Publisher Health

If you’re feeling more sudden urges to run to the bathroom as you age, you’re not alone. A new study suggests postmenopausal women aged 45 to 54 years are more likely to have overactive bladder (OAB) syndrome. Additionally, obesity and multiple births put a woman at greater risk for stress urinary incontinence (SUI). Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).
Urinary incontinence symptoms are common in women and typically worsen as women age. In the United States, the prevalence of urinary incontinence is 17.1% in women aged 20 years or older and 38% in women aged 60 years and older.
There are two main types of urinary incontinence — urinary urge incontinence (UUI) and SUI. Urinary urge incontinence is defined as the involuntary loss of urine associated with the urge to urinate. Stress urinary incontinence, in contrast, is the involuntary loss of urine because of effort or physical exertion, including sporting activities, sneezing, and coughing. Of the two, women are more likely to be diagnosed with SUI. Overactive bladder syndrome is characterized by urinary urgency and is usually accompanied by increased daytime frequency and/or nocturia, with urinary incontinence.
Multiple studies have been conducted on these urinary issues that can adversely affect a woman’s quality of life. However, this is the largest known study, with data from more than 12,000 women. The goal of this new study was to investigate the prevalence and factors associated with urinary symptoms.
Although the study showed a significant association of OAB in women aged 45 to 54 years and postmenopausal status, it also demonstrated that SUI symptoms may likely become less frequent after menopause. Stress urinary incontinence symptoms, however, were shown to increase as a result of a high body mass index and the number of times a woman has given birth.
Other factors studied included smoking status, history of diabetes, hysterectomy, and the use of hormone therapy. The researchers suggest that additional studies should be conducted to consider the association between time since menopause and OAB symptoms in the perimenopause period.
Study results are published in the article “Prevalence and factors associated with overactive bladder and stress urinary incontinence in the Japan Nurses’ Health Study.”
“This study underscores how common urinary incontinence is in women, with nearly one in five Japanese women reporting urinary incontinence related to OAB or SUI in the last month. Midlife women were particularly affected by SUI (18.2% in women aged 50 to 54 years). Given the significant negative effect on quality of life and the presence of effective strategies for management of these burdensome symptoms, clinicians should routinely ask women about urinary incontinence,” says Dr. Stephanie Faubion, NAMS medical director.
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Treatment for high blood pressure during pregnancy appears safe for many women and may reduce maternal risk for severe hypertension without increasing fetal and neonatal risks, according to a new American Heart Association scientific statement published today in the Association’s journal Hypertension.
A scientific statement is an expert analysis of current research and may inform future clinical practice guidelines. In this statement, “Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy,” experts in obstetrics and gynecology, maternal-fetal medicine, cardiology, nephrology, hypertension and internal medicine reviewed and analyzed quality studies focusing on high blood pressure during pregnancy including gestational hypertension and preeclampsia/eclampsia.
The latest American Heart Association statistics indicate hypertension during pregnancy, defined as a systolic pressure (the top number in a blood pressure reading) of 140 mm Hg or higher, is the second leading cause of maternal death worldwide. Severe cases are associated with increased risks of cardiovascular complications for mothers immediately or soon after delivery, and for years after pregnancy. Hypertension during pregnancy increased the risks for complications for the offspring such as preterm delivery, small for gestational age and low birthweight. Rates of hypertension during pregnancy are increasing globally, and the data indicate that it disproportionately affects women who are from diverse racial and ethnic backgrounds in the U.S., particularly those who are Black, American Indian or Alaskan Native.
The goals of treatment during pregnancy include preventing severe hypertension and preventing early delivery to allow the fetus time to mature before delivery.
“For decades, the benefits of blood pressure treatment for pregnant women were unclear. And there were concerns about fetal well-being from exposure to antihypertensive medications,” said Chair of the statement writing group Vesna D. Garovic, M.D., Ph.D., a professor of medicine, chair of the division of nephrology and hypertension with a joint appointment in the department of obstetrics and gynecology at Mayo Clinic in Rochester, Minnesota. “Through our comprehensive review of the existing literature, it is reassuring to see emerging evidence that treating high blood pressure during pregnancy is safe and effective and may be beneficial at lower thresholds than previously thought. Now, we have the current statement focused on hypertension during pregnancy to help inform optimal treatment and future research.”
