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From Chaos To Calm: A Life Changed By Ketamine

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An anesthetic and sometimes-party drug, ketamine is helping some patients calm the symptoms of mental disorders.

For six years now, life has been really good for James. He has a great job as the creative director of an advertising firm in New York City. He enjoys spending time with his wife and kids.

And it has all been possible, he says, because for the past six years he has been taking a drug called ketamine.

Before ketamine, James was unable to work or focus his thoughts. His mind was filled with violent images. And his mood could go from ebullient to dark in a matter of minutes.

Ketamine “helped me get my life back,” says James, who asked that we not use his last name to protect his career.

Ketamine was developed as a human and animal anesthetic in the 1960s. And almost from the time it reached the market it has also been used as a mind-bending party drug.

But ketamine’s story took a surprising turn in 2006, when researchers at the National Institutes of Health showed that an intravenous dose could relieve severe depression in a matter of hours. Since then, doctors have prescribed ketamine “off label” to thousands of depressed patients who don’t respond to other drugs.

And pharmaceutical companies are testing several new ketamine-related drugs to treat depression. Johnson & Johnson expects to seek approval for its nasal spray esketamine later this year, though the approval would be limited to use in a clinical setting.

Meanwhile, doctors have begun trying ketamine on patients with a wide range of psychiatric disorders other than depression. And there is now growing evidence it can help people with anxiety, bipolar disorder, post-traumatic stress disorder, and perhaps even obsessive-compulsive disorder.

“I think it’s actually one of the biggest advances in psychiatry in a very long time,” says Dr. Martin Teicher, an associate professor of psychiatry at Harvard Medical School and director of the Developmental Biopsychiatry Research Program at McLean Hospital.

Ketamine For Severe Depression: 'How Do You Not Offer This Drug To People?'

Ketamine may also offer new hope for people like James who have symptoms of several different psychiatric disorders.

James had a happy childhood, he says. But his thoughts were out of control. “I always felt like I was crossing a freeway and my thoughts were just racing past me,” he says.

He spent much of his childhood terrified of “an unknown, an ambiguous force out there.” The fear was “overwhelming,” he says. “I literally slept with the cover over my head with just room to breathe through my mouth until I went to college.”

And there was something else about James: his body temperature.

“I overheated constantly,” he says. “I would wear shorts all year long. In my 20s in my apartment I would sleep with the windows open in the middle of the winter.”

In his late 20s, James saw a doctor who told him he had attention deficit hyperactivity disorder. So he started taking stimulants.

At first, the pills helped him focus. Then they didn’t, no matter how many he took.

He’d done well as an idea guy in the advertising industry. But now James was trying to work at home, and it wasn’t going well.

“ADHD pills will make you interested in anything,” he says. “So I was putting the desk together and taking the desk apart. I was putting a laptop stand together and taking it apart. I was going in a massive downward spiral.”

James had always suffered from mood swings. But now they were rapid and extreme. And he couldn’t stop thinking about gruesome scenarios, like a murderer coming for his family.

“My wife took a summer off to be with me because she was scared of what was going to happen to me,” he says. “She would go to work for a few hours, then rush home. There would be times I’d call her just screaming, ‘Please come home. I can’t get through another minute.’ ”

Eventually, James found his way to Dr. Demitri Papolos, an associate professor of clinical psychiatry at Albert Einstein College of Medicine.

“He was like a whirling dervish when he came into my office,” Papolos says. “He was extremely fearful and scanning the environment all the time and he overheated at the drop of a hat.”

Papolos diagnosed James with a variant of bipolar disorder he calls the “fear of harm phenotype.” It typically appears in childhood and often doesn’t respond to traditional psychiatric drugs.

But Papolos has found that the condition does respond to ketamine. “It’s been transformational,” he says.

Ketamine Relieves Depression By Restoring Brain Connections

In January, Papolos published a study of 45 children with the problem. They inhaled a nasal mist containing ketamine about twice a week. Nearly all got dramatically better.

Scientists still aren’t sure why ketamine works, but there’s evidence that it encourages the brain to rewire, to alter the connections between cells. That process has been linked to recovery from depression. And it may also explain why ketamine helps people who have symptoms associated with several different psychiatric disorders.

“I think it’s having multiple effects, and that means it’s probably useful for multiple different disorders,” Teicher says.

One of those effects involves a part of the brain involved in temperature regulation. And that could explain why patients like James usually stop overheating once they are taking ketamine.

James started taking a ketamine nasal spray every other day. He says his response was dramatic.

“One day I turn to my wife and I’m like, ‘I feel calm today. I don’t know if it’s the sun coming in, I don’t know if it’s just the way we’re sitting here, but I feel like I could go and sit at the computer and work.’ ”

The next day, James did sit down at his computer. A month later, he was back at work.

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Why Children Aren’t Behaving, And What You Can Do About It

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Boy completes his chore of raking leaves

Childhood — and parenting — have radically changed in the past few decades, to the point where far more children today struggle to manage their behavior.

That’s the argument Katherine Reynolds Lewis makes in her new parenting book, The Good News About Bad Behavior.

“We face a crisis of self-regulation,” Lewis writes. And by “we,” she means parents and teachers who struggle daily with difficult behavior from the children in their lives.

Lewis, a journalist, certified parent educator and mother of three, asks why so many kids today are having trouble managing their behavior and emotions.

Three factors, she says, have contributed mightily to this crisis.

First: Where, how and how much kids are allowed to play has changed. Second, their access to technology and social media has exploded.

Finally, Lewis suggests, children today are too “unemployed.” She doesn’t simply mean the occasional summer job for a high school teen. The term is a big tent, and she uses it to include household jobs that can help even toddlers build confidence and a sense of community.

“They’re not asked to do anything to contribute to a neighborhood or family or community,” Lewis tells NPR in a recent interview. “And that really erodes their sense of self-worth — just as it would with an adult being unemployed.”

Below is more of that interview, edited for length and clarity.

What sorts of tasks are children and parents prioritizing instead of household responsibilities?

To be straight-A students and athletic superstars, gifted musicians and artists — which are all wonderful goals, but they are long-term and pretty narcissistic. They don’t have that sense of contribution and belonging in a family the way that a simple household chore does, like helping a parent prepare a meal. Anyone who loves to cook knows it’s so satisfying to feed someone you love and to see that gratitude and enjoyment on their faces. And kids today are robbed of that.

It’s part of the work of the family. We all do it, and when it’s more of a social compact than an adult in charge of doling out a reward, that’s much more powerful. They can see that everyone around them is doing jobs. So it seems only fair that they should also.

Kids are so driven by what’s fair and what’s unfair. And that’s why the more power you give kids, the more control you give them, the more they will step up.

You also argue that play has changed dramatically. How so?

Two or three decades ago, children were roaming neighborhoods in mixed-age groups, playing pretty unsupervised or lightly supervised. They were able to resolve disputes, which they had a strong motivation to because they wanted to keep playing. They also planned their time and managed their games. They had a lot of autonomy, which also feeds self-esteem and mental health.

Nowadays, kids, including my own, are in child care pretty much from morning until they fall into bed — or they’re under the supervision of their parents. So they aren’t taking small risks. They aren’t managing their time. They aren’t making decisions and resolving disputes with their playmates the way that kids were 20 or 30 years ago. And those are really important social and emotional skills for kids to learn, and play is how all young mammals learn them.

The Key To Raising A Happy Child

While we’re on the subject of play and the importance of letting kids take risks, even physical risks, you mention a remarkable study out of New Zealand — about phobias. Can you tell us about it?

This study dates back to when psychologists believed that if you had a phobia as an adult, you must have had some traumatic experience as a child. So they started looking at people who had phobias and what their childhood experiences were like. In fact, they found the opposite relationship.

People who had a fall from heights were less likely to have an adult phobia of heights. People who had an early experience with near-drowning had zero correlation with a phobia of water, and children who were separated from their parents briefly at an early age actually had less separation anxiety later in life.

We need to help kids to develop tolerance against anxiety, and the best way to do that, this research suggests, is to take small risks — to have falls and scrapes and tumbles and discover that they’re capable and that they can survive being hurt. Let them play with sticks or fall off a tree. And yeah, maybe they break their arm, but that’s how they learn how high they can climb.

You say in the book that “we face a crisis of self-regulation.” What does that look like at home and in the classroom?

It’s the behavior in our homes that keeps us from getting out the door in the morning and keeps us from getting our kids to sleep at night.

In schools, it’s kids jumping out of seats because they can’t control their behavior or their impulses, getting into shoving matches on the playground, being frozen during tests because they have such high rates of anxiety.

Really, I lump under this umbrella of self-regulation the increase in anxiety, depression, ADHD, substance addiction and all of these really big challenges that are ways kids are trying to manage their thoughts, behavior and emotions because they don’t have the other skills to do it in healthy ways.

