What an autopsy may (or may not) have revealed about Otto Warmbier’s death

(CNN)What happened to Otto Warmbier while he was in North Korean custody is a mystery. And it’s likely to remain that way. Following his death on Monday, Warmbier’s parents Cindy and Fred asked the coroner not to perform an autopsy on their son.

“The family’s objection to an autopsy was honored, and only an external examination was performed,” the Hamilton County (Ohio) Coroner’s Office said in a statement Tuesday.
“No conclusions about the cause and manner of Mr. Warmbier’s death have been drawn at this time, as there are additional medical records and imaging to review and people to interview,” the statement said.
    Forensic experts say autopsies can reveal important information about how or why a person died; in this case, determining what events may have led up to Warmbier’s arrival in the United States in a persistent vegetative state.

      What happens during an autopsy?

    “I think it’s a terrible mistake” not to perform an autopsy, said Dr. Cyril Wecht, a prominent forensic pathologist who was not involved in Warmbier’s case. “If you have something that could be anything other than a natural death, you’re obligated to do an autopsy.”
    As far as what put Warmbier in a coma in the first place, Wecht said it would be difficult to determine in someone who had been comatose for such a long time “because the brain continues to undergo decomposition.”
    The possibilities could have been any number of things, Wecht said, including strangulation, suffocation, medication or a botched suicide attempt. But “the basic cause, no matter what the mechanism, would have been … hypoxia,” the medical term for insufficient oxygen reaching the brain.

    What happened in North Korea?

    Up until last week, one of the last times the world saw Warmbier, an American college student, was at a news conference in North Korea on February 29, 2016. Warmbier stood accused of a “hostile act”: taking down a political poster in a hotel in Pyongyang. Through tears, the then-21-year-old begged for forgiveness but was ultimately sentenced to 15 years of hard labor during his one-hour trial on March 16, 2016.
    Then, on June 13, 2017: North Korea released Warmbier in a state of “unresponsive wakefulness,” according to doctors at the University of Cincinnati Medical Center, who examined him upon his return to the US. In a news conference last week, they disputed the North Korean regime’s claims that Warmbier had contracted botulism and slipped into a vegetative state after taking a sleeping pill.
    Dr. Daniel Kanter, director of UC Health’s Neurocritical Care Program, said Warmbier’s MRI scan showed “extensive loss of brain tissue in all regions of the brain” but no evidence of a skull fracture.
    “We have no certain or verifiable knowledge of the cause or circumstances of his neurological injury,” Kanter said. “This pattern of injury, however, is usually seen as the result of cardiopulmonary arrest, where the blood supply to the brain is inadequate for a period of time, resulting in the death of brain tissue.
    “He has spontaneous eye-opening and blinking,” Kanter continued. “However, he shows no signs of understanding language, responding to verbal commands or awareness of his surroundings. He has not spoken. He has not engaged in any purposeful movements or behaviors.”

    Determining cause of death

    According to the US Centers for Disease Control and Prevention, just two states — Arkansas and Nevada — have no conditions under which an autopsy is required by law.
    The remaining 48 states and the District of Columbia have different criteria as to when an autopsy is mandatory. In Warmbier’s home state of Ohio, an autopsy is required in five circumstances, including when a death is ruled a homicide, in cases where it is related to a public health threat, and when a “child death appears natural and occurs suddenly when in good health.”
    The Warmbier family has not said why they objected to an autopsy, but Wecht said some families cite religious reasons, overwhelming grief or a desire to more quickly move on.
    “It’s not that I’m insensitive or indifferent to family objections,” Wecht said. “When I was coroner, for 20 years, of Allegheny County (Pennsylvania), if I could bend, I bent. Other times, you cannot bend. This is a case of unknown etiology, and the only way to ascertain what may have gone wrong would be to do an autopsy.”
    Despite the tragic circumstances, CNN Chief Medical Correspondent Dr. Sanjay Gupta said the case was very interesting from a medical perspective.
    “For 15 months or so, (Warmbier) had a devastating neurological injury but was kept alive,” said Gupta, who is also a member of the American College of Forensic Examiners and a practicing neurosurgeon. “One of a few things likely happened here — and we may never know, especially if there’s no autopsy.
    “One thing to keep in mind is that he did just have a long flight from North Korea to the US,” he said. “Even healthy people can develop deep-vein thrombosis, or DVT. With someone who is not moving, the risk is even greater. The risk of a blood clot in the lungs is also a possibility, especially given how sudden this was.”
    Gupta, who has not reviewed Warmbier’s medical records, said Warmbier could have been given a new medication or have had an old medication withheld.
    For example, “he could have been treated for a body-wide infection such as sepsis, which is not uncommon in someone who is bedridden,” Gupta said. “The family could have decided to stop giving him antibiotics, then sepsis may have led to his death.”
    Given Warmbier’s prognosis last week, “this would not have been unreasonable,” Gupta said.

