While it is not known what type of cancer Princess Catherine has, oncologists say what she described in her public statement released Friday – discovering cancer during another procedure, in this case a “major abdominal surgery” – is all too common. .

“Unfortunately, a lot of the cancer we diagnose is unexpected,” says Dr. Elena Ratner, a gynecologic oncologist at Yale Cancer Center, who has diagnosed many patients with ovarian cancer, uterine cancer and cancer of the endometrium.

Without speculating about Catherine’s procedure, Dr. Ratner situations in which women require surgery for endometriosis, a condition in which tissue similar to the uterine lining is found elsewhere in the abdomen. Dr. Ratner often says the assumption is that the endometriosis has appeared on an ovary and caused a benign ovarian cyst. But one to two weeks later, when the supposedly benign tissue has been examined, pathologists report that they have found cancer.

In the statement, Princess Catherine said she is receiving “a course of preventive chemotherapy.”

That is also common. In medical settings, this is commonly referred to as adjuvant chemotherapy.

Dr. Eric Winer, director of the Yale Cancer Center, said that with adjuvant chemotherapy, “the hope is that this will prevent further problems” and prevent a recurrence of the cancer.

It also means that “you’ve removed everything” that was visible with surgery, said Dr. Michael Birrer, director of the Winthrop P. Rockefeller Cancer Institute at the University of Arkansas for Medical Sciences. “You can’t see the cancer,” he added, because microscopic cancer cells may remain. The chemotherapy is a way to attack microscopic diseases, he explained.

Other parts of Catherine’s statement also struck a chord with Dr. Ratner, especially her concern for her family.

“William and I have made every effort to process and manage this privately in the best interests of our young family,” the statement said.

And “it has taken us time to explain everything to George, Charlotte and Louis in a way that suits them, and to reassure them that I will be fine.”

These are feelings that Dr. Ratner regularly hears which she says reveal “how difficult it is for women to be diagnosed with cancer.”

“I see this day in and day out,” she said. “Women always say, ‘Will I be there for my children? What will happen to my children?’”

“They don’t say, ‘What will happen to me?'”

Catherine, Princess of Wales, has been diagnosed with cancer and has started preventive chemotherapy, she announced in a video message on Friday.

“It’s been an incredibly tough few months for our entire family,” Catherine said in the video. She said it took time to recover from the surgery to start treatment for her cancer. “But most importantly, it has taken us time to explain everything to George, Charlotte and Louis in a way that suits them, and to reassure them that I will be fine,” she added.

Conversations like the one Catherine has had with her children are among the most important and delicate discussions parents can have, said Kathy Hirsh-Pasek, professor of psychology at Temple University and senior fellow at the Brookings Institution.

Children, especially younger children, look to their parents as a rock, she said. When something disrupts that stability — “even if it’s a manageable cancer — in a child’s ears, wow, that’s scary.”

Dr. Hirsh-Pasek recommended explaining that “there will be times when Mom doesn’t feel as good as other times, but she will be there for you, and she will be close.”

But she clarified, “I’m not saying you’re lying.” Children are very observant, Dr. Hirsh-Pasek said. “If you hide something, children know you are hiding something.”

These conversations naturally bring fear and pain to parents, says Hadley Maya, a clinical social worker at the Center for Young Onset Colorectal and Gastrointestinal Cancer at Memorial Sloan Kettering Cancer Center.

“We try to help parents understand that having these conversations with your child in an honest way can help the child cope and give them the feeling that they are not left alone with their feelings, their concerns and their imaginations, ” she said. Often a child imagines something worse than what happens.

The word cancer “doesn’t scare them as much as it does us as adults,” added Ms. Maya, who also helps coordinate Memorial Sloan Kettering’s Talking with Children about Cancer program. “Not knowing makes them even more afraid.”

Parents may also worry that a child sees them crying. But it’s not a bad thing to show vulnerability, Dr. Hirsh-Pasek and Ms. Maya both said. It’s an opportunity for parents to show that it’s okay to feel unwell, to express emotions and ask for help.

Conversations about serious illness can be very different than they were a few years ago, Dr. Hirsh-Pasek said, because many children have lived through the coronavirus pandemic and still remember it. That does not mean that the discussions become easier, but children may be more aware of what it means to be very ill.

This also means that explaining cancer is more important than ever. Ms. Maya recommends focusing on three “C’s”: catch, cause and cancer. Explain that cancer is not contagious and that they can still hug their parents and share food. Tell children that they didn’t cause the cancer or the circumstances surrounding it (which is a common idea, especially among young children, she said). And be clear: the disease is called cancer, not “boo” or disease.

Let your child take the lead in some conversations, Ms. Maya said. Give them a chance to ask questions and recognize “that even though you may not have all the answers, you will try to figure it out and get back to them.”

In her statement, Catherine shared some of what she said to her children: “As I told them, I am doing well and growing stronger every day by focusing on the things that will help me heal; in my mind, body and spirit.”

That kind of language reassures children, Dr. Hirsh-Pasek said, and it shows them how we can move beyond the things that are difficult.

“I wouldn’t use these kinds of occasions to discuss death and dying,” said Dr. Hirsh-Pasek. “I would use these opportunities to discuss life and living.”

There have now been 64 cases of measles in the United States this year, surpassing the total of 58 cases in all of 2023, according to new data from the Centers for Disease Control and Prevention.

The increase in cases would “alarm us rather than alarm us,” said Dr. Demetre Daskalakis, director of the National Center for Immunization and Respiratory Diseases at the CDC. Most communities across the country have vaccination rates high enough to provide robust protection against the disease. highly contagious virus, he said. Even after the increase, the number of cases is still significantly lower than in 2019, when more than 1,200 people were infected, more than two-thirds of whom were children.

