36 Burst results for "Johns Hopkins"

US Hitting Encouraging Milestones on Virus Deaths and Shots

AP News Radio

00:50 sec | 1 d ago

US Hitting Encouraging Milestones on Virus Deaths and Shots

"Coated nineteen deaths have hit a level not seen since the pandemic's early days after topping out at more than thirty four hundred daily deaths in January Johns Hopkins University says the average is now about two hundred ninety three the first time it's been below three hundred since March twenty twenty last year the CDC says only heart disease and cancer killed more Americans now data suggests more are dying each day from accidents chronic lower respiratory disease strokes or Alzheimer's there are about eleven thousand four hundred new cases daily down from more than a quarter million in January the nation's approaching another vaccination miles still one hundred fifty million Americans fully vaccinated that's about forty five percent of the population Sager mag ani Washington

Chronic Lower Respiratory Dise Johns Hopkins University CDC Heart Disease Cancer Alzheimer Washington
Fresh update on "johns hopkins" discussed on The KFBK Morning News

The KFBK Morning News

01:11 min | 6 hrs ago

Fresh update on "johns hopkins" discussed on The KFBK Morning News

"Looked like it could be up into 105 degree range. Okay, news from your neighborhood is up next and we're joined now by Albert Parnell. Good morning. Good morning. That's coming out of the Auburn Journal. So the Plaster County Board of Supervisors approved its letters of support for the termination. Of the Covid 19 State of emergency, Although California is reopened Gavin Newsom still as a state of emergency related to the pandemic, so the county's letters note full support of Senate resolution of five in the Assembly resolution 46 with both which, if passed, would declare the termination of the emergency proclamation. Okay. Well, a lot of lot of counties or have tried to get the governor to do certain things. In some cases he has in many cases he has not well. And there there is this legislation pending, but hard to see it going anywhere, given the right balance in this California legislature, Exactly, or imbalances. Balance. Yeah. So coming up in the next couple of minutes, the CDC is going to be meeting They're going to have that emergency meeting finally about the covid vaccine and kids and some of the hundreds of reports of receiving of heart inflammation and issues concerning Children and the vaccine after the second shot. So we're going to hear from a guy named Dr Marty Makary. He is John Hopkins professor. And he talks about the second shot in particular and about kids. What the W. H O is now saying what new Israeli evidence is showing and and you know what he sees as the path forward for the CDC. Kids don't need that second shot..

Albert Parnell Marty Makary 105 Degree CDC Plaster County Board Of Superv Second Shot W. H O Senate John Hopkins Both California Assembly Resolution 46 Five Auburn Journal Hundreds Israeli Gavin Newsom 19
US COVID-19 Deaths Hit 600,000, Equal to Yearly Cancer Toll

AP News Radio

00:51 sec | Last week

US COVID-19 Deaths Hit 600,000, Equal to Yearly Cancer Toll

"As two of its biggest states lived most of their covert nineteen restrictions the nation's pandemic death toll has hit another milestone the pandemic's now killed more than six hundred thousand people in America as tallied by Johns Hopkins University average daily virus deaths are now around three hundred forty a tenth of January's peak with more than forty percent of Americans now fully vaccinated more governors are dropping restrictions like California's Gavin Newsom we are here June fifteenth to turn the page and Andrew Cuomo in New York we can now return to life as we know it new Yorkers will still have to wear masks in schools and on subways not so in Maryland where governor Larry Hogan says the state will not require masks anywhere Sager mag ani Washington

Johns Hopkins University Gavin Newsom America Andrew Cuomo California Larry Hogan New York Maryland Sager Ani Washington
U.S. Crosses 600,000 COVID-19 Deaths

AP News Radio

00:45 sec | Last week

U.S. Crosses 600,000 COVID-19 Deaths

"The US has hit another grim milestone in the covert nineteen pandemic the virus has now killed six hundred thousand Americans according to a Johns Hopkins University tally that's more than the populations of Baltimore were Milwaukee and about equal to the number of Americans who died from cancer in twenty nineteen even as the nation makes progress against the pandemic we're still average in the last seven days because of three hundred and seventy deaths per day president Biden says that significantly lower than at the pandemic's peak but it's still a real tragedy and he's making another please if you have not been vaccinated get vaccinated Sager mag ani Washington

Johns Hopkins University Milwaukee Baltimore United States Cancer Biden Sager Mag Ani Washington
Governor Newsom Lifts Most COVID-19 Restrictions

Dr. Daliah

00:32 sec | Last week

Governor Newsom Lifts Most COVID-19 Restrictions

"Gavin Newsom, lifting most of his state's covid restrictions, the order rolls back rules on masks and distancing, Although unvaccinated people are still being asked to wear face coverings in public, no word on how the state plans to enforce that Newsome was the first governor to issue a stay at home order at the beginning of the pandemic. The Democrats. Handling of the virus has sparked fierce criticism from Republicans who are hoping to beat him in a likely recall election this fall. Foxes John Scott. Meanwhile, new data from Johns Hopkins University shows new covid 19 cases are declining

Gavin Newsom Newsome John Scott Johns Hopkins University
Bringing the Sensation of Touch to a Robotic Limb

Short Wave

02:02 min | 2 weeks ago

Bringing the Sensation of Touch to a Robotic Limb

"Hey everybody emily kuang here with npr. Brain correspondent john hamilton. John what do you got for us today. I want to talk about a big change. That's happening in the field of artificial limbs so this includes prosthetic arms and legs. Those are for people who've lost limb it also includes robotic arms and legs these are. What a person who is paralyzed can use in place of a limb that they no longer can control for the past decker. So i've been doing stories about systems that allow a person to control these devices just by using their thoughts. Yeah i've heard about this. That's pretty amazing technology. It is an an obviously to to make it work. You have to decode information. That's coming from a person's brain and send it out to some mechanical device. But what's new. What's happening now is that scientists are turning this out. They are finding ways to have mechanical arms and legs send information back to the users brain sending it in the other direction and what. What sort of information are we talking about. What's getting the most attention is touch or in scientific terms tactile feedback. It turns out that touch is really important for people who are trying to control a state of the art robotic arm or a prosthetic limb and over the past twenty years some artificial limbs have gone from just say grasping object to rotating it and manipulating with individual fingers. It can be really hard for a person to control a device like that just by watching. What their arm enhance doing. It's like trying to tie a shoelace when your fingers are numb when you can feel what your fingers are doing. I talked about this with a scientist named jeremy brown. He's in the department of mechanical engineering at johns hopkins university and he started reeling off this long list of things that are sense of touch tells us about an object. I feel the pressure. I feel the slip. I feel where the object is wet or dry. I can feel the texture of it. I know whether it's rough weather is smooth. There's just as wealth of information that comes through touch and i think as engineers and scientists. We're just understanding how it works and in how you replicate

Emily Kuang John Hamilton NPR John Department Of Mechanical Engin Jeremy Brown Johns Hopkins University
What's the History of US-Israel Relations?

Monocle 24: The Foreign Desk

01:08 min | 3 weeks ago

What's the History of US-Israel Relations?

"Joined first of all from jerusalem by david makovsky distinguished fellow at the washington institute and professor in middle east studies at johns hopkins university david festival. I think when people think about this relationship now it's assumed that this full-throated barely critical support for israel is an article of faith for the united states but if we think back to the foundation of israel in nineteen forty eight was that always the case now not at all the foreign policy establishment of the united states was dead against us. Recognition of israel led by secretary of state. George marshall no foreign policy establishment viewed. Israel is getting in the way of trying to shore up arab support for america's position in the cold war which was deemed critical given the importance of the european recovery and making sure that arab oil slow to europe. So truman the president harry. Truman swearing against the tide and insisting upon immediately after the state was

David Makovsky David Festival Foundation Of Israel Washington Institute Israel Johns Hopkins University United States Jerusalem Middle East George Marshall President Harry Truman Europe
US' Daily COVID-19 Cases Fall Below 30K

Leo Laporte

00:13 sec | Last month

US' Daily COVID-19 Cases Fall Below 30K

"A number of daily Cove in 19 cases in the U. S has dropped below 30,000 for the first time since June. Going to Johns Hopkins website the U. S reported a little over 29,000 new coronavirus cases on

U. Johns Hopkins
Local Governments Promoting Incentives to Encourage Covid Vaccinations

Marketplace with Kai Ryssdal

02:06 min | Last month

Local Governments Promoting Incentives to Encourage Covid Vaccinations

"According to the centers for disease control just a bit more than forty six percent of the entire. us population. that's everybody has gotten at least one dose of covid vaccine thirty five percent is fully vaccinated but things are slowing down. Millions of people are still hesitant and herd. Immunity is for now maybe not looking so great so local governments are partnering with businesses to offer free stuff in exchange for getting a shot incentives matter that we know but do they work. Marketplace's kristen schwab has more on that. The mission to get more vaccines into people's arms is starting to take on a bit of an oprah. winfrey vibe. west. Virginia is giving one hundred dollars savings bonds to adults under thirty. Five main is offering free hunting and fishing licenses and in new orleans a pound of crawfish. Incentives are nice. Because they're the bronx near leading people toward something in a positive way. Knoll brewer researches vaccination behavior at the university of north carolina. He says incentives appeal to people across party. Lines and studies show. They increase vaccine uptake by about eight percent. If the incentive is of value mario macho is a behavioral economist at johns hopkins. There are costs and benefits to any any action and a person engages in the action if her perceived benefits exceed her received. The costs costs can be literal like to and from a vaccination site. The biden administration has partnered with uber and lift to provide free rides but benefits can also offer people. Something they want. New jersey is running a shot and a beer program macho says this can make a needle in the arm. Seem fun ause you. They might go without with a friend or a group of friends and get vaccinated together and then go out and get their free beer and incentives. Like new york's free tickets to a mets or yankees game. Also whisper freedom like. Hey remember when we high five strangers after home runs without fear gretchen chapman who studies vaccine behavior at carnegie mellon says incentives usually work on people who only need a little push and researchers. Don't know if they'll work for the covid vaccine like to have for others

