Parents who want to keep their teenagers safe while they're driving might want to tuck them in bed early the night before.

Drowsiness is a well-known risk for adult drivers, but teenage drivers are more impaired than adults when facing an equivalent lack of sleep, an Australian study finds.

"Young people are particularly at risk for sleep deprivation," Alexandra Martiniuk, lead author of a study on sleep teens study's lead author, and a researchers at the George Institute in Sydney, said in an email to Shots. "It doesn't take drastic sleep reductions to increase the risk of crash."

And many young people aren't getting nearly enough sleep. In this study, which tracked the habits of almost 20,000 new drivers in Australia for two years, 10 percent of the 17-year-olds and 17 percent of the 20- to 24-year-olds said they slept for six hours a night or less.

That's a lot less than the 8 1/2 to 9 1/4 hours of sleep a night that teenagers need, according to other studies.

Six hours of sleep a night was enough to increase the young people's relative risk of an accident. Those short-sleepers were also more likely to engage in risky behaviors like drinking and using illegal drugs.

The large number of participants in this study, and the fact that it followed their behavior over time, make it more likely to be accurate than studies that ask people to remember what they did. The researchers relied on police reports of accidents.

The findings lend support to the use of graduated drivers' licenses that keep new drivers from driving at night. It found that the risk of accidents was greatest when young people were driving between 8 p.m. and dawn. This may help explain why most fatal accidents with teenagers happen at night, even though most of their driving is done during the day.

Drinking and driving poses much more of a risk than lack of sleep, but the study didn't have a way to measure the new drivers' blood alcohol level at the time of accidents. That could confuse this data, but the scientists are confident that the lack of sleep remains a risk even when accounting for other factors.

"This age group is just learning to drive," Martiniak told Shots. Blunting a new driver's shaky skills with sleep deprivation, she says, "makes for a dangerous combination."

The study was published online in JAMA Pediatrics.

When the sun rises over the Rio Grande Valley, the cries of the urracas — blackbirds — perched on the tops of palm trees swell to a noisy, unavoidable cacophony. That is also the strategy, it could be said, that local officials, health care providers and frustrated valley residents are trying to use to persuade Gov. Rick Perry and state Republican lawmakers to set aside their opposition and expand Medicaid, a key provision of the federal health law.

The Rio Grande Valley has a load of troubles: high unemployment, low-paying jobs, warring Mexican cartels, a meager tax base and legions of people without health insurance. While many of those woes seem incurable, expanding Medicaid to the region's uninsured is, to Paula Gomez, who runs several local health clinics, a no-brainer.

"I think if we're not ready, if Texas doesn't buy in in the next three months, shame on us," she says.

Texas has the highest rate of uninsured residents in the nation — 1 in 4 Texans has no health coverage — and the rate in the Rio Grande Valley is even higher. Medicaid is closed to anyone earning more than $196 a month, leaving many working adults ineligible and without coverage.

Under the health law, the federal government would pay the entire cost of the expansion for the first three years, then 90 percent in subsequent years. As it stands, Texas would have to spend about $1 billion a year over the next three years, say Democrats, to receive $27 billion in federal matching funds.

But Gov. Perry says Texas can ill afford to expand Medicaid, and he doesn't trust that the federal government will pay its promised share. At a news conference last month, he blasted Obamacare's Medicaid provisions:

"Seems to me an appropriate April Fool's Day event, makes it perfect to discuss something as foolish as Medicaid expansion, and to remind everyone that Texas will not be held hostage by the Obama administration's attempt to force us into the fool's errand of adding more than a million Texans to a broken system."

For now, uninsured patients in the Rio Grande Valley pay what they can for basic medical care, but specialty care — to follow up on a lump in the breast, for example — is almost always out of reach without some type of insurance, including Medicaid, according to Dr. Henry Imperial, the Brownsville Community Health Center's medical director. "Once you diagnose a cancer, then what? How are you going to give me chemotherapy or surgery or radiation therapy?" he asks.

Hospitals in Texas end up with millions in unpaid bills, and the counties, by state law, have to provide basic medical care to destitute residents. That has led a number of counties in the Rio Grande Valley — and elsewhere — to pass resolutions supporting the Medicaid expansion.

For local Republicans, that mild act of defiance against a powerful governor — who is opposed to every provision in the federal health law — can seem like political suicide. It's not something they're eager to draw attention to.

"It's contrary to what the [GOP] leadership in Austin is recommending, but we thought it was important enough to take a position," says Republican Carlos Cascos, the county's top elected official.

State Rep. Eddie Lucio III, a Democrat from Brownsville, faces daunting odds in trying to persuade the conservative Republicans who control the Legislature to buck Perry and approve a bill to expand Medicaid in Texas.

Lucio says he's not sure what effect, if any, the resolutions by county officials, including Republicans like Cascos, are having. There is ample pessimism here in Brownsville that lawmakers 350 miles away in Austin will ever understand life in the Valley.

But because there is no hard deadline for when Texas or any other state has to sign up for the Medicaid expansion, health clinic director Paula Gomez is pressing on. She says she still remembers fighting the state to get drinkable water in the Rio Grande Valley, and she'll patiently fight this war too.

When movie stars become unbankable, they're no longer a slam dunk at the box office. When investments become unbankable, they're relegated to the Wall Street's junk pile. For ordinary Americans deemed unbankable — those who don't have a traditional checking or savings account — it can be hard to simply pay bills.

And that absence of a bank account is about to become a big problem for those who also lack health coverage — and for the health insurance companies trying to sell them coverage. After all, how do you sell a product to a customer who has no easy way to pay you?

One in five households in the U.S. have only a tenuous relationship with a traditional bank. Many of 51 million adults in these households rely on check-cashing stores and money lenders, according to the Federal Deposit Insurance Corporation.

The federal health law requires most Americans to carry health insurance starting next January. The presents a particular problem for those households. Most health plans accept a credit card for the first month's premium payment and then require customers to pay monthly with a check or an electronic funds transfer from a checking account.

