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Husband's demand for ‘me time' after ‘stressful' work day scrutinized by stay-at-home-mom sympathizers: ‘Can you buck up?'

Husband's demand for ‘me time' after ‘stressful' work day scrutinized by stay-at-home-mom sympathizers: ‘Can you buck up?'

Yahoo6 hours ago
Working six days a week in healthcare isn't exactly a picnic — but one husband's plea for 'me time' after his grueling shifts has sparked a Reddit uproar in defense of his stay-at-home wife's nonstop kid-wrangling gig.
The man, a dad of three — ages nine, six and two — recently spilled his burnout woes on Reddit's AITAH [Am I The A—hole?] forum.
'I work in healthcare, so I can have pretty full-on/stressful days and can often feel very emotionally as well as physically drained when I get home from work and have been feeling increasingly burnt out recently.'
After long, stressful days, he claimed he's running on empty. 'I find I can function at work to get the job done, but once I'm home, I've got nothing in the tank, which leads to having very little patience and really only being present in body only,' he wrote. His only 'me time,' he explained, is the commute home and a rare weekly run, with post-bedtime doom-scrolling and TV binges to recharge.
The real kicker? He's expected to tag-team with wifey to wrestle with his little rascals as soon as he enters the ring.
The man asked bluntly, 'AITAH [am I the a—hole] for wanting some me time when I get home?'
Reddit users were quick to weigh in — and it wasn't a unanimous cheer squad.
'Can you get a sitter or someone to watch the kids for 1-2 days a week?' one practical soul suggested.
Another dropped marriage counselor wisdom: 'The solution was for him to have 10-15 minutes decompression time when he got in from work. But once that time was up, he had to do whatever she needed him to do.'
Some users, however, served a cold dose of reality.
'I'm a physician (F). My ex-wife raised our 2 kids while I did a very stressful job… So I guess you signed up for having kids? Do you want someone else to raise them? Can you buck up and realize you are all in? … You need to understand that it's a sacrifice and it won't be forever.'
Others called out the dad for overlooking his wife's nonstop 24/7 grind.
'NTA [not the a—hole] for now, but leaning towards YTA [you're the a—hole]. What breaks does the stay-at-home Mom get? What adult interaction does she get? Does she have a commute to decompress? Does she get ME time?'
'You get vacation time… when is hers? Not only is she raising kids, she's managing the house, cooking, cleaning and mental load… Grow up and be a partner.'
Still, some offered a middle ground. 'NTA for wanting a little me time, but you also have to think about your wife's me time too. Talk to her… maybe call a sitter, schedule her a spa day during your work hours and let her have her me time that day and have your me time the day after… You guys have to communicate and compromise.'
As previously reported by The Post, today's busy parents are finding creative ways to make every second count with their kids — like millennial stay-at-home mom Sara Martinez, who went viral with the '9-minute theory,' spotlighting three key three-minute windows a day when parental presence matters most.
From Upper West Side entrepreneurs hiring help to moms moving off the grid for quality time, parents are reshaping the rules on how to balance burnout and bonding — proving that sometimes, it's less about quantity and more about making moments count.
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Evidence-Based Guidelines Issued for LAAO Devices
Evidence-Based Guidelines Issued for LAAO Devices