Kristen Schwab Knoll Brewer Centers For Disease Control Mario Macho Winfrey Biden Administration University Of North Carolina New Orleans Virginia Johns Hopkins West United States New Jersey Gretchen Chapman Carnegie Mellon Mets
Devastating Virus Surge Spreads Impact Into India's Politics

AP News Radio

00:42 sec | Last month

Devastating Virus Surge Spreads Impact Into India's Politics

"India has recorded over three hundred and sixty eight new coronavirus cases and over three thousand deaths in one day Johns Hopkins University put the total death toll it over two hundred and eighteen thousand the latest figures come a thirteen politicians have urged the government tax now Bible to get free vaccination drive I'll provide an uninterrupted flow of oxygen to all hospitals in New Delhi many hospital authorities pushed for legal proceedings of oxygen supplies as a local doctor Allen has been extended by another week to contain the spread prime minister Narendra Modi's government has been severely criticized over the handling of the sites which has pushed India's already fragile and under funded health system to the brink I'm Karen Thomas

Johns Hopkins University India New Delhi Narendra Modi Allen Karen Thomas
Creating Smart Cities With Data Science

DataFramed

02:09 min | Last month

Creating Smart Cities With Data Science

"I'm in great to have you on the show. A dallas my pleasure. Thank you so much needed to be a part of this conversation. Really looking forward to this discussion. I am excited to talk to you. About data science and government agencies the importance of data drills how to leverage data for better disaster response But before it can you tell me a bit about your background in how you got into the data space yes I think the way. I would talk about how i got into the data science faces to sort of give you a sense of sort of my journey as a computer. Scientists undergraduate master's doctorate degrees in computer science and engineering. Until i really started off as a computer scientist and i was at engineered a motorola for long period of time and then i moved into academia Dr moved into. Academia narrowly focused on sort of bioinformatics domain at johns hopkins. And then from there. I moved into the federal government where i focused on tech and policy. And and really it was the larger concept of Technology all facets but Because it was a political appointees obama administration in newborn administration really focused on this relatively new concepts specifically for the federal government of big data and data a concepts and big data technology. And that's why. I really began to cut my teeth in data science face really thinking. About how big data can be used in the federal government space right so i spent a lot of time. Working with agencies on big data did concepts big data technologies investing in cloud computing on and so forth and then i got the opportunity of a lifetime to become the chief officer for the city of new york. I mean that's where. I really jumped into the deep end with both feet and grew sort of my ability to use the to often complex problems specifically in an urban context for me in a science was never conceptual. I didn't learn it in academia. It was always understanding from the applied. Expecting

Federal Government Obama Administration Newborn Administration Dallas Johns Hopkins Motorola New York Academia
The Latest: India sets record of 386,000 daily virus cases

AP News Radio

00:59 min | Last month

The Latest: India sets record of 386,000 daily virus cases

"India has set another global record with over three hundred and eighty six thousand cases in one day according to Johns Hopkins University as thousands across the nation mourned their loved ones the health ministry reported in you said to death bringing the total to two hundred and eight thousand one relative outside a hospital in Maratha bad was inconsolable after hearing of the death of his brother okay bit because there weren't enough oxygen supplies to keep him alive another man Rajat Kumar Singh said his father passed away in the hospital when I read that in the ward my father's dead body was lying back one else what had happened there was no one to inform us and later when I spoke to a nurse that she told me that they ran out of oxygen supply in the morning as well as oxygen shortages in just pandemic response has been marred by insufficient data an online appeal signed by over three hundred and fifty scientists almost the government to release data about the sequencing of virus variants I'm Karen Chama

Rajat Kumar Singh Johns Hopkins University Maratha India Karen Chama
Tranexamic Acid Plus Uterotonic Agents Significantly Reduce Postpartum Blood Loss

NEJM This Week - Audio Summaries

02:11 min | 2 months ago

Tranexamic Acid Plus Uterotonic Agents Significantly Reduce Postpartum Blood Loss

"Hemorrhage remains a leading cause of severe maternal complications and death worldwide prophylactic administration of traffic amick. Acid has been associated with reduced postpartum blood loss after caesarean delivery in several small trials but evidence of its benefit in the clinical context remains inconclusive in this trial. Four thousand four hundred thirty. One women undergoing caesarean delivery before or during labor at thirty four or more jess station weeks were randomly assigned to receive an intravenously administered prophylactic utero tonic agent and either traffic amic acid or placebo. The primary outcome of postpartum hemorrhage occurred in twenty six point seven percent of women in the traffic samick acid group and thirty one point six percent of women in the placebo group. There were no significant between group. Differences in mean gravity metrically estimated blood loss or in the percentage of women with provider assessed clinically significant postpartum hemorrhage. Use of additional utera. Tonic agents or postpartum blood transfusion thromboembolic events. In the three months after delivery occurred in zero point. Four percent of women who received traffic samec acid and in zero point one percent of women who received placebo among women who underwent cesarean delivery and received prophylactic utero. Tonic agents traffic samick. Acid treatment resulted in a significantly lower incidents of calculated estimated blood loss greater than one thousand milliliters or red cell transfusion by day two then placebo but it did not result in a lower incidence of hemorrhage related secondary clinical outcomes postpartum hemorrhage a review article by jessica beanstalk from johns hopkins university school of medicine baltimore. Postpartum hemorrhage continues to be the leading preventable cause of maternal illness and death. Globally worldwide postpartum hemorrhage accounts for eight percent of maternal deaths in developed regions of the world and twenty percent of maternal deaths in developing

Severe Maternal Complications Postpartum Hemorrhage Jess Station Jessica Beanstalk Johns Hopkins University Schoo
India Breaks COVID Daily Record for the 3rd Day in a Row

Pat McDonough

00:43 sec | 2 months ago

India Breaks COVID Daily Record for the 3rd Day in a Row

"India is continuing to struggle with the latest surge in the pandemic cases around the world. For the third day in a row, India has set a global daily record with more than 346,000 coronavirus cases. That's according to the tally by Johns Hopkins University. India's total of more than 16 million cases now ranks behind only the United States. Hospitals are being overwhelmed and even some who meant to find a better suffocating with oxygen in short supply. India's Health Ministry reports another 2600 deaths in the past 24 hours. That's pushed India's confirmed told to more than 189,000.

India Johns Hopkins University Health Ministry United States
India Sets Another Global Daily Record of 346000 COVID-19 Cases

Eye on Travel

00:44 sec | 2 months ago

India Sets Another Global Daily Record of 346000 COVID-19 Cases

"Ryan. India continues to struggle with the largest surgeon coronavirus cases around the world. AP correspondent Ben Thomas reports For the third day in a row. India has set a global daily record with more than 346,000 coronavirus cases. That's according to the tally by Johns Hopkins University. India's total of more than 16 million cases now ranks behind only the United States. Hospitals are being overwhelmed, and even some who managed to find a better suffocating with oxygen in short supply. India's Health Ministry reports another 2600 deaths in the past 24 hours. That's pushed India's confirmed told to more than

India Ben Thomas Ryan AP Johns Hopkins University Health Ministry United States
India Virus Patients Suffocate Amid Oxygen Shortage in Surge

AP News Radio

00:59 sec | 2 months ago

India Virus Patients Suffocate Amid Oxygen Shortage in Surge

"India continues to struggle with the largest search in corona virus cases around the world for the third day in a row India has set a global daily record with more than three hundred and forty six thousand coronavirus cases that's according to the tally by Johns Hopkins University India's total of more than sixteen million cases now ranks behind only the United States hospitals are being overwhelmed and even some who managed to find a better suffocating with oxygen in short supply MoveOn trauma tells Sky News his father died outside a hospital in Delhi Friday morning game this year shama was back Saturday with his grandfather all the loans you no one's seen him either India's health ministry reports another twenty six hundred deaths in the past twenty four hours it's pushed India's confirm toll to more than one hundred and eighty nine thousand people on Ben Thomas

India Corona Johns Hopkins University Shama United States Delhi Ben Thomas
COVID-19 Hospitalizations Tumble Among US Senior Citizens

AP News Radio

00:53 sec | 2 months ago

COVID-19 Hospitalizations Tumble Among US Senior Citizens

"Amid the troubling numbers on the corona virus pandemic there's at least one piece of encouraging data hospitalizations among older Americans are down a lot dele covert nineteen infections have held steady above sixty thousand for the last two months a level health officials say is far too high to consider the pandemic anywhere close to being contained the code nineteen hospitalizations among Americans sixty five and older have plunged eighty percent since the start of the year and senior citizens have accounted for about eighty percent of deaths from covert nineteen since the virus first hit the U. S. after peaking above more than thirty four hundred in mid January overall deaths have dropped to about seven hundred per day according to Johns Hopkins university's tally the number of Americans who have succumbed to the virus is approaching five hundred and seventy thousand Ben Thomas Washington

