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DiversityNursing Blog

Artificially Intelligent Robot Scientist 'Eve' Could Boost Search For New Drugs

Posted by Erica Bettencourt

Wed, Feb 04, 2015 @ 02:08 PM

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Eve, an artificially-intelligent 'robot scientist' could make drug discovery faster and much cheaper, say researchers writing in the Royal Society journal Interface. The team has demonstrated the success of the approach as Eve discovered that a compound shown to have anti-cancer properties might also be used in the fight against malaria.

Robot scientists are a natural extension of the trend of increased involvement of automation in science. They can automatically develop and test hypotheses to explain observations, run experiments using laboratory robotics, interpret the results to amend their hypotheses, and then repeat the cycle, automating high-throughput hypothesis-led research. Robot scientists are also well suited to recording scientific knowledge: as the experiments are conceived and executed automatically by computer, it is possible to completely capture and digitally curate all aspects of the scientific process.

In 2009, Adam, a robot scientist developed by researchers at the Universities of Aberystwyth and Cambridge, became the first machine to independently discover new scientific knowledge. The same team has now developed Eve, based at the University of Manchester, whose purpose is to speed up the drug discovery process and make it more economical. In the study published today, they describe how the robot can help identify promising new drug candidates for malaria and neglected tropical diseases such as African sleeping sickness and Chagas' disease.

"Neglected tropical diseases are a scourge of humanity, infecting hundreds of millions of people, and killing millions of people every year," says Professor Steve Oliver from the Cambridge Systems Biology Centre and the Department of Biochemistry at the University of Cambridge. "We know what causes these diseases and that we can, in theory, attack the parasites that cause them using small molecule drugs. But the cost and speed of drug discovery and the economic return make them unattractive to the pharmaceutical industry.

"Eve exploits its artificial intelligence to learn from early successes in her screens and select compounds that have a high probability of being active against the chosen drug target. A smart screening system, based on genetically engineered yeast, is used. This allows Eve to exclude compounds that are toxic to cells and select those that block the action of the parasite protein while leaving any equivalent human protein unscathed. This reduces the costs, uncertainty, and time involved in drug screening, and has the potential to improve the lives of millions of people worldwide."

Eve is designed to automate early-stage drug design. First, she systematically tests each member from a large set of compounds in the standard brute-force way of conventional mass screening. The compounds are screened against assays (tests) designed to be automatically engineered, and can be generated much faster and more cheaply than the bespoke assays that are currently standard. This enables more types of assay to be applied, more efficient use of screening facilities to be made, and thereby increases the probability of a discovery within a given budget.

Eve's robotic system is capable of screening over 10,000 compounds per day. However, while simple to automate, mass screening is still relatively slow and wasteful of resources as every compound in the library is tested. It is also unintelligent, as it makes no use of what is learnt during screening.

To improve this process, Eve selects at random a subset of the library to find compounds that pass the first assay; any 'hits' are re-tested multiple times to reduce the probability of false positives. Taking this set of confirmed hits, Eve uses statistics and machine learning to predict new structures that might score better against the assays. Although she currently does not have the ability to synthesise such compounds, future versions of the robot could potentially incorporate this feature.

Professor Ross King, from the Manchester Institute of Biotechnology at the University of Manchester, says: "Every industry now benefits from automation and science is no exception. Bringing in machine learning to make this process intelligent -- rather than just a 'brute force' approach -- could greatly speed up scientific progress and potentially reap huge rewards."

To test the viability of the approach, the researchers developed assays targeting key molecules from parasites responsible for diseases such as malaria, Chagas' disease and schistosomiasis and tested against these a library of approximately 1,500 clinically approved compounds. Through this, Eve showed that a compound that has previously been investigated as an anti-cancer drug inhibits a key molecule known as DHFR in the malaria parasite. Drugs that inhibit this molecule are currently routinely used to protect against malaria, and are given to over a million children; however, the emergence of strains of parasites resistant to existing drugs means that the search for new drugs is becoming increasingly more urgent.

"Despite extensive efforts, no one has been able to find a new antimalarial that targets DHFR and is able to pass clinical trials," adds Professor King. "Eve's discovery could be even more significant than just demonstrating a new approach to drug discovery."

The research was supported by the Biotechnology & Biological Sciences Research Council and the European Commission.

