A University of Missouri nurse researcher is working to ensure people who use hearing aids for the first time are not bombarded by sounds that could be overwhelming and potentially painful.
Individuals who wear hearing aids for the first time can potentially hear sounds they have not heard in months of even years, according to a University of Missouri news release on the research. The study, published online Dec. 17, in the journal Clinical Nursing Research, looked at the feasibility and initial effect of Hearing Aid Reintroduction to assist people 70 to 85 years old to adjust to hearing aids.
Some of the noises hearing aids enable their users to hear are not always easy to embrace, researchers found. These include air conditioners, wind and background conversations which can be annoying, painful and tough to ignore, the release said.
Kari Lane, PhD, RN, MOT, assistant professor of nursing at MU Sinclair School of Nursing, studied a group of elderly adults’ satisfaction with hearing aids after participating in HEAR, according to the release. Study participants recorded the total time they wore hearing aids for 30 days. Participants gradually increased the amount of time they wore the hearing aids and the variety and complexity of sounds they experienced, including household appliances or sounds from crowded areas, the release said.
“Hearing loss is a common health problem facing many aging adults that can have serious effects on their quality of life, including heightened chances of depression and dementia,” Lane said in the release. “Hearing aids are not an easy fix to hearing loss. Unlike glasses, which provide instant results, it takes more time for the brains of hearing-aid users to fully adjust to the aids and new sounds they could not hear before.”
All participants at the start of the research reported being unsatisfied with their hearing aids, Lane said. At the end of the study, more than half of participants reported being able to increase their hearing aid use and 60% of them said they were satisfied with their hearing aids, the release stated.
“It is common practice for audiologists to have their patients wear hearing aids all day when they first buy them, but not all persons are able to do this comfortably,” Lane said in the release. “Prior research shows there is a need for alternative ways to teach people how to use hearing aids like the HEAR intervention, which allows hearing-aid users to gradually adjust to using the aids while receiving support and coaching from health professionals and family members.”
Healthcare providers should give patients guidance on conditions they might experience during the aging process, such as hearing loss, according to the release. Such proaction could help to reduce the stigma surrounding hearing aids, Lane said.
“If healthcare professionals begin discussing hearing loss with their patients sooner, before problems arise, the use of hearing aids could be normalized, and individuals would be better prepared for the transition when it is time for them to begin use,” Lane said in the release.
A nurse who contracted Ebola at the Dallas hospital where she worked plans to sue the hospital's parent company, Texas Health Resources, hoping to be a "voice for other nurses," her lawyer said today.
In the suit, which Nina Pham plans to file Monday, the 26-year-old nurse alleges that Texas Health Presbyterian Hospital didn't train the staff to treat Ebola and didn't give them proper protective gear, which left parts of their skin exposed, her lawyer Charla Aldous said.
"One of the most concerning things about the way [the hospital] handled this entire process is you've got a young lady who has this disease which she should not have. And if they properly trained her and given her the proper personal protective equipment to wear, she would not have gotten the disease," Aldous said.
Aldous said Pham hopes the suit will "help make sure that hospitals and big corporations properly train their nurses and healthcare providers."
"This is not something that Nina chose," Aldous said, but "She's hoping that through this lawsuit she can make it a change for the better for all nurses."
Pham is still coping with Ebola's after-effects, including nightmares and body aches, her lawyer said.
"She has not gone back to work yet and she is working on recovering," Aldous said. "I don't know if she'll ever be a nurse again."
Texas Health Resources spokesperson Wendell Watson said in a statement: "Nina Pham bravely served Texas Health Dallas during a most difficult time. We continue to support and wish the best for her, and we remain optimistic that constructive dialogue can resolve this matter."
Last fall, Pham cared for Liberian native Thomas Eric Duncan, who flew to the U.S. and was diagnosed with Ebola at Texas Health Presbyterian Hospital.
Pham took care of Duncan when he was especially contagious, and on Oct. 8, Duncan died from the virus.
Pham tested positive for Ebola on Oct. 11, marking the first Ebola transmission on U.S. soil.
On Oct. 16, Pham was transferred to the National Institutes of Health's hospital in Bethesda, Maryland. She was discharged on Oct. 24.
At the news conference announcing Pham's discharge, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the NIH, said she tested negative for Ebola five times, and that it wasn't clear which treatment saved her because they were all experimental.
"I want to first tell you what a great pleasure and in many respects, a privilege ... to have the opportunity to treat and care for and get to know such an extremely courageous and lovely person," Fauci said, adding that she represents the health care workers who "put themselves on the line."
Pham's dog, Bentley, was also quarantined for several weeks, over fears that he, too, would develop Ebola.
A blind man is now able to see objects and people again, including his wife and family, for the first time in a decade. How? With the help of a bionic eye implant.
Affected by a degenerative condition known as retinitis pigmentosa, Allen Zderad was effectively blind, unable to see anything but a bright light. As the condition has no cure, Zderad, from Minneapolis-Saint Paul, MN, was forced to quit his professional career.
