that in the fall.”

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businessliveme · 5 years ago

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India Extends Lockdown; Japan in a Recession: Virus Update

(Bloomberg) — A top U.S. official suggested Beijing sent airline passengers to spread the coronavirus worldwide, as the Trump administration stepped up its campaign of blaming China for the pandemic.

Japan’s economy sank into a recession, while Thailand’s economy contracted for the first time since 2014 due to the virus. Federal Reserve Chairman Jerome Powell said a U.S. recovery could stretch through the end of next year and depend on the delivery of a vaccine.

India extended its nationwide lockdown to the end of the month while easing some curbs. The U.K. and Italy reported the fewest deaths since March, while France saw the most fatalities in three weeks.

Key Developments:

Virus Tracker: Cases top 4.7 million; deaths exceed 315,000

Pandemic shatters world order, sowing anger and mistrust

China faces angry world seeking virus answers at key WHO meeting

More Chinese dine out, schools reopen as normalcy resumes

New Zealand plans safe haven as Arden charts rapid rebuild

Subscribe to a daily update on the virus from Bloomberg’s Prognosis team here. Click VRUS on the terminal for news and data on the coronavirus. See this week’s top stories from QuickTake here.

Thailand’s Economy Contracts for First Time Since 2014 (10:44 a.m. HK)

Thailand’s economy contracted in the first quarter for the first time since 2014 as the coronavirus outbreak cut off tourist arrivals and shuttered commerce. Gross domestic product shrank 1.8% from a year ago, the National Economic and Social Development Council said.

South Korea Nightclub Cases Rise to 168 (10:21 a.m. HK)

South Korea’s health ministry said coronavirus cases related to nightclubs in Seoul increased to 168 as of midnight. The ministry said there has been no drastic increase in the outbreak, with findings of about 10 cases a day on average.

About 65,000 people possibly exposed through the nightclubs have been tested so far, as South Korea tries to prevent a possible second wave of infections in the country.

China Reports Seven New Cases (8:32 a.m. HK)

China reported seven new coronavirus infections, with three of them locally transmitted cases in Jilin province and Shanghai, while four are imported cases in Inner Mongolia.

Total deaths in China rose to 4,634, after the National Health Commission said on Sunday that Jilin province revised its fatality count by one.

Jilin, in northeastern China, has locked down several cities in the province. President Xi Jinping has called for strengthened controls in the region as a growing cluster of infections near the Russia and North Korea borders threatens to become a second wave.

Trump to Tour Ford Ventilator Assembly Plant (8:24 a.m. HK)

U.S. President Donald Trump will visit a Ford plant Thursday that has been repurposed to manufacture ventilators and personal protective equipment, according to a White House official, who added the president is expected to tour the plant and discuss the collaboration between Ford and General Electric to respond to the coronavirus outbreak.

Japan’s Economy Sinks Into a Recession (7:54 a.m. HK)

Japan’s economy sank last quarter into a recession that’s likely to deepen further as households limit spending to essentials and companies cut back on investment, production and hiring to stay afloat amid the coronavirus pandemic.

Gross domestic product shrank an annualized 3.4% in the three months through March from the previous quarter, the Cabinet Office reported. Economists had forecast a 4.5% fall, as the start of social distancing last quarter crimped consumer spending, while supply-chain disruptions and sliding exports hurt manufacturers.

Apple to Reopen 25 U.S. Stores, 12 in Canada (7:30 a.m. HK)

Apple Inc. said it’s reopening more than 25 stores across the U.S. and 12 stores in Canada this week, adding to nearly 100 global locations that have reopened to customers after the novel coronavirus outbreak forced them to close. Some stores will offer only curbside or storefront service, the company added in an emailed statement.

Brazil Delays Naming Health Minister (7:15 a.m HK)

Brazil’s President Jair Bolsonaro held back from replacing his health minister Sunday, instead joining supporters who marched in front of the presidential palace as the coronavirus crisis deepened.