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    Warmbier also may have been given new medications for comfort care in the US that he didn’t receive while in North Korea, which could have led to his death, Gupta said.
    Wecht said he was surprised the family didn’t want to make one last attempt at determining what happened to their son while he was a prisoner of what President Donald Trump has called a “brutal regime.”
    For their part, Cindy and Fred Warmbier said their son had “completed his journey home.”
    Otto Warmbier will be laid to rest Thursday after a funeral service at his high school in Wyoming, Ohio.

    Read more: http://www.cnn.com/2017/06/21/health/otto-warmbier-autopsy/index.html

    Family declines autopsy for former North Korea detainee Otto Warmbier

    (CNN)The family of American college student Otto Warmbier objected to an autopsy, leaving the former North Korea detainee’s official cause of death a mystery for the time being.

    The Hamilton County Coroner’s Office in Ohio confirmed that it received and examined the 22-year-old’s body after his death on Monday.
    The Warmbier family’s “objection to an autopsy was honored,” the office said, and only an external examination was performed.
      The coroner’s office reviewed medical records from the University of Cincinnati Medical Center and the air ambulance service that helped bring Warmbier from Pyongyang to Cincinnati after 17 months. “Extensive” conversations with his treating physician took place, too.
      “No conclusions about the cause and manner of Mr. Warmbier’s death have been drawn at this time as there are additional medical records and imaging to review and people to interview,” the statement said.
      His death led to strong condemnations of the regime and speculation about the implications. Politicians renewed calls for the regime to release three US citizens being held in the country.
      Warmbier visited North Korea in January 2016 on a sightseeing tour. He was arrested for allegedly stealing a political sign from a restricted area and sentenced to 15 years of hard labor.
      US President Donald Trump’s administration worked to secure his return. He died less than a week after returning from North Korea. He could not speak or move voluntarily and his doctors said he suffered extensive brain damage.
      His treating physicians said he suffered from unresponsive wakefulness, a condition also known as persistent vegetative state. In a news conference before Warmbier’s death, they said they could not speculate on the cause of his condition. But they found no evidence that he had contracted botulism, casting doubt on North Korea’s claim that he fell into a coma after contracting botulism and taking a sleeping pill.
      “This pattern of brain injury is usually seen as result of cardiopulmonary arrest where blood supply to the brain is inadequate for a period of time, resulting in the death of brain tissue,” Dr. Daniel Kanter said last week.
      A funeral will be held Thursday at Warmbier’s alma mater, Wyoming High School in Ohio.

      Read more: http://www.cnn.com/2017/06/20/health/otto-warmbier-autopsy/index.html

      Feminism, politics and death: my mum died the night Hillary Clinton lost

      They may seem like unrelated events but the end of Clintons campaign and my mothers life made me reflect differently on my own political career

      My mother died the night Hillary Clinton lost. These might seem like two very unrelated events and youd be right about that. But for me, and my somewhat particular circumstances, Ive found a plethora of meaning about life and death, feminism and politics.

      See, it was also the night I was due to be sworn in as a councillor for my local city council. It was my first political foray and Ive reflected on the start of my own political journey while on the other side of the world a smart and skilled female politician saw the end of hers, with our whole gender brutalised by a despicable Trump. And though Mum doesnt know it, all my political guts I got from her.

      Mum was diagnosed with breast cancer 10 days before the 2016 Australian federal election. Dad called me from Canberra to say he had taken Mum to hospital and she had acute pneumonia. I was going through the processes of my Labor nomination for council elections. With days to the federal election, every spare moment I wasnt working I was door-knocking and pre-polling.

      I dont remember that first conversation with Dad. I do remember the call the next day when Dad told me Mum had terminal cancer (as well as acute pneumonia) and the cancer had spread through her ribs, spine and pelvis. I was at my desk so I booked a flight home and, as I headed out the door, asked a colleague to cancel me out of every election activity I was signed up for.

      Breast cancer is a disease that inflicts itself predominantly on women. Its also one of the most misdiagnosed cancers around. Mum had her last mammogram only months earlier and it hadnt appeared. I grew bitter quickly.

      At the same time this was a federal election where it was one bloke versus another bloke versus another bloke, and women barely seemed to get a mention. I had volunteered the bulk of my time on campaigns to support female candidates in tough Victorian seats, none who won. I sat bedside my mother who taught me everything and watched women largely erased out of public life.

      On Sunday 3 July, a day after the federal election Mum was only in the second week of a disastrous five week stint in hospital my journal shows compassion draining out of me:

      I suspect I will grow rough and battle hardened and unforgiving from this. A part of me hopes I will. Perhaps I will grow ruthless and mean and brutal like life and that might make me powerful like men. I dont think Mum will like the new me. Ill have an excuse to be mean now, finally.

      I thought at length about quitting the council race. We didnt know the timeline Mums cancer was working to, although wed been told up to 24 months for stage four breast cancer. I was enjoying caring for her and all her needs. But quality of life for Mum was also about quality of life for her daughters and, honestly, I just always thought shed make it a little longer.

