FDA has informed customers about the possible quality concerns associated with specific surgical gowns. Last week, Cardinal Health, a company that manufactures medical devices, released a statement notifying the public regarding the quality concerns related to its Level 3 surgical gowns and the packs used to keep these gowns.
Cardinal Health provides no guarantee regarding the sterility of these surgical gowns and PreSource surgical packs used for them. The company and the Food and Drug Authority have suggested that customers should stop the use of these affected products instantly.
Cardinal Health has collaborated with the FDA for analyzing the origin and effects of these quality concerns. In any health care facility, surgical gowns are found to be beneficial in providing barrier protection and preventing moderate to high risk of contamination.
On the basis of the functioning of their liquid barrier, surgical gowns have been divided into four categories, providing barrier protection of different intensities. Among these, Level 3 surgical gowns are being used in knee replacement or open-heart surgeries, offering moderate risk protection.
Wearing surgical gowns prevents transmission of particulate matter, body fluids, and microbes, providing protection to not only patients but also health care professionals. FDA and Cardinal Health are working together to deal with quality health concerns related to these products.
They will make an effort to understand the possible impact of these surgical gowns and packs on the users and patients. The team will also identify the particular lots that are affected and their affect on the supply chain.
Right now, FDA is majorly concerned about the potential contamination of Cardinal Health’s medical products and has suggested customers avoid their use. FDA’s spokesperson said that the company would also inform the public about the specific products affected and issue a recall.
The disruption in the supply chain of these products can also affect patient care. In health care facilities like hospitals, this matter may even lead to the cancellation of non-elective surgical treatments. FDA is dedicated to alleviating any harmful effects in the patients as a result of this concern. But currently, there isn’t any evidence regarding the harm caused by this concern.
Many FDA-approved alternatives for these level 3 surgical gowns are also available in the market that provides protection at the same level. The Food and Drug Administration will proceed with its collaboration with Cardinal Health and warn customers about the impact of these concerns on the supply chain of these medical products and the possible shortages.
FDA motivates healthcare facilities to provide them with data regarding possible or actual supply concerns. The authority’s device shortages mailbox ([email protected]) permits patient, user, organization, or manufacturer to notify FDA of any delay in the product distribution or anticipated shortage.
FDA added that it will keep on monitoring the situation and will keep the public informed of the evolving situation.
About Cardinal Health
Cardinal Health, Inc. is a company that provides healthcare products and services at a global level. It supplies its clinically-proven medical devices and solutions to physician offices, pharmacies, hospitals, clinical laboratories, health systems, and ambulatory surgery centers.
The death of Supreme Court Justice Ruth Bader Ginsburg — and the insistence of President Donald Trump and the GOP-led Senate to fill that vacancy this year — could have major implications for health care. The high court will hear yet another case challenging the constitutionality of the Affordable Care Act the week after the November election, and a long list of cases involving women’s reproductive rights, including both abortion and birth control, are working their way through lower federal courts.
Meanwhile, scandals at the Department of Health and Human Services continue to surface, such as the case of a media spokesperson for the National Institutes of Health who criticized his boss’s handling of the pandemic via a conservative website. And the Centers for Disease Control and Prevention continues to struggle with its credibility, after posting and then taking down another set of guidelines, this one concerning whether the COVID-19 virus is spread through aerosol particles.
This week’s panelists are Julie Rovner of Kaiser Health News, Anna Edney of Bloomberg News, Kimberly Leonard of Business Insider and Mary Ellen McIntire of CQ Roll Call.
Among the takeaways from this week’s podcast:
The Supreme Court’s upcoming ACA case was brought by Republican state officials seeking to invalidate the law based Congress’ elimination of the penalty for not having insurance, a provision that the court once used to uphold the law because it was considered part of Congress’ right to impose taxes.
Many legal experts believe that even if the high court were to decide that the loss of the penalty invalidates the individual mandate to get insurance, other parts of the law should be able to stand. But it’s not clear conservatives on the court will agree.
With so much emphasis on the ACA’s insurance marketplace, the expansion of the Medicaid program for low-income people and protections for people with preexisting conditions, many consumers don’t realize that the law touches nearly all aspects of health care, including guarantees of preventive services, insurance practices and even requirements for calorie counts on restaurant menus.
Ginsburg’s death could also influence efforts to undermine abortion rights. Two cases are already before the court, one involving the ability of doctors to remotely prescribe drugs that can end a pregnancy and a Mississippi ban on abortions after the 15th week of pregnancy.
As the nation marks more than 200,000 deaths from the coronavirus, the “What the Health?” panel looks at problems in the U.S. effort to fight COVID-19, including flip-flops on the need for masks, inconsistent messaging from different parts of government and the politicization of science.
The Centers for Disease Control and Prevention’s decision to remove guidance on the coronavirus’s ability to spread through the air created more concerns about the politicization of the federal government’s scientific studies. The controversy over the agency’s work is a stark change from the past, when the CDC was considered among the least politicized parts of the government.
It may take years after these coronavirus controversies for the CDC to restore its credibility with the public, no matter who is elected president.
Trump has touted his efforts to lower prescription drug prices, and last week The New York Times reported that the administration tried unsuccessfully to get drugmakers to send a $100 gift card to all seniors to help cover the costs of their medicines. The companies objected because, among other reasons, they were worried the move could be seen as an effort to help the Trump campaign.
This week, Rovner also interviews KHN’s Sarah Jane Tribble, whose new podcast, “Where It Hurts,” drops Sept. 29. The podcast chronicles what happens to a small rural community in Kansas after its local hospital closes.
Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:
SANTA CRUZ, Calif. — California will allow public health officials to participate in a program to keep their home addresses confidential, a protection previously reserved for victims of violence, abuse and stalking and reproductive health care workers.
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The executive order signed by Democratic Gov. Gavin Newsom late Wednesday is a response to threats made to health officers across California during the coronavirus pandemic. More than a dozen public health leaders have left their jobs amid such harassment over their role in mask rules and stay-at-home orders.
“Our public health officers have all too often faced targeted harassment and stalking,” wrote Secretary of State Alex Padilla in a statement. This “program can help provide more peace of mind to the public health officials who have been on the frontlines of California’s COVID-19 response.”