How Schools Are Handling An 'Overparenting' Crisis

You write a lot about the importance of giving kids a sense of control. My 6-year-old resists our morning schedule, from waking up to putting on his shoes. Where is the middle ground between giving him control over his choices and making sure he’s ready when it’s time to go?

It’s a really tough balance. We start off, when our kids are babies, being in charge of everything. And our goal by the time they’re 18 is to be in charge of nothing — to work ourselves out of the job of being that controlling parent. So we have to constantly be widening the circle of things that they’re in charge of, and shrinking our own responsibility.

It’s a bit of a dance for a 6-year-old, really. They love power. So give him as much power as you can stand and really try to save your direction for the things that you don’t think he can do.

He knows how to put on his shoes. So if you walk out the door, he will put on his shoes and follow you. It may not feel like it, but eventually he will. And if you spend five or 10 minutes outside that door waiting for him — not threatening or nagging — he’ll be more likely to do it quickly. It’s one of these things that takes a leap of faith, but it really works.

Kids also love to be part of that discussion of, what does the morning look like. Does he want to draw a visual calendar of the things that he wants to get done in the morning? Does he want to set times, or, if he’s done by a certain time, does he get to do something fun before you leave the house? All those things that are his ideas will pull him into the routine and make him more willing to cooperate.

Whether you’re trying to get your child to dress, do homework or practice piano, it’s tempting to use rewards that we know our kids love, especially sweets and screen time. You argue in the book: Be careful. Why?

Yes. The research on rewards is pretty powerful, and it suggests that the more we reward behavior, the less desirable that behavior becomes to children and adults alike. If the child is coming up with, “Oh, I’d really like to do this,” and it stems from his intrinsic interests and he’s more in charge of it, then it becomes less of a bribe and more of a way that he’s structuring his own morning.

The adult doling out rewards is really counterproductive in the long term — even though they may seem to work in the short term. The way parents or teachers discover this is that they stop working. At some point, the kid says, “I don’t really care about your reward. I’m going to do what I want.” And then we have no tools. Instead, we use strategies that are built on mutual respect and a mutual desire to get through the day smoothly.

How To Raise Brilliant Children, According To Science

You offer pretty simple guidance for parents when they’re confronted with misbehavior and feel they need to dole out consequences. You call them the four R’s. Can you walk me through them?

The four R’s will keep a consequence from becoming a punishment. So it’s important to avoid power struggles and to win the kid’s cooperation. They are: Any consequence should be revealed in advance, respectful, related to the decision the child made, and reasonable in scope.

Generally, by the time they’re 6 or 7 years old, kids know the rules of society and politeness, and we don’t need to give them a lecture in that moment of misbehavior to drill it into their heads. In fact, acting in that moment can sometimes be counterproductive if they are amped up, their amygdala’s activated, they’re in a tantrum or excited state, and they can’t really learn very well because they can’t access the problem-solving part of their brain, the prefrontal cortex, where they’re really making decisions and thinking rationally. So every misbehavior doesn’t need an immediate consequence.

You even tell parents, in the heat of the moment, it’s OK to just mumble and walk away. What do you mean?

That’s when you are looking at your child, they are not doing what you want, and you cannot think of what to do. Instead of jumping in with a bribe or a punishment or yelling, you give yourself some space. Pretend you had something on the stove you need to grab or that you hear something ringing in the other room and walk away. That gives you just a little space to gather your thoughts and maybe calm down a little bit so you can respond to their behavior from the best place in you — from your best intentions as a parent.

I can imagine skeptics out there, who say, “But kids need to figure out how to live in a world that really doesn’t care what they want. You’re pampering them!” In fact, you admit your own mother sometimes feels this way. What do you say to that?

I would never tell someone who’s using a discipline strategy that they feel really works that they’re wrong. What I say to my mom is, “The tools and strategies that you used and our grandparents used weren’t wrong, they just don’t work with modern kids.” Ultimately, we want to instill self-discipline in our children, which will never happen if we’re always controlling them.

If we respond to our kids’ misbehavior instead of reacting, we’ll get the results we want. I want to take a little of the pressure off of parenting; each instance is not life or death. We can let our kids struggle a little bit. We can let them fail. In fact, that is the process of childhood when children misbehave. It’s not a sign of our failure as parents. It’s normal.

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Now, you can hold a copy of your brain in the palm of your hand

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New 3D printing technique enables faster, better, and cheaper models of patient-specific medical data for research and diagnosis

Summary:
Medical imaging technologies like MRI and CT scans produce high-resolution images as a series of ‘slices,’ making them an obvious complement to 3D printers, which also print in slices. However, the process of manually ‘thresholding’ medical scans to define objects to be printed is prohibitively expensive and time-consuming. A new method converts medical data into dithered bitmaps, allowing custom 3D-printed models of patient data to be printed in a fraction of the time.
This 3D-printed model of Steven Keating’s skull and brain clearly shows his brain tumor and other fine details thanks to the new data processing method pioneered by the study’s authors.
Credit: Wyss Institute at Harvard University

What if you could hold a physical model of your own brain in your hands, accurate down to its every unique fold? That’s just a normal part of life for Steven Keating, Ph.D., who had a baseball-sized tumor removed from his brain at age 26 while he was a graduate student in the MIT Media Lab’s Mediated Matter group. Curious to see what his brain actually looked like before the tumor was removed, and with the goal of better understanding his diagnosis and treatment options, Keating collected his medical data and began 3D printing his MRI and CT scans, but was frustrated that existing methods were prohibitively time-intensive, cumbersome, and failed to accurately reveal important features of interest. Keating reached out to some of his group’s collaborators, including members of the Wyss Institute at Harvard University, who were exploring a new method for 3D printing biological samples.

“It never occurred to us to use this approach for human anatomy until Steve came to us and said, ‘Guys, here’s my data, what can we do?” says Ahmed Hosny, who was a Research Fellow with at the Wyss Institute at the time and is now a machine learning engineer at the Dana-Farber Cancer Institute. The result of that impromptu collaboration — which grew to involve James Weaver, Ph.D., Senior Research Scientist at the Wyss Institute; Neri Oxman, Ph.D., Director of the MIT Media Lab’s Mediated Matter group and Associate Professor of Media Arts and Sciences; and a team of researchers and physicians at several other academic and medical centers in the US and Germany — is a new technique that allows images from MRI, CT, and other medical scans to be easily and quickly converted into physical models with unprecedented detail. The research is reported in 3D Printing and Additive Manufacturing.

“I nearly jumped out of my chair when I saw what this technology is able to do,” says Beth Ripley, M.D. Ph.D., an Assistant Professor of Radiology at the University of Washington and clinical radiologist at the Seattle VA, and co-author of the paper. “It creates exquisitely detailed 3D-printed medical models with a fraction of the manual labor currently required, making 3D printing more accessible to the medical field as a tool for research and diagnosis.”

Imaging technologies like MRI and CT scans produce high-resolution images as a series of “slices” that reveal the details of structures inside the human body, making them an invaluable resource for evaluating and diagnosing medical conditions. Most 3D printers build physical models in a layer-by-layer process, so feeding them layers of medical images to create a solid structure is an obvious synergy between the two technologies.

However, there is a problem: MRI and CT scans produce images with so much detail that the object(s) of interest need to be isolated from surrounding tissue and converted into surface meshes in order to be printed. This is achieved via either a very time-intensive process called “segmentation” where a radiologist manually traces the desired object on every single image slice (sometimes hundreds of images for a single sample), or an automatic “thresholding” process in which a computer program quickly converts areas that contain grayscale pixels into either solid black or solid white pixels, based on a shade of gray that is chosen to be the threshold between black and white. However, medical imaging data sets often contain objects that are irregularly shaped and lack clear, well-defined borders; as a result, auto-thresholding (or even manual segmentation) often over- or under-exaggerates the size of a feature of interest and washes out critical detail.

The new method described by the paper’s authors gives medical professionals the best of both worlds, offering a fast and highly accurate method for converting complex images into a format that can be easily 3D printed. The key lies in printing with dithered bitmaps, a digital file format in which each pixel of a grayscale image is converted into a series of black and white pixels, and the density of the black pixels is what defines the different shades of gray rather than the pixels themselves varying in color.

Similar to the way images in black-and-white newsprint use varying sizes of black ink dots to convey shading, the more black pixels that are present in a given area, the darker it appears. By simplifying all pixels from various shades of gray into a mixture of black or white pixels, dithered bitmaps allow a 3D printer to print complex medical images using two different materials that preserve all the subtle variations of the original data with much greater accuracy and speed.