      So I ran my council campaign in between working full time and flying back home to care for Mum, alternating every second weekend with my sister. Offering a parallel world to my campaigning life, my life with Mum gave me such relief. I loved the quiet nights I shared with her. From the carers bed in her room, I would lie facing her and would listen for her breathing as her lungs drew in air from her oxygen tank.

      In late October, I won the third and final spot at the council ward elections; Mum went back into hospital and I flew home again.

      While nothing can prepare you for the death of a parent I did everything I could to prepare myself. I read memoir and non-fiction (by women) and I talked with women who had experience, both personal and professional.

      In the final days, as Mum slept sedated, I read A Very Easy Death by Simone de Beauvoir. It was the 50th anniversary of the translation of the French feminists account of her mothers death. The months of that death also mirrored my mothers own: a few long weeks over October and November.

      De Beauvoirs mothers death was frightening to me because it was everything her maman didnt want. She wasnt ready for death and her medical wishes were not respected: the doctors operated on her even though she had begged de Beauvoir that she wouldnt let them touch her body. Her final moments were full of pain and distress. De Beauvoir wasnt even there as she had slept through the panicked phone calls from her sister.

      I was not watching the US election results that afternoon and evening in November. Mum was at Canberras public hospice set amongst beautiful gardens and overlooking Lake Burley Griffin. For the last few days she had been heavily sedated. Mums breathing changed late in the afternoon and we knew, not long now.

      In academia, philosopher Michel Foucault called it a heterotopia, but most of us might think of it as a bit of a headfuck, a space or place in time that has more meaning or relationship to another space than it might first appear. As my mum lay dying, I was in a room full of strong women with her. My cousin brought in the bad news from the US and I slumped in my chair beside Mum, overwhelmed by yet more insurmountable grief. I thought if I was back in Melbourne, if my mum wasnt dying, Id be at my council ceremony right now and Hillary might even have been winning but here I was in this awful parallel universe that happened to be real.

      Mum died that night. A little after midnight, I woke from a light doze and Mum was turned slightly in her bed, facing me and she had stopped breathing. I leaned in close and checked for a pulse on her wrist. Her skin was so perfectly warm. The family all woke and we said our goodbyes.

      I stayed with Mums body till morning. I picked out clothes for her as the nurses cleaned and dressed her. Then finally watched on as they are you ready for this? put Mums body into the transport bag. I followed the nurses as they pushed her bed down the hallway to the cold room, where I thanked them and having already said my goodbyes, left for my car and for my first day without my mum in a bleak, bleak new world.

      In the months after, it was through the company of women, and particularly women who have lost their mothers, that I have found my feet again. I havent turned bitter and mean as I once thought or hoped I would. My feminism is softer with new compassion but also bolder with new militancy.

      Im still finding my political feet, but Ive been elected to a council with majority women membership plus we have a female mayor and CEO too. At every council meeting I reflect deeply on the values, learnt from my mother, that drive my decision-making even if at times they wont make me popular.

      I dont see much of Hillary in the news these days, which Im thankful for. It reminds me of Mum each time and when I do, bystanders watch me dab at my eyes and think she must really have liked Hillary. Little do they know that was the night my mum died.

      Read more: https://www.theguardian.com/lifeandstyle/2017/jun/18/feminism-politics-and-death-my-mum-died-the-night-hillary-clinton-lost

      Baby reacts to aunt’s EEG leads and the internet can’t handle the cuteness

      The internet fell in love with a confused little girl.

      Blogger Jordyn Smith uploaded some photos to Twitter of her niece reacting to her EEG leads, and of course, it was simply precious.

      Smith has epilepsy and her EEG (electroencephalogram) leads are used to monitor her brain activity.

      Image: Jordyn smith

      Babies, however, don’t understand what any of this means, so 9-month-old Amina was pretty confused when she saw her auntie.

      Image: jordyn smith

      Image: jordyn smith

      Image: jordyn smith

      At the time of this writing, Smith’s post has been retweeted over 70,000 times and has even become a meme.

      Smith retweeted some of her favorites.

      Many people were just shook with how adorable Smith’s niece is.

      Smith was delighted that so many people found humor in the photos.

      “I felt so embarrassed when I first had to wear the leads for three days and didn’t even want to leave my house,” Smith said in an email. “But I took those pictures of her and… just realized how easy you can make light of a crummy situation.”

      “Life sucks sometimes and that’s okay!”

      Smith has been blogging for a year-and-a-half but only recently went public about her medical struggles. She finds it rewarding that documenting her health journey has sparked other people to reach out about “their own battle with epilepsy.”

      Since the tweet about her niece went viral, Smith says that people have been sending her pictures of them wearing “EEG’s when they otherwise would’ve been self conscious.”