A community college instructor accused of stalking and threatening Santa Clara health officer Sara Cody was arrested in late August. The Santa Clara County sheriff said it believes the suspect, Alan Viarengo, has ties to the “Boogaloo” movement, a right-wing, anti-government group that promotes violence and is associated with multiple killings, including the murders of a federal security officer and a sheriff deputy in the Bay Area. Thousands of rounds of ammunition, 138 firearms and explosive materials were found in his home, the sheriff’s office said.
In Santa Cruz County, two top health officials have received death threats, including one allegedly signed by a far-right extremist group.
In May, a member of the public read aloud the home address of former Orange County health officer Nichole Quick at a supervisors’ meeting and called for protesters to go to her home. “You have seen firsthand how people have been forced to exercise their First Amendment. Be wise, and do not force the residents of this county into feeling they have no other choice than to exercise their Second Amendment,” said another attendee. Quick later resigned.
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Protesters angry over mask mandates and stay-at-home orders have gone to the homes of health officers in multiple counties, including Orange and Contra Costa.
The executive order would allow health officials to register with the Secretary of State’s Safe at Home program. Those in the program are given an alternative mailing address to use for public records so that their home addresses are not revealed.
Threats of violence have added to the already immense pressure public health officials have experienced since the beginning of the year. Amid chronic underfunding and staffing shortages, they have been working to limit the spread of the coronavirus, while also deflecting political pressure from other officials and anger from the public over business closures and mask mandates.
“California’s local health officers have been working tirelessly since the start of the pandemic, using science to guide policy,” said Kat DeBurgh, the executive director of the Health Officers Association of California. “It is regrettable that this order was necessary — but we are grateful for it nevertheless.”
Nationwide, at least 61 state or local health leaders in 27 states have resigned, retired or been fired since April, according to a review by The Associated Press and KHN, a figure that has doubled since the newsrooms first began tracking the departures in June.
Thirteen of those departures have been in California, including 11 county health officials and the state’s two top public health officials.
Dr. Sonia Angell, former director of the California Department of Public Health and state public health officer, quit in early August after a series of glitches in the state’s infectious disease reporting system caused weeks-long delays in reporting cases of COVID-19.
In Placer County, north of Sacramento, health officer Dr. Aimee Sisson resigned effective Sept. 25 after the county Board of Supervisors voted to end its local COVID-19 health emergency. “It is with a heavy heart that I submit this letter of resignation,” she wrote in her resignation letter. “Today’s action by the Placer County Board of Supervisors made it clear that I can no longer effectively serve in my role.”
Organizations across the state have expressed concern over the treatment of health officials during the pandemic, including the California Medical Association.
“Basic science has become politicized in so many parts of our state, and our country,” wrote California Medical Association president Dr. Peter N. Bretan Jr. in a statement after Sisson’s departure. “Public health officers are public servants who seek to do what their job description states — to protect public health.”
The executive order also directs the state to assess impacts of the pandemic on health care providers and health care service plans, and halts evictions for commercial renters through March 31, 2021, among other pandemic-related matters.
KHN and California Healthline correspondent Angela Hart contributed to this report.
Most Americans have never heard of Dr. Richard Whitley, an expert in pediatric infectious diseases at the University of Alabama-Birmingham.
Yet as the coronavirus pandemic drags on and the public eagerly awaits a vaccine, he may well be among the most powerful people in the country.
Whitley leads a small, secret panel of experts tasked with reviewing crucial data on the safety and effectiveness of coronavirus vaccines that U.S. taxpayers have helped fund, including products from Moderna, AstraZeneca, Johnson & Johnson and others. The data and safety monitoring board — known as a DSMB — is supposed to make sure the medicine is safe and it works. It has the power to halt a clinical trial or fast-track it.
Shielding the identities of clinicians and statisticians on the board is meant to insulate them from pressure by the company sponsoring the trial, government officials or the public, according to multiple clinical trial experts who have served on such panels. That could be especially important in the pressure-cooker environment of COVID vaccine research, fueled by President Donald Trump’s promises to deliver a vaccine before Election Day.
As pharmaceutical companies work to produce one as quickly as possible, the board’s anonymity has stirred concerns that the cloak of secrecy could, paradoxically, allow undue influence. Whitley, for example, represents the specialized world these experts inhabit — a professor revered in academia who also is paid by the drug industry.
Any political pressure to rush pharmaceutical companies or lean on federal regulators to prematurely greenlight a vaccine would undermine a system put in place to ensure public safety. Calls are growing for companies and the government to be more open about who’s involved in reviewing the vaccine trials and whether board members have any conflicts of interest.
“We want to know they’re truly independent,” said Dr. Eric Topol, director of the Scripps Research Translational Institute and a specialist in clinical trials. “The lack of transparency is exasperating.”
Data and safety monitoring boards have existed for decades to vet new drugs and vaccines, acting as a backstop to help ensure unsafe products don’t make their way to the public. Typically, there’s one board for each product. This time, a joint DSMB with 10 to 15 experts will review unblinded data across trials for multiple coronavirus vaccines whose development the U.S. government has helped fund, according to five people involved in the Trump administration’s Operation Warp Speed or other coronavirus vaccine work. It is run through the National Institute of Allergy and Infectious Diseases at the National Institutes of Health and consists of outside scientists and statistical experts, not federal employees, NIH Director Francis Collins said on a call with reporters.
“Until they are convinced that there’s something there that looks promising, nothing is unblinded and sent to the FDA,” Collins said. “I doubt if there have been very many vaccine trials ever that have been subjected to this size and the rigor with which it’s being evaluated.”
The NIH safety board oversees trials in the U.S. from Moderna, Johnson & Johnson and AstraZeneca, U.S. officials and others involved in Operation Warp Speed said, but not Pfizer, which is fully funding its clinical trial work and established its own five-member safety panel. Pfizer has attested that it can conclusively determine by late October the effectiveness of its vaccine, being jointly developed with German company BioNTech. It secured a $1.95 billion purchase agreement with the Department of Health and Human Services for the first 100 million doses produced. The agreement gives HHS the option to buy an additional 500 million doses.
Moderna, Johnson & Johnson and AstraZeneca, which have either started or are aiming to soon begin large-scale trials in the U.S. involving thousands of patients, collectively have received more than $2 billion in government funds for vaccine development; billions more have been meted out under agreements similar to the HHS contract with Pfizer to buy millions of vaccine doses. Having one safety board oversee multiple trials could allow researchers to better understand the field of products and apply consistency across evaluations, clinical trial experts said in interviews.