But health experts said the milestone is a troubling reminder that even though there is an effective vaccine against the virus, measles remains a persistent threat to public health.

What causes measles to spread?

Doctors say there are several factors contributing to the spread of measles, cases of which have increased around the world in recent years. Many cases reported in the United States this year were linked to international travel, according to the CDC, as travel destinations such as Britain, Austria and the Philippines have had outbreaks. Many of the people in the United States who have become infected are unvaccinated children aged 12 months and older.

Routine vaccinations for children, including the two-dose vaccine that protects against measles, mumps and rubella, came to a halt when the pandemic took hold. At the same time, vaccine hesitancy has become increasingly common, says Dr. Paul Offit, a vaccine expert at Children’s Hospital of Philadelphia. In general, a community is protected against measles if more than 95 percent of the people in it have been vaccinated. But state required vaccinations among preschoolers in the United States fell from about 95 percent in the 2019-2020 school year to about 93 percent in the 2022-2023 school year.

This gap in vaccination has left approximately 250,000 preschoolers vulnerable to measles each year over the past three years, according to the CDC. vaccine exemptions for children has also increased, underscoring the challenges posed by vaccine hesitancy.

“People use the term ‘personal choice’, ‘individual freedom’, ‘bodily autonomy’ – this is a contagious disease,” said Dr. Offit. “You make a decision for yourself and others you come into contact with.”

Barriers to access to the vaccinations may also be partially responsible for the rising number of cases in the United States. Experts say some parents may not be aware that they can get their children vaccinated for free, either through private insurance or through the Vaccines for children program.

Parents might also wrongly assume “that measles is a mild disease,” says Dr. Sean O’Leary, professor of pediatrics and infectious diseases at the University of Colorado School of Medicine. Most cases cause fever, coughing, runny noses, red eyes and a telltale rash. In some cases, people can develop pneumonia and swelling of the brain that leads to deafness or intellectual disability. “It’s potentially a very serious disease,” said Dr. O’Leary.

About one in five people in the United States who are infected with measles and not vaccinated end up in the hospital, according to the CDC. And as many as one in twenty children with measles develop pneumonia, the most common cause of death from measles in young children.

So far, cases have been reported in at least 17 US states: Arizona, California, Georgia, Illinois, Indiana, Louisiana, Maryland, Michigan, Minnesota, Missouri, New Jersey, New York, Ohio, Pennsylvania, Virginia, Washington and Florida.

In Florida, the state surgeon general issued guidelines that contradicted widespread medical advice and allowed parents to send unvaccinated children to school during a measles outbreak.

How to protect against measles

Vaccination is “the most powerful thing parents can do to protect their children from measles,” said Dr. Offit. Two doses of the vaccine are about 97 percent effective at preventing measles. The CDC generally recommends that children receive the first dose starting at age 1 and the second dose starting at age 4. However, in some cases, especially when outbreaks are spreading, children under age 1 may be able to get vaccinated, said Dr. Daskalakis.

On Monday, the CDC issued a health advisory encouraging parents to vaccinate children over six months before traveling internationally, regardless of their destination.

Doctors may recommend vaccination for certain people with compromised immune systems, such as people undergoing chemotherapy.

Dr. Daskalakis encouraged parents to talk to their pediatricians about vaccination. These types of conversations – parents seeking health information directly from doctors they trust – can be a vital tool in what Dr. Daskalakis considers it an ‘uphill battle’.

“Given the impact on vaccine confidence that we’ve seen post-Covid, and during Covid,” he said, “I think we just need to keep that drumbeat going.”

Rat feces from New York City. Poop from dog parks in Wisconsin. Human waste from a hospital in Missouri. These are some of the materials that prepare us for the next chapter of the coronavirus saga.

More than four years into the pandemic, the virus has loosened its grip on most people’s bodies and minds. But a new variant could still emerge that is better able to evade our immune defenses, derailing a hard-fought return to normality.

Scientists across the country are watching for the first signs.

“We’re no longer in the acute phases of a pandemic, and I think it’s understandable and probably a good thing” that most people, including scientists, have returned to their prepandemic lives, said Jesse Bloom, an evolutionary biologist at the Fred Hutchinson Cancer Center in Seattle.

“That said, the virus is still evolving and still infecting large numbers of people,” he added. “We have to continue to monitor this.”

Dr. Bloom and other researchers are trying to understand how the coronavirus behaves and evolves as populations build immunity. Other teams are investigating the body’s response to the infection, including the complex syndrome called long Covid.

And some scientists have taken on an increasingly difficult task: estimating the effectiveness of vaccines in a crowded respiratory environment.

“Intellectually, this virus, at least to me, is just getting more interesting,” said Sarah Cobey, an evolutionary biologist at the University of Chicago.

“In some ways, SARS-CoV-2 is a fantastic reminder of some of the deepest questions in the field, and also of how far we have to go in answering many of them.”

Carefully analyzing new variants that appear in wastewater can help predict what additional forms might emerge, says Marc Johnson, a virologist at the University of Missouri who has looked for repeats of the coronavirus in stool samples from rodents and humans.

“They help inform the evolution of this virus and what is likely to happen next, and may even inform how a better vaccine can be made,” said Dr. Johnson.

The ‘Black Swan Event’

Evolutionary biology was once an esoteric pursuit that involved staring at a computer screen for hours. The public health implications of the work were often weak.

The pandemic has changed that. Vaccines can now be made more easily and much faster than before, so “truly understanding how viruses evolve has increasing practical use,” said Dr. Bloom.

Many evolutionary biologists now studying the coronavirus, including Dr. Bloom, were experts on influenza, which evolves every two to eight years into a new variant of its most immediate predecessor.