The team of researchers used bitmap-based 3D printing to create models of Keating’s brain and tumor that faithfully preserved all of the gradations of detail present in the raw MRI data down to a resolution that is on par with what the human eye can distinguish from about 9-10 inches away. Using this same approach, they were also able to print a variable stiffness model of a human heart valve using different materials for the valve tissue versus the mineral plaques that had formed within the valve, resulting in a model that exhibited mechanical property gradients and provided new insights into the actual effects of the plaques on valve function.

“Our approach not only allows for high levels of detail to be preserved and printed into medical models, but it also saves a tremendous amount of time and money,” says Weaver, who is the corresponding author of the paper. “Manually segmenting a CT scan of a healthy human foot, with all its internal bone structure, bone marrow, tendons, muscles, soft tissue, and skin, for example, can take more than 30 hours, even by a trained professional — we were able to do it in less than an hour.”

The researchers hope that their method will help make 3D printing a more viable tool for routine exams and diagnoses, patient education, and understanding the human body. “Right now, it’s just too expensive for hospitals to employ a team of specialists to go in and hand-segment image data sets for 3D printing, except in extremely high-risk or high-profile cases. We’re hoping to change that,” says Hosny.

In order for that to happen, some entrenched elements of the medical field need to change as well. Most patients’ data are compressed to save space on hospital servers, so it’s often difficult to get the raw MRI or CT scan files needed for high-resolution 3D printing. Additionally, the team’s research was facilitated through a joint collaboration with leading 3D printer manufacturer Stratasys, which allowed access to their 3D printer’s intrinsic bitmap printing capabilities. New software packages also still need to be developed to better leverage these capabilities and make them more accessible to medical professionals.

Despite these hurdles, the researchers are confident that their achievements present a significant value to the medical community. “I imagine that sometime within the next 5 years, the day could come when any patient that goes into a doctor’s office for a routine or non-routine CT or MRI scan will be able to get a 3D-printed model of their patient-specific data within a few days,” says Weaver.

Keating, who has become a passionate advocate of efforts to enable patients to access their own medical data, still 3D prints his MRI scans to see how his skull is healing post-surgery and check on his brain to make sure his tumor isn’t coming back. “The ability to understand what’s happening inside of you, to actually hold it in your hands and see the effects of treatment, is incredibly empowering,” he says.

“Curiosity is one of the biggest drivers of innovation and change for the greater good, especially when it involves exploring questions across disciplines and institutions. The Wyss Institute is proud to be a space where this kind of cross-field innovation can flourish,” says Wyss Institute Founding Director Donald Ingber, M.D., Ph.D., who is also the Judah Folkman Professor of Vascular Biology at Harvard Medical School (HMS) and the Vascular Biology Program at Boston Children’s Hospital, as well as Professor of Bioengineering at Harvard’s John A. Paulson School of Engineering and Applied Sciences (SEAS).

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Pediatric Medication Safety in the Emergency Department

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Abstract

Pediatric patients cared for in emergency departments (EDs) are at high risk of medication errors for a variety of reasons. A multidisciplinary panel was convened by the Emergency Medical Services for Children program and the American Academy of Pediatrics Committee on Pediatric Emergency Medicine to initiate a discussion on medication safety in the ED. Top opportunities identified to improve medication safety include using kilogram-only weight-based dosing, optimizing computerized physician order entry by using clinical decision support, developing a standard formulary for pediatric patients while limiting variability of medication concentrations, using pharmacist support within EDs, enhancing training of medical professionals, systematizing the dispensing and administration of medications within the ED, and addressing challenges for home medication administration before discharge.

 

  • Abbreviations:
    AAP —
    American Academy of Pediatrics
    ACEP —
    American College of Emergency Physicians
    ADE —
    adverse drug event
    CDS —
    clinical decision support
    CPOE —
    computerized physician order entry
    ED —
    emergency department
    ENA —
    Emergency Nurses Association

 

Background

Despite a national focus on patient safety since the publication of the Institute of Medicine (now the National Academy of Medicine) report “To Err is Human” in 1999, medical errors remain a leading cause of morbidity and mortality across the United States.1 Medication errors are by far the most common type of medical error occurring in hospitalized patients,2 and the medication error rate in pediatric patients has been found to be as much as 3 times the rate in adult patients.3,4 Because many medication errors and adverse drug events (ADEs) are preventable,1 strategies to improve medication safety are an essential component of an overall approach to providing quality care to children.

The pediatric emergency care setting is recognized as a high-risk environment for medication errors because of a number of factors, including medically complex patients with multiple medications who are unknown to emergency department (ED) staff, a lack of standard pediatric drug dosing and formulations,5 weight-based dosing,6,7 verbal orders, a hectic environment with frequent interruptions,8 a lack of clinical pharmacists on the ED care team,9,10 inpatient boarding status,11 the use of information technology systems that lack pediatric safety features,12 and numerous transitions in care. In addition, the vast majority of pediatric patients seeking care in EDs are not seen in pediatric hospitals but rather in community hospitals, which may treat a low number of pediatric patients.13 Studies also outline the problem of medication errors in children in the prehospital setting. A study of 8 Michigan emergency medical services agencies revealed errors for commonly used medications, with up to one-third of medications being dosed incorrectly.14 Medication error rates reported from single institutions with dedicated pediatric EDs range from 10% to 31%,15,16 and in a study from a pediatric tertiary care center network, Shaw et al6 showed that medication errors accounted for almost 20% of all incident reports, with 13% of the medication errors causing patient harm. The authors of another study examined medication errors in children at 4 rural EDs in northern California and found an error rate of 39%, with 16% of these errors having the potential to cause harm.17 The following discussion adds to the broad topic of medication safety by introducing specific opportunities unique to pediatric patients within EDs to facilitate local intervention on the basis of institutional experience and resources.

Strategies for Improvement

A multidisciplinary expert panel was convened by the Emergency Medical Services for Children program and the American Academy of Pediatrics (AAP), through its Committee on Pediatric Emergency Medicine, to discuss challenges related to pediatric medication safety in the emergency setting. The panel included emergency care providers, nurses, pharmacists, electronic health record industry representatives, patient safety organization leaders, hospital accreditation organizations, and parents of children who suffered ADEs. The panel outlined numerous opportunities for improvement, including raising awareness of risks for emergency care providers, trainees, children, and their families; developing policies and processes that support improved pediatric medication safety; and implementing best practices to reduce pediatric ADEs. Specific strategies discussed by the panel, as well as recent advances in improving pediatric medication safety, are described.

Decreasing Pediatric Medication Prescribing Errors in the ED

Computerized Physician Order Entry

Historically, the majority of pediatric medication errors were associated with the ordering phase of the medication process. Specific risks related to pediatric weight-based dosing include not using the appropriate weight,6 performing medication calculations based on pounds instead of the recognized standard of kilograms,6 and making inappropriate calculations, including tenfold dosing errors.18–20 Childhood obesity introduces further opportunity for dosing error. In addition to the lack of science to guide medication dosing in patients with obesity,21 frequent underdosing22 is reported, and currently available resuscitation tools are commonly imprecise.23 Furthermore, there are limited opportunities for prescription monitoring or double-checking in the ED setting, and many times calculations are performed in the clinical area without input from a pharmacist.9 The implementation of computerized physician order entry (CPOE) and clinical decision support (CDS) with electronic prescribing have reduced many of these errors, because most CPOE systems obviate the need for simple dose calculation. However, CPOE systems have not fully eliminated medication errors. Commercial or independently developed CPOE systems may fail to address critical unique pediatric dosing requirements.12,24 Kilogram-only scales are recommended for obtaining weights, yet conversion to pounds either by the operator or electronic health record may introduce opportunity for error into the system. In addition, providers may override CDS, despite its proven success in reducing errors.16,25 Prescribers frequently choose to ignore or override CDS prescribing alerts, with reported override rates as high as 96%.26 Allowing for free text justification to override alerts for nonformulary drugs may introduce errors. The development of an override algorithm can help reduce user variability.27 As the use of CPOE increases, one can expect that millions of medication errors will be prevented.28 For EDs that do not use CPOE, preprinted medication order forms have been shown to significantly reduce medication errors in a variety of settings and serve as a low-cost substitute for CPOE.29–32

Standardized Formulary

The Institute of Medicine (now the National Academy of Medicine) recommends development of medication dosage guidelines, formulations, labeling, and administration techniques for the pediatric emergency care setting.5 Unfortunately, there are currently no universally accepted, pediatric-specific standards with regard to dose suggestion and limits, and dosing guidelines and alerts found in CPOE are commonly provided by third-party vendors that supply platforms to both children’s and general hospitals. The development of a standard pediatric formulary, independent of an adult-focused system, can reduce opportunities for error by specifying limited concentrations and standard dosage of high-risk and frequently used medications, such as resuscitation medications, vasoactive infusions, narcotics, and antibiotics, as well as look-alike and sound-alike medications.33 A standard formulary will allow for consistent education during initial training and continuing medical education for emergency care providers, creating a consistent measure of provider competency. At least 1 large hospital organization has successfully implemented this type of change.34 In addition, the American Society of Health-System Pharmacists is working with the Food and Drug Administration to develop and implement national standardized concentrations for both intravenous and oral liquid medications.35