According to the statement, among high-income countries, the United States has one of the highest hypertensive-related maternal mortality rates. Cardiovascular disease, which includes stroke and heart failure, now accounts for up to half of all maternal deaths in the U. S, and pregnancy-related stroke hospitalizations increased more than 60% from 1994 to 2011. Preeclampsia, which occurs when hypertension during pregnancy is accompanied by signs of liver or kidney problems such as protein in the urine, affects 5% to 7% of pregnancies and is responsible for more than 70,000 maternal deaths and 500,000 fetal deaths worldwide every year, according to the American Heart Association.

Scientists have spotted signs of ‘pre-resistance’ in bacteria for the first time — signs that particular bacteria are likely to become resistant to antibiotics in the future — in a new study led by UCL and Great Ormond Street Hospital researchers.
The findings, published in Nature Communications, will allow doctors in the future to select the best treatments for bacterial infections.
The team led by Great Ormond Street Hospital (GOSH) and the UCL Great Ormond Street Institute of Child Health, in collaboration with the Peruvian Tuberculosis programme and funded by Wellcome and the National Institutes of Health (USA), sequenced the full genomes of over 3,000 tuberculosis (TB) samples, tracing TB infections back through patients over nearly two decades.
Mycobacterium tuberculosis (TB) is a bacterial infection that largely affects the lungs. It was the second leading infectious cause of death after COVID-19 in 2020, killing 1.5m people. It can be cured if treated with the right antibiotics, but treatment is lengthy and many people most at risk lack access to adequate healthcare. Drug-resistant TB can develop when people do not finish their full course of treatment, or when drugs are not available or are of poor quality.
Multi-drug resistant TB represents a huge, unsustainable burden and totally drug resistant strains have been detected in a handful of countries. As health systems struggle to cope with the pandemic, progress on TB treatment globally has slowed.
In order to develop a better understanding of, and ultimately better treatments for, TB, this new research has identified for the first time how to pre-empt drug resistance mutations before they have occurred. The researchers have termed this concept ‘pre-resistance’: when a disease-causing organism — such as a virus or bacteria — has a greater inherent risk of developing resistance to drugs in the future.

Consuming lead can cause health problems for anyone, but children are particularly vulnerable because the element can interfere with their growth and development. While water systems will soon be required to measure lead levels in school tap water, it’s not clear how these measurements should be interpreted. In a new study in ACS’ Environmental Science & Technology Letters, researchers used real-world data to determine an approach for identifying schools likely to have problematic lead levels.
Under certain circumstances, pipes, faucets and other plumbing system components can release lead into the water they carry. Research has shown that such contamination is widespread among schools, so the U.S. Environmental Protection Agency recently developed a plan to revise its rules on testing for lead in these buildings. The revision will require water systems to test for lead content based on five samples from a school. However, the amount of lead that shows up within a building’s water can fluctuate, so some researchers are concerned that this approach won’t accurately detect those schools with potentially problematic levels. Kelsey Pieper and colleagues wanted to take a closer look at the problem, and to see whether just five samples could be used to identify at-risk schools.
The researchers analyzed 47,727 lead measurements taken from 1,094 schools in Massachusetts. They found that water from 12% of the fixtures, such as water fountains and faucets, had lead levels of more than 15 parts per billion (ppb) — the threshold at which the state requires that a fixture be shut off. These problematic fixtures were not evenly distributed: 90% of them were located in just 34% of schools. The team also used these data, which averaged nearly 44 samples per building, to classify schools as having low or high lead levels. They then tested two ways of making the same classification with only five measurements, the results of which they verified by comparing them to those derived from the full data set. In the first, they simply counted how many of the five samples had more than 5 ppb, and for the second, they used a statistical analysis to score the five together. By combining the two approaches, they found they could most accurately identify schools at low or increased risk of having elevated lead levels. The strategy couldn’t classify schools based on a lower, 1 ppb threshold. Despite that limitation, the researchers say that these results confirm that five samples could be used to prioritize lead remediation efforts if analyzed in these two ways.
The authors acknowledge funding from the U.S. Environmental Protection Agency and Northeastern University.
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When ocean waves break, microscopic particles break free into the air. For beachgoers, aerosolized sea salts contribute to the tousled “beach hair” look. But other compounds found in seawater, including perfluoroalkyl substances (PFASs), could become airborne as bubbles pop at the water’s surface. Now, researchers reporting in ACS’ Environmental Science & Technology have observed in a thorough field study that sea spray pollutes the air in coastal areas with these potentially harmful chemicals.