Medscape

time22 minutes ago

  • Medscape

Evidence-Based Guidelines Issued for LAAO Devices

Created to address the 'uncertainty and practice variation' that surrounds transcatheter left atrial appendage occlusion (LAAO), the Society for Cardiovascular Angiography and Interventions and the Heart Rhythm Society have published jointly the first set of guidelines for the use of the procedure. 'There is tremendous diversity in left atrial appendage occlusion practice regarding appropriate patients, periprocedural imaging, adjunctive medical therapy, and management of device leak and device-related thrombus,' said Andrew M. Goldsweig, MD, MS, director of cardiovascular clinical research at the University of Massachusetts-Baystate, in Springfield, Massachusetts, who led the group that wrote the recommendations. Nonvalvular atrial fibrillation (AF) is a major risk factor for stroke, and it is a condition that affects at least 12 million individuals in the US, according to data cited in the new guidelines. Oral anticoagulation is a first-line strategy for reducing stroke risk in patients with the arrhythmia, but the benefit is potentially compromised in people at high risk for bleeding. More Than 100K Implants Per Year and Growing Clots associated with nonvalvular AF commonly form in the left atrial appendage. The FDA has approved two LAAO systems for the prevention of stroke: the Amplatzer Amulet (Abbott) and the Watchman (Boston Scientific). Earlier this month, the FDA announced that Boston Scientific is recalling Watchman systems that were performed without the use of positive pressure-controlled ventilation. The agency said at least 120 people have been seriously injured, and 17 have died, after undergoing the procedure. For both systems, the current indication remains limited to people with contraindications to oral anticoagulation; however, the consensus expressed in the new guidelines is that this restriction is 'outdated' in the wake of evidence that has become available since the publication of pivotal trials that preceded approval of both available devices. How often devices are being implanted outside current FDA labeling is unclear, but LAAO has become 'one of the most frequent procedures' in cardiology, with an estimated 100,000 performed in 2024, according to data cited by Goldsweig. Eight evidence-based recommendations, covering patient selection, how imaging should be employed to assess and follow patients, and whether adjunctive oral anticoagulation should be considered in those with peridevice leak or device-related thrombus, were outlined in the new guidelines, which were simultaneously published in the Journal of the Society for Cardiovascular Angiography & Interventions and Heart Rhythm . Two address patient selection. The first reiterates the current indication, which is that LAAO should be considered in patients with nonvalvular AF with a contraindication to oral anticoagulation. The second identifies LAAO and oral anticoagulation as treatment options for patients with nonvalvular AF who do not necessarily have a contraindication to oral anticoagulation. Specifically, the guideline includes LAAO as an option for those 'with strong preferences to avoid long-term oral anticoagulation.' Based on current evidence, 'the main point of this recommendation is that LAAO is every bit as good as OAC [oral anticoagulant] — maybe even better — in terms of preventing atrial fibrillation-associated stroke,' Goldsweig said. Superiority for LAAO cannot be claimed because the large, randomized trials conducted to date have all employed a noninferiority design, Goldsweig acknowledged. Although earlier noninferiority trials, such as PREVAIL, compared LAAO to warfarin, most of the patients in the comparator group in the latest of these trials received a non-vitamin K oral anticoagulant. This trial, called OPTION, published earlier this year, compared arms for noninferiority on the primary composite endpoint of death from any cause, stroke, or systemic embolism at 36 months. Over the study period, the endpoint was reached by 8.5% in the LAAO group and 18.5% in the anticoagulation group, which easily met statistical significance for noninferiority. Superiority ( P < .001) for LAAO was also shown, but this result was hypothesis-generating given that the trial was not designed to study superiority. Trials May Expand Indications for LAAO Trials comparing LAAO to anticoagulant therapy as a first-line stroke prevention strategy among those who are candidates for either are underway. The CHAMPION-AF trial with the Watchman device and the CATALYST trial with the Amplatzer Amulet device in patients are in progress. Results are expected in 2026. Three other sets of recommendations involve periprocedural imaging, which is not being employed consistently across centers performing LAAO, according to Goldsweig. In one recommendation, pre-procedure transesophageal echocardiography or CT is identified as preferable to no such imaging. In the second and third, transesophageal echocardiography or CT are recommended, respectively, during and after the procedure. The remaining recommendations involve the use of oral anticoagulation following LAAO procedures with attention to peridevice leak and device-related thrombus, but data for these recommendations are generally limited, so they are accompanied by discussions of knowledge gaps. The authors of the guidelines caution that the relative role of oral anticoagulation and LAAO in nonvalvular AF is an evolving area. Many of the recommendations were labelled as 'conditional' based on evidence that generated 'low certainty.' Differences in relative acute and long-term costs, which were not addressed in the new guidelines, are another factor that might affect a stroke prevention strategy for individual patients. The Centers for Medicare and Medicaid Services announced a 27% reduction in the proposed 2026 Medicare fee schedule for the procedure. The American College of Cardiology, which attributed the proposed change to ' a proposed efficiency adjustment reduction,' is among several cardiology groups protesting the potential change. Some interventionalists have posted on social media that they can perform the procedure in under 10 minutes and about the safety of safe-day discharge of patients — practices that suggest clinicians are becoming more efficient with LAAO. But whether those statements influenced cardiometabolic syndrome is unclear. The expansion of LAAO past current indications is not uniformly embraced. John M. Mandrola, MD, a clinical electrophysiologist in Louisville, Kentucky, and host of the This Week in Cardiology podcast on has been a long-time critic of LAAO. The popularity of 'this well-compensated procedure has gotten ahead of the evidence,' he said. 'For evidence-minded physicians who are concerned about the rapid rise in LAAO procedures in patients without absolute contraindications to oral anticoagulants,' the conclusion that LAAO is as good as oral anticoagulation 'is very premature,' Mandrola said. Not least of his concerns, he noted that LAAO 'failed to show noninferiority to warfarin — a weaker comparator to the now commonly used direct-acting oral anticoagulants.' Mandrola said most patients now undergoing LAAO would not have been eligible for the pivotal Watchman vs warfarin trials. He has repeatedly called for a more conservative approach until proper trials provide evidence of equivalence. Mandrola said older patients with multiple competing causes of stroke — a common type of patient receiving LAAO — likely derive little to no net benefit from the focal strategy of appendage closure. The principal investigator of the recently published OPTION trial, Oussama Wazni, MD, MBA, section head of cardiac electrophysiology and pacing at the Cleveland Clinic in Cleveland, emphasized the need to consider risks and benefits. 'I think it is reasonable to consider LAAO as an alternative to oral anticoagulation' on the basis of patient preference, he said, but only 'after a careful and thorough shared decision discussion with patients regarding the potential acute complications and the potential for leaks and device-related thrombus.' Goldsweig, Mandrola, and Wazni reported having no relevant financial conflicts of interest.

