Putting all publicly-available tweets with the word “cholera” and the hashtag “#cholera” on a timeline, researchers at Harvard Medical School were able to show a surge in cholera-related tweets early in the epidemic. The timeline correlates closely with later health-ministry tallies.

The researchers used tweets from around the world – 65,728 total with the word “cholera” – that were sent between October 20 and November 3, 2010, including those that came from aid organizations and/or media outlets in Haiti and elsewhere.

The goal is to someday harness the immediacy of social media and use it to make better decisions early on about where to deploy public health resources, said Professor John Brownstein of Children’s Hospital Boston and co-founder of HealthMap.org, which aggregates global information about infectious diseases.
“You don’t have a lot of data about what’s happening in the population early on – even in the best of situations, even in the U.S., but especially in Haiti. So the idea is what other health information can you draw on to make assessments of the impact of the disease?” said Brownstein.

“So in this case, what we were able to show – and this is retrospectively of course – is that utilizing this data that’s coming out from these news and social media we can begin to understand the impact. Depending on how transmissible the strain is, it impacts what types of prevention that you do.”

So far, there’s no replacement for the traditional chain-of-command structure of public health that tallies and reports case numbers in an epidemic, but social media could be another tool in the toolbox for decision makers.

The next step is figuring out how it could work in real-time, instead of in hindsight.

“We found that there was better correlation between the social media and the official case numbers early on,” said Rumi Chunara, a research fellow at HealthMap.

The tweets didn’t coincide uniformly to official health numbers, but there were periods of time when they corresponded best – such as the first incident of the outbreak and then a hurricane which passed by Haiti a few weeks after the cholera epidemic began.

Cholera brings about a painful death, as quickly as within two to three hours, because of the amount of fluid and electrolytes that are lost. Symptoms are watery diarrhea, dehydration, nausea and vomiting.

The bacterial disease spreads through contaminated water. While it has largely been eradicated in the West, it has been known to come back during war or natural disasters when people are forced to live in crowded places without proper sanitation and clean water.

As of mid-December 2011, cholera had killed 7,000 people and infected 520,000 in Haiti, according to the Pan American Health Organization.

Medical workers continue to encounter about 200 new cases everyday, said Dr. Jon Andrus, deputy director of PAHO, which is part of the World Health Organization.

The best way to prevent cholera is to get clean water and better sanitation. Immediate treatment for the disease is necessary through re-hydration, intravenous fluids, antibiotics and zinc supplements.

Perhaps you’ve been staring at the computer for two hours straight and need to tear your eyes away for a few minutes. Maybe it’s nearing the end of a long day and you need to get outside for the first time. Or maybe you’re trying to get work done, but all the people around you are making that impossible.

It’s smart for workplaces to view distractions in two ways, says Rachel Permuth-Levine, Ph.D., senior director of human capital research and outcomes at the blog “toLive.”

“It is important to minimize distractions in the workplace and at the same time promote those ‘pleasant’ distractions that allow us to have a reprieve from the stressors of our job,” Permuth-Levine says.

“Some types of distractions — too much paperwork, multitasking, too much noise — are harmful. They can lead to safety issues, lack of productivity or absenteeism. The pleasant distractions — coffee break, taking a walk, talking to colleagues — recharge us and help our health and performance on the job.”

In a recent survey conducted by GSN Digital, the interactive division of the Game Show Network, nearly 80 percent of respondents who play online games during the workday said they feel more focused on work as a result of periodic mental breaks associated with game play.

Fifty-nine percent of those who play games at work play for 30 minutes or less. These respondents reported that taking just a few minutes off from work to play games helps them refocus, increases creativity and calms them down during stressful situations.

