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Tuesday, January 1, 2019

Being Bullied May Alter the Teen Brain


Teens who are often bullied may be left with shrinkage in key parts of their brain, increasing their risk for mental illness, European researchers report.
They said such shrinkage eventually appears to create a growing sense of anxiety, even after taking into account the possible onset of other mental health concerns, such as stress and/or depression.
“We don’t know how early in life these brain changes begin,” said study author Erin Burke Quinlan. “But the earlier bullying is identified, and the sooner it can be dealt with, the better.”
Her team analyzed brain scans of nearly 700 14- to 19-year-olds in England, Ireland, France and Germany. The teens were part of a long-term project called IMAGEN that is studying adolescent brain development and mental health.
“We found that the relationship between chronic peer victimization — an umbrella term that includes bullying — relates to the development of anxiety partly via changes in the volume of brain structures,” Quinlan said.
She’s an IMAGEN project coordinator at the Center for Population Neuroscience and Precision Medicine at King’s College London.
Researchers aren’t sure if the bullied teens’ brain shrinkage is permanent or if it may be reversible.
“We would need to follow adolescents into adulthood to start to answer this question,” Quinlan said. “In this study we did not look at changes in brain activity, which could be a mechanism by which the effects of bullying on mental health could persist even if structural changes were halted or reversed.”
And that, Quinlan said, means the focus should be on preventing bullying in the first place. “Or at least, stopping bullying as soon as it’s been identified,” she added. “While prevention still takes resources and education, it’s likely easier than trying to reverse brain changes years later.”
Quinlan noted that as many as 3 teens in 10 are affected by bullying, some almost daily.
The participants completed surveys at ages 14, 16 and 19 to gauge their exposure to bullying. Brain scans were done at ages 14 and 19.
Thirty-six students — about 5 percent — were characterized as victims of chronic bullying.
By age 19, those teens had reduced size in two key regions of the brain, compared to age 14. The two affected regions — known as “caudate” and “putamen” — are involved in regulation of motivation, attention and emotional processing. However, the researchers only found an association between bullying and brain changes.
Quinlan suggested parents who suspect bullying is taking place speak with a child’s principal or teacher about it. But, she cautioned, victims are often reluctant to tell anyone what’s happening.
“Sometimes a child may not verbally admit they’re being bullied, so parents can watch out for nonverbal cues or changes in their child’s behavior or their attitudes towards school,” Quinlan said. “A mental health professional could be useful to help a child develop tools to deal with being bullied.”
She and her colleagues discuss their findings in the current issue of Molecular Psychiatry.
Stephen Russell is a professor of child development at the University of Texas at Austin. He said the findings suggest “an obvious link between bullying, stress and long-term health,” and called the study important.
“Hopefully,” Russell added, “this will be additional data that will help change the minds of people who think that bullying is ‘natural’ or a normal part of growing up.”
He said the research should underscore the importance of efforts to reduce bullying at the individual and school levels. Russell said several strategies have proved successful.
“Many, many youth experience bullying and grow up to be thriving adults,” he said. “So even though bullying may even [affect] the structure of our brains, that doesn’t mean that we don’t have the ability to cope and compensate. And the very things that bullying may change — like attention or sensitivity — could be things that people learn to use to their advantage.”
More information
The U.S. Department of Health and Human Services offers more about bullying.
SOURCES: Erin Burke Quinlan, Ph.D., project coordinator, Social, Genetic and Developmental Psychiatry Center, Center for Population Neuroscience and Precision Medicine, King’s College London, England; Stephen Russell, Ph.D., professor, child development, University of Texas at Austin; Dec. 12, 2018, Molecular Psychiatry

How to Develop Better Habits in 2019


Just about everyone wants to cultivate better habits. The problem is, very few of us want to do the work to make those habits a reality. We hope they will magically develop, that one day we’ll just wake up (early, without even considering the snooze button) and head straight to the gym. Then we’ll have a healthy breakfast and sit right down with that creative project we’ve been putting off for months. At some point our desire to smoke or lie or complain will mysteriously disappear too.
The reality? This has never happened for anyone, and it’s never going to happen. This is what inspired Epictetus’ famous quote from 2,000 years ago: “How long are you going to wait before you demand the best for yourself?” He’s really asking how much longer you are going to wait until you demand the best of yourself.
I know I want to eat better and be more present. For a long time, I’ve wanted to do push-ups every day. I also want to work less and spend less time checking my phone. I want to start saying no so I can say yes to things I have been putting off. But I’ve wanted to make these changes for a long time. How do I transform my vague hopes into reality?
To start, I need to develop better habits, better accountability, and a clearer vision for my day-to-day life. Here are the steps I am taking. We are all staring down the barrel of a new year, and if we aren’t going to do it now, when will we?