PFASs, which include perfluoroalkyl acids (PFAAs), don’t break down easily, so they’ve garnered the label “forever chemicals.” These persistent, potentially harmful compounds were widely used in industrial processes, food packaging, personal care products and water-repellant coatings before being phased out from these products in some countries. They’re now found worldwide, including in the oceans, where they’ve been expected to diffuse enough to not be a major concern. However, with previous laboratory experiments, Bo Sha, Jana Johansson, Ian Cousins, Matthew Salter and colleagues showed that when bubbles containing PFAAs burst at the surface of saltwater, these compounds are ejected as aerosols — extremely small airborne particles. Their findings indicated that sea spray aerosols could be an important way that these contaminants are transported long distances. So, as the next step, the team wanted to conduct field observations to find out whether this was the case in the real world.
At two coastal locations in Norway, the researchers collected over 100 air samples between 2018 and 2020. They analyzed the microscopic particles in the samples for 11 PFAAs, including the possible carcinogens perfluorooctanoic acid and perfluorooctane sulfonic acid, as well as sodium ions, which are an indicator of sea spray aerosols. The researchers detected the contaminants in all of the air samples collected. When the team compared the levels of individual PFAAs to sodium ions, many of them were strongly related, especially perfluorooctanoic acid, which they say indicates that these compounds leave the ocean with sea spray and could be blown inland. Finally, using the field measurements, the researchers estimated that for eight of the PFAAs, there could be 284 to 756 U.S. tons released globally from the oceans to the air each year, a higher amount than in previous estimates. Based on their field measurements, the researchers conclude that sea spray is an important source of this class of PFASs to coastal communities. They add that because sea spray can travel far distances inland, this is also likely to be a route for PFASs to be transported, and potentially return, to terrestrial regions from the ocean.
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The diagnosis came from an unlikely source. The 66-year-old man had just started his third lap at the community swimming pool outside Poughkeepsie, N.Y., when it struck. As he was turning his head to take a breath, an octopus of pain wrapped around the right side of his skull, starting at the joint where the jaw connects and slamming across his face and head with tentacles of squeezing agony. For a moment he was paralyzed — first with pain, then with fear. He couldn’t breathe; he could barely move. He struggled to the side of the pool and hung on, his breath ragged through involuntarily clenched teeth. His wife hurried over. He was a good swimmer; what was wrong? She saw his lips move and leaned closer. His jaw was clenched. “I can’t speak,” he mumbled. She helped him out of the pool. “We’re going to go to urgent care,” she said as she handed him a towel. These strange pains had been tormenting the man for nearly three weeks. It started as a headache that woke him from a dead sleep, a squeezing pressure deep inside his brain. He got up and took some acetaminophen. When he awoke the next morning, the headache was gone, but the regions around his head and face where the pressure had been strongest felt strangely tender. He couldn’t even brush his hair on the right side of his head. Bizarre as this was, he most likely would have soon forgotten about it except that it happened again the next night — and just about every night since. The pain in his jaw started a couple of days later. Opening and closing his mouth, and especially chewing, made his jaw throb. Eating anything more solid than mashed potatoes triggered excruciating pain. He went to his dentist, who poked and prodded. The only tenderness was in the joint where the jaw attached to the skull. It’s most likely TMJ, the dentist concluded — temporomandibular joint pain. That joint and the many attached muscles make speech and facial expressions possible. Lots of people have pain there, the dentist added. Bad habits like jaw-clenching and tooth-grinding aggravate the joint. The treatment is behavior modification to unlearn these habits, and sometimes a bite block, a custom-made piece of acrylic worn at night to protect teeth from injury. That didn’t sound right to the patient — or to his wife. She would know if he was grinding his teeth. She found a dentist online who specialized in jaw pain and TMJ. That dentist wasn’t sure what it was, either. Maybe it was some sleep issue, because the pain was worst at night. He referred the man for a sleep study. But that didn’t sound right, either.Two of EverythingThat weekend, the couple went to their club so the man could play in a tennis tournament. As he got out of the car, his world shifted, and he suddenly saw two of everything, one image on top of the other. “I can’t play tennis,” he told his wife calmly. “I’m seeing double.” The words terrified his wife. Did he have a brain tumor? All the worst possibilities suddenly seemed probable. Let