One big advantage “could be more standardization,” said Dr. Walter Orenstein, associate director of the Emory Vaccine Center at Emory University and a former senior official at the Centers for Disease Control and Prevention. “They can look at that data and look at all the trials instead of just doing one trial.”
But it also means that one board has an outsize influence to dictate which coronavirus vaccines eventually succeed or come to a halt, all while most of their identities remain secret. The NIH declined to name them, saying they were “confidential” and could be identified only once a study was complete.
One exception to the mystery is Whitley, who was appointed as chair by Dr. Anthony Fauci, the nation’s top infectious disease official. Fauci said that following a “combination of input from us and from him and other colleagues, the people who had the greatest expertise in a variety of areas, including statistics, clinical trials, vaccinology, immunology, clinical work,” were selected for the panel.
Whitley’s role became public when his university announced it, an unusual move. He is a professor as well as a board member of Gilead Sciences, which recently signed a contract with Pfizer to manufacture remdesivir to treat COVID-19 patients. Whitley, who’s been on Gilead’s board since 2008, conducted research that led to remdesivir’s development.
In 2019, he was paid roughly $430,000 as a Gilead board member, according to documents filed with the Securities and Exchange Commission. That same year, he received more than $7,700 in payments from GlaxoSmithKline for consulting, food and travel, according to a federal database that tracks drug and device company payments to physicians.
GlaxoSmithKline and Sanofi are jointly developing a vaccine that’s received $2 billion from the U.S. government under Operation Warp Speed; however, Whitley, through a university spokesperson, said his DSMB has not seen any GlaxoSmithKline COVID protocols. The companies have yet to begin phase 3 trials. Although he chairs a separate GSK data and safety monitoring board for a pediatric vaccine, he was vetted and cleared by the NIH conflict-of-interest committee with its knowledge of his involvement, the spokesperson said.
“When handled responsibly, it is appropriate for physicians to collaborate with external entities,” said UAB spokesperson Beena Thannickal, saying the university works with physicians to ensure that industry engagement is appropriate. “It facilitates a critical exchange of knowledge and accelerates and advances clinical treatments and cures, and it fuels discovery.”
Multiple experts praised his skill — Dr. Walter Straus, an associate vice president at the drug company Merck & Co., said Whitley is an “éminence grise” in pediatrics whom people trust.
“I actually trust that process, and the fact that they asked Rich to do it makes me feel reassured because he’s so good,” said Dr. Jeanne Marrazzo, director of the University of Alabama-Birmingham’s division of infectious diseases.
Multiple scientists who have participated in data and safety monitoring boards maintain it’s important to keep the board anonymous to shield them against pressure or even for their safety. For example, when trials were conducted in San Francisco for HIV/AIDS research, the board was confidential to protect members from patients desperate for treatment, said Susan Ellenberg, a professor of biostatistics, medical ethics and health policy at the University of Pennsylvania who’s written extensively on the history of DSMBs.
If approached by a patient, it “would be very hard to tell you, ‘Oh I can’t help you.’ It’s an unreasonable burden,” said Ellenberg, who said she was involved in coronavirus-related safety boards but would not name them.
As part of a large-scale clinical trial, the DSMB and a statistician or team that prepares data for those individuals are generally the only ones who see unblinded data about the trial, making it clear who is getting what treatment. A firewall is set up between them and executives from the sponsoring company with financial interests in the trial. The companies sponsoring COVID vaccine trials are not part of any closed sessions during which unblinded data is reviewed. Those are limited to members of the DSMB, the NIAID executive secretary and the independent unblinded statistician who is presenting the data, a NIAID spokesperson said.
DSMB members or their family members should have no professional, proprietary or financial relationship with the sponsoring companies, and the NIAID DSMB executive secretary vetted all members for potential conflicts of interest, NIAID said in response to questions from KHN. Members are paid $200 per meeting.
“It’s generally done out of a sense of public service,” said Dr. Larry Corey of the Fred Hutchinson Cancer Research Center, who is working with NIH officials to oversee the U.S. coronavirus vaccine clinical trials. “You’re doing it because of your sense of altruism and obligation to knowing the important role it plays in clinical research and the important role it plays in preserving the scientific integrity of important trials.”
Moderna, AstraZeneca, Johnson & Johnson and Pfizer have each released protocols that include details on when their DSMBs would review unblinded information about trial participants, and at what points they could recommend pausing or stopping trials. The vaccine data and safety board organized by NIAID advises a broader oversight group consisting of the drug companies sponsoring the trial and representatives from NIAID and HHS’ Biomedical Advanced Research and Development Authority that reviews the DSMB recommendations. Ultimately, the drug company has final authority over whether to submit its data to the Food and Drug Administration.
Moderna and Johnson & Johnson are each aiming for their vaccines to have 60% efficacy, which means there would need to be 60% fewer COVID cases among vaccinated individuals in their trials. AstraZeneca’s target is 50%. The FDA has said any coronavirus vaccine must be at least 50% effective to secure approval from regulators. While the parameters of their clinical trials have similarities, there are some differences, including when and how many times the DSMB can conduct interim reviews to assess whether each vaccine works.
Pfizer is similarly aiming for its vaccine to be 60% effective. The company allows for four interim reviews of the data starting at 32 cases — a schedule that has been criticized by some researchers who contend it makes it easier for the company to stop the trial prematurely.
Pfizer declined to name the individuals on its monitoring committee, saying only that the group consisted of four people “with extensive experience in pediatric and adult infectious diseases and vaccine safety” and one statistician with a background in vaccine clinical trials. An unblinded team supporting its data-monitoring committee — which includes a medical monitor and statistician — will review severe cases of COVID-19 as they are received and any adverse events associated with the trial at least weekly.
“There is an irresolvable tension between speed and safety,” said Dr. Gregory Poland, the head of Mayo Clinic’s Vaccine Research Group. “Efficacy is pretty easy to figure out. It’s safety that’s the issue.”
California Healthline editor Arthur Allen contributed to this report.
At Bumpass Hell in California’s Lassen Volcanic National Park, the ground is literally boiling, and the aroma of rotten eggs fills the air. Gas bubbles rise through puddles of mud, producing goopy popping sounds. Jets of scorching-hot steam blast from vents in the earth. The fearsome site was named for the cowboy Kendall Bumpass, who in 1865 got too close and stepped through the thin crust. Boiling, acidic water burned his leg so badly that it had to be amputated.