We asked our readers how they get through the workday. Here’s what they had to say:

“One thing that gets me through the day is to get paperwork or computer work ‘completed’ during whatever breaks I can get through the day. The feeling of ‘completion’ is important to me, and I actually feel it improves my overall attitude and effectiveness. When work piles up, I feel more stressed and very time sensitive.” — Len Saunders, public education teacher

“White noise on my iPod has become my new best friend in the workplace. I changed jobs recently and the new company has an open office floor plan. The constant chatter in the office can be extremely distracting. Music tends to overstimulate and distract me as much as office chatter, but I find white noise at varying frequencies does the trick.” –Troy Adkins, director of marketing and membership, CoreNet Global Inc.

“In a creative industry, it is super-critical to be able to keep the inspiration flowing and avoid workday burnout. Here are some of the things I do to make sure I stay focused and inspired: ‘Bing’ your favorite color. Surprisingly, a simple search can result in some gorgeous images to keep you smiling from the inside out. Fresh flowers on your desk make a huge difference; they not only add a lovely and fragrant element, but they greet everyone who walks into your office or work space. Take a few minutes to create a Pandora music channel that provides hours of your favorite music to keep you in a happy workplace rhythm. Watch a three-minute travel video to inspire you and have you looking forward to that well-earned vacation. Beautiful imagery and daydreams of that perfect vacation can keep you plugging away another day.” — Gina Samarotto, principal, The Samarotto Design Group

“The workplace distraction that gets me through my day is running at lunchtime. When I run, I can choose to sort out work items in my head or just zone out, not think and listen to music or my feet pounding the pavement. Running at lunch breaks up my day, and I come back for the afternoon energized and productive. Not only am I getting exercise, but my co-workers and clients are also benefiting from my workplace distraction.” — Jenika Scott, channel marketing manager, Hall Internet Marketing

“My favorite workplace distraction is the on-site massage. Our company has an in-house masseuse that visits the office once a week. I make sure I am on her schedule, as the quiet down time helps keep me motivated throughout the day. On days when I don’t have a massage, I find solace playing one of the many video games found in our office, as they help sidetrack my attention, if only for a few minutes. Pac-Man never gets old!” –Taryn Lomas, vice president of strategic accounts, Underground Elephant

EPA rules in place under the 1990 Clean Air Act have targeted acid rain and smog-forming chemicals emitting from power plants. But perhaps surprising to many, those rules have never included limits on mercury, a neurotoxin known to damage developing fetuses and children.

How this policy affects your health

The benefits of this new rule, in terms of dollars saved and death prevented, far outweigh the costs to companies and consumers, according to peer-reviewed EPA studies.

U.S. power plants account for only about 1% of global mercury emissions. Even so, for each dollar spent reducing mercury and hazardous air pollutant emissions under the new rule, the EPA projects up to $9 in health benefit savings by preventing an estimated 11,000 premature deaths and 4,700 heart attacks each year.

Among children, the new limits are projected to prevent 130,000 cases of asthma and 6,300 cases of acute bronchitis each year, the EPA estimates.

“These standards rank among the three or four most significant environmental achievements in the EPA’s history,” said John Walke, Clean Air director of the National Resources Defense Council, an environmental advocacy group. “This rule making represents a generational achievement.”

Despite federal limits on emissions of mercury from other sources, such as waste incinerators, there have been no limits on coal-fired power plants, which the EPA says constitute the single largest source of mercury emissions.

“As a mom, I’m especially excited to know that millions of mothers and babies will now be protected from mercury poisoning,” said Mary Anne Hitt, director of Beyond Coal Campaign, a clean energy advocacy group.

“We all teach our kids the simple rule that if you make a mess you should clean it up – and now polluters will have to follow that same rule,” she wrote in an e-mail conversation.

“Mothers around the country who have been worried about mercury pollution causing learning disabilities and other problems for their kids will be able to sleep easier tonight.”

Health experts have known for a long time that mercury causes damage to developing fetuses, with long-term effects on the child.

Methylmercury, found in fish and shellfish, can harm a child’s thinking, language, fine motor skills, memory, attention, and visual spatial skills when exposed in the womb.