me just walk around a bit to see if it gets better, the man said. It did get better, and he was able to play in the tournament.The next week seemed endless as the man waited to start feeling better. Instead, the headaches continued to interrupt his nights. He lost nearly 10 pounds because it hurt too much to eat. And he had a second episode of double vision that really scared him. All of this made working nearly impossible.So he was relieved when the next weekend came. It was his wife’s birthday on Sunday, and he had a lovely dinner planned. But when his afternoon swim turned nightmarish, the couple ended up instead in the emergency room of the MidHudson Regional Hospital in Poughkeepsie. As they waited to be seen, the wife got a text from Sarah Cope, the director of her art gallery. “How’s your day off?” Cope asked after some preliminary shoptalk. Awful, she texted back; she was in the E.R. with her husband. Sarah had heard all about the strange issues her boss’s husband was having, and now read through her friend’s description of the terrible scene at the pool. The couple were soon taken into the bowels of the E.R. and given a tiny cubicle. That’s when Cope texted back: “Does his scalp hurt?” It did. “There is something called giant cell arteritis — an inflammation of the arteries in your brain. Same symptoms.” Neither the patient nor his wife had heard of this disorder. Cope shot back that she searched the internet for patients with similar symptoms and came across a story about a man who had been diagnosed with TMJ but actually had this much rarer disease. Photo illustration by Ina JangTesting an Amateur’s TheoryThe wife immediately searched the term on her phone. Giant cell arteritis (G.C.A.) is an autoimmune disease, and like most such diseases, it is rare. It causes inflammation and pain in the blood vessels of the face and brain. The couple scrolled through the description of the disease and the patients who have it. It’s seen in those over 50 and is most common in people of Northern European heritage. It’s much more common in women than men — but men do get it. And it seemed to account for every one of her husband’s symptoms: headache, double vision, jaw pain that worsens with use. Everything. Dr. Danielle Belser, the emergency-​medicine doctor on duty, entered the cubicle and introduced herself to the couple. The patient quickly went through his story, and after a short examination, the doctor stepped back. “I have a few ideas,” she said. She held her hand over the side of her face, with the first three fingers extended toward her mouth, her nose and her eyes. The fifth cranial nerve, she explained, also called the trigeminal nerve, comes out of the brain just in front of the ear and immediately divides into three branches that provide sensation to the skin of the face, the nose and the mouth. In trigeminal neuralgia, an injury to the nerve causes terrible pain in one of these branches. Even as she was explaining her theory, she could see the couple shaking their heads. They were quite familiar with trigeminal neuralgia, the wife explained, because she had it just a couple of years before. It was awful and painful, but it wasn’t what her husband had. She was sure of that. “I know you’re going to hate this,” the wife added, “but we have a different idea about what it might be: giant cell arteritis.” The doctor smiled. “That was the very next thing on my list,” she said. Belser ordered blood tests to look for signs of the significant inflammation this disease causes. If they were high, it could indicate the presence of G.C.A., but to really nail the diagnosis, the patient would need to get a biopsy of his temporal artery. In autoimmune disorders like this, the immune system mistakenly starts attacking parts of the body it’s designed to protect. In G.C.A., the targets are usually the blood vessels of the face, the eyes and the brain. Untreated, the disorder can cause blindness, strokes, even heart attacks. Because of that risk, when the diagnosis of G.C.A. is considered, treatment with high doses of steroids must be started immediately — even before the biopsy. When the blood tests came back positive, the patient was given his first dose of prednisone. He would be on it for months, perhaps years. The headaches disappeared after the first couple of doses. And by the end of the week, he could eat again. The biopsy confirmed what he already knew: He had G.C.A. He has been on a high dose of prednisone since early this summer. His rheumatologist is slowly tapering the medicine, but no one can tell him how long he’ll need it. His face, he told me recently, is a little rounder than it used to be. Prednisone often causes what’s called a moon face. The rest of him is a little rounder as well — weight gain is another effect of the drug. Sarah Cope is thrilled that she got the diagnosis right. She has always prided herself on her research skills, she says. “I’m 35. That means I know how to use a card catalog. But I can also use a computer to get the right answer.”Lisa Sanders, M.D., is a contributing writer for the magazine. Her latest book is “Diagnosis: Solving the Most Baffling Medical Mysteries.” If you have a solved case to share, write her at Lisa.Sandersmd@gmail.com.