He made adjustments to his lifestyle and was able to continue woodworking through his sense of touch and spatial awareness. However, with the help of his new retinal prosthesis, Zderad is now able to make out the outlines of objects and people, and could even register his reflection in a window.
"I would like to say I think he's a remarkable man, when you consider what he's overcome in dealing with his visual disability," says Dr. Raymond Iezzi Jr., an ophthalmologist from the Mayo Clinic. "To be able to have offered him the retinal prosthesis to enhance what he can already do was a great honor for me."
Retinitis pigmentosa is an inherited condition that causes the degeneration of specific cells in the retina called photoreceptors. The disease can cause some people to lose their entire vision. Mr. Zderad's grandson has the disease in its early stages and, after seeing him, Dr. Iezzi asked if he could meet his grandfather.
The eye implant that Zderad now has works by bypassing the damaged retina and sending light wave signals directly to the optic nerve. A small chip was attached to the back of the eye with multiple electrodes offering 60 points of stimulation.
'Not like any form of vision that he's had before'
Wires from the device on the retinal surface connect to a pair of glasses worn by Mr. Zderad. The glasses have a camera at the bridge of the nose that relay images to a small computer worn in a belt pack. These images are then processed and transmitted as visual information to the implant which in turn interprets them, passing them on to the retina and eventually the brain.
"Mr. Zderad is experiencing what we call artificial vision," explains Dr. Iezzi. "It's not like any form of vision that he's had before. He's receiving pulses of electrical signal that are going on to his retina and those are producing small flashes of light called electro-phosphenes. These small flashes of light are sort of like the points of light on a scoreboard at a baseball game."
There are only 60 of these flashes of light, but it is enough for Zderad to reconstruct scenes and objects. Although he will not be able to see the details of faces or read, Mr. Zderad will now be able to navigate through crowded environments without the use of a cane, significantly improving his quality of life.
Dr. Iezzi would like to see the technology expanded to patients who have lost the use of their eyes, such as wounded soldiers or people with advanced diabetes or glaucoma.
"In addition, while Mr. Zderad has 60 points of stimulation, if we were able to increase that number to several hundred points of stimulation, I think we could extend the technology so that patients could recognize faces and perhaps even read," he concludes.
"It's crude, but it's significant," said Zderad happily, as he first used the device. "It'll work."
Zderad will now be able to see his family again, including his 10 grandchildren and his wife, Carmen. And how does he distinguish her, having not seen her for a decade? "It's easy," says Zderad, "she's the most beautiful one in the room."
At the end of last year, Medical News Today reported on the story of a woman with quadriplegia who is now able to use her mind to move a robotic arm, demonstrating "10° brain control" of the prosthetic.
I find it strangely interesting that this time last year, as I was enduring the beginning of my life with a TBI, I had no idea that March was National Brain Injury Awareness Month. This year I feel compelled to shout it from the rooftops (or the computer screen)! Over the next few weeks, I intend to share with you stories and journeys of those living with a traumatic brain injury (TBI) or caring for a loved one who is recovering from one. My hope is to educate those who aren't familiar with TBI, and to help other TBI-ers understand that they are not alone, and that their symptoms are not just "in their head" (pun intended).
Let me start by offering you some statistics on TBI from BrainTrauma.org:
- Traumatic brain injury (TBI) is the leading cause of death and disability in children and adults from ages 1 to 44.
- Brain injuries are most often caused by motor vehicle crashes, sports injuries, or simple falls on the playground, at work or in the home.
- Every year, approximately 52,000 deaths occur from traumatic brain injury.
- An estimated 1.5 million head injuries occur every year in the United States emergency rooms.
- An estimated 1.6 million to 3.8 million sports-related TBIs occur each year.
- At least 5.3 million Americans, 2 percent of the U.S. population, currently live with disabilities resulting from TBI.
- Moderate & severe head injury (respectively) is associated with a 2.3 and 4.5 times increased risk of Alzheimer's disease.
- Males are about twice as likely as females to experience a TBI.
- Exposures to blasts are a leading cause of TBI among active duty military personnel in war zones.
- Veterans' advocates believe that between 10 and 20 percent of Iraq veterans, or 150,000 and 300,000 service members have some level of TBI.
- 30 percent of soldiers admitted to Walter Reed Army Medical Center have been diagnosed as having had a TBI.
- The number of people with TBI who are not seen in an emergency department or who receive no care is unknown.
There are three levels of traumatic brain injuries: mild, moderate and severe. Don't let these names fool you. A mild TBI is just as serious as a moderate or severe one. The names refer to loss of consciousness and mental alteration as a result of the trauma. In my case, we think I was unconscious for only about a minute or so, therefore classifying me as "mild". But like I said, don't let the name fool you. The resulting damage can be the same for all three -- a TBI does not discriminate.