One study estimates that for each part per million of mercury found in a mother’s hair — a common way of testing for mercury exposure — her child loses approximately 0.18 IQ points.

Outbreaks of methylmercury poisoning have resulted in some children being born with severe disabilities, even when their mothers did not show signs of nervous system damage. But adults are at risk for mercury poisoning too; symptoms can include impairment of vision, speech, hearing and walking.

In addition to mercury, the new EPA rule also limits emissions of hazardous air pollutants like arsenic, benzene, chromium, formaldehyde, hydrochloric acid, and nickel.

How to protect against mercury exposure

Once airborne, mercury enters bodies of water through precipitation, becomes methylmercury, and accumulates in the food chain.

The EPA and the Food and Drug Administration recommend that pregnant women and young children limit their consumption of fish and shellfish to two meals a week, because the methylmercury contamination found in fish can cause harm to humans.

The EPA and FDA say that some larger predatory fish, such as shark, swordfish, king mackerel, and tilefish, should be avoided entirely by pregnant women and children.

Exposure can also occur from breathing in polluted air, for example near incinerators and coal-burning power plants.

A lab test using blood or hair sample can determine the methylmercury levels.

What’s the controversy?

The new rule requires that the vast majority of mercury contained in coal be captured and prevented from releasing into the air when burned for energy. It would require operators to shut down or upgrade the most environmentally dangerous power plants.

Power plant operators have three years to comply with the new standards, but plant operators may be granted additional time to install the necessary emissions improvement technologies if they are able to demonstrate a valid need.

Not everyone supports the new limits, in part because the new rules will increase costs for plant operators who need to make upgrades.

The rule has been criticized by industry groups and some Republicans.

“Analyses predict EPA’s rules will force the premature retirement of power plants that are needed to provide affordable, reliable power to consumers and our growing economy,” said Fred Upton, the chairman of the House Energy and Commerce Committee.

“Other plants will require multi-million dollar retrofits that will result in higher electricity bills,” said the Republican congressman from Michigan.

The EPA states that its rule is cost-effective and “ensures electric reliability,” noting that the agency has received more than 900,000 comments from industry and the public to better inform the decision.

Amid a divisive political climate and persistent unemployment, the EPA noted in its March 2011 rule proposal that it “finds that more jobs will be created in the air pollution control technology production field than may be lost as the result of compliance with these proposed rules.”

The final EPA rule regulating power plant mercury emissions has been decades in the making.

The 1990 version of the Clean Air Act signed into law by President George H.W. Bush directed the EPA to conduct studies to determine whether regulating mercury and other hazardous air pollutants from power plants was “appropriate and necessary.”

In December 2000, having completed the required studies, the EPA formally announced its intention to regulate mercury emissions from power plants.

Then in 2005, under the administration of President George W. Bush, the EPA reversed its determination that mercury regulations were “appropriate and necessary,” and removed power plants from the list of sources to be regulated. Instead the Bush-era EPA proposed the “Clean Air Mercury Rule,” a cap-and-trade system for mercury emissions.

Under “cap and trade,” mercury emissions would not be restricted, but heavy polluters would pay a fee that could be pocketed by companies whose factories or power plants pollute less.

In February 2009, the new EPA Administrator Lisa Jackson announced a return to the 2000 decision to put limits on mercury emissions. The rule proposed on March 2011 was made final in an announcement on December 21 at the Children’s Medical Center in Washington.

Altogether, the environmental regulations beginning with the 1970 Clean Air Act have saved millions of American lives, according to the EPA.

The reductions in fine particle and ozone pollution emissions mandated under the 1990 Clean Air Act prevented more than 160,000 cases of premature mortality, 130,000 heart attacks, and 1.7 million asthma attacks in just the year 2010, according to EPA figures.

Lack a little rhythm? Well, there’s a trend on the list for just about every person, preference and body part.

