Sleep and mental health

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The right kind of inflammation is essential to your body’s healing system. But chronic inflammation can be a problem.

Published: April, 2020

The saying «too much of a good thing» applies to much of life, but especially to inflammation.

«People think inflammation needs to be stomped out at all times, but it plays an essential role in healing and injury repair to keep your body safe and healthy,» says Dr. Robert H. Shmerling, medical editor of Understanding Inflammation from Harvard Health Publishing and an associate professor of medicine at Harvard Medical School. «Some inflammation is good. Too much is often bad. The goal is to recognize when inflammation is simply doing its job, and when it can potentially cause problems.»

Signs of inflammation are like a car’s dashboard engine light. It tells you that something is wrong. But your response is not to take out the bulb, because that’s not the problem. Instead, you look at what caused the light to turn on. «It’s the same with inflammation,» says Dr. Shmerling. «It’s telling you that something bigger is going on that requires attention.»

Research suggests a regular meditation practice could protect against heart disease. Here’s how to begin one.

Published: February, 2018

Image: Wavebreakmedia Ltd/Thinkstock

What’s good for the mind also tends to be good for the heart.

The mind-calming practice of meditation may play a role in reducing your risk of heart disease, according to a scientific statement published in the Sept. 28, 2017, Journal of the American Heart Association.

Experts reviewed dozens of studies published over the past two decades and found that meditation may improve a host of factors linked with heart disease — making it worth including in an overall program for ongoing heart care.

«Not only can meditation improve how your heart functions, but a regular practice can enhance your outlook on life and motivate you to maintain many heart-healthy behaviors, like following a proper diet, getting adequate sleep, and keeping up regular exercise,» says Dr. John Denninger, director of research at the Harvard-affiliated Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital.

Moving meditations

Sitting and being still isn’t the only way to practice meditation. Mind-body activities like yoga and tai chi are similar to meditation in that they emphasize slow movements, controlled breathing, and mental focus. Even exercises that emphasize steady, repetitive movements, such as riding a bike, swimming laps, or walking can be a form of meditation, if you focus your brain on the task at hand.

Married men and mortality

A major survey of 127,545 American adults found that married men are healthier than men who were never married or whose marriages ended in divorce or widowhood. Men who have marital partners also live longer than men without spouses; men who marry after age 25 get more protection than those who tie the knot at a younger age, and the longer a man stays married, the greater his survival advantage over his unmarried peers. But is marriage itself responsible for better health and longer life?

Although it’s hard to be sure, marriage seems to deserve at least part of the credit. Some have argued that self-selection would skew the results if healthy men are more likely to marry than men with health problems. But research shows the reverse is true: unhealthy men actually marry earlier, are less likely to divorce, and are more likely to remarry following divorce or bereavement than healthy men.

Another potential factor is loneliness; is the institution of marriage linked to better health, or is it simply a question of living with another person? Although studies vary, the answer seems to be a little of both. People living with unmarried partners tend to fare better than those living alone, but men living with their wives have the best health of all.

Numerous studies conducted over the past 150 years suggest that marriage is good for health. More recently, scientists have begun to understand why married men enjoy better health than their single, divorced, and widowed peers. But before we turn to the why, let’s look at how marriage affects specific diseases, including America’s leading killers, cardiovascular disease and cancer.

Are educated wives heartbreakers?

In the 1980s, several studies suggested that men whose wives had more education than they had were more likely to die from coronary artery disease than men married to less educated women. With more and more women getting advanced degrees, that might give some single guys pause. But a 2002 study found that the more educated a man’s wife, the lower his risk for coronary artery disease and risk factors such as hypertension, obesity, high cholesterol, smoking, and lack of exercise. And a 2009 study reported that men married to more educated women also enjoyed a lower death rate than men married to less educated women. In the contemporary world, smart wives promote healthy hearts.

Techniques to counter chronic stress

Many people are unable to find a way to put the brakes on stress. Chronic low-level stress keeps the HPA axis activated, much like a motor that is idling too high for too long. After a while, this has an effect on the body that contributes to the health problems associated with chronic stress.