ED Pharmacists

Currently, many medications are prepared and dispensed in the ED without pharmacist verification or preparation because many EDs lack consistent on-site pharmacist coverage.9,36 In a survey of pharmacists, 68% reported at least 8 hours of ED coverage on weekdays, but fewer than half of EDs see this support on weekends, with a drastic reduction in coverage during overnight and morning hours.37 The American College of Emergency Physicians (ACEP) supports the integration of pharmacists within the ED team, specifically recognizing the pediatric population as a high-risk group that may benefit from pharmacist presence.38 The Emergency Nurses Association (ENA) supports the role of the emergency nurse as well as pharmacy staff to efficiently complete the best possible medication history and reduce medication discrepencies.39,40 The American Society of Health-System Pharmacists suggests that ED pharmacists may help verify and prepare high-risk medications, be available to prepare and double-check dosing of medications during resuscitation, and provide valuable input in medication reconciliation, especially of medically complex children whose medications and dosing may be unknown to ED staff and who present without a medication list or portable emergency information form.41 Medically complex patients typify the difficulty with medication reconciliation, with an error rate of 21% in a tertiary care facility.42 In this study, no 1 source from the parent, pharmacy, and primary provider group was both available and appropriately sensitive or specific in completing medication reconciliation. Pharmacist-managed reconciliation has had a positive impact for admitted pediatric patients and may translate to the emergency setting.43,44 ED pharmacists can also help monitor for ADEs, provide drug information, and provide information regarding medication ingestions to both providers and patients and/or families.45

Dedicated pharmacists can be integrated through various methods, such as hiring dedicated pharmacy staff for the ED,7 having these staff immediately available when consulted, or having remote telepharmacy review of medication orders by a central pharmacist.46,47 Although further research is needed on the potential outcomes on medication safety and return on investment when a pharmacist is placed in the ED, current experience reveals improvements in medication safety when a pharmacist is present.48 Studies from general EDs reveal significant cost savings as well,49 with the authors of 1 study in a single urban adult ED identifying more than $1 million dollars of cost avoidance in only 4 months.50

Training in Pediatric Medication Safety

Dedicated training in pediatric medication safety is highly variable in the curricula of professional training programs in medical, nursing, and pharmacy schools.51 Although national guidelines support the training of prehospital personnel with specific pediatric content and safety and error-reduction training,52 a nearly 35% prehospital medication error rate for critical medications for pediatric patients remains.14 At the graduate medical education level, the curricula of pediatric and emergency medicine residency programs and pediatric emergency medicine fellowship programs do not define specific requirements for pediatric medication safety training.53–55 The same is true for pharmacy programs.56 Although schools of pharmacy include pediatric topics in their core curricula, pediatric safety advocates believe there is an opportunity for enhanced and improved training.57

Experts in pediatric emergency care from the multidisciplinary panel recommend development of a curriculum on pediatric medication safety that could be offered to all caregivers of children in emergency settings. A standard curriculum may include content such as common medication errors in children, systems-improvement tools to avoid or abate errors, and the effects of developmental differences in pediatric patients. Demonstrating competency on the basis of this curriculum is 1 means by which institutions may reduce risks of medication errors.

Decreasing Pediatric Medication Administration Errors in the ED

The dispensing and administration phases serve as final opportunities to optimize medication safety. Strategies to reduce errors include standardizing the concentrations available for a given drug, having readily available and up-to-date medication reference materials, using premixed intravenous preparations when possible, having automated dispensing cabinets with appropriate pediatric dosage formulations, using barcoded medication administration,58 having pharmacists and ED care providers work effectively as a team, and having policies to guide medication use.59,60 Although yet to be studied in the ED environment, smart infusion pumps have shown promise in other arenas in reducing administration errors for infusions.61

Nurses are held accountable by each state’s nurse practice act for the appropriateness of all medications given. Nursing schools teach the 5 rights of medication administration: the right patient, the right medication, the right dose, the right time, and the right route.62 Elliott and Liu63 expand the 5 rights to include right documentation, right action, right form, and right response to further improve medication safety. Simulated medication administration addresses opportunities beyond those captured within these rights and may have implications within the ED.64 Additionally, given the association of medication preparation interruptions and administration errors,65 the use of a distraction-free medication safety zone has been shown to enhance medication safety.66,67 Implementation of an independent 2-provider check process for high-alert medications, as suggested by The Joint Commission, also reduces administration errors.68 Both the Institute for Safe Medication Practices and The Joint Commission provide excellent guidance on these topics.69

Decreasing Pediatric Medication Errors in the Home

Recognizing and addressing language barriers and health literacy variability in the ED can affect medication safety in the home. Nonstandardized delivery devices continue to be used in the home, and dosing error rates of greater than 40% are reported.70 Advanced counseling and instrument provision in the ED are proven to decrease dosing errors at home.71 Pictograms provided to aide in medication measurement have also been shown to decrease errors and may be considered as part of discharge instructions.72 The AAP supports policy on the use of milliliter-only dosing for liquid medications used in the home and suggests that standardized delivery devices be distributed from the ED for use with these medications.73 As the body of literature regarding health literacy evolves, further addressing these issues in real time may influence out-of-hospital care.

Summary

Pediatric medication safety requires a multidisciplinary approach across the continuum of emergency care, starting in the prehospital setting, during emergency care, and beyond. Key areas for medication safety specific to pediatric care in the ED include the creation of standardized medication dosing guidelines, better integration and use of information technology to support patient safety, and increased education standards across health care disciplines. The following is a list of specific recommendations that can lead to improved pediatric medication safety in the emergency care setting.

Recommendations

  1. Create a standard formulary for pediatric high-risk and commonly used medications;

  2. standardize concentrations of high-risk medications;

  3. reduce the number of available concentrations to the smallest possible number;

  4. provide recommended precalculated doses;

  5. measure and record weight in kilograms only;

  6. use length-based dosing tools when a scale is unavailable or use is not feasible;

  7. implement and support the availability of pharmacists in the ED;

  8. use standardized order sets with embedded best practice prescribing and dosing range maximums;

  9. promote the development of distraction-free medication safety zones for medication preparation;

  10. implement process screening, such as a 2-provider independent check for high-alert medications;

  11. implement and use CPOE and CDS with pediatric-specific kilogram-only dosing rules, including upper dosing limits within ED information systems;

  12. encourage community providers of children with medical complexity to maintain a current medication list and an emergency information form to be available for emergency care;

  13. create and integrate a dedicated pediatric medication safety curriculum into training programs for nurses, physicians, respiratory therapists, nurse practitioners, physician assistants, prehospital providers, and pharmacists;

  14. develop tools for competency assessment;

  15. dispense standardized delivery devices for home administration of liquid medications;

  16. dispense milliliter-only dosing for liquid medications used in the home;

  17. employ advanced counseling such as teach-back when sharing medication instructions for home use; and

  18. use pictogram-based dosing instruction sheets for use of home medications.

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How I Freed Myself Spiritually with 3 Life Changes

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When I decided to start making a conscious effort to develop my spiritual life, I was at a point when life’s biggest questions needed answers fast: Who am I? Why am I? What is God? What is the purpose of life? I was in college, when my goals and my reasons for having them were important to figure out in order to navigate my schooling. But these questions are also important for life in general.

Wrestling with these questions while trying to engage seriously in the spiritual side of life and re-evaluate what I had already been taught or learned caused turmoil, confusion, resistance, instability, and a feeling of being lost. I was only truly able to grow spiritually when I made the following changes.

1. Release Guilt.

We tend to get caught up in whether or not our actions are right or wrong. We’ve all made mistakes, done things we later regretted, and acted against others as well as ourselves. Some of these things have kept me up at night tossing and turning and begging for forgiveness or release. One day I heard a spiritual leader on the radio talking about how guilt did more damage to us than the “wrong act” itself. Something clicked inside of me, confirming that the worst thing I could do was to continue to hold on to guilt. I had to free myself.

It wasn’t until I granted myself permission to let go of the idea that I had done something “bad” and accepted that it was mostly an experience to grow that I began to feel free and able to be a greater version of myself. Experience is our greatest source of knowledge and wisdom. Allowing ourselves to be and feel forgiven is not only healing and transforming, but is also one of the most courageous things we can do.