Source: www.sciencedaily.com

Topics: science, infections, malaria, A.I, artificial intelligence, robot, scientist, health, healthcare, research, medical, cancer, medicine, patient, treatment

FDA Approves ADHD Drug to Treat Binge Eating

Posted by Erica Bettencourt

Mon, Feb 02, 2015 @ 12:04 PM

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The Food and Drug Administration has approved the use of an attention deficit/hyperactivity disorder drug to treat binge eating.

Should ADHD medication be prescribed to help cut compulsive overeating?

The drug, Vyvanse, is usually used for ADHD but it's been shown to help control binge-eating disorder, the FDA said.

"In binge-eating disorder, patients have recurrent episodes of compulsive overeating during which they consume larger amounts of food than normal and experience the sense that they lack control. Patients with this condition eat when they are not hungry and often eat to the point of being uncomfortably full," the FDA said in a statement.

"Patients may feel ashamed and embarrassed by how much they are eating, which can result in social isolation. Binge-eating disorder may lead to weight gain and to health problems related to obesity."

The drug is not approved for weight loss, and it's a Schedule II controlled substance because it has high potential for abuse and dependence. But any doctor can write a prescription for any approved drug for any use he or she sees fit.

"The concern in our country especially is the desperation to lose weight," said NBC's diet and nutrition editor Madelyn Fernstrom. "Everyone will say, 'Oh, I have binge eating disorder'. I think there's a huge potential for abuse in our country."

Source: www.nbcnews.com

Topics: FDA, weight, ADHD, prescription, prescribed, binge eating, overeating, disorder, health problems, health, healthcare, medication, patients, medicine

TV Anchor Shares Personal News In Heartbreaking Broadcast: 'I have ALS'

Posted by Erica Bettencourt

Mon, Feb 02, 2015 @ 11:55 AM

By Chris Serico

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Larry Stogner, a retiring news anchor for an ABC affiliate in North Carolina, stunned viewers on Friday when he revealed he has ALS.

"For nearly four decades, I have met you right here, usually at 6," the WTVD anchor said during a Jan. 23 broadcast, as a slideshow of his life and career appeared on a screen behind him. "Boy, we've seen a lot of change over those years, but we have to stop meeting this way. I am sure that in recent months, you've noticed a change in my voice; my speech, slower. Many of you were kind enough to email me ideas about what it might be, or just to show concern, and I truly appreciate that. As it turns out, I have ALS, Lou Gehrig's disease."

Stogner added that, last summer, he'd participated in an Ice Bucket Challenge video to help raise awareness and money for the cause. "Little did I know, it was about to change my life," he said. "There is no cure. My career in broadcast journalism is coming to an end."

Married with six children, Stogner joined WTVD in 1976. In addition to conducting one-on-one interviews with Barack Obama, John McCain and other prominent political figures, the Air Force veteran reported live from Raleigh-Durham and beyond — including a 2002 assignment in Afghanistan, according to his ABC11 bio.

In the final minute of the broadcast, Stogner called his WTVD position "the best job in the world," and shared plans to take two weeks of vacation with his wife before returning in early February to share "a few final thoughts and a more personal goodbye."

Flanked by four of his WTVD colleagues, he concluded, "And now more than ever, I say to you, for all those 39 years: Thanks for the company. Have a good night."

Source: www.today.com

Topics: news, Awareness, health, healthcare, disease, medicine, treatment, cure, ALS, ice bucket challenge, TV, cause

The Interspersing of Nursing: A Geographical Look at the Demand for Nurses

Posted by Erica Bettencourt

Thu, Jan 29, 2015 @ 02:09 PM

Nurses are an important part of the medical workforce. They provide crucial supplementary services and are primary caregivers in a lot of industries. As such, the demand for nurses is high, though there are variations according to different states. As the country’s population and access to medicine continues to grow, the demand for nurses does as well.

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Source: http://online.adu.edu

Topics: jobs, demand, Workforce, nursing, health, healthcare, nurse, nurses, health care, medical, medicine, treatment, career, infographic

Pets Find Pain Relief Using Ancient Method Of Acupuncture

Posted by Erica Bettencourt

Wed, Jan 28, 2015 @ 10:24 AM

By MICHELLE CASTILLO

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Pets are getting some pain relief thanks to a centuries-old method that has helped some of their owners: acupuncture.