A TBI changes you. Literally and figuratively. My personality is different. My energy levels and sleep patterns are foreign to me. The confused woman in the kitchen staring at the oven is someone I am just now starting to understand. The woman who has to write a Post-it note for every single task on her to-do list is no longer the multi-tasker she once was. The woman who used to type at 100 words per minute with zero mistakes now has to take her time and correct many keystroke errors as she goes because her brain gets confused with letters.
I am finally coming to terms with this "new me." It has been just over a year since I fell on the ice, landing full force on my skull. In the beginning I was angry. I was confused. I was in a lot of pain, both physically and emotionally. People didn't understand. Didn't believe me. Couldn't understand my hidden injuries. I didn't have a strong support system, but what I did have was determination!
Life with an "invisible" injury or illness can be a real challenge. Since I posted my last blog, "Life With a Traumatic Brain Injury," on The Huffington Post last month, I have made an entirely new circle of friends. I created a group on Facebook, affectionately named "The TBI Tribe." This is a safe place where we can hang out, talk, vent frustrations, share in each other's successes, and more importantly, have a place where we all feel like we fit in. I was craving an environment where others understood my struggles and didn't pass judgement. I have found exactly that in this tribe!
I want to share with you a little bit about one of my new friends, Jennifer L. White from St. Louis, Missouri:
In July of 2000 Jennifer collapsed in her Atlanta, Georgia apartment. She called 911 and told them she was dying. She did, in fact, die in the ambulance on her way to the hospital. Fortunately medics were able to resuscitate her. Doctors determined that she had had a stroke and performed brain surgery to eradicate the brain bleed. She spent 10 days in the ICU followed by several months in a rehab facility. Overnight she went from the vice president of a large marketing firm, to unemployable and on disability. The massive stroke has left Jennifer with cognitive deficiencies, balance issues, and double vision. She jokes that she can, however, make a killer peanut butter sandwich! It's important to have a good sense of humor when dealing with a TBI. Aside from her impairments, Jennifer looks completely healthy and "normal." A few words from Jennifer:
The brain injury has affected me in a variety of ways. Emotionally, I am fragile but working hard to toughen my spirit. I am much more introspective (I don't know if this is from the actual brain injury or the fact I now have more time to be introspective). Things are just harder for me than most people. I have to actually think seriously about where I am stepping.
I define my life in two ways: before and after the stroke. It has certainly delivered me a tough blow. I have been advised not to have children. I am scared that I am predisposed to have something else happen to me, and I am sorry that I don't find sweetness in the sweet things in life because I am more bitter than I want to be. But call me crazy... I am glad to be alive.
I hope that you will join me this month as I share with you more stories and continue to bring awareness to the world about TBI.
DONALD G. McNEIL Jr.
A major study testing whether Americans would take their H.I.V. drugs every day if they were paid to do so has essentially failed, the scientists running it announced Tuesday at an AIDS conference here.
Paying patients in the Bronx and in Washington — where infection rates are high among poor blacks and Hispanics — up to $280 a year to take their pills daily improved overall adherence rates very little, the study’s authors said.
The hope was that the drugs would not only improve the health of the people taking them, but help slow the spread of H.I.V. infections. H.I.V. patients who take their medicine regularly are about 95 percent less likely to infect others than patients who do not. The Centers for Disease Control and Prevention estimates that only a quarter of all 1.1 million Americans with H.I.V. are taking their drugs regularly enough to not be infectious.
Paying patients $25 to take H.I.V. tests, and then $100 to return for the results and meet a doctor, also failed, the study found.
“We did not see a significant effect of financial incentives,” said Dr. Wafaa M. El-Sadr, an AIDS expert at Columbia University and the lead investigator. But, she said, there is “promise for using such incentives in a targeted manner.”
Cash payments might still work for some patients and some poor-performing clinics, she said.
Other H.I.V.-prevention research released here Tuesday offered good news for gay men but disappointing results for African women.
Two studies — both of gay men, one in Britain and the other in France — confirmed earlier research showing that pills to prevent infection can be extremely effective if taken daily or before and after sex. Both were stopped early because they were working so well that it would have been unethical to let them continue with men in control groups who were not given the medicine.
But a large trial involving African women of a vaginal gel containing an antiviral drug failed — apparently because 87 percent of the women in the trial were unable to use the gel regularly.
The failure of the cash-incentives trial was a surprise and a disappointment to scientists and advocates. It had paid out $2.8 million to 9,000 patients in 39 clinics over three years, but the clinics where money was distributed did only 5 percent better than those that did not — a statistically insignificant difference.
Some small clinics and those where patients had been doing poorly at the start of the study did improve as much as 13 percent, however.
People in other countries have been successfully paid to stop smoking while pregnant and to get their children to school. In Africa, paying poor teenage girls to attend school lowered their H.I.V. rates; scientists concluded that it eased the pressure on them to succumb to “sugar daddies” — older men who gave them money for food, clothes and school fees in return for sex.