Persistent epinephrine surges can damage blood vessels and arteries, increasing blood pressure and raising risk of heart attacks or strokes. Elevated cortisol levels create physiological changes that help to replenish the body’s energy stores that are depleted during the stress response. But they inadvertently contribute to the buildup of fat tissue and to weight gain. For example, cortisol increases appetite, so that people will want to eat more to obtain extra energy. It also increases storage of unused nutrients as fat.

Fortunately, people can learn techniques to counter the stress response.

Relaxation response. Dr. Herbert Benson, director emeritus of the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, has devoted much of his career to learning how people can counter the stress response by using a combination of approaches that elicit the relaxation response. These include deep abdominal breathing, focus on a soothing word (such as peace or calm), visualization of tranquil scenes, repetitive prayer, yoga, and tai chi.

Most of the research using objective measures to evaluate how effective the relaxation response is at countering chronic stress have been conducted in people with hypertension and other forms of heart disease. Those results suggest the technique may be worth trying — although for most people it is not a cure-all. For example, researchers at Massachusetts General Hospital conducted a double-blind, randomized controlled trial of 122 patients with hypertension, ages 55 and older, in which half were assigned to relaxation response training and the other half to a control group that received information about blood pressure control. After eight weeks, 34 of the people who practiced the relaxation response — a little more than half — had achieved a systolic blood pressure reduction of more than 5 mm Hg, and were therefore eligible for the next phase of the study, in which they could reduce levels of blood pressure medication they were taking. During that second phase, 50% were able to eliminate at least one blood pressure medication — significantly more than in the control group, where only 19% eliminated their medication.

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Physical activity. People can use exercise to stifle the buildup of stress in several ways. Exercise, such as taking a brisk walk shortly after feeling stressed, not only deepens breathing but also helps relieve muscle tension. Movement therapies such as yoga, tai chi, and qi gong combine fluid movements with deep breathing and mental focus, all of which can induce calm.

Social support. Confidants, friends, acquaintances, co-workers, relatives, spouses, and companions all provide a life-enhancing social net — and may increase longevity. It’s not clear why, but the buffering theory holds that people who enjoy close relationships with family and friends receive emotional support that indirectly helps to sustain them at times of chronic stress and crisis.

Disclaimer:As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Medical education

Curriculum

Harvard Medical School has gone through many curricular revisions for its MD program. In recent decades, HMS has maintained a three-phase curriculum with a classroom-based pre-clerkship phase, a principal clinical experience (PCE), and a post-PCE phase.

The pre-clerkship phase has two curricular tracks. The majority of students enter in the more traditional Pathways track that focuses on active learning and earlier entry into the clinic with courses that include students from the Harvard School of Dental Medicine. Pathways students gain early exposure to the clinic through a longitudinal clinical skills course that lasts the duration of the pre-clerkship phase. A small portion of each class enter in the HST track, which is jointly administered with MIT. The HST track is designed to train physician-scientists with emphasis on basic physiology and quantitative understanding of biological processes through courses that include PhD students from MIT.

Admissions

Admission to Harvard Medical School’s MD program is highly selective. There are 165 total spots for each incoming class, with 135 spots in the Pathways curriculum and 30 spots in the HST program. While both use a single application, each curricular track independently evaluates applicants.

For the MD Class of 2023, 6,815 candidates applied and 227 were admitted (3.3%). There was a matriculation rate of 73%.

Complications

About 19 million Americans have GERD. Most have heartburn and many experience throat or lung symptoms. But a few go on to develop complications. The most common is esophagitis, inflammation of the food pipe. It produces consistent burning pain that can make swallowing and eating difficult. Left untreated, the inflammation can cause ulcers of the tube’s lining, bleeding, or both. Repeated cycles of esophagitis and healing can lead to a scarring and narrowing of the tube (a stricture).

Severe esophagitis only strikes about 2% of people with GERD. An even smaller number develop Barrett’s esophagus, a condition in which severe inflammation and acid conspire to produce premalignant changes in the cells that line the esophagus. Some 2% to 5% of people with Barrett’s esophagus go on to develop cancer. To prevent that, people with severe esophagitis should take medications to suppress acid indefinitely. In addition, patients with Barrett’s esophagus require regular endoscopies to detect any progression toward cancer.