A new analysis of data from “The Biggest Loser” highlights the complex ways the body compensates when we drop pounds.Many of us remember “The Biggest Loser,” the somewhat notorious reality television show that ran for more than a decade starting in 2004, in which contestants competed feverishly to drop massive amounts of weight over a short period of time. One of the biggest lessons of the show appeared to be that extreme exercise, along with draconian calorie restriction, would lead to enormous weight loss. Media coverage of the contestants years later, though, seemed to tell a different story, of weight regain and slowed metabolisms and the futility of attempting long-term weight loss. Now a new scientific analysis of the show and its aftermath, published last month in the journal Obesity, suggests many beliefs about “The Biggest Loser” may be misconceptions. The analysis tries to untangle what really happened to the contestants’ metabolisms and why some of them kept off weight better than others. It also looks into the complex role of exercise and whether staying physically active helped the contestants keep their weight under control for years, or not.For those who may have forgotten, or tried to, “The Biggest Loser” ran on NBC to generally high ratings for more than a dozen seasons. Contestants competed to drop the most pounds using extreme calorie restriction and hours of daily strenuous exercise. “Winners” typically shed hundreds of pounds in a few months.Such rapid and extreme weight loss caught the attention of Kevin Hall, a senior investigator at the National Institute of Diabetes and Digestive and Kidney Diseases, which is part of the National Institutes of Health. An expert on metabolism, Dr. Hall knew that when people drop lots of weight in a short period of time, they typically send their resting metabolic rates — the baseline calories we burn every day just by being alive — into free-fall. A lower resting metabolic rate can mean we burn fewer calories over all. This effect was believed to be caused, in part, by the loss of muscle during dieting. A relatively active tissue, muscle burns more calories than fat, and more muscle typically means elevated metabolic rates. So, Dr. Hall wondered, would the maniacal levels of exercise during “The Biggest Loser” help dieters hold onto muscle and keep their resting metabolism high, even as they cut calories?Starting more than a decade ago, Dr. Hall and his colleagues began the first of a series of experiments to find out. In a study from 2012, they compared 16 men and women who had lost massive amounts of weight by cutting calories, thanks to gastric bypass surgery, and 16 contestants from “The Biggest Loser,” whose extreme weight loss involved exercise as well as dieting. As expected, the bypass group shed muscle, as well as fat, while “The Biggest Loser” contestants kept most of their muscle and primarily dropped fat. But everyone’s resting metabolic rate dropped, and to about the same extent, whether they remained well-muscled or not.Dr. Hall said he and his colleagues were surprised by the results. And their confusion intensified when, for a 2016 study, they rechecked 14 of same contestants six years after their competition, expecting their metabolisms to have rebounded by then. Most dieters’ resting metabolisms rise somewhat after they stop actively losing weight, and especially if they regain pounds. Larger people burn more baseline calories than people who are slighter. By this time, most of the contestants had regained weight. But their resting metabolisms remained stubbornly slow, burning an average of about 500 fewer daily calories than before they joined the show.The next year, a follow-up study concluded physical activity had helped some contestants stave off weight gain. If they moved around or formally exercised for about 80 minutes most days, they added back fewer pounds than if they rarely worked out. But their exercise did not boost their resting metabolisms. The exercisers, in fact, showed the greatest relative declines in their resting metabolic rates.Perplexed, Dr. Hall recently began to reconsider the “Biggest Loser” studies in light of an emerging concept about how human metabolism fundamentally works. This idea grew out of an influential 2012 study showing that highly active hunter gatherers in Tanzania burn about the same relative number of calories every day as the rest of us, even though they move around far more.The scientists involved in that research postulated the tribespeople’s bodies must automatically be compensating for some of the calories they burned while hunting for food by decreasing other physiological activities, such as growth. (The tribespeople tended to be short.) In that way, the researchers felt, the hunters’ bodies could keep the overall number of calories they burned each day in check, no matter how many miles they jogged in search of tubers and game. The scientists called this idea the constrained total energy expenditure theory.Aware of this research, Dr. Hall began to see potential parallels in “The Biggest Loser” results. So, for the new analysis, he looked back at his group’s data for hints about whether contestants’ metabolisms had behaved, in effect, like the metabolisms of the hunter gatherers. And he found clues in their resting metabolic rates. That number plummeted early in their “Biggest Loser” filming, he noted, when they slashed how much they ate, and their bodies, understandably, reduced the calories they burned to avoid starving.But in later years, when contestants typically returned to eating as they had before, their metabolisms stayed depressed because, he concluded — and this was key — most of them still exercised. Counter-intuitively, he wrote in the new analysis, frequent physical activity seems to have prompted their bodies to hold resting metabolic rates low, so total daily energy expenditure could be constrained.