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Eleven New Professors Appointed in Department of Internal Medicine – Yale School of Medicine

Recently, the appointment of ten new professors became official within the Department of Internal Medicine. One professorial announcement from fiscal year 2021 was also recently approved.

Learn more about their journeys to professor below.

Joseph Akar, MD, PhD, was filled with joy when he learned he earned the rank of professor. It fills me with tremendous pride to have my clinical and academic accomplishments acknowledged by my peers in the heart rhythm space, and by aspirational Yale faculty. Being part of this distinguished group gives validation for the hard work over the years.

He contacted his family immediately, he considers his wife Rana his north star throughout his academic journey, and a true force for good. Upon receipt of the news, his son Nedi gave him a huge hug, and then asked for cake.

He loves the feeling of wonder that comes with discovery in the world of academia. Akar credits Yale for having a special place in his heart since he came to New Haven for his residency training. So, coming back home to the institution I love and subsequently being promoted within the Yale family is the crowning achievement of my career, he said.

Fun fact: Akar was born and raised in Beirut, Lebanon. Upon arrival to the U.S. for college, the first phone call to his family was to inform his brother that there is so much green in the U.S., you can practically play soccer anywhere. He is a die-hard soccer fan and huge supporter of the Arsenal Football Club.

Ursula Brewster, MD, loves nephrology. She fell in love with it in Medical School where Dr. Fred Appleton taught the 2nd year nephrology course. He instilled in her a healthy respect for the kidney, and a love for longitudinal patient relationships. While undergoing subsequent clinical training at Yale, she was spoiled by brilliant clinicians who modelled what it was to be a great physician and educator, Brewster said. I trained with so many great people, but I really connected to the nephrology way of thinking, and was star struck by the likes of Dr. Asghar Rastegar and Dr. Mark Perazella.

She is grateful to all those who invested time into making her a better physician and educator. And since she has been at Yale since 1998, she jokes that thats a long list of people. When she found out about her promotion, she snuck over to hug Margaret Bia, MD, professor emeritus of medicine (nephrology), whom Brewster credits as a life mentor and advocate for a generation of women physicians at Yale. When she started at Yale, Dr. Bia was the only other woman in the section, and has been a support, a champion and a friend throughout her entire career.

She derives pride from the fellows that she teaches as the director of the Nephrology Fellowship program. Each year, a new group of brilliant, energetic young physicians start in our nephrology fellowship, and watching them progress through the training program, and into their own careers is such fun. It is a very rigorous program, filled with ups and downs, but each and every year they make me so proud, she said. She loves to hear from them once they are out in practice. She regularly receives texts about great diagnoses they made, academic accolades, and their policy work. But her favorite messages to receive from them are the wedding and baby pictures.

Brewster loves being in academia. Being surrounded by brilliant and passionate people who want to push the edge of our understanding of medicine and the human condition is just thrilling. Watching great minds at work simply never gets old.

But she does need to unplug on occasion, so she goes off the grid. Every summer, her family travels to a small remote lakeside cabin in the Maritimes, Canada.

No electricity, no cell towers, no one else can get there and there is no outside information that comes in. Truly disconnecting from the pace of this job is really important for me to recharge and it has become almost impossible with the EMR. As clinicians, if we have the ability to check on a patient we are worrying about, we will. You cant turn that off. And if we see something wrong, then we have to do something about it. Pretty soon we are spending our time away on EPIC. We all do it. The only way not to is to either have more self-control than I have to not check in the first place or to go so far away you cant check even if you want to. So thats what I do. And its great.

When Sarwat Chaudhry, MD, found out that she was promoted to professor, she thanked three people who were instrumental in her career: Patrick OConnor, MD, MPH, MACP; David Fiellin, MD; and Harlan Krumholz, MD, SM. Dr. Patrick OConnor is my section chief who provided enduring and tireless encouragement; Dr. David Fiellin provided the professional guidance I needed to make it across the promotion finish line; and Dr. Harlan Krumholz interviewed me for the Clinical Scholars Program over 20 years ago and has been a fierce supporter, advocate, and friend ever since, explained Chaudhry. She credits this trio and her other amazing colleagues as her favorite part of academia.

Chaudhry said that it is very validating to have her professional accomplishments recognized as worthy of promotion to full professor by Yale School of Medicines senior faculty. On a practical note, its great that I wont have to go through the review process again! she joked.

During her career, she is most proud of developing insights that can improve the way we provide care for patients and supporting the development of the next generation of physician-scientists.

Fun fact about Chaudhry: She can deadlift 200 pounds!

Lauren Cohn, MD, started her medical career working in the lab studying the immunology of asthma in preclinical models. Her laboratory, along with others, defined the cytokine pathways underlying asthma pathobiology. Pharmaceutical companies took this knowledge to design monoclonal antibody therapeutics to block the pathways. Cohn and team tested the medications in clinical trials, which then led to a use of the therapeutics in the clinic.

My career has spanned a period of remarkable advancement in asthma care, from bench to bedside. I have had a unique opportunity to harness my deep interest in lung immunity, understand some of the mysteries of asthma and offer life-changing therapies to patients with severe asthma and other complex lung diseases, said Cohn.

Her promotion validated her effort to expand the understanding of lung diseases and apply it to patient care. In fact, when she learned about the promotion, she continued with her day, caring for the next patient on her schedule.

Cohn admits the process of learning and sharing in academia is both inspiring and humbling. The academic environment allows me to ask penetrating questions about lung diseases. It provides time to dig deep into understanding my patients, inspiring colleagues who are knowledgeable and committed and who have similar motivations, and then the imperative to disseminate this knowledge by teaching those around me.

Fun fact: Cohn wore a cast on her left leg for much of high school, after breaking her tibia and fibula in a bicycle accident and later in a gymnastics meet. The surgeon told me I wasnt going to win any beauty pageants given my leg. I told him I was going to medical school, so I didnt care, said Cohn.

A cardiologist, Jeptha Curtis, MD, works to improve the quality of care delivered to patients with coronary artery disease and those undergoing percutaneous coronary intervention. Upon learning about his promotion, Curtis enjoyed a brief moment of tremendous satisfaction, and then started the next case. Upon returning home that evening, he has a celebratory drink with his wife, happy that the process is completed. Curtis credits her patience and support for making everything possible.

Throughout his career, he is most proud of the success of his mentees. He loves academia because he can work with some of the smartest and most committed people in the world to have a positive impact on the care of patients with heart disease.

Fun fact: Some people say that Curtis has too many antique cars. He respectfully disagrees.

Neera Dahl, MD, PhD, came to Yale School of Medicine 15 years ago and helped build the clinical polycystic kidney disease (PKD) program. Her nephrology section chief applauded this accomplishment, along with Dahls promotion in an announcement to the team and included one important detail that was unknown to Dahl; that Yales PKD program is now one of the largest in the country.

When notified that she was being promoted to professor, she emailed her PhD thesis advisor. I had just seen her recently as I was in Boston for the National Kidney Foundation meeting, and it was finally safe to connect. I was her first graduate student, and I think at the time we were both a little uncertain of our future success. She went on to do brilliant things and recently retired as acting chair and a tenured professor in physiology, said Dahl.

Dahl appreciated that she took a chance on her, because she admits that she wasnt a very disciplined student at the time. She told me she was stronger for having had me in the lab, and I knew she understood the effort in the achievement, said Dahl.

Dahl knows that the promotion isnt something she achieved alone. It was a group effortpatients, nurses, the clinical trials team, my friends, family, mentors, and colleagues all supported this process. I am celebrating their efforts as well.

Overall, Dahl cites a joy of academia is the ability to teach, informally or formally. She works extensively with fellows and post-grads and notes that they always bring different talents and ambitions to their roles. She said, It is a privilege to be able to shape that raw energy into academic success.

She credits Yale with giving her the resources to create a program from scratch. I have learned that at Yale if I can imagine a program, we can build it. There are many resources that can be leveraged, so its just a matter of holding on until the infrastructure forms underneath you. I am grateful to everyone who has shared or offered resources or advice.

She also acknowledges the administrative staff for their resourcefulness. They are unsung heroes, said Dahl. If you tell them what you need, they can usually create it for youwe've acquired everything from spare furniture to extra closet space to innovative patient-facing scheduling this way.

Fun fact: Dahl is really into bees, butterflies, and hummingbirds, and anything that can be considered a pollinator. She has always enjoyed gardening but during the pandemic, it became an obsession. She tore up parts of her front lawn to make a wildflower meadow and rain garden. Last fall, she planted to extend the season for the early pollinators, and now has been watching with delight as her garden is both blooming in late April/early May and attracting pollinators, although she says that the bees still look cold.

Within medicine, teaching has always been the greatest love of Alfred Lee, MD, PhD. After completing his residency and fellowship training in Boston, he actively pursued faculty positions oriented towards teaching. I chose to return to Yale because of what seemed like an extraordinary commitment on the part of the institution to the teaching mission of academic medicine, far beyond other institutions I looked at, said Lee.