They Cleaned the Subway During Covid. Now They Will Earn Back Pay.
They Cleaned the Subway During Covid. Now They Will Earn Back Pay.

New York Times

time23 minutes ago

  • New York Times

They Cleaned the Subway During Covid. Now They Will Earn Back Pay.

At the height of the coronavirus pandemic, Susana Baez would begin her shift at 1 a.m., scrubbing trash, vomit and human excrement from subway cars. She and her team, a largely immigrant work force contracted by private companies to clean New York City's subway stations and train cars, often had to work without enough safety equipment, like gloves, she said. Many contracted Covid-19 on the job. 'It was trauma,' Ms. Baez, 53, said in Spanish about the job, which she performed from 2020 to 2023, when her contract abruptly ended. Now, Ms. Baez and more than 450 other subway cleaners will split $3 million in back pay, after a multiyear investigation by the city comptroller found that they were grossly underpaid. The workers, who were employed by two private cleaning companies, earned around 25 percent less than they were owed, said Brad Lander, the city comptroller. His office sets the prevailing wage, or the typical rate, for certain types of public work. The cleaners made $16 to $18 an hour on average in the first years of the pandemic, without supplemental benefits, when $20 to $21 an hour was standard, Mr. Lander said. Minimum wage at the time was $15 an hour. Want all of The Times? Subscribe.

Therapists Leverage AI For Mental Health By Delving Into Virtual Digital Twins Of Their Clients And Patients Minds
Therapists Leverage AI For Mental Health By Delving Into Virtual Digital Twins Of Their Clients And Patients Minds

Forbes

time23 minutes ago

  • Forbes

Therapists Leverage AI For Mental Health By Delving Into Virtual Digital Twins Of Their Clients And Patients Minds