Some scientists contend that life on our planet arose in such seemingly inhospitable conditions. Long before creatures roamed the Earth, hot springs like Bumpass Hell may have promoted chemical reactions that linked together simple molecules in a first step toward complexity. Other scientists, however, place the starting point for Earth’s life underwater, at the deep hydrothermal vents where heated, mineral-rich water billows from cracks in the ocean floor.
As researchers study and debate where and how life on Earth first ignited, their findings offer an important bonus. Understanding the origins of life on this planet could offer hints about where to search for life elsewhere, says Natalie Batalha, an astrophysicist at the University of California, Santa Cruz. “It has very significant implications for the future of space exploration.” Chemist Wenonah Vercoutere agrees. “The rules of physics are the same throughout the whole universe,” says Vercoutere, of NASA’s Ames Research Center in Moffett Field, Calif. “So what is there to say that the rules of biology do not also carry through and are in place and active in the whole universe?”
At Bumpass Hell hot spring, cycles of wetting and drying at the edges of the geothermal pools are thought to promote the assembly of biomolecules.Joe Benning/Alamy Stock Photo
Lure of the land
At its biochemical core, the recipe for life relies on only a few ingredients: chemical elements, water or other media where chemical reactions can occur and an energy source to power those reactions. On Earth, all of those ingredients exist at terrestrial hot springs, home to some hardy creatures. Great Boiling Spring in Nevada, for example, is a scalding 77° Celsius, yet microbes manage to eke out an existence in water near the spring’s clay banks, researchers reported in 2016 in Nature Communications. Such conditions may reflect what it was like on early Earth, so these life-forms are most likely “related to some of the organisms that were originally on this planet,” says Jennifer Pett-Ridge, a microbial ecologist at Lawrence Livermore National Laboratory in California.
Microorganisms at hot springs can form communities called microbial mats. Made up of layers of microbes, mats have been found in geothermal areas all over the world, including in Yellowstone National Park, the Garga hot spring in southern Russia and Lassen — home to Bumpass Hell.
Over time, microbial mats can form into stromatolites, structures of microbes and minerals that have accumulated on top of one another; the layered appearance of a stromatolite reflects the passage of time, like a tree’s growth rings. Researchers found evidence of stromatolites in the Dresser Formation, a 3.5-billion–year-old rock feature in the Western Australia outback, along with evidence of hot spring mineral deposits, describing the findings in 2017 in Nature Communications. These findings, plus other signs of past microbes, led the team to suggest that some of the earliest life on Earth flourished in a hot spring environment.
David Deamer, a biophysicist at UC Santa Cruz, has spent four and a half decades exploring how life on our planet may have begun. He started out studying lipids, oily molecules that make up the membranes surrounding cells. Deamer, a big proponent of hot springs as the source of life’s start, has shown that conditions at terrestrial hot springs can produce bubblelike vesicles, with an outer layer made up of lipids. Such structures may have been the ancestral precursors of modern-day cells (SN: 7/3/10, p. 22).
Bruce Damer, an astrobiologist at UC Santa Cruz who brings a computer science approach to questions about the origins of life, worked with Deamer to test whether conditions at hot springs could drive condensation reactions, which join two molecules into one larger composite.
When water splashes out of a hot spring and evaporates, molecules that were in the liquid could undergo condensation reactions and link up. A subsequent splash would add more molecules that could undergo additional condensation reactions as liquid dries again. Repeated rounds of wetting and drying could produce chains of molecules.
In 2018, Damer set up shop at an active geothermal area in New Zealand, named along the usual theme — Hells Gate — to test that hypothesis. He prepared vials with ingredients needed to assemble strands of RNA, a nucleic acid that acts as a messenger during protein synthesis and may have catalyzed chemical reactions involved in the origins of life on early Earth (SN: 4/10/04, p. 232). The concoction included two of the four RNA building blocks — the nucleotides that link together to form RNA chains.
In February, astrobiologists Bruce Damer and Luke Steller (shown) performed wet-dry cycling experiments in acidic hot spring pools at Hells Gate in New Zealand.B. Damer
Damer stood the open vials in a metal block, roughly the size of two CD cases stacked together, and set the contraption into a near-boiling hydrothermal pool. To simulate the sometimes-wet, sometimes-dry burbling of the primordial Earth, Damer squirted acidic hot spring water into the vials, let them dry out and then repeated the wet-dry cycle several more times. When he brought the vials back to the lab, he found that they contained RNA-like strands that were 100 to 200 nucleotides long.
These results, reported in December 2019 in Astrobiology, indicate that complex molecules can form at hot springs, supporting the hypothesis that life on Earth may have developed in such an environment. In 2020, Damer returned to Hells Gate with Deamer and colleagues to confirm Damer’s results and do more wet-dry cycling studies.
Nicholas Hud, a chemist at Georgia Tech in Atlanta, studies the origins of life from a slightly different perspective: He explores how DNA and RNA nucleotides originated. He agrees that molecules are more likely to link together by condensation reactions on land, where wet-dry cycles can occur, than in the ocean. These reactions produce water; the formation of such a chemical bond isn’t energetically favorable when there’s already a lot of water around. “The best place to form that is in a hot, dry place,” Hud says. “The worst place to form it is in a wet, hot place.”
Bruce Damer has visited Hells Gate in New Zealand twice to test whether the conditions are right for linking nucleotides into strands of RNA.Joshua Hawley/iStock/Getty Images Plus
Underwater visions
Yet, wet, hot environs are just the place for life to originate, other evidence suggests. At hydrothermal vents on the deep, dark ocean floor, heated water spews into seawater that’s just a few degrees Celsius above freezing (SN: 7/23/16, p. 8).
In 2017, researchers found fossils in 3.77-billion-year-old rocks from Quebec that originated from the ancient ocean floor and had signs of hydrothermal activity (SN: 4/1/17, p. 6). The researchers claim that the distinct structures resemble those of microbes, suggesting that deep-sea environments may have supported some of the earliest life on Earth.
These environments can be extreme: Some vents belch dark plumes of water as hot as 400° C. However, if vents played a role in nurturing early forms of life, it likely happened at milder vents. For example, Lost City is a hydrothermal area in the middle of the Atlantic Ocean where the fluid streaming from vents ranges in temperature from 40° to 90° C. The region is named for dramatic limestone chimneys that rise as much as 60 meters above the seafloor.
These spires are home to microbes that feed off the products of a chemical reaction known as serpentinization. “Hydrothermal vents are interesting because they are at the interface of water and rock,” says astrophysicist Laurie Barge of NASA’s Jet Propulsion Laboratory in Pasadena, Calif.