Along with directing the Hematology/Oncology Fellowship Program, Lee also teaches the hematology course for the Yale medical students. In August, he gave the keynote address at the White Coat Ceremony for the incoming first year medical students, where he spoke about the nonlinearity of his own path to becoming a clinician-educator, which saw him exploring career interests in music and science before finding his calling as a physician. I always try to reassure students and trainees that unexpected detours are all part of the natural process of learning and professional development, and that these experiences make us all better doctors and better people in the end. Lee said that his promotion to professor is confirmation that Yale genuinely values teaching as one of its core academic principles.

Two fun facts about Lee:

The favorite part of working in academia for Richard A. Martinello, MD, are the opportunities to collaborate with colleagues and students both within and external to Yale, which have culminated in meaningful scientific advancements, along with the opportunity to impact the processes, practice, and operations at Yale New Haven Health, which improves quality and safety for patients and staff. He also enjoys teaching and mentoring talented, energetic students.

Throughout his career, he is most proud of the research he has done and the teams that he has built and led. Martinello acknowledges that the road he has taken to professor has been a long and challenging journey, with uncertainties, but is proud of his accomplishment. [Being a professor] further cements my role as a mentor and will allow me additional opportunities which I can share with others who are not quite as far down the career path as me, said Martinello.

This path has led him to work with the Department of Veterans Affairs (VA) in different capacities, from working with the VA to lead the response to the 2009 pandemic; participating in the initial development of federal Combatting Antibiotic Resistant Bacteria plans and implementation; and leading the VAs increased involvement to further vaccinate veterans and VA staff. When he was working in the VA Central Office in Washington, D.C., he would attend occasional meetings at the White House, including in the Situation Room.

When he received the news, he had an immediate sense of joy and relief, and shared the news with his wife and family.

Fun fact: Bicycling is Martinellos hobby, and he logs thousands of miles each year. His longest ride to date is 107 miles.

When he found out about his promotion to professor, William Ravich, MD, said he immediately called his wife Elaine, because she had been waiting as long as I had.

To Ravich, being promoted to professor represents a level of recognition for my work that is really appreciated. Traditionally, prestigious medical institutions - including Yale - have been reluctant to promote faculty who are primarily clinicians, to professor, but The Times They Are A-Changin, Ravich said.

His favorite part of academia is teaching in clinic. Ravich believes there is nothing better than sharing his experience and thoughts in the context of trying to solve a patients clinical problem. Taking care of patients is always interesting and challenging but sharing my experience with gastroenterology (GI) fellows, medical residents, and medical students now thats the icing on the cake.

When asked about his career accomplishments, Ravich responded that he was most proud of his expertise in the field of swallowing disorders. Through my experience taking care of patients with difficult swallowing problems, during which I have collaborated with clinicians from a variety of specialties, I have developed what I believe to be a unique perspective on the evaluation and treatment of swallowing disorders.

Fun fact about Ravich: During the 1980s, he served as an informal consultant to the National Zoo in Washington DC. In that capacity he performed endoscopies on a giant panda and an orangutan, lead into publications in the veterinary literature.

When Donna Windish, MD, MPH, found out she was being promoted to professor, she immediately told her husband and 10-year-old son. Because it was two weeks before Christmas, her son convinced her to wait to tell the rest of the family until Christmas Eve. To prepare for the big announcement, he created a video montage of her career in medicine, adding graphics and music, and recording the narration. On December 24, he presented his video tribute. I was surprised what he understood of what I/we do in medicine. It was well-done, so kind, and touching. I cried, admitted Windish.

Her promotion is special. I feel my hard work as a clinician-educator and scholar has been recognized by my peers at Yale and across the country as being important. I hope that my promotion will inspire other clinician-educators to find enjoyment in educational scholarly work and purse their own areas of interest.

Throughout her career, she is most proud of the two programs she developed: the Yale General Internal Medicine (GIM) Medical Education Fellowship Program, and the Department of Internal Medicine Advancement of Clinician-Educator Scholarship (ACES) Faculty Development Program.

The Yale General Internal Medicine Medical Education Fellowship Program started in 2016 and was built from her accumulated experience and ideas of what knowledge, attitudes, and skills a clinician-educator scholar needs to succeed in academic medicine. The fellowship has become a popular option for internal medicine residents looking into academic careers and who want to be scholarly clinician-educators. I truly am impressed at how successful the program graduates have become as clinician scholars, educators, and leaders, said Windish.

In 2019, Windish started ACES, a program is designed to improve the educational scholarship of junior clinician-educators in the department. She used the blueprints of the Yale GIM Medical Education Fellowship program to put this new program forward. Windish is excited to see the ideas of the junior faculty participants come alive in their curriculum development, abstract presentations, publications, grants, and leadership positions.

Fun fact about Windish: She is an avid baker who loves to try new recipes and expand her repertoire. While she has made many desserts over the years, her most favorite are the hand decorated birthday cakes of varying shapes and sizes: trains, cars, bulls, bunnies, video game characters, etc. These cakes were designed for her son, niece, and nephew, but were enjoyed by all, she said. If medicine were not her calling, she thinks she would open a pastry shop!

Eric Winer, MD, was named professor in 2008 during his time at Harvard Medical School. Upon his return to Yale School of Medicine (YSM) earlier this year, he was appointed as professor of medicine (medical oncology) and named the Alfred Gilman Professor of Medicine and Pharmacology.

Being a professor at YSM is meaningful to Winer because New Haven is where he began his career in medicine. He is thrilled to have returned to Yale, where he earned his undergraduate degree, medical degree, and completed his residency training.

It is special to be a Yale professor having attended Yale College and Yale School of Medicine, and then serving as a house officer in internal medicine. When I was a college student, I never thought that I would ultimately become a professor, said Winer.

He loves mentoring residents, fellows, and junior faculty. While at Harvard, he was honored with a lifetime mentoring award, an honor that he was very proud to receive.

An additional source of pride for Winer is both his clinical work that focuses on patients with breast cancer and the research he has done that has led to significant improvements in cancer care.

Fun fact about Winer: He did not take any science as an undergraduate. He majored in history and Russian Studies, but ultimately decided he did not want to work for the CIA.

The Department of Internal Medicine at Yale is among the nation's premier departments, bringing together an elite cadre of clinicians, investigators, educators, and staff in one of the world's top medical schools. To learn more, visit Internal Medicine.

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70 million years on earth, 40 years of decline: the endangered eel – Japan Today

Eels were once so abundant that they were considered a pest, but today the ancient creature is threatened by human activity and risks disappearing altogether, scientists and environmentalists warn.

How have eel populations changed?

Eels appear in human mythology and ancient art, and their bones have been found in tombs dating back thousands of years.

Just thirty years ago, they were so common that in France they were even classed a nuisance, accused of damaging salmon stock and destroying fishing lines.

"When I was young, eels were in every river and estuary," said French researcher Eric Feunteun, a leading expert on the creature.

"My grandmother had a cafe... and sometimes customers who were down on their luck would bring a bucket of young eel to pay for their coffee," he said.

In less than half a century, the situation has changed radically: the European eel's population is now just 10 percent of its 1960-70s level.

"We sounded the alarm in the 1980s," explained Feunteun, a marine ecology professor at France's National Museum of Natural History, but it wasn't until 2007 that the European Union required its members to protect the species.

The European eel now appears on the International Union for Conservation of Nature's critically endangered list, with its Japanese and American cousins just one category behind, on the endangered list.

What threatens eel populations?

The eel's complex life cycle makes it vulnerable to a wide range of human activity, including overfishing of a species that is a much-loved delicacy in Asia.

But that pressure is far from the only thing driving eel decline.

"We've known since the 1980s that there are multiple reasons and that fishing probably isn't the main factor," said Feunteun.

He points out that polluting waterways with contaminants like pesticides, medicines and plasticisers has a much greater effect, including on eels' reproductive capacity.

Habitat destruction also plays a significant role, according to Andrew Kerr, president of the Sustainable Eel Group.

He points to the "draining of three quarters of the wetlands of Europe. And then the one million plus barriers to fish migration in the rivers, like dams."

"So we basically destroyed the eel's habitat. And that's what's really killed it off," he told AFP.

Climate change is also a factor, shifting marine currents that carry eels from their spawning grounds in tropical waters to the rivers and estuaries where they will spend most of their lives.

Longer and slower routes mean higher mortality rates for young eels as they drift towards coastlines.

How are eels being protected?

Since 2012, Japan, China, Taiwan and South Korea have cooperated on conserving the Japanese eel found in their waters, including with fishing quotas.

But fishing limits alone are insufficient, experts say.

Other efforts include programs that range from helping eels over migration barriers, to moving young eels from areas where they are abundant to places where they are in decline.

Elsewhere, dams that can trap, injure and kill eels as they migrate have been adapted, and systems to trace them and interrupt trafficking have also been introduced.

More is needed though, experts say, including on habitat protection.

"It won't take long for the other 16 species of eels to get on the endangered list. So we have to have a global approach to safeguarding the eel," said Kerr.

What about artificial reproduction?

The eel has proved resistant to reproducing naturally in captivity and artificial fertilization is possible but expensive.

"The reproductive rate is low and it takes a long time for the (juvenile) glass eels to grow," said Ryusuke Sudo of the Japan Fisheries Research and Education Agency in the Izu region, southwest of Tokyo.