Normal swallowing

A complex set of 29 muscles in your mouth and tongue get the process started. They close off your windpipe (trachea) to protect your lungs, and then move food into your esophagus, or food pipe. The esophagus is a narrow 10- to 13-inch-long tube leading from your throat to your stomach. But food doesn’t just slide down the esophagus. Instead, muscles that encircle the food pipe contract in an orderly, wave-like fashion to propel food into the stomach. That’s why an adventurous (and athletic) guy can perform the old parlor stunt of drinking while standing on his head (as they say on TV — don’t attempt this at home).

Swallowing is normally a one-way affair. To prevent food from returning to the esophagus, the ring-like muscles of the lower esophagus pinch the tube closed. Doctors call these muscles the lower esophageal sphincter, or LES (see figure).

GERD: Acid on the rise

In GERD, stomach acid backs up into the esophagus, injuring sensitive tissues.

Eat right, move more

Diet and exercise have an especially strong impact on managing chronic inflammation since they both also can help control weight and improve sleep.

The evidence is not clear that a specific type of diet can prevent chronic inflammation. However, certain foods are associated with either promoting or inhibiting the inflammatory response. These foods also are linked to a lower risk of problems related to chronic inflammation, such as heart disease, weight gain, and cancer.

For instance, cut back or eliminate foods high in simple sugars like soda, fruit juices with added sugars, sports drinks, processed meat, and refined carbs like white bread and pasta. «These foods can spike blood sugar levels, which can lead to overeating and weight gain,» says Dr. Shmerling.

Also, eat more foods high in the antioxidants known as polyphenols, which can lower inflammation. Examples include all types of berries, cherries, plums, red grapes, onions, turmeric, green tea, and dark green leafy vegetables like spinach and kale.

Regular exercise can help protect against conditions linked with chronic inflammation, especially heart disease and obesity. A 2017 study in Brain, Behavior, and Immunity found that just 20 minutes of moderate-intensity exercise (in this case, walking on a treadmill) can have an anti-inflammatory effect.

Image: Mingirov/Getty Images

Disclaimer:As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Other health issues

Although the data are sparse, marriage appears to have a positive effect on a variety of health outcomes. Mental health is the most prominent; married men have a lower risk of depression and a higher likelihood of satisfaction with life in retirement than their unmarried peers. Being married has also been linked to better cognitive function, a reduced risk of Alzheimer’s disease, improved blood sugar levels, and better outcomes for hospitalized patients. In contrast, widowhood boosts the likelihood of sexually transmitted diseases in men, but not women.

Couples «therapy»

It’s often said that old married couples come to resemble each other. That may or may not be true, but according to Italian researchers, married couples do have similar cardiac risk factors. In their 2009 report, the scientists reviewed 71 earlier studies that covered more than 100,000 couples. All in all, the spouses demonstrated many shared risk factors, including hypertension, diabetes, cholesterol, obesity, and smoking. Some of the similarities can be explained by the tendency for people to choose spouses like themselves, and some of the shared risk factors depend on lifestyle habits partners have in common. That’s why Australian doctors have reported success with a program that seeks to improve nutrition and exercise habits in both spouses simultaneously. That’s couples therapy with a new twist.

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Getting the better of GERD

GERD is a problem of modern life. Smoking, poor eating habits, obesity, alcohol abuse, and stress all fuel the fire of heartburn. A little heartburn from time to time is no big deal — but persistent GERD can lead to serious complications. Fortunately, this modern problem can be solved with old-fashioned lifestyle changes, modern drug therapy with PPIs or other agents, and new surgical options.

Disclaimer:As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Harvard University guidance and policies:

Harvard University and Harvard Medical School are closely monitoring the ongoing coronavirus disease 2019 (COVID-19) outbreak. The health, safety and well-being of our community, on and off campus, is our top priority.  We will continue to update the community regularly to keep you informed.