In today's column, I examine an advanced use of generative AI and large language models (LLMs) that entails therapists and other mental health professionals making use of so-called digital twins that are reflective of their respective clients and patients. The deal is this. Via the use of personas in generative AI, a feature that nearly all LLMs inherently include, it is presumably conceivable that you could devise a persona that somewhat matches and reflects a client or patient that is undergoing therapy. This is considered a digital twin, or more specifically, a medical digital twin. Yes, perhaps unnervingly, it seems possible to construct an AI-based simulated version of a client or patient that a therapist could then use to gauge potential responses and reactions to a planned line of psychological analyses and therapeutics. Let's talk about it. This analysis of AI breakthroughs is part of my ongoing Forbes column coverage on the latest in AI, including identifying and explaining various impactful AI complexities (see the link here). AI And Mental Health Therapy As a quick background, I've been extensively covering and analyzing a myriad of facets regarding the advent of modern-era AI that produces mental health advice and performs AI-driven therapy. This rising use of AI has principally been spurred by the evolving advances and widespread adoption of generative AI. For a quick summary of some of my posted columns on this evolving topic, see the link here, which briefly recaps about forty of the over one hundred column postings that I've made on the subject. There is little doubt that this is a rapidly developing field and that there are tremendous upsides to be had, but at the same time, regrettably, hidden risks and outright gotchas come into these endeavors too. I frequently speak up about these pressing matters, including in an appearance last year on an episode of CBS's 60 Minutes, see the link here. Therapists And AI Usage Many therapists and mental health professionals are opting to integrate AI into their practices and overtly use the AI as a therapeutic adjunct for their clients and patients (see my coverage at the link here). Even those therapists and mental health professionals who don't go down the route of incorporating AI are bound to encounter clients and patients who are doing so. Those clients and patients will often walk in the door with preconceived beliefs about how their therapy should go or is going, spurred and prodded by what AI has told them. In this sense, one way or another, therapists and mental health professionals are going to ultimately be impacted by the growing use of generative AI and LLMs. Right now, there are already around 700 million weekly active users of ChatGPT. You might find it of notable interest that the top-ranked use by the public of contemporary generative AI and LLMs is to consult with the AI on mental health matters, see my coverage at the link here. If that kind of AI can do a proper job on this monumental task, then the world will be a lot better off. Many people cannot otherwise afford or gain access to human therapists, but access to generative AI is generally plentiful in comparison. It could be that such AI will greatly benefit the mental status of humankind. A dour counterargument is that such AI might undercut mental health, doing so on a massive population-level scale, see my discussion at the link here. Personas Are Coming To The Fore Let's shift gears and focus on the use of AI-based personas. I've repeatedly emphasized in my writing and talks about generative AI that one of the most underutilized and least known pieces of quite useful functionality is the capability of forming personas in the AI (see the link here). You can tell the AI to pretend to be a known person, such as a celebrity or historical figure, and the AI will attempt to do so. In the context of mental health, I showcased how telling AI to simulate Sigmund Freud can be a useful learning tool for mental health professionals, see the link here. As a mental health professional, you ought to give serious consideration to making use of personas for your own self-training and personal refinement. For example, you might craft a persona that will pretend to be a person with deep depression. You could then use this persona to hone your therapeutic prowess regarding depression in patients and clients. It can be quite useful. Plus, there is no danger since it is just AI. You can try out various avenues to gauge what works and doesn't work. No harm, no foul. For my suggestions on how to write prompts that suitably create or cast personas, see the link here. Digital Twins And Humans There is specialized parlance in the tech field that has been around for many years and refers to the concept and practice of using computers to simulate a real object or entity. The parlance is that you are crafting and making use of a digital twin. This became popular when machinery used on factory floors could be modeled digitally. Why would a digital model or simulation of a factory assembly machine be useful? Easy-peasy, there are lots of crucial benefits. One is that before you even construct the machine, you can try it out digitally. You can make sure that the machine will hopefully work suitably once it is constructed and put into operation. Another advantage is that you can readily make lengthy runs of the digital twin and predict when the real version might break down. This gives a heads-up to the maintenance crew working on the factory operations. They get estimates of the likely time at which the machine will potentially start to degrade. Recently, there has been a realization that digital twins can be used in other, more creative ways, such as modeling or simulating human beings. This is often referred to as a medical digital twin (note that other names and phrases are sometimes used too). Medical Digital Twins In a research article entitled 'Toward Mechanistic Medical Digital Twins' by Reinhard Laubenbacher, Fred Adler, Gary An, Filippo Castiglione, Stephen Eubank, Luis L. Fonseca, James Glazier, Tomas Helikar, Marti Jett-Tilton, Denise Kirschner, Paul Macklin6, Borna Mehrad, Beth Moore, Virginia Pasour, Ilya Shmulevich, Amber Smith, Isabel Voigt, Thomas E. Yankeelov, and Tjalf Ziemssen, Frontiers In Digital Health, March 7, 2024, these salient points were made (excerpts): Please note that as emphasized above, the advent of medical digital twins is still early on. There is plenty of controversy associated with the topic. One major qualm is that with a factory floor machine, you can pretty much model every physical and mechanical aspect, but the same can't be said about modeling human beings. At least not yet. Lucky or not, we seem to be more complex than everyday machines. Score a point for humankind. Personas As Digital Twins When you think about devising a medical digital twin, there are customarily two major elements involved: Some would insist that you cannot adequately model the mind without also modeling the body. It's that classic mind-body debate; see my analysis at the link here. If you dogmatically believe that a mind is unable to be sufficiently modeled without equally modeling the body, I guess that the rest of this discussion