Scientists have also never observed eel larvae eating in the wild, so their preferred food remains a mystery. They grow slower in captivity and each eel requires individual human intervention to reproduce.

Could the eel disappear?

Eels are believed to have been around for 60-70 million years, and have not diversified much, with just 19 species and subspecies in the Anguilla genus.

For all their longevity, much about them remains a mystery, with scientists only recently pinpointing the first spawning grounds.

In some ways, eels are "super-adapted", said Feunteun. They are able to breed in areas where most fish could not find food, because eel young can feed on "marine snow", dead and decaying plant and animal matter that drifts down the water column.

But the long distances they migrate and disperse leave them vulnerable.

"Seventy million years of existence and 40 years of decline," as Feunteun puts it.

Still, he holds out some hope.

"It's a species that has shown during previous climatic changes that it can rebound from very few individuals," he said.

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Covid-19 Live News and Updates – The New York Times

Heres what you need to know:Genomic sequencing can detect and track virus variants, but the United States is sequencing relatively few coronavirus test samples. Lab technicians at Duke University prepared samples for sequencing earlier this month.Credit...Pete Kiehart for The New York Times

As Americans anxiously watch the spread of coronavirus variants that were first identified in Britain and South Africa, scientists are finding a number of new variants that seem to have originated in the United States and many of them may pose the same kind of extra-contagious threat.

In a study posted on Sunday, a team of researchers reported seven growing lineages of the coronavirus, spotted in states across the country. All have gained a mutation at the exact same spot in their genes.

Theres clearly something going on with this mutation, said Jeremy Kamil, a virologist at Louisiana State University Health Sciences Center and a co-author of the new study.

Its not clear yet whether this shared mutation makes the variants more contagious, but because it appears in a gene that influences how the virus enters human cells, the scientists are highly suspicious.

I think theres a clear signature of an evolutionary benefit, Dr. Kamil said.

Its not unusual for different genetic lineages to independently evolve in the same direction. Charles Darwin recognized convergent evolution in animals. Virologists have found that it happens with viruses, too. As the coronavirus branches into new variants, researchers are observing Darwins theory of evolution in action every day.

Its difficult to answer even basic questions about how prevalent the new variants are in the United States because the country sequences genomes from less than 1 percent of coronavirus test samples. The researchers found examples scattered across much of the country, but they cant tell where they first arose.

Its also hard to say whether the variants are spreading now because they are more contagious, or for some other reason, like holiday travel or superspreader events.

Scientists say the mutation could plausibly affect how easily the virus gets into human cells. But Jason McLellan, a structural biologist at the University of Texas at Austin who was not involved in the study, cautioned that the way that the coronavirus unleashes its harpoons was still fairly mysterious.

Its tough to know what these substitutions are doing, he said of the mutations. It really needs to be followed up with some additional experimental data.

Vaccinations are picking up pace. The spread of the coronavirus in the United States has slowed drastically. The Centers for Disease Control and Prevention is urging K-12 schools to reopen safely and as soon as possible.

But just as states are again lifting mask-wearing mandates and loosening restrictions, experts fear that more contagious variants could undo all that progress.

That threat seems only to grow as researchers learn more. British government scientists now believe the more contagious variant that is ravaging Britain is also likely to be deadlier than earlier versions of the virus, according to a document posted on a government website on Friday. An earlier assessment on a smaller scale warned last month that there was a realistic possibility the variant was more lethal.

The variant, also known as B.1.1.7, is spreading rapidly in the United States, doubling roughly every 10 days, another recent study found.

In line with an earlier warning from the C.D.C., the study predicted that by March the variant could become the dominant source of coronavirus infection in the United States, potentially bringing a surge of new cases and increased risk of death.

Beyond that, scientists reported on Sunday that they have begun to spot more new variants that seem to have emerged in the U.S. and are concerned that they may spread more readily than earlier versions.

Vaccine distribution is accelerating the U.S. is now averaging about 1.66 million doses a day, well above the Biden administrations target of 1.5 million but B.1.1.7 has a worrisome mutation that could make it harder to control with vaccines, a Public Health England study found this month.

The variant has spread to at least 82 countries, and is being transmitted 35 percent to 45 percent more easily than other variants in the United States, scientists recently estimated. Most people who catch the virus in Britain these days are being infected by that variant.

The British research on B.1.1.7s lethality did come with caveats, and the reasons for the variants apparently elevated death rate are not entirely clear. Some evidence suggests that people infected with the variant may have higher viral loads, a feature that could not only make the virus more contagious but also potentially undermine the effectiveness of certain treatments.

But government scientists were relying on studies that examined a small proportion of overall deaths. They also struggled to account for the presence of underlying illnesses in people infected with the new variant, and for whether the cases originated in nursing homes.

Bill Hanage, an epidemiologist at Harvard University, said that although we do need to have a degree of caution in looking at the findings, its perfectly reasonable to think that this is something serious I am certainly taking it seriously.

Its pretty clear we have something which is both more transmissible and is more worrying if people become infected, he said.

Angela Rasmussen, a virologist at Georgetown University, said relaxing restrictions now would be courting disaster. She urged Americans to be extra vigilant about mask wearing, distancing and avoiding enclosed spaces.

You dont want to get any variant, Dr. Rasmussen said, but you really dont want to get B.1.1.7.

The United States confirmed its first case of the B.1.1.7 variant on Dec. 29. Unlike Britain, it has been conducting little of the genomic sequencing necessary to track the spread of new variants that have caused concern, though the Biden administration has vowed to do more.

On Friday, for the fifth time in six days, the number of new virus cases reported in the United States dipped below 100,000 far less than the countrys peak of more than 300,000 reported on Jan. 8.

As the number of virus cases and hospitalizations has fallen, the Republican governors of Montana, Iowa, North Dakota and Mississippi have recently ended statewide mask-wearing mandates. In New York, Gov. Andrew M. Cuomo, a Democrat, has allowed indoor dining to resume at 25 percent capacity, though experts have repeatedly warned that maskless activities, such as eating, in enclosed spaces are high-risk.

Although virus case numbers are moving in the right direction, the loosening of restrictions has unnerved experts like Saskia Popescu, an epidemiologist at George Mason University in Virginia.

Now more than ever, with novel variants, we need to be strategic with these reopening efforts and be slow and not rush things, she said.

The director of the Centers for Disease Control, Dr. Rochelle Walensky, tried on Sunday to build support for reopening schools, even in districts with high infection rates and before vaccinating teachers, political sticking points for the Biden administration.

In a round of appearances on the morning news shows, Dr. Walensky promoted her agencys new guidelines for schools, seeking to build confidence that the Biden administrations strategy could satisfy teachers and parents alike and fulfill the new presidents promise to reopen schools by his 100th day in office.

We hadnt previously had the science in order to inform how to open safely, Dr. Walensky said on Fox News Sunday. We didnt have the data, and prior we didnt have any guidance as to how to do it safely, so we are really anticipating with this guidance emerging, that schools will be able to start reopening.

She reiterated her earlier, controversial statement at a news briefing that scientific data supported the idea of reopening schools before teachers were vaccinated but she also noted that the C.D.C.s advisory panel on vaccines recommended that states consider teachers to be essential workers, placing them high on the priority list.

The Biden administration is juggling demands to open schools as soon as possible with teachers concerns about safety. Earlier this month, teachers unions objected to Dr. Walenskys comment about teachers not needing to be vaccinated before schools reopened. The comment also drew a rebuke from the White House press secretary, Jen Psaki, who said Dr. Walenskys remark was made in her personal capacity.

The guidelines issued on Friday offered a chance for a reset, by outlining strict and expensive safety measures, like cleaning, mask wearing, contact tracing, frequent testing and social distancing.

But on Sunday, Dr. Walensky acknowledged that few schools were currently up to the task, without a significant infusion of federal funds.

Not all schools are able to do all of those things right now, she said on CNN, and many of those schools are in red zones, referring to communities with high infection rates. We need to do the work to get all of those mitigation strategies up and running in all of the schools.

transcript

transcript

Its a very important day for us, weve been waiting for it, this pandemic took a great toll. Weve had a lot of cases, a lot of fatalities in Lebanon. So were really looking forward to the vaccine to hopefully see some light at the end of the tunnel. Privileged. Excited. Happy that this is happening, that it is happening to Lebanon. A good thing for once. Its working. And I look forward to everybody being able to get the chance to get it too.

BEIRUT, Lebanon Lebanon began vaccinating its citizens against Covid-19 on Sunday, offering a rare glimmer of hope in a country suffering badly from several overlapping crises, just one of which is the pandemic.

The first shot was administered to the director of the intensive care unit at the lead government hospital fighting the pandemic. The second was given to a famous 93-year-old comedian.

The vaccination drive began after Lebanon received its first batch of 28,500 doses of the Pfizer-BioNTech vaccine. Using $34 million in financing from the World Bank, Lebanon is buying enough doses to vaccinate about two million people, roughly one-third of its population. Millions more doses are expected to arrive in the spring and summer through a United Nations program and commercial sources.

Lebanons worst coronavirus surge peaked in mid-January, when the country was averaging more than 4,800 newly reported cases a day, according to a New York Times database; the average has since fallen somewhat, to about 2,700 a day. Some 337,000 people in Lebanon almost 5 percent of the population are now known to have had the virus, and more than 3,900 have died.