A dachshund named Samson benefitted from the treatment. Samson was pawed aggressively by another dog at the park and needed surgery immediately. After his first procedure, it was clear he was still in some pain. Doctors recommended a second surgery, but owner Ellie Sutton wasn't so keen to make Samson go under the knife again.

"I wouldn't want to risk something like paralysis," Sutton told CBS News. She decided "to try every other kind of step first."

To her surprise, the veterinarian suggested acupuncture, the traditional Chinese medicine method of inserting needles into the skin to stimulate parts of the body.

Veterinary acupuncturists can use .2 to .3 mm needles that range in length from .5 inches to 1.5 inches on pooches.

"A lot of people come for acupuncture because they've exhausted a lot of the traditional Western medicine roots, whether it's medication or surgery," Dr. Marc Seibert, Samson's vet, told CBS News. Siebert is the owner and medical director of Heart of Chelsea Animal Hospital and Lower East Side Animal Hospital in New York City.

Seibert explained there are two main theories behind how acupuncture works. Eastern medicine teaches that energy flows through channels in the body called meridians. When the meridians are blocked, the person -- or the animal -- experiences physical pain. The acupuncture needles help direct the energy to the correct path.

Western medicine, on the other hand, suggests that acupuncture may help by bringing oxygen to the area that the doctor is trying to treat. Hormones called endorphins, which promote feelings of well-being, are released, and the anti-inflammatory parts of the immune system kick in.

"Most people think of acupuncture as a pain reliever, but it's more than that," says Dr. Ihor Basko, a holistic veterinarian in private practice in Honolulu, certified by the International Veterinary Acupuncture Society in Ft. Collins, Colo., told Paw Nation. "Acupuncture can boost the immune system and improve organ functions, and it has other benefits. It can complement conventional medicines and procedures without dangerous side effects."

Not everyone is convinced the method works. Veterinarian Craig Smith, the complementary-care expert for the American Veterinary Medical Association, told U.S. and World News Report that it's hard to know for sure if canines and felines are feeling relief from their pain.

"While many people treating pets with acupuncture report success, there isn't any data that proves it works," he said.

Ellie Sutton admitted that a lot of the "energy flow" talk is hard for her to believe. But she says Samson has definitely benefited from the treatment.

"The fact is he walks better afterwards," she said.

Source: www.cbsnews.com

Topics: needles, body, animals, pain, acupuncture, pets, pain relief, nurse, medical, medicine, treatment, doctor

Reasons Why Nurses Are Secretly Angels Living Among Us (Part 2)

Posted by Erica Bettencourt

Wed, Jan 21, 2015 @ 11:17 AM

6. …but people still expect them to show up the second they ring the call bell.

...but people still expect them to show up the second they ring the call bell.

7. Sometimes they’re working so hard, they can go entire shifts without eating, drinking water, or sitting.

Lunch break? What’s that?

8. Ditto going to the bathroom.

9. Some patients will incessantly hit on them.

27 Reasons Why Nurses Are Secretly Angels Living Among Us

10. Others will expose themselves for no clear medical reason.

Others will expose themselves for no clear medical reason.
Flickr: eflon / Creative Commons / Via Flickr: eflon

“Your arm is broken… so why is your dick out?”

Source: www.buzzfeed.com

Topics: humor, health, healthcare, nurse, nurses, health care, medical, patients, medicine, treatment, hospitals, career

Seattle Children's Hospital Patients Congratulate the Seahawks

Posted by Erica Bettencourt

Wed, Jan 21, 2015 @ 11:09 AM

By SYDNEY LUPKIN

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Seattle Children's Hospital hallways erupted in cheers and applause this weekend as the Seattle Seahawks played a nail-biter of a game against the Green Bay Packers and officially locked down their spot in Super Bowl XLIX.

And 8-year-old Maria Moore's room was no exception. The recovering leukemia patient watched the game while wearing her Seahawks hat and clutching her signed football. On the table next to her, she propped up a photo of herself with Seahawks quarterback Russell Wilson, who visited her at the hospital in November.

At one point, Maria was so bummed that her team appeared to be losing, she shed a little tear, her dad told ABC News. He told her not to worry, that Wilson and the Seahawks would come back. And they did.

"We were just totally shouting and applauding and hollering and giving high fives to each other," Thomas Moore told ABC News. "It was an amazing gave to watch. She was super excited."

