By Mark D. Marotta

Somewhere along the line, my duties here at Valley Forge Press, which brings you Therapy Times, grew to include coming up with environmentally-themed articles for its sister publication, rt image.

Not sure how that happened, but it did, for better or worse. So far, Therapy Times had been lucky in escaping my clutches as a nag on going green.

That%u219s about to change with this blog. While poking around on Therapy Times just the other day, I came upon a news item from the University of Maryland-Baltimore about the National Alliance of Nurses for Healthy Environments (ANHE).

The press release indicates that the ANHE was formed in December 2008 and is headquartered in College Park, Md. Its mission is to promote healthy people and healthy environments by educating and leading the nursing profession, advancing research, incorporating evidence based practice and influencing policy.

To that end, ANHE has developed a strategic plan to integrate environmental health into nursing education, practice, research, and advocacy. Members have developed a curriculum that they are encouraging nursing schools to adopt to foster knowledge about environmental health.

In the field of policy, the alliance is working in tandem with other groups on issues related to sustainable agriculture and climate change. For more information about the group, visit its Web site.

That all sounds pretty good to me. Do any readers know of similar organizations operating in their own therapy fields? If so, let us know. You might just give me an idea for another "green" topic to bring up on Therapy Times.

For better or worse.

By Kelly Olsen-Stanko

Therapy Times is an online resource and as such, we're committed to providing you with the most current and innovative therapy news and information sent to your inbox, phone, or computer screen. But if you thought we were all over the Web before, think again. Now you can follow us on Twitter, friend us on Facebook, or become our contact in LinkedIn – and we hope you will.

I must admit, I wasn't Twitter-savvy before we started this endeavor. Facebook? Piece of Cake. Myspace? In my sleep. But Twitter? I wasn't so sure about this one. What are retweets? How do I tell if someone tweeted at me?

However, the process turned to be pretty painless, and is now my favorite one to update. Being confined to a 140-word limit was initially going against everything I've learned as a writer, but now I've come to regard it as a practice in creativity – ultimately fun and challenging. So if you haven't made your online presence known, through Twitter or any of the other social networking sites that Therapy Times is apart of, I hope that you'll sign up and check us out. And if it turns out that it's fun and you like it, then that's okay, too.

By Mark D. Marotta

Okay, I admit it. I'm middle-aged. It's not something I'm proud of, or even particularly happy about, nor is it something I consciously chose to become. It just kind of snuck up on me over the years, and, well, here we are.

Now, there might be an argument that it's not all that bad a thing to be. For instance, I'm well past the point of feeling teenage angst.

That may be true, but there is definitely a downside. For instance, I saw an online article about a recent study reportedly showing that the decline in cardiorespiratory fitness accelerates after the age of 45, especially in men. Hey, that's me!

The study, appearing in the Archives of Internal Medicine, looked at data for more than 3,400 women and nearly 17,000 men, from ages 20 to 96, participating in something called the Aerobics Center Longitudinal Study from 1974 to 2006. During that time, the participants, who were mostly white, well educated, and in middle- or upper-income brackets, underwent health examinations and treadmill tests. According to the study, the participants' decline in fitness was not linear, but became more heightened after the magic age of 45.

On the other hand, the researchers said that keeping active, maintaining a low body-mass index, and not smoking were tied to keeping higher levels of fitness. That's not too surprising, but I guess it shows there's hope, sort of, although it sounds like there's some work involved, and, for that matter, all you can hope to accomplish is to keep the decline from being worse than it would otherwise be.

As far as being active goes, another online article reports that a study at the Duke University Medical Center has found that exercise helps conrol blood pressure, weight loss, and fitness. No surprises there, either, I guess.

The article goes on to recommend working out at lunchtime if you're otherwise too busy. I'm okay with some of the suggestions, like having a handy pre-workout snack (such as nuts or cheese), but I'm not so sure about the bit about keeping baby wipes around so you don't have to shower. If nothing else, it seems a little ironic that, as a middle-aged person, I should be thinking about making sure I get more exercise, but also considering the use of baby wipes. What's next: teenage angst?

Posted by: Bob Stott

Every fall, my dad gets the family together for one weekend camping trip – as he puts it, "a last chance to get away from everyone before we're trapped in with them for the winter." In years past, these trips to the great outdoors have meant primarily one thing: person-to-person communication.