Those options won't work for the so-called unbankables looking to purchase health coverage with federal subsidies through online insurance marketplaces, says Dan Schuyler, a director at Leavitt Partners, a firm that is advising private insurers and states on how to comply with the law. "You don't want to take these millions of unbankable people through the entire enrollment process and then at the end of line say, 'OK, the only way you can pay for your share of the premium is with a bank account number,' " he says.

The consequences could be severe. When your cable gets turned off, you miss The Walking Dead or Pawn Stars. But starting next year, if your insurance is canceled, you'll be breaking federal law and liable for any medical bills.

Researchers who study consumer financial behavior say people have their reasons for spurning banks. New immigrants, for example, may have distrusted the banks in their home country and brought that skepticism with them to the U.S. And for many people of modest means, overdrafts and fees charged by traditional banks can upend the financial balance in their household.

"The bank account is extremely stressful when you don't have a job that's reliable," says Tran, a 25 year-old community organizer and Ivy League graduate who lives south of San Francisco.

Her current employer doesn't offer her health benefits, and she was turned down, she says, when she applied for health coverage on her own. Tran hopes to get hired to a full-time position and asked that we use just her last name so it didn't give her bosses a bad impression.

Tran says when she took her new job and no longer had direct deposit, Bank of America began charging her, up to $12 a month. "I was not happy with the charges," she says.

Consumers who will be required to purchase health coverage will need payment options that are simple, easy and affordable, say consumer advocates and health care experts.

"I think there is a dawning awareness that this is a large problem," says Brian Haile, senior vice president for health policy at Jackson Hewitt Tax Service. Until last year, Haile was wrestling with this problem on behalf of the state of Tennessee, where he served as director of the Insurance Exchange Planning Initiative. "We raised these issues with the federal government well over a year ago and in a series of about four or five letters." Haile said he didn't get much of a response then.

Indeed, neither the Affordable Care Act, nor any other federal health laws, require health insurers to accept all forms of payment, such as credit cards or the cash-loaded, prepaid debit cards that many people without bank accounts often rely on.

Federal officials are wary of doing anything to discourage insurance companies from selling plans on the exchanges, say current and former state health officers who have pressed the federal Department of Health and Human Services for a ruling.

One of the largest players on the new exchanges is likely to be WellPoint, a Blue Cross and Blue Shield licensee. In an email, a WellPoint spokesperson says the company is "evaluating expanded payment options to members." Other insurers, including Cigna and UnitedHealthcare, are urging state officials in planning documents to allow companies to set their own payment policies.

Federal health officials issued a letter in April stating that all health plans selling coverage in the federally run insurance marketplaces in 28 states will have to accept payments in ways that don't discriminate against their customers, but didn't prescribe what those payments should be.

Varney is a reporter with our partner Kaiser Health News, a nonprofit news service.

Men who were diagnosed with ADHD as children are more likely to be obese in adulthood, according to a new study.

The men who had ADHD weighed 19 pounds more at age 41 than otherwise similar men who hadn't had ADHD as boys, the researchers found.

"It makes sense, because they're self-medicating with carbohydrates," says Dr. Edward Hallowell, a psychiatrist in Sudbury, Mass., who has ADHD and treats adults with ADHD. "Carbs do the same thing that stimulant medications do — promote dopamine," says Hallowell, who wasn't involved in the latest study. "So you get the gallon of ice cream at midnight."

Attention deficit-hyperactivity disorder may affect up to 11 percent of American children, the majority of them boys.

Earlier studies had suggested that adults with ADHD may be more likely to gain weight.

That research doesn't prove that the ADHD is causing the weight gain. And this new study doesn't prove that, either. But it does provide better evidence for a potential link because it followed the same group of people over time. It looked at a group of 111 boys with ADHD at age 8. Then their weight was assessed at age 41. The men with ADHD were then compared to similar men who didn't have ADHD as children.

The men who had had ADHD weighed an average of 213 pounds, and 41 percent of them were obese. By contrast, the men who hadn't had ADHD weighed 194 pounds on average, and 22 percent were obese.

The study leaders realized that weight was becoming an an issue for their participants when some who came in for MRI scans were too fat to fit in the machine.

"In most studies you eliminate those people," says F. Xavier Castellanos, a psychiatrist at the Child Study Center at NYU Langone Medical Center in New York and a co-author of the study, which was published in the journal Pediatrics. Instead, the researchers started collecting information on the participants' weight and body mass, or BMI.

This study doesn't figure out why boyhood ADHD might be causing weight problems in adulthood. The weight gain could be caused by psychological factors or neurobiology, Castellanos speculates. Differences in the pathways for dopamine, a neurotransmitter in the brain, have been found in both people who are obese and people with ADHD, he says.

Or it could be that the impulsiveness typical of ADHD makes it harder for people to say no to food. Children who take stimulant medications like Ritalin typically don't have problems with weight gain because the medications suppress appetite. But eating issues may emerge later.

Hallowell says he often sees adult patients with ADHD who struggle with overeating. "Nutrition should be part of the treatment plan," he says.

Parents of children with ADHD should take particular care to make sure their children develop lifelong good eating habits, Castellanos says. "The reality is that ADHD people can be at risk for being swayed by temptation."

Her hair is brown and tied back into a professional-looking ponytail. She wears a blue shirt, tan sweater and delicate gold chain. It's the first time she has met the man sitting across from her, and she looks out at him, her eyes curious.

"So how are you doing today?" she asks cautiously, trying to build rapport.

"I'm doing well," he answers. His eyes blink.

"That's good," she continues. "Where are you from originally?"

"I'm from L.A.," he tells her, and this makes her smile slightly.

"Oh!" she says with surprise in her voice. "I'm from L.A. myself!"

She is from L.A. She was created in Los Angeles and "lives out her life" there on a computer screen in a lab at the University of Southern California. She's not a real woman but a virtual one, created to talk to people who are struggling emotionally, and to take their measure in a way no human can. Her makers believe that her ability to do this will ultimately revolutionize the way mental health care is practiced in this country. Her name is Ellie.

There's Power In A Well-Timed 'Uh-Huh'

The project that resulted in Ellie began almost two years ago at USC's Institute for Creative Technologies. Two scientists in particular are responsible for her existence: psychologist Albert "Skip" Rizzo and computer scientist Louis-Philippe Morency.