“It’s still just a hypothesis,” Dr. Hall said, “but it seems like what we’re observing” in the “Biggest Loser” data “is an example of the constrained energy model.”So, what could this rethinking of “The Biggest Loser” story mean for the rest of us, if we hope to keep our weight under control? First and most fundamentally, Dr. Hall said, it suggests that abrupt and colossal weight loss generally will backfire, since that strategy seems to send resting metabolic rates plunging more than would be expected, given people’s smaller body sizes. When people drop pounds gradually in weight-loss experiments, he pointed out, their metabolic changes tend to be less drastic.Second and more befuddling, if you have lost substantial weight, “Biggest Loser” style, exercise likely will be both ally and underminer in your efforts to keep those pounds at bay. In Dr. Hall’s new interpretation of contestants’ long-term weight control, frequent exercise kept contestants’ resting metabolic rates low but also helped them stave off fat regain. In essence, the contestants who worked out the most wound up adding back the least weight, even though they also sported the slowest relative resting metabolisms.Exactly how, then, exercise aided with their weight maintenance is not yet clear, Dr. Hall said. He suspects that exercise affected people’s appetites in ways that may have made them less prone to overeating, while also burning some extra calories. He hopes to develop future experiments to elucidate how exercise influences metabolisms, for better and worse, he said.For now, though, the most reverberant lesson of “The Biggest Loser” may be that long-term weight loss, although daunting, is not unfeasible. Yes, most “Biggest Loser” contestants regained weight, Dr. Hall said, but not necessarily every pound they dropped. After six years, most still weighed about 12 percent less than before joining the show, a meaningful difference, and the most successful of the former contestants were those who still worked out.

At the urging of producers, Meredith Willson cut a boy in a wheelchair from the early scripts for his 1957 musical. A look back shows what was lost.Many know Meredith Willson’s 1957 Broadway musical, “The Music Man,” as a light comedy centered on a cheeky scam artist who pretends to be a musician and sells the idea of starting a boys’ band to a small town in Iowa. The show is being revived on Broadway starring Hugh Jackman and Sutton Foster, and will begin performances this month.But several newly recognized drafts of the musical, written between 1954 and 1957, show that originally, the story focused more on the town’s persecution of a boy in a wheelchair — carrying a much more serious message than the final draft. At the time, children with disabilities were routinely institutionalized in horrid conditions and denied an education.In the version that debuted in 1957, the only character that doesn’t fall for the scheme is Marian Paroo, a well-read single woman who has a shy younger brother with a lisp, named Winthrop. But the con man, Harold Hill, manages to charm Marian and wins her over in part by being kind to Winthrop and including him in the band.In the earlier drafts, Marian’s younger brother was a character named Jim Paroo, a boy in a wheelchair who, in some versions of the show, has limited use of his arms and could not speak. Wherever Jim goes, townspeople want to lock him up, and in some versions, this drives him to hide and live in the school basement instead of at home.Then, Harold comes along and challenges the community’s assumptions about Jim by bringing him into the band and finding an instrument he’s capable of playing with his limited range of motion. An early title for the show, “The Silver Triangle,” highlights Jim’s instrument of choice and contribution to the band.“I think that Jim was very much at the heart of the show,” said Dominic Broomfield-McHugh, a musicology professor at the University of Sheffield in England who discovered many of the earlier drafts in 2013 at the Great American Songbook Foundation in Indiana. These discoveries were published in May in Broomfield-McHugh’s new book, “The Big Parade: Meredith Willson’s Musicals from ‘The Music Man’ to ‘1491.’” The book explores the musical’s journey from “The Silver Triangle” to “The Music Man” we know today — and has a chapter devoted to the various early drafts of the show.“When you read the first draft, it feels quite thin until you get to the scenes with Jim or about Jim, and suddenly it becomes very dramatic and serious,” he said. “I still feel astonished when I look at it.”Most of the songs and scenes in earlier drafts are also significantly different, according to Broomfield-McHugh. In one deleted song, Jim, who is nonverbal in this version of the show, starts to sing onstage alone.