The country awaiting an announcement following Nelson Teich’s resignation Friday after 29 days on the job as health minister. He had taken over the post in April after Bolsonaro fired his predecessor amid public discord over social distancing.

Brazil has 241,080 cases — the fourth-highest in the world — and 16,118 deaths so far, according to data released on Sunday.

Trump Wants Stadiums ‘Loaded’ With Fans (5:10 p.m. NY)

Donald Trump said the return of professional sports is essential for the “psyche of our country” in rebounding from the pandemic but signaled impatience with plans to play games without spectators.

“We want big stadiums loaded with people,” Trump said as he called into the broadcast of a charity golf event. “We don’t want 15,000 people watching Alabama-LSU.”

South Africa’s New Cases Accelerate (4:30 p.m. NY)

South Africa reported a third straight day of higher infections, with 1,160 new cases — the most in one day. That brings the total to 15,515. Western Cape, home to the city of Cape Town, has almost 60% of cases nationwide and contributed 76% of new infections, according to the Health Ministry.

U.S. Cases Rise 1.5%, Below Week’s Average (4 p.m. NY)

U.S. cases increased 1.5% from the same time Saturday to 1.48 million, according to data collected by Johns Hopkins University and Bloomberg News. The rise was below the average daily increase of 1.6% for the past seven days.

Deaths rose 1.1% to 89,207.

New York reported 1,889 new cases, bringing the total to 350,121, new deaths were 139 — a seven-week low — as the state total rose to 22,619.

Cuomo Takes Nasal Test on Camera (3 p.m. NY)

Governor Andrew Cuomo engaged in a bit of political theater during his daily briefing as he had a swab inserted in his nostril to demonstrate the ease of getting checked for the virus.

“I’m not in pain, I’m not in discomfort,” he said in Albany after Dr. Elizabeth Dufort used a long stick to collect the sample. “There is no reason why you should not get the test.”

Cuomo said the state is performing 40,000 tests a day and has the capacity to do more to make sure it avoids a new spike in cases. He also expanded who is qualified for testing: those in sectors returning to work first, in construction, manufacturing and curbside retail.

French Deaths Rise Most in 3 Weeks (2 p.m. NY)

France reported the largest daily increase in deaths since April 23, while hospitalizations and the number of patients in intensive care continued to decline. Cases increased less than the recent average.

Deaths rose by 483 to 28,108, France’s health ministry said, without giving a reason for the surge. Authorities reported a 490 new cases, bringing the total to 216,030. Hospitalizations declined by 71 to 19,361 and patients in intensive care fell by 45 to 2,087.

U.K. First to Get AstraZeneca Vaccine (1 p.m. NY)

AstraZeneca Plc will make as many as 30 million doses of vaccine available to the U.K. by September and deliver 100 million this year. The U.K. will get first access to the vaccine should it be successful.

The vaccine, being developed at the University of Oxford, will get 65.5 million pounds ($79 million) of funding, U.K. Business Secretary Alok Sharma said. The inoculation is being studied in humans and could reach late-stage trials by mid-year. Another 18.5 million pounds will go to Imperial College London as trials accelerate.

Italy’s Deaths Lowest Since Early March (12:15 p.m. NY)

Italy reported 145 new deaths, the lowest total since March 9, as the government prepares to further ease restrictions on movements and activities starting Monday. Total deaths rose to 31,908 while cases rose by 675 to 225,435 as of Sunday, according to the Italian Ministry of Health.

Azar: Vaccine Plan is ‘Goal,’ Not ‘Pledge’ (11:50 a.m. NY)

Health and Human Services Secretary Alex Azar said the Trump administration has a goal to make of 300 million vaccine doses by year end, and the target could be missed. “It’s not a pledge,” Azar said on CBS’s “Face the Nation.” “It’s a goal of what we’re going to mobilize the entire U.S. government, private sector to achieve.”

Azar said drug manufacturers are “wringing the inefficiency” out of the traditional multi-phase process to speed development and get safe and effective vaccines.