Rizzo and Morency spent months laboring over every element of Ellie's presentation and interaction with patients, experimenting with a range of different personalities, outfits and vocal mannerisms.

"Everything has been thought of," says Morency. For example, when patients talk, Ellie encourages them to continue talking with a well timed "uh-huh," just as real people do.

"We have recorded more than 200 of these uh-huhs," Morency says, "and these are so powerful. Because a simple 'uh-huh' and a silence — if they are done the right way — can be extremely powerful. So we spent a lot of time on these little details."

But the most important thing about Ellie is not her skill at gently probing all of the people her scientist brings into the lab to talk to her. Her real value, the reason she was built at all, is her skill at taking and analyzing thousands of measurements of those people.

Under the wide screen where Ellie's image sits, there are three devices. A video camera tracks facial expressions of the person sitting opposite. A movement sensor — Microsoft Kinect — tracks the person's gestures, fidgeting and other movements. A microphone records every inflection and tone in his or her voice. The point, Rizzo explains, is to analyze in almost microscopic detail the way people talk and move — to read their body language.

"We can look at the position of the head, the eye gaze," Rizzo says. Does the head tilt? Does it lean forward? Is it static and fixed?" In fact, Ellie tracks and analyzes around 60 different features — various body and facial movements, and different aspects of the voice.

The theory of all this is that a detailed analysis of those movements and vocal features can give us new insights into people who are struggling with emotional issues. The body, face and voice express things that words sometimes obscure.

"You know, people are in a constant state of impression management," Rizzo says. "They've got their true self and the self that they want to project to the world. And we know that the body displays things that sometimes people try to keep contained."

So, as Ellie gets the person in front of her to ruminate about when they were happy and when they were sad, the machines below her screen take measurements, cataloging how much the person smiles and for how long, how often they touch their head.

Morency says the machines record 30 measurements per second, or "about 1,800 measurements per minute." Literally every wince, pause and verbal stumble is captured and later analyzed.

Ellie was originally commissioned by the U.S. Department of Defense. After all of the deployment in Iraq and Afghanistan, the military was seeing a lot of suicides and wanted to find a way to help military therapists stop them. Soldiers don't always like to confess that they're having problems, but maybe their bodies would say what their words wouldn't.

This is why Ellie is being programmed to produce a report after each of her sessions — it's a kind of visual representation of the 60 different movements she tracks.

"For each indicator," Morency explains, "we will display three things." First, the report will show the physical behavior of the person Ellie just interviewed, tallying how many times he or she smiled, for instance, and for how long. Then the report will show how much depressed people typically smile, and finally how much healthy people typically smile. Essentially it's a visualization of the person's behavior compared with a population of depressed and nondepressed people.

If the person's physical behaviors are similar to someone who's depressed, then the person will be flagged.

The idea here is not for Ellie to actually diagnose people and replace trained therapists. She's just there to offer insight to therapists, Morency says, by providing some objective measurements.

"Think about it as a blood sample," he says. "You send a blood sample to the lab and you get the result. The [people] doing the diagnosis [are] still the clinicians, but they use these objective measures to make the diagnosis."

Real People Are Complicated

Now, obviously this work raises all kinds of issues, and even on a practical level, real obstacles remain. Jeff Cohn, a psychologist at the University of Pittsburgh, studies the relationship between physical movements and emotion and says signals from the face, voice and body are incredibly complicated to interpret.

"Individuals vary a lot in how expressive they are," Cohn explains. "You know, if I'm someone who is very expressive and I smile frequently, [even] when I'm depressed and smiling less, I may still smile more than you do if you're a tight-lipped, not very emotive individual."

This means, Cohn says, that using Ellie in the way blood tests are used — as proof positive of one diagnosis or another — will be really difficult.

"It strikes me as unlikely that face or voice will provide that information with such certainty," he says.

But Skip Rizzo, the psychologist working on Ellie, genuinely believes these technologies will eventually change the field of mental health. One of the central problems with humans, he says, is that they bring their own biases to whatever they encounter, and those biases often make it hard for them to see what's directly in front of them.

"You can get training to be a health care provider or psychologist," he says, "and try to put those things on hold and be very objective. But it's still a challenge. It's always going to be biased by experience. What computers [like Ellie] offer is the ability to look at massive amounts of data and begin to look at patterns, and that, I think, far outstrips the mere mortal brain."

This summer, Ellie is being tested. She's scheduled to sit down with dozens of veterans from Iraq and Afghanistan.

She'll ask them about their lives, encourage them to open up.

Then, silently, Ellie will measure their answers.

On average, men aren't as healthy as women.

Men don't live as long, and they're more likely to engage in risky behaviors, like smoking and drinking.

But in the past decade, global health funding has focused heavily on women.

Programs and policies for men have been "notably absent," says Sarah Hawkes from the University of London's Institute of Global Health.

She and a colleague published a commentary in The Lancet on Friday calling for more gender equality in global health funding.

"If you look at the top 10 health problems around the world, they are much more common in men," she tells Shots. "But the current focus is predominantly on women's health. "

Take for instance, the United Nations's Millennium Development Goals. In 2000, global leaders agreed on eight ways to improve the lives of the poorest people around the world.

The fifth goal is specifically aimed at maternal health. And all of the other goals "touch on essential aspects of women's well-being, and in turn, women's empowerment is critical for achieving the goals," the U.N. Women's website says.

There isn't a specific goal targeted at men.

Hawkes agrees that maternal health is important and should be funded. "We don't want to see this money diverted away from women's health," she says. "But focusing on maternal health means you miss the biggest burdens of disease."

Hawkes says that when you look at recent data, men lose three times more years of healthy living than women because of tobacco, alcohol and unsafe driving.

"It's cool to be a man that smokes and drinks — who drives a fast motorbike, or fast cars," she says. "If you were really serious about saving lives, you would spend money tackling unhealthy gender norms" that promote these risky behaviors.

Health economist Karen Grepin of New York University agrees that more focus should go to stopping tobacco and alcohol use. But she doesn't think there should be specific policies for men versus women. "If we focus on closing inequality, we'll miss the boat," she says. "The goal is to reduce mortality, not to reduce inequalities in the measure of mortality."