Marie was diagnosed with acute lymphoblastic leukemia in September and initially didn't respond to chemotherapy, but the doctors at Seattle Children's and Fred Hutchinson Cancer Research Center helped get her treatment "recipe" just right, he said. Marie underwent a cord blood transplant on Jan. 2, and is in remission, but should be at the hospital a few more weeks, he said.

"We’ll probably be watching [the Super Bowl] from the hospital, but that's OK," he said. "As long as she's doing well, that’s fine by me."

Nearly every Tuesday, the team's star quarterback, Russell Wilson, visits Seattle Children's Hospital to meet with patients, said hospital spokeswoman Kathryn Bluher. So the team holds an extra special place in the hearts of patients and their families.

Wilson visited Maria the day after flying back from an East Coast game in November, and she was "all smiles," Moore said.

"It makes a bigger fan out of me. I really can't say enough," Moore said. "[Wilson] is a down to earth, really nice guy. He takes time talk to the kids, do pictures, sign some things."

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After Sunday's win, patients at Seattle Children's Hospital took photos with "Congratulations" signs from their hospital beds to show their support.

"It takes their mind of things," Moore said. "It gives them something fun to think about."

Source: http://abcnews.go.com

Topics: Children's Hospital, football, Super Bowl, Seattle, NFL, fans, health, healthcare, nurse, nurses, patients, hospital, medicine, treatment, doctor

Gotta Dance

Posted by Erica Bettencourt

Wed, Jan 21, 2015 @ 10:50 AM

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Moments after Jacob "Jake" Boddie woke from surgery to remove a tumor in his pelvis, his father, Kyle Boddie, said to his 2-year old son, "Hey, Jake, bust a move!" Although he was still groggy, the toddler smiled. One tiny shoulder, then the other, wiggled in time to a beat. 

Kyle and Jake's mother, Ashley McIntyre, say Jake started dancing long before he could walk. "And now that's all he does," Kyle said. "He loves it. You can't stop him."

During his yearlong treatment for a rare cancer, Jake danced with his nurses, child life specialists and doctors at the University of Chicago Medicine Comer Children's Hospital. He boogied in his hospital room, in the hallways, and even on the way to the operating room. His parents say dance helped Jake recover from his treatments and surgery. It helped them cope with their son's illness. 

"Even though Jake went through so much, he uplifted us," Ashley said. "We thought, if he can have fun through all of this, why can't we?"

Kyle and Ashley knew something was wrong when Jake wasn't acting like himself at a Fourth of July picnic in 2013. Agitated and restless, the toddler wasn't his "silly self" and refused to dance or play with the other children. A few days later he began limping. An ultrasound performed in the emergency room at Comer Children's Hospital showed a large mass resting in the lower part of his abdomen and reaching into his pelvis.

A biopsy revealed the mass to be a sarcoma, a fast-growing cancer. "The tumor was 4 inches in diameter, about the size of a small grapefruit," said pediatric oncologist Navin Pinto, MD, an expert on sarcoma treatment. In addition to his clinical work, Pinto leads a personalized medicine initiative at Comer Children's Hospital that is sequencing the genetic makeup of pediatric tumors from every patient to help guide treatment.

For Jake, several rounds of chemotherapy were needed to shrink the tumor to half its original size. It was then small enough to be removed, but Jake's surgery would be complicated. The tumor was wrapped around critical blood vessels as well as the right ureter, a tube that brings urine from the kidney to the bladder. 

On the morning of the surgery in January 2014, Ashley and Kyle danced with Jake to the song "Happy" as they headed toward the operating room doors; there they turned him over to the surgical team. "Jake knew something was going on," Ashley recalled, "but I think it made him feel better to see us laughing and dancing."

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Pediatric urologist Mohan Gundeti, MD, and pediatric surgeon Grace Mak, MD, worked together in the surgical suite. First, Gundeti used an endoscopic approach, placing a stent in the ureter to mark its location and keep the fragile tube open. Mak then surgically removed as much of the tumor as possible, meticulously separating it from the vessels and ureter while avoiding nearby nerves. 

"Jacob recovered beautifully and bounced back quickly after the operation," Mak said, adding, "he was eating -- and doing his moves -- a few days later."