A chemical reaction between water and rock at sites like Lost City makes the water coming out of vents more alkaline than the water in the ocean, which has a higher concentration of positively charged hydrogen ions. The resulting gradient from alkaline to more acidic water is like the difference between the positive and negative ends of a battery and can serve as an energy source for chemical activity.
To study the conditions at underwater vents, Barge creates simulated environments in the lab that, she says, “can mimic what you see in the natural world.” To represent an ocean on early Earth, she fills an inverted glass bottle with an acidic mixture containing iron but no oxygen. One end of a plastic tube pokes through the narrow end of the bottle, connected to a steady supply of a basic, or alkaline, solution just like a vent.
NASA’s Laurie Barge simulates an alkaline hydrothermal vent in an acidic ocean to explore the chemistry of ancient oceans. The conditions produce chimney structures like the one above. JPL-Caltech/NASA
When Barge and colleagues injected an alkaline vent solution containing RNA nucleotides into an ocean-simulating bottle, individual RNA nucleotides linked up into short chains. These strands were only three or four nucleotides long, but the results suggest that the conditions at deep-sea vents could have supported reactions that led to the emergence of life on Earth, the researchers proposed in 2015 in Astrobiology.
Problems with both
To Deamer, there are big barriers to putting life’s pieces together near underwater vents: The vastness of the ocean would dilute molecules so they wouldn’t be concentrated enough to drive chemical reactions. Also, there are “no wet-dry cycles underwater.” In his view, repeated evaporation is needed to pull together enough molecules to bump into each other and react to form longer chains. Plus, unlike a hot spring’s freshwater, salty ocean water inhibits the formation of membranes and reactions that link together molecules, he says.
However, Deamer’s hot springs theory has its critics as well. DNA and RNA strands are composed of alternating phosphate and sugar molecules, but sugars “are profoundly unstable in hot spring environments,” says David Des Marais, an astrobiologist at NASA’s Ames Research Center.
And it may be too soon to rule out wet-dry cycles underwater. “You can have a little bit of water get stuck in a pore,” says Bill Brazelton, a marine microbiologist at the University of Utah in Salt Lake City. And then, because the serpentinization reaction at a vent uses up water in making other molecules, “you can have these cycles of dehydration inside a rock underneath the ocean.”
It may be impossible to nail down how life truly began on Earth: Most geologic records of what actually happened during Earth’s earliest days have long disappeared. There are numerous alternative hypotheses for where life began, beyond terrestrial hot springs and deep-sea vents. Recent research, for example, suggests that asteroid impacts could have sent superheated seawater into the crust to produce hydrothermal systems resembling hot springs (SN: 7/4/20, p. 10).
“I think we have to admit that there might be more than one little torturous path that might have been traversed in order for life to begin,” Des Marais says.
The Bláhver hot spring in Iceland is one of many locations that Bruce Damer and David Deamer argue are the kind of environment where life may have formed on early Earth.imageBROKER/Alamy Stock Photo
Life beyond Earth
Researchers are using what they’ve learned about how and where life may have originated on Earth to guide the search for biological signatures beyond our planet. There are several promising locales in our solar system.
“One of the things that NASA is really interested in knowing is whether or not there could be life in the subsurface oceans of the icy moons, like Europa and Enceladus,” says Batalha, of UC Santa Cruz. Scientists have evidence that the two moons, one orbiting Jupiter and the other, Saturn, have oceans of salty, liquid water beneath their icy shells (SN Online: 6/14/19).
These moons are intriguing because, along with liquid water, both have plumes of water erupting from their surfaces (SN: 6/9/18, p. 11), suggesting ongoing hydrothermal activity. NASA’s Cassini space probe even identified compounds containing carbon, nitrogen and oxygen within Enceladus’ plumes, some of the ingredients of amino acids, the building blocks of proteins. Europa and Enceladus fascinate astronomers because activity on their ocean floors may resemble the hydrothermal vents found on our own planet and may provide the chemical conditions to support life (SN: 4/18/15, p. 10).
Plumes of water vapor, plus compounds containing carbon, nitrogen and oxygen, spew from the frozen surface of Enceladus, a moon of Saturn, as captured by NASA’s Cassini spacecraft. Hydrogen in the plumes is evidence of hydrothermal activity in the ocean beneath the ice, similar to deep-sea vents on Earth.JPL-Caltech/NASA, Space Science Institute, Planetary Science Institute
Icy moons may also promote condensation reactions. “Even if you were on an icy moon, you might have … freezing and thawing of ice,” Barge says. “So, I think it’s important to say, if wet-dry cycling is important, then we should look for any environment in the solar system that might be able to promote oscillating conditions of dehydration.”
But to find signs of past life, Damer and Deamer believe Mars is a more promising place to look. Mineral deposits indicate the presence of hot springs and hydrothermal activity in the planet’s past, which would have sustained the wetting and drying cycles that the two researchers see as crucial for condensation reactions to get life going.
Missions to the Red Planet are already under way. NASA’s Perseverance rover will be searching for signs of ancient life, such as telltale minerals in rock samples, at Mars’ Jezero crater when the mission lands in February 2021 (SN: 7/4/20 & 7/18/20, p. 30). Though at least 54.6 million kilometers separate them, Mars and Bumpass Hell may not be so different.
Working as a fast-food cashier in Los Angeles, Juan Quezada spends a lot of his time these days telling customers how to wear a mask.
“They cover their mouth but not their nose,” he said. “And we’re like, ‘You gotta put your mask on right.’”
Quezada didn’t expect to be enforcing mask-wearing. Six months ago, he was a restaurant manager, making $30 an hour, working full time and saving for retirement. But when Los Angeles County health officials shut down most restaurants in March because of the spreading pandemic, Quezada lost his job. The only work he could find pays a lot less and is part time.
“I only work three hours and four hours rather than eight or 10 or 12 like I used to work,” he said.
Quezada doesn’t know anyone who has gotten COVID-19, but the pandemic has affected nearly every aspect of his life. “I am just draining my savings — draining and draining and draining,” he said. “I have to sell my car. Uber is a luxury.” Mostly, he now bikes or rides the bus to his part-time job.