2. Re-Create Yourself.

Take a good hard look at yourself on every level: mentally, emotionally, physically and spiritually. What has created your worldview? How have your upbringing, your experiences, your neighborhood, institutions, and environment shaped who you are now? Ask yourself, “Why am I me?” Then take the lens through which you see the world off. Why? A lot of the answers I could come up before I committed to change were external things.

This really made me sit back and rethink myself. If I hadn’t grown up in this town or with this faith, who would I be and what would I believe to be true? At some point, you’re no longer the product of your environment but a creator in your life, free to choose who you are. I personally wanted not to be so heavily dependent on my outside world, but to be driven by something greater, something more internal: my divine self.

3. See Perfection.

A zen proverb suggests that when someone points at something, we initially tend to observe their finger instead of the object itself. We focus on things that don’t serve us well or mask the truth. The proverb says, “To look at the moon, it is necessary to gaze beyond the finger, right?” Yet when life throws us transformative experiences, which can also be very painful, we’re at a loss as to why these things are happening to us. We let the scariness and disappointments cripple us and keep us down, instead of seeing the situation for what it really is: an opportunity to heal and grow, which can transform us.

By being more mindful in life and observing things as they really are, we can be more like masters and creators and less like victims or reactors. It’s a simple choice, and it will give you a great sense of freedom to see past the surface of our experiences into the perfection and blessing in all things.

I’ve found it to be an amazing experience to live knowing that even the seemingly problematic issues in my life are actually the answers to my prayers.

 

About the author:

Gogo Thule Ngane is a Sangoma Traditional Healer, Priestess, and Medicine Woman. She is guided by the Amadlozi, Elevated Ancestors of her lineage. Her work includes divination, traditional healing, and leads workshops, ceremonies, and retreats on ancient African healing and spirituality. She is devoted to awakening ancestral wisdom on the earth.

 

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6 Health Benefits of Liver Cleansing

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Your liver is responsible for processing toxins in the body, so you’ll want to keep it working at its best. Sometimes, though, diet or lifestyle can catch up to us, and if that happens, a liver cleanse becomes necessary. With a cleanse, you’ll certainly get rid of all that toxic buildup, but there are lots of other perks as well.

6 Benefits of Liver Cleansing

Many people disregard liver cleansing, but there are many benefits associated with the practice. Not only does it jump start a healthy eating program, it may also help you lose weight. Just what can liver cleansing do for you?

1. Weight Loss

Your liver produces bile, which the digestive systems use to break down fat. And since liver cleansing promotes bile production, detoxing your liver might be just the place to start if you want to lose weight.

2. Immune System Support

Since the liver reduces toxins, among other things, it makes sense that a healthy liver is crucial to a strong immune system. [1] [2] Cleansing your liver could even give your immune system a boost.

3. Discourages Liver Stones

Liver stones, a product of diet, form because of too much cholesterol in the liver. [3] The extra cholesterol makes bile harden into tiny stones that can block the liver and gall bladder; you could even have up to 200 to 300 of these affecting your liver’s ability to detox. When you cleanse, though, somewhere between 100 to 300 of the stones could actually be purged from your body.

4. Supports Whole Body Detox

Since the liver removes toxins, turning them into harmless byproducts, there are usually small amounts of toxins in your liver. This is generally not a problem. Issues start, however, when there’s a buildup of too many toxins. That’s when you need to detox in order to get your liver working exactly as it should.

5. Boosts Energy

Some of the harmless byproducts the liver makes are actually nutrients the body will use. Whether from liver stones or too much toxic build up, some of those nutrients simply won’t make it back into the bloodstream. When that happens, your energy levels will likely drop, so liver cleansing will make you feel better because not only will you have all of your nutrients — but also all of your energy.

6. Increases Vitality

Remember that by cleansing the liver, you’re restoring it to peak efficiency. Reducing all that toxic buildup will make your skin look brighter and healthier. And since promoting bile production helps with fat breakdown, you’ll also tone your body easier and could even look and feel at least five years younger!

If you’re ready to make a change for the better, a liver cleanse might be a great start. You can get my recommended liver cleanse instructions here. You’ll also find valuable information in the following articles:

If you’ve performed a liver cleanse before, leave a comment below and let us know what difference it made for you!

References:

  1. Parker, G. A. & Picut, C. A. Liver Immunobiology. Toxicologic Pathology. 33 (1).
  2. Racanelli, V. & Rehermann, B. The Liver as an Immunological Organ. Hepatology. 43 (2, Supplement 1).
  3. Grünhage, F. et al. Increased gallstone risk in humans conferred by common variant of hepatic ATP-binding cassette transporter for cholesterol. Hepatology. 46 (3).

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The Age of Synthesis: Fluid Boundaries, Limitless Possibilities

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“Love is the affinity which links and draws together the elements of the world. … Love, in fact, is the agent of universal synthesis.” — Pierre Teilhard de Chardin, Activation of Energy.

Fluid Boundaries and Concrescence

Concrescence for humanity is possible through the art of letting go. By letting go of preconceived ideas, limiting reality constructs, and rigid notions of reality, we open into the realm of curiosity and creativity where anything can happen. We transform our placeholders to graceholders. By living in our hearts and applying Fluid Boundaries to what appears to be happening, we can move into the gap of the unknown to make new collective heart-prints. There is not just one way to move forward.

Concrescence is defined as “the coalescence or growing together of parts originally separate.” The concept of concrescence originated in biology and was later adopted by philosopher Alfred North Whitehead in his book Process and Reality as part of a philosophical ontology.

Every event in Whitehead’s ontology is thus a unique combination of possibility and actuality. The process of combining the two is imagined by Whitehead to be organic and is consequently called “concrescence.” The term concrescence stands for the process that is fundamental for existence. It can be thought of as the growing together of the multiple entities in the world to one single actual entity, which then becomes the material for new entities. Because of being organic, a concrescence is different from a mere combination where the whole is the sum of its parts.[1]

According to Whitehead, concrescence can occur through creative synthesis where the act of decision merges the already decided past with the not yet decided future.[2]

Human nature is to look to past experiences to create future expectations. We think things will be a certain way because they were that way before. The presence of the past creates the future. But concrescence integrates past experiences not as predictions of the future but as references only to catalyze new potentials, new probabilities, new creative expressions. Many existing perspectives and models working together will build concrescence.

Consider that concrescence is already occurring in many paradigms when viewed from a heart-centered, vertical perspective. None of the models are absolutely true, but all of the models are relatively true for the scale they are describing.

The scale we use to look at reality matters.

Scale is defined as a range of numbers used as a system to measure or compare things. According to world-renowned Harvard professor of theoretical physics Lisa Randall:

Effective theories are keeping track of measurable details without getting caught in unmeasurable components. … The speed of light is finite and the universe we know has existed a finite amount of time. This doesn’t mean the universe isn’t bigger. It is just that we can’t make observations beyond that scale.[3]

A Theory of Everything

Wouldn’t it be great if we had a theory to explain everything? In physics, string theory is currently under development. This model aims to reconcile quantum mechanics with general relativity and seems to have all the necessary characteristics for becoming a Theory of Everything. It is founded on the principle that matter, energy, and, under certain hypotheses, space and time are manifestations of physical entities below which, according to the number of dimensions they develop in, they are called “strings.” For the theory to be valid, physicists propose that there are ten dimensions.[4]

A true Theory of Everything would possibly include all theories, as there is not one ultimate reality. All realities are a matter of scale or, more simply, a matter of perspective. Each model often describes the respective dimension it is observing.

Consider that the evolution of physics and science may simply be an evolution of our perspectives based on scales. Current research builds on and is a logical extension of what is previously known. Current research comes from the past and is based on measurable observations. Aspects of string theory known as super-symmetry and Brane models seem to hold the most promise of being able to build on what is already known and linking to the unknown. However, none of these models can get there alone. They rely on a delicate balance between what has been discovered in the past (predictability) and the unexplained mysteries of the universe (probability).

Predictability and Probabilities

The science of our three-dimensional life is Newtonian physics. Newtonian physics explains how objects obey the laws of gravity. This is the world of physicality and matter. This is a science of predictability.

The science of 4-D is a realm of probabilities. Traditional models consider 4-D to be space-time, which includes four-dimensional combinations of width, height, depth, and time. Because space consists of three dimensions, and time is assumed to be one-dimensional, spacetime must, therefore, be a four-dimensional object. Oxford physicist and mathematician Roger Penrose proposed that space and time themselves are secondary constructs that emerge out of a deeper level of reality. Mathematics professor Andrew Hodges of Oxford University says that “This idea of points of space-time as being primary objects is artificial.”[5]

Quantum physics explores an unknown future of probability states. Quantum entanglement experiments reveal that particles can instantaneously communicate over infinite distances. This is a model of a world in which everything is connected. At the subatomic level, the reason electrons are able to communicate with each other from thousands of miles away is because they are not separate. Quantum physics challenges our basic ideas about space-time. Relativity from a quantum physics perspective reveals a realm of possibilities. This is also a realm of the mind in which probabilities can be explored before they fully actualize as experience. We can traverse the past via memories and explore the future through imagination.