The scientists expected the coronavirus to behave similarly. But Omicron arrived with dozens of new mutations — a shocking “black swan event,” Dr. Bloom said. Then came BA.2.86, another huge leap in evolution, indicating that the virus remained unpredictable.

The iterations of a virus that thrives in an entire population have some advantage: perhaps the ability to evade the immune system, or extreme contagiousness. In an individual, “there’s no such evolutionary pressure,” says Katia Koelle, an evolutionary biologist at Emory University.

The result is that a chronic infection – usually in a person with a weakened immune system – gives the virus an opportunity to experiment with new formats, allowing it to press the evolutionary equivalent of a fast-forward button. (Viral tenacity in the body is also considered play a role in long Covid.)

Chronic infections with the coronavirus rare, even among immunocompromised people people. But the Alpha variant from late 2020, the Omicron variant from late 2021 and BA.2.86, first discovered last summer, are now all caused by people with weakened immune systems.

Some mutations acquired as the virus evolves may provide no benefit at all, or may even hinder it, said Dr. Cool. Not all virus versions pose a widespread threat to the population; BA.2.86, for example, ultimately does not.

But these genetic changes can nevertheless predict the future.

After BA.2.86 emerged, careful analysis of its genome revealed one spot where the virus remained susceptible to the body’s immune defenses. Dr. Johnson suspected that the virus’s next step would be to acquire a mutation at that site.

“And sure enough, it seemed normal,” he said, referring to JN.1the variant that is now responsible for a large majority of infections.

“The more we see these lines like BA.2.86, which seem to arise from chronic infections, the more we have an argument like, Hey, this is really something we need to pay attention to,” he added.

Analyzing more than 20,000 wastewater samples from across the country, Dr. Johnson found fewer than 60 viral genetic sequences that likely came from people with weakened immune systems.

Such sequences only pop up if a “supershedder” – a person who sheds massive amounts of viruses in their feces – happens to live in an area where wastewater is monitored. “I’m sure there are many more,” said Dr. Johnson. “I just don’t know how much more.”

Spotty surveillance

Scientists looking for signs of renewed danger are limited by limited surveillance of coronavirus variants in the United States and elsewhere.

Many countries, including the United States, stepped up tracking efforts at the height of the pandemic. But they have since been scaled back, leaving scientists guessing at the extent of respiratory virus infections. Wastewater and hospital admissions may provide clues, but neither is a sensitive measure.

“We’ve never had particularly systematic surveillance of respiratory pathogens in the United States, but now it’s even less systematic,” said Dr. Cobey. “Our understanding of the burden of these pathogens, much less their evolution, is really compromised.”

Not closely monitoring viruses has another consequence: with multiple respiratory viruses to be combatted every year, it is now extremely challenging to estimate how effective the vaccines are.

Before Covid, scientists estimated the effectiveness of the flu vaccine by comparing the vaccination status of those who tested positive for flu with those who did not.

But with vaccines for Covid and respiratory syncytial virus in the mix, the calculations are no longer simple. Patients show up at clinics and hospitals with similar symptoms, and each vaccine prevents these symptoms to varying degrees.

“It becomes a much more complex network of prevention,” said Emily Martin, an epidemiologist at the University of Michigan. “It does funny things to the numbers.”

An accurate estimate of effectiveness will be critical for designing a vaccine for each season, and for preparing doctors and patients for a tough respiratory season.

For example, in 2021, the University of Michigan experienced a flu outbreak. When the researchers learned that the seasonal vaccine did not protect against that strain, they were able to alert other college campuses to prepare for clusters in their dorms, and hospitals to stock up on antiviral drugs.

Solving the problem could itself pose complications, as several divisions of the Centers for Disease Control and Prevention deal with flu, Covid and other respiratory diseases.

“It requires problem solving across these kinds of artificial lines from different departments,” said Dr. Martin.

Immunity and long Covid

As variant after variant of the coronavirus emerged, it became clear that while the vaccines provided a powerful bulwark against severe illness and death, they were far less effective at stopping the virus from spreading.

If a vaccine wants to prevent infections, it must not only generate antibodies in the blood, but also at places where the virus enters the body.

“Ideally you would want them on the mucous membranes, so in your nose, in your lungs,” says Marion Pepper, an immunologist at the University of Washington in Seattle.

Scientists discovered about fifteen years ago that much of the body’s defenses come not only from the cells and organs of the immune system, but also from these other tissues.

“One of the things we’ve really focused on is trying to understand the immune responses in the tissues better than before,” said Dr. Pepper.

In a small group of people, the virus itself can also persist in different parts of the body and can be one of the causes of long Covid-19. Vaccination and antiviral medications alleviate some of the symptoms, making this idea more credible.

At Yale University, Akiko Iwasaki and her colleagues are testing whether a fifteen-day course of the antiviral drug Paxlovid can eliminate a slowly replicating virus reservoir in the body.

“We hope to determine the cause if that is the cause of people’s illness,” said Dr. Iwasaki.

She and her colleagues began studying immune responses to the coronavirus almost as soon as the virus appeared. As the pandemic progressed, collaborations became larger and more international.

And it became clear that the coronavirus is leaving a lasting legacy of immune-related problems in many people.

Two years ago, Dr. Iwasaki a new center to study the countless questions that have arisen. Infections with many other viruses, bacteria and parasites also cause long-term complications, including autoimmunity.

The new virtual institute, which launched last summer, focuses on studying post-infection syndromes and strategies to prevent and treat them.

Before the pandemic, Dr. Iwasaki is already studying viral infections with a large laboratory and multiple projects. But it doesn’t compare to her life now, she said.

“Scientists are often obsessed with the things they are working on, but not with this level of urgency,” she said. “I work pretty much every waking hour.”

During Scott Walker’s fifteen years as a kidnap negotiator, he learned how to get his message across quickly, calmly, and efficiently.