Cell phones, BlackBerries, and PDAs had no service and no outlets to recharge them, televisions at best had one grainy basic cable channel, and the nearest (and most audible) radio station had a strictly 1960s classic rock format. In desperation, our younger generations were forced to return to the primal basics and, some perhaps for the first time, engage our parents and relatives in actual open, face-to-face communication. No texting. No constant e-mail updates. No escaping in online games.

However, even the expanse of the great outdoors doesn't seem to be much of a barrier against the flood of portable technology – at this year's camping trip, most of the younger children's cellular devices had direct satellite connections and batteries that could last for days, as they sat quietly, texting each other across the campfire.

And right there, it stares at me: the blinding contradiction. While we insist that our world is becoming increasingly complex, we have instead created a communications culture that has decreased the time available for us to sit and think, uninterrupted. We are ever primed to receive a quick message to which we are expected to give a rapid response – never mind the necessities of conversation, the back of forth of actual human communication with the underlying subtle messages, emotions, etc. I think my younger cousins may never know another way to think and interact.

For example, we can spend hours keeping up with our e-mails. A friend once told me, "I look at my watch to check the time. I look at my BlackBerry to check on my life." Its frightening to think about. People become alienated from their own physical experience and anxious about watching a virtual testament of their lives scrolling along faster than they can handle. Over time, I've watched 'screen addiction' – whether its a laptop, palmtop, cell phone or BlackBerry – consume people. We learn to see ourselves as one with our devices: always on, always uploading, always updating status, profile, life.

Many of today's kids get cell phones from their parents and more than likely I will follow suit when I have children (if I haven't implanted tracking devices in them by that point, of course). However, merely by extension of the device, kids are never quite alone, never having to count on themselves, or be wary of getting lost – not with a parent on speed dial. This is a comfortable element in a dangerous world, yet there is a price to pay in the development of autonomy.

There, at the campfire, it dawns on me how much many of these children can't be "alone" – cut off from their digital identity, tied up in e-mail, status updates, and social networking, I don't think many of them know how to act in a legitimate social encounter. How do you express an emotion verbally that usually only requires a symbol – one emoticon of the curt range of happy and sad faces – to say in a text message?

I think about their emotional development, these kids growing up with dolls in one hand and a cellular device in the other: when the breadth of human emotions is reduced to a shorthand of emoticon emotions, and reformatted for the small screen, how much is left out, presumably floating in cyberspace, in the process?

By Mark D. Marotta

There are just some days when all you get is bad news. And then it only gets worse.

A few weeks ago, my doctor told me that I have to start taking cholesterol medicine, because my blood test showed my triglycerides or some such thing were too high. It was a bullet I had tried to dodge for years, by eating lots of vegetables and trying to get at least a modicum of exercise. My efforts apparently had been in vain, however.

Having to go onto to the medication put me in a pretty dour mood, which is saying a lot, because my mood is usually pretty dour to begin with. For one thing, the reported side effects (including possible liver damage) of the medicine I have to take are frankly scary sounding. But even without taking that into consideration, the whole thing got me feeling much, much older than I used to.

My mood only worsened after I came upon a news item reporting that adults with even moderately elevated cholesterol levels in middle age are at an increased risk of Alzheimer's disease. A study of 9,844 people over a four-decade period found that close to 600 had developed either Alzheimer's or vascular dementia, a related condition. A high range of cholesterol at the start of the study was associated with a 66-percent increase in the risk of Alzheimer's. Borderline high cholesterol raised the risk of vascular dementia by 52 percent. According to the study's lead author, controlling heart disease risk factors, including cholesterol, can reduce the risk of dementia. I don't know if she happened to mention whether sticking to your cholesterol medicine is one way to get yourself off the hook. Here's hoping.

There has recently been other news about Alzheimer's disease. According to one report , amyloid protein clumps that are characteristic of Alzheimer's begin affecting memory long before the disease's symptoms do. Another study has found that biomarkers in cerebrospinal fluid may accurately identify people with mild cognitive disease who may be more likely to develop Alzheimer's.

On the somewhat bright side, I guess, another news item reported that there may be evidence that taking anti-inflammatory drugs, such as ibuprofen, may help prevent Alzheimer's. But the article also quoted a couple of experts who pointed out that the drugs have side effects and should not be taken just to avoid Alzheimer's.