Quezada is one of hundreds of people who responded in a newly published poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. Among other things, the poll, which surveyed people from July 1 to Aug. 3, found that a whopping 71% of Latino households in Los Angeles County have experienced serious financial problems during the pandemic, compared overall with 52% of Black households there and 37% of whites. (Latinos can be of any race or combination of races.)
Like Quezada, many are burning through their savings and are having a hard time paying for necessities such as food. Quezada estimated he has about six months of savings left.
In Los Angeles, more than 35% of households report serious problems with paying credit cards, loans or other bills, while the same percentage report having depleted all or most of their savings. Eleven percent of Angelenos polled said they didn’t have any savings at the start of the outbreak.
Nationally, the picture is similar. In results released last week, the poll found that 72% of Latino households around the country reported they’re facing serious financial problems, double the share of whites who said so. And 46% of Latino households reported they have used up all or most of their savings during the pandemic.
How Poverty Differs for Latinos
Nationally, the poll found that 63% of Latinos reported loss of household income either through reduced hours or wages, furloughs or job loss since the start of the pandemic.
But Latinos have kept working through the crisis, said David Hayes-Bautista, a professor of medicine and public health at UCLA.
“In Washington, the idea is you’re poor because you don’t work. That’s not the issue with Latinos,” he said. “Latinos work. But they’re poor. The problem is, we don’t pay them.”
Latinos have the highest rate of labor force participation of any group in California. In March, when state and local officials shut down many businesses, Latinos lost jobs like everyone else. But Latinos got back to work faster.
“In April, the Latino [labor force participation] rate bounced right back up and actually has continued to increase slowly, whereas the non-Latino rate is dropping,” Hayes-Bautista said. “The reward that Latinos have for their high work ethic is a high rate of poverty.”
That work ethic has also contributed to a much higher rate of COVID-19. Hayes-Bautista pointed out that in California, as in some other regions in the U.S., Latinos tend to hold many of the jobs that have been deemed essential, and that’s made them highly susceptible to the coronavirus. Latinos now account for 60% of COVID-19 cases in California, even though they’re about 40% of the population.
“These are workers usually in their prime years — peak earning power and everything else,” Hayes-Bautista said. “Latinos between 50 and 69, those are the ones that are being hit the hardest. That’s pretty worrying.”
Exposed — And Often Without Health Insurance
Nationally, according to the poll, 1 in 4 Latino households report serious problems affording medical care during the pandemic.
Many of the essential jobs that Latinos are more likely to perform — farmworker or nursing home aide or other contract work, for example — lack benefits. That means some Latinos are more exposed to the coronavirus and less likely to have health insurance because they don’t get coverage through an employer.
Others, such as Mariel Alvarez, lack health insurance because of citizenship restrictions. She lives with her parents and sisters in Los Angeles County’s San Fernando Valley. Alvarez lost her sales job and her employer-sponsored health insurance when the pandemic hit in March, she said. Then she got sick.
Eventually, her whole family was ill. Alvarez had to pay out-of-pocket to go to a CVS clinic near her home. But after a couple of $50 visits, it got too expensive.
“I just couldn’t afford to continue to go to the doctor,” she said. She suspected it was COVID-19 but was unable to get tested.
Now that she’s recovered, getting a job with health insurance is crucial because she doesn’t qualify for any state or federal support. Alvarez is undocumented and was brought to the U.S. by her parents as a child from Bolivia. She’s one of roughly 640,000 immigrants who has a permit allowing her to work and defer deportation under the Deferred Action for Childhood Arrivals program, or DACA.
“I don’t want to jeopardize that,” Alvarez said. “You’re not supposed to use any of the government assistance when you’re on that. You’re only supposed to work, and that’s it.”
The pandemic has created a big need for one job: contact tracers. So Alvarez completed a free certificate online in the hope it will give her an edge. She’s going through the application process; if she gets hired, she hopes to have benefits again.
In the meantime, she’ll do her best not to get sick.
Jackie Fortiér is a health reporter for KPCC and LAist.com.
This story is part of a partnership that includes KPCC, NPR and KHN, an editorially independent program of KFF.
Laura Stutzman had no doubts that this year’s Twin Falls County Fair should go on despite the pandemic still raging across the U.S. — and several outbreaks tied to such community fairs.
Though she saw few people wearing masks from her volunteer station in the fair’s hospitality tent in southern Idaho earlier this month, she said she wasn’t concerned. Stutzman, 63, had been attending the fair off and on for 30 years, and she didn’t consider this year that different. People in rural communities know how to respect one another’s space, she said, and don’t have time to “fret and worry” about the coronavirus.
“Common sense is knowing that COVID-19 is in the picture,” she said, yet not allowing fear to “dictate how we live.”
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Hundreds of state and county fairs typically take place across the U.S. each year. They are a centerpiece for the agricultural industry — particularly for the 4-H kids who raise livestock all year to show off at their local events. Thousands of people are drawn to small towns for the concerts, rodeos, races and carnivals that flesh out the experience.
But only about 1 in 5 fairs took place as scheduled this summer, while the rest were dramatically modified or outright canceled because of the pandemic, according to data provided by the International Association of Fairs & Expositions.
Fairs are the economic lifeblood and cultural high point of the year for many rural communities, so the decision to cancel one is especially consequential. Scaling back can have devastating effects on the finances of the fair organizers and local community. And organizers fear that skipping a single year could mean losing a fair permanently.
“With very few exceptions, most fairs get most of their income from one single annual event,” said Marla Calico, president and CEO of the International Association of Fairs & Expositions. “Some fairs are trying to figure out how they will survive after this.”
In pressing on with their events, many organizers cited the fair’s importance to their counties, precisely because of the pandemic — people have been isolated from one another and communities are struggling economically.
One, the Montrose County Fair and Rodeo in Colorado, wanted to give students a chance to show and sell their livestock in person, Montrose County Fairgrounds & Event Center director Emily Sanchez said. Organizers promoted the event on social media with the hashtag #spreadingjoy, which Sanchez said was not intended to be a tongue-in-cheek reference to the pandemic.
“What we noticed was a lot of people saying that this was the worst year,” Sanchez said. “We were just giving people a minute to enjoy the small things.”
Montrose and most other fairs that took place scaled back events and made other changes to try to prevent coronavirus transmission. Fairs posted signs encouraging mask use and social distancing, and some canceled concerts and carnival-type attractions. The Fresno County fair in California, which is scheduled for October and typically draws 600,000 people, has been rebranded as a “series of drive-thru and virtual experiences.”