Completing Jake's treatment required both chemotherapy and radiation to eliminate any lingering cancer cells. In addition, the lower section of the right ureter had narrowed, leading to pressure on the right kidney, and needed attention before it became completely obstructed. 

Gundeti performed reconstructive surgery, moving the right kidney down a few centimeters and making a new tube for the ureter using a flap from the bladder. Again, Jake recovered quickly from an extensive surgery.

Today, the 3-year-old visits Comer Children's Hospital regularly for follow-up care with the nurses and doctors who cared for him. 

"He feels comfortable at the hospital; he's always laughing and having a good time," Kyle said. "Everyone knows him now. And everyone dances with him."

Source: www.uchicagokidshospital.org

Topics: surgery, toddler, biopsy, health, healthcare, nurse, nurses, doctors, health care, medical, cancer, hospital, medicine, treatment, physicians, tumor

10 Warning Signs You Are Working with the Wrong Nurse Leader

Posted by Erica Bettencourt

Wed, Jan 14, 2015 @ 01:01 PM

By Cynthia Howard RN, CNC, Phd

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Finding the right nursing job includes finding a manager that will help you grow, develop, and support your career goals.

There is a saying that people leave their managers and not their jobs and to have success in your career may mean you want to circulate your resume in order to find the best fit for you. This means you have to know what you want and need in the area of support.

Here are 10 warning signs you may be working with the wrong manager:

  1. You never hear from your manager prior to your performance reviews. Over 75% of performance problems can be improved with proper feedback and less than 33% of the time, feedback is provided.
     
  2. You have no idea what they want.  This can be worse than not having feedback at all. When a manager says, “I do not like how you did that,” you really have no way of knowing what they really mean. Make sure to ask for clarification. Review your job description and ask for your manager to specify what parts of your job responsibilities are most important to them. It could be they are focused on patient safety and you have an interest in health literacy. Knowing what they want gives you the advantage of focusing your efforts for the greatest gain.
     
  3. It is their way or the highway.  This is a problem for many nurses. Job satisfaction comes with autonomy and the opportunity to solve your own problems as they show up on the job. When a manager consistently tells you what and how to do something, employees quickly turn off their own creativity; more than likely, with an increase in mistakes.

    A nurse who is practicing for 7 years shared a story about his experience on a new unit. His Clinical Specialist was a micro-manager. She told him to give this medication immediately because of incoming admissions. She had poured the med. This went against his better judgment but because he knew she would have a fit, he gave it, to the wrong patient. She was extremely apologetic however the “error” was on him. Do not compromise your judgment for the sake of status quo.
     
  4. Your manager wants you to figure it out.  The opposite of micro-managing is to not manage at all and letting everyone figure it out for themselves. This happens quite a bit leaving the power position to go to the most domineering individuals on the unit. Everyone needs to know the manager is in charge and when needed will make those tough decisions.
     
  5. You could not recognize them if your life depended on it.  If your manager hides behind email or a closed door, having a relationship with your manager will be impossible. Communication and trust is the foundation of a great working relationship.  

    Suggestion for managers: Time is an important commodity and getting around to all your staff can be time consuming. Why not use technology and set up a short video. Most iPhones take excellent video. Take 2-3 minutes every week and share what is going on. You may also want to share something personal about yourself; if you just started juicing, kickboxing, celebrated an anniversary or a milestone with your children. Interview them, show images along your morning run, and share something of yourself in order to make the connection with your staff.

    Suggestion for staff: Make a short video on your unit of a new initiative, gratitude board in the break room, more efficient way to give report, a snippet of rounds, and just a friendly hello from everyone on the unit. You may even want to say thanks and express appreciation; managers are people too!
     
  6. The way out the door is faster than up. If you have a manager that makes any attempt for you to advance your skills difficult, it will be hard to boost your resume. Managers can feel threatened by qualified staff members who want to move up the ladder and may indirectly thwart your efforts to move forward. This is really short sighted on the manager’s part because any manager that turns our qualified leaders actually looks really good to their higher ups given the ongoing need for good talent in any organization.
     
  7. Lack of training.  Being able to do a job well requires the right training. Often it takes the manager to assess the need for training based on performance and outcomes. This relates to the lack of feedback. While every employee really should do their own assessment of what they need to do well and then make the request of their manager, the manager should also be on the lookout for staff that need training and set up opportunities to make this happen.
     