      Smith wearing EEG leads

      Image: jordyn smith

      Overall, Smith had this to say:

      “A lot of the time people just want you to ‘be positive,’ but what I blog about is about increasing positivity but also accepting that life sucks sometimes and that’s okay! And to just make the best out of it.”

      Jordyn with her niece, Amina

      Image: jordyn smith

      Read more: http://mashable.com/2017/06/16/baby-niece-eeg-cute-funny/

      The best and worst countries to be a kid

      (CNN)Children growing up in Niger are at the highest risk of having their childhood cut short, according to a report by Save the Children.

      The nongovernmental organization’s report for 2017 ranked the country as the worst place to be a kid, globally.
      Norway and Slovenia share the top position as the best places to grow up. (The top 10 best and worst places are listed below)
        The End of Childhood Report ranked 172 countries from best to worst in an effort to explore the main reasons why childhood comes to an early end in certain places.
        The rankings were determined by measuring the average level of performance across eight topics: under-5 mortality, malnutrition that stunts growth, out-of-school children, child labor, early marriage, adolescent births, displacement by conflict and child homicide.
        The United States, at 36th on the list, was not found to be exempt from the threats that contribute to premature death among children. It is one of seven countries where half of all teen births occur, and its number of infant deaths was 23,455 in 2015: more than those of 40 European countries combined in the same year.
        Richard Bland, Save the Children’s national director of policy, advocacy and development, was most surprised by the country’s low ranking and its position between Bosnia and Russia.
        The US “is falling behind some countries that have had some pretty severe economic turmoil like Greece or Ireland, and yet a number of those nations are prioritizing childhood,” Bland said. “They are investing in childhood and ensuring access to proven programs for childhood.”
        Bland said the three most noticeable global trends this year that may not have been occurring at as high a rate in past years were violence, famine and displacement.
        West and Central Africa, where the 10 worst countries to be a child are located, are particularly affected by famine and displacement, states the report. In Niger, the lowest-ranked country, 43% of children 59 months or younger have stunted growth from malnourishment. The Central African Republic, ranked the fourth worst for children, has 19.3% of its population forcibly displaced by conflict, with evidence of recruitment and use of child soldiers.
        “More people are fleeing war and persecution than ever in history,” Bland said.
        Syria has the highest percentage of a forcibly displaced population on the list, at 65.4%.
        In 2015, 263 million children were out of school, 168 million were involved in child labor, and nearly 28 million were forced to leave their homes globally, according to the report.
        The 10 countries with the highest child homicide rates are in Latin America and the Caribbean, according to the report. This is due to a combination of gang- and drug-related violence, Bland said.
        A positive trend, Bland noted, is that the movement on maternal, newborn and child survival has cut infant mortality by half since 1990.
        But he is concerned by President Donald Trump’s proposed fiscal budget for 2018, which diminishes foreign aid by 31%. This includes humanitarian assistance as well as maternal and newborn child health programs.
        “We’re talking about children dying,” Bland said. “I mean, there is no greater childhood-ender than mortality and infant mortality, and to us, that’s unconscionable to consider cutting programs that have been so successful.”
        The report lacks an exploration into the root causes of why certain countries made the top of the list or why places like Niger were at the bottom, said Lindsay Stark, an associate professor of population and family health at Columbia University’s Mailman School of Public Health.
        But it can be assumed that it has to do with levels of economic development, fertility rates and family planning, strong social supports and the absence or presence of conflict, she said.
        Save the Children admits that the report has limits, Stark said. A crucial limitation is that the data were drawn from household surveys, missing children who are homeless or living in orphanages, she said.

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        “Given what we know about the risks to children who are not even living in a household, I think that this is very true that these are conservative estimates,” Stark said.
        But Stark approves of how the methodology equally weighed the eight indicators of a childhood’s end in order to determine the global rankings.
        “Some might say ‘if a child dies, that’s the end of childhood in a very different kind of way, and so we’re going to give that more weight in the index,’ ” she said. “But Save the Children actually chose to give equal weight, which I personally quite like, because I think it highlights the severity and importance of other issues, which I think might receive less attention.”

        Best countries to be a kid

        1. Norway, Slovenia (tie)
        3. Finland
        4. Netherlands, Sweden (tie)
        6. Portugal
        7. Ireland
        8. Iceland, Italy (tie)
        10. Belgium, Cyprus, Germany, South Korea (tie)

        Worst countries to be a kid

        1. Niger
        2. Angola
        3. Mali
        4. Central African Republic
        5. Somalia
        6. Chad
        7. South Sudan
        8. Burkina Faso
        9. Sierra Leone, Guinea (tie)

        Read more: http://www.cnn.com/2017/06/15/health/best-worst-places-to-be-a-kid/index.html

        Overweight pregnancy increases risk of birth defects, study says

        (CNN)Risks of major birth defects increased in step with the severity of a mother’s obesity or overweight, a study published Wednesday in the BMJ medical journal found.