The trends were selected through an annual survey conducted by the American College of Sports Medicine. The survey was completed by 2,620 fitness professionals worldwide who ranked their selections into a list of 20 trends they believed would be big in 2012.

“The survey attempts to show a distinction between fads and trends and is a good representation of what’s occurring in the health and fitness industry worldwide,” said Walter Thompson, Ph.D., the lead author of the survey and a fellow of the American College of Sports Medicine.
Top 10 worldwide fitness trends for 2012
1. Educated, certified and experienced fitness professionals

2. Strength training

3. Fitness programs for older adults

4. Exercise and weight loss

5. Children and obesity

6. Personal training

7. Core training

8. Group personal training

9. Zumba and other dance workouts

10. Functional fitness

The list serves to educate consumers and have them question the health clubs they attend. Gym-goers need to determine if their club offers the services that have been deemed trendy across the fitness industry in the year ahead, Thompson says.

For instance, Zumba, a dance workout, offers classes in more than 110,000 gyms in more than 250 countries. So it probably won’t be hard to find a gym that offers these classes.

“I think people are waiting to see if we’re a fad, but class numbers keep getting bigger and Zumba is becoming more popular, so now, people realize we’re here to stay,” said Alberto Perlman, CEO and co-founder of Zumba fitness.

Zumba’s popularity has skyrocketed over the years, and the dance workout was one of the biggest surprises on the list for 2012.

“Zumba is liberating and magical, and one of the key ways it has expanded is through word of mouth,” Perlman said.

Zumba ranked ninth on this year’s list. Thompson is curious to see if it will follow Pilates’ short run in the top 20 fitness trends. Pilates was ranked in the top 10 for three consecutive years, beginning in 2008, but dropped off in 2011.

Of course, there are always trends that are expected to make an appearance on the list each year, such as educated, certified and experienced fitness professionals; strength training; and fitness programs for older adults.

Fitness professionals claimed the No. 1 spot on the 2012 list — and have done so for the past five years.

The demand for fitness trainers is expected to boom over the next half-decade. The U.S. Department of Labor’s Bureau of Labor Statistics determined that the “… jobs for fitness workers are expected to increase much faster than the average for all occupations [through 2018].”

“It starts with knowledge, and from that stems all the different ways to get in shape. If you have a certified and educated fitness professional, they can guide you through the other 19 fitness trends,” said Brian Attebery, a trainer certified by the National Fitness Professionals Association and the owner of RESULTS Fitness and Nutrition Center in Edmond, Oklahoma.

Also returning among the veteran trends is No. 3 on the list: fitness programs for older adults.

As baby boomers are aging, more are attempting to keep their youthful physique and energy with frequent gym visits.

“The baby boom generation is retiring, and retiring more healthy. They’re a lot more active, and many enjoy working out,” Thompson said. “And with the economy the way it is, group training was another trend that didn’t come as a surprise. These group training sessions are directly related to the economy, and trainers often offer discounts to groups of people.”

Once the new year rolls in and resolutions to hit the gym go into full effect, this predicted list of fitness trends will certainly come in handy.

In Long Beach, about 2,000 nurses staged a one-day strike at Long Beach Memorial Medical Center and Miller Children’s Hospital, but nurses were later told that they will be locked out of their jobs for four days because replacements had to be hired in a five-day block, nurses told CNN.

The Long Beach registered nurses are in a dispute with management over RN-to-patient staffing levels and safe patient lift policies to prevent accidents and injuries, the union said.

The nurses are also objecting to hospital demands for increases in health care premiums, which they claimed would cost the nurses about $3,000 more in out-of-pocket premiums — which the hospitals disputed.

Officials with Memorial Care Health System, which owns both Long Beach facilities, said that more than 30% of the 2,000 nurses decided not to participate in the strike.

“Over 30% of the nurses chose to cross the picket line,” said Dr. Susan Melvin, associate chief medical officer of the Long Beach Memorial. “Every unit is open and fully functioning. From a physician perspective, they feel their patient care needs are being well met,” Melvin told CNN.