Think Small—Really Small

The writer James Clear talks a lot about the idea of “atomic habits” (and has a really good book with the same title). An atomic habit is a small habit that makes an enormous difference in your life. He talks about how the British cycling team was completely turned around by focusing on 1 percent improvements in every area. That sounds small, but it accumulates and adds up in a big way. He emphasizes thinking small with big habits. Don’t promise yourself you’re going to read more; instead, commit to reading one page per day. Thinking big is great, but thinking small is easier. And easier is what we’re after when it comes to getting started. Because once you get started, you can build.

Create a Physical Reminder

A physical totem can make the habit or standard you’re trying to hold yourself to into something more than an idea, and that helps—a lot. The author and minister Will Bowen has a simple system that helps people quit complaining. He provides each member of his congregation with a purple bracelet, and each time they complain, they switch the bracelet from one wrist to the other. This method is simple and straightforward and makes it easy to hold yourself accountable. Over my desk, I have a picture of Oliver Sacks. In the background he has a sign that reads “NO!” that helped remind him (and now me) to use that powerful word. One of the reasons we made coins for Daily Stoic was that when you have something physical you can touch, it grounds you. The coins are made at the same mint where the first Alcoholics Anonymous chips were invented, and they represent the same idea. If you have 10 years of sobriety sitting in your pocket or clasped in your hand, you’re less likely to throw it away for a drink.

Lay Out Your Supplies

When I get to my desk in the morning, the three journals I write in are sitting right there. If I want to skip the habit, I have to pick them up and move them aside. So most mornings I don’t move them, and I write in them. You can use the same strategy if, for example, you want to start running in the morning. Place your shoes, shorts, and jacket next to your bed or in the doorway of your bedroom so you can put them on immediately. You’ll be less likely to take the easy way out if it’s embarrassingly simple to do the thing you want to do.

Piggyback New Habits on Old Habits

In 2018, I kept telling myself I wanted to contribute more to my community or be of more service. When I heard about someone volunteering, I would say to myself, “I’m going to start doing that.” I read about William MacAskill giving up a great deal of his income and thought, “Wow, I’d like to do something like that.” And then, of course, I didn’t do much of either. Then I listened to an interview with David Sedaris, who talked about how he likes to go on long walks and pick up trash near his home. I go for a walk nearly every morning. It’s an ingrained habit that’s part of my routine. Boom: I just added picking up garbage to my walk. This was easy because I had already done the heavy lifting of creating the first habit. Now it’s harder not to pick up trash, like when I don’t have a bag. Will this little activity save the world? Of course not. But it helps. And I can build on it.

Surround Yourself With Good People

“Tell me who you spend time with and I will tell you who you are” was Goethe’s line. Jim Rohn came up with the phrase that we are the average of the five people we spend the most time with. If you want to have better habits, find better friends. Most of my friends are in good shape. None smokes. Most are in good relationships. Most seem to have their shit together. I’m inspired to be better because I’m around them (and I get lots of good ideas for habits and activities). I’m also shamed into not being worse. If I started slipping, I would stand out.

Commit to a Challenge

In 2018, we did our first Daily Stoic Challenge, which was 30 consecutive days of different challenges and activities based on Stoic philosophy. It was an awesome experience. Even I, the person who created the challenge, got a lot out of it. Why? I think it was the process of handing myself over to a script. It’s the reason personal trainers are so effective. You just show up at the gym and they tell you what to do, and it’s never the same thing as the last time. Deciding what we want to do, determining our own habits, and making the right choices is exhausting. Handing the wheel over to someone else is a way to narrow our focus and put everything into the commitment. That’s why Whole30 is so popular. You buy a book and follow a regimen, and then you know what you’re doing for the next month.
To kick off 2019 we’re doing another Daily Stoic Challenge, this time for 14 days. The idea is that you ought to start the new year right—with 14 great days to create momentum for the rest of the year. If you want to have better habits this year, find a challenge you can participate in. Just try one: It doesn’t matter what it’s about or who else is doing it.