Grepin, who wasn't involved with the commentary, also doesn't think that the recent focus on women's health is a bad thing.

"Women are politically, economically disadvantaged around the world," she tells Shots. "There are really important consequences for women's health. They play a large role in taking care of children. When they get sick, there's a spillover effect in the house — for the next generation."

Grepin thinks that maternal health may have been undervalued and underfunded in the past. "In many places, women still have a high risk of dying during childbirth, which is completely avoidable," she says. "The fact that this still happens is appalling. It's a blight on society that needs to be addressed."

With the recent emphasis on maternal health, she says, the world is making progress on this front. The risk of a mother dying during childbirth has declined by nearly half worldwide since 1990.

"Has that necessarily driven up mortality in men?" she asks. "Probably not."

When the American Psychiatric Association releases its new Diagnostic and Statistical Manual of Mental Disorders — DSM-5 — this weekend, lots of journalists and commentators will refer to it as "psychiatry's bible."

That's a term that makes the manual's authors and other mental experts cringe.

"Bible implies that it's been handed down by some deity as the absolute truth," says Michael First, a psychiatrist at Columbia University who's had a hand in the past two revisions of the DSM. "We don't consider this to be a bible. It's a guidebook."

Dr. Thomas Insel, director of the National Institute of Mental Health, also wants people to know the DSM isn't some sacred text. "It's a dictionary, not a bible," he says.

The DSM has taken on biblical proportions over the years because its list of several hundred disorders is often used to decide whether a particular behavior is abnormal and insurance will cover a problem. DSM-5, for example, has provoked lots of debate about new diagnoses like Binge Eating Disorder or Disruptive Mood Dysregulation Disorder in children.

But insurance coverage and defining what's normal are not why the DSM was created. It was created to solve a communication problem.

Before DSM-III came along in 1980, "It was really chaotic," Insel says. "We had no common language" for describing mental disorders. The new manual provided clear definitions for the first time, he says, so that "when one person says major depressive disorder another person will know what that is."

Revisions since then have updated those definitions and added or eliminated diagnoses based on the latest research, First says. "The DSM is a synthesis of the best knowledge at this moment in time," he says. "So DSM-5 is the culmination of research in the past 20 years."

That makes the DSM "a tool used by clinicians to take care of patients," not a bible, First says.

Insel adds that the DSM only becomes a problem when mental health professionals forget that and start "looking at the manual instead of listening to their patients. That's never a good outcome."

When the diagnosis is cancer, the expenses can pile up in a hurry.

Even people with insurance can face steep copayments for drugs, a sizable share of hospital bills and significant incidentals. These side effects of cancer care are sometimes even called "financial toxicity."

So wouldn't it make sense for doctors and patients to talk over the financial strain that cancer treatment might bring and what might be done to manage it?

Well, it's not always easy for patients to bring it up, says S. Yousuf Zafar, a gastrointestinal cancer specialist at Duke Cancer Institute. He and his colleagues recently asked hundreds of insured cancer patients at Duke and three affiliated rural cancer clinics about their financial concerns.

Median household income for the people in study was about $60,000 a year, and the median out-of-pocket costs for their care were nearly $600 a month .

"The bottom line was that patients want to talk about the cost but only a minority actually do," Zafar tells Shots.

The people who did talk about financial issues told the researchers it was helpful to do so. "They said it helped decrease their expenses," Zafar says. Unfortunately, in this study the researchers didn't get into the details of how that happened.

But he drew one possible way from his own practice. "I treat colon cancer, and I have the option of giving a drug as an IV or an oral pill," he says. "If I give the pill form, the patient faces a copay even if they have insurance, and that copay goes away if I give the intravenous version."

The two forms of the drug are pretty much the same when it comes to effectiveness, though the side effects differ a little. "For the most part, it doesn't matter to me," he says. "It comes down to patient preference and cost."

Why don't most patients ask about costs?

"Many said they didn't think their financial problems were bad enough to bring it up," he says. "Many said they wanted the best care regardless of costs." And they may have been worried that doctors might cut corners on care after a cost discussion.

Some patients said it's not their doctor's job to think about the costs, Zafar says, and others figured the doctor wouldn't know what to do about them anyway.

Patients might have a point there. "I don't think the majority of oncologists are prepared to have a discussion about cost," he says. "Quite honestly, we haven't received the training to do so."

In the meantime, doctors can direct patients to social workers and financial counselors to lend a hand. "Any help is likely better than none," Zafar says.

Doctor need to get with it, though. "We can't necessarily give the best care to patients unless we address cost," Zafar says.

The research hasn't been published yet. Zafar will present the findings to cancer specialists at the American Society of Clinical Oncology annual meeting in Chicago in a few weeks.

The tragic deaths of 29 coal miners in a massive explosion in 2010 have provided new evidence of a resurgence of the disease known as black lung.

On Monday, a team of pathologists and lung disease experts will present the results of a detailed study of lung tissue from some of the victims of the Upper Big Branch mine disaster in West Virginia. They'll describe the findings at the American Thoracic Society's annual conference in Philadelphia this weekend.

"Our pathology — where we actually see the lung tissue, we actually see the scars, we see the dust — confirms we're seeing a problem," says Robert Cohen, the lead researcher and chairman of pulmonary and critical care medicine at Cook County Health and Hospitals System in Illinois.

Cohen's team reviewed lung tissue obtained from autopsies of seven of the Upper Big Branch victims. Only seven families of the deceased coal miners granted permission for the study.

Six of the seven samples bore telltale scarring that indicates black lung. One of the samples showed a "fairly advanced form of the disease."

One of the miners worked for less than five years underground, and several had worked about 10 years in coal mines. They ranged in age from about 30 to 60. The names and specific information about the miners weren't disclosed because their families were promised confidentiality.

Cohen says the relatively young ages of some of the miners and limited tenure underground "means that there were probably some intense exposures and excessive exposures over a short period of time. That raises some concerns."

Extraordinarily high rates of black lung in the Upper Big Branch victims were first found during autopsies just after the explosion. The West Virginia medical examiner told mine disaster investigators that 24 of the victims had sufficient lung tissue for testing. He concluded that 71 percent had black lung, a rate 10 times the average for southern West Virginia.