To try to drive the numbers down, the government imposed a very strict lockdown in mid-January, with a 24-hour curfew and widespread shop closures. It eased the restrictions slightly last week, but the curfew largely remains in effect.

The suffering caused by the pandemic has been compounded by a political crisis that has left Lebanon without an effective government for six months, and a financial crisis that has drastically weakened the local currency, making imported medicines, food and other products more expensive.

A huge explosion in the port of Beirut last August also made matters worse, heavily damaging four hospitals, killing 200 people and leaving thousands more wounded.

global roundup

transcript

transcript

These new cases pose questions our public health staff are working around the clock to answer. We dont yet have a complete picture of the potential source of the infection and spread, if any, beyond one household. And we are waiting for the genome sequencing and serology, both of which will provide important pieces of this puzzle. As of 11:59 p.m. tonight, Sunday, Feb. 14, Aukland will move to Level 3 for a period of three days, until midnight on Wednesday. The rest of New Zealand will move to Level 2 for the same period of time. The main thing we are asking people in Auckland to do is to stay home to avoid any risk of spread. That means staying in your bubble other than for essential personal movement. People should work from home unless that is not possible. If you go outside your home, please maintain physical distancing of two meters outside. Or if youre in a controlled environment where you know others present, one meter. Im asking New Zealanders to continue to be strong and be kind. I know we all feel the same way when this happens. We all get that sense of, not again. But remember, we have been here before. That means we know how to get out of this again. And that is together. If you know someone in Auckland, reach out, please check on them. And if youre in Auckland, please check on your neighbors, ensure theyre looked after and supported. And finally, as Ive said all the way through this, ultimately, please remember, we are going to be OK.

AUCKLAND, New Zealand Faced with the creeping threat of more infectious coronavirus variants, Australia and New Zealand have responded to a small number of cases with near-immediate regional lockdowns.

On Sunday night, as couples celebrating Valentines Day strolled arm-in-arm through central Auckland, Prime Minister Jacinda Ardern of New Zealand announced that the city would begin a three-day lockdown at midnight because of three unexplained positive test results in a single family. The rest of New Zealand would be subject to increased physical distancing requirements over the same period, she said.

Ms. Ardern said Monday that all three cases were the variant first detected in Britain, and that its higher transmissibility meant the government had been absolutely right to order the lockdown. Australia has also suspended quarantine-free travel with New Zealand for at least 72 hours over the new cases.

Separately, both countries said Monday that they had received their first shipments of the Pfizer vaccine.

New Zealand has had almost no virus-related restrictions since the fall, when it successfully eliminated the virus for a second time. Over all, the country has reported 2,330 coronavirus cases and 25 deaths, far fewer in proportion to its population than most other developed nations.

The Australian state of Victoria has also been placed in a short-term lockdown in response to a small outbreak, which began at a quarantine hotel and has grown to 16 cases. During the lockdown, which began at 11:59 p.m. Friday and is intended to last five days, most of Victorias six million people are not allowed to leave home except for limited periods of outdoor exercise or shopping. Professional tennis players who are in Melbourne, the state capital, for the Australian Open are considered essential workers and have been allowed to continue playing their matches, albeit without fans in attendance.

Like New Zealand, Australia has had relatively few infections and deaths, and acts aggressively at the first sign of new outbreaks. Similar snap lockdowns in the Australian cities of Perth and Brisbane were successful recently at quashing transmission.

Announcing the Auckland lockdown on Sunday, Ms. Ardern said, Our view is, youll have less regret if you move early and hard than if you leave it and it gets out of control.

In other news around the world:

The start of ski season in Italy is delayed, the health minister Roberto Speranza announced. Citing the spread of a coronavirus variant, Mr. Speranza said amateur skiing was forbidden through at least March 5, The Associated Press reported. Italys last ski season was halted as the country became a coronavirus epicenter last spring, and it hasnt restarted since then. This years closure is another blow to an industry that generates 1.2 billion euros, or $1.5 billion, in annual revenues.

Portugal, which until the last few days had been enduring one of the worlds worst coronavirus surges, has prolonged its Covid-19 state of emergency. The extension, until at least March 1, comes as new daily cases fell over the weekend to their lowest level since late December, while the latest daily death toll, 138, is the lowest since Jan. 11. Still, Portugals Covid-19 death toll now stands at 15,321. By comparison, Greece, which has a roughly equal population of about 10 million, has recorded 6,126 deaths.

Japan issued its first approval for a vaccine against the coronavirus on Sunday, saying that it would use the Pfizer-BioNTech vaccine to begin inoculating frontline health care workers this week. Japan has been slower than the United States and Europe to authorize any coronavirus vaccines, but it has also had the luxury of time. Public health measures have successfully kept case rates low and the countrys economy has suffered less than others. It showed a sharp rebound, growing 3 percent, in the last three months of 2020. But the growth was fragile and could easily be disrupted, analysts cautioned.

New Yorkers with chronic health conditions that made them newly eligible for the Covid-19 vaccine flooded a state website and call center Sunday morning, leaving many unable to immediately schedule appointments at mass vaccination centers.

State officials said on Sunday that 73,000 appointments had been scheduled as of 11:30 a.m., while 500,000 people went through an online eligibility screening tool needed to make appointments. Thousands were in virtual waiting rooms that can hold up to 8,000 people per vaccination site. Once those waiting rooms are full, people attempting to schedule appointments are told to try again later.

Richard Azzopardi, a senior adviser to Gov. Andrew M. Cuomo, said demand was high, but our infrastructure has remained up and intact. He said that the states ability to make appointments depended on the vaccine supply, which is steadily increasing.

Officials said the new criteria, which include chronic health conditions like obesity and hypertension, made four million more New Yorkers eligible for the Covid-19 vaccine. They join a growing number of people in the state who are eligible for the vaccine despite a shortage in supply.

Those who are now eligible include adults who have certain health conditions that may increase their risk of severe illness or death from the coronavirus. Aside from obesity and hypertension, other conditions that would qualify New Yorkers for the vaccine include pulmonary diseases and cancer, Mr. Cuomo announced this month. He also made pregnancy a qualifying condition.

Appointments for people who are in this group can be scheduled for as early as Monday, though most people will probably face a long wait because vaccine doses are scarce now. New Yorkers must provide proof of their condition with a doctors note, signed certification or medical documentation, Mr. Cuomo said.

While this is a great step forward in ensuring the most vulnerable among us have access to this lifesaving vaccine, its no secret that any time youre dealing with a resource this scarce, there are going to be attempts to commit fraud and game the systems, Mr. Cuomo said in a statement.

In New York State, about 10 percent of the population has received its first dose, according to data gathered by The New York Times. With the new criteria, about 11 million people are now eligible in the state, including people ages 65 and older, health care workers and teachers over half the state population.

New York City recently opened mass vaccination sites at Yankee Stadium in the Bronx and Citi Field in Queens to better reach communities hit hard by the virus. The state and federal government also announced last week that the Federal Emergency Management Agency would open vaccination sites at Medgar Evers College in Brooklyn and York College in Queens.

To check on eligibility and schedule an appointment, New Yorkers can complete a prescreening on the states website. They can also call the states vaccination hotline at 1-833-NYS-4VAX (1-833-697-4829) for more information about vaccine appointments.

Phila Lachaux, a 22-year-old business student in France, dreamed of striking out on her own in the live music industry. But the pandemic led to the loss of her part-time job as a waitress, and sent her back to live at her family home.

Now, struggling to envision a future after months of restrictions, Ms. Lachaux says that loneliness and despair seep in at night. I look at the ceiling, I feel a lump in my throat, she said. Ive never had so many suicidal thoughts.

With curfews, closures and lockdowns in Europe set to drag into the spring or even the summer, mental health professionals are growing increasingly alarmed about the deteriorating mental state of young people.

Last in line for vaccines and with schools and universities shuttered, young adults have borne many of the sacrifices made largely to protect older people, who are more at risk from severe infections.

Across the world, the young have lost economic opportunities, missed traditional milestones and forfeited relationships at a pivotal time for forming identity.

Many feel theyre paying the price not of the pandemic, but of the measures taken against the pandemic, said Dr. Nicolas Franck, the head of a psychiatric network in Lyon, France. In a survey of 30,000 people that he conducted last spring, young people ranked the lowest in psychological well-being, he said.

In Italy and in the Netherlands, some youth psychiatric wards have filled to record capacity. In France, professionals have urged the authorities to consider reopening schools to fight loneliness. And in Britain, some therapists said that they had counseled patients to break lockdown guidelines to cope.

In the United States, a quarter of 18- to 24-year-olds said they had seriously considered suicide, one report said. In Latin America and the Caribbean, a survey conducted by UNICEF of 8,000 young people found that more than a quarter had experienced anxiety and 15 percent depression.

We are in the midst of a mental health pandemic, and I dont think its treated with near enough respect, said Arkadius Kyllendahl, a psychotherapist in London who has seen the number of younger clients double in recent months.

If you are having thoughts of suicide, the following organizations can help.

In Britain, call Papyrus at +44 800 068 4141 (9am to midnight), or message Young Minds: text YM to 85258. You can also find a list of additional resources on Mind.org.