Myra Gregorian, vice president of human resources at both hospitals, said the facilities were meeting state requirements on nurse-to-patient staffing.

“We comply with the law and compensate appropriately and it rarely happens,” Gregorian said. “As a California hospital, we have state-mandated ratios, and we comply with state levels.”

The two Long Beach hospitals offered the California Nurses Association a three-year contract that included at least 3% raises over each year, and Gregorian told CNN the union’s claims about $3,000 premium increases were “not true.”

The average premium increase is $4.76 per paycheck, which occurs every two weeks, and the maximum premium increase is $18.28 per paycheck, Gregorian told CNN.

The last contract expired September 30, Gregorian said.

“We have been negotiating with the union since July. We had 16 bargaining sessions. We were disappointed that they chose to do a strike over the holidays,” Gregorian said. “We’re looking forward to having our RNs return to work next week and despite these differences, we’ll be able to ratify a contract soon.”

Meanwhile, in the San Francisco Bay area, about 4,000 nurses were striking at nine facilities that are part of the Sutter Health corporation, the union said. The nurses are protesting what they described as “some 150 demands for major contract concessions in patient protections and health coverage for the RNs and their families,” according to the California Nurses Association and National Nurses United.

“We are dealing with hospital corporations that are part of the 1% and behave just as abusively as Goldman Sachs or Lehman Brothers, and it is very sad that they show such disrespect for their communities, for the patients and for the nurses who take care of the patients who make money for these hospitals,” said Charles Idelson, spokesperson for the California Nurses Association.

The “1%” remark refers to a slogan by the Occupy movement that contends the richest 1% of people write the rules of an unfair global economy.

Karen Garner, spokeswoman for Sutter Health, said the health facilities were committed to “providing our nurses competitive wages and benefits, while also doing our part to make health care more affordable for our patients.”

“But the union demands new, costly benefits — such as health care for life — that will increase costs at our hospitals by tens of millions of dollars each year,” Garner said in a statement.

“A nurse who chooses to work full-time at one (of) our hospitals with an open labor contract earns an average of $136,000 a year plus receives other generous benefits such as an employer-paid pension plan worth $84,000 per year on average for life and up to 40 days off per year,” Garner said. “Most nurses also have the option of 100% employer-paid health benefits or a low-cost option.”

“We extend our deepest condolences to this baby boy’s family as they try to come to grips with their loss,” said Dianna Gee, a Wal-Mart spokeswoman. ” As soon as we heard what happened, we immediately reached out to the manufacturer of the formula and to the Department of Health and Senior Services to provide any information we may have to help with the investigation.”

Wal-Mart said it is pulled a batch of Enfamil from its stores nationwide that matched the size and lot number of the formula that may have sickened the baby in Missouri, Gee said.

That lot number is ZP1K7G. The baby formula was purchased from a Wal-Mart in Lebanon, Missouri. After the purchase, a 10-day-old infant died from a rare bacterial infection, CNN affiliate KYTV reported.

Authorities are running tests to determine if the death came from the formula, the water to make the formula or any other factor, said Mead Johnson Nutrition, the company that makes Enfamil.

“We are highly confident in the safety and quality of our products — and the rigorous testing we put them through,” said Chris Perille, a Mead Johnson Nutrition spokesman.

“At first, I thought, OK, he is just catching up because he was up many nights studying for finals. But now two weeks have gone by and he is still sleeping the day away.”

There are a number of reasons that college kids or teens could be sleeping all day. As my friend suspected, we do indeed try to “catch up” on sleep. It seems to work to a certain extent, but we can’t make up for the full amount of sleep lost.

Also, it is difficult to pinpoint exactly what it is that we “lose” when we lose sleep. So Charlie could have been studying (and partying?) very hard before the holiday break and would indeed have the tendency to sleep in.