“What Willson was trying to do was to sort of say, even though he can’t physically speak, he has all these thoughts and ideas going around in his head,” Broomfield-McHugh said.Though Willson’s writing of disability was sometimes gimmicky in ways that could now be seen as offensive — in one scene, music inspires Jim to stand up for the first time — Broomfield-McHugh believes that the playwright was trying to spark a conversation about how people with disabilities were treated at the time.He found evidence that the playwright had visited organizations for disabled children but couldn’t find any other personal reasons that Willson may have had for writing about this issue.Just 10 months before the show opened, Willson dropped the character of Jim, replacing him with Winthrop at the urging of producers who felt there was no place for serious representations of disability onstage.“But I sense such a frustration in him that he really, really tried for years to make it work like this,” Broomfield-McHugh said.One memo urged Willson to change the character, stating that “physical disability in a child is impossible to view in any terms but pity and sentiment, the problem is to find some other form of disability besides physical.” The memo is undated and unsigned, but Broomfield-McHugh believes it was written in early 1957 by an employee of a producer. He found it in Wisconsin Historical Society archives, tucked in the back of a script that belonged to the producer Kermit Bloomgarden, who took over production of the show in 1957.A 1955 letter from the playwrights Jerome Lawrence and Robert E. Lee.The Great American Songbook FoundationAnother letter to Willson, written in 1955 by the playwrights Jerome Lawrence and Robert E. Lee, says, “The easy solution is to dump Jim Paroo,” but that doing so “might conceivably reduce a major work to the dimension of mere entertainment.”Today, audiences can more regularly see disabled actors onstage thanks to efforts by small theater companies like The Apothetae, which produces works centered on the disabled experience; and Theater Breaking Through Barriers, an Off Broadway organization that regularly casts actors with disabilities.But on Broadway, which can elevate shows into mainstream commercial hits, authentic representations of disability are still few and far between, said Talleri A. McRae, a founder of National Disability Theater.There have been some successes. Ali Stroker made history in 2019 as the first actor in a wheelchair to win a Tony Award for her role as a flirty fiancée, Ado Annie, in ‘Oklahoma!’; Madison Ferris, who has muscular dystrophy and uses a wheelchair, played Laura in a 2017 production of “The Glass Menagerie.” There was also the casting of a disabled actor in the role of Tiny Tim in “A Christmas Carol” in 2019; a 2015 revival of “Spring Awakening” by Deaf West Theater, which featured deaf and hearing actors side by side; as well as Martyna Majok’s Pulitzer-winning 2017 Off Broadway play, “Cost of Living,” about people with disabilities.Even with this progress, many disabled characters are not written in well-rounded ways, and actors without disabilities are often cast in these roles, McRae said.To her knowledge, the character of Nessarose in “Wicked” — who uses a wheelchair — has never been played by a disabled actress on Broadway, and the same was true for the character of Crutchie, who uses a crutch in the show “Newsies.”“Look how far we haven’t come,” said Gregg Mozgala, an actor with cerebral palsy and the founder and artistic director of the Apothetae. “Or how far we have yet to go.”Part of the problem is inaccessibility for acting training programs, said Mozgala, who is also the director of inclusion for the Queens Theater’s program Theater for All, which helps support and train disabled playwrights and actors. In his own acting program at the Boston University School for the Arts, he was the only person who identified as disabled and said many actors with disabilities have been told to sit out of certain classes, such as movement classes, because professors felt uncomfortable teaching students with disabilities.Another barrier is the perception of audiences. Nicholas Viselli, the artistic director of Theater Breaking Through Barriers, said audiences still feel uncomfortable watching disabled actors or characters onstage. For the plays he stages, he said he often receives donations from people who say they think the work is important but don’t want to come see it.“When you advertise disability, it becomes a turnoff,” Viselli said. “People are like, ‘I’ll feel bad for them. It will perhaps diminish my experience.’”In the end, the version of “The Music Man” without Jim was a hit; it won five Tony Awards, including best musical, ran for 1,375 performances and was adapted into an Oscar-winning movie in 1962.“The Music Man” has since been criticized for making light of its con artist’s problematic, predatory behavior, such as a scene in which he follows Marian home and tries multiple times to seduce her.The legacy of “The Music Man” may have been different if Willson’s original vision had made it onto the Broadway stage in a way that authentically represented people with disabilities. Many of the stigmas and barriers it tried to confront still persist, according to Penny Pun, the managing director of the National Disability Theater.“A lot of these works are being put down before they even see the light of day,” Pun said. “So how do we know if they have mainstream appeal? They never get a chance.”

Despite a lack of evidence that the intrusive IVF treatment process of scratching the womb (endometrial scratching) increases the chances of having a baby, a third of fertility specialists are still offering this often-painful procedure.