“If I messed up, people could die,” said Walker, a former Scotland Yard detective who helped solve hundreds of cases. And those high stakes, he said, “tended to focus the mind a little bit.”

While asking for a raise, setting your teen’s curfew, or coordinating a visit from the in-laws may not be as fraught, difficult conversations can still trigger anxiety. All successful negotiations require preparation, said Walker, author of the new book “Order Out of Chaos.”

“Negotiation,” he added, “is simply a conversation with a purpose.”

Walker shared his best strategies for reaching compromise during high-stress situations.

Make use of your ‘red center’.

First, identify what Walker’s crisis team called a red center. In kidnapping cases it is a physical command center, but in everyday negotiations it is a state of mind.

Jitters and anxiety can be contagious, Walker said. He writes in his book that he makes sure he approaches each case “grounded, focused and focused, with an agile mind.” Before your conversations, practice deep breathing or anything that helps you feel centered.

And before you negotiate or have a difficult conversation, he said, ask yourself this insightful question: What am I most afraid of losing in this situation? Is it freedom, reputation, money, power?

Going straight to what you fear most, no matter how painful it may be, will increase self-awareness and help you manage any surprising emotions that can derail your conversations, such as frustration, jealousy, or anger.

Watch your tone.

“You always want to approach a negotiation in a friendly, calm manner,” Walker said, because the way you speak can do that make or break a deal.

He prefers to speak face-to-face, by phone or on video, rather than via email or text, which can easily be misinterpreted, he said.

He’s also found that smiling even when you’re on the phone can help keep your tone friendly.

Don’t rush to fill every silence, Walker writes in his book. On his desk is a stress ball with the abbreviation WAIT – which stands for ‘Why am I (still) talking?’ – as a memory.

If you’re dealing with someone who is difficult, Walker suggested reframing that person in your mind as a “worthy opponent” to help you gain a more positive attitude.

Clarity is power.

During negotiations, we are often guided by the need for control, which is a mistake, Walker said. So leave your ego at the door, he said. To get someone else’s cooperation, you must first understand that person’s point of view, beliefs and values ​​by being curious and empathetic, Walker said. Unless the person truly feels understood, “there will always be some pushback.”

Ask open-ended questions and reflect on the person’s answers, Walker said. He recommended using phrases like “Tell me about…” or “What needs to happen before you…”

“Curiosity without shame, guilt and judgment is not easy, but it is a negotiating superpower,” Walker said. “We can only influence someone if we know what already influences him or her.”

If negotiations are stalling, ask yourself these questions.

The ultimate goal is to reach an agreement. But when things get stuck, Walker takes a short break and asks himself some questions.

They include: What can I control or not control? What don’t I see here? And what opportunity am I missing? Those questions, he said, shift our attention from what went wrong to what still has the potential to go right. Then he goes back in there.

Although Walker has had success negotiating with violent criminals, his two teenagers can still throw him off balance. “They know all the tricks in the book,” he said.

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Oprah tackles the rise of weight-loss drugs.

On Monday, Oprah Winfrey hosted “An Oprah Special: Shame, Blame and the Weight Loss Revolution.” Her goal, she said, was to let go of “the stigma, shame and judgment” around weight and weight loss — starting with her own.

Read the story: Oprah faces weight stigma in the Ozempic era

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How much salt is too much?

Experts say most people consume far too much sodium, increasing the risk of high blood pressure and heart disease. Here are the guidelines – and ways to cut back if you need to.

Read the story: Your questions about sodium, answered

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The week in Well

Here are some stories you won’t want to miss:

Let’s keep the conversation going. Follow closely Instagram, or write to us at well_newsletter@nytimes.com. And check out last week’s newsletter about how toddlers can hold the secret to good health.

Surgeons in Boston have transplanted a kidney from a genetically engineered pig into a sick 62-year-old man, the first procedure of its kind. If successful, the breakthrough will offer hope to hundreds of thousands of Americans whose kidneys are failing.

So far the signs are promising. The new kidney began producing urine shortly after surgery last weekend and the patient’s condition continues to improve, according to doctors at Massachusetts General Hospital, known as Mass General. He is already walking the halls of the hospital and may be discharged soon.

The patient is a black man, and the procedure may have special significance for black patients, who suffer a lot from end-stage kidney disease.

A new source of kidneys “could solve a persistent problem in the field – minority patients’ inadequate access to kidney transplants,” said Dr. Winfred Williams, deputy chief of nephrology at Mass General and the patient’s primary renal physician.

If kidneys from genetically modified animals can be transplanted on a large scale, dialysis “will become obsolete,” said Dr. Leonardo V. Riella, medical director of kidney transplantation at Mass General. The hospital’s parent organization, Mass General Brigham, developed the transplant program.

More than 800,000 Americans suffer from kidney failure and require dialysis, a procedure that filters toxins from the blood. Well over 100,000 people are on a waiting list to receive a transplanted kidney from a living or dead human donor.

In addition, tens of millions of Americans have chronic kidney disease, which can lead to organ failure.

While dialysis keeps people alive, the gold standard treatment is an organ transplant. However, thousands of patients die every year while waiting for a kidney because there is an acute shortage of organs. Only 25,000 kidney transplants are performed annually.

Xenotransplantation – the implantation of an organ from an animal into a human – has been proposed for decades as a possible solution that could make kidneys much more widely available. But the human immune system rejects foreign tissue, causing life-threatening complications, and experts note that long-term rejection can occur even if the donors are a good match.

In recent years, scientific developments including gene editing and cloning have brought xenotransplants closer to reality, making it possible to modify animal genes to make the organs more compatible and less likely to be rejected by the immune system.

The kidney came from a pig developed by the biotech company eGenesis, which removed three genes involved in possible rejection of the organ. In addition, seven human genes were inserted to increase human compatibility. Pigs carry retroviruses that can infect humans, and the company has also inactivated the pathogens.