        Based on these results, women should be encouraged to adopt a healthy lifestyle and be at a normal body weight before conception, said researchers led by Martina Persson, a researcher in the clinical epidemiology unit at Karolinska Institutet in Stockholm, Sweden.
        The study’s findings are not entirely new, but “expand on previous knowledge,” Persson said in an email. Past studies have shown an increased risk of congenital malformations among obese mothers.
          What was not known is whether the same risk increased when mothers were simply overweight and whether risks escalated as the severity of overweight/obesity increased.

          More than a million women studied

          Persson and her colleagues analyzed data on more than 1.2 million live births, excluding twins and other multiples, in Sweden between 2001 and 2014.
          For the mothers in the study, being underweight was defined as having a body mass index of less than 18.5. Normal weight ranged from BMI 18.5 to 24, while overweight ranged from BMI 25 to 29. Obesity among the mothers was categorized as either class I, a BMI of 30 to 34, class II, a BMI of 35 to 39, or class III, a BMI of 40 or higher. Body mass index is the ratio between a person’s weight and height.
          A total of 43,550 of the infants — 3.5% — had a major congenital malformation, the researchers found when looking at the medical records. Heart defects were the most common birth defect, followed by flaws in the genital organs, limbs, urinary system, digestive system and nervous system.
          Babies of normal-weight mothers had a 3.4% risk of a major congenital malformation, the researchers calculated. By comparison, the proportion of major birth defects among the children of overweight mothers was 3.5%. Among the babies of mothers in obesity class I, the rate was 3.8%; in obesity class II, 4.2%; and obesity class III, 4.7%.
          “We demonstrate increased risks of major malformations also in offspring of mothers with overweight and risks progressively increase with a mother’s overweight and obesity severity,” Persson said. She noted that these results show a connection — but cannot prove a direct cause — between maternal weight and birth defects.
          Risk of congenital heart defects, malformations of the nervous system, and limb defects also progressively increased as BMI rose from overweight to obesity class III, while genital and digestive system defects increased in babies of obese mothers only. Overall, the study showed, the risk of a major malformation was higher in boys, 4.1%, than in girls, 2.8%.
          “Overweight and obesity in pregnancy increases risks of several severe complications in the mother and her child,” said Persson, who added that high rates of obesity are a “problem in many parts of the world.”
          A study released this week in the New England Journal of Medicine found that more than 2 billion adults and children globally are overweight or obese; that equates to one-third of the world’s population.

          The benefits of a healthy weight

          Dr. Siobhan M. Dolan, a medical adviser to March of Dimes who was not involved in the study, said the “findings are consistent with prior research, which shows an association between increasing weight and adverse perinatal outcomes such as preterm birth and birth defects.”
          Dolan, who is a professor of obstetrics/gynecology and women’s health at Montefiore Medical Center in the Bronx, New York, said the research “demonstrates a dose-response relationship between increasing weight and increasing risk for congenital anomalies.” In other words, the more overweight a mother, the higher the odds for a baby born with a defect.
          “Getting to a healthy weight has so many benefits, for both mothers and babies, including decreasing risks of diabetes and hypertension for moms, as well as decreasing risks for preterm birth,” said Dolan.
          Dr. Raul Artal, professor and chairman emeritus of the department of obstetrics, gynecology and women’s health at Saint Louis University, said the new study is important in that it “emphasizes a medical problem around the world.” He was not involved in the new study.
          Obese women, overweight women and sedentary women “have a very high incidence of diabetes and high blood pressure in pregnancy. As a result, their offspring are at very high risk for certain congenital malformations that come along with obesity,” said Artal, who is a maternal fetal medicine specialist.
          Congenital heart disease is “by far” the most common “birth defect among mothers that have obesity and diabetes,” Artal said. Other birth defects include neural tube defects, such as spina bifida and hydrocephalus, where cerebrospinal fluid causes pressure on the brain, cleft palate, anorectal aphasia, where a child lacks an anus and the lower bowels, and limb reductions or absence, for example, a missing foot.
          The vast majority of babies born to obese mothers are large for their gestational age with “organ maturity delay,” said Artal. “So they could have problems with breathing … and they have delayed neurodevelopment and the vast majority of them end up having childhood obesity,” he said.
          Obesity then becomes an inter-generational problem, one that is “grossly neglected,” said Artal.

          Getting started before pregnancy

          Artal noted that until the mid-1980s, textbooks told women “they should rest as much as possible and indulge” during pregnancy. Among certain physicians, this advice continues.
          “Women have heard this for generations,” said Artal. Since 1985, he has been the main author of the guidelines for exercise in pregnancy published by the American College of Obstetricians and Gynecologists and updated most recently two years ago.
          If women followed these exercise guidelines during pregnancy, “they will be in good shape, figuratively and literally,” said Artal.
          Current guidelines for weight gain for pregnancy are 28 to 40 pounds for women who are underweight, 25 to 35 pounds for women who are normal weight, 15 to 25 pounds for women who are overweight and 11 to 20 pounds for women who are obese.
          Generally, pregnant woman “should watch their weight and use judicious weight gain in coordination with their physician — but taking into account that the current guidelines for gestational weight gain for overweight and obese women are excessive,” said Artal. “And you can put ‘excessive’ in bold letters and put my name behind that.”