U. Johns Hopkins University Ben Thomas Washington
Disaster Medicine and Emergency Care With Dr Mathew Levi

Medicine, We're Still Practicing

02:02 min | 2 months ago

Disaster Medicine and Emergency Care With Dr Mathew Levi

"Well we get an interesting guest. Our special guest. Dr matthew levy is an associate professor at johns hopkins department of emergency medicine. He leads hopkins division of special operations which provides for central command and coordination of emergency medicine. Operation and dr levy is board certified in emergency medicine and a sub specialty certified in ems. He's the guy who sets up the teams and strategies that we don't even know we need until god forbid we need them. Thanks for joining us actor levy. Hey doing okay after greetings. It's wonderful to be here. Thank you so much for having me and for that. Very warm reduction so division of special operations. What exactly is that sounds more military than civilian well. It's structured is what i would say and indeed our division special operations at johns hopkins. The division really got its roots nearly two decades ago in being the central focus for all of the out of hospital medicine activities that johns hopkins emergency medicine overseas and that includes the interval syllabi transport programming includes some of our operational medical programs in support of tactical law enforcement medicine special event medicine and a few other topics and initially had some roots in disaster medicine. Which has also grown into its own unique and blossoming flourishing specialty area or focus area so we were close with some of our colleagues as well nowadays so are you coordinating and training these guys on the line. The guys who show up first. Those first responders that were so appreciative for well. It certainly is a team effort. I would say that. I'm one of the people doing that. Training in my role as an ems medical director. I certainly work very closely with our ems. Educators and helping to design implement and facilitate the delivery of educational content. And yes. i do spend a good portion of my time. An educator not only educating our physician colleagues but also educating our pre hospital emergency medical services clinicians in those lifesaving conditions recognition treatment management

Dr Matthew Levy Johns Hopkins Department Of Em Hopkins Division Of Special Op Dr Levy Johns Hopkins Emergency Medici Levy Johns Hopkins
COVID-19: 140 Million Cases and 3 Million Deaths Confirmed Globally

AP 24 Hour News

00:23 sec | 2 months ago

COVID-19: 140 Million Cases and 3 Million Deaths Confirmed Globally

"Another three quarters of a million cases of covert 19 have been confirmed worldwide over the past 24 hours that, according to the tally by Johns Hopkins University, and after the global death toll crossed the threshold of three million Saturday. The virus has claimed another 11,000 people in the past day. India currently has the highest daily rate of infections well in excess of 200,000

Johns Hopkins University India
"johns hopkins" Discussed on Medicine, We're Still Practicing

Medicine, We're Still Practicing

03:40 min | 2 months ago

"johns hopkins" Discussed on Medicine, We're Still Practicing

"We will always be grateful for dr. Jose how is this changed your life and your perspective on practice and are you suffering. You feel any. Ptsd from what you've been through some for the past year. I've never seen anything like this ever. And i think the way that it's changed my life is. I feel very grateful for the medical system. That i work in. I'm very inspired by all of the practitioners that i get to work with. I mean people who in the early days said. I might be negatively affected by this. But i'm gonna put on my ppe. And i'm going to do the best i can anyway. That's very inspiring a think the way that it changes my practice in that it deepens some of the things that we already knew how vulnerable it can feel to be in the hospital how somebody's prognosis. Trajectory can change in a day on in either direction. I think these are things we knew already but have seen so much more of it. Now i think your your final question was about ptsd. I mean i would say in. May in june i was having some irritability and having some dreams about my patients and their families and i think the things that made it easiest to cope with. Were my colleagues. Or i have a bunch of psychologists colleagues. I have dale needham mardi brodsky. Who you've had the opportunity to talk to already. So and all the colleagues in mixed use having that contingent of people meet it really. Okay to unpack knowing that there were other people who sort of understood what was happening in inviable to talk to them about it better. What made it harder at that time though. I think all of this is getting easier. What made it harder at that. Time was to go to work in. See the things we were seeing in here the things we were hearing and then have loved ones or family members. Kind of say well. Is it really that big a deal. Is this really as hard as everyone says it is. But i think that there was some real scary early days. But i think i'm okay now and people like dr tailback know how to treat this so much better than we did in the beginning. At least here at hopkins. We now have a funnel of support to pass our patients along to our post acute. Covid team catch patients on the other side. Which makes us feel a little bit more confident about their recovery's and i think the the biggest way this changes my practice is to just have that much more empathy for what our patients our providers. Go through together and so. I'm really hoping that once we can get through some of the severity of this and have more of it behind us. I really do think that as a system will be able to look back and not. Just think about what needs to change. But how proud we are of how we stepped up and saved a lot of people and thank you for joining us on a tour through this special series and a special. Thank you to johns hopkins for allowing us to pick your brains here on medicine. Where still practicing. If you know a doctor or healthcare worker that would benefit from listening to the series. Please send them a link and if you would rate this podcast. It helps us so much. This episode was produced edited for kurt. Commedia aj moseley. Mastering by steve. Ricky burg music. By celeste eric. Dick stay safe. Everyone broom kirk. Oh media media for your mind..

johns hopkins Jose dale needham mardi brodsky celeste eric kurt june past year Ricky burg hopkins dr. May in steve. aj moseley Covid dr tailback
"johns hopkins" Discussed on Medicine, We're Still Practicing

Medicine, We're Still Practicing

08:00 min | 2 months ago

"johns hopkins" Discussed on Medicine, We're Still Practicing

"Ease their mind and their psyche. I think the main thing that we spend time telling patients is your at johns hopkins and in the context of conversation we might say. And now that it's noon at hopkins will do x and y and z for example if the nurses bathing or providing a medication. They'll remind them what they're out to do. They will briefly mentioned that. They're breathing with the help of events because often patients are don't really have a sense of what's happening with that and then finally a really important one in the wake of covid is reminding people that their loved ones may not be in the hospital because of the visitor restrictions and letting them know hopefully that all of their loved ones are safe a common delusion for patients is for them to think that something really terrible has happened to a loved. One you know. Been in practice for twenty nine years. I've not seen your position in any hospital. I've worked at worked at several over the years. Naturally what happens. In the academic centers that takes takes time to filter down to the community and ultimately it should. Because that's the whole point in so right now we're in the process of trying to minimize delirium by keeping our patients awake at all times and minimizing sedation. But we don't have. Is you the resource from the psychological support. And so that's something that's being taken care of as best we can by nurses and physicians. So what advice to have to us. Who are we are in. This watershed area where we're trying to keep our patients awake. But then how are we going to give them the same kind of support that you're giving when we really don't have those resources. I think that right now. My perception is that we're in a space where we don't give the nurses and docs a whole lot of time to be doing this extra emotional support. So that's a big shot just from basic psychological and behavioral perspective. Whenever we ask a person to change their behavior to stop doing something we have to give them something else to be able to do instead right and so i think. Abcd model is one of the most common things that we rely on. So involving family perhaps including things like zoom and allowing the family to be a part of the patient's care whenever possible again that providing really basic reorientation for patients who are delirious ensuring that the environment is conducive as it can be to keeping people alert and awake so that means the setting matches the time of day so if it's morning we have shades open. If it's evening were quiet and really promoting sleep. I think that that also means just a mindset that says this person might be having one of the very worst days of their life and so when they're awake alert and potentially not fully engaging with us or sort of what we would say like refusing. Or being non adherent sort of thinking through with the patients about why that might be and sort of eliciting some ways that we can change that. If the patient's not delirious rounding out our trio of experts related to johns hopkins. Icu care is speech. Language pathologist dr martin brodsky. He is a leader in establishing communication with patients which is absolutely integral to their care in the icu. A speech language pathologist in an icu setting is far from common. But johns hopkins and dr brodsky are paving the way when it comes to dealing with swallowing and vocal challenges caused by time. Spent on a respirator. He is also innovating new and successful methods for dealing with communication difficulties. During treatment. I asked dr brodsky. How he performs the difficult task of communicating effectively with delirious patients. So the reality here is yes once. The patient is able to be interactive. We're able to work with the patient. And whether it's writing and writing has its own difficulties. Because of icy acquired weakness. Perhaps the patients even restrained with safra strands to keep from pulling the lines the tubes drains and so forth so you have the added obstacle if you will of even if the patient to strong enough to be able to put marker in their hand with the white board it's lifting their arm off the bed to be able to write on the white board which is another issue. How is that going to help. Patients ultimately speak better or swallow better once they've been liberated from the ventilator in the first place working with people to get them communicating gets the more involved in their own patient care. that's a big issue for patients. We've known that for some time and getting a speech language pathologist to maximize that communication. And whether it's a letter board maybe it's a basic communication or that says. I need to go to the bathroom. My back itches. My arm is in pain. Whatever it might be is a lot more than even trying to read their lips. There's i gaze that you can use for the simple. Yes and no questions. Their technology that's available to track their eyes and to be able to communicate much. The way that you saw in the past. Stephen hawking do it now. He had a more advanced communication board. But you can see that. There really is a continuum there that we're able to meet the patient's needs and meet the communication needs where you have the communication even with the nurse or the physicians or therapists that walking through and the patient has question or needs to tell you how they're feeling now. Moving away from the icu. We had the pleasure of having a discussion with sleep expert. Dr christopher early yes. We did chat about some rather interesting aspects of sleep hygiene the state of the art with sleep medicine. Go out and check out the whole episode if you haven't yet it's really valuable stuff but even more unique about dr early. His interest and expertise in rls restless leg syndrome. You may have heard about this ailment and an endless run of commercials. Recently however before this discussion i really didn't get it. It sounded like it could be a rather minor inconvenience but dr early shared with us. The actual challenge is difficult. Disease can present and how he and his colleagues set out to solve the puzzle. Well essentially it's about three to four times. More common women and men it basically increases in prevalence over the age group coming to a plateau at about fifty to sixty years of age but there was a progressive increase through childhood lessons up through the younger adults ages. Most of our research for the last thirty years has been trying to understand the pathophysiology of the disease and what we know is that there is a association on what we believe is. Part of the primary pathology is that the brains of patients with wrestling syndrome have lower levels of iron and certain regions of the brain so that rain aren't insufficient state. Despite the fact that their blood levels of iron or normal so it's very organs specific phenomena and this iron insufficiency leads to a couple of changes in your brain one of which is an alteration in this chemical called dopamine by offering doesn't specifically decrease the overall amount of dopamine it basically changes the circadian changing dopamine. So don't levels are high in the morning and low at night and it seems to make that nater point at night lower or decreased such you start having symptoms that lower level of dope me at night that triggers the symptoms and therefore some the first treatments that we had available was the use of some of the agents commonly used in parkinson's disease cinema at pex reequip the dopamine agnes. The symptoms are somewhat different in the.