All Harvard faculty, staff and students must follow the University’s policies and guidelines found on this webpage:Harvard University coronavirus webpage. This web page includes important guidance for remote courses, travel policies, campus restrictions and visiting or returning to campus.

What do we know?

Everyone wants to know if supplements can help. It’s a good question. Here’s where we stand today — but you should keep an eye out for new results, since recommendations will change as scientific studies trickle in. Unfortunately, in most cases, the studies have failed to confirm our hopes, though there are exceptions.

Many people take supplements in the belief that they will preserve health or ward off illness; many others use supplements in an attempt to treat specific conditions that have already developed. We’ll have a look at popular supplements in both categories, starting with preventive supplements used principally by healthy people.

When to worry

Most of the time, you don’t need to worry too much about acute inflammation, says Dr. Shmerling. You can take an over-the-counter pain reliever to help relieve symptoms, or apply cold compresses to reduce swelling. «Otherwise, it is usually best to let the inflammation do its work to help with healing,» says Dr. Shmerling.

Of course, the cause of acute inflammation may need treatment. For example, a bacterial infection may require antibiotics, so if you have a fever or significant symptoms — such as severe pain or shortness of breath — see your doctor.

Chronic inflammation is trickier to deal with. The problem is that chronic inflammation is often «invisible,» since it does not show telltale physical signs the way acute inflammation does.

So how can you prevent or reduce inflammation you cannot necessarily see or feel?

The only way to detect chronic inflammation is to have an evaluation by your doctor. He or she will review your symptoms, perform a physical exam, and perhaps check your blood for signs of inflammation. (See «A test for inflammation.»)

Otherwise, the best approach is to prevent conditions related to chronic inflammation. «It goes back to the basics: maintaining a healthy weight, choosing a good diet, getting plenty of sleep, and exercising regularly,» says Dr. Shmerling.

A test for inflammation

How do you know if you have chronic inflammation? A blood test measures a protein produced by the liver, C-reactive protein (CRP), which rises in response to inflammation. A CRP level between 1 and 3 milligrams per liter of blood often signals a low, yet chronic, level of inflammation. The erythrocyte sedimentation rate is another blood test for inflammation. It is used for people with inflammatory conditions, like rheumatoid arthritis.

Dairy fat and heart disease

In a nutshell, researchers found that dairy fat was not associated with a higher risk of cardiovascular disease (defined as nonfatal heart attack, fatal heart disease, and stroke) when compared with the same amount of calories from carbohydrates. However, replacing about 5% of calories from dairy fat with a similar amount of unsaturated fat from vegetables or vegetable oil was linked to a 24% lower risk of cardiovascular disease.

«Overall, the results are consistent with current dietary recommendations to consume mostly unsaturated fats rather than saturated fats,» says Dr. Frank Hu, professor of nutrition at the Harvard T.H. Chan School of Public Health and senior author of the study.

Published in the August 2016 American Journal of Clinical Nutrition, the study looked at more than 220,000 women and men in the Health Professionals Follow-Up Study, the Nurses’ Health Study, and the Nurses’ Health Study II, all of which explore the role of risk factors (especially diet and lifestyle) in major chronic diseases. The participants filled out food questionnaires every four years for up to 26 years. The dairy products they tracked included skim and low-fat milk, whole milk, cream, ice cream, yogurt, cottage and ricotta cheeses, cream cheese, and other cheese.

The analysis also suggested that replacing dairy fat with other animal fat (that is, from meat) would slightly raise the risk for cardiovascular disease. Several earlier studies have suggested that diets that include dairy products—even full-fat dairy—don’t seem to raise heart disease risk and may even help reduce risk for obesity and type 2 diabetes.

Perspectives

Many men marry for love, some for money, and others for a variety of personal and family reasons. Until now, at least, few have married for health. Should that change?

Not really. Happily married men might add health to the things they thank their wives for. Unhappily married men should work with their wives to reduce stress and improve their relationship. But instead of marrying for health, unmarried men should try to achieve some of the health benefits they’re missing. That means making wise choices about diet, exercise, alcohol, and other health behaviors. It means seeing your doctor even if you don’t have a wife to drag you in, and it means seeking ways to reduce stress and build social ties and mutually supportive relationships. None of this will earn a marital deduction on your 1040 form, but it will improve your health.