That’s the findings of a new survey of fertility clinic experts internationally — only 10% of whom actually believe endometrial scratching improve pregnancy and live birth rates during the first round of IVF.
Published in the peer-reviewed journal Human Fertility, results from over a half (55%) of respondents suggest that endometrial scratching is only offered to patients for psychological reasons, rather than medical — as it is often a ‘last resort’ treatment option for those who have failed with several rounds of IVF.
“Many participants felt that endometrial scratching reduces distress among women who request it and offers hope to women who have had unsuccessful treatments; however more research will be needed to clarify whether this does have psychological benefits for patients,” explains lead researcher Dr Sarah Lensen from the University of Melbourne, Australia.
As many as 10% of couples experience subfertility — defined as the failure to conceive after at least one year of trying for a baby.
Assisted conception methods are available to help these couples get pregnant, including medication to assist with ovulation and in vitro fertilisation (IVF), where sperm and eggs are collected for fertilisation in the laboratory before an embryo is transferred directly into the womb.

Xavier Becerra, the secretary of health and human services, hinted on Tuesday that the Biden administration may need to ask Congress for more money to fight the coronavirus pandemic, depending on the scope and severity of a potential new wave of infections fueled by the Omicron variant.During a round-table discussion with reporters that focused heavily on testing, Mr. Becerra noted that while the administration has some flexibility to move money around, of the $50 billion Congress has allocated for testing, about $10 billion is left. President Biden has made expanded testing a centerpiece of the winter pandemic strategy he announced last week.“Are we going to have more than $10 billion worth of needs and costs on Covid, especially in regards to testing?” Mr. Becerra said. “There’s a strong chance we will, depending on where Omicron takes us.” He added that his department’s experts were trying to make projections to determine whether additional funding would be necessary — before the need becomes urgent.“The president said we’ve got to stay ahead of this, so we don’t want to be asking Congress for money after we know we need it,” he said.With the pandemic heading into its third year, and Omicron on the horizon, much of the money that Congress has allocated for coronavirus response has been spent. The $2 trillion CARES Act was signed by former President Donald J. Trump in March 2020, and the $1.9 trillion American Rescue Plan was signed by Mr. Biden in March 2021. Both were aimed at boosting the economy, as well as addressing Americans’ health needs during the crisis.The rescue plan included $14 billion to speed up vaccine distribution, and $130 billion to help schools reopen safely, among other coronavirus-related provisions. But the plan, and the CARES Act before it, went into effect before the emergence of the Delta variant this summer, which caused hospitalizations and deaths to spike, adding strain to an already overburdened health care system. The Centers for Disease Control and Prevention has been tracking Omicron cases, which have now turned up in more than 20 states. “Even if most infections are mild, a highly transmissible variant could result in enough cases to overwhelm health systems,” agency officials wrote in a report last week.On Thursday, the Department of Health and Human Services announced it was releasing $9 billion in “provider relief fund” payments to bolster hospitals and other health care providers that have experienced revenue losses because of the pandemic. More than 69,000 providers in all 50 states, plus Washington, D.C., and eight territories, will receive payments.In September, the department announced that it would spend a total of $25.5 billion on the effort. That includes the $9 billion released on Thursday and $8.5 billion released last week to rural health care providers. The remainder of the funds will be disbursed in 2022.In announcing his winter strategy last week, Mr. Biden vowed to fight the pandemic with “science and speed.” He said that people who buy at-home rapid coronavirus tests would soon be eligible for reimbursement from their insurers, and that to ensure access for the uninsured, the federal government would distribute 25 million tests to community health centers and rural clinics.After the announcement, administration officials said people buying the tests would have to request reimbursement, rather than being reimbursed in the pharmacy as when filling prescriptions. Some public health experts and consumer advocates have balked at that. Mr. Becerra said Thursday that his department was still figuring out the particulars. A number of states have been distributing free at-home tests, including Massachusetts, New Hampshire, Maryland, Colorado and Ohio.Other countries have spent more heavily on rapid testing. In Britain, citizens can use a government website to order free rapid tests for home use. Germany invested hundreds of millions of dollars to create a network of 15,000 rapid testing sites. The United States has instead focused public purchasing on vaccines, and efforts to encourage their uptake.On Tuesday, Mr. Becerra pledged, “We are going to make sure that the American people have access to tests and they don’t have to pay out of pocket.”“How that exactly gets done, we work with our team to make it happen,” he added. “We’re hoping that it will be done in a way that is as smooth as possible.”