Stephen hawking twenty nine years christopher early first treatments dr one sixty years four times dr brodsky martin brodsky brodsky about fifty last thirty years trio of experts One about three johns hopkins first place parkinson pex
"johns hopkins" Discussed on Medicine, We're Still Practicing

Medicine, We're Still Practicing

06:26 min | 2 months ago

"johns hopkins" Discussed on Medicine, We're Still Practicing

"Innovation from one of the top hospitals in the country. We wanted to devote an episode to really digging into some of the most significant revelations that were shared with us by these world class practitioners. You'll see why these are featured moments as we relive the groundbreaking and passionate practice of one of the nation's very best in research hospitals. So join me on this special medicine. Where still practicing. I'm bill curtis. Johns hopkins may be known for its outstanding research and development in all facets of care but what stood out for us is there equal commitment towards streamlining the full recovery process as well as their compassion for the whole patient. This attention to the patient is best exemplified by a unique and industry. Changing style of care. In the icu. Dr dale needham shared his groundbreaking research in regard to keeping patients awake while in the intensive care unit out. I know such a scary environment like an. Icu may be the last place where patients wanna be awake and lucid. But here dr needham shares. Why keeping patients coherent and engaged is actually best. Practice for the healthcare industry going forward. Most patients don't know how critical care is delivered so most patients we don't need to have discussions with them around this other than when we're not giving them deep sedation. And they're awake alert and contract with us we can directly asked them if they're anxious if they're in pain and give just the right amount of medication to take away any discomfort and allow them to be awake and in fact when we most often ask patients you know. Are you uncomfortable. Would you like some additional medications. When patients are not delirious. Most often they tell us no. I do not want your medications that. Give me confused thinking. Let's give a little bit of pain medication. Let's be up and moving so my back doesn't hurt lane in bed. Let's turn on tv. Let's engage with family either in person or through video conference. Let's do some things that help distract them. Were so very fortunate that we have dr megan hosie a rehabilitation psychologists who will address issues of anxiety through talking to patients rather than trying to give them powerful sedatives that 'cause confused thinking delirium and long-term cognitive impairments. So did you have a difficult time in the transition. Having been in the icu. Now in my twenty ninth year there is a culture at least in our main intensive care unit. The culture has always been patient. Comfort is paramount concern. In the i think the reflects amongst the nursing staff has always been because of the old adage to sedate is really compassionate. Did you have the same that we've been trying to overcome in changing the culture of from sedation to awakening absolutely most people who practice in the intensive care unit telling them that our patients should be awaken. Moving is like telling them. The earth is flat. This is completely different than everything that most of us learned when we are in our training and most of us have seen however if we go back to the early days of critical care when intensive care units were first being created patients were routinely awake and moving at that early stage but then the pendulum swung justice. You said with people thinking that sedation was going to make patients feel better. But when we began to think that we didn't understand this concept of delirium and we didn't realize that giving patients these powerful sedatives also directly causes this confused thinking and during this confused thinking patients aren't calm peaceful in an amnesic state like in the operating room. These patients are having horrible nightmares and delirium feeling like somebody's trying to harm them. There's blood coming out of the walls that there's rats on the floor that they're dead babies lane next to them in bed. These are actual memories that patients have had during their delirium. So there's nothing about back that's common peaceful and the biggest modifiable risk factor for delirium is our heavy use of sedatives that must change issues in order to provide compassionate care to our patients. These memories that i've talked about can last for months or years and are typically the same kind of memories that patients flash back to when they have post traumatic stress disorder after the issue that affects approximately one in four patients. That have been in an icu. As you may have heard. Dr nita mentioned there is another special tool in his belt for delivering exceptional. Care to icu. Patients and that's his rehabilitation psychologist. Dr megan hosie dr. Jose is kind of practitioner. That you hope you never need but if you or your loved ones find yourselves in the uncomfortable situation of being an icu patient you could experience side effects that cause delirium nightmares or even worse under those circumstances dr. Jose is the exact person you by your side to prevent or treat the psychological side of an icu stay. dr hoses. position is a rarity in hospitals these days. But as you're about to hear the work she does on a day to day. Basis is absolutely vital when it comes to excellence in compassionate intensive care so anytime. We're walking in for these patients in this bizarre p. e. We've been finding that a really important tweak is to remind people what it is along with the general reorientation that were doing so for example. We'll tell people where they are. Why they're there and we'll say i'm wearing these masks. And that's to protect us from infection for example enjoy because having colludes nations and delusions won't really understand what fat is aside from introducing yourself any other techniques that can give you leverage on patient who might be half in and half out of reality to help.

nita Jose twenty ninth year dale needham dr. Johns hopkins one dr needham bill curtis megan hosie dr approximately one four patients years earth months
"johns hopkins" Discussed on Medicine, We're Still Practicing

Medicine, We're Still Practicing

07:18 min | 3 months ago

"johns hopkins" Discussed on Medicine, We're Still Practicing

"A lot during the process. This is triggering a memory of of may for me so i remember one of our amazing nurse. Practitioners in the medical intensive care unit saying there was a period of time where you know we were calling it fall off a cliff right. They were managing at home managing at home. And then all the sudden were in the e. d. and they were being intimated with us and it would happen within hours so we were having series of patients were sedated. For longer periods of time were starting to wake up and we were having conversations with them that you know you've been in the hospital for this long. You're now a bit weak physically in and we're helping you train to get off events so they would be having these very strong reactions to how long they'd been sedated. How did i even wind up here. And there were a couple of points for the nurse. Practitioner said people are panicking when they when we tell them that they're here because of covid. They didn't do this but there were points per the nurse. Practitioner or seeing is. Is it worse to tell them that. They're here because of covid so was scary for a while. And i will say. Is that really quickly. Once people were coming off. The sedation were recovering. We were pretty to say like we think you're stable and you're going to have a good outcome in a lot of those situations we saw a lot of. I think i would call it like a double edged sword a lot of gratitude in patients. Just going i was one of the few made it in these early days and the other side of the sword was a bit of survivor's guilt. I think like what made me so lucky. Why did i get to make it especially in the early days again. We're seeing this last now but where we would have multiple family members affected and perhaps one died and one didn't gutter. Jose how is this your life and your perspective on practice and are you suffering. You feel any. Ptsd from what you've been through soup for the past year. I've never seen anything like this ever. And i think the way that it's changed my life is. I feel very grateful for the medical system. That i work in. I'm very inspired by all of the practitioners that i get to work with. I mean people who in the early days said. I might be negatively affected by this. But i'm gonna put on my p. p. e. and i'm going to do the best i can anyway. That's very inspiring a think the way that it changes my practice in that it deepens some of the things that we already knew how vulnerable it can feel to be in the hospital how somebody's prognosis or trajectory can change in a day on either direction. I think these are things we knew already but have seen so much more of it. Now i think your final question was about ptsd. I mean i would say in. May in june i was having some irritability and i was having some dreams about my patients and their families and i think the things that meet it easiest to cope with. Were my colleagues. Or i have a bunch of psychologists. Colleagues i have dale. Need them in mardi brodsky. Who you've had the opportunity to talk to already. So and all the colleagues in the mic. You so having that contingent of people meet it really. Okay till like unpack knowing that there were other people who sort of understood what was happening and be able to talk to them about it better. What made it harder at that time though. I think all of this is getting easier. What made it harder at that. Time was to go to work and see the things we were seeing in here the things we were hearing and then have loved ones or family members. Kind of say well. Is it really that big a deal. Is this really as hard as everyone says it is. But i think that there was some real scary early days. But i think i'm okay now and people like dr tailback not treat this so much better than we did in the beginning. At least here at hopkins. We now have a funnel of support to pass our patients along to our post acute. Covid team can catch patients on the other side which makes us feel little bit more confident about their recovery. And i think the again the biggest way that this changes might practice is to just have that much more empathy for what our patients our providers go through together. and so. i'm. I'm really hoping that once we can get through some of the severity of this and have more of it behind us. I really do think that as a system will be able to look back and not just think about what needs to change how proud we are of how we stepped up and saved a lot of people. I think you know a spoke a little bit to our medical staff nursing staff. And i think that was one of the things that really impressed me the most. Is i make the comparison to to the military in your training about being forward deployed. We had no training. You're on your couch watching tv. And you're enjoying your life with your family and then suddenly you're at war and nobody asked you but you are on the front lines. Certainly the nursing staff is amazing to me how they stepped up put their p. e. on state at the bedside of doctors. We jump in the room and out of the room. It'll quickly the nurses of their feeding patients. Twenty minutes thirty minutes. And they're just accepting the realities and accepting the risks and taking care of people like they always do and you do get this renewed and heightened sense of respect and admiration for the people that you work with me. Ask you this after some major battles a war. One of the things that the va has to deal with is ptsd a year or years later when it really hits who's gonna take care of the health care workers and focus on making sure that after they returned from this battle that they're taking care of so. I wanna stay humble about what all this is going to look like. I will say so if you wanna read some interesting stuff on psychological recovery after trauma or potentially traumatic events. There's this guy at columbia. Called george bonano and he researches what we call aries recovery. Meaning that a certain proportion of patients or people hit a traumatic event and they had already been kind of struggling rate so we would call those people who have chronic challenges. There were a proportion of people who are doing just fine before and they might persist and be fined during a traumatic event. There might be people who take in early hit in their anxiety depression. Ptsd levels but then sort of normalize and long story short. His research suggests that the majority of people will return to some sense of normalcy. And not have. Ptsd anxiety depression. So the lessons. That i take from this are for providers to be honest with themselves. If you are struggling a little bit before the pandemic or if you had any inkling towards mental health challenges before this was probably not going to help and so getting yourself care and acknowledging that and getting.