In France, call SOS Amiti at +33 9 72 39 40 50 (24/7) or Fil Sant Jeunes at +33 800 235 236 (9am to 11pm). Ameli has a list of additional resources.

In Italy, call Telefono Amico at +39 2 2327 2327 (10am to midnight) or Telefono Azzurro at +39 19696 (a webchat is also available).

A team of experts selected by the World Health Organization to investigate the origins of the coronavirus returned last week from Wuhan, China, site of the worlds first outbreak. Having broken the ice with Chinese scientists, the team plans to produce a joint report on the possible origins of the virus.

The two groups of scientists agreed to pursue some ideas that the Chinese government has been promoting, like the possibility that the virus was transported on frozen food. But the W.H.O. team also became frustrated by Chinas refusal to turn over raw data for analysis.

Peter Daszak, a member of the W.H.O. team and the president of EcoHealth Alliance in New York, is primarily concerned with the animal origins of the virus. A specialist in animal diseases and their spread to humans, Dr. Daszak has worked with the Wuhan Virology Institute, a collaboration that last year prompted the Trump administration to cancel a grant to his organization.

In an interview after his return to New York, he said that the visit had provided some new clues, which all of the scientists, Chinese and international, agreed most likely pointed to an animal origin within China or Southeast Asia. The scientists have largely discounted claims that the virus originated in a lab, saying that possibility was so unlikely that it was not worth further investigation.

He reflected on the atmosphere in Wuhan and his first glimpse of the seafood market where the initial outbreak occurred last year, although it was not the site of the first cases. He also said the path ahead would be straightforward scientifically, but not politically.

The W.H.O. investigation was the subject of a sharp exchange over the weekend between the U.S. and Chinese governments. Jake Sullivan, the national security adviser, said Saturday that the Biden administration had deep concerns about its early findings and how they were communicated.

It is imperative that this report be independent, with expert findings free from intervention or alteration by the Chinese government, he said in a statement.

In response, the Chinese government asked whether the United States could be considered a credible partner in the matter, having only recently rejoined the W.H.O. after withdrawing during the Trump administration.

What the U.S. has done in recent years has severely undermined multilateral institutions, including the W.H.O., and gravely damaged international cooperation on Covid-19, the Chinese Embassy in Washington said in a statement.

But the U.S., acting as if none of this had ever happened, is pointing fingers at other countries who have been faithfully supporting the W.H.O. and at the W.H.O. itself, it continued. With such a track record, how can it win the confidence of the whole world?

Austin Ramzy contributed reporting.

WHEELING, W.Va. After nearly a year in lockdown for the residents of Good Shepherd Nursing Home eating meals in their rooms, playing bingo through their television sets and isolating themselves almost entirely from the outside world their coronavirus vaccinations were finished and the hallways were slowly beginning to reawaken.

In a first, tentative glimpse at what the other side of the pandemic might look like, Betty Lou Leech, 97, arrived to the dining room early, a mask on her face, her hair freshly curled.

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Dissecting Anatomy Lab: The Lifecycle of Anatomy Instruction – Pager Publications, Inc.

Editors Note: We are featuring a series of essays by Kate Crofton on anatomy lab. Her essays are based on 27 interviews with medical students, faculty, clinicians and donors. This is the third installment in the series. Read the second installment here.

It is the day before the first anatomy lab for the first-year medical students, and a single professor walks alone, up and down rows of tables laden with twenty-six naked, embalmed bodies. He silently shares a few minutes with the donors, a private thank-you. Soon the donors will be covered in white sheets, and the students will tentatively spill through the locked wooden doors of the labs, a rush of anticipation, teamwork, questions and learning. But right now, no one makes a sound. There is no buzzing of saws, whirring of the suction machine, or gentle clinking of hemostats and Metzenbaum scissors against the metal tables, no nervous laughter, exclamations of discovery or confused mumblings.

The professor will be joined by an eclectic team of his colleagues. They are educators who use dead people as their teaching medium. They spend hours on end in rooms reeking of formaldehyde. Above all, they care deeply about doing their work with respect. With their turquoise gloves, blue paper surgical shoe covers, rainbow of expo markers, memorized atlas page numbers, thoracic spine necklaces, golden dissecting scissors and pockets full of little colored wires, they will help each student learn to find their way.

These professors find beauty in anatomy: the relationships of the structures to each other, the functionality of the human body, unique variations and even pathology. The brachial plexus dissection is a favorite of one professor, a lab which reveals a complicated bundle of nerves branching and recombining to serve the arm. For another, the most beautiful structures are the hands and the head, the parts worn outside of clothing that express personality and individuality. They love the search for structures: When you first look at the tissue, it looks like a messnon-descript gauze. There is no real reason to think there are nerves or vessels running through that. But then once you find them and then you see how tightly packed things are, you realize just how incredible it is.

Another instructor asserts that her upbringing in a family of hunters contributed to her early interest in anatomy and her understanding of the place of death in the lifecycle. My brothers and my dad hunted, and so from the time that I was really little, I was used to seeing deer butchered in our garage. I was struck by the intricacy and the beauty of how a body could be put together and function properly I can remember my mom buying one pound of ground beef, and she would make our meals for the week goulash, Spanish rice, things that would spread it out. I realized that deer put meat on our table and kept deer from starving; it managed the population. Death is a natural part of life.

My dad and brother are also deer hunters, and I remember deer carcasses hanging in my dads shop during my childhood. I perched on overturned five-gallon buckets amidst sawdust and pine two-by-fours and watched as my dad sliced away the hide and wrapped chunks of bloody meat in crisp white freezer paper. I loved the warm, buttery taste of venison and intuited more easily then the cycling of life into death into life again. The deer were beautiful, running through our hay fields, and they were beautiful still as carved up slabs of meat in the deep freezer.

To find beauty in the anatomy lab might seem crass; after all the mechanical process of disassembling the donor is brutal, and at the end the body is a carcass, a dried-out pile of flayed skin and bones. Professors acknowledge this difficulty, I am always intrigued by different things that I see in the lab beautiful dissections and I know the word beautiful is sometimes a complicated word in that space Youre right, its by seeing many donors over time that you come to appreciate that were all the same, theres a pattern, but were also all unique. Everybody has an interesting story, and their body often tells that.

I interrogate the professors for a list of the most fascinating anatomy theyve seen. They oblige with developmental abnormalities: situs inversus, horse-shoe kidneys, bifid muscles, extra blood vessels and abnormal arrangements of nerves. They also mention impressive pathology: swollen cirrhotic livers, big black lymphatic balls of cancer, white hardened atherosclerotic plaque, occluded coronary vessels and cerebral hemorrhages. They recount biomedical devices and remnants of medical procedures, too, a demonstration of medicines advances to thwart pathology: coronary bypasses and stents, pacemakers, orthopedic prosthetics and deep-brain-stimulating electrodes.

I ask one professor if theres any anatomical anomaly that hes still hoping to see in his career. He gently chides, No, its not like Im going to go out looking for donors to have things that Im interested in; thats not the point. And I realize that I have indeed missed the point. The anatomists dont see donors as collections of interesting or rare anatomy but instead see them as their partners in teaching us.

The anatomy instructors are guardians. One professor explains that she feels a deep sense of responsibility to take care of the donors so that they may teach her students, Its funny, Ive described myself as the curator of those donors. I feel like Im a caretaker of sorts. When I walk into that anatomy lab, I find it to be a very comforting space. When I go in there its quiet and I think about the various lives that are represented by the donors in there, and I think about that gift that they were willing to share to let all of you learn.

I picture an art gallery, with paintings carefully framed on the walls. The anatomy instructor appears, robed in a long white coat and blue scrubs, hair held in place precisely with a barrette. She softly dusts each painting, adjusts the lighting, and adds a placard underneath each one so that it may be better understood. My job is to make sure that all of them are cared for well and that they are the best learning tool for all of you to learn that anatomy and have it be memorable.

The relationship between professor and donor can prompt reflection and even conflict, in the professor. When a young medical professional died of a drug overdose and donated his body to medical education, it provoked one lab instructor to be more reflective than usual. An eighty-seven-year-old died of a heart attack Ive heard that one before, but a twenty-seven-year-old is there something thats fundamentally been lost even more in the twenty-seven-year-old? For whatever reason I did stop and think more and feel a little bit sad, not to the point of tears, but sad and reflective.

She pauses, and then continues, I also felt grateful and then felt a little sick about feeling grateful because that dissection was really beautiful. It looked so much like [the anatomy textbook] a lot of the time the muscle integrity, color, shading, shape and distinction. Things werent blending together, there was no marbling of fat infiltrating the muscles. It was such a beautiful, easy dissection and the students learned so much.

These professors didnt always have such mature relationships with the donors. One faculty member recalls her first experience in an anatomy lab as a student, looking at the donor and thinking, I dont know if I recognize you as a personor a dissection tool. I relate deeply to her memory, and it resonates also with many of my interviews with students. As novices in anatomy, its much more difficult and requires a more deliberate effort to switch between viewing the cadaver as a body and as a person. I am cutting the body, and the person is gone, but the person chose for the body to be here. Its clunky. The professors are more fluid with this duality and coexist with it in a more peaceful way.