Disclaimer:As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

История

Школа была основана хирургом Джоном Уорреном (англ.)русск. и врачами Бенджамином Уотерхаусом (англ.)русск. и Ароном Декстером 19 сентября 1782 года, и является старейшей по времени возникновения в США (после Перельманской медицинской школы (англ.)русск. Пенсильванского университета и Колледжа врачей и хирургов (англ.)русск. Колумбийского университета). Первые лекции прошли в Гарвард-холле (англ.)русск. и Капелле Холдена (англ.)русск..
Первый выпуск произошёл в 1788 году и состоял из двух человек.

В 1810 году школа переехала из Кембриджа в Бостон.

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В —1846 годы называлась Массачусетский медицинский колледж Гарвардского университета.

В распоряжении школы находятся четыре ведущие учебные больницы (англ.)русск. — Медицинский центр Бет Исраэль Диаконисс (англ.)русск., Больница Бригама и женщин (англ.)русск., Бостонская детская больница (англ.)русск. и Массачусетская больница общего профиля в Бостоне .

The heart of meditation

Meditation involves sitting comfortably with closed eyes and focusing on your breathing, a mental image, or repetition of a single positive word or phrase. The goal is to keep your mind focused on the present and away from stressful or distracting thoughts. As your mind becomes calm, so does your body.

A meditation practice supports your heart in many ways — from changing how you cope with stress to lowering high blood pressure.

Research has found that meditation can positively affect a measure of heart health known as heart rate variability (HRV). HRV reflects how quickly your heart makes small changes in the time interval between each heartbeat. A high HRV is a sign of healthier heart. A 2013 study found that low HRV is associated with a 32% to 45% increased risk of heart attack or stroke among people without cardiovascular disease.

With regular meditation, you may be able to raise your HRV. A 2013 study found that people who did five minutes of meditation daily for 10 days had a better HRV compared with those who didn’t meditate.

A number of high-quality studies also show that meditation can modestly lower blood pressure, according to a 2013 American Heart Association scientific statement published in Hypertension. One analysis pooled results from nine studies and found that, on average, meditation lowered systolic blood pressure (the top number in a reading) by 4.7 milligrams of mercury (mm Hg) and diastolic blood pressure (the bottom number) by 3.2 mm Hg.

Take a seat

There are many different styles and approaches to meditation, but here is a simple routine to begin with.

  1. Sit quietly and close your eyes. Breathe slowly.

  2. Relax all of your muscles, beginning with your feet, legs, and thighs.

  3. Shrug your shoulders and roll your neck to the left and then right.

  4. On each exhalation, say the word «peace» out loud or to yourself.

  5. When your thoughts wander (and they will), don’t get discouraged. Simply go back to repeating the pattern.

  6. Continue for five to 10 minutes.

Podcast: Coronavirus Update: We’re facing the start of a second wave (recorded 6/11/2020)

Dr. Ashish K. Jha, head of the Harvard Global Health Institute, offers information on where we are where we’re going with the COVID-19 outbreak. Some take-aways:

  • Communications missteps by the WHO regarding asymptomatic transmission have been quickly corrected. Yes, you can catch COVID-19 from people who are not showing symptoms.
  • A second wave has begun, particularly in the south and Midwest. And calculations show we’ll reach more than 200,000 COVID-19 related deaths by September.
  • Jha offers advice for parents, teachers and administrators on workable back-to-school scenarios.
  • We know you don’t want to hear it, but COVID-19 will be a fact of global life for the rest of the year until a vaccine becomes widely available.

Causes

Poor function of the LES is responsible for most cases of GERD. A variety of substances can make the LES relax when it shouldn’t, and others can irritate the esophagus, exacerbating the problem. Other conditions can simply put too much pressure on the LES. Some of the chief culprits in GERD are shown below.