Make It Interesting

As I mentioned before, I’ve always tried to be someone who does push-ups every day. Since June, I’ve done at least 50 push-ups a day (sometimes as many as 100) almost without fail. How? I’ve been using Spar!, which is basically the most addictive and rewarding app I’ve ever downloaded. Right now I’m in a 50-push-up challenge with about two dozen people. Every day, we do 50 push-ups and upload video proof that we’ve done them. If you miss a day, the app charges you $5. At first you do the daily deed just so you don’t lose money. But soon enough, it’s about competing with the people in the group. Then a few days in, another motivation kicks in: The winners (people with the fewest misses) split the pot of everyone else’s fees. So you keep going because you want the reward. I’ve done thousands of push-ups, squats, burpees, and sit-ups (and even did one about cleaning my car and another about writing 500 words a day)—and in the process I also made a couple hundred bucks.

It’s About the Ritual

Professional dancer Twyla Tharp has written about how every morning she gets up early, dresses, and takes a cab to the same gym, where she works out for several hours. This is how she trains and keeps herself fit. Her workouts are tough and exhausting, and you’d think she would need a lot of discipline to commit to showing up each morning. But, as she writes in The Creative Habit, she just has to get herself to the cab. That’s it. The rest takes care of itself. The ritual takes over.

It Doesn’t Have to Be an Everyday Thing

I read a lot, but not usually every day. I do most of my reading when I travel, when I binge on books. Trying to force myself to read every single day (or for a set amount of time or a set amount of pages) would not be as productive or as enjoyable as periods of three to five days of really heavy reading (where I might finish three to five books). Binge reading may not be the right thing for everyone, but not every good habit has to be part of a daily routine. Sprints or batching can work too. What matters is that the results average out.

Focus on Yourself

One of the reasons I’ve talked about watching less news and not obsessingover things outside your control is simple: resource allocation. If your morning is ruined because you woke up to CNN reports of another ridiculous Trump 2 a.m. tweet-storm, you’re not going to have the energy or the motivation to focus on making the right dietary choices or sitting down to do that hard piece of work. I don’t watch the news, I don’t check social media much, and I don’t stress about everything going on in the world—not because I’m apathetic, but because there are all sorts of changes I want to make. I just believe these changes start at home. I want to get myself together before I bemoan what’s going on in Washington or whether the U.K. will figure out a Brexit strategy. “If you wish to improve,” Epictetus said, “be content to be seen as ignorant or clueless about some things.” (Or a lot of things.)

Make It About Your Identity

Generally, I agree with Paul Graham that we should keep our identities small, and generally, I think identity politics are toxic. It’s a huge advantage, however, to cultivate certain habits or commitments that are foundational to your identity. For example, it is essential to my understanding of the kind of person I am that I am punctual. I also have decided that I am the kind of person who does not miss deadlines. That I see myself as a writer is also valuable because if I’m not writing, I’m not earning that image. You can see why being vegan becomes part of people’s identity too. If it was just about choosing not to eat any animal products, the diet would be extremely difficult to adhere to. But because it is a lifestyle and an ideology, vegans are willing to push through all that. They don’t see it as a choice, but rather as the right thing to do.

Keep It Simple

Most people are way too obsessed with productivity and optimization. They want to know all the tools a successful writer or an artist uses because they think this is what makes these individuals so great. In reality, they are great because they love what they do and they have something they’re trying to say. When I look at some people’s routines and all the stuff they’re trying to manage, I shudder. Their habits require habits! No wonder they don’t make progress. My to-do lists are always short. I want my goals to be reachable, and I don’t want to be constantly busy or get burned out. This is why James Clear’s concept of atomic habits is so important. Look at the little things that make a big difference—not only is this more manageable, but the results will also create momentum.