I'm more hopeful about this report, about a study finding that engaging in activities that stimulate the brain, such as doing puzzles, may help delay the onset of dementia-related memory loss.

Right now, I am wondering if feeling puzzled might, by itself, count for something here.

Now let me go take my pill.

Posted by: Sabrina Rodak, editorial intern

I prefer the purple shirt. No, the green shirt. Definitely the green shirt. Wait, wait, wait, the orange one looks nice too. Although we often refer to "changing one's mind" as changing one's choice, the brain can actually change in a real, physical way.

The ability for the brain to change its physical structure is called neuroplasticity. This ability is at its peak during the early years of life, which is why early intervention is essential for treating developmentally delayed children. When I was researching for "my article on early intervention" in this week's Therapy Times, I was struck by the urgency early interventionists expressed; they emphasized the need to treat the child early so that the treatment can be most effective and long lasting.

However, the brain doesn't stop changing in infancy, as was thought in the past. Experts now agree that neuroplasticity remains throughout one's life, although at a much lower level than it was during ages zero to three. Neuroplasticity allows people to learn new things and to recover from brain injury.

The power of neuroplasticity in adulthood makes me wonder how plastic, or malleable, the young brain is. Why is intervention essential between ages zero to three if the brain remains plastic throughout adulthood? How exactly does neuroplasticity change over one's lifetime? Is the difference only the amount of adaptations the brain is capable of, or does neuroplasticity function differently at different ages?

Neuroplasticity raises questions like those above and many more. Like our young brains, neuroplasticity is a rapidly growing field that promises to discover new findings about the brain and how it changes throughout life. I am interested to see how the science of neuroplasticity can apply to early intervention and policy. While early intervention functions on the premise that the early years are a critical time to treat developmental delays, new findings may influence the type, method, or length of treatment for the child. I have high hopes for neuroplasticity; it seems magical! No, surreal! No, a better word is miraculous! There I go changing my mind again...

In elementary school, I remember receiving a sheet of paper with four illustrated squares, each containing a sentence or part of a sentence. I had to order them to form a complete story or sentence. For instance, reading left to right might produce,"I was soaking wet. I walked home. My car was in the shop. It was raining." After rearranging the squares, a clearer story emerges: "It was raining. My car was in the shop. I walked home. I was soaking wet."

While reading Bob Stott's "Therapy Sounding Off: Interventions with therapeutic ultrasound," however, it seemed like ultrasound therapy jumbled its story squares. Someone was soaking wet before it started raining!

My confusion and surprise stem from the fact that therapeutic ultrasound, which doctors already use, is only recently gaining formal standards and educational programs. For example, there are no specific guidelines for this technique on the Web sites of either the American Institute of Ultrasound in Medicine (AIUM) or the International Society for Therapeutic Ultrasound (ISTU) that I could find. Moreover, professionals in the field continue to debate the effectiveness of this technique.

This year marks the first concerted effort to standardize therapeutic ultrasound, including a management agreement between the AIUM and the ISTU and the establishment of the group Therapeutic Ultrasound Community of Practice. These organizations are dedicated to developing educational materials and opening communication about ultrasound's role in therapy. I think a more logical progression includes creating educational programs and best practices first, and then instituting the procedure in healthcare facilities.

With a lack of hard evidence overwhelmingly suggesting the efficacy of therapeutic ultrasound, I wonder why doctors use it. How do people have confidence in something that has yet to have formalized guidelines or principles? I neither encourage nor discourage the use of ultrasound in therapy, for I am not an expert on the science behind the device. Instead, I advocate a better understanding of therapeutic techniques before they are incorporated into the healthcare system.

Every once in a while, when my wife and I are in a particularly finger-pointing frame of mind, we get into a silly little discussion about which of us is the boss. It pretty much goes like this: "You are." "No, you are."

Invariably, this conversation never comes to a resolution, which only means we wind up resuming it later on, always with the same lack of result.

It's a puzzling thing. And now I have the answer to the puzzle.

The boss at our house is ... the cat. We do indeed have a cat – a kitten, actually – whom we call Hieronymus, named after Hieronymus Bosch, who painted some rather scary images in The Netherlands in the 15th or 16th century.