When I ask the same professor whether she now views the donor as a person or a body she responds with an analogy: Its like electrons in orbitals. They can be in one place but never in-between. I try to maintain respect for what I imagine as the person that they were in the decision that they made to be here, the life that they had. But at the same time, I dont believe theyre alive anymore or have any sort of soul inhabiting whats left. Theres all this meat and bones left behind, but theres nothing that can be hurt or embarrassed. The donors are gifts, teaching tools, partners and even friends, extending an invitation to come learn.

The anatomy lab is not an immediately comfortable place for everyone, and even the professors, whom we view as our seasoned guides, once needed to habituate to the space. An instructor recalls her first time leading an anatomy course, I had a really profound visceral response to every dissection. For the first half hour walking in there, I felt nauseated, I felt faint. I always made sure I was bracing myself on a table or against a wall just in case, and I didnt admit it to anyone because I was in charge. I recollect my own experience in lab, repeating a silent mantra mind over matter as the room clouded over and the din grew distant, willing myself to remain vertical. Mind over matter carried me through the course for weeks, and I left the lab each day feeling like a soggy balloon, sapped of all emotional reserves.

The professor continues, Ive been trying to figure out what changed. My first time [as a student] I was fine, and this time Im falling apart and not admitting it to anyone. I think a couple things the crazy amount of stress of trying to learn anatomy, run the course and teach all at the same time. Also, in that instructor role, you cant immerse yourself in dissection. Youre walking from one table to another and watching as people make these incisions and take things apart, and you dont have control over it yourself.

She describes being in lab one day when students were dissecting the lower extremity. At that point, the legs had been severed from the trunk of the body, and they were propped at ninety-degree angles to practice the anterior drawer test. A living person might assume the same position, perhaps strewn out on the sofa reading a book, feet on the cushions and knees bent in the air. It didnt feel right, because it [aligned] too much with what I think an intact human looks like. She adapted and the second year developed strategies to be more comfortable as an instructor in the space. I knew that if I could reduce the smell, that helps. I got Vicks Vapor Rub, and I would wear a mask that year. I realized that getting hands-on as soon as possible helped, so I made sure to get in on someones dissection as soon as I got in the room. Partly just seeing it again and again, I habituated.

To our instructors, the donors are far more than dead bodies; they are teachers. Textbooks and plastic models only represent our notion of typical, but donors show us great variation. In an even voice with steady conviction, an anatomy instructor explains, I see [the donors] silently saying Bring the book over here, and if you dont see it, change the book because this is real. The anatomical donor population provides an immediate education of what we currently understand about how human bodies function and some of the ways they stop functioning. The donors inform our knowledge and make us better scientists and clinicians.

They also move us to be better people. Groups in power have historically used pseudoscientific arguments to justify their social status. For example, in the 1800s Samuel George Morton thought that it was possible to define the intellectual ability of a race by skull size. Rigorous scientific methods and access to good data have refuted his racist claims. If our anatomy is all the same, then how can biology determine the inherent superiority of one class of people? As one professor believes, the donors show us the importance of inclusion and respect for all human beings. There used to be quite a bit of wrong speculation of how bodies were put together and how they functioned. Over the past century, we finally have moved into an understanding of how things really work, and the donor population is a large part of the reason why we now understand.

The donors help us understand anatomy, and they also help us come to terms with our own mortality. I ask one professor if anatomy has changed his view of death. He tells me no, rather its the opposite; because of donors, his personal grief has emerged in the classroom. The year that his father died, the first day of class fell on his fathers birthday and there happened to be a cadaver in lab that resembled the professors father. A first-year student in that class had recently lost his mother to breast cancer. When the student peeled back the white sheets in preparation for anterior dissections, he discovered a breast-less chest bearing the scars of a mastectomy, and so we bothhad these acute reminders of the grief that we were going through. When the same professors wife of thirty-eight years died of colon cancer, he knew that he would need to take extra care in order to be able to teach the gastrointestinal anatomy. Well its not like all twenty-six cadavers died of colon cancer. So it wasnt something every day that I had to deal with. The stress for me is the teaching part; I want to make sure that Im doing a good job You put things aside, and you cant be thinking about grief and the death of someone all the time, you just wouldnt be functional. Its not that I intentionally put it aside, its just other things become more important in the moment and then I go home and think about it.

Anatomy instruction has both accelerated and become more humanistic over the last fifty years. A professor contemplates his first anatomy course as a student in the 1970s, I can remember that there were students who put clothes on their cadavers. Surprisingly there was not a lot of student reaction to that; people just werent as thoughtful or as sensitive about it as they are now. We didnt do it, but someone did it to our cadaver. Thats probably my most vivid memory. Decades later, he shifts uneasily in his chair and his eyes moisten. Some of our professors rules make more sense now. Photography is not allowed in the gross anatomy labs, only medical students may enter the locked space, and we are warned to treat the donors with respect for their personhood.

He continues reminiscing, Although [medical school] had a body donation program, we also had unclaimed bodies. Our cadaver was African-American, and Im going to guess that he was unclaimed just from the wear and tear. So thats changed now too, the anatomical program has changed. Anatomical gift programs really began to get formalized in the mid-20th century and werent really codified well until the 1960s. All the cadavers used at our medical school today are donated. I try to imagine what it would feel like to dissect a body that was discarded at the hospital or county morgue, perhaps because the decedents family couldnt afford to pay a bill. It feels ugly. I am grateful for my donors gift of his body, and also immensely grateful that it was a gift. The professor agrees that he is much more comfortable with our exclusively donor-based anatomy program.

A students time in anatomy lab today is abbreviated compared to our professors educations. [My medical anatomy class] had three hundred hours. When I first came here in 1985 we had a one hundred ninety hour [anatomy] course and one hundred sixty [of those hours] were laboratory. We are down now to less than one hundred hours of lab. Surprisingly the detail [that we teach you] hasnt changed that much. We had to become more efficient. Our education today prioritizes early clinical exposure and multi-disciplinary learning. A consequence though, is that it is more difficult for the anatomy professors to get to know their students, and theres less time for students to process the experience as they rush to learn all the material.

What do our anatomy instructors want us to learn? Hopefully some basic anatomy, replies a professor, but I know that unless you are using it, its going to disappear. So, Im sure that if I started asking you questions I laugh nervously, and stammer, please dont desperately trying to remember the branching of the cranial nerves in case he does quiz me. Maybe he has a skeleton in his office that he will pick up, pointing to the pinprick fossa of the skull? But he continues, More importantly is when you get to the clerkships during your third and fourth years and someones going to ask you some anatomy do you know where to go to review that? Have we made you a good learner?

Other professors respond, We need to have excellent physicians,and to bean excellent physician you have to know anatomy. The best way to teach anatomy is through dissection.

Equally important, youve learned about yourselves.

You have to learn teamwork, patience, perseverance, humility and gratitude.

Its these moments: watching lightbulbs go off for students as they make a connection across disciplines or overcome challenges, that come up again and again as our teachers biggest joys. Ive always been motivated to teach, and that stems from when I was a little kid taking swimming lessons. By the time that I graduated from tadpole to polliwog, I would help as a teachers aide for the group behind me. I loved when people were able to gain a skill, and I found being part of that process to be very rewarding. I always felt somehow that teaching needed to be part of what I would do for a living. Teaching forms a key part of their identities.

And so, I am surprised, though maybe I shouldnt be, that when I ask if they want to be anatomical donors when they die, a high proportion of our professors responds with an emphatic YES. (One says that if hes healthy enough, hed prefer to be an organ donor. Others qualify that theyd personally be interested in whole body donation but would need to take their familys needs into account, and some havent yet settled on their end of life wishes.) These are people who know with staggering detail everything that happens in the anatomy lab. They know the entire series of maneuvers of the gloved fingers, scalpels, scissors, chisels, and saws required to deconstruct and study what may someday be their cold, bloodless bodies on the dissecting tables.

Its because I know exactly what happens in that space that its important to me. I realize how thorough the dissections are, I realize how much students can learn, I realize how memorable those experiences are, and I realize that it is a space for learning more than just anatomy. If I can support that for one more year, thats incredibly important to me.

I imagine that I am again a first-year student several weeks into gross anatomy lab, and the funeral director visits my table to tell us about our donor. How startling it would be to learn that the body that we had been dissecting belonged to an anatomy professor. One instructor tells me that she loves the ideal of the reveal, Its meta an anatomy professor teaching anatomy again, thats so cool. I am also hoping that it will give comfort to students who feel uncomfortable knowing that theyre dissecting donors who didnt know all the details. [For example] were going to bisect your pelvis thats the one that gets most people to know that most people in the room didnt know that, but heres someone who knew all the nitty gritty details of what was going to happen, and they chose it anyway. I hope that it would give them comfort. They are teachers in life and teachers in death.

Image Credit: Courtesy of the National Library of Medicine. Image is in the public domain.

Contributing Writer

University of Rochester School of Medicine and Dentistry

Kate Crofton is a fourth year medical student at the University of Rochester School of Medicine and Dentistry in Rochester, New York, class of 2021. In 2016, she graduated from Carleton College with a Bachelor of Arts in biology. In her free time, she enjoys writing poetry, reading narrative nonfiction, and baking sourdough. After graduating medical school, Kate intends to pursue a career in OB/GYN.