Pick Yourself Up When You Fall

The path to self-improvement is rocky, and slipping and tripping is inevitable. You’ll forget to do the push-ups, you’ll cheat on your diet, you’ll get sucked into the rabbit hole of Twitter, or you’ll complain and have to switch the bracelet from one wrist to another. That’s okay. It doesn’t mean you’re a bad person. I’ve always been fond of this advice from Oprah: If you catch yourself eating an Oreo, don’t beat yourself up; just try to stop before you eat the whole sleeve. Don’t turn a slip into a catastrophic fall. And a couple of centuries before her, Marcus Aurelius said something similar:
When jarred, unavoidably, by circumstance, revert at once to yourself, and don’t lose the rhythm more than you can help. You’ll have a better group of harmony if you keep on going back to it.
In other words, when you mess up, come back to the habits you’ve been working on. Come back to the ideas here in this post. Don’t quit just because you’re not perfect.
No one is saying you have to magically transform yourself in 2019, but if you’re not making progress toward the person you want to be, what are you doing? And, more important, when are you planning to do it?
I’ll leave you with Epictetus once more, who wrote so eloquently about feeding the right habit bonfire. It’s the perfect passage to recite as we set out to begin a new year, hopefully, as better people.
From now on, then, resolve to live as a grown-up who is making progress, and make whatever you think best a law that you never set aside. And whenever you encounter anything that is difficult or pleasurable, or highly or lowly regarded, remember that the contest is now: you are at the Olympic Games, you cannot wait any longer…

2018 Sector ETF Performance


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Patients now living a median 6.8 years after stage IV ALK+ lung cancer diagnosis


According to the National Cancer Institute, patients diagnosed with non-small cell lung cancer (NSCLC) between the years 1995 and 2001 had 15 percent chance of being alive 5 years later. For patients with stage IV disease, describing cancer that has spread to distant sites beyond the original tumor, that statistic drops to 2 percent. Now a University of Colorado Cancer Center study published in the Journal of Thoracic Oncology tells a much more optimistic story. For stage IV NSCLC patients whose tumors test positive for rearrangements of the gene ALK (ALK+ NSCLC), treated at UCHealth University of Colorado Hospital between 2009 and 2017, median overall survival was 6.8 years. This means that in this population, instead of only 2 percent of patients being alive 5 years after diagnosis, 50 percent of patients were alive 6.8 years after diagnosis.
“What this shows is that with the development of good targeted therapies for ALK-positive lung , even  with stage IV disease can do well for many, many years,” says Jose Pacheco, MD, investigator at CU Cancer Center and the study’s first author.
Of the 110 patients on the current study, 83 percent were never-smokers, and had a median age of 53 years. Almost all of these patients were initially treated with the drug crizotinib, which earned FDA approval in August 2011 to treat ALK+ NSCLC, but had previously been available in Colorado and other academic medical centers in the setting of clinical trials. Importantly, after treatment with crizotinib, when patients on the current study showed evidence of worsening disease, 78 percent were transitioned to another ALK-inhibitor, commonly brigatinib, alectinib or ceritinib.
“Many studies have reported shorter overall survival for patients with stage IV ALK+ NSCLC treated with crizotinib. These studies had lower survival outcomes in large part because of a lower percentage of patients receiving next-gen ALK inhibitors after progressing on crizotinib. Patients here were getting next-gen ALK inhibitors in phase 1 and 2 clinical trials before many other centers had access to them,” Pacheco says.
Another factor that influenced survival was the use of pemetrexed-based chemotherapies in ALK+ lung cancer. Often, in addition to targeted therapy with ALK inhibitors, patients will undergo chemotherapy (and sometimes radiation). However, there are many chemotherapies to choose from, and it is often unclear which specific chemotherapies are most successful with specific cancers, stages, and patient characteristics. A 2011 study by CU Cancer Center investigator D. Ross Camidge, MD, Ph.D., who is also senior author of the current study, suggested that pemetrexed works especially well against the ALK+ form of the disease.
“We try to use mainly pemetrexed-based chemotherapies in ALK+ lung cancer,” Pacheco says, “It is possible shorter survival in other studies may be associated with use of non-pemetrexed based chemotherapies.”
Interestingly, the existence of brain metastases at time of diagnosis did not predict shorter survival.
“A lot of the new ALK inhibitors that were developed after crizotinib get into the brain very well, and they work similarly in the brain when compared to outside the brain. And we’re doing more careful surveillance of patients to see when they develop brain mets—instead of waiting for symptoms and then treating, we’re monitoring for the development of metastases with imaging of the brain and if we see something new, we sometimes treat it before it causes symptoms,” Pacheco says.
The most predictive factor of shorter survival was the number of organs that were found to carry cancer at the time of diagnosis.
“At this point, 6.8 years one of longest median survivals ever reported for a NSCLC subpopulation with stage IV disease,” Pacheco says. “It shows the benefit of targeted therapy and how it’s changing survival for a lot of patients. And I think it suggests that for some types of NSCLC, it may become much more of a chronic condition rather than a terminal disease.”
More information: J.M. Pacheco et al, Natural history and factors associated with overall survival in stage IV ALK rearranged non-small-cell lung cancer, Journal of Thoracic Oncology (2018). DOI: 10.1016/j.jtho.2018.12.014