In September 2021, surgeons at NYU Langone Health in New York attached a genetically modified pig kidney to a brain-dead man and watched as it began to function and produce urine. Shortly afterwards, scientists at the University of Alabama at Birmingham announced that they had performed a similar procedure with similar results.

Surgeons at the University of Maryland have twice transplanted hearts from genetically modified pigs into patients with heart disease. While the organs functioned and the first did not appear to be rejected, both patients, who were in advanced stages, died shortly afterwards.

(Patients who agree to these groundbreaking experimental treatments are usually extremely ill and have few options; often they are too sick to qualify for the waiting list for a precious human organ or are ineligible for other reasons.)

Boston transplant patient Richard “Rick” Slayman, supervisor of the state transportation department, had suffered from diabetes and high blood pressure for many years and had been under treatment at Mass General for more than a decade.

After his kidneys failed, Mr. Slayman was on dialysis for seven years and finally received a human kidney in 2018. But the donated organ failed within five years and he developed other complications, including congestive heart failure, Dr. Williams said.

When Mr. Slayman resumed dialysis in 2023, he experienced serious vascular complications — his blood vessels clotted and failed — and required repeated hospitalizations, Dr. Williams said.

Mr. Slayman, who continued to work despite his health problems, had to wait a long time for a new human kidney, and “he became despondent,” said Dr. Williams. “He said, ‘I just can’t go on like this. I can’t keep doing this.’ I started thinking about extraordinary measures we could take.”

“He would have to wait five to six years for a human kidney. He couldn’t have survived,” added Dr. Williams added.

When Dr. Williams asked Mr. Slayman about receiving a pig kidney, Mr. Slayman had many questions, but ultimately decided to go ahead.

“I saw it not only as a way to help me, but also as a way to provide hope to thousands of people who need a transplant to survive,” he said in a statement released by Mass General.

Mr. Slayman’s new kidney appears to be functional so far and he has been able to stop dialysis. In addition to creatinine, the new pig kidney also produces urine, a waste product.

Other measures are also improving daily, his doctors said. Doctors will continue to monitor Mr. Slayman for signs of organ rejection.

“He looks like himself. It’s remarkable,” said Dr. Williams.

The four-hour operation was performed by a team of surgeons including Dr. Tatsuo Kawai, director of the Legorreta Center for Clinical Transplant Tolerance at Mass General, and Dr. Nahel Elias.

The procedure was performed under a Food and Drug Administration protocol known as a compassionate use provision, which is granted to patients with life-threatening illnesses who may benefit from an unapproved treatment. Under the protocol, new drugs were also used to suppress the immune system and prevent rejection of the organ.

“He is remarkably brave for coming forward,” said Dr. Williams about Mr. Slayman. “Hats off to him. He makes an enormous contribution.”

Two years ago, Amy Gruenhut suffered a near-fatal brain infection that left her in a coma for almost two weeks. Since then, she has gone from learning to eat, speaking and walking to running four marathons.

Ms. Gruenhut had been a regular runner before the coma, but after leaving the hospital, returning to the jogging paths of Central Park felt like a return to life itself.

Progress requires patience and willpower that seemed almost superhuman. But like everyone else, Ms. Gruenhut sometimes had trouble getting out of bed and putting on her sneakers. For those moments, she gathered a group of training buddies to encourage her to get moving.

“I didn’t want to stop them,” said Ms Gruenhut, 44, adding: “They made that commitment to me too.”

No matter how inspired people are to achieve their health and fitness goals, many face barriers when investing time, reps or steps. But experts say the difference between quitting and not quitting often comes down to having a person, group, app, or other outside force pushing you to keep going.

Most accountability tricks aren’t universal: one person might find it motivating to share running times on the fitness app Strava; another may find it very stressful. The key is to shop around until you find a strategy that works for you.

Find a buddy who is more committed than you…

Making plans to exercise with a friend will increase your chances of exercising. But some experts say we benefit most from working with someone who is more enthusiastic about exercise than we are.

a new study on gym motivation, soon to be published in the journal Management Science, found that participants who struggled to exercise saw a significant improvement when they connected with a regular gym-goer, said Rachel Gershon, lead author of the study and assistant professor of marketing at the University of California, Berkeley.

“Working with someone who is already doing well in the goal you’re trying to pursue can be effective,” she said. “And the more committed partner also benefited.”

…or someone who needs an extra push.

If you The more dedicated training buddy, you can benefit from serving as a motivator and teacher for a less experienced friend, says Ayelet Fishbach, professor of behavioral sciences at the University of Chicago.

When you give advice, you not only make yourself accountable to the other person, but you also strengthen your own commitment by hearing yourself articulate how or why you do something, she said.

Justin Ross, a Denver-based clinical psychologist who specializes in athlete mental health and performance, experiences firsthand the benefits of this type of asymmetric collaboration when coaching newer athletes. “I have to show up, not just for me, but for them,” he said.

Sign up for a race, but don’t tell (many) people.

Deciding to train for a race or other athletic event can provide both structure and accountability, experts say. But it’s probably best to keep your plans relatively private.

Sharing a lofty goal widely — on social media, for example — can backfire because it can make you “feel like you’ve already achieved it,” says Gabriele Oettingen, a professor of psychology at New York University. Research has suggested that for some people, talking about an upcoming goal can be a substitute for actually doing it: you get the same satisfaction without working hard for it.

Wait to hype your event until you’re close to the finish line, she said, both literally and figuratively.

Promise a fitness instructor you’ll come.

While paying a monthly gym membership encourages some people to exercise, for others it’s not enough: just half of the gym members go twice a week.