george bonano Jose june May columbia dale hopkins One Twenty minutes thirty minutes one past year a year years later mardi brodsky one of the things double Covid aries
"johns hopkins" Discussed on Medicine, We're Still Practicing

Medicine, We're Still Practicing

05:35 min | 5 months ago

"johns hopkins" Discussed on Medicine, We're Still Practicing

"Or difficulties with memory and the physicians discounted. These symptoms are so incredibly real if you actually look for them know about them and measure them so a vital part of the recovery process for many patients after critical illness is involving mental health professionals psychologists psychiatrists a counselor somebody to help them work to host dramatic stress disorder and of course our primary care doctors. Who have this kind of skill set as well. We just need to recognize that the entity of post traumatic stress disorder can happen to somebody that was critically ill somebody. That wasn't the car crash somebody that wasn't in military combat. Somebody that wasn't sexually assaulted but somebody who was critically ill and what they're having post traumatic stress disorder symptoms about are things that never actually happened unlike the other people that have talked about. It's the memory of them believing that they were sexually assaulted in the icu or that a dead child was lane next to them. These things are incredibly frightening and feel just like the memories of anyone else of a real event so it really is important to get that help in order to work through these things how much of it is psychosocial that we can work through with therapy. And how much of this is. maybe. A sub clinical or a metabolic disturbance of the brain. That is going to be lifelong. What do you think they'll on something like that. So i think some of the psychological symptoms such as post traumatic stress disorder can be worked through and can be worked through because we have existing therapies that address it they may address post traumatic stress disorder from a different cause. But we have no reason to believe that those kind of interventions are not also effective when it comes to ptsd anxiety or depression after critical illness. The bigger challenge. I think that you highlight as well is the cognitive impairment the difficulties with memory in thinking and there we have much less evidence about interventions that are going to make those kinds of impairments better but it doesn't mean that patients shouldn't seek help because through things like rehabilitation psychologists. We can learn better ways to adapt even if we have more difficulties with planning and executing tasks we can do compensatory interventions. We can begin to make lists more often. Lists are going to help us with memory impairment. We can plan things out. We can write them down. We can organize organizers days in the way to address potential cognitive impairments so there are ways to have a way forward in to improve patient outcomes for sure how does care differ now in the intensive. Care unit. In your icu. And what is recommended for all the ice us now shirt so we routinely have our patients awakened moving whenever possible. That's the default. So there are modern sedation scoring systems. One is called harass score. So our target our sedation. Target for patients who ever breathe into is arrest score of zero. which means alert and com. That's our goal. That's how we come to work every day. That's our default. that's what we aim for. It's not possible every single patient every single day but our default approach is to have patients awaken moving. We're very fortunate that we spend a lot of time with our nurses and our nurses have training in a culture that embraces this over time we are very fortunate that we have occupational physical therapists and rehabilitation doctors and psychologists. Help us with that approach to care but it all starts with the doctor and the icu nurse. That are arranging care. Such that a patient can be awake and not just starting continuous infusions of heavy sedative medications just because there's a breathing tube in place and importantly this isn't just a practice at johns hopkins hospital. The society of critical care medicine in two thousand eighteen released clinical practice guidelines called tata's these are guidelines for management of pain agitation sedation delirium. Immobility sleep had his dis and said that this approach to care is what the evidence tells us. We should be delivering to all of our patients and in fact that same organization the society of critical care medicine has put together. Bundles of practical interventions to practically a help issue doctors nurses and pt's not come together to deliver this kind of based care. So i don't want anyone to think that this is something that only happens at johns hopkins or this is something that that unique to us. There's a large audience. Evidence n clinical practice guidelines that. Tell us that this is how we should be practicing as well as practical resources to help us with this with this bundle of care.

johns hopkins johns hopkins hospital two thousand zero single patient eighteen every single day One stress
"johns hopkins" Discussed on 5 Things

5 Things

07:31 min | 7 months ago

"johns hopkins" Discussed on 5 Things

"We delete vaccine candidates by pfizer and madeira both required to doses so that's around six hundred million doses and not everybody's going to have access at the same time it's gonna come out on a rolling basis based on priority groups so healthcare workers high risk individuals may be in the best case scenarios december january. They'll start vaccinate them but for the general public. We're looking well into twenty twenty one. So we will still see some level of restrictions and they move to the level of guidance versus mandates as more and more people get vaccinated but really about seventy to eighty percent of the population needs to be vaccinated across the herd immunity threshold. The first goal of the vaccine though is not herd immunity it's to protect vulnerable populations so our hospitals don't go go under that they don't go into crisis and because of that they're still going to be spread of the virus because those individuals aren't going to be in the first priority group to to be vaccinated it's going to be healthcare workers high risk individuals. So we'll still need to be very vigilant. This is going to be a virus. That's not going to be a radical but it's going to be with us and it's going to become less of a public health emergency but we still need to be to be vigilant for several month period. At least and and i think that's the important point to remember. Is that that. This is now going to establish itself in the human population and we are very enthusiastic about the levels of protection that this vaccine to initial vaccines have provided over ninety percent. Which is really really astonishing based on what we thought would happen. But i do think that there's still a lot of work to go before these vaccines can can realize their full potential of the public health. Emergency that we're in. It's a very interesting moment in terms of when we when we think about the whole time line thus far with emergence of this new virus and how it is establishing itself in human population and i totally agree. It's it's not going away. We're going to have to learn how to live with. This and vaccine is going to be one of our critical tools but until we're able to really get the vaccine to all the people who need it. It's going to take some time. But i think the thing we have to remember is that even though science is a process and we needed to be that process so that we can rigorously. Check the data. We can make sure what we're doing is safe. We can make sure that it has the human benefit that we need to have and we can continue to push forward in sao during the week where most of us are grappling with. These thinks giving plans and recognizing that you know what it. It really is important for us to see grandma next year and not have her succumb to to corona virus. And so we're being flexible in these plans. And then we get this glimmer of hope right that we have these now to vaccines that are marching very consistently very strongly towards manufacturing that we could even potentially see vaccine available for our healthcare workers by the end of this calendar. Year is an amazing feat. And it's just we have to remember that this is. This is a slow inconsistent march. Working as fast as we can but we are not going to be Short cutting any of the safety or any of the science that we need to in order to make sure that the vaccine is is right for human population so yes it means. We are going to still be wearing masks. It means we are still going to need to social distance. These are just milestones on this on this longer process. Absolutely an a mesh. This might be a question more for you. But if we see a spike in cases ten days out from thanksgiving what could that mean for our health infrastructure. I'm thinking that you know if more people are getting tested for covid that could lead to a shortage of tests. And that means that it's gonna take longer to get those test results in and that means that it's gonna take our contact tracers longer to start their investigations. Because they don't have the test results back and that's time that people won't be quarantining given the the numbers of cases that we're seeing if the rate of spread continues and is accelerated by thanksgiving. What could that do to our health infrastructure. Well i think it's going to be inevitable that we see some spike in cases after thanksgiving. If you just wind back a month. When the canadian thanksgiving occurred canada saw spy can in many people are still going to gather. And we know that there's gonna be some level. Even with the cdc guidance some level of of cases that occur because of thanksgiving and there are many parts of the country were hospitals are getting near capacity or really concerned about capacity. So i do think that this added burden is going to be something that pushes hospitals closer to the edge. And that's something we've been trying to avoid. You have to remember the flattening. The curve is primarily about. Having cases occur at a pace it's manageable by the healthcare system. So that not everybody is getting sick at once and thanksgiving is an opportunity where you may have a lot of people get sick at once. And there's going to be an increased demand on tests and we know since the beginning of this pandemic. the testing has been in abysmal failure in this country. That the turnaround time even the best days for outpatient testing maybe three or four days and that makes it really worthless because the contact tracers can't do anything with the four day old test because it's not going to be very impactful when they start trying to tell people to isolate so so. I do think that this is going to be a major challenge for our healthcare system for the public health infrastructure that we kind of lack in this country and we already are seeing runs on. Testing prior to thanksgiving is people use tests as a as a way to try and decrease the risk. It's on ironclad but some people are are doing it. And that's already putting pressure on tests. So i just think that this is probably going to accelerate some of the problems that we've had from the very beginning of this pandemic and it's important to remember if we would have had a better testing solution if we would have had access to test. In the way that countries like taiwan south korea. Have we would never have been in this situation and wouldn't be thinking about these types of dilemmas so that being said there are so many alternatives to gathering in person for thanksgiving meal. You could do a distanced food. Drop off you could plan virtual cookie decorating party. You could order take out. You could have a virtual watch party and watch a holiday movie with family. I as soon as we get off this call. I'm going to be putting some thanksgiving greeting cards in the mail and sending them to my family professor. Altaf what would you say to someone who is hesitant to shake things up because they feel that they really need to be physically with family. This week so i think we all should remember that in years to come. We will be thinking back on this thanksgiving right. We will all have stories about how we celebrated the holidays during a pandemic. And i think the thing that you have to allow yourself to do is to shake things up right. You have to give yourself permission to shake things up. You have to give yourself permission to let your kids run the show on the thanksgiving and get yourself some takeout right. You have to give yourself permission to to reach an have that our long call with an elderly a loved one. Who is not leaving home for thanksgiving this year right. So it's the moments that you want to find where you truly have connection right because that's what we're missing. Usually we get we get connection kind of even on a daily basis waving to someone at the store those types of things. All of that has really reduced and rightfully so. It's helping to keep people safe. So in order to kind of refill. That and reenergize ourselves to have really meaningful connections on thanksgiving. I think is going to be really important so jump into it. I know that there are a lot of webcam..