Help cancer patients benefit from social media and avoid the pitfalls


Oncologists should help cancer patients be savvy about social media, a recent review argued.
Judicious patient use of social media can improve health outcomes, according to an earlier survey. However, benefits of social media for cancer patients, such as psychosocial support and patient engagement, can be offset by drawbacks including misinformation and privacy violations.
With social media’s potential for both benefits and harms for cancer patients, oncologists and other healthcare providers have an obligation to help patients use social media wisely, researchers wrote this month in Journal of Oncology Practice.
“Oncology professionals are encouraged to speak with their patients about social media and to suggest best practices to enjoy the positive and circumvent the negative aspects of social media. As social media platforms continue to modify the social landscape, the oncology community must recognize and act on their influence on patients with cancer,” the researchers wrote.
The researchers highlighted five benefits for cancer patients from social media:
1. Promotes patient engagement and empowerment
The researchers reviewed 170 studies of patients using information technology, which showed 89% of the studies found positive impacts on health, such as weight loss. In addition, 83% of the studies found enhanced patient engagement, such as text messaging for diabetes patients to access clinical data.
The researchers also found social media can help empower patients by giving them an opportunity to mentally process their cancer experience. Earlier research has shown empowered patients are more likely to attend checkups and screenings.
2. Provides psychosocial support
Earlier research has associated social support with better physical and mental health. Social media communities can help cancer patients who do not have in-person social support by reducing social isolation. Social media can also help cancer patients have conversations about emotional, spiritual, and physical treatment barriers.
3. Offers informational support
Social media can help cancer patients find oncology information. Social media can also spark incidental learning, such as hashtag searches on Twitter that inadvertently connect cancer patients with online support communities. Video platforms like YouTube can overcome healthcare literacy barriers.
4. Enhances the physician-patient relationship
Cancer patients should not use social media to interact with their physicians, but accessing oncology information through social media can increase confidence in relationships with physicians. Experiencing physicians sharing oncology information on social media can improve patients’ perceptions of medical professionals in general and improve relationships with their healthcare providers.
5. Find clinical trials and cancer research education
Social media can help cancer patients find clinical trials for particularly isolated populations who can be reached through social media advertising. Patients with rare forms of cancer can join social media groups targeted at their diagnosis, where they can connect with trial recruiters and other research opportunities.
The researchers also highlighted five social media drawbacks for cancer patients:
1. Substitute for in-person support
“Social support from social media ranges from infrequent and unstructured to regularly scheduled formal online support groups,” the researchers wrote. Behavior on social media can interfere with in-person assessment and treatment. Social media use can become impulsive, which could impede in-person interactions.
2. Misinformation
Online health information is often unreliable compared to information from healthcare providers. Online research should form building blocks for conversations with caregivers. Cancer patients should also keep a vigilant eye on conflicts of interests, such as healthcare professionals not disclosing their ties to medical supply and pharmaceutical companies, then promoting them on social media. With the untrustworthy nature of information online, cancer patients should be skeptical of information gathered through social media and fact check it with healthcare providers.
3. Financial exploitation
For cancer patients, financial perils on social media include unproven cancer cure claims, such as vitamins and special diets. Another risk is medical ads on social media that promote unnecessary procedures and treatments.
4. Information overload
Cancer patients who have internet access can be overwhelmed with medical information. Earlier research has linked information overload with anxiety over the inability to comprehend the avalanche of information and harness it for decision-making.
5. Compromised privacy
Social media users face privacy risks. Social media are public forums, so cancer patients should avoid posting private information. Patients should avoid sharing information that could be identifiable, including age, disease type, sex, and location.
How Physicians Can Help
There are three primary ways healthcare providers can help cancer patients navigate social media safely and effectively, according to the Journal of Oncology Practiceresearchers.
  • Experience cancer-related social media, including exposure to content that patients are viewing.
  • Help patients navigate the benefits and drawbacks of social media, such as by gauging the social media sophistication of a patient or cautioning patients to be skeptical about information found through social media.
  • To limit privacy risks, physicians should not offer medical advice via social media or interact with their own patients via social media.