One study presented here at the annual Conference on Retroviruses and Opportunistic Infections estimated that every prevented H.I.V. infection saved $230,000 to $338,000. Much of that cost is borne by taxpayers.
Mathematical modeling suggested that paying people up to $5,000 a year could be cost effective, Dr. El-Sadr said, but $280 was settled on after a long, difficult debate.
Paying more than $280 at some clinics was not an option, she said; achieving statistical relevance would have meant signing up even more clinics. The study had already involved almost every H.I.V. patient in the Bronx and Washington.
“I don’t think anyone has an answer to what amount would be sufficient without being excessive,” Dr. El-Sadr said.
One advocate suggested that more money could work — in the right setting.
“In South Africa, $280 is a lot of money,” said Mitchell Warren, the executive director of AVAC, an organization that lobbies for AIDS prevention. “For that much, you’d definitely get some behavior change.”
The two studies among gay men looked at different ways to take pills. A 2010 American study, known as iPrEx, showed that taking Truvada — a combination of two antiretroviral drugs — worked if taken daily.
The British study, known as PROUD, used that dosing schedule, and men who took the pill daily were protected 86 percent of the time.
In the French trial, known as Ipergay, men were advised to take two pills in the two days before they anticipated having sex and two in the 24 hours afterward.
Those who took them correctly also got 86 percent protection.
“The problem,” Dr. Susan P. Buchbinder, director of H.I.V. prevention research for the San Francisco health department, said in a speech here commenting on the study, “is that studies have shown that men are very good at predicting when they will not have sex and not good at predicting when they will.”
The African study, known as FACTS 001, was a follow-up to the smaller trial from 2010, which showed that South African women who used a vaginal gel containing tenofovir, an antiviral drug, before and after sex were 39 percent better protected than women who did not.
But it also found that many women failed to use the gel because it was messy or inconvenient or because partners objected.
In this trial, there was virtually no effect.
One problem, said Dr. Helen Rees, the chief investigator, was that the women were very young — the median age was 23, and most lived with their parents or siblings.
“They had no privacy for sex,” she said. “They had to go outside to use the product.”
Mr. Warren, of AVAC, said: “The women wanted a product they could use. But this particular product didn’t fit into the realities of their daily lives.”
The development means that advocates are hoping even more that other interventions for women now in trials will work. They include long-lasting injections of antiretroviral drugs and vaginal rings that can be inserted once a month and leach the drugs slowly into the vaginal wall.
Another trial in Africa, the Partners Demonstration Project, conducted among couples in which one partner had H.I.V. and the other did not, found it was extremely effective to simultaneously offer treatment to the infected partner and preventive drugs to the uninfected one until the other’s drugs took full effect.
In the group getting the treatment, there were zero infections that could be traced to partners who were in the study.
Each year more than 15,000 women under the age of 55 die of heart disease in the United States. And younger women are twice as likely to die after being hospitalized for a heart attack as men in the same age group.
It doesn't help that women tend to delay seeking emergency care for symptoms of a heart attack such as pain and dizziness, says Judith Lichtman, an associate professor of epidemiology at the Yale School of Public Health. "We've known that for a while," she says.
In a small study published Tuesday in Circulation: Cardiovascular Quality and Outcomes, Lichtman and her colleagues looked into why women delay getting help. The researchers conducted in-depth interviews with 30 women, ages 30 to 55, who had been hospitalized after a heart attack.
It turned out that many had trouble recognizing that they were having symptoms of a heart attack. "A lot of them talk about not really experiencing the Hollywood heart attack," Lichtman tells Shots.
A heart attack doesn't necessarily feel like a sudden painful episode that ends in collapse, she notes. And women are more likely than men to experience vague symptoms like nausea or pain down their arms.
"Women may experience a combination of things they don't always associate with a heart attack," Lichtman says. "Maybe we need to do a better job of explaining and describing to the public what a heart attack looks and feels like."
But even when women suspected that they were having a heart attack, many said they were hesitant to bring it up because they didn't want to look like hypochondriacs.
"We need to do a better job of empowering women to share their concerns and symptoms," Lichtman says.
And medical professionals may need to do a better job of listening, she adds. Several women reported that their doctors initially misdiagnosed the pain, assuming that the women were suffering from acid reflux or gas.
Doctors should pay special attention to women who have high blood pressure or cholesterol, as well as those with a family history of heart disease, Lichtman says.
This is just a preliminary study. Lichtman has already started working on a much larger study investigating why women have a higher risk of dying from heart disease than men.
But the findings aren't too surprising, says Dr. Nisha Parikh, a cardiologist at the University of California, San Francisco who wasn't involved in the research.
"I take care of young women who have heart disease, and this story is very common," she says.
Part of the issue is that most of the research on heart disease has focused on men, since the condition is more common among men. As a result, the diagnostic tools that doctors use to identify heart disease aren't always well suited for female patients.
Cardiologists are just beginning to rethink how to best recognize and treat heart attacks in women, Parikh notes.