However, it is doubtful that the catch-up period would last for weeks. Most teens and college kids require nine to nine and a half hours to feel their best. If they curtail their sleep for a few nights, they will usually have long sleep times for one to two nights. If they are chronically sleep deprived, then that period will be extended.

Of course, we must keep in the mind that sleeping for extended periods could be a sign of illness.

Diseases such as mononucleosis or depression can have an insidious onset marked by sleepiness and fatigue.

The sleepy college kid or teen might have developed a primary sleep disorder such as obstructive sleep apnea, restless legs syndrome (now known as Willis-Ekbom disease) or periodic limb movement disorder. Most importantly in this age group, narcolepsy should be considered.

Get some sleep: Is restless legs syndrome real?

The telltale feature of narcolepsy is daytime sleepiness, and it usually occurs in teens and young adults. People can have actual sleep attacks where one minute they are awake and the next they are asleep. They could be driving or talking to someone and without much warning, they fall asleep.

Many times, the sleepiness is not so dramatic; people can have profound sleepiness that impairs their quality of life, but still be able to fight off the sleep attacks.

The other hallmark symptom is cataplexy which is often confused with sleep attacks. In cataplexy, the muscles become suddenly relaxed and people can fall to the ground and seem to faint. Muscle relaxation is a feature of REM sleep and what has happened is that that one aspect of REM sleep has suddenly intruded into the wake state. Cataplexy usually occurs after a person is startled or has a sudden burst of emotion, often a good one such as suddenly finding something very funny. Narcolepsy can, and often does, occur without cataplexy.

Therefore, although the presence of cataplexy cinches the diagnosis, the absence does not rule out narcolepsy by any means. A suspicion of narcolepsy should be investigated with a sleep specialist.

Kleine-Levin Syndrome is another disorder that should be considered if the young person has recurrent episodes of sleepiness and long sleep times. It is a rare and poorly understood disorder marked not only by hypersomnia (sleepiness) but also by megaphagia (overeating) and hypersexuality (usually masturbation).

In the wake periods, there is almost always cognitive and mood disturbance. The episodes last anywhere from two days to four weeks and tend to recur at least once a year, although there is a tendency for them to abate over time. It is much more common in boys and young men than in women, although there is a well described hypersomnia syndrome that can occur during menstruation. The cause of Kleine-Levin Syndrome is unknown and none of the attempts at treatment has given consistent results.

An important question to ask is what time the teen went to sleep. Teens and young adults have a natural shift in their circadian rhythm such that they are naturally sleepy only later in the night, for example, midnight-1 am. And the lifestyle of young people often encourages an even more delayed bedtime.

Therefore, before you assume that your college kid has a sleep pathology that is making him sleep for 16 hours a day, find out when he finally finished gaming and when he stopped texting his girlfriend who is visiting her family in a time zone that is three hours behind.

It turned out that Charlie was sleeping 10 hours a day, from 4 am to 2 pm, which, although on the long side, is still considered well within normal limits. Staying up late, as I said, is a biological tendency that is reinforced and exacerbated by social norms in that age group. The pervasiveness of continual electronics use only makes matters worse.

The court announced Monday it will hear 5½ hours of arguments spread over three days March 26-28.

The Patient Protection and Affordable Care Act (PPACA or ACA) was signed into law March 23, 2010, passed by a Democratic congressional majority with the support of the president. It has about 2700 pages and contains 450 some provisions.

A ruling from the court is expected by late June and regardless of the outcome, will become a major issue in a presidential election year.

The largest and broadest legal challenge to the Patient Protection and Affordable Care Act comes from a joint filing by 26 states, led by Florida. It was that series of appeals the high court had accepted for review.

At issue is whether the “individual mandate” section — requiring nearly all Americans to buy health insurance by 2014 or face financial penalties — is an improper exercise of federal authority. The states also say that if that linchpin provision is unconstitutional, the entire law must be also go.