At the time, investigator Davitt McAteer, a former federal mine safety chief, said the autopsy results were shocking because of "the number of miners who showed evidence of black lung, particularly among younger miners and miners who you would not have expected to have black lung."

McAteer asked Cohen to assemble a team of experts to examine the lung tissue of as many victims as possible.

Cohen acknowledges that the sample size is limited. "It's a small number of miners," Cohen says. "But the miners who were referred to the study were a random sample — people who just happened to be working in that mine that day who were killed in the disaster."

Several investigations of the disaster concluded that mine owner Massey Energy had permitted dangerous accumulations of coal dust in the mine. That may explain the high rate of black lung in the tested lung samples of victims.

"Mines that tend to have accidents do tend to be less clean than mines that don't have accidents," Cohen says. But Upper Big Branch "may be representative of a number of mines in the United States today," he says.

Cohen also says the tissue analysis "adds supportive information" in the wake of a number of studies documenting a resurgence of black lung in portions of Appalachia, onset of the disease among younger miners and more rapid progression to advanced stages of disease.

Cohen and another group of researchers summarized those studies in a report last month in the American Journal of Respiratory and Critical Care Medicine.

That report, Cohen says, tackles "ancient legendary teachings" about black lung that have led to misdiagnoses and rejection of claims for black lung benefits payments.

"Contemporary medical school training and residency training and even fellowship training hasn't really kept up with the latest research and science in coal-mine dust lung diseases," Cohen contends.

"Many pulmonary physicians were diagnosing miners with lots of exposure to coal dust as having disease as unknown cause," he adds.

The report says many physicians erroneously believe that only round scars on lung tissue, and only scars in upper lobes, are signs of black lung. "That's not true," Cohen says. The disease "can cause irregular scars or linear scars all over the lungs."

The report urges more frequent X-rays and lung function tests for coal miners. It also urges physicians to "take exposure histories" for coal miners, including the jobs they performed, the machinery they operated, the kind of mines that employed them and how long they worked.

A spokeswoman for the National Mining Association, a trade group, responded narrowly to the report, noting the group's support for mandatory X-ray testing of coal miners. The testing is voluntary now.

"This would provide miners and mine operators the information required to take corrective actions where miners are found to suffer from lung disease," says NMA spokeswoman Nancy Gravatt.

Federal law gives miners the right to seek reassignment to jobs with less coal dust exposure when they have indications of disease, but miners' advocates worry that mandatory testing will give coal companies the ability to dismiss workers with signs of black lung.

Cohen says the lung tissue testing of the Upper Big Branch victims and the new report for physicians confirm "that there is a problem in our control of our exposure to dust that's causing worsening disease and resurgent disease."

The federal Mine Safety and Health Administration said in 2010 that tougher coal-mine dust exposure limits are a top priority. Congressional Republicans delayed action on new limits until the Government Accountability Office could complete a study. The GAO study was issued last August, and it supported MSHA's efforts.

The agency set a target date for next month for rule-making on its proposal, but it's unclear whether that deadline will be met. MSHA spokeswoman Amy Louviere says, "I have no new information about the dust rule."

Black lung has killed 70,000 coal miners since 1970. NPR, the Center for Public Integrity and The Charleston (W.Va.) Gazette documented widespread industry cheating in the coal-dust control system and weak federal regulation in a series of stories last year.

Update 5:15 pm:

"These results are beyond disturbing," says Wes Addington, an attorney at the Appalachian Citizens' Law Center, which represents coal miners seeking black lung benefits.

"I don't care how small the sample," Addington adds. "To find black lung in 85 percent of these miners shouldn't be happening in this country."

Coincidentally, the National Institute of Occupational Safety and Health has just published a study in the American Journal of Public Health that assesses the accuracy of its black lung data documenting the resurgence of the disease in Appalachia.

Industry critics were concerned that researchers tested miners who already had symptoms. But the NIOSH review found that healthy miners with no X-ray indications of black lung participated in the NIOSH screening and returned for additional testing even when they had no symptoms.

The NIOSH study reviewed its reporting for bias and concludes that it is "broadly accurate, although the data likely underestimated the national prevalence of [Coal Workers Pneumoconiosis]," the formal label for black lung.

The undercount, the researchers say, is likely due to the fact that the surveillance system is limited by federal mandate to working coal miners and does not include those who have retired. Black lung is progressive and retired miners may still develop symptoms and advanced disease.

The report also reviewed NIOSH data on other possible causes of lung disease suffered by coal miners and found the "increasing prevalence of pneumoconiosis among coal miners could only be attributed to inhalation of unsafe amounts of coal mine dusts, and could not be attributed to age, smoking, other diseases, or background radiographic abnormalities."

NIOSH concludes the study by urging MSHA to adopt its proposed new standard for coal mine dust exposure, which NIOSH first recommended in 1995.

There's a lot to love about biking to work: the exercise, the fresh air, the cost savings and the benefits for the environment.

But does it make you healthier?

That's a question that's not as easy to answer as you might think. But since today is Bike to Work Day, we'll give it a try.

A large study of 30,000 people in Copenhagen over 14 years found that those who biked to work lowered their risk of death by 40 percent compared to sedentary people. And in the short term, another study of 100 people in Perth, Australia, who replaced some car commutes with bike trips over the course of a year, found the bicycling improved aerobic fitness, cholesterol numbers, and lowered the risk of heart attacks and strokes.

That seems pretty straightforward. But what about the risk of getting crushed by a trash truck? Anyone who's bicycled even a little bit knows all too well the fear of an encounter with a motor vehicle. Just yesterday the Washington Post reported on 20-year-old bicyclist who was critically injured after being hit by a car in downtown Washington.

In 2011, 677 bicyclists died in collisions with motor vehicles. According to the U.S. Department of Transportation, bicycle travel accounts for 2 percent of traffic deaths and just 1 percent of trips.

But that stat doesn't account for the miles traveled by bicyclists, and how long it takes them to travel those miles, as well as the type of road they're on, and time of day. (Bicycling later in the day is riskier, and alcohol use may be a factor in that, on the part of both motorists and bicyclists.)

Data on bike accidents is even sketchier, since bicyclists don't typically report crashes to insurers the way drivers do.