  8. When the manager has obvious “favorites.”  Everyone has preferences in personality style, but when the manager consistently selects one particular individual for all the initiatives, opportunities for advancement, or other assignments that provide variety, the manager is sending a message to others they do not care about your skills or your future.
     
  9. When your manager routinely says, “I’ll think about it.”  Obviously considering all sides of the problem/ situation is important however some managers hide behind this and never make a decision about what is the ideal way to go.  Quickly, this can be frustrating if you are looking for a course of action to solve a problem.
     
  10. When your manager over reacts or criticizes you in front of others.  This is a toxic behavior and is an indication you want to find a new place to work. Quickly this will diminish your self-esteem, leading to resentment and stagnation.

    Knowing what you want in the way of workplace is key and will help you avoid a poor manager. What type of opportunities are you looking for in the workplace? What are your career goals? Evaluate the workplace, ask questions, find out the management style, review a performance appraisal, ask about turnover, and see if you can build a relationship with your new manager.  

Enjoy the opportunity to find a place that truly supports and honors you! 

Source: www.nursetogether.com

Topics: jobs, work, patient safety, job, resume, shift, manager, LPN, performance, clinical specialist, nursing, RN, nurse, nurses, medical, hospital, medicine, practice, career

Baby buried by 2010 Haiti quake: See her now

Posted by Erica Bettencourt

Mon, Jan 12, 2015 @ 10:13 AM

By Elizabeth Cohen

150109162711 baby buried in hait quake see her now cohen 00001717 super 169 resized 600

For 10 days following the 2010 Haiti earthquake, two CNN colleagues and I lived in a tent hospital run by Project Medishare. Our hearts ached as we heard the cries of the injured, as we watched surgeons performed amputations without general anesthesia, as people died in front of our eyes.

But, in the midst of this despair, a miracle arrived at Project Medishare. CNN Senior Photographer Ferre Dollar caught these images seconds after she arrived. Look closely at the center of the photo.

This 4-month-old baby had spent four days alone in the rubble and was unconscious and extremely dehydrated. No one knew if she would live or die. 

But look at her now!

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CNN medical producer John Bonifield and I had the pure joy of seeing this wonderful young lady again last week. Her name is Jenny, and she's 5 years old and a pre-kindergartner in Miami. She can write her name and loves to color and dress up as a princess and is adorable and spunky and smart and funny. 

Here are all the miracles that it took to save her life: 

1. That someone happened to find Jenny in the rubble four days after the quake. 

2. That at a time when vehicles were in short supply, Jenny's rescuers flagged down a car to rush her to the hospital. 

3. That the Medishare team of doctors and nurses, led by Dr. Karen Schneider, an emergency medicine physician at Johns Hopkins, managed to get fluids into her. Jenny was so dehydrated her veins had collapsed and Schneider had to put a needle through her shinbone and directly into her bone marrow to deliver fluids. They didn't have to sedate her -- Jenny was so unconscious she didn't even cry.

4. That Project Medishare found a flight headed immediately to Miami, because she needed surgery the tent hospital couldn't provide. Hospital workers flagged down a UN truck and promised the driver they'd name the baby after her if she got the airport on time. 

5. That the baby, then named Patricia after the truck driver, survived the flight to Miami and the emergency surgery. 

When the baby arrived in Miami, it was presumed her parents were dead. She'd been found in the rubble next to the body of a woman, thought to be her mother. 

But that woman turned out to be her baby sitter. Shortly after the baby arrived in Miami, a couple came forward saying they were her parents. Many people doubted them, thinking they just wanted to get to Miami, but DNA testing showed they were telling the truth and the baby's name was actually Jenny. 

Now Jenny and her parents, Nadine Devilme and Junior Alexis, and her 17-month-old little sister, Naima, live in an apartment in North Miami. Her parents have explained to Jenny that the bumpy scars on her left arm are from when she was crushed in the rubble of the Haiti earthquake. They've told her she's a miracle, that Jesus saved her. 

Jenny nods her head and says she understands. But really she's a little embarrassed by all the attention and just wants to go put on her Cinderella dress and go outside and ride her bike and then draw pictures of big red flowers under a sun and sign her name: 

Jenny Alexis.

Source: www.cnn.com

Topics: rescue, survive, miracle, emergency, earthquake, Haiti, baby, nurses, medical, hospital, medicine, treatment

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