I'm pretty sure that our naming the cat was the last time we exerted any kind of influence over him.

A news item about a recently published study from the United Kingdom confirms my suspicion. According to the study author, Karen McComb, PhD, in the University of Sussex's psychology department, cats learn that a combination of crying and purring is the best way to get their owners to feed them in the morning. It seems that cats only emit this particular combination of sounds in the presence of long-time human companions.

In McComb's study, people rated recorded vocalizations of cats. Her research found that listeners gave the highest rating of urgency to purrs combined with cries. McComb speculates that cats' use of the combined purr and meow takes advantage of the natural human response to feed babies. According to McComb, people apparently put up with such manipulation from cats because we accept it as part of their independent nature.

I'm not quite sure what system Hieronymus uses to command me to feed him first thing in the morning, because I'm usually in a zombie-like state as I spoon his canned food into his little dish.

I have to say, however, that I've never actually noticed Hieronymus emit the particular type of combined purring and meowing sound that McComb describes.

But it may just be a matter of time until he does, and, if so, I'll be ready ... to feed him.

After all, he's the boss.

Posted By: Sabrina Rodak, editorial intern

While reading "Achieving Team Collaboration," the article by Joan Alverzo, RN, CRRN recently posted on Therapy Times, I was amazed at how small changes created big improvements in relations between rehabilitation nurses and therapists. For instance, just the physical proximity of the two departments increased the interaction between the two groups, resulting in stronger professional and personal relationships. Alverzo said that at the N.J.-based Kessler Institute for Rehabilitation, the nurse and therapy managers began to have lunch together as part of their mission to improve nurse-therapist teamwork.

How simple, yet how effective! I think using lunch to foster tighter bonds between two professional groups is a wonderful idea. People can meet and talk without scheduling extra time into their already-busy workday. I think more businesses should adopt this practice. In fact, I would like to see more lunch gatherings here at Therapy Times! Sometimes the editors eat together, and we have a relaxing, fun time. Other times, however, due to work or other obligations, we eat at our respective desks. But, what if it was company policy that we ate lunch together? What if not only the editorial team, but also the art, sales, and business teams ate together? I have a warm feeling inside now even writing about this idea; I can picture the serenity and harmony, and...well, I guess it won't solve world peace, but I do think it would create a more collaborative and comfortable work atmosphere. Moreover, putting a face behind an email contact might improve communications between departments, thus increasing productivity.

What do you think? Do you and your coworkers eat lunch together, or do you prefer your solitude and time away from other people? I would love to hear your opinions on communal lunches in the workplace, and their effect on people's jobs.

Posted By: Sabrina Rodak, editorial intern

As the school year ends and summer fast approaches, images of barbeques, pools, and sunshine take over. For recent high school graduates, no doubt dreams of college also dominate their thoughts. The friends! The parties! The freedom!

But what about depression? I think depression and other health issues are neglected while information on student population, housing, and campus life flood students' folders and minds. I argue that high school counselors and other mentoring adults should have honest and direct discussions with prospective college students regarding the emotional and physical challenges of college.

Each semester, the American College Health Association administers the National College Health Assessment (ACHA -NCHA) to college students to assess their physical and mental health as well as health habits and beliefs. The statistics may shock those familiar with the popular refrain "College is the best time of your life!" Although college offers new opportunities for socializing and learning, it also presents trials that can take a toll on one's emotional and physical well-being. I think that adults who counsel college-bound students on their future education should present both the positive aspects, like developing lasting relationships, and the negative aspects, such as depression.

According to the ACHA-NCHA of Spring 2008, 17 percent of students reported feeling depressed within the last school year. Moreover, 36.4 percent of students identified between one and ten instances in the last year in which they felt so depressed it was difficult to function. However, only 14.9 percent of students reported being diagnosed with depression. Of those diagnosed, only 24.5 percent were concurrently in therapy for depression. Not only is there a high percentage of depression among students, but there is also a high percentage of students who don't receive therapy for their depression. Obviously, college as "the best time of your life" is not true for everyone. I suggest, and hope, that guidance counselors and families prepare high school graduates for the emotional challenges of college, and that college health centers establish a stronger relationship with students on campuses.

For more information on the ACHA –NCHA: http://www.acha-ncha.org/ For more information on depression: http://www.nimh.nih.gov/health/topics/depression/index.shtml