cdc Altaf professor taiwan canada south korea
"johns hopkins" Discussed on 5 Things

5 Things

06:47 min | 7 months ago

"johns hopkins" Discussed on 5 Things

"I'm joined by professor carrie. Ann all talk and dr a mesh dulger. They both teach at the bloomberg school of public health at johns hopkins university. We spoke this week about small things. People can do to minimize corona virus during the holidays. Here's that conversation dr dodger. I'll start with you. What would you say to someone who has already bought a plane ticket and is planning to travel for. This week's holiday was the first thing i would do is think about what your risk tolerance is and you have to realize any kind of interaction with people especially for going from one part of the country to another is going to have significant cova nineteen risk of of you either acquiring it or spreading it. And that's why the cdc has issued guidance recommending. People not travel the one thing that you could do if you are not going to go or be based on the cdc guidance is to try and call your airline agency and see if they have any refund policies available or if you can change your ticket or postponed the ticket and maybe not go on what. The situation is in the country if you are going to go. There's a whole list of things that you need to kind of keep in mind and it's remember it's not so much the plane where your risk is it's actually getting to your gathering and i think probably go into that in more detail what you need to do but again i would probably be trying to see if the ticket is refundable. Yeah professor top. Do you have anything to add. You know. I think the cdc was very clear this week with with this devastating statistic that there were one million new cases over seven days and so we are in this period right now where cases are accelerating very quickly so the name of the game with this holiday season is just going to be flexibility. I know it can feel very devastating to have to change plans. I think if we enter this holiday season by just saying things are going to be fluid. And we're going to have to make a plan. Abc and probably in order to make sure that we have our celebrations. And the safest way possible if someone isn't traveling far. But they're still interacting with people outside their household that's still high risk. According to the cdc right yes gathering even in your household with family. That may be more local to where you are. So we're not talking about distance traveling but just gathering locally can still put you at high risk for krona virus infection and this is because we're seeing a lot of transmission and a lot of community is right. Now i agree. We know that small gatherings where people let their guards down especially when it's people that they know very well that are from the same town as them. That's that's a place where we're seeing transmission occur. And when you're thinking about a thanksgiving gathering it's going to be a time when people are not going to social distance when it's going to be hard to keep different households separate so so. This is a high risk activity and you can expect. Just based on the community prevalence of this infection around the that. When you have people from other households gathering you're also gathering with that virus to what small steps can people take. That will make their thanksgiving safer. I'm thinking of a scenario where everyone brings their own food. A scenario where. You're going to try to increase the ventilation in the house. Whether that's opening a window or turning on the fan above the stove everyone using disposable plates and silverware what are some small concrete things that people can do. So i think the first concrete thing that you can do to really reduce the risk is to see if you could hold your event outside now. I know a lot of places in this country are getting colder right now. The temperatures are dropping even in maryland. Here seems a little bit colder than what i would be comfortable with studying outside for an entire meal so perhaps instead of an entire meal it's desert gathering outside or if you're if you're able to access a fire pit or something like that where you could invite your family again a small number of households to gather outside with masks on around a fire pit to say hello that that's one way you could still have a gathering and yet really reduce that risk as we've seen in a number of studies when people gathered together and sit down and share a meal in a place where there's not great bent ventilation. That is a high risk environment. We've seen this and in studies in restaurants and so if you arguing invite people into your home and again this is not what the cdc recommends but if you decide to do that definitely open your windows. Make sure your guests. No it may be chillier in your home. Make sure that individuals have enough space from each other while they're eating so you really have to think about your layout of your table and where you're going to put people but the idea here would be you know that seems like quite a bit of additional effort whereas instead of going to all of that you could just say let's gather outside. Let's go for a walk. Let's do something where we can definitely get some six feet of space between our households. We can wear masks and we can enjoy each other. I agree all of those recommendations would decrease the risk. I think you can also couple that to Trying to have more than one household coming. Try to kind of pod them so that they stay six feet away from other households. And if you're having this endorsed maybe you. You change your seating that way You can you can bring your own food. That's one way to do it. Or you can just have it kind of serve restaurant style wherever you where. The food is kind of Put on the table when people are not at the table. So you avoid the congregation of people around the When it occurs. I don't necessarily think you have to bring paper plates. Disposable disposable silverware we see surface transmission as being much less likely than people. Interacting with each other and transmitting it. You can also for people who aren't going to wear masks or they may not they may be reticent to wear masks for whatever reason You can have them wear face shields which which may also have an impact in decreasing the risk. Especially because you can you can drink with. You can put give people straws that they can drink under their face shield you can even eat under a facial. I've tried to eat a piece of pizza under facial wants so. There are other things you can do to try and reduce the harm. The virus causes. You just have to be creative and really just think about the virus being at the table with you and not allowing it to have access to your friends and family but those are so many great suggestions we've had good news about vaccines filing for fda emergency use authorization but tell us why. Vaccines are a silver bullet solution. So you have to remember the to make a vaccine. It's going to be very long and arduous process and it's not going to be available in a in a couple of months for the whole entire country or the whole entire world..

cdc professor carrie dr dodger johns hopkins university Ann bloomberg school cova professor maryland Abc fda
"johns hopkins" Discussed on Scientific Sense

Scientific Sense

05:41 min | 8 months ago

"johns hopkins" Discussed on Scientific Sense

"By guest today's David Linden a professor of the Department of Neuroscience at the Johns Hopkins University School of Medicine. His lap because what forbidding use the cellular. Memory storage recovery of function after brain injury at a few other topics. He's the author of full bestselling books on the biology of behavior for the general audience. His most recent book is unique the science of human individuality. Doklam David. Thank you for having me on. Sure. Yeah. So the topic of conversation is your most recent book that just came out. And it's simple. Human individuality. Then I think about humans David. I see eight point three billion people around the world we see do sorta micro segmented ourselves into. An ideal buckets by skin color by language by country be have looted leaders of great democracies reminding us VR in in different buckets. At all the time. So what do you mean by human individuality? Well, what I really mean is all the traits physical. behaviorally emotional cognitive that you can describe about a person them away that I began to think about this. This is about five years ago when I found myself single midlife and I did as people do these days and. I went to an online dating website and I was reading the profiles trying to find woman who I might want to have a conversation with. And worked out very well I met a woman who became my wife She's wonderful. Happy ending. But You know the Nerdy side of me was reading the list of traits that people have their used to describe themselves and wondering how they come about. So you know someone might say, well, I'm five foot eleven and I'm bisexual and I have a Boston accents and I like a bitter beer, but I don't like white chocolate and. I tend to be a risk taker, and so I started thinking well Gosh. How do these traits that make her an individual? Come about. So that's how it all got started. Okay, okay and so So so we'll get into the book in detail, and so you know then I think about sort of human individuality. Yeah..

David Linden Doklam David Johns Hopkins University Schoo professor Department of Neuroscience Boston
"johns hopkins" Discussed on Scientific Sense

Scientific Sense

01:47 min | 9 months ago

"johns hopkins" Discussed on Scientific Sense

"Welcome to the site of accents podcast. Where we.

"johns hopkins" Discussed on Future Ear Radio

Future Ear Radio

02:16 min | 10 months ago

"johns hopkins" Discussed on Future Ear Radio

"The. World Voice Technology. Power these worlds starting to intersect power these worlds starting to collide what cool things are gonNA come from this intersection of technology. Without further. Ado. Let's get on with the show. Okay. So rejoined here today by Dr. Nick Read. Nick tell us a little bit about who you are and what you do. Sure. Thanks for having me. So I am clinically trained doesn't audiologist. However I spend A. Day Job in this world. Epidemiology. Assistant. Professor in the Department of Epidemiology at Johns Hopkins Adversity Bloomberg School of Public Health which is a mouthful. And I'm core faculty at the Center for the Kook Later Center for a health, which is also at the Johns Hopkins Bloomberg School of Public Charles. Awesome. Well, thank you for coming on today. It's great to chat with you. Again I know that the last time we spoke was when I was doing the. Videos. So sort of the natural progression of those is now the podcast but I wanted to have you on because like you mentioned you work at Johns Hopkins you know you're working in the. Whole Epidemiology field, and I just find a lot of the work that you do super fascinating i. think that it's going to be really I think a a really important piece to driving more awareness more just of a broader understanding of the importance of hearing protection, hearing conservation, and the idea that hearing loss ultimately can lead to some pretty nasty co morbidity and so I WANNA get. into some of the different ways in which you know the work that you all have done outlines ways that you might be able to kind of mitigate damage, and so to start with a one, a lead with the kind of the like end point actually when I kinda like lead with the ending we'll come back around to it. So recently the, Lancet. Lancet Commission Dementia Prevention, they issued a list of different both points around ways to prevent dementia and what was striking for anybody that's working in and around the..