U.K. Reports Fewest Deaths Since March 24 (11:40 a.m. NY)

The U.K. reported an additional 170 deaths from the coronavirus, the smallest increase since March 24. Total deaths rose to 34,636 with 243,303 confirmed cases.

Newsom: Most of California Is Open (11:30 a.m. NY)

Governor Gavin Newsom said about 75% of California’s economy is reopened as dozens of counties get restaurants, offices, manufacturing, logistics and warehouses back operating. People are observing physical distancing and wearing face coverings, Newsom said on CNN’s “State of the Union.” One missing element: stadiums with sports fans. “As much as we want to see that happen,” he said, “the health consequences could be profound and devastating and set back all the progress we have made.”

Trump Aide Blames China for Spread (10:23 a.m. NY)

The Trump administration stepped up its campaign of blaming China for the coronavirus, with a top aide suggesting Beijing sent airline passengers to spread the infection worldwide.

“The virus was spawned in Wuhan province, patient zero was in November,” White House trade adviser Peter Navarro said on ABC’s “This Week.” “The Chinese, behind the shield of the World Health Organization, for two months hid the virus from the world and then sent hundreds of thousands of Chinese on aircraft to Milan, New York and around the world to seed that.”

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sophie-zadeh · 6 years ago

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Bernard Tomic's 60 Minutes Interview: Body Language and True Emotion Revealed

Yesterday, ABC Radio Perth invited me to talk about the wink gesture, on Geoff Hutchison’s Drive show. The invitation came in response to the unusual and repetitive winking behaviour displayed by tennis player, Bernard Tomic, whilst being interviewed by Allison Langdon on Australia’s 60 Minutes.

When Lucie Bell, the Producer, spoke to me about Tomic’s winking, I hadn’t seen the clip. I didn’t know anything about him, his previous notorious behaviours, nor the negative perceptions about him. I assumed Tomic’s repetitive winking must have been a nonverbal tic, fuelled by stress. And then, I watched a short clip from the show. I was wrong. He was overtly and inappropriately flirting with Allison Langdon. I was somewhat surprised, as it isn’t often we see ‘professionals’ behaving in a way, and to a degree, that is entirely inappropriate in the context of the situation.

Tomic’s verbal messaging confirmed his nonverbal behaviour–the flirtatious wink–when he asked Langdon, “You want to come to the restroom with me?”. At first, I heard ‘restaurant’. My brain had filled in the slightly more appropriate question, and, I was probably distracted by seeing the winking. However, on playback, it sounded more like ‘restroom’–wholly inappropriate! What did you hear?

In the short snippet I watched, I counted nine winks. Langdon ignored Tomic’s question, but Tomic wouldn’t let it go, he continued winking urging her, nonverbally, to pay attention and respond to his overt flirtatious signalling. You can read about the various meanings of a wink in this article.

Just moments later I spotted some more behaviours, both interesting and telling. I could see the bigger picture–it was a mask. This was Tomic’s defence mechanism. He was deliberately being dismissive to distract, escape from and avoid the reality of the interview, concealing his true emotion. As a result, his nonverbal behaviour and verbal message were disrespectful towards Langdon.

Bernard Tomic’s Body Language Reveals his True Emotion

The first behaviour I noticed, after the wink, was his one-sided shoulder shrug. This nonverbal behaviour points towards deception. For that reason, it’s my favourite behaviour to observe because it can reveal so much. It’s a very common behaviour, along with its sister behaviour, the double shrug (both shoulders), but it's not always significant. Its significance is determined by the words spoken at the time. In this case, it’s not significant, but it does give us insight into the bigger picture and Tomic’s true emotion.

Langdon

“You could have been better though.”

Tomic

“Do I have to try mega hard–no.”

On the word, “no”, Tomic’s left shoulder raises and falls. His one-sided shrug reveals he isn’t confident when he says, “no”. It tells us he does have to work hard–to some degree. In one way that’s obvious, it would be a stretch to say that a professional sports person doesn’t have to try hard. But his response in general, the very fact he says this, is defensive.