“If you don’t follow the rules, there’s no real punishment,” says Dr. Kevin Volpp, director of the Penn Center for Health Incentives and Behavioral Economics, other than feeling like you’ve wasted money.

To create more accountability, he said, forge a relationship with an instructor or trainer and say you’ll show up for a class or training session at a certain time. Social responsibility – not wanting to come across as a flake – can be a powerful motivator.

Create a paperclip chain to track your progress.

If you are someone who responds well to visual cues or reminders, Dr. Ross recommends you create a paperclip chain to track your workouts and keep them in a visible place.

Start with one paper clip and add a new clip to the end of the chain each time you practice. You can also make a rubber ball.

“On days when you’re really not feeling it,” he said, these visual reminders “can help give you some of that energy to get you going.”

Being paid.

If you need an extra incentive, sign up for an app pays or rewards you for moving, says Heather Royer, a health economist at the University of California, Santa Barbara.

These apps track metrics such as minutes or miles through your phone or wearable fitness device and offer discounts on products or even charitable donations in your name. They are typically funded by corporate sponsors or commissions from partner brands.

Dr. Royer prefers Pacelijn, which offers gift cards and discounts for 150 minutes of moving per week. Even though the payout itself is small (only about a dollar or two a week), it is motivating for her. “It’s enough that at the end of the week, if I haven’t achieved that goal yet, I’m going to work out at 10 p.m.,” she said.

A few years ago, a Google employee sent an email to thousands of her colleagues: What if you spent one night a week without technology for six weeks?

The email was from Laura Mae Martin, Google’s executive productivity advisor, a role created in part to help staff members maintain healthier relationships with their gadgets and apps. After sending the note, Ms. Martin was inundated with responses from colleagues eager to take a break from some of the products they had helped build. Thousands of employees have since taken part in the annual “No-Tech Tuesday Night Challenge,” said Ms. Martin, author of the forthcoming book “Uptime: A Practical Guide to Personal Productivity and Well-Being.”

The problem she was trying to solve isn’t unique to Google employees. A survey found that most Americans say they spend too much time on it on their phones. But dramatic solutions—a digital detox, a phone downgrade, or a complete exit from social media—can feel impractical.

Is it possible to have a healthy relationship with technology while still using it every day? Fortunately, according to experts, the answer is a resounding yes.

Start with one simple question.

You know that urge you get to reach for your phone without even realizing it? And then, before you know it, you’re on a social media binge for an hour?

If you want to coexist peacefully with technology, you have to get a grip on those impulses. Start by noticing when you feel the urge to pick up your phone or open social media in your browser window, says Richard J. Davidson, the founder and director of the Center for Healthy Minds at the University of Wisconsin-Madison.

By becoming aware of what you’re about to do, you interrupt automatic behavior and wake up the part of your brain that regulates self-control, he said. If one research article suggests that awareness of your actions can help you curb bad habits.

“When you become aware of the urge, just ask yourself, ‘Do I really have to do this?’” said Dr. Davidson.

Asking that question might help you pause, think about it, and resist the temptation to check your device. And let’s be realistic: sometimes you might decide to spend some screen time. But being aware of your urges can help you become more intentional about your habits, Dr. Davidson said.

Get the ‘mobile’ out of your mobile devices.

Dr. Anna Lembke, a professor of psychiatry and addiction medicine at Stanford University School of Medicine, said one of the biggest problems with smartphones is what she calls “texting while running to catch a bus.” Using our devices while we’re on the go (walking from meeting to meeting, taking a child to school, or taking the bus) can make us feel disconnected from our lives, says Dr. Lembke.

“We are missing out on a wealth of information and cues in the world around us, as well as depriving ourselves of the ability to process and interpret what we have experienced,” she said.

One way to create harmony with your technology is to limit your phone use while on the road. Out for a walk? Turn off your notifications. Are you going to get a coffee? Leave your phone on your desk. If you’re feeling brave, try turning off your phone while you’re out and about, said Dr. Lembke, who wrote “Dopamine Nation: Finding Balance in the Age of Indulgence.” It won’t buzz with notifications, texts, or phone calls, which Dr. Lembke said it could help you focus on the world around you.

Schedule small tech breaks.

Extended vacations with your gadgets may not be possible. But if you’re trying to spend less time staring at your screens, 10- or 15-minute breaks may be a more practical option, says Dr. Adam Gazzaley, a neuroscientist at the University of California, San Francisco and author of “The Distracted Mind: Old Brains in a High-Tech World.” You can take a short walk, close your eyes, work on a puzzle or read a book.

Another trick: put tech breaks on your calendar, said Dr. Gazzaley. It may feel strange to plan something like “taking a phone-free walk,” but that shouldn’t happen if it’s a priority, he said.

Control your environment.

Don’t rely solely on your willpower to keep screen time down, says James A. Roberts, a consumer behavior expert at Baylor University. Instead, adjust your environment.

“Anything you can do to create an environment where you can move away from the phone as easily as possible will be helpful,” says Dr. Roberts, who wrote “Too Much of a Good Thing: Are You Addicted to Your Smartphone?”

Here are a few things you can try:

• Buy an alarm clock. A phone alarm forces you to pick up your device when you wake up, making it far too easy to start checking email and alerts, Dr. Roberts said. But with a standalone alarm clock, you can leave your phone untouched until you decide it’s time to dive in.

• Appoint an accountability partner. Dr. Roberts suggested asking a family member or friend to remind you to put down your device if you’ve been using it for too long, if someone is trying to have a conversation with you, or at other times when it’s interfering with your life. environment disrupted. offline world.

• Delete social media from your phone. To manage social media use without stopping it altogether, make it less accessible, Dr. Roberts said. One tip he suggested is to delete it from your phone but keep it on your computer so you can still use it for work or to keep in touch with family and friends.