Heart disease is the third leading cause of death for women ages 35 to 44, and it's the second leading cause of death for women 45 to 54, according to the Centers for Disease Control and Prevention. (Cancer is the No. 1 cause.)
"Historically we thought of heart disease as sort of a man's disease," Parikh says. "But that's not the case."
This study also highlights the importance of empowering women to speak up about their worries, says. Dr. Jennifer Tremmel, a cardiologist at Stanford University.
"It's interesting because the whole idea of female hysteria dates back to ancient times," Tremmel says. "This is an ongoing issue in the medical field, and we all have to empower women patients, so they know that they need to not be so worried about going to the hospital if they're afraid there's something wrong."
Days before he's scheduled to leave the hospital, he's already gone viral on social media because he was born 'en caul.'
Silas was completely encased in his amniotic sac, said Los Angeles' Cedars-Sinai Medical Center in a Facebook post. That's so rare, that even doctors delivering babies hardly see it. So Silas' doctor snapped a photo with his cell phone.
It looked like the baby was trapped in a big water bubble.
"Even though it's a cliche -- we caught our breath," neonatologist William Binder told CNN affiliate KCAL. "It really felt like a moment of awe."
Then Binder got to work helping Silas to breathe - and giving him special care, because Silas was born three months before his due date via Caesarean section.
Later, Silas' grandmother showed the cell phone photo to his mother, Chelsea Philips.
"It was definitely like a clear film, where you could definitely make out his head and his hair," Philips told the affiliate. Silas was curled up in fetal position inside.
What is 'en caul'
The amniotic sac is an opaque bubble that covers all babies in the womb from right after conception. As the baby grows, it fills with fluid, including the baby's urine.
The sac cushions the baby from bumps and jostles during mom's daily ups and downs.
Normally, during a birth, it breaks, and the fluid rushes out, which is where the term 'breaking water' comes from.
But sometimes, the sac can get stuck around part of the baby, according to Dr. Amos Grunebaum, an obstetrician and gynecologist, who publishes a website on birth and baby care.
It can, for example, get stuck on the baby's head, which makes it look like its wearing a glass space helmet. That's also where the term caul comes from -- it derives from Latin words that refer to a helmet.
Such amniotic sac helmet births are rare enough, but to have the entire baby inside the sac, or 'en caul,' occurs in less than one in 80,000 births, Cedars-Sinai said.
When Philips heard how rare her Baby's birth was, she was flabbergasted. "I was like, oh my gosh, Silas, you're a little special baby," she told KCAL.
It's particularly surprising in a C-section, because the scalpel usually pierces the amniotic sac.
The doctors must have missed Silas's.
For Tabitha Waugh, it was another typical day of chaos on the sixth-floor cancer ward.
The fire alarm was blaring for the second time that afternoon, prompting patients to stumble out of their rooms. One confused elderly man approached Ms. Waugh, a registered nurse at St. Mary’s Medical Center here, but she had no time to console him. An aide was shouting from another room, where a patient sat dazed on the edge of his bed, blood pooling on the floor from the IV he had yanked from his vein.
“Hey, big guy, can you lay back in bed?” she asked, as she cleaned the patient before inserting a new line. He winced. “Hold my hand, O.K.?” she said.
Ms. Waugh, who is 30 and the main breadwinner in her family of four, still had three hours to go before the end of a 12-hour shift. But despite the stresses and constant demands, all the hard work was paying off.
Her wage of nearly $27 an hour provides for a comfortable life that includes a three-bedroom home, a pickup truck and a new sport utility vehicle, tumbling classes for her 3-year-old, Piper, and dozens of brightly colored Thomas the Tank Engine cars heaped under the double bed of her 6-year-old, Collin.
The daughter of a teacher’s aide and a gas station manager, Ms. Waugh, like many other hard-working and often overlooked Americans, has secured a spot in a profoundly transformed middle class. While the group continues to include large numbers of people sitting at desks, far fewer middle-income workers of the 21st century are donning overalls. Instead, reflecting the biggest change in recent years, millions more are in scrubs.
“We used to think about the men going out with their lunch bucket to their factory, and those were good jobs,” said Jane Waldfogel, a professor at Columbia University who studies work and family issues. “What’s the corresponding job today? It’s in the health care sector.”
In 1980, 1.4 million jobs in health care paid a middle-class wage: $40,000 to $80,000 a year in today’s money. Now, the figure is 4.5 million.
The pay of registered nurses — now the third-largest middle-income occupation and one that continues to be overwhelmingly female — has risen strongly along with the increasing demands of the job. The median salary of $61,000 a year in 2012 was 55 percent greater, adjusted for inflation, than it was three decades earlier.
And it was about $9,000 more than the shriveled wages of, say, a phone company repairman, who would have been more likely to head a middle-class family in the 1980s. Back then, more than a quarter of middle-income jobs were in manufacturing, a sector long dominated by men. Today, it is just 13 percent.