However, moving beyond 4-D is problematic for science due to the measurement problem. But nonetheless, there is compelling evidence that there is more than meets the eye, and portals into infinite dimensions may soon be discovered.

Harvard cosmologist and theoretical physicist Lisa Randall, author of Knocking on Heaven’s Door, posits that there is a hidden fifth dimension that we can’t see. According to her widely recognized model, which dovetails with string theory, “The fifth dimension could be so warped that the number of dimensions you see would depend on where you were. … The fifth dimension could actually be infinite and we would not have noticed it.”[6]

Infinite extra dimensions, depending on our perspective.

Randall has made some astounding discoveries in theoretical physics linking tiny quantum particles to a model of the cosmos. While she utilizes a very pragmatic approach, starting from what science already has proven, her colleagues cite her “amazing nose” in terms of knowing where to look for hidden variables. She has a knowing without knowing how she knows, and her intuitive hunches consistently enable her to follow her nose (knows).

Dimensions are simply the different facets of what we perceive to be reality. We are aware of the three dimensions that surround us—length, width, and depth—because we can see them in everyday life. String theory proposes that beyond these three dimensions are additional dimensions that are not immediately apparent to us but that can be still be perceived as having a direct effect on the universe and reality as we know it.

Consider that that hidden fifth dimension, too small to measure and too vast to quantify, can possibly be found without measuring devices and mathematical computations. This hidden dimension is found in the field of the heart.

The field of the heart is the gateway to infinite potential and infinite expression, as well as infinite dimensions,[7] beyond the realities we can see and measure into the realm of the unknown. The heart-field is where predictability meets boundless possibility.

The heart-field is the timeless transformative treasure that moves us beyond past experiential patterns of linear time into the holofractal realm of new patterned potentials; we are able to move up, down, right, and left, any which way in all dimensions, esoterically and practically, for they are one and the same from the field of the heart. Vertical and horizontal awareness meets perpendicular planes of possibilities simultaneously.

The field of the heart is a counter-rotating torsion field or tube torus. Torsion fields are instantaneous signal transmitters and receivers linking local linear effects with nonlocal, nonlinear reality. Our heart-field enables us to traverse all axes of reality from zero-point to all points of perspectives inclusively.

The heart-field is where infinite potentials meet infinite expressions. Infinite perspectives. Infinite choices. Infinite dimensions.

Curiously enough, the physics of heart-centered awareness, a physics of torsion fields, would conceivably enable scientists to reconcile electromagnetism and gravity and would enable mainstream science to prove the existence of unknown dimensions. More than 4,000 papers have been published by more than 150 teams of scientists in the past 120 years describing what a torsion field is, what function it performs, how it works, and where it may be located. Despite this fact, widespread scientific knowledge of this critical, fundamental aspect of physics and biology has been almost completely excluded from the world of academic scientists and mainstream research institutions.[8]

Torsion fields or scalar waves are still considered “fringe science.” Part of the reason for this is that torsion fields are characteristically supraluminal; they travel faster than the speed of light. Because our measuring devices are based on the electromagnetic spectrum and these tools (based on light) cannot go faster than the speed of light itself, we can’t measure torsion fields. However, we can measure the effects of torsion fields.[9] Nonetheless, mainstream science dismisses torsion fields as junk science. In other words, traditional mainstream science has dismissed the existence of scalar wave energy (torsion fields) simply because current measurement tools are based on electromagnetic frequencies, action, and motion, and these measurement tools cannot seem to measure scalar or torsion waves. As we learned from renowned theoretical physicist Lisa Randall, effective theories are keeping track of measurable details without getting caught in unmeasurable components.

The prevailing scientific paradigm is that which is not measurable must not be included.

According to MIT- and Princeton-educated physicist Dr. Claude Swanson, in his Synchronized Universe model, the new sciences of biophotons and torsion fields provide a bridge between two views of life: the old 20th-century view of an organism as a chemical machine and the emerging view of life as communication and energetic flows.[10]

The physics of torsion fields also reveals how language can reprogram our DNA. Russian biophysicist Peter Gariaev and his team have proven the existence of torsion fields. Gariaev’s work, wave genetics, utilizes the principles of laser light and sound and scientifically demonstrates that torsion fields carry information to the biophotons of the body, informing the body to heal and grow. Despite the fact that he is healing so-called genetic diseases, the dead-end dogma of prevailing paradigms has yet to accept his progressive research into mainstream avenues.[11]

Age of Synthesis

Moving toward concrescence entails our ability to see truth in all models. Moving toward concrescence will entail our ability to occupy multiple perspectives simultaneously. Concrescence at the collective level begins with concrescence at the individual level.

So are things really falling apart, or are they coming together in a new way?

Everything at the collective level is moving toward integration. The historic split between mind and body has melded. Wave particle duality has been resolved. Science and spirituality are merging, and even separate masculine and feminine constructs are evolving in an integrated, holistic manner. There is an emergence of synthesis.

Today, many disparate systems are synthesizing. Nothing seems as separate as it did in the past. The boundaries between so-called opposites are beginning to dissolve, and dualities are transforming into an integrated expression of wholeness.

Scientist Dr. Carl W. Hall considered the 21st century the The Age of Synthesis:

Synthesis is a way of thinking and doing, of providing a vision, in which an idea or a thing, imagined or real, is seen as a coherent whole; often consisting of parts, from which thought can be developed, action can be rejected or taken, and the thing made, assembled, or constructed; either as a new creation or activity or as a duplicate or substitute of known substances.[12]

Fluid Boundaries

To bridge the gaps between all paradigms, fostering synthesis and a movement toward concrescence, we are invited to leverage Fluid Boundaries in relation to our models and maps to describe reality and the way we relate to others.

The art of limitless living includes releasing the fixed boundaries we may have previously established relative to our models and maps, parameters that create a false sense of control over our lives and reality, but that also create a real form of limitation and segregation for collective humanity.

Fluid Boundaries are boundaries that aren’t predefined in anticipation of situations or experiences. In truth, we never know how a circumstance will present itself before it actually happens. At the quantum level, reality is a series of probabilities that only seem to actualize when we observe them. Fluid Boundaries allow us to move freely among the patterns we encounter in the moment so as to allow for maximal flexibility and flow.

Fluid Boundaries at the interpersonal level are a game-changer. We never know what is going to happen in the very next moment. For example, we never really know how another person is going to show up or respond to us. If boundaries are established in advance, those very boundaries may serve to inform and restrict a situation of circumstance, with the preset limitation triggering a reaction. Thus, boundaries can bind us rather than liberate us. Predefined boundaries create separation rather than connection.

For example, we may create boundaries in advance to withstand an expectation of our spouse becoming angry with us, and subsequently guilt-tripping us when we say we would rather stay home next weekend than go to the firing range. The very expectation of the future behavior may indeed be based on prior reactions. Establishing boundaries based on past experiences may actually serve as the trigger for the pattern we were attempting to avoid. This is because an associative reference for the behavior is encoded in the boundary. So instead of avoiding the anger and guilt, the boundary triggers the very pattern we are trying to circumnavigate or avoid.

Conversely, approaching this same anticipated circumstance centered in an open heart, without preconceived notions, with a commitment to notice when circumstances come up as placeholders that may take us out of our hearts, allows for Fluid Boundaries to be created.

When the tendency to move out of the heart occurs, this can serve as a cue to bring in Fluid Boundaries, moving parameters that honor our needs while still allowing others to have their experiences. Fluid Boundaries without expectations can lead to a softening of the interactions, with others wielding very powerful and often surprising results. Whatever the outcome, the possibilities become limitless when navigating with Fluid Boundaries.