Make the technology work for you.

One thing the experts agreed on: to build a healthy relationship with technology, you need to control it, not the other way around. Think of your gadgets as tools that you decide how to use.

“Make it work for you, not against you,” says Ms. Martin, the productivity expert at Google. “Whether it’s an email program or your dishwasher, it’s the intention behind the way you use it that really makes the big difference.”

Basal cell carcinoma is the most common form of skin cancer, but it can easily be overlooked or mistaken for another skin problem.

Doctors often discover the cancer during a routine skin check, said Dr. Melissa Piliang, chair of the department of dermatology at the Cleveland Clinic. “A patient may not even notice the signs of the disease,” she said.

In a Facebook post this week, health and fitness personality Richard Simmons announced that he had been treated for basal cell carcinoma. He said he first noticed a “weird-looking bump” under his eye that he tried to treat with Neosporin. It was only after visiting a dermatologist that Mr. Simmons was diagnosed with basal cell carcinoma.

Although it can be difficult for patients to identify basal cell carcinoma, it is estimated to have an impact several million people in the United States every year – is very treatable. Here’s what you need to know about causes, prevention and treatment.

What causes basal cell carcinoma? And how does it differ from other skin cancers?

People usually develop basal cell carcinoma after being exposed to UV radiation from sunlight, tanning beds, or sun lamps. The disease is the result of cumulative, chronic exposure, said Dr. Karen Connolly, a dermatologist at Memorial Sloan Kettering Cancer Center. Research suggests it is most common in adults over 40 years of age.

The disease starts in basal cells, which are located in the outer layer of the skin. Another type of skin cancer can develop in squamous cells.

Basal cell carcinoma is more common and much less fatal than another form of skin cancer, melanoma, which grows in skin cells called melanocytes. Melanoma is especially dangerous because it can grow quickly and spread to other parts of the body without treatment. Melanomas typically look darker or browner than basal cell carcinomas, said Dr. Connolly, but patients should bring any lesion they are concerned about to the attention of a dermatologist.

What does basal cell carcinoma look like?

Basal cell carcinomas often occur in the parts of the body most exposed to the sun: usually the head, face, neck and arms, said Dr. Paras Vakharia, assistant professor of dermatology at Northwestern Medicine. Usually the lesions are “pink and pearly,” he said. “They almost look a little shiny,” he said. They can sometimes be brown, blue or gray. The lesions can also bleed easily even when people wash their faces, said Dr. Piliang.

“When I present to patients, I tell them to look for pimples that won’t heal,” she added.

People sometimes confuse basal cell carcinoma with acne scars, small skin lesions, moles, warts, or freckles. according to the American Academy of Dermatology.

How do you treat and prevent basal cell carcinoma?

Basal cell carcinoma grows slowly, but it is important to tackle the disease as soon as possible, doctors said.

Doctors use different approaches to treat the condition. One is known as Moh’s surgery, in which doctors remove thin layers of skin one by one to remove cancerous lesions. In other cases, doctors may perform a procedure called electrodesiccation and curettage – or, as Dr. Connolly put it, a ‘burning and scraping’ of skin growth. If the carcinoma is very small, it can be treated with a chemotherapy cream, said Dr. Vakharia.

Basal cell carcinomas are rarely fatal. Dr. Connelly said that sometimes patients “hear the word ‘cancer’ and think, ‘I’m going to die from this.'” But, she explained, most cases “really have no effect on the patient’s overall health.”

Dr. However, Vakharia said a diagnosis of basal cell carcinoma should be a clear sign for patients that “they should be more careful about sun exposure.” He encouraged people to wear wide-brimmed hats that fully protect the face from UV rays and to use sunscreen with at least SPF 30 protection. Reapply sunscreen if you’ll be outside for extended periods of time, he added.

And “using a tanning bed is a big no-no,” said Dr. Connolly. A growing body of evidence has linked indoor tanning to an increased risk of melanoma, she said.

If you have had a significant amount of sun exposure throughout your life, have been burned so intensely that blisters form, or if you have a family history of skin cancer, you may want to see a dermatologist for a basic skin exam, added Dr. Vakharia added. .

And in general, people should take the time to scan their skin about every month, said Dr. Connolly, to “make sure nothing new is growing and changing rapidly.”

Scientists at a leading cancer lab at Columbia University have now retracted four studies and added a stern note to a fifth accusing them of “serious abuse of the scientific publishing system,” the latest fallout from allegations of research misconduct recently leveled against several leading cancer scientists. .

A scientific sleuth in Britain last year discrepancies in the data were revealed published by the Columbia lab, including the reuse of photographs and other images in various newspapers. The New York Times reported last month that a medical journal quietly halted a stomach cancer study by its researchers in 2022 after the journal’s internal investigation found ethical violations.

Despite the removal of that study, the researchers – Dr. Sam Yoon, head of one cancer surgery department at Columbia University Medical Center, and Changhwan Yoon, a junior biologist there, continued to publish studies with suspect data. Since 2008, the two scientists have collaborated with other researchers on 26 papers that the researcher, Sholto David, publicly marked for misrepresenting the results of experiments.

One of those articles was withdrawn last month after The Times asked publishers about the allegations. In recent weeks, medical journals have done just that withdrawn three Additionally studies, which described new strategies for the treatment of stomach, head and neck cancer. Other labs had cited the articles in about 90 articles.

A major scientific publisher also added a blunt note to the article that it originally removed in 2022 without explanation. “This reuse (and partial misrepresentation) of data without appropriate attribution represents a serious abuse of the scientific publishing system.” said.

Yet these measures only affected a small portion of the laboratory’s suspicious papers. Experts said the episode illustrated not only the extent of unreliable research by top labs, but also the tendency of scientific publishers to respond slowly or not at all to significant problems once they are discovered. As a result, other labs continue to rely on questionable work while pouring federal research money into studies, allowing errors to accumulate in the scientific record.