Often, those precautions haven’t worked, though, as fairgoers shed masks and gathered in large groups to watch rodeos and other attractions.
Health officials have since traced some COVID outbreaks to fairs. For example, Ohio Gov. Mike DeWine announced restrictions to county fairs after at least 22 cases of COVID-19 were traced back to the Pickaway County Fair in June.
Another fair linked to a COVID outbreak is the Phillips County Fair in the vast plains of northeastern Montana. The organizers of the event in Dodson, a small farming community about 40 miles south of the Canadian border, have long proclaimed that theirs was the longest continuously running fair in the state.
Until the fair took place in early August, Phillips County had another unique distinction: It was one of just a handful of Montana’s 56 counties to have no confirmed cases of COVID-19.
By mid-August, an outbreak of COVID-19 occurred — 68 cases within a week in the county of 4,000 people. The county’s small public health team scrambled to perform contact tracing. They concluded the fair and other events held at the same time, including a softball tournament and a large wedding, caused the spread.
“It was really just a perfect storm that led to an outbreak,” said public health nurse Jenny Tollefson.
The number of infections in Phillips County eventually rose to 114, but county officials have since curbed the outbreak. There were no active cases in the county as of mid-September, according to state health officials.
Sue Olsen, chairperson of the Phillips County Fair board, said organizers did everything they could to safely hold a large community event amid a global pandemic. They purchased 500 gallons of hand sanitizer and encouraged attendees to wear masks, although she said few did. They also improved cleaning procedures in the bathrooms.
They canceled events in which social distancing would not be possible, such as the carnival games and rides, face painting and a clown show. The county’s Native American neighbors on the Fort Belknap Reservation disagreed with the decision to hold the fair and canceled the relay races that are a traditional part of the event.
But organizers felt they needed to hold the fair.
“If you don’t have an event one year, you might just lose it,” Olsen said.
Other fair organizers took notice but pressed ahead. Near Montana’s Glacier National Park, Flathead County held the Northwest Montana Rodeo and Fair in mid-August despite 140 local health care professionals writing a letter urging organizers to cancel it. Among the medical community’s chief concerns: Schools were reopening just a week after the fair.
“We had a health department that was willing to work with us on a plan when a lot of other counties or states just simply said no to public events,” he said.
Campbell said the fair was different than in past years, with a bigger focus on 4-H and agricultural education. They canceled the carnival and parade, plus ditched the beer garden during the concerts and rodeos. Masks were required to enter the fair and the grandstands, although images posted by a local newspaper that quickly circulated on social media showed many people simply took off their masks once inside.
Interim county health officer Tamalee St. James Robinson said the images of so many maskless people in the grandstands were concerning, and fair organizers should have ensured compliance. Campbell said that the organizers took corrective actions to make sure people did wear masks after the images surfaced but that his staff didn’t have time to constantly remind people.
Back in Twin Falls, Idaho, about 3,500 people — half the usual number — showed up at the fair’s opening on Sept. 2, according to news reports. Despite the smaller crowd, the carnival games and rides went ahead and so did the rodeo.
Stutzman said she spent some of her time during the rodeo sanitizing the hospitality tent — but not necessarily because of the coronavirus.
“We were all raised with manners and good hygiene and consideration for others in our neck of the woods,” she said. “So everything pretty much goes on as it always has.”
The fair ended on Sept. 7, and it remains to be seen what effect, if any, it will have on Twin Falls County’s COVID-19 cases.
Type 2 diabetes or adult-onset diabetes is a form of diabetes that causes a high level of glucose in the blood and less sensitivity to insulin (the hormone that draws glucose from the blood to get energy). Weight loss increased thirst, and frequent urination is some common symptoms of Type 2 diabetes.
Current research regarding health reveals that people above the age of sixty-five facing health issues should exercise at least for a minute per. This short span of exercise is sufficient to give health benefits.
In Dundee, researchers from Abertay University observed many people who participated in workout sessions. People of sixty-five to seventy-five years old participated in groups for eight weeks. Each individual of all the groups had been enjoying an idle and settled life without any physical activity.
None of them had been doing workout consistently. Every individual was given a stationary bike and was guided to wheel the bike for about 60 seconds by putting full energy and without taking any break.
If any of them failed to cycle the bike for a minute would perform the process of SIT (Sprint Interval Training) again.
Researchers found that a weekly workout session was sufficient to control the glucose level in the blood and improve the mobility of the participants. Insulin resistance increases in individuals as they get older and fail to draw glucose out of the blood.
This failure causes many complications like liver and heart problems and may direct to Type 2 diabetes. Physical activity is the best thing to treat type 2 diabetes. Along with exercise, a healthy meal is required to maintain blood glucose levels. Diabetes may lead to kidney problems and nerve pain so physical fitness and activity are required to reduce the chances of diabetes.
Dr. John Babraj found that SIT plays an important role in improving health. SIT enhances the capacity to draw glucose out of blood if completed once or twice a week. Muscles get the required glucose produced from exercise and in turn, a lower glucose level of blood. It not only lowers blood sugar level but also cope with heart complications, lowers blood pressure, reduces cholesterol level, and increases the sensitivity to insulin.
The study revealed that individuals performing SIT twice a week showed a better performance than those who didn’t. Progress was also observed in individuals participating in SIT once a week.
Many improvements in the general activity to do daily work were observed in the individual participating in STI and differences were assessed in a common occupation like the effectiveness to walk up and downstairs, to open the door, and to do the daily chores.
For people with old age have huge complications because of the loss in the physical functioning of the body, social isolation and it affects the standard of life. Social isolation intentionally declines life standards.
The current researches find that older adults need to participate in the workout. Older people should go for an exercise of moderate intensity every week but it is very hard for older people to complete this task. Dr. Babraj wills to introduce SIT (sprint interval training) in the Government’s physical activity guidelines.
Better acclimatization was observed from both groups participating in STI once and twice a week than the minor changes expected by the researches.
To break the record for longest dive by a marine mammal, take a deep breath and jump in the water. Then don’t breathe in again for almost four hours.
Cuvier’s beaked whales (Ziphius cavirostris) are master divers (SN: 08/21/18). The creatures not only hold the record for deepest plunge by a marine mammal — measuring nearly 3,000 meters — but also for the longest dives. In 2014, scientists documented one dive that lasted just over two hours at 137.5 minutes, setting a record. Another Cuvier’s beaked whale has now shattered that record, going 222 minutes, or three hours and 42 minutes, without coming up for air, researchers report September 23 in the Journal of Experimental Biology.