A very unscientific survey on the NPR science desk found that almost all of the bike commuters have been injured at least once, with most of the injuries involving broken ribs and collarbones.

Many of them involved collisions with other bicyclists or pedestrians. Some involved another bicyclist violating traffic laws, and some were just bad luck. That includes the time Joe Palca hit a pothole, crashed, and wiped out Richard Harris, who was riding beside him. Both suffered broken bones. Harris says that's the only accident he's had in 21 years of bike commuting to NPR.

"For me, biking to work is the only reason that I've kept in even marginal shape throughout my 20s and 30s," says global health reporter Michaeleen Doucleff. At age 20 she mangled the cartilage in one knee when she hit a pedestrian; he broke a wrist. "Otherwise, I've been pretty lucky. Sixteen years of commuting and just one major accident. Knock on wood."

Several studies have tried to weigh the risk of injury and death in weighing the health aspects of bike commuting. A 2011 study of a bikeshare program in Barcelona found that the increased life expectancy due to better health substantially outweighed the accident risk. Biking's health benefits also outweighed harms caused by exposure to pollution. The further the bicyclists traveled and the more days they biked, the greater the health benefits.

A 2010 study that compared bike commuting to car commuting in the Netherlands estimated that the health benefits of biking adds 3-14 months of life, compared to 5-9 days lost due to accidents, and 0.8 to 40 days lost due to air pollution exposure.

And a 2009 study in The Lancet estimated that switching to biking would do more to reduce greenhouse gas emissions and improve health than using low-emissions vehicles.

But these studies were done using computer models, not by actually measuring the health of bicyclists and drivers over time. And they were done using data from European cities, where longstanding acceptance of bicycle travel should make for safer commutes.

Indeed, one of the more fascinating threads to emerge from the skimpy science of bike commuting in America is that the more people bike, the safer it may become. In cities like Seattle, Portland, and Minneapolis, bike travel has soared in the past few years, but accident rates have stayed stable. That may be because of new bikeways that separate cars and bikes, or the fact that drivers are getting used to sharing the road with cyclists.

What next for bike commuters? Expect plenty of argument over whether adults should be required to wear bike helmets.

"Helmets prevent 85 percent of brain injuries," says Frederick Rivara, a professor of pediatrics at the University of Washington who has studied helmets and injury. "One of the concerns now is that with the bikeshare programs like the one that's going to start in New York and the one you have in DC, they have not dealt with the whole helmet issue."

Some proponents of increased urban biking say that helmets shouldn't be required because it discourages bicycle use for short commutes, errands, and impromptu rides. They point to enviable safety data from European cities where most bike commuters don't wear helmets. A 2012 study of bicycle riders in DC and Boston found that 20 percent of bikeshare riders used helmets, compared to 50 percent of adults using their own bicycles.

But the doctors aren't buying it. "Concussion is what we're trying to prevent," says Dr. David Milzman, a professor of emergency medicine at Georgetown University and co-author of the study. "There's all this crazy literature that the helmet makes you actually more likely to get injured, because people think they're safer with a helmet. That stuff is crap."

Get a concussion, Milzman says, and you'll be lucky if you miss just a few weeks of work.

Stimulating the brain with a very small electrical current through the forehead could boost a student's ability to learn and remember basic mathematics, a provocative experiment suggests.

The work, published online Thursday by the journal Current Biology, could help those who struggle with mental arithmetic. But the study was small and the long-term effect wasn't profound.

The study tested something called transcranial random noise stimulation, a technique that sends a tiny current to the brain.

The current, generated by a small electronic device, is delivered through two electrodes attached to the temple. The electricity seems to affect the brain's neurons, which themselves use electrical signals to communicate with each other.

The results are preliminary, and alpha parents seeking an edge for their children shouldn't risk electrocution. "Do not try this at home," says Jackie Thompson, a psychologist at the University of Oxford in the U.K.

Some studies suggest that up to 1 in 5 of us has difficulty learning basic math, according to Thompson. Thompson and her colleagues thought that very slight electrical stimulation could help. Electrical stimulation has sometimes been shown to boost basic cognitive skills, Thompson says.

To find out if it could help with more complex brain functions, the team tried mathematics. They took 25 students and asked them to memorize a series of made-up mathematical equations. For example, 4 # 12 = 17. The idea was to test their ability to memorize sums that they hadn't seen before.

EDITOR'S ADD NOTE, Friday, May 17, 10:48 a.m.

The team also had the students execute problems with several arithmetic steps, such as 12 - 4 + 10 + 12 = 30. The idea was to test their ability both to calculate math problems and to memorize sums that they hadn't seen before.

And the original post continues...

All the students had two electrodes stuck to their foreheads, but only half received the tiny electrical signal. The signal was too small to be felt, and even the researchers conducting the tests didn't know who had received a signal and who hadn't.

When they went back and checked, they found that those who had received the stimulation appeared to memorize their sums faster and better than those who hadn't. Moreover, the effect seemed to last for six months after the stimulation. But it wasn't as strong.

Researchers aren't quite sure how it works, but co-author author Thompson says that the electrical signal may get brain cells synchronized: "Kind of like if you have eight rowers in a boat, if they're all rowing together they go faster," she says.

Researchers hope that their new technique could eventually be developed into a tool to help those with learning disabilities, or anyone who finds they are severely math challenged. But Thompson says that more research is needed to see what method of stimulation works best.

When the Senate voted Tuesday to make Marilyn Tavenner the official administrator of the Centers for Medicare and Medicaid Services, it was the first time the world's greatest deliberative body had approved someone to head the huge health agency since 2004.

That's right, you have to go way back to the Bush administration to find Dr. Mark McClellan, the last person to be officially put in the post.

Tavenner, who has been running the agency in an acting capacity since late 2011, has a big job. CMS oversees Medicare, Medicaid, and the Children's Health Insurance Plan, which together serve north of 100 million Americans and have a combined budget larger than the Defense Department's.

CMS is also playing a major role in the implementation of the Affordable Care Act. The agency is in charge of the Medicare changes in the law, the creation of health exchanges and a significant expansion in Medicaid.