“For every paper that is retracted, there are probably 10 that should be,” says Dr. Ivan Oransky, co-founder of Retraction Watch, which maintains a database of more than 47,000 retracted studies. “Journals are not particularly interested in correcting the data.”

Columbia Medical Center declined to comment on the allegations against Dr. Yoon. It said the two scientists remained at Columbia and that the hospital is “fully committed to maintaining the highest ethical standards and to rigorously maintaining the integrity of our research.”

The laboratory web page was recently taken offline. Columbia declined to say why. Neither Dr. Neither Yoon nor Changhwan Yoon could be reached for comment. (They are not related.)

Memorial Sloan Kettering Cancer Center, where the scientists worked when much of the research was done, is examining their work.

The Columbia scientists’ retractions come amid growing attention to the suspect data underlying medical research. Medical journals have been doing the same since the end of February seven withdrawn paper by scientists at Harvard’s Dana-Farber Cancer Institute. This followed investigations into data problems published by Dr. Davidan independent molecular biologist who, sometimes with the help of AI software, looks for irregularities in published images of cells, tumors and mice.

The wave of misconduct allegations has drawn attention to the pressure on academic scientists – even those like Dr. Yoon, who also work as doctors – to produce a huge amount of research.

Such studies often require strong images of the results of experiments. By publishing them, scientists can win prestigious academic appointments and attract federal research grants that can bring profits to themselves and their universities.

Dr. Yoon, a robotic surgery specialist known for his treatment of stomach cancer, helped introduce it almost $5 million in federal research money throughout his career.

The latest retractions from his laboratory include papers from 2020 and 2021 that Dr. David said contained noticeable irregularities. Their results appeared to include identical images of tumor-stricken mice, despite those mice supposedly being subjected to different experiments with separate treatments and types of cancer cells.

The medical journal Cell Death & Disease has retracted two of the latest studies, and Oncogene the third. The journals revealed that the studies had also reused other images, such as identical images of constellations of cancer cells.

The studies that Dr. David flagged because they contained image problems, were largely overseen by the more experienced Dr. Yoon. Changhwan Yoon, a senior research associate who has worked with Dr. for a decade. Yoon, was often the first author, which usually indicates the scientist who performed the bulk of the experiments.

Kun Huang, a scientist in China who oversaw one of the recently withdrawn investigations, a 2020 paper in which senior Dr. Yoon was not included, attributed the problematic sections of that study to Changhwan Yoon. Dr. Huang, who made those comments This month, PubPeer, a website where scientists post about research, did not respond to an email seeking comment.

But the more experienced Dr. Yoon has long been aware of the problems in the study he published with Changhwan Yoon: the two scientists were notified in January 2022 of the removal of their stomach cancer study, which was found to have violated ethics guidelines.

Research misconduct is often blamed on the younger researchers conducting experiments. Other scientists, however, assign greater responsibility to the senior researchers who run laboratories and oversee studies, even as they juggle jobs as physicians or administrators.

“The research community is starting to realize that with great power comes great responsibility and that in fact you are not only responsible for what one of your direct reports has done in the laboratory, but also for the environment you create,” said Dr . Oransky.

In their latest public retraction notices, medical journals said they had lost confidence in the results and conclusions. Imaging experts said some by Dr. David identified irregularities showed signs of deliberate manipulation, such as flipping or rotating images, while others could have been sloppy copy and paste errors.

The little-noticed removal by a journal of the gastric cancer study in January 2022, the policy of some scientific publishers not to make public the reasons for retracting articles until they have formally appeared in print was highlighted. That study was only published online.

Roland Herzog, the editor of the journal Molecular Therapy, said the editors had prepared a statement that they planned to publish at the time the article was removed. But Elsevier, the magazine’s parent publisher, told them such a note was not necessary, he said.

Only after last month’s Times article did Elsevier agree to publicly explain the article’s removal with the stern letter. In a editorial this weekMolecular Therapy editors said they would explain the removal of articles that had only been published online in the future.

But Elsevier said in a statement that it does not consider online articles “to be the latest articles published.” As a result, company policy continues to advise that such items be removed without explanation if they are found to contain issues. The company said it allowed editors to provide additional information as necessary.

Elsevier, which publishes and generates almost 3,000 journals billions of dollars in annual revenueshas long criticized for its opaque takedowns of online articles.

Papers by the Columbia scientists with data discrepancies that remain unaddressed were largely distributed by three major publishers: Elsevier, Springer Nature and the American Association for Cancer Research. Dr. David alerted many journals to the discrepancies in the data in October.

Each publisher said it is looking into the concerns. Springer Nature said studies take time because they involve consulting experts, waiting for responses from authors and analyzing raw data.

Dr. David also raised concerns about studies published independently by scientists who collaborated with the Columbia researchers on some of their recently retracted papers. For example, Sandra Ryeom, associate professor of surgical sciences at Columbia, published an article at Harvard in 2003 in which Dr. said it contained a duplicate image. According to a mortgage document from that year, as of 2021 she was married to the eldest Dr. Yoon.

The paper had a notice of default added said last week that “appropriate editorial action will be taken” once concerns about the data were resolved. Dr. Ryeom did not respond to an email seeking comment.

Columbia has tried to reinforce the importance of good research practices. Hours after the Times article appeared last month, Dr. Michael Shelanski, the medical school’s senior vice dean for research, sent an email to faculty members titled “Research Fraud Allegations – How to Protect Yourself.” It warned that such allegations, whatever their merits, could take their toll on the university.

“In the months it can take to investigate an allegation,” wrote Dr. Shelanski, “funding could be suspended and donors could feel like their trust has been violated.”