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          The March of Dimes’ Dolan emphasized that pregnant women should eat a healthy, well-balanced diet and take a daily prenatal vitamin containing 400 micrograms of folic acid, beginning before conception and continuing with a daily prenatal vitamin that has 600 micrograms of folic acid throughout pregnancy. Thirty minutes of moderate exercise most days of the week is also recommended for most pregnant women.
          “But getting to a healthy weight is a big part of what women can do before they become pregnant, along with quitting smoking and discussing any medications they take with their doctor,” said Dolan. “If we can help women get to a healthy weight and to quit smoking, we can help prevent some birth defects.”
          Persson also suggests women do what they can to avoid birth defects. Her research, she said, should “encourage women in reproductive age to strive towards a normal BMI before conception.”

          Read more: http://www.cnn.com/2017/06/14/health/overweight-pregnancy-birth-defects/index.html

          Woman in texting suicide case ‘intoxicated’ by antidepressants, doctor says

          Taunton, Massachusetts (CNN)A woman on trial for urging her boyfriend to kill himself was delusional after becoming “involuntarily intoxicated” by antidepressants, a psychiatrist said Monday.

          Michelle Carter “was unable to form intent” after switching to a new prescription drug only weeks before her boyfriend committed suicide in July 2014, Dr. Peter Breggin testified. She even texted his phone for weeks after he died, Breggin said.
          Carter, 20, is on trial for involuntary manslaughter in the death of Conrad Roy III, who was 18 when he poisoned himself by inhaling carbon monoxide in his pickup truck.
            Prosecutors have argued that while Carter played the role of a loving and distraught girlfriend, she had secretly nudged Roy toward suicide by sending him numerous text messages encouraging him to take his own life.
            Prosecutors say the texts prove Carter badgered Roy to his death. But defense attorneys argue he already was intent on killing himself and that Carter had urged him to get help.
            Legal experts are watching the trial closely because it could set a legal precedent on whether it is a crime to tell someone to commit suicide.

            A switch in drugs

            Breggin, testifying for the defense, said that Carter had no nefarious intent but genuinely thought she was helping Roy. She had been on Prozac for years before switching to another antidepressant, Celexa, in April 2014 — three months before Roy’s death, Breggin said.
            Such drugs can impair judgment, wisdom, understanding, love and empathy, he said — especially in the adolescent brain, which is still developing and is “more susceptible to harm and all intrusions.”
            At the time of Roy’s death, Carter was 17.
            Breggin, who did not treat Carter, told Bristol County Juvenile Court Judge Lawrence Moniz that he reached his conclusions after reviewing Carter’s educational records, text messages and police files and interviewed a half-dozen people who knew her.
            Carter is being tried as a youth because she was a minor when her alleged crime took place. She waived her right to a jury trial, so the judge will render a verdict after testimony concludes.
            Before age 12, Carter had seemed to be loving, caring and helpful. But as a teen she became “a very troubled youngster,” Breggin said.
            Carter began taking Prozac in 2011, when she was 14, after developing anorexia, Breggin said. She later transitioned to Celexa, which he said can increase suicide risk in people younger than 24 along with agitation, panic attacks, grandiosity and not understanding the trouble one is getting into.
            Adverse changes also can occur when doses change, Breggin said.
            Breggin testified that Carter began cutting herself between April and June of 2014.

            ‘My life’s a joke’

            Roy’s body was found July 13, 2014, a day after his suicide in his parked truck in a Kmart parking lot in Fairhaven, nearly 40 miles from his home.
            As early as October 2012, Roy told Carter he was going to kill himself and that there was nothing she could do to stop him, Breggin said. The psychiatrist said Roy made four suicide attempts before succeeding.
            Over the course of many texts to Carter about depression and hopelessness, Roy spoke often of killing himself and going to heaven, Breggin said.
            Roy believed he had seen the devil at a hospital, and Carter said she had dreamed of the devil, said Breggin, who added that nightmares are common among people who are on Prozac.
            “My life’s an abortion,” the young man told Carter in a text, Breggin said. “I just feel like my life’s a joke. My negative thoughts have controlled me to the point where I’m legit going insane.”
            Roy suggested the pair should end up like Romeo and Juliet, Shakespeare’s suicidal young lovers, and believed they would still be able to communicate after death, Breggin said.
            Breggin said his clinical analysis was that Carter would do anything to help Roy and was always cheering him up. Meanwhile, Roy provided little encouragement and was negative about dating and marrying her, Breggin said.

            ‘Enmeshed in a delusion’?