She comes to the agency with a reservoir of good will that eluded two previous nominees for the job, Obama appointee Donald Berwick and Bush appointee Kerry Weems.

Tavenner, a nurse, hospital executive, and one-time Virginia health secretary won the backing of House Majority Leader Eric Cantor, which made it safe for many Senate Republicans to support her.

She also benefited from auspicious timing. Weems' nomination got caught up in the politics of the Children's Health Insurance Program renewal; Berwick's in the furious fight over the Affordable Care Act. Even McClellan's nomination was held up briefly because then Sen. Byron Dorgan, D-N.D., was irritated because McClellan, in his previous position as commissioner of the Food and Drug Administration, had opposed Dorgan's legislation allowing easier importation of cheaper prescription drugs from Canada and other industrialized nations.

Tavenner also takes over just as the agency is getting some good news from the Congressional Budget Office.

It seems that CBO is among the agencies now predicting a slowdown in health spending. The latest 10-year spending estimates for Medicare and Medicaid, according to CBO, are down some $225 billion ($138 billion for Medicare and $89 for Medicaid) from where they were in March 2010.

Finally, of course, Tavenner takes the reins officially with a groundswell of goodwill from those whose economic future she now controls. Within moments of her confirmation, reporters' inboxes were flooded with congratulations and praise.

"Her leadership, extensive experience and strong knowledge of the healthcare system are huge assets in tackling our nation's healthcare challenges moving forward," said Scott Serota, president and CEO of the Blue Cross/Blue Shield Association.

Agreed Rich Umbdenstock, president and CEO of the American Hospital Association, "As acting administrator, Marilyn has demonstrated her willingness to listen to, learn from and work in partnership with the nation's health care providers."

She better enjoy it now. It only gets harder from here.

The American Psychiatric Association is about to release an updated version of its Diagnostic and Statistical Manual of Mental Disorders. The DSM helps mental health professionals decide who has problems such as depression, anxiety and schizophrenia.

Psychiatry's new manual, DSM-5, has been nearly 20 years in the making. During that time, scientists have learned a lot about the brain. Yet despite some tweaks to categories such as autism and mood disorders, DSM-5 is remarkably similar to the version issued in 1994.

"There are lots of changes throughout the manual that reflect the research in the last 20 years," says Michael First, a clinical psychiatrist at Columbia University who was involved in creating both DSM-IV and DSM-5. (The APA abandoned Roman numerals for the new manual.) "But because that kind of research hasn't allowed for a paradigm shift, the DSM is not a paradigm shift either," First says.

Specifically, DSM-5 will continue to use symptoms as the primary way to decide whether a person has a particular disorder. That may not sound odd until you consider what's happened in other fields of medicine, like cardiology.

If you go to a hospital with chest pain these days, chances are you'll get a diagnosis based on tests of the electrical activity in your heart, the enzymes in your blood, and the blood flow through your arteries. But if your problem is emotional pain, your diagnosis will probably be based on a conversation.

So why is psychiatry still so last-century? Scientists say it has to do with the nature of the brain itself.

The Hippo Problem

When psychiatrists began work on DSM-5, they expected to come up with a document that would signal a new era in mental health care, First says.

"We were hoping and imagining that research would advance at a pace that laboratory tests would have come out," he says. "And here we are 20 years later and we still unfortunately rely primarily on symptoms to make our diagnoses."

That's not ideal, First says. Not for doctors. Not for patients. Not for scientists.

The problem is that the new DSM is still classifying mental disorders based on their surface appearance, not their underlying biology. And the history of science shows that appearances can be deceiving.

Take hippos, for example. Early naturalists thought hippos must be related to pigs. After all they look somewhat alike and have similar teeth. But fossils and genetic studies showed that hippos' closest living relatives are actually dolphins and whales.

So to avoid the hippo problem, many areas of medicine have begun to look beneath the superficial appearance of an illness.

A New Kind Of Medicine

"For literally centuries, doctors have looked at diseases using signs and symptoms," says Susan Desmond-Hellman, an oncologist who is chancellor of the University of California, San Francisco. So, she says, doctors would ask questions like, "Do you have a lump somewhere?"

But now, many scientists are concerned that this emphasis on the signs and symptoms of a disease "could be seen as holding us back," Desmond-Hellman says. Instead, she's been advocating something called "precision medicine," which tries to classify diseases in a way that indicates what's truly causing the problem.

A good example of this new approach is breast cancer, Desmond-Hellman says. "I'm a cancer doctor and had the incredible opportunity to work on revolutionizing how we treat breast cancer based on what's in your DNA that's signaling the breast cancer to grow," she says. "And it's a wonderful opportunity because if a patient has a breast cancer that's driven by something in the genome, we can turn it off."

This revolution happened in part because cancer researchers looked beyond the old way of classifying tumors according to simply what body part they appeared in, Desmond-Hellman says. And something similar needs to happen in mental health because, she says, "everything from autism to Alzheimer's is classified in ways that clearly don't work today."

Desmond-Hellman adds that she's not criticizing psychiatrists or psychologists for using the DSM. It's still the best option because there still aren't genetic tests or brain scans that offer a better way to classify patients with mental disorders.

Brain Research Looks Ahead

So why haven't researchers developed simple lab tests for mental disorders?

"We've tried," says Thomas Insel, director of the National Institute of Mental Health. "You know we've actually looked — using brain imaging, using various endocrine tests, looking at a range of other kinds of biomarkers. So far that has been found wanting."

For example, researchers tried for many years to find a genetic test or a brain-scanning technique that could identify people with depression. That approach would make sense if scientists knew that all depression can be linked to the same underlying problem. But what if it can't, Insel says. What if depression is like a fever?

"Some people who have a fever have a bacterial infection, some a viral infection, some an endocrine problem," Insel says, "a whole range of reasons why that would be your presenting symptom and a whole range of different treatments that you need for each of those causes."

So a few years ago, the NIMH began moving away from research based on categories defined only by symptoms. Instead, it's pushing an approach it calls Research Domain Criteria that emphasizes basic functions in the brain. Researchers might get money to study circuits involved in fear, or so-called working memory.