Joining Florida in the challenge are Alabama, Alaska, Arizona, Colorado, Georgia, Idaho, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Nebraska, Nevada, North Dakota, Ohio, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Washington, Wisconsin and Wyoming.

Four issues will be addressed by the Supreme Court:

Anti-Injunction Act

First, the court on March 26 will consider whether those challenging the law be barred from making any legal or constitutional claims until the individual mandate actually goes into effect in 2014.

The AIA — in place since the 19th century — bars claimants from asking for a refund on a tax until that tax has been collected and paid. Judges in two federal appeals courts have made that argument, which would effectively stop the current legal fight in its tracks. Citing that law might give the court a way out of deciding the explosive issue in an election year.

The majority could decide the political branches can best resolve the conflicts, at least for now, or that the matter can be handled after the November elections. Some court watchers have called this the health care “sleeper issue.” It could potentially delay a decision on the constitutionality of the individual mandate for at least four years.

Individual mandate

The court will hear two hours of arguments on this most key issue on March 27. This provision requires nearly all Americans to buy some form of health insurance beginning in 2014, or face financial penalties. May the federal government, under the Constitution’s Commerce Clause, regulate economic “inactivity”? Three federal appeals courts have found the PPACA to be constitutional, while another has said it is not, labeling it “breathtaking in its expansive scope.” That “circuit split” all but assured the Supreme Court would step in and decide the matter.

The Florida-led coalition of say individuals cannot be forced to buy insurance, a “product” they may neither want nor need. The Justice Department has countered that since every American will need medical care at some point in their lives, individuals do not “choose” to participate in the health care market. Federal officials cite 2008 figures of $43 billion in uncompensated costs from the millions of uninsured people who receive health services, costs that are shifted to insurance companies and passed on to consumers.

Severability

This is the “domino effect” issue, and the court will hear 90 minutes of argument on this aspect on March 28.

If the individual mandate section is ruled unconstitutional, must the entire law collapse as well? A federal judge in Florida had ruled as much in February: “Because the individual mandate is unconstitutional and not severable, the entire Act must be declared void.”

But a federal appeals court overruled on the severability question, while upholding the individual mandate’s unconstitutionality. Opponents of the law say the individual mandate is crucial to the overall law, since it is the main funding mechanism for the expansion of a range of other programs. This may be the one question on which the justices will ultimately agree in favor of the government.

Medicaid ‘coercion’

Can states be forced by the federal government to expand their share of Medicaid costs and administration, with the risk of losing that funding if they refuse? The court will devote an hour to that question on March 28.

The 28 GOP-led states say the new law’s significant expansion of the social safety net unconstitutionally “coerces” state governments. That program is administered by the states with a combination of federal and state money, currently requiring coverage only for poor children and their parents or caretakers, adults with disabilities, and poor individuals over age 65. The “coercion” issue was surprisingly added to the healthcare debate by the justices.

Both sides of the issue agree what the high court decides on this question could have monumental implications for the regulatory ability of the federal government to set long-term national policy goals in areas like the environment, education, and the workplace.

Some states have long complained their autonomy is being eroded by creeping federal intervention on spending matters. Article 1 of the Constitution gives Congress the power “lay and collect … taxes to pay the debts and provide for the common defense and general welfare of the United States” and to “regulate commerce… among the several states.” Such authority has long been broadly interpreted, including when imposing conditions on recipients, including individuals and states. No federal court has ever ruled states have been unlawfully coerced when they accept conditions or strings attached to federal funds. The Supreme Court in 1987 affirmed that congressional discretion.

The PPACA’s Medicaid changes — beginning in 2014 — would make millions of additional Americans eligible for benefits, by raising the income level they earn and still qualify. That would include all adults, up to 133% of the federal poverty line. The tricky question is that states are not forced to agree to the law’s incremental Medicaid increases, spread out over six years. But the states say abandoning their participation as a result would be a financial, social, and political catastrophe– one which they cannot realistically foresee. Their needy citizens rely on Medicaid, states argue, but the law’s expansion of the program could cripple state budgets, currently on average about 20-percent. That would threaten other state spending priorities.