            On Celexa, Breggin said, Carter became “involuntarily intoxicated” and began to think she could help Roy get what he wanted — to die painlessly, to get to heaven and to help his family grieve less by understanding him.
            “She is not forming the criminal intent — ‘I’m gonna harm him,'” Breggin said. “She’s found a way to use her unique power to help and to help this boyfriend — in her mind but not in his — to not keep making mistakes and not keep hurting himself.”
            Assistant District Attorney Maryclare Flynn said last week that when Roy had second thoughts that fateful night, Carter told him to get back in the truck and listened on the phone while he cried out in pain and took his last breaths.
            “She was enmeshed in a delusion,” Breggin testified. “She was unable to form intent because she was so grandiose.”
            Breggin also reviewed a letter that Roy left for Carter. It said Roy was expecting to reach heaven, that he loved her, and that he thanked her for her kindness. In the letter he didn’t say anything about being bullied.
            A day after Roy’s suicide Carter texted him, saying: “Did you do something??! Conrad I love you so much please tell me this is a joke. I’m so sorry I didn’t think you were being serious Conrad please don’t leave us like this,” according to the text shown in court.
            Two months later, Carter also texted Roy to say that she had raised $2,300 through a softball tournament to raise awareness of mental health issues.
            “She imagines him looking down upon her,” Breggin said.

            Prosecutor: Carter was untruthful

            During cross-examination, Assistant District Attorney Katie Rayburn tried to paint Carter as an untruthful person who craved attention.
            Rayburn said Carter had routine medical checkups but doctors never noted on her medical records that she was cutting herself.
            Rayburn said Breggin used text messages to conclude Carter was cutting herself.
            The prosecutor said Carter was sending simultaneous messages of distress to a friend named Lisa and innocuous messages to boy she liked named Luke.
            In the text message exchange, which Rayburn read out loud, Carter texted Lisa: “completely lost control tonight and I’m really disappointed in myself I thought I was getting better.” Moments later, she texted Luke to say: “I’m bored as hell. You?”
            In another message to Lisa, Carter wrote that she couldn’t stop shaking because she “cut way too deep it won’t stop bleeding.”
            The prosecutor said Carter’s mother also never reported any concerns about the cutting.
            Breggin said people who cut themselves are very secretive and learn how to conceal it.
            Rayburn also tried to pin Breggin down on the exact period of involuntary intoxication. Breggin said it started between June 29 and July 2, 2014, but he wasn’t clear when it ended.
            On July 15, 2014, Rayburn said Carter met with a therapist, who did not indicate that Carter had any symptoms of involuntary intoxication.

            Read more: http://www.cnn.com/2017/06/12/health/text-message-suicide-trial/index.html

            Lincoln Memorial Reflecting Pool to be drained after 80 ducks die

            (CNN)The National Park Service will drain the Lincoln Memorial Reflecting Pool this weekend after approximately 80 ducklings were found dead, including 53 in one day.

            The federal agency says chemical treatments alone aren’t sufficient to fully reduce the parasite and snail population. So the pool must be drained and cleaned.
            The cleanup begins Sunday. It will take about two days to fully drain the water. On Tuesday, crews will begin cleaning the interior.
              Humans who come in contact with the parasite could develop cercarial dermatitis, better known as “swimmer’s itch.” It’s not contagious and rarely requires medical treatment, but it’s uncomfortable.
              Crews will refill the pool next Friday and things should be back to normal the following week.

              Read more: http://www.cnn.com/2017/06/09/health/dead-ducks-lincoln-memorial-trnd/index.html

              Oldest Homo sapiens fossils discovered

              (CNN)The oldest fossil remains of Homo sapiens, dating back to 300,000 years, have been found at a site in Jebel Irhoud, Morocco. This is 100,000 years older than previously discovered fossils of Homo sapiens that have been securely dated. The discovery was presented in a study in the journal Nature on Wednesday.

              This marks the first discovery of such fossils in north Africa, and widens the”cradle of mankind” to encompass all of Africa, the researchers said. Previous finds were in south or east Africa. The fossils, including a partial skull and a lower jaw, belong to five different individuals including three young adults, an adolescent and a child estimated to be 8 years old. Stone tools, animal bones and evidence of fire were also found within the same layer at the site.
              But what the researchers found to be most remarkable about these fossils is that they capture a moment in time of evolution. The facial features of the skull look like a modern human, but the brain case is very elongated and archaically characteristic of early humans.
                There has been increasing evidence that the modern human lineage diverged from Neanderthals and Denisovans 500,000 years ago, making us close relatives rather than direct descendants. Before this discovery, it was believed that the early modern humans we evolved from were in Africa 200,000 years ago and looked very similar to modern humans. But what happened in between that time?
                This is still unknown, although the researchers suggest the possibility that there were multiple groups of hominins, or human ancestors, overlapping and having complex relationships.
                If we could see these Homo sapiens from 300,000 years ago walking around today, they would look very similar to us — if they were wearing a hat, Hublin said. Their faces would be short, flat and retracted compared to Neanderthals, and even some of the dental aspects are similar to ours.
                But that elongated skull would give them away as being not quite like us. Their brains, and specifically the cerebellum, wasn’t shaped like ours. But based on the brain case they discovered, these Homo sapiens did have a larger cerebellum than Neanderthals.
                “The story of our species in the last 300,000 years is mostly the evolution of our brain and in this time period, a number of mutations occurred affecting brain connectivity,” Hublin said.