Johns Hopkins Bloomberg School Dr. Nick Read Johns Hopkins Lancet Commission Dementia Pre Bloomberg School of Public Hea Lancet Department of Epidemiology Kook Later Center core faculty Professor
"johns hopkins" Discussed on Outcomes Rocket

Outcomes Rocket

07:09 min | 1 year ago

"johns hopkins" Discussed on Outcomes Rocket

"We discuss interoperability building. Scaling a digital health solution and the work that he and the team at Corey Health has done to bring cardiovascular care and prevention in two communities that more than likely would not have this care and also scaling in such a way to allow people to get that type of care during an era of cove in nineteen and beyond and so with that. Glad to have Dr Seth Martin here with US and today will be super focus around his thoughts on health care but also around interoperability and the idea of building in scaling a digital health solution but also the execution of that so Such a privilege to have you here Dr Martin so glad you could join us my pleasure to join you. Thank you for having me so Dr Martin. What inspires your work in healthcare. Yes I Have been inspired for a long time. I come from a medical family and knew for a long time that I was probably heading towards a career in healthcare and so I'm on the front lines. Now of clinical care as cardiologists at Johns Hopkins Hospital. And so the being able to help my patients solve the problems that they're facing and lead healthier lives and more time with family. Stay out of the hospital that inspires me. It's really from that that inspiration but also seen that there's still room for improvement in the way that our healthcare system serves patients inspired me to become part of the Corey health team and really work on building the future of of healthcare. And so think I'd love to sort of share some of that story and how Corey started. It's basically been at this point about five years in the in the making and I was fortunate to meet really incredible physician. France was marvel back at that time when she was at the beginning of her internal medicine residency and this came at a time that I started getting interested in health technology and had recently returned from a training and in mobile health technology at the NIH and really was becoming ingrained in me. The importance of working on a multidisciplinary team with more than physicians but engineers and and nurses and having patients as partners in research. Around that time that I was starting to think you know what could be some next steps to really help the cardiovascular patients that I've seen in in the inpatient setting of the hospital and an outpatient setting and I've done some work around promoting physical activity but that I knew that there was more than than that one thing that we the patients really need a full package And Not one thing and so France was marvel was starting to work in this accelerator program at Johns Hopkins around technology and thinking about building a smartphone APP for patients and connecting with some great engineers and early on we connected with Amazing Engineer League was in the PhD program that at Hopkins and really the we wanted to work on something that was addressing a problem. Our patients were facing and the problem that we honed in on. Was this transition from the hospital to home. We're seeing that our patients with who came in suddenly clenching chest with a heart attack in the hospital. We have all these great interventions putting stents in arteries really proven medications that help after that and we do all that really well in the hospital but then the transition happens home and that transition happens quickly and it's a really a paper based process where patients get given those instructions. Really lifesaving instructions the hill under that hospitalization and there. There's really this. We thought opportunity to improve implementation of everything we know by better engaging patients in their care around that time and using the time they're in the hospital to start introducing to to a tool not to papers but a tool on the devices that folks are having their hands on the smartphone to guide them through that recovery and so we started working with we got connected around that time through our Tech Innovation Center with team Apple Health and they were incredible partners as we began to build a smartphone based solution for patients. And it's just been an incredible journey of working with patients working with engineers working with other physicians like Dr Marvel. Working with nurses like errands spalding building. Something from scratch bring this vision to life of moving beyond just the paper based processes to something. That's really serving our patients to help them engage better in in guideline therapies. And so it's been a journey overtime of building the smartphone APP which is paired with smartwatch and a blood pressure cuff and getting that in the hands of patients and their families to and then to study this to see the impact that we're having and we're still working on the final study results but we just published a paper in partnership with one of our patients in the M J case reports and her words are so powerful about the the impact that this type approaches is having her and that's what inspires me to work in healthcare is to have a positive impact on the lives of our patients. And there's just so much I can do by delivering everything that we know how to do. But I but I've come to realize that my impact his. It's one thing to see a patient in the hospital and have that brief moment of time with them. It's one thing to see my patients and outpatient clinic every now and then every few months or six months or year that I can really extend my reach an impact. I can have as clinician if I can work with other folks and build technologies that can empower the patient every second of the day and it really the extending that reach. I think is going to be future of the master clinician understanding how to empower patients with technology because ultimately it's about what the patient understands and recognizes as important and has access to what they need to take care of themselves because they're ultimately the the person responsible and them and their family. I think I've also learned throughout this process the importance of the caregiver. Whether that's about the caregiver helping them engage with technology or helping engage with getting the aspects of their care that that they need to engage with. So.

Dr Seth Martin Johns Hopkins Hospital Corey Health France spalding building Dr Marvel Corey US Johns Hopkins Apple Health NIH Hopkins Tech Innovation Center Engineer
"johns hopkins" Discussed on AP News

AP News

03:01 min | 1 year ago

"johns hopkins" Discussed on AP News

"Wire Johns Hopkins which has been taking account of the nineteen inspection to death says the U. S. now has more than eighty two two thousand cases the most in the world despite the growing number of cases in this country president trump says he still wants to see parts of the country return to business every day that we stay out it gets harder to bring it back very quickly and we don't want to stay at a White House coronavirus coordinator Dr Deborah Berke says there's growing evidence to major urban areas could see a jump in cases Detroit and Chicago we are concerned about certain counties that look like they're having a more rapid increase I'm going to look at Wayne County in Michigan and you look at kick cook county and Chicago so we have integrated all of our information to not only look at where the cases are today but how they're moving so we can alert FEMA to where we think it's the next potential hot spot is army hospitals being sent to two of the hardest hit areas army chief of staff general James McConnell dissector defense signed orders for three army hospitals deployed in New York and Washington state the five thirty first hospital from fort Campbell Kentucky and the night hospital from Fort Hood Texas will deploy to New York City the hospitals will be used to treat patients other than those with corona virus taking a load off the many hospitals now swamped with the virus patients in the New York City area the markets despite word that three point three million people applied for unemployment last week rose for a third straight day the driver the two point two trillion dollars relief package passed by the Senate under consideration in the house Bankrate dot com's Marc Cameron you cannot stop economic activity across at least half of the country and not have what is essentially a decline or contraction think of a minus sign in GDP this is a pain is the economy grew two point one percent in the last quarter of last year that was before the pandemic the U. S. economy grew at a rate of two point one percent in the fourth quarter government officials should enjoy that two point one percent fourth quarter growth from twenty nineteen many economists believe it'll be the last positive growth seen for some time as the country indoors a sharp contraction due to the corona virus many economists believe GDP will to negative in the current January to March quarter some see a drop of around six percent with much bigger declines in the second quarter federal reserve chair Jerome Powell we may well be in recession but again I would point to the difference between this and a normal recession this isn't there's nothing fundamentally wrong with our economy quite the contrary Powell appeared on NBC's today show I'm showing up where Fred curly Neal the dribbling wizard to entertain millions with the Harlem Globetrotters for parts of three decades has died he was seventy seven I timid wire AP news thank you for listening to the AP radio network Hey did you.