I went back to the start of the video clip and spotted three behaviours following on from each other. The first was a lip lick–a stress indicator. When we feel stressed and anxious our body responds, preparing us for the freeze, flight or fight response, it’s coming from the emotion of fear. A small part of this response is a dry mouth, due to a reduction in the production of saliva. We physically respond to this physiological change, by licking our lips or moving our tongue around in our mouth. This tells us Tomic is stressed.

The lip lick was immediately followed with a short eyelid flutter, consisting of two rapid blinks. An eyelid flutter is observed in people who are struggling with something. It stems from a high cognitive load. Stress on its own does increase cognitive load, but often, it’s more than that–it’s an emotional struggle or turmoil. We know Tomic is stressed and we can assume he is struggling with something emotionally. What? We don’t know. We can’t decipher the reason for the stress or the eyelid flutter, because reading body language can only tell us about emotional state. Anything beyond that is assumed.

The third behaviour in the cluster looks like the expression of shame. As Tomic’s eyelids flutter, his eyes avert downwards. This is observed within the emotional expressions of sadness and shame. In this case, it looks more like shame. Tomic possibly feels guilt or remorse.

There’s another behaviour that Tomic displayed throughout most of the short clip. His arm is across his torso, with his hand on his knee. This is a blocking behaviour. He’s blocking with both his arm and his leg. An extremely common behaviour, we observe this in people when they feel discomfort. For most people, it takes only the slightest level of discomfort, such as a stranger being in the room, to result in a blocking behaviour. Where this stems from is our drive to survive. When a threat is perceived, our brain responds in the same way it’s always responded for many thousands of years, keeping us safe. The physical reaction is to protect the most vital organs in our body–located in the torso.

If we put all of this together, we can decipher that Tomic is stressed, possibly struggling with something emotional, feeling shame and discomfort. I don’t know how that makes you feel, but for me, it reverses some of the negative emotion I felt in observing his inappropriate winking. It makes him seem more human. He’s just like everyone else, dealing with his feelings the way he thinks is best. He perhaps doesn’t have the emotional intelligence to know what is best, but none of us are perfect. I’m not trying to justify his behaviour, but I do want you to see it from another perspective.

Reading and understanding nonverbal communication often unveils the masks people use to disguise or conceal their inner emotion. You see people’s true emotion, and who they are as a person becomes accessible. It can alter snap judgements and give a deeper understanding of emotion and personality–it makes you more understanding and empathic.

Learn • Develop • Improve

Want to learn more about reading body language and nonverbal communication?

Click on the categories ‘Body Language Audit’, People of Interest’ or ‘Reading Body Language’ to read more posts like this.

Need more help with Reading Body Language?

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woodleyagnatanjahj70insuran-blog · 6 years ago

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When Pat Deaken’s back pain sets in—the result of degenerative disk disease and a severe curvature in her spine—she no longer immediately reaches for her pain meds. Instead, she inhales deeply and exhales slowly, taking notice of where her pain is. It’s usually in her lower back. She makes her pain the main point of her concentration as if she’s zooming into it. “The mindfulness makes me stop and think about where and how my pain is,” said Pat. “The breathing relaxes me and reduces my anxiety so I don’t mind the pain as much.”

“The mindfulness makes me stop and think about where and how my pain is”

Pat still takes opioid medication for her chronic pain condition, but has decreased the amount she takes significantly since learning a variety of mindfulness techniques in the Mindfulness-Oriented Recovery Enhancement (MORE) program, pioneered by University of Utah professor, Eric Garland, Ph.D., Aimed at decreasing patients’ use (and misuse) of prescription drugs, the eight-week program teaches mindfulness techniques to ease pain and craving, while using savoring practices to shift participants’ awareness to the emotions that arise in response to a pleasant experience.