So the long-standing fight over “federalism” and the leverage the national government wields over states may soon reach epic levels with a high court decision either strengthening — or limiting — congressional authority on this and potentially a host of other regulatory areas.

The amoeba, Naegleria fowleri, can be found in lakes and ponds as well as in contaminated lukewarm tap water. The organism doesn’t pose a threat when ingested, but if it becomes lodged in a person’s nose it can end up in the brain and cause an infection.

The infection, lethal in 95% of cases, triggers an array of symptoms that resemble those of bacterial meningitis, including vomiting, headaches and sleepiness. As it progresses, it can cause changes in a person’s behavior and lead to confusion and hallucinations. It usually causes death within one to 12 days, according to the Centers for Disease Control and Prevention.

The Louisiana Department of Health and Hospitals issued its warning after a 51-year-old woman in DeSoto Parish died after rinsing her sinuses with a neti pot, a small vessel used to pour warm water into one nostril and out the other. Earlier this year, a 20-year-old man near New Orleans died after contracting the infection in the same way.

“Tap water is safe for drinking, but not for irrigating your nose,” said Dr. Raoult Ratard, Louisiana state epidemiologist in a statement. Ratard urged neti-pot users to fill the pots only with distilled, sterile, or previously boiled water, and to rinse and dry them after each use.

The infection, known as primary amebic meningoencephalitis, is extremely rare. In the previous decade, just 32 cases have been reported in the United States, according to the CDC. Only one person is known to have survived.

Deaths involving neti pots are even more rare. Most deaths from the amoeba, including three last summer, occur in Southern states during the summer, when people swim in warm freshwater where Naegleria fowleri lurks.

The partially blind, hairless, wrinkly, cold-blooded mammals were good candidates for the study because of their unique insensitivity to acid-induced pain.

Native to sub-Saharan Africa, the naked mole-rat makes its home burrowed deep in huge colonies in underground tunnels, with access to very little oxygen and high levels of carbon dioxide.

“Exposure to high levels of carbon dioxide in turn would evoke acidosis, but the naked mole-rat has evolved in a way to manage this acid load and to be able to live in acidic environments, which for most other rodents in the world would be uninhabitable,” said neuroscientist Ewan St. John Smith, the lead author of the study.

Scientists say in most mammals – including humans – exposure to acid stimulates special channels at the tips of sensory neurons, called nociceptors. Once these nociceptors are activated, they transmit a signal along the spinal cord to the brain.

But among naked mole-rats, although acid triggers the nociceptors, their pain-sensing neurons contain proteins with genetic mutations that prevent neurons from firing off pain signals in response to acid.

Inflammatory disorders, such as arthritis, are normally associated with acidosis, scientists say.

“If a drug could now be developed which acts on these particular proteins on the sensory neurons, you could limit the ability of acid to cause pain in patients with arthritis and other inflammatory disorders,” Smith said.

According to the Centers for Disease Control and Prevention, an estimated 50 million U.S. adults (about 1 in 5) report doctor-diagnosed arthritis. That number is projected to increase to 67 million by 2030.

“We can learn a lot from comparative physiology. By understanding how an animal adapts to its environment, this will teach us a lot of our own biological system,” said neuroscientists Gary R. Lewin, one of the authors of the study, conducted by the Max Delbrück Center for Molecular Medicine in Germany.

The naked mole-rat has been the subject of other groundbreaking studies. The buck-tooth rodent has been found to have an unusually long life span; it can live three years longer than other rodents and is resistant to cancer.

Most recently, scientists sequenced and analyzed the entire genome, which Smith and his colleagues hope to be able to use for their next phase of research.

“It’s cool to know how things work, especially when things don’t work as you expect them to,” Smith said.