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Dissecting Anatomy Lab: The Lifecycle of Anatomy Instruction - Pager Publications, Inc.

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The mistrusted medical miracle: Vaccines have revolutionized health, but some still question their safety – Charleston Gazette-Mail

In 1775, Gen. George Washington was fighting two enemies. His visible enemy was the British, with whom the Colonists had begun fighting at the battles of Lexington and Concord. Washingtons second enemy was invisible, but deadlier than British muskets: smallpox.

A smallpox epidemic threatened Washingtons Continental Army. Fortunately, Washington had experience with the disease (he had caught and survived smallpox while in the Caribbean Islands) and sought to have his troops inoculated.

Inoculation was new and controversial in Colonial America, even outlawed in places. It didnt help that the method of inoculation practiced at the time was risky. Called variolation, the procedure entailed making a small incision in a patients arm and inserting a dose of the live virus large enough to trigger immunity but small enough to prevent severe illness or death, writes Andrew Lawler in an April 2020 National Geographic article.

But Washington was a firm believer in the science-based treatment. While soldiers already in the army were given a choice (and many refused), Washington insisted that all new recruits be inoculated. By the end of 1777, some 40,000 soldiers had been vaccinated.

A compelling case can be made that his (Washingtons) swift response to the smallpox epidemic and to a policy of inoculation was the most important strategic decision of his military career, Lawler quotes historian Joseph Ellis as saying.

This story touches on the dilemma of immunization as a medical treatment. On the one hand, vaccines have saved millions of lives. Yet despite being applauded as a medical miracle, vaccines have always generated a level of public distrust.

This is not a new problem. It has waxed and waned ever since weve had vaccines, said Dr. Christopher Martin, a professor in the West Virginia University Schools of Public Health and Medicine. Martin also serves on the West Virginia COVID-19 Vaccine Medical Advisory Group.

When it comes to vaccine hesitancy, people fall along the spectrum. At one end are people like me, who love vaccines. Whenever a new vaccine comes up thats indicated for me, I get it right away, Martin said.

Theres another group at the other end of the spectrum that are completely resistant to any kind of data or argument. Theres nothing you can say. As my Irish father used to put it, you might as well save your breath to cool your porridge.

But most people fall somewhere in the middle. These are the ones Martin tries to reach. Calling someone anti-science isnt helpful, he said. We have to tailor the message. In focus groups it came out that West Virginians concern is I dont want to be told to have this vaccine. They are concerned about personal liberties.

Thats why our theme for the COVID vaccine is that its a choice. We try to get people to understand what a powerful decision they can make to protect themselves.

A brief look at how vaccines developed in this country can shed light on the present cultural divide.

While variolation can be traced back to ancient China, it is Edward Jenner who is generally credited with devising the first vaccine. In 1796, he inoculated a 13-year-old boy with the vaccinia virus (cowpox) and demonstrated that it gave immunity to smallpox. The practice quickly became widespread.

Louis Pasteur began experimenting with attenuated vaccines in the late 1800s. Attenuation takes an infectious pathogen (a bacteria or virus) and makes it less virulent. Although weakened, the pathogen is still viable.

Pasteur developed a rabies vaccine in 1885. His research led to other attenuated vaccines, including ones for cholera, anthrax, measles, mumps, rubella and yellow fever.

Attenuated vaccines are in contrast to inactivated vaccines where a killed, nonviable version of the germ is used. Generally, inactivated vaccines do not provide long-term immunity; additional shots could be necessary (the annual flu shot is an example).

Over the next 200 years, mass implementation of the smallpox vaccine led to the disease being eradicated globally in 1979 one of the greatest successes of modern medicine.

Research for a polio vaccine began in the 1930s. Jonas Salk was the first virologist to become a celebrity after he developed an inactivated polio vaccine in 1954.

Polio is a disabling disease caused by the poliovirus. It can infect a persons spinal cord, causing paralysis and sometimes death.

Children are especially vulnerable, and 1950s American families were terrified of the disease. It was said fear of polio was second only to fear of the atom bomb. An epidemic in 1952 resulted in more than 21,000 paralytic cases and more than 3,000 deaths, according to the Centers for Disease Control.

In 1955, a nationwide polio inoculation campaign began for schoolchildren, sponsored by the March of Dimes. But the campaign was quickly suspended when it was discovered that Cutter Laboratories in California had produced defective batches of the vaccine.

Cutter was one of five companies producing the polio vaccine. A flaw in the labs manufacturing process led to batches of vaccine being distributed where the virus was not inactivated. As a result, more than 200,000 children received a polio vaccine that contained live, viable virus. It was later determined that the faulty batches caused an estimated 40,000 cases of polio, with about 200 cases leading to paralysis. Ten children died.

As tragic as these numbers were, they were a small fraction of the casualties caused by natural polio each year during this period.

The incident led to tighter federal regulations overseeing the production of vaccines. Pharmaceutical companies made improvements to their production processes and applied more rigorous safety testing. The inoculation campaign was resumed and polio cases began to drop.

The Salk vaccine was later replaced by an oral attenuated vaccine. Many of the Baby Boom generation remember lining up as schoolchildren in the 1960s to swallow a sugar cube dosed with the polio vaccine.

By 1979, there were no new cases of polio originating in the United States. The World Health Organization and other groups are still working to eradicate polio globally.

Not surprisingly, Cutter Laboratories was taken to court over its botched rollout of the vaccine. In the landmark case they were declared not at fault, but still liable for their product. This liability without negligence decision would have major repercussions for the pharmaceutical industry.

Dr. Paul A. Offit addressed the mixed legacy of this legal precedent in his 2005 book, The Cutter Incident: How Americas First Polio Vaccine Led to the Growing Vaccine Crisis. He contends that the verdict in the court case against Cutter made vaccine manufacturers an easy target for litigation and huge monetary awards from juries.

Such litigation persisted despite overwhelming consensus from the scientific and health communities that vaccines were low risk and that adverse effects were rare. Pharmaceutical companies began to shy away from vaccine research and manufacturing because of liability issues.

Pharmaceutical and biotech companies continued to be hauled into court throughout the 1970s and 1980s, and supplies were threatened. By 1985, for example, only one company was still making the pertussis vaccine (for whooping cough) a critical vaccine for childhood safety.

Vaccines were the first medical product almost completely eliminated by litigation, Offit said, discussing his book in an American Enterprise Institute video in 2006.

Congress saw that action was needed to protect vaccine manufacturers and health care providers and passed the National Childhood Vaccine Injury Act in 1986, which included the National Vaccine Injury Compensation Program.

This law created a special vaccine court to handle disputes and shield vaccine manufacturers from most lawsuits. The law was upheld in a Supreme Court ruling in 2011.

Despite this protection, vaccine shortages became an intermittent problem. Offit gives more examples. In 1998, the tetanus vaccine was in such short supply that its use was restricted to emergency rooms. The flu season of 2003-2004 began early and created a demand that exceeded supply. The following year proved even worse with 30 million fewer doses of flu vaccine than the year before.

There have been shortages of nine of the 12 vaccines routinely given to children including the vaccine for meningitis (pneumococcus).

Parents could only hope that their children werent among the thousands permanently harmed or killed by pneumococcus every year, Offit writes.

Lyme disease is a bacterial infection transmitted to humans through the bites of certain types of ticks. Symptoms include fever, fatigue, joint pain and rash. Left untreated, the disease can lead to serious joint and neurological complications. The CDC says cases are on the rise. EPA studies show that climate change is likely a factor in increasing the range of ticks that carry infection.

Only one company has ever marketed a Lyme disease vaccine. SmithKline Beecham (now GlaxoSmithKline) licensed the LYMErix vaccine in 1998, and would end up distributing some 1.5 million doses.

Anecdotal reports surfaced of people who said they developed arthritis after getting the vaccine. Lyme disease itself can cause chronic arthritis, but controlled case studies did not show a higher incidence of arthritis as an adverse effect of the vaccine.

An advisory panel by the Food and Drug Administration confirmed this conclusion, as did a report from the National Institute of Allergy and Infectious Diseases, which concluded that the rate [of arthritis] was not shown to be elevated among vaccine recipients.

According to CDC statistics, some 23% of adults in the U.S. get some form of arthritis (in West Virginia, the figure is 33.6%). In all likelihood, the people who developed arthritis would have done so regardless of whether they received the vaccine or not.

Even though no credible evidence surfaced to link the vaccine to these claims, that didnt stop anti-Lyme vaccine groups from forming or media outlets from carrying their anti-vax message to the general public. A class action lawsuit was filed on behalf of 121 people.

It was a fiasco that has really never occurred to any other vaccine, said Dr. Stanley Plotkin, an emeritus professor of pediatrics at the University of Pennsylvania and veteran vaccine researcher, in a 2019 Scientific American article.

With demand dampened by the distrust and backlash, the company pulled the LYMErix vaccine from the market in 2002. Today, 20 years later, there still is no available human vaccine for Lyme disease.

While Lyme disease is not deadly, the same cant be said of COVID-19. But a significant segment of the population is showing hesitancy over receiving either of the two COVID-19 vaccines currently being distributed.