This sort of research has the potential to uncover problems in the brain that will change the way mental disorders are classified, Insel says. "A biological thing that presents with depression in some people might present with psychosis or anxiety in others," he says. "And so maybe what you'll find is a problem that cuts across the current diagnostic categories."

Insel says findings like that are years off. Maybe they'll get here in time for the next version of the DSM. Maybe.

A Better Future?

Michael First, the psychiatrist who spent much of his career working on the DSM, says he's learned to be cautious about anticipating major advances in any problem that affects the brain.

Back in the 1990s, when he was writing a guidebook to DSM-IV, First says, he made an unfortunate prediction about Alzheimer's. "I stuck my neck out," he says. "We said that by the time DSM-5 comes out, Alzheimer's will be the first diagnosis that has a laboratory test."

That hasn't happened. Even though scientists have learned a huge amount about the plaques and tangles associated with Alzheimer's and even though high-tech scans can reveal ever more subtle changes in the brains of people with the disease, there's still no lab test that's good enough to diagnose Alzheimer's.

First says migraine headaches are another brain problem still waiting for a lab test. "If you have a headache and you go to a neurologist, even though they might run some blood tests, the actual diagnosis of a migraine vs. a cluster headache depends on the description of the symptoms," he says. "So psychiatry is not unique."

In fact, almost every specialty that deals with the brain has run into the same roadblocks facing psychiatrists. "The brain is very, very complicated and it really hasn't yielded its secrets yet," First says.

And that, he says, is the primary reason mental health isn't more like cardiology or oncology, why psychiatrists and psychologists still rely on symptoms, rather than lab tests. The human brain is the most complicated thing in the universe. It has nearly 100 billion neurons and many trillions of connections, and its complex wiring changes all the time.

But the daunting complexity of the brain is no reason to give up on the DSM or the ability of mental health professionals to treat mental disorders, First says. "When people walk into our offices they come for help, not some explanation of the neurobiology of what's going on," he says. "They want some relief of suffering and the DSM remains the most valuable tool for psychiatrists to be able to do that."

Perhaps you've noticed a toddler's sagging swim diaper and wondered if it's really keeping the poop out of your neighborhood pool.

The Centers for Disease Control and Prevention has the answer for you: no.

Last summer, researchers at the federal public health agency collected 161 filter samples from public swimming pools in the Atlanta area. More than half of those samples, 58 percent, were contaminated with E. coli.

That, the CDC reported today, "signifies that swimmers introduced fecal matter into pool water."

Toddlers who aren't toilet trained are just one source of the problem, according to the study, which was published in the latest Morbidity and Mortality Weekly Report.

People who don't shower with soap before swimming bring E. coli on their backsides, the CDC reports. And people who swim while sick with diarrhea are much more likely to introduce E. coli, Cryptosporidium, and other yucky germs into the water.

That takes some of the shine off the opening of summer pool season, doesn't it?

Fortunately, a properly chlorinated pool can kill E. coli quickly. So if your local pool is doing a good job maintaining chlorine and pH levels, that takes care of that problem.

The testing method used in this study couldn't tell if the E. coli was alive or had already been killed. And no outbreaks of pool-related disease were reported last summer in Atlanta.

Wondering why the lifeguards kick you out of the pool for 30 minutes after a "fecal incident"? That's the amount of time the CDC recommends to make sure that E. coli, by far the most common fecal pathogen, has been killed.

Other bugs are a lot harder to kill, unfortunately. It can take 45 minutes to kill Giardia, which causes diarrhea, in a pool chlorinated with 1 part per million of free chlorine. But it can take more than a day to kill Cryptosporidium, even with 10 times as much chlorine.

The CDC wants you to do your part by showering before you get in the pool. Children should be taken to the bathroom every hour, and diapers should be checked and changed at least that often. Most important, stay out of the pool when suffering from diarrhea.

Oh, and the CDC knows you pee in the pool, too. The nitrogen in urine depletes free chlorine in pool water, making it harder to kill germs. Nitrogen also converts the chlorine into a form that irritates the eyes and lungs. So stop doing that.

But this subject isn't a complete bummer. It's given us here at Shots an excuse to revisit the classic Baby Ruth in the pool scene from the 1980 movie "Caddyshack." Enjoy!

People smell yummy to mosquitoes.

So yummy, in fact, that our scent is a big way the pesky insects track us down.

But just how much mosquitoes like Eau de Human may not be entirely up to the bugs.

Mosquitoes are more attracted to human odors when they're infected with the malaria parasite, scientists reported Wednesday in the journal PLOS ONE.

Entomologists at the London School of Hygiene and Tropical Medicine gave malaria-transmitting mosquitoes two places to land: a clean, nylon stocking and one worn for 20 hours on the foot of young Dutch woman (who happens to be an author on the study).

All the mosquitoes gravitated more toward the dirty sock than the fresh one. But the bugs infected with malaria landed on the smelly nylon more frequently. And while they were there, the parasite-possessed bugs were more likely to try and bite the stocking than the malaria-free insects.

It's almost like mind control. The parasite changes the behavior of the insects for its own benefit. The more biting the bugs do, the more they spread the protists.

This kind of parasitic mind control isn't limited to mosquitoes and malaria. One type of fungus is notorious for turning carpenter ants into so-called zombies. After the Ophiocordyceps unilateralis infects the ants, the insects march to a precise location on a leaf that is optimal for dispersing the fungus's spores. Eventually, the ant dies at this location and the Ophiocordyceps sprouts from the dead corpse.

Malaria appears to be more subtle with its subterfuge. It just amplifies the mosquitoes' preference for human blood.

Scientists have known for a decades that the malaria vector Anopheles gambaie is highly attracted to people. In fact, these ladies – it's only the females that bite us — actually prefer to feast on humans than many other animals. They even have a strong aversion to cow odor.

So what's in our bouquet that makes us so alluring to mosquitoes?

Human skin emits over 350 different odor molecules. The An. gambaie mosquitoes have odor receptors in their antennae specifically built to detect a handful of these scents.

One these compounds, known as mushroom alcohol (because it's made by mushrooms), gives our skin a moldy or meaty smell. Another compound, diacetyl, has a buttery scent. It's the same molecule found in Chardonnay and added to microwave popcorn to simulate butter.