                How the fossils were discovered

                East Africa has been considered the “cradle of life” for the origins and evolution of humans, but north Africa has been largely ignored in this aspect. A skull was found in Florisbad, South Africa, in the 1930s and originally dated to 260,000 years ago, but it’s fragmentary and the exact date is subject to debate, the researchers said.
                During the 1960s, mining began on top of a large hill of limestone in Morocco and when the miners hit a pocket of sediment, it partially collapsed to reveal a human skull, bones and stone artifacts. Initial research revealed the artifacts to be 40,000 years old, although that didn’t align with the features of the bones.
                In 2004, efforts were made to clean up the site and excavate it in order to figure out its true age. It’s been an active site ever since, and there is still more to be discovered, the researchers said.
                Hublin and Abdelouahed Ben-Ncer of the National Institute for Archaeology and Heritage in Rabat, Morocco, found human and animal bones, stone flints and evidence of fire in a preserved layer of the site.
                While this isn’t the oldest evidence of fire, not many sites can document this back to 300,000 years ago. And these fires were controlled, being created and used easily. The fire evidence on the animal bones and burnt flints were key.
                Through a dating technique called thermoluminescence, which measures how long it’s been since a material with crystalline minerals was heated or exposed to sunlight, they determined that the site was anywhere between 300,000 to 350,000 years old. This included other previous discoveries at the site.
                “This was a ‘big wow,'” Hublin said. “We realized this site was much older than anyone could imagine.”
                This discovery, combined with a Homo sapien skull found in South Africa, challenges the theory that Homo sapiens were confined to east Africa.
                “I’m not claiming Morocco became the cradle of modern humankind,” Hublin said. “Rather, we would support the notion that around 300,000 years ago, very early forms of Homo sapiens were already dispersed all over Africa. This is facilitated by the fact that between 330,000 to 300,000 years before present, Africa did not look like it does today and there was no Sahara Desert. There was a lot of connections between other parts of the continent.”
                The Sahara was effectively “green” at the time, with open grasslands, groupings of trees, rivers and huge lakes and more wet and humid than it is today. This supported animal life like gazelles, zebras, wildebeests, lions and other big cats — all of which were discovered at the site through fossil evidence of animals that these Homo sapiens hunted.
                The tools and fire evidence also point to this being a site linked with the Middle Stone Age. A period spanning a million and half years before this involved the use of large, heavy stone tools like hand axes and cleavers.
                “What distinguished the Middle Stone Age is a shift from large, heavy-duty stone tools to an emphasis on producing stone flakes that were smaller and lighter,” said Shannon McPherron, archaeologist at Max Planck and one of the study authors. “They would transform these flakes into pointed forms that most archeologists think were part of weaponry, increased sufficiency in hunting at a distance, which was more effective and safer for the hunter.”
                During the time these Homo sapiens lived, the site at the collapsed hill was actually a cave that provided shelter. Their findings paint a picture of a hunting encampment where people passing through the landscape would spend the night, take shelter and clean and consume the animals they hunted, McPherron said.
                There are also no nearby sources for flint, meaning that the Homo sapiens found their high quality raw materials elsewhere. McPherron believes that the flakes indicate that the hunters were sharpening and transforming the flints while they were in the cave.

                What’s next

                Sequencing of the Neanderthal and Denisovan genomes happened at the Max Planck Institute of Evolutionary Anthropology, but that won’t happen with these fossils. Although they tried to extract DNA from them, it wasn’t there, Hublin said. Ancient DNA has yet to be recovered from Africa because the fossils are too old and the conditions are too hot.
                The researchers hope to return to Jebel Irhoud because there is still more to be excavated.
                But this discovery creates more questions about how, when and where we evolved.

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                Evolution was not a sudden shift, but a gradual accretion of features and a series of mutations affecting development, the researchers said. And due to environmental changes, it was happening sometimes in isolated populations; other times, exchanges of genes and innovation occurred when populations came together, causing favorable mutations to spread through populations due to positive selection, Hublin believes.
                This is the oldest known fossil to date — for now, Hublin said. And the center of origin for us as a species is still unknown. But this discovery widens the “cradle of life” from East Africa to the whole continent, Hublin said, and suggests that these evolutionary changes were happening across the continent at the same time.
                “Our results challenge the preconceived notion of early modern humans in East Africa in many ways regarding the date of emergence of our species, the geographical conditions of this emergence and the conditions of the evolution of the early forms of Homo sapiens,” Hublin said.

                Read more: http://www.cnn.com/2017/06/07/health/oldest-homo-sapiens-fossils-found/index.html