Advances in immunology, microbiology and molecular genetics have led to new categories of vaccines in recent years. Both the Pfizer/BioNTech and Moderna COVID-19 vaccines approved by the FDA for emergency use are made from messenger RNA (mRNA).

These vaccines are different from traditional vaccines discussed above, in that they do not contain either weakened attenuated virus or inactivated virus proteins.

Instead, mRNA uses synthetic genetic material that encodes a harmless piece of viral protein in this case, the spike protein in the SARS-CoV-2 coronavirus.

The synthetic mRNA issues this code to the bodys cells and teaches them to build the protein, which triggers the bodys immune response, the same as with a natural infection. This builds up our immunity to the virus. How long this immunity will last is still unknown.

The Pfizer and Moderna vaccines are the first mRNA vaccines to advance through all the clinical trial stages and be approved for use.

These vaccines use a new platform [mRNA], but theres no additional risk, Martin said. Long before COVID came out, we had done the science. All the pioneering work has been done.

In fact, research into mRNA vaccines has been ongoing for decades. If there was a real problem with the technology, wed have seen it before now for sure, said Michael Goldman, a professor of immunology and director of the Innovative Medicines Initiative, in Horizon, a European Union research and innovation publication.

Some people have expressed concerns, not with the mRNA platform as such, but with the compressed time frame in which COVID-19 vaccines were rushed into production.

But one of the advantages of the mRNA platform is speed. It takes far less time to produce a synthetic mRNA vaccine than with traditional vaccines.

Also, as Martin points out, in this case the companies began manufacturing the vaccines before clinical trials were completed. They did steps in parallel, which was a financial risk, not a safety risk, Martin said.

There is nothing different about the clinical studies that were done. Ive had both doses. The only negative experience for me is knowing its not yet available for more people.

Martin adds that psychological considerations come into play surrounding vaccine hesitancy. Nothing is risk free, he said. But we arent very good at perceiving risk accurately. Subjectively, doing nothing feels safer. People feel that doing something making a choice to get the vaccine is more risky. But it is clear that if you dont get vaccinated, you are at greater risk.

After releasing its instructions to the cells, the mRNA is quickly broken down by enzymes and does not enter the nucleus of a cell. Its not DNA. It has nothing to do with your genetic material, Martin said. And its not possible to get COVID from the vaccine.

Allergic reactions are possible, but very, very rare. If it happens, a reaction is entirely manageable. Vaccination clinics are easily equipped to handle that.

Some people have reported mild symptoms, particularly after the second shot. In a statement, the FDA said that the most commonly reported side effects, which typically lasted several days, were pain at the injection site, tiredness, headache, muscle pain, chills, joint pain, and fever ... more people experienced these side effects after the second dose than after the first dose.

But Martin takes issue with calling these side effects. You might feel unwell or have a low-grade fever, he said. Thats not a side effect thats the primary effect. Thats just your immune system at work. It means you are going to be one of the 95% who are protected.

Scientists question whether COVID-19 will ever be eradicated, as with smallpox, or even largely eliminated, as with polio. What is certain is that, whatever happens, vaccines and the publics willingness to trust them will play a major role.

Ultimately, overcoming a pandemic isnt just about science. Its about culture and the perceptions that people bring to science.

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The mistrusted medical miracle: Vaccines have revolutionized health, but some still question their safety - Charleston Gazette-Mail

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Lodge named inaugural Blasingame professor – Washington University School of Medicine in St. Louis

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Professorship supports research into development of antifungal drugs, vaccines

Jennifer Lodge, PhD, the vice chancellor for research at Washington University in St. Louis, has been named the inaugural David T. Blasingame Professor.

Jennifer K. Lodge, PhD, the vice chancellor for research at Washington University in St. Louis and a leading expert in fungus that can cause a potentially fatal brain infection, has been named the inaugural David T. Blasingame Professor. She also serves as the senior associate dean for research and a professor of molecular microbiology at the School of Medicine.

The new professorship, funded by Washington University, was created to honor the extraordinary contributions of David T. Blasingame, who led the universitys Alumni & Development Office for 28 years until his retirement in 2018.

Lodge was named to the professorship by Chancellor Andrew D. Martin and David H. Perlmutter, MD, executive vice chancellor for medical affairs, the George and Carol Bauer Dean of the School of Medicine, and the Spencer T. and Ann W. Olin Distinguished Professor.

I am delighted to be recognizing Dr. Jennifer Lodge with a professorship honoring the legacy of David Blasingame, Martin said. Both of these distinguished individuals have long histories of extraordinary contributions to the university, and it is a pleasure to recognize those contributions with this professorship. The new professorship will support and facilitate the important work that Dr. Lodge continues to perform including her outstanding leadership of the universitys research programs during these unprecedented pandemic times as well as the vital research she has conducted over her long and distinguished career. At the same time, we are recognizing the dedication of David Blasingame in his tireless commitment to raising vital funds for the university over his many decades of service.

Lodge studies a type of fungus called Cryptococcus neoformans that typically causes lung disease that can spread through the blood to the brain in people. The fungal infection can cause meningitis in patients who are immune-compromised, and it kills an estimated 180,000 people each year. Her expertise is focused on the fungal cell wall, which is required for the fungus to grow and determine how the fungus interacts with the host. Understanding these processes could lead to new antifungal treatments and vaccines.

She is the author of over 75 scientific papers and, since 1997, her work has been funded continuously by the National Institutes of Health (NIH). In her administrative roles, Lodge also leads the massive research infrastructure across Washington University, and most recently has focused considerable efforts navigating the unprecedented circumstances and pressures the COVID-19 pandemic has placed upon the universitys research labs.

Not only is Dr. Lodge a talented and productive scientist, she has done extraordinary work in her leadership of research for the medical school and the rest of the university, including tremendous work during the pandemic, Perlmutter said. We could not have had more capable leadership supporting our research programs, often times with essential services that otherwise go unrecognized and especially during this unprecedented time. Research is an essential part of everything we do, and Jennifer Lodge has been incredibly skilled in supporting interdisciplinary research projects that bring together collaborators across many departments, securing new potential funding opportunities, and maximizing the benefits of the universitys continuing investments in research and the infrastructure required to support it.

Lodge is an elected fellow of the American Association for the Advancement of Science, the American Academy of Microbiology and the National Academy of Inventors. In 2014, she graduated from the Executive Leadership in Academic Medicine program at the university, and in 2015, she received the Academy of Science St. Louis Trustee Award. She has served as chair of the Group on Research at the Association of American Medical Colleges and serves on several editorial boards and NIH review panels.

It is an honor to receive this professorship recognizing the extraordinary contributions of David Blasingame, Lodge said. The support from the university will help continue my labs research into a debilitating and deadly infection. It also has been a tremendous honor to guide the extraordinary response of the universitys research community to this pandemic. Our researchers have spectacularly risen to the challenge posed by the virus from donating protective equipment to our front-line health-care workers, to pivoting work in their labs to focus on COVID-19, to adhering to our public health guidelines so that we can productively continue our important research mission.

Lodge earned her bachelors degree from Oberlin College in 1979 and her doctorate in biomedical sciences from Washington University in 1988. She continued her postdoctoral training at both Washington University and what was then Monsanto. She began her career at Saint Louis University School of Medicine, where she went on to serve as associate dean for research, from 2005 to 2009.

In 2009, she joined the Washington University faculty in the Department of Molecular Microbiology and also became the School of Medicines associate dean for research. In 2014, she was named vice chancellor for research for the entire university. In this role, she oversees university investments in research on the Medical and Danforth campuses, and oversees research compliance, education, grants and contracts.

Blasingame

Blasingame, a native of Little Rock, Ark., arrived as a freshman at Washington University in 1965 and went on to earn a bachelors degree in psychology and then a Master of Business Administration. Blasingame served in the U.S. Army and then returned to the university in 1974 as associate director of alumni relations. He was director of development for the John M. Olin School of Business from 1978 to 1985 and then named associate vice chancellor for alumni and development programs. In 1990, he was appointed vice chancellor of the department, and in 2004, he became executive vice chancellor.

Blasingame has a long history of success in leading campaigns supporting Washington University. In 2018, when Leading Together: The Campaign for Washington University ended, the program had raised more than $3.3 billion, surpassing the campaigns initial goal of $2.2 billion. His achievements in university advancement have been recognized with several awards, including the Lifetime Achievement Award from the Association of Fundraising Professionals in St. Louis and the Circle of Excellence Award from the Council for the Advancement and Support of Education.

I am so grateful for this professorship established in my name and could not be more pleased for Jennifer Lodge to serve as the inaugural holder, Blasingame said. While at Washington University, I saw the incredible passion and commitment our faculty bring to their work, and I had the distinct privilege of sharing news of their tremendous accomplishments with our alumni and friends. To have my name associated with our facultys life-changing scholarship, teaching, and research and with an institution that has meant so much to me is a very special honor.

Washington University School of Medicines 1,500 faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Childrens hospitals. The School of Medicine is a leader in medical research, teaching and patient care, ranking among the top 10 medical schools in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Childrens hospitals, the School of Medicine is linked to BJC HealthCare.

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