References:

  1. Daniel J. Ott, “Process Communitarianism,” Concrescence 10 (2009): 67–75.
  2. Alfred North Whitehead, Process and Reality, Corrected ed. (New York: Free Press, 1978).
  3. Lisa Randall, “Knocking on Heaven’s Door,” lecture at Harvard University, November 2011, https://m.youtube.com/watch?v=FiCNLZMhScI.
  4. “Looking for Extra Dimensions,” http://www.superstringtheory.com/experm/exper51.html.
  5. “SpaceTime, Relativity, and Quantum Physics,” http://www.ws5.com/spacetime/.
  6. Dennis Overbye, “On Gravity, Oreos, and a Theory of Everything,” New York Times, November 1, 2005, http://www.nytimes.com/2005/11/01/science/on-gravity-oreos-and-a-theoryof-everything.html; Lisa Randall, Knocking on Heaven’s Door: How Physics and Scientific Thinking Illuminate the Universe and the Modern World (New York: HarperCollins, 2011).
  7. Barbara Hand Clow and Gerry Clow, The Alchemy of Nine Dimensions (Charlottesville, Va.: Hampton Roads, 2010).
  8. David Yurth, Seeing Past the Edge (Mesa, Ariz.: Dandelion Books, 1997); Richard C. Hoagland and David Wilcock, “The Bees’ Needs: It’s the Physics, Stupid!,” http://www.enterprisemission.com/Bees/thebeesneeds.htm.
  9. P. Gariaev and M. Pitkanen, “Model for the Findings about Halogram Generating Properties,” unpublished manuscript, http://tgd.wippiespace.com/public.html.
  10. Swanson, Claude. Life Force: The Scientific Basis. (Tucson, AZ: Poseidia Press, 2011).
  11. “The Torsion Field and the Aura.” Subtle Energies and Energy Medicine 19, no. 3 (2008): 43–89.
  12. Carl W. Hall, The Age of Synthesis (New York: Peter Lang, 1995).

About the author:

Melissa Joy Jonsson is the founder of M-Joy, a unifying “we” movement that provides a new language to experience self-love as integrity. She is best known for her ability to engage people to embrace their true authentic power by playing in the field of the heart. Melissa has been teaching popular life-transformational seminars around the world since 2008. As an intuitive coach and holistic practitioner, Melissa has a diverse client base in more than 25 countries. Melissa spent more than a decade as an executive in the pharmaceutical industry. She is the author of “The Art of Limitless Living”, “Little Book of Big Potentials”, “Practical Play the Heart-Centered Way”, and “M-Joy Practically Speaking”. Melissa has a bachelor’s degree in psychology from the University of California at Santa Barbara. She resides in San Diego, California.

This article is excerpted and adapted from ‘The Art of Limitless Living’, available in Print, E-book and AudioBook.

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For Some Hard-To-Find Tumors, Doctors See Promise In Artificial Intelligence

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A team at Johns Hopkins Medicine in Baltimore is developing a tumor-detecting algorithm for detecting pancreatic cancer. But first, they have to train computers to distinguish between organs.

 

Artificial intelligence, which is bringing us everything from self-driving cars to personalized ads on the web, is also invading the world of medicine.

In radiology, this technology is increasingly helping doctors in their jobs. A computer program that assists doctors in diagnosing strokes garnered approval from the U.S. Food and Drug Administration earlier this year. Another that helps doctors diagnose broken wrists in X-ray images won FDA approval on May 24.

One particularly intriguing line of research seeks to train computers to diagnose one of the deadliest of all malignancies, pancreatic cancer, when the disease is still readily treatable.

That’s the vision of Dr. Elliot Fishman, a professor of radiology at Johns Hopkins Medicine in Baltimore. Artificial intelligence and radiology seem like a natural match, since so much of the task of reading images involves pattern recognition. It’s a dream that’s been decades in the making, Fishman says.

“When I started in radiology, they said, ‘OK, don’t worry about reading the chest X-rays because the computers will read them,’ ” Fishman says. “That was 35 years ago!”

Elliot Fishman says the goal of developing an artificial intelligence program is to spot pancreatic tumors early.

 

Computers still can’t perform the seemingly simple task of reading a chest X-ray, despite sky-high expectations and more than a little hype around the role of artificial intelligence. Fishman is undaunted as he turns this technology on pancreatic cancer.

And that disease is a huge challenge. Only 7 percent of patients given a pancreatic cancer diagnosis are alive five years later. One reason the disease is so deadly is that doctors usually diagnose it when it’s too late to remove the tumors with surgery. Fishman and his team want to change that, by training computers to recognize pancreatic cancer early. Working with Johns Hopkins computer science students and faculty, they are helping develop a tumor-detecting algorithm that could be built into CT scanner software.

Americans get 40 million CT scans of the abdomen every year, for everything from car accidents to back pain. Imagine if a computer program with expert abilities could look for pancreas tumors in all those scans.

“That’s the ultimate opportunity — to be able to diagnose it before you have any symptoms and at a stage where it’s even maybe too subtle for a radiologist to be able to detect it,” says Dr. Karen Horton, chair of the Johns Hopkins radiology department and Fishman’s collaborator on the project.

Karen Horton is chair of the Johns Hopkins radiology department and is collaborating with Fishman on The Felix Project.

The challenge lies in teaching a computer to detect what a well-trained doctor knows to look for.

“Elliot and I are very subspecialized so we’re really, really good,” Horton says matter-of-factly. “We see more pancreatic cancer than probably anyone in the world.”

She says if the computer algorithm could capture their collective knowledge about how to diagnose pancreatic cancer and give that expertise to the typical doctor, “you could be, I would argue, better than us, but certainly as good as us — which would mean better than most of the practicing radiologists.”

Even a program perfectly attuned to finding patterns can’t reliably recognize cancer if it hasn’t been trained on reliable starting material.

When it comes to developing AI, “sometimes people say, ‘oh just take a bunch of cases and put them in a computer and the computer will figure out what to do’,” Fishman says. “That’s nonsensical.”

The Felix Project at Johns Hopkins, as the pancreas effort is called, pours a huge amount of human time, labor and intellect into training computers to recognize the difference between a normal pancreas and one with a tumor.

Of all the internal organs to deal with, “the pancreas is the hardest,” Fishman says. “The kidney looks like a kidney, the liver’s a big thing.” On the other hand, he says, “The pancreas is a very soft organ, it sits way in the middle and the shape varies from patient to patient. Just finding the pancreas, even for radiologists, is at times a challenge.”

Eva Zinreich, a medical researcher, digitally paints a CT scan to help train the computer program. The process can take almost four hours for a single scan.

 

Eva Zinreich, a retired oncologist, is up for that challenge. She is one of a team of medical experts who spend their days poring over CT scans and teaching the computer how to recognize the pancreas, other organs, and then, tumors within the pancreas.

She sits at a computer workstation, wielding a digital paintbrush.

“I’ll show you in 3D because that’s the fun stuff, ok?” she says as she sets about coloring in the aorta and other blood vessels on a scan.

Next, she colors the pancreas yellow.

“You see that shaded area?” she asks. “That’s the tumor,” and she proceeds to color it red.

Zinreich digitally paints the pancreas (yellow) and a tumor (red) in a CT scan.

 

It will take her almost four hours just to mark up this single scan. Four medical experts have been working full-time for well over a year on this project. They’ve done this painstaking work on scans from about 1,000 healthy people, and their tally of pancreatic cancer images is now approaching 1,000 as well, Fishman says.

They are feeding their annotated scans into the project’s computer program and gradually teaching it to recognize the same signs of a tumor that radiologists now pick out of the scans.

At another workstation in the lab, radiologist Linda Chu is trying to make the computer system even more adept than Elliot Fishman and Karen Horton are at recognizing pancreas cancers. She’s developing ways for the computer to look for patterns in the scan that the human eye can’t pick out. It’s interpreting textures in the images, rather than shapes and shading.

Chu says she’s making tentative progress. For example, she’s been training the software to identify subtle clues that distinguish between a benign cyst and cancer.

“We don’t truly understand what the computer is seeing, but clearly the computer is able to see something in the images that us humans cannot comprehend at this point,” Chu says.

But this is also part of the challenge of AI — if the computer highlights something that a human expert can’t see, and it’s not clear how it arrived at that conclusion, can you trust it?

“That’s what makes the research interesting!” Chu says.

Computer science students from the Johns Hopkins University main campus are key to developing the software that’s learning how to read and interpret the images that flow from Fishman’s lab.

The Lustgarten Foundation, which is focused on pancreatic cancer, has provided nearly $4 million over two years to fund the Felix Project. Horton says if it’s successful, all the information they collected on healthy people can be used as a starting point to study tumors elsewhere in the body.

“You could have Felix kidney, Felix liver, Felix lung, Felix, heart,” she says. And they could all go together into the scanner software.

The project is named after the “Felix Felicis” good-luck potion, from the Harry Potter books. And, absent an effective magic spell, the laborious process is a reminder that success in bringing artificial intelligence to medicine will not be as simple as dumping piles of data into a computer and trusting that an algorithm will sort it all out.

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Canola Oil Impairs Brain and Memory

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Canola Oil Increases Memory Loss

Think your cooking oil is safe and healthy? Canola oil producers claim that it’s the healthiest oil you can use, but science begs to differ. Unless significant weight gain and diminished memory are your idea of good health!