To last so long underwater, the mammals may rely on large stores of oxygen and a slow metabolism. Once oxygen runs out, the animals may have the ability to tolerate lactic acid building up in their muscles from anaerobic respiration — a method of generating energy that doesn’t rely on oxygen. “These guys blow our expectations,” says Nicola Quick, an animal behaviorist at Duke University Marine Laboratory in Beaufort, N.C.
Calculations based on a seal’s oxygen stores and diving time limits hinted that the whales should last only about half an hour before running out of oxygen. Seals can exceed their limit about 5 percent of the time, so Quick’s team analyzed 3,680 dives by 23 whales. While most dives lasted around an hour, 5 percent exceeded about 78 minutes, suggesting it takes more than twice as long as thought for the whales to switch to anaerobic respiration.
The researchers expected to find that the whales spend more time at the surface recovering after long dives, but the team did not see a clear pattern. “We know very little about [the whales] at all,” Quick says, “which is interesting and frustrating at once.”
I am the mother of four, but addiction is my ever-present extra child. My grandparents died of alcoholism. My father-in-law did, too. My 43-year-old brother died of a heroin overdose in May. He became addicted after taking prescribed OxyContin following an appendectomy.
When my 13-year-old daughter needed hernia surgery as my brother was hitting rock bottom, it wasn’t the operation I feared. It was the opiates that would be part of her recovery. A 2018 study in the journal Pediatrics reported “persistent” opiate use by nearly 5 percent of patients age 13 to 21 following surgery, as compared to 0.1 percent in the nonsurgical group.
I wanted to figure out a way to help my daughter through the pain without resorting to using opiates.
Days before my daughter’s operation, our family devised a pain protocol based on what we learned from a popular TEDtalk byJohann Hari, a journalist who believes that people avoid addiction through “bonds and connections.”
He cites a study comparing two groups of rats. One group lived alone in cages, with only food, water and water laced with heroin. Those rats became addicted and quickly died. The other group lived in what Mr. Hari called “Rat Park.” They had treats, activities and interaction with other rats. They chose the plain water over the heroin water. They thrived, despite the presence of an addictive substance.
The message I took from it was that affection and connection might help reduce my daughter’s pain. If we surrounded her with comfort, maybe she wouldn’t need the drugs at all.
Our pain protocol included my daughter’s favorite movies, books and foods. We made a list of relaxing activities that build oxytocin: braiding hair, massage, cuddling and wearing cozy clothes. We listened to her fears. As a distance swimmer she could tolerate discomfort, but she was afraid of the unknown of surgical pain. We agreed to bring home whatever pain medication was prescribed, but to avoid using it if possible.
At the hospital, my daughter changed into a pink cotton gown, dotted with lambs and rainbows. I smoothed her hair as a tech struggled to pin an IV into the back of her hand.
“It hurts, Mommy,” she pleaded. “I’m scared.”
A nurse offered a thimble of liquid Xanax to help ease her anxiety. She looked to me for permission, then nodded her head yes. Moments later I witnessed a powerful transformation from fear to nonchalance. She waved goodbye as a team wheeled her bed around a corner. I thought of previous outpatient procedures my children had faced: tubes in the ears, a meniscus tear. I was never given instructions about alternative pain management and I didn’t think to ask. The difference, now, was that my brother was an addict. What if I gave my children pain pills and they became addicted too?
Three hours later the surgeon breezed through the waiting room doors. The hernia was deeper than expected, he reported, and she would be in considerable pain tomorrow.
In the recovery room, my daughter lay propped up in bed, sucking on a frozen rocket pop. “Mama,” she said drowsily. “I’m all done.” She battled to keep her heavy eyelids open. The ice pop melted upright in her hand.
I thought of my brother, nodding off on a family ski vacation; in a parked car waiting for an oil change; during a children’s egg hunt on Easter Sunday.
While my daughter slept, a discharge nurse told me how to change her dressing and watch for fever. Then she explained how to “stay on top” of the pain with a prescription for 44 Oxycodone tablets. My jaw tightened.
“I don’t want to give this to her,” I said, shaking my head at my own memories.
The busy hallway went silent, except for the alarm of an empty IV drip.
“This is like heroin to me,” I said. “My brother is addicted.”
The nurse looked away. “My daughter too,” she said, and began to cry. “She won’t stop. I had to kick her out.”
We exchanged the mournful words of opiate families: “It’s everywhere.”
“Is this all for me?” she asked quietly. She collapsed, smiling, into the stack of duvets on the sofa.
The anesthesia kept the edge off the initial pain. My daughter dozed while we watched episodes of “MasterChef Junior.” That night, my husband carried her to bed, then I slept beside her, alternating Tylenol and ibuprofen. In the morning, I inquired about her discomfort, hoping she wouldn’t ask for a pill.
“It’s just annoying,” she said.
“Annoying like you’re suffering?” I asked.
“Annoying like can I have ice cream for breakfast?”
“Coming right up,” I said. I offered her our specialty of the house: mint chip and a side of Advil. That day, nestled in our sofa oasis, we nibbled from a wooden bowl of buttered popcorn mixed with M&Ms. While surviving all three “High School Musicals,” I stroked her skin, smoothed her hair and praised her bravery. We played Uno, and worked on a puzzle. Greeting cards and balloon bouquets came in from friends and teachers. The principal called. Not once did she complain of intolerable pain.
She winced gingerly when she wanted to flip sides on the couch. We assisted her so that she wouldn’t use her abdominal muscles.
The discharge nurse had told us that walking would speed recovery, so we pretended her stuffed animals were babies and carried them on laps around the first floor of our house.
By day three, she didn’t even want the over-the-counter medication.
“I’m good,” she said. “I don’t need it.”
I felt a mixture of relief and rage. Why were we sent home with so many pills? Without my brother’s experience, I might have given all of them to her.
Her recovery was so quick that it became hard to keep her quiet. On day four I found her teetering on the back of the sofa, arms wide, like she was walking a tightrope.
“Have you lost your mind?” I snapped. “Get down from there!”
“Mom, I’m training,” she protested. “Pain doesn’t bother me so I’m practicing for the military. I made the sofa into an obstacle course.”
As I tucked her back under a blanket, I thought of the twists, turns and pressures my children will inevitably face in their adult lives. My daughter’s resilience has given me reason to hope. Together we are defying our family heritage.