is going to give you heartburn. Sorry about that. We are going to make a brash assumption that you can use generative AI to aid in crafting a kind of model or simulation of a person's mind, at least to the extent that the AI will seek to exhibit similar personality characteristics and overall psychological characteristics of the person. So, in that sense, we are going to pursue a medical digital twin that only focuses on the second of the two major elements. Does that mean that the AI-based digital twin is missing a duality ingredient that wholly undercuts the effort? I'm going to say that it doesn't, but you are welcome to take the posture that it does. We can amicably agree to disagree. On a related facet, there are advocates of medical digital twins who would insist that a medical digital twin must encompass the bodily aspects, else it isn't a medical digital twin at all. In that case, I guess we might need to drop the word 'medical' from this type of digital twin. Just wanted to give you a heads-up on these controversies. Personas Of Your Clients Or Patients Moving on, let's further consider the avenue of creating a digital twin of your client or patient so that you can utilize the AI to ascertain your line of therapy and treatment. The first step involves collecting data about the person. The odds are that a therapist will already have obtained an extensive history associated with a client or patient. Those notes and other documents could be used to feed the AI. The idea is that you will provide that data to the generative AI, and it will pattern-match and craft a persona accordingly. You might also include transcripts of your sessions. Feeding this data into AI is often done via a technique known as retrieval-augmented generation (RAG), see my explanation at the link here. Please be very cautious in taking this type of action. Really, really, really cautious. Many therapists are already willy-nilly entering data about clients and patients into off-the-shelf publicly available LLMs. The problem is that there is almost no guarantee of data privacy with these AIs, and you could readily be violating confidentiality and HIPAA provisions. You might also need to certify consent from the client or patient, depending on various factors at play. For more, see my discussion at the link here and the link here. Make sure to consult with your attorney on these serious matters. One approach is to stridently anonymize the data so that the client or patient is unrecognizable via the data you have entered. It would be as though you are simply creating a generic persona from scratch. Whether that will pass a legal test is something your legal counsel can advise you on. Another approach is to set up a secure private version of an LLM, but that, too, can have legal wrinkles. More On Personas As Digital Twins Yet another approach is to merely and shallowly describe the persona based on your overall semblance of the person. This is somewhat similar to my earlier point that you can use personas by simply entering a prompt that the devised persona is supposed to represent a person with depression. That's a vague indication and would seem untethered to a specific person. The downside, of course, is that the surface-level persona might not be of much help to you. What are you going to do with whatever persona you craft? You could try to figure out the emotional triggers of the person, as represented via the persona. What kind of coping style do they have? How does their coping mechanism react to the therapy you have in mind? All sorts of therapy-oriented strategies and tactics can be explored and assessed. In essence, you are trying out different interventions on the persona, i.e., the digital twin. Maybe you are mulling over variations of CBT techniques and want to land on a particular approach. Perhaps you often use exposure therapy and are unsure of how that will go over with the client or patients. This provides a no-risk means of determining your therapy in a simulated environment and prepares you for sessions with the actual person. Don't Fall For The Persona I trust and hope that any therapist or mental health professional going the route of using a persona as a digital twin is going to keep their wits about themselves. Ordinary users of AI who use personas can readily go off the deep end and believe that the persona is real. Do not let that same fate befall you. The persona is merely the persona. Period, end of story. You cannot assume that the persona is giving you an accurate reading of the person. The AI could be completely afield in terms of how the person will actually respond and react. Expect that the AI will almost certainly overrepresent some traits, underrepresent other traits, and be convincing as it does so. Convincingness is the trick involved. Contemporary generative AI is so seemingly fluent that you are drawn into a mental trap of believability. Inside your head, you might hear this internal voice: 'It must be showing me the true inner psyche of my client or patient! The AI is working miracles at modeling the person. Wow, AI is utterly amazing.' You must resist the urge to become over-reliant on the digital twin. Over-reliance is a likely possibility. Here's how. You use the persona. After doing so, you later meet with the client or patient. Everything the AI indicated as to responses and reactions appears to mirror what the person says and does during the session. Awesome. You decide to keep using the persona. Over and over, you use the persona. Voila, you are hooked. The persona has led you down a primrose path. The seemingly uncanny portrayal has been spot-on. The problem is that when the client or patient diverges from the persona, you are going to have your mind turned backward. The person must be wrong, because the persona was always right. In other words, the person is supposed to be acting as the persona does. The world has gone topsy-turvy. But it's you, because you have forsaken your therapist mindset and allowed AI to capture and defeat your real-world acuity. That's bad news. Do not let that happen. Additional Twists And Turns There is a lot more to consider when using AI as a digital twin in a mental health context. I'll be covering more in a series of postings. Be on the watch. One quick point to get your mental juices flowing is this. Suppose that you have gotten written consent from the client or patient, and they know that you are using AI to depict a persona of them. The person comes to one of your later sessions and starts to suspect that you are proceeding as if it is based on what the AI told you. They worry that the AI is portraying them in some unpleasant fashion. Furthermore, they now insist that you let them access the persona. They want to see how it represents them. Mull that over and think about how you would contend with that potential nightmare scenario. It's a doozy. It could arise. A final thought for now. Albert Einstein famously made this remark: 'My mind is my laboratory.' Yes, that's abundantly true. In the case of mental health therapy, besides your mind being your laboratory, it turns out that AI can be your laboratory too. Proceed with aplomb.

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