Pain and the Opioid Epidemic

Chronic pain—or pain that exists every day for at least three months—is a serious problem for Americans, afflicting over 25 million adults, or 11.2% of the population. But the pain, itself, is no longer the only problem. Opioids, such as oxycodone (OxyContin) and hydrocodone (Vicodin), are used frequently as an antidote to chronic pain, but are highly addictive and their misuse has skyrocketed into what’s been called America’s 50-state epidemic. Over two and a half million Americans are estimated to have a problem with opioids—and in 2016, opioids were involved in the majority (66%) of drug overdose deaths, five times higher in than in 1999.

While pain levels have reportedly remained the same over the past two decades, the numbers of opioid medication prescriptions—sold to pharmacies, hospitals, and doctors’ offices—has quadrupled. Doctors prescribe opioids medications, a class of drugs that can effectively regulate pain, particularly following injury or surgery. But the risks of falling victim are high, making them the root of a catastrophic epidemic. The probability of long-term opioid use rises most sharply in the first days of therapy, especially after five days of taking the medication. And that number increases to about 13 percent for patients who first took the drugs for eight days or more. It only takes an initial 10-day opioid prescription for one in five patients to become a long-term user.

It only takes an initial 10-day opioid prescription for one in five patients to become a long-term user.

“In the current epidemic we are facing, most people begin with a legitimate prescription for pain relief and take opioids as prescribed by their physicians,” said Garland. “But there’s a subset of patients who start taking opioids to simply control pain and begin to slip down this cycle towards greater dependence on the drug and migrate into misuse—these are the folks at heightened risk.”

The standard treatment, once a diagnosis of opioid addiction is made (DSM-5 provides diagnostic criteria for the term “opioid use disorder”), involves the use of methadone and buprenorphine, part of a class of extended-release and long-acting opioids that are approved for the treatment of opioid addiction. Opioid addicts can safely take these medications for months or years. But this type of treatment is not without complications and controversy, and the overwhelming surge of addiction rates is prompting a much-needed examination of alternative treatments to curb the rate of misuse.

The Neuroscience of Opioid Addiction

Enter mindfulness, which Garland has been researching as a therapeutic tool to target chronic pain and opioid use simultaneously. The results of a 2014 study led by Garland and published in the Journal of Behavioral Medicine, showed that for a sample of chronic pain patients who had been misusing opioids and who subsequently underwent the mindfulness intervention, the more their brains were activated by natural, healthy rewards and positive experiences—such as a beautiful sunset, an affectionate animal, and delicious foods—the less they craved opioids. These results, along with additional studies showing MORE’s potential impact on heart-rate variability, have initiated a quest for more research on the effects of mindfulness on chronic pain and opioid addiction, bringing Garland $23 million in grants, awarded by the NIH, the Department of Defense (DOD), and the Patient-Centered Outcomes Research Institute (PCORI).

“The findings are scientifically important because one of the major theories about how and why addiction occurs asserts that over time, drug abusers become hypersensitive to drug-related cues, such as driving past a pharmacy or seeing a pill bottle, and dulled to the pleasure derived from natural, healthy rewards, like enjoying the beauty of nature, social connections and positive life experiences,” explained Garland. “So as addicts lose the ability to feel joy from spending time with a friend or playing with a pet, for example, they are pushed to take higher and higher doses of the drug to obtain comfort and relief.”

Garland’s research suggests that this process can be reversed. “We can teach people to use mindfulness to appreciate and enjoy life more, and by doing that, they may feel less of a need for addictive drugs,” he says. “We need a treatment that not only targets addictive behavior but also the pain that drove the addiction to opioid misuse.”

“We can teach people to use mindfulness to appreciate and enjoy life more, and by doing that, they may feel less of a need for addictive drugs” —Eric Garland, Ph.D.

Findings indicate that the MORE program reduces pain intensity itself by teaching people to shift from a more emotional way of processing pain to a sensory way of processing pain. Rather than focusing on pain as an awful, emotionally agonizing experience of suffering, the MORE patients are taught mindfulness skills to deconstruct the pain experience into its sensory components—such as sensations of heat, tingling, or tightness, as well as to notice non-painful or even pleasing sensations. “Thus, ‘pain’ is just a word or label we attribute to a cluster of sensations that may be innocuous or harmless in and of themselves,” said Garland.