As the job market has shifted, women, in general, have more skillfully negotiated the twists and turns of the new economy, rushing to secure jobs in health care and other industries that demand more education and training. Men, by contrast, have been less successful at keeping up.
In many working- and middle-class households, women now earn the bigger paycheck, work longer hours and have greater opportunities for career advancement. As a result, millions of American families are being reconfigured along with the economy.
“The culture still has traditional attitudes about who does what, who brings home the bacon and who scrambles the eggs,” said Isabel Sawhill, co-director of the Center on Children and Families at the Brookings Institution. “The economy is now out of sync with the culture, and I think that’s creating tensions within marriage.”
A New Springboard
At the Waughs’ house, it is T.J. Waugh, 33, who picks up the couple’s two children from the babysitter when he leaves his afternoon shift at a small plant in Huntington.
By the time Ms. Waugh arrives home in rural Salt Rock from her shift, often far later than her 7 p.m. quitting time, the children have been bathed and fed.
The house is usually messy. The bathroom walls are covered with scribbles from bath crayons; dirty clothes pile up. Ms. Waugh often jams six 12-hour shifts into one week, leaving little time for cleaning and laundry. Mr. Waugh mows the lawn and will run the vacuum cleaner now and then, and if there are no clean towels, Ms. Waugh will do a load of laundry. Otherwise, housework waits until she has a stretch of days off.
“I’m just really tired when I get home,” Ms. Waugh said.
Ms. Waugh is the keeper of the family’s books. That she out-earns her husband — a pipe fitter who hunts deer and plays men’s softball on the weekends — is an unspoken given.
“She doesn’t rub that in,” he said.
Without missing a beat, Ms. Waugh adds, “It doesn’t matter where it comes from.”
Most of the new jobs produced by America’s sprawling economy — especially since the turn of the century — are either in highly paid occupations that often require an advanced degree, or, more predominantly, in lower-paid positions providing direct services that cannot be sent overseas and, at least for now, are difficult to automate.
But even with a hollowing out of the job market and a broad stagnation in wages, an analysis by The New York Times has found, a set of occupations has emerged that holds promise as the base of a more robust middle class.
Many are in health care, which has grown sharply over the last few decades.
Economists at the Labor Department project that by 2022, as baby boomers age, health care and social assistance will absorb nearly 20 percent of consumer spending, double the share of manufactured goods. The sector is expected to support over 21 million jobs, five million more than today. This includes half a million more registered nurses.
A Rare Green Shoot
The reordering of the economic landscape can be seen all over West Virginia’s old coal country, where billboards along the highways that run through the region advertise a new cardiac center and an orthopedic clinic; and where a strip mall houses Scrubs Unlimited, a medical outfitter, its retail floor crammed with nursing uniforms in 38 colors and Peter Pan prints.
Hugging the Ohio River as it bends around the Appalachian foothills, Cabell County, which includes Huntington, has often found itself on the wrong side of economic change. The population — about 97,000 today — has shrunk 10 percent over the last three decades, as the old have died and many of the young have left.
The railroad that helps shuttle coal to Huntington, one of the nation’s busiest inland ports, is still a source of jobs. But manufacturing employment — once clustered at the long-gone glassmaking plants and furniture makers — has dwindled to fewer than 5,000 jobs. Recently, a 1920s-era nickel alloy plant laid off dozens of workers after a bankruptcy, a corporate acquisition and weak sales.
In real terms, wages in Cabell County now are lower than in the 1970s, stumbling along well below the national average. One in five residents lives in poverty.
The health care industry — which added 3,000 jobs here over the last 10 years — is one of the few green shoots in a struggling economy.
West Virginia has been battered by the same forces that have reshaped the nation since the late 1970s, when global competition, an overvalued dollar, declining unions and advanced technology began to undercut the jobs created during America’s industrial heyday, deepening income inequality. And since 2000, the share of middle-income workers has been squeezed and wages have stagnated.
Yet many of the jobs added in medical services here and across the nation have turned out to be surprisingly good ones.
That was what motivated the only male registered nurse colleague of Ms. Waugh’s on the sixth-floor cancer unit, Johnny Dial, a former highway construction worker and heavy equipment mechanic. More men are joining nursing, but they still make up only 10 percent of the ranks, compared with 4 percent in 1980.
As Mr. Dial contemplated supporting a family, it came down to health care or the railroad if he wanted job security and benefits. He chose what he thought would be a more fulfilling career, and the same one as his wife, who is also a nurse.
“You get to help people,” Mr. Dial said.
Women Stepped Up
Similar thinking was behind the career choices of Ms. Waugh’s fellow female R.N.s. They include a former waitress, a former journalist, an ex-administrator in a metals factory and a former store clerk at Bath & Body Works. In addition to the satisfaction of the work, they all said, the wages are generally better in health care than they could find in other fields.
Ms. Waugh has urged her husband to try to move up at his company, where he earns about $40,000 in regular wages, plus pay for occasional extra shifts, or to switch to a more lucrative career, maybe even in health care as a radiology technician.