Canola oil has been heralded as a modern healthy alternative to olive oil, and ‘saturated fats’ like coconut and palm oil, backed by a big promotional push from North American growers. The Canola Council of Canada pulls no punches, calling it “the healthiest of all commonly used cooking oils.”[1] The marketing campaign appears to be working: canola oil consumption in the United States has nearly tripled since 2000, up to almost 3 million metric tons in 2017.[2]

When asked if canola oil is the same as rapeseed oil, the answer is both “yes” and “no.” Canola oil comes from the rapeseed plant, and was called rapeseed oil until the early 1970s, when a promotional campaign to rebrand the oil was devised in conjunction with genetic-modification to remove two of the plant’s undesirable elements, erucic acid and glucosinolates.

The Rapeseed Association of Canada took the opportunity to rename the plant, and “Can” for Canada, plus “ola” for oil, was born.[3] Producers are still keen to leave the rapeseed designation behind, hence their claim that this GM-version is a distinct type of plant. Essentially, it is a very comprehensive marketing campaign designed to confuse and lead the public to a foregone conclusion.

With more than 90% of U.S. crops and upwards of 80% of Canadian canola derived from genetically-engineered seeds, it’s almost certain that your bottle of canola oil comes from plants contaminated with chemical herbicides. Because processing removes the genetically-modified protein from the finished oils, producers consider it the same as conventional oil,[4] believing this production process removes all potential for harm. It is therefore marketed as being 100% safe for unlimited human consumption. But as the latest medical science points out, this oil is far from being a healthy choice for human brains and bodies.

Canola oil is often promoted as a low-cost alternative to olive oil, possessing the same health benefits. It’s even promoted as having a mere 7% saturated fat, compared to olive oil’s 15%. But what does science say about the healthfulness of canola? Until recent years, no data were available on the effect of canola oil intake in relation to increasingly common diseases, like Alzheimer’s disease. Canola oil had never been examined as a causal factor in the sixteen-fold increase in deaths from Alzheimer’s reported in 1991: a total of 14,112, up from just 857 deaths reported in 1979.[5]

In December 2017, researchers from Alzheimer’s Center at Temple University investigated the effect of daily consumption of canola oil on mice whose brains had developed both plaques and tangles, common brain characteristics for Alzheimer’s patients.[6] Mice in the control group received a typical diet, while mice in the experimental group were fed a diet supplemented with canola oil for a period of 6 months. At the beginning of the study, mice had the same body weight. They were put through three different tests involving memory functions and conditioning, such as mazes. Ability to navigate these environments demonstrated measurable brain function and emotional stimulation.

Their findings debunked the claims of Canola oil marketers, demonstrating negative impacts to bodies and brains. 

Mice who were chronically exposed to canola oil experienced a significant increase in body weight; a gain of nearly one-fifth of total weight recorded just six months earlier. Effects on the brain were equally undesirable. Mice showed impairments in their working memory, demonstrated by decreased problem-solving abilities. Together with reduced levels of beneficial brain proteins that mark synaptic integrity, or how well neurons are firing, the mice performed significantly worse on all tests as compared to control mice. Synaptic integrity can affect whether or not critical connections are made in the brain, something that is vital to a functional memory and enjoying a high quality of life. Canola oil impairs synaptic integrity, which greatly exacerbates the debilitating symptoms of Alzheimer’s disease.

Researchers concluded that their findings do not support the beneficial effect of regular canola oil consumption, nor does their data justify the current trend aimed at replacing olive oil with canola oil in your diet. Not when research has consistently shown that olive oil reduces the same brain plaques and unhealthy proteins that canola oil increases.[7] The same way that Big Pharma selectively publishes only favorable scientific research on drugs,[8] canola oil producers have cherry-picked data that is both contradictory and inconclusive when viewed in its entirety.[9] Meanwhile, consumption of extra virgin olive oil continues to deliver on its promise of being a true superfood.

A similar study was conducted by the same Temple University research group in June 2017,[10] but this time the focus was on olive oil and its effects on Alzheimer’s brain plaques and tangles. Mice were fed a diet of normal food, or food supplemented with extra virgin olive oil for six months. Compared with controls, the group fed olive oil demonstrated improvements in their prior behavioral deficits. Synaptic integrity also improved, thanks to a significant increase in steady-state levels of synaptophysin, a protein marker of synaptic integrity. In addition, brain plaque deposition decreased, thanks to reductions in insoluble peptides and specific proteins associated with the disease. Overall, their findings supported the beneficial effect of olive oil consumption on all major features of Alzheimer’s disease.

GreenMedInfo has over 70 abstracts on olive oil, demonstrating its healthful effects on over 150 different disease conditions, including Alzheimer’s disease and breast cancer. Start enjoying these benefits immediately by swapping out your canola oil today!

References:

About the author:

Sayer Ji is the founder of Greenmedinfo.com, a reviewer at the International Journal of Human Nutrition and Functional Medicine, Co-founder and CEO of Systome Biomed, Vice Chairman of the Board of the National Health Federation, and Steering Committee Member of the Global Non-GMO Foundation.

 

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Age related BP targets for chronic kidney disease patients work better

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A cautious approach to lowering blood pressure (BP) in elderly patients with chronic kidney disease (CKD) is recommended, said US-based researchers. Treatment of hypertension in younger patients with CKD can follow current clinical guidelines, they added.

“Hypertension affects almost all patients with CKD, and is one of the few conditions that is treatable with a wide array of medications,” said lead author Professor Casaba P. Kovesdy, from the Division of Nephrology, Memphis Veterans Affairs Medical Center, Memphis, Tennessee, US.

Kovesdy and team examined systolic BP (SBP) and diastolic BP (DBP) with all-cause mortality, together with the incidence of chronic heart disease (CHD), ischaemic stroke, and end stage renal disease (ESRD) in 339,887 patients with CKD. [Clin J Am Soc Nephrol 2016;doi:10.2215/CJN.08660815]

During the 4.8 year median follow-up 100,763 patients died (95 percent confidence interval [CI], 62.6- 63.4). Mortality rates were high in older SBP patients. SBP ≥ 140mmHg and <120 mmHg was associated with higher mortality rates across all age groups. Lowest mortality was seen in SBP 120-139 mmHg for patients <80 years, and SBP 120-159 mmHg for patients ≥80 years.

Compared to SBP of 130-139 mmHg, SBP ≥170mmHg in patients aged <50, 50-59, 60-69, 70-79, and ≥80 years were adjusted hazard ratio [aHR], 1.95, 95 percent CI, 1.34-2.84; aHR, 2.01, 95 percent CI, 1.75-2.30; aHR, 1.68, 95 percent CI, 1.49-1.89; aHR, 1.39, 95 percent CI, 1.25-1.54; and aHR, 1.30, 95 percent CI, 1.17-1.44, respectively.

Lower DBP was associated with high mortality. DBP of 70-79 mmHg in patients <50 years and 80-89 mmHg in patients ≥50 years had the lowest mortality.

CHD was experienced in 9,450 patients during the study period (95 percent CI, 9.6-10.0). Higher SBP was associated with higher CHD rates in patients <80 years. However, lowest CHD rates were associated with SBP<110 mmHg in patients <70 years and SBP<140 mmHg in patients ≥70 years. DBP on the other hand had no association with CHD.

Ischaemic stroke was experienced by 14,557 patients (95 percent CI, 10.2-10.6). While higher SPB was associated with higher stroke rates across all age groups, DBP showed no association. Lowest stroke risk was seen in patients with SBP <100mmHg.

ESRD rates were found to be lower in older individuals compared to younger patients. ESRD was seen in 5,161 patients (95 percent CI, 3.2-3.3). DBP was found to have no association with ESRD, but high SBP was associated with high ESRD incidence. Patients <80 years with SBP ≥170mmHg had high ESRD risk, but SBP <170mmHg in this age group had no associated risk.

“Our results reinforce the significant association of elevated SBP with all the studied outcomes but suggest weak association in the elderly, especially in patients aged ≥80years,” said Kovesdy. “The best outcomes were seen with SBP of 120-130 mmHg in patients <80 years and of 120-159 mmHg in those ≥80years.”

In a separate editorial, Assistant Professor Jessica W. Weiss from the Division of Nephrology and Hypertension, Oregon Health and Science University, Portland, Oregon, US said that the study by Kovesdy and team added to the collective understanding of the relationship between BP and a wide range of various clinical outcomes in older adults with CKD, a group rarely studied. This, she said, may be useful in guiding the design of future studies in this area. [Clin J Am Soc Nephrol 2016;doi:10.2215/CJN.03100316]

“These results may also add a note of caution to newfound enthusiasm for lower BP targets after the release of the SPRINT* via the suggestion that harm may persist at upper and lower extremes of BP among populations more comorbid and complex than those evaluated in the setting of a clinical trial,” said Weiss.

 

*SPRINT: Systolic Blood Pressure Intervention Trial.

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