Johns Hopkins
"johns hopkins" Discussed on 77WABC Radio

77WABC Radio

11:34 min | 1 year ago

"johns hopkins" Discussed on 77WABC Radio

"A Johns Hopkins we have been searching for an answer is there a civil war are we in one now we can not now the Romans couldn't tell two thousand years ago and all of the civil wars ever since are very difficult in fact that's one of the definitions of civil war you cannot be certain you're inside of it until long afterwards so the question is raised what we're witnessing in Washington now for a time out until the new Congress because the house is going home what we're witnessing in Washington looks like moments in our history where disorder has overwhelmed the constitutional a structure and we then it's led us into conflict most importantly what happened in eighteen sixty sixty one but also what happened and seventeen seventy five seventy six seventy four seventy five seventy six in Pennsylvania that was a civil war a break with the majority of colonists who were loyal to the king by those who were not in the civil war period it was quite clearly a secession of states since then there's been no occasion to entertain it although the country has been resolved especially during the Great Depression Michael a very good evening to you I tell this story about Congress after witnessing the enmity that was obvious dripping from the remarks on the floor of the house ending the vote by the democratic majority to condemn the president to impeach the president as an abuser of power and up structure of Congress is justice the and code is about eighteen six to eighteen fifty nine late eighteen fifty on early eighteen sixty after John brown's hanging the anecdote is that at the door going into the old Senate building at the old Senate chambers and it's still there in the capital a hand written sign was put up check your guns I have the time I read this I was researching the civil war for the first time I thought no really I guess everybody was armed in those days and that was a way of preventing violence such as the caning of as of Charles Sumner in eighteen fifty six however after witnessing these last days and now the incomplete record because Nancy Pelosi has chosen not to send the vote of by her democratic majority to the Senate we're in limbo for this conflict but check your guns sounds like good advice good evening to you Michael good evening John it it really does seem as though we're entering the kind of terra incognito the uncharted terrain that precedes the crisis and we don't have to imagine or or or project to predict the crisis to understand that the dynamics under way today are eerily similar to those in the polity such as it was in the colonies in the early eighteen seventies organ in that last several years in the eighteen fifties seventeen seventies Michael meant the eighteenth century yes seventeen yeah absolutely yeah that and and we work a coherent policy but we will be coming up like an identity at that time and so those early years in the seventeen seventies entered into a shifting terrain of loyalty and commitment that happened in the very last years of the eighteen fifties and it really seems to be gathering force today and the nature of the election process which has been terribly riddled by the entire constantly of investigations that have covered the entirety of the of the trump administration's tenure has really created of a visceral understanding among all Americans that the nature of the polity which is based on you know periodic presidential elections regularly that that that that that naturally and always lead to new president but now the the amity and the the nature of political warfare has become so overriding that the entire in politics and this is been amply illustrated the last several years the entire effort in politics now is to unseat and destroy whoever happens to he is the current of the holder of the office of president and under those circumstances it becomes increasingly difficult to imagine how an orderly transfer of power after a presidential election as possible and there are so many ways in which an election now could be perceived as being it somehow he you know falsely twisted or you know that there was massive fraud or interference all of this was beginning to come to a head in twenty sixteen but one can only assume that it will be more intense and twenty twenty and the fact is that the the tightness of the election will will undoubtedly be at least an anticipated part of the upcoming election in a year and so that there is a vast anxiety that is hard to take the pulse of across the entirety of of American consciousness now because people understand in their gut that things could literally come apart as a result of of election outcome that one side refuses to accept and this is the this is the great anxiety that was only partly a laid by the insurance strangely from both Democrats and Republicans that this current impeachment imbroglio would would not seriously threatened the completion of this president's term press two little bit on this Michael B. as the impeachment imbroglio strangely now comports with our understanding of the states that descent to the point of withdrawing or no longer acknowledging Donald Trump as president for two example Nancy Pelosi representing the people of San Francisco Adam Schiff representing the people of Los Angeles Jerrold Nadler representing the people of New York what we were describing here are two states that are in defiance of the trump administration from the beginning Ryan certainly leading the charge are such as it is to impeach and remove him from office within a year of the election so in your in your proposal of a close election and good heavens how do you get close to them what we had in twenty sixteen well just watch in your proposal you're identifying the very states where there would be uniform celebration due to disavow eat up the make up of of these sort of most embittered and and most in rage state is very similar to what we would see right before the American revolution if you're looking at Boston and Massachusetts or say at the Virginia and it before the civil war you had South Carolina and you also had core areas of of of super premium abolitionist passion and intensity in in the north specially in the Midwest in the course again in New England and these are epicenters that that you you can't really call radical it necessarily in an ideological sense but their radical in their willingness to to push for the outcome that they require even if that entails breaking down the constitutional order and so what what you have today are those states you mentioned maybe including the Pacific Northwest and some other parts of well they're always leaders Michael I'm just pointing to leaders in the in the affair in South Carolina was a leader and others followed yes Hey in eighteen sixty South Carolina let right and so what what I think you have today is any outcome that that speaks to a a kind of a hung jury result in the presidential election where there's no clear decision we will protest any sort of remedy that would lead to such a decision so whereas in the two thousand people accepted the supreme court's decision often they accepted it with great anger and and and bitterness but they accepted it and I'm not sure given the make up of these these radical leaders and sort of radical upstate constituencies on both sides I'm not sure that there would be a willingness to do that detail about two thousand Michael there was an empty White House and both candidates were this were beseeching the American people to like them and Al Gore chose to pull back from the fight eventually after the machinations of the South Florida Supreme Court and the US Supreme Court so it is not comparable to having an incumbent who of the opposition means to dislodge by any means possible yes and and the incumbency itself isn't critical because all the other ten incumbents in presidential elections out of fifty eight that with an incumbent who defeated they all did as gore did Nixon this another example he had good cause to us to speak to speak of fraud in and massive yeah in nineteen sixty Hoggan nineteen nineteen sixty but he didn't and and so what you have today is the opposite of that sentiment among American leaders with they're willing to push and the other thing that that it's hard to fax just nana Michael will continue hold on hold that thought we're talking we're talking about something that won't happen except that it happens which is a civil war and we're talking about something that won't happen a close election that turns on the courts except that it has which is the year two thousand and I could go back to other court cases there eighteen seven eighteen seventy six comes to mind an ideal that was made to overwhelm the popular and.

Johns Hopkins
"johns hopkins" Discussed on MYfm 104.3

MYfm 104.3

01:45 min | 2 years ago

"johns hopkins" Discussed on MYfm 104.3

"Johns Hopkins medicine, I've been here since two thousand two this fired by any woman that has accomplished what no one expected them to accomplish. I always knew that. I wanted to be a physician to very exciting time to be a practicing. Call chemotherapies that we're using now the biologics targeted therapies, the HP vaccination. We're ten years into the vaccines. We could look at an era that we are cervical cancer free that time for breaking open education is now because I think that have even grander affect on women's health as part of Johns Hopkins medicine Sibley Memorial Hospital suburban hospital and Johns Hopkins community physicians are improving health care for women and setting the standard of excellence in research and treatment. Visit Hopkins medicine dot org. Radio. Music for rioting. Three. To me. Because I'm the. Then they have gone back to. Come. But the naval all..

Johns Hopkins medicine Sibley Johns Hopkins ten years
"johns hopkins" Discussed on KIIS 102.7

KIIS 102.7

02:02 min | 2 years ago

"johns hopkins" Discussed on KIIS 102.7

"Johns Hopkins medicine, I have lived in the DC area my entire life. I see one enduring very stressful and difficult time in their lives facing, the diagnosis of breast cancer and amazed and inspired by their strength and the courage. They have to battle this disease and breast cancer surgery in particular has been changing so much in the last twenty years. We have better ways to diagnose breast cancer. Earlier surgeries are much less invasive, we have new medications better survival rates and better quality of life. The advances are amazing. We're getting there as part of Johns. Hopkins medicine Sibley Memorial Hospital suburban hospital and Johns Hopkins community positions are proving healthcare for women and setting the standard of excellence in research and treatment visit Hopkins medicine. Dot org. Live from Hollywood kids club with Julia Martinez. On one or two point seven kiss FM. Down the road. A fight fighter. World a fight. You fight myself. Still left afraid pain hurricanes.

Hopkins medicine Sibley Memori breast cancer Johns Hopkins Hopkins medicine Julia Martinez Hollywood twenty years
"johns hopkins" Discussed on Newsradio 970 WFLA

Newsradio 970 WFLA

03:03 min | 2 years ago

"johns hopkins" Discussed on Newsradio 970 WFLA

"I never. Pretty UV for the first time. And I love your show, and I pray for you and your life everyday. Thank you. I'm alone money. Was had been with intelligence after. Going to school in Baltimore. At Johns Hopkins to be a neurosurgeon, but he was asked to come back with intelligence agency. So and he was. Murdered because he was friends with on more Sadat, and they didn't even check as to why. But anyway, so be it. And I wouldn't you couldn't for our whole listening to colossal prayer for those older people manipulate the weather. It's so true. So true to stop it. I would like for gone too. And just let it go away. And let me earthy natural again. It. So. And I would also Lyster audience to pray for me. I never heady surgery before. And I would really appreciate someone confronted with something. That is quite scary. And. I don't want chemo and radiation. So I would really appreciate appear your audience your audience. Will you've got my prayers, and you know, I was just talking with Janine today. And she, and I were discussing how she's recovering, and she was telling me that, you know, prayers and natural things and taking care of the body naturally also helps and that, you know. Do. Yeah. Your chances are very high. Then that you're gonna be fine. Supplement that you guys take and I also to a special doctor that has a it's a computer unit coal. Oh, I can't remember what it stands for. But it has healing Elena. The tonics with Shane, and they she and her husband does say that. I have very good genes. That's never heading surgery. And I've always taken what a supplement, and I don't eat junk food feeling that. If that's the case, you're going to be fine. You're gonna be fine. Thank you. You're going to be fine. And then if there's anything that you have to deal with aftermath complications could be taken care of with more supplements and making taken care of with a lot of rest and a lot of patients from a lot of friends and those who love you, Linda, so make.

Sadat Janine Lyster Johns Hopkins chemo Shane Baltimore Linda
"johns hopkins" Discussed on Sawbones: A Marital Tour of Misguided Medicine

Sawbones: A Marital Tour of Misguided Medicine

02:03 min | 4 years ago

"johns hopkins" Discussed on Sawbones: A Marital Tour of Misguided Medicine

"Several physicians at johns hopkins were be kind of kind of becoming aware they were younger physicians who are involved in research and they're become aware of of these procedures these searches being done and wandering is this something we should be where here we are this renowned institute of medical research is this something we should be doing and they were already and this is cut this is a whole other subject unto itself but at johns hopkins they were already doing procedures that were somewhat similar to to some of these things on intersex patients bridge exactly which is a whole other topic because these were done against anybody's them nobody was ask permission these were forced on children the does is it is it is a whole can of worms the intersex thing because that is like at least within the us that seems to be the the root of a load of surgeons expertise is hey these children have been born with ambiguous genitalia wigan to make a decision on their behalf of what to do with that genitals and they may grow up liking it or not find out 5050 chance let's that you're exactly right that's as unfortunately a lot of the kind of technical expertise that some of these surgeons already had was born of that but their interest group beyond that and so they opened what was called the gender identity clinic in nineteen 66 and they began treating patients with hormones and as well surgery they were kind of the beginning of this very strict criteria i think some of what you've already started to talk about some four hormone therapy or certainly for surgery um they had a there is a psychiatric evaluation that was standard that everyone had to undergo a you had to start with a hormone therapy and you had to spend a year kind of.

johns hopkins us