But for Mr. Waugh, the only way up at the plant is to go into sales, a promotion he already turned down because he said he did not want to “deal with people.” He could earn more in the coal mines, but that work is dirty and dangerous.
Mr. Waugh has talked about trying college again; he dropped out twice in the past. At one point, his wife even filled out application papers for him to jump-start his re-enrollment, but he did not pursue class work.
“My philosophy is he is lazy,” Ms. Waugh said, standing in the hospital’s white hallway. “That’s what makes me so mad.”
For all the troubles associated with traditionally male jobs, women have not had an easy ride through the economic turmoil, either.
“The occupational structure has not somehow become more women-friendly,” said David Autor, an economist at M.I.T. who has studied the changing American job market. In fact, he added, “the hollowing out of middle-skill jobs was larger for women than for men.” The process intensified sharply during the financial crisis and the ensuing economic downturn.
But in general women have reacted much better, climbing the educational ladder to capture more of the better jobs. Today, 38 percent of women in their late 20s and early 30s have a college degree, compared with 15 percent 40 years ago. The completion rate for young men is now 7 percentage points lower than for women — back then it was 7 points higher.
This has given women an edge in the new job market: Today, almost 58 percent of registered nurses have a bachelor’s degree or more, compared with about a third in 1980.
This is true across the range of occupations capable of supporting a middle-class life. In 1980, 55 percent of workers who earned the equivalent of $40,000 to $80,000 in today’s dollars had at most a high school diploma, according to the analysis by The Times, which reviewed census returns for employed people ages 25 to 64. Only a quarter had a college degree. Today, the share of college graduates has risen to about 41 percent, while just under 31 percent have completed no more than high school.
“The days when a very, very substantial share of the work force would be able to make good middle-class incomes from jobs that did not require post-high school training are just not the case anymore,” said Francine D. Blau, an economics professor at Cornell University.
Men still hold most of the top jobs in the economy, including seven out of 10 jobs that pay over $80,000 a year. But women are rapidly moving up the ranks. Women hold 44 percent of middle-income jobs, compared with about a quarter 30 years ago.
These trends may not hold forever. Though educational attainment continues to rise for women, their progress in the workplace — in terms of both wages and jobs — has slowed significantly. Tighter controls on the cost of health care could weaken the job growth and pay raises helping support the new American middle. And while the industry is largely immune to foreign competition, it may be affected by advances in labor-saving technology.
Even as more women get ahead, many men are struggling to grab a handhold into higher-paying jobs. After her husband was laid off from a string of auto mechanic jobs, Donna Colbey, 53, urged him to switch careers and become a radiology technician.
It was a job Ms. Colbey knew would offer a good salary and require only two years of training. She had taken the same route, which eventually led her to a nursing career at a Washington hospital.
He enrolled in the courses but dropped out after a few months.
“He got tripped up over the math and didn’t go back,” said Ms. Colbey, who regularly picks up extra shifts to support her family.
A Relentless Pursuit
Far more is expected of nurses now than even two decades ago. Medical advances have kept patients alive longer, meaning many are sicker with more complex illnesses than in the past. Nurses must master technology that helps both treat and track patients, and they are called on to coordinate not just with doctors but also social workers and physical therapists.
At St. Mary’s Medical Center, Ms. Waugh, in her navy scrubs, fed potassium on a recent day into the vein of one woman with a broken hip who was on the cancer floor because of a lack of beds. She gave anti-nausea medicine to a moaning young man with liver cancer in the midst of chemotherapy and prepared pills for a half-dozen other patients, documenting it all on a computer.
An outpatient arrived for his regular blood-drawing and, squatting alongside him in a waiting room, Ms. Waugh unbuttoned his shirt and collected blood from an access port in his chest.
Ms. Waugh’s pursuit of learning to advance her career has been relentless. By her own count, she has been out of school for no longer than two years since kindergarten.
All that education has come with a cost. The couple has amassed about $50,000 in student debt. Ms. Waugh would like to send her children to a better school, but the $10,000 annual tuition that would require is out of reach. “I can’t save for their college and send them to private school,” she said.
To her husband’s co-workers who are raising families on pipe fitters’ salaries, the Waugh family is rich. Ms. Waugh’s purchase of a new Toyota S.U.V. raised eyebrows around the plant.
“We’re not wealthy,” Mr. Waugh said, “but we’re not poor.”
It hasn’t been easy getting to this point. As she made the rounds at the hospital, Ms. Waugh explained how her family was set back in 2008 after Collin was born. She stayed home for one year with the boy, who had digestive problems and required expensive formula. Living on just Mr. Waugh’s salary, they ran through their savings and they accumulated credit card debt that they are still paying off.
“That was a horrible financial situation,” Ms. Waugh said.
But later this year, when her classes and other course work are finished, Ms. Waugh will qualify as a nurse practitioner, a job that she expects will allow her to earn at least 50 percent more than her current salary. And she will be prepared, she believes, for almost anything to come.