Common causes of GERD symptoms

Foods

  • Garlic and onions

  • Coffee, cola, and other carbonated beverages

  • Alcohol

  • Chocolate

  • Fried and fatty foods

  • Citrus fruits

  • Peppermint and spearmint

  • Tomato sauces

Medications

  • Alpha blockers (used for the prostate)

  • Nitrates (used for angina)

  • Calcium-channel blockers (used for angina and high blood pressure)

  • Tricyclics (used for depression)

  • Theophylline (used for asthma)

  • Bisphosphonates (used for osteoporosis)

  • Anti-inflammatories (used for arthritis, pain, and fever)

Other causes

  • Smoking

  • Obesity

  • Overeating

  • Tight clothing around the waist

  • Hiatus hernia (part of the stomach bulges through the diaphragm muscle into the lower chest)

  • Pregnancy

Некоторые известные выпускники

— Кристиан Б. Анфинсен, 1943, биохимик, лауреат Нобелевской премии по химии ().
— Роберт Дж. Уайт (Robert Joseph White), 1953 — нейрохирург, первым осуществивщий трансплантацию головы обезьяны в 1970 году, обезьяна прожила 9 дней. Вдохновитель Серджо Канаверо.
— Тенли Олбрайт, 1961 — хирург, в прошлом двукратная чемпионка мира (, ) по фигурному катанию.
— Дэвид Альтшулер (David Altshuler), генетик и эндокринолог, обладатель награды имени Курта Штерна в 2011.
— Гарольд Амос (Harold Amos), микробиолог, советник Президента США Никсона, обладатель награды Public Welfare Medal Национальной академии наук США в 1995.
— Питер Диамандис, 1989, — учредитель и глава Фонда X-Prize, со-основатель компании Human Longevity, Inc. и других, а также учредитель и организатор множества других проектов, связанных с развитием космоса, медицины и передовых технологий.

What you can do

In the meantime, if your LDL cholesterol level is in a good range (less than 70 mg/dL if you’ve had a heart attack or less than 100 mg/dL if you haven’t) but you have other risk factors, including a family history of heart disease, ask your doctor whether an hsCRP test would better assess your risk. A high level should give you even more incentive to follow Dr. Ridker’s advice: «Throw out your cigarettes, go to the gym, and eat more vegetables.» You also might want to ask your physician about increasing your statin dose or switching to a more potent statin, he adds.

Inflammation Image: 7activestudio/Getty Images

Disclaimer:As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Treatment: Surgery

Lifestyle modifications and medications — particularly the PPIs — have produced such good results that surgery for GERD is recommended much less often than it used to be. But surgery has improved, too, and it can be very beneficial for patients with severe GERD who don’t respond fully to medical therapy and, perhaps, in young people who are leery of lifelong medication.

The major advance is the introduction of laparoscopic surgery for GERD. While the patient is under general anesthesia, the surgeon makes several small incisions in the abdomen that are used to introduce a fiber-optic tube and tiny surgical instruments. The most popular GERD operation is the Nissen fundoplication, in which the upper portion of the stomach is wrapped around the lower esophagus to prevent reflux. New approaches include using radiofrequency energy to tighten the LES (the Stretta procedure) and tightening the LES with sutures (the Bard system).

Affiliated teaching hospitals and research institutes

Harvard Medical School does not directly own or operate any hospitals and instead relies on affiliated teaching hospitals for clinical education. Medical students primarily complete their clinical experiences at Beth Israel Deaconess Medical Center, Boston Children’s Hospital, Brigham and Women’s Hospital, Cambridge Health Alliance, and Massachusetts General Hospital.

  • Beth Israel Deaconess Medical Center
  • Boston Children’s Hospital
  • Brigham and Women’s Hospital
  • Cambridge Health Alliance
  • Dana–Farber Cancer Institute
  • Harvard Pilgrim Health Care Institute
  • Hebrew SeniorLife
  • Joslin Diabetes Center
  • Judge Baker’s Children’s Center
  • Massachusetts Eye and Ear
  • Massachusetts General Hospital
  • McLean Hospital
  • Mount Auburn Hospital
  • Spaulding Rehabilitation Hospital
  • VA Boston Healthcare System
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