Garland sees MORE therapy as a promising treatment for addiction, and the next step is to confirm its efficacy in full-scale clinical trials and to understand for whom mindfulness-based therapies work best. What is novel about the MORE intervention, he explained, is that it’s based on the neuroscience of addiction and designed to target specific mechanisms underlying the problem of addictive behavior and chronic pain. MORE restructures reward processing, from valuation of drug reward to valuation of natural rewards, and also uses mindfulness practices to strengthen self-regulation of automatic drug-use habits,” said Garland. “In our new studies, we will be able to measure how MORE changes the brain’s ability to regulate pain and respond to natural rewards, as well as deepen our understanding of exactly how these changes in neural mechanisms happen.”

What Mindfulness for Opioid Addiction Looks Like

The MORE program is made up of three mindfulness-based components—mindfulness, reappraisal and savoring—aimed at training the participants’ mind to learn how to focus their attention on the present moment, allowing them to bring awareness to automatic habits and more fully engage in their present moment experience.

Mindfulness, such as mindful breathing and body scans that bring awareness to sensations of the body lay the groundwork for learning focused concentration as a way to gain an objective, non-judgmental stance toward their pain. Mindful eating introduces a routine that many of us do on autopilot, and is an example where slowing down and being mindful can enhance an experience. For learning about the mindfulness of urges, Brandon Yabko, Ph.D., a psychologist who leads MORE groups of Veterans in Garland’s lab, said that they use chocolate—asking participants to examine the urge to eat it—as a tool to practice being mindful of urges. Participants are then asked to imagine that the chocolate is their pain pill, and finally given the choice of eating or throwing out their “pill.”

Reappraisal, where a client learns to reframe the meaning of a stressful or habitual action, such as fighting pain, in order to see that event with greater flexibility, even as purposeful and growth promoting. “This is a mindful twist on the ABC’s of cognitive therapy, where we ask participants to examine an Activating event, Beliefs about the event, and Consequences, or emotions, related to the specific event,” said Yabko. Followed by a mindful breathing practice, the participants are then asked if they could look at their beliefs from a different perspective. “Most of the time, they begin to see that there are other ways to look at this event and some even hold off on using their pain medication for a few minutes, hours, or maybe longer.”

Savoring pleasant events, one of the highlights of this treatment, according to Yabko, teaches participants how to mindfully focus their attention on a positive experience, as a way to concentrate on and expand positive feelings. During a meditation, for example, MORE participants were instructed to focus their awareness on the colors, scents and textures of fresh flowers and to notice the joy that arises from that experience. They are learning to see how the mind and body respond, and to notice the emotions and physical sensations that result from being aware of natural beauty.

Change the Struggle, Not the Pain

Emily Johansson, 44, takes opioids to help with her rheumatoid arthritis and myofascial pain syndrome, and noticed a couple of years ago that she was also using the meds for anxiety. Since learning mindfulness, Johansson said she’s emerged from a dark place. “Learning how to not judge my thoughts and notice them as a third party, watching them float away on a cloud has made a huge difference,” she explained. Her daily practice, learned in the MORE program, has given her the tools to pause and consider an alternative before popping a pain med. “When it’s time to take a pill, I’ll check in first to see how I’m feeling and ask myself, ‘Would a body scan be helpful? Or a recorded mindfulness meditation? Can I wait a while?’” she added.

Using the breath and opening to an awareness of her body sensations helps Johansson shift into a more grounded, objective frame of mind, from where she can explore her pain. Sometimes she’ll opt for a walk to the park, or play with the neighbor’s dog, using the practice of training her attention on the present moment to notice the beauty, rather than focus, or hyperfocus, on her pain. During the eight-week program, Johansson learned the benefits of savoring her present moment experience, and how to “drink in” the sights, sounds and smells and let them flow through her body. “When I am feeding the baby ducks and geese, I don’t think about the pain,” she said.