“I knew if I was a nurse I could be self-sufficient,” she said, “and wouldn’t have to rely on anyone to take care of me.”
Type "drunk," "hammered," or "trashed" into YouTube's search bar and some pretty unsavory videos are likely to turn up.
And that can't be good for teenagers and young adults, researchers say. User-generated YouTube videos portraying dangerous drinking get hundreds of millions of views online, according a study published Friday in the journal Alcoholism: Clinical and Experimental Research.
Do you think dangerous drinking videos harm teens?
These videos often present wild bingeing in a humorous light, the study found, without showing any of the negative consequences, like potentially fatal alcohol poisoning and accidents caused by drunk driving.
The researchers didn't reveal which videos they looked at, to avoid singling out particular YouTube users.
Our own unscientific search turned up many videos under the words "drunk fails," with people who are publicly intoxicated or completely passed out, as well as sleazier stuff like Best Drunk Girls Compilation, Part 1.
There's been lots of research on paid-for alcohol advertisements and product placement on TV shows, in the movies and in music, says Dr. Brian Primack, an associate professor of medicine and pediatrics at the University of Pittsburgh and the study's lead author. "But we haven't really looked at YouTube before," he tells Shots.
Primack and his colleagues looked at a cross-section of 70 YouTube videos that showed unsafe drinking. Together those videos pulled in over 330 million views. Even though the videos weren't paid for by alcohol companies, nearly half of them referenced specific brands of alcohol.
The researchers weren't able analyze who is watching these videos, Primack says, because YouTube no longer makes that information publicly available. But Primack suspects that many viewers are underage, because of previous research he has done on YouTube demographics..
It's also not clear how watching these videos may influence young people's decisions on alcohol use.
This is just a preliminary study, Primack says, but the findings highlight the fact that the Internet is full of unhealthy messages about alcohol. Researchers should look more carefully at sites like YouTube and Tumblr, as well as apps like Instagram and Snapchat, he says.
"We already know that visuals are influential for teens and peer influence is important," Primack says. "Sites like YouTube combine both. You've got video paired with likes, comments and peer-to-peer dialogue."
We contacted YouTube, but a spokesperson declined to speak on the record. YouTube does have a policy against harmful or dangerous content and viewers can report inappropriate videos for review.
But these videos are still easy to find, Primack says, and there's no way to completely shield children from negative depictions of alcohol use, Still, he adds, "I don't think the right response is to freak out and block kids' Internet use."
Instead, parents and educators should push kids to think critically about the messages they're exposed to on the Internet, says Dr. Michael Siegel, a professor of community health at Boston University who wasn't involved in the study.
"By actually understanding and talking about it, kids become resistant to these messages," Siegel says. "They'll be able to see that these portrayals online aren't realistic."
Public health agencies could also make better use of platforms like YouTube to put out their own messages, Siegel says.
On her 50th birthday, Sandy Oltz sat on the film set of “Still Alice” and listened to actress Julianne Moore speak a line that Oltz, an early onset Alzheimer’s patient, had struggled to write.
“Please do not think I am suffering. I am not suffering,” Moore said as the character of Alice Howland. “I am struggling, struggling to be a part of things, to stay connected to who I once was.”
Playing a woman with early onset Alzheimer's disease, Moore was giving a speech to a fake meeting of the Alzheimer's Association. It's a position that Oltz has been in many times before.
Oltz, a self-described “type-A” person and former nurse, was diagnosed with early onset Alzheimer’s disease at age 47, when she was raising two teenage sons and juggling a high-pressure job.
“There is some family history, but I never really thought that it would be me,” said Oltz of her early diagnosis. "We tried menopause, we tried brain tumor, we thought stroke, seizure. It took about a year to come to Alzheimer’s.”
Months before the “Still Alice” film shoot in New York, Oltz partnered with the cast and crew of the film through the Alzheimer’s Association. She gave tips from her own life about how to cope with Alzheimer's, such as using a highlight to mark text she's reading. The work seems to have paid off with Moore winning a Golden Globe and an Oscar for her role.
"[Moore] would just ask questions like, ‘What does it feel like to have Alzheimer's,'" said Oltz. "I would say, 'Well, it’s like all these words [are here] and you can’t find the right one.'"
After living with the disease for three years, Oltz said she's mostly learned to accept her limitations, but she still worries that her disease will have an impact on how her sons view her.
"I worry ... they’re never going to know how smart I really was," she said. "They see their mom as kind of funny because I have to be."
Oltz said the film was important so that people can understand that it does not just affect the elderly.
“There’s a stigma that they’re grandmas and grandpas, and their life has been lived and they’re done,” she said of stereotypes about Alzheimer patients. “I pray [the film] breaks the stigma.”
Early onset Alzheimer’s disease affects 200,000 people in the U.S., according to the Alzheimer Association. The film “Still Alice” will be released in limited locations this Friday.