With mindfulness-based therapy, chronic pain patients are learning to change their relationship to their pain.

With mindfulness-based therapy, chronic pain patients are learning to change their relationship to their pain. It’s a path they can take to go from a non-accepting, combative, judgmental perspective, to one of acceptance, openness and curiosity.

Yabko shares with his MORE groups his own personal experience with chronic pain and mindfulness. He tells them how he began practicing mindfulness 10 years ago, and that it didn’t reduce the chronic pain he felt in his back, but it reduced his struggle with the pain. “When people get wrapped up in fighting their pain, they end up creating such a deep tension within themselves that they are causing suffering,” said Dr. Yabko. “Opioid misuse comes from that suffering component.”

Judson Brewer, MD, Ph.D., a psychiatrist, addiction expert, and Director of Research and Innovation at the Mindfulness Center at the School of Medicine at Brown University, agrees that when chronic pain patients resist pain, that increases the level of suffering, and when they stop resisting, suffering decreases. “From a preventive angle, someone with chronic pain can learn to be with and work with pain on a sensation level, noting that this is heat, tension, burning, vibration,” said Dr. Brewer. “When they have pain, they also see that it comes and goes, it changes: pain is not the same from moment to moment.”

According to Brewer, cravings for drugs have a lot of similarities to the impact of pain. “They drive us to do things, give us feelings of restlessness, tension, tightness—sensations people can identify with when they feel chronic pain,” he explained. “There are a lot of overlaps, especially that restless, driving quality that says do something to make this go away, and the do something is opioids.”

When chronic pain patients resist pain, that increases the level of suffering, and when they stop resisting, suffering decreases.

Don Deaken, Pat’s husband, worked for 42 years as an oil-field machinist, a job that required heavy lifting. Now a diabetic with neuropathy from his knees down, Deaken has had four back surgeries and continues to live with constant back pain. He began taking opioids in 1999, and over time his dosage increased to 15 milligrams of oxycodone, six times a day. “I was pretty doped up most of the time,” said Deaken. But when he began having difficulty breathing at night, his doctor suggested cutting back on the opioids and sent him to the University of Utah’s Center on Mindfulness and Integrative Health Intervention Development (C-MIND), where he began the MORE training program.

Since learning mindfulness in the spring of 2016, Deaken has cut back his pain meds significantly, reducing them from 15 to 5 milligrams, and from six to four times a day. “I was always taking pills just to get rid of the pain, and now I take them to keep it under control,” Deaken said. “The pain never goes away, but mindfulness has taught me how to focus on the pain rather than ignore it, so when I breathe into the spot where I feel it, I relax in a way that helps the pain fade.”

So can these mindfulness-based therapies prevent chronic pain sufferers from reaching straight for their powerfully addictive pain meds?

It remains to be seen, but looks encouraging. “After someone practices mindfulness for a period of time, their cravings usually go down, because they are like emotions that come and go, and they don’t last forever and the patients begin to see that,” said Yabko.

Mindfulness exercises are the prescription Emily Johansson wishes every chronic pain sufferer could have. “Pain wants to control your brain and get your full attention until you give it a pain med,” she said. Johansson has learned to zoom in on her pain, accept it and let it go, and using mindfulness has helped her feel hopeful. “I went out to my car after it snowed one day and I stood there, watching the snowflakes,” she said. “They had spikes on them and are such a simple, cool part of nature, something I ‘d never noticed before. When I slow down, I can see there are things going on in my life that can be enjoyable.”

Mindfulness Research

How the Brain Can Change Your Experience of Pain

New research using mindfulness meditation suggests we can ease pain by the way we pay attention to it. Read More

Jennifer Wolkin

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Mental Health

Easing Chronic Pain with Mindfulness

A recent study demonstrates that Mindfulness-Based Stress Reduction (MBSR) is effective in easing pain symptoms. Read More

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November 22, 2015

Health

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March 19, 2018

The post What Mindfulness for Opioid Addiction Looks Like appeared first on Mindful.

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