Cadila Healthcare gains as USFDA grants approval for Acne Gel


Shares of Cadila Healthcare were trading 1% higher on Monday as the company received approval from the USFDA to market Clindamycin Phosphate and Benzoyl Peroxide Gel.
The combination medication is used to treat a certain type of acne (inflammatory acne vulgaris), the company said in a press note to the exchanges on Saturday. Cadila will manufacture this gel at the groups topical manufacturing facility at Ahmedabad.

Amazon com D.C.-Area HQ2 a New Beachhead in Battle for Tech-Savvy Vets


Amazon.com Inc.’s planned regional headquarters in the heart of the U.S. military establishment is creating a new potential battleground for veterans. This time, the fight is for them.
Amazon says it wants to hire 25,000 staff for its planned facility near Washington, D.C. over the next several years. That would be almost a sixth of the existing private-sector workforce for defense contractors and government IT specialists in the area.
Defense companies including Lockheed Martin Corp. and Booz Allen Hamilton Holdings Corp. are already tackling a shortage of skilled tech workers in a tight labor market. Contractors working through a two-year uptick in Pentagon spending on projects including cybersecurity and cloud-computing capabilities say they worry Amazon’s arrival will exacerbate a local talent crunch.
“Amazon does put stress on the system,” said Mac Curtis, CEO of Perspecta Inc. a government IT specialist with 14,000 staff that counts the Pentagon and the CIA among its clients.
Amazon wouldn’t say what kind of workers it plans to hire and has yet to post any job listings for the office complex in the National Landing neighborhood of Arlington, Va. The company plans to add another 25,000 workers over the next decade in New York City, the site of its other new second headquarters, or “HQ2.” While less of a magnet for government work, those offices will also require software engineers and cloud experts.
Amazon already employs more than 18,000 U.S. veterans and their spouses, about 3% of its global workforce. The company has said it wants to hire 25,000 more over the next three years. Earlier this year Amazon announced a partnership with the Labor Department to train 1,000 veterans in cloud computing. Some who have completed the program are now working for Amazon Web Services.
That unit is Amazon’s fastest growing, with sales up 48% annually in the nine months to Sept. 30. The company is pursuing more government contracts, including with the Pentagon. Many analysts view Amazon as the front-runner for a deal worth up to $10 billion to shift more Defense Department data to the cloud.
Some of the most prized new hires for defense contractors, and potentially for Amazon, are the roughly 250,000 people who leave active-duty military service each year, said companies and recruitment specialists. Big government-services companies such as Leidos Inc., which is remapping the Pentagon’s health care system, draw a third or more of their staff from people leaving the military.
“Veterans are clearly going to be a target,” said John Barney, a senior consultant at recruitment specialist Korn Ferry.
The Washington area is home to almost 210,000 employment-age veterans, the biggest metropolitan concentration nationwide, according to northern Virginia’s successful pitch for the new Amazon site.
The most sought-after are those with security clearances, a requirement for around 15% of the private-sector government IT and defense jobs advertised in the Arlington area that includes National Landing on recruitment site Glassdoor. The Pentagon is working through a backlog of 275,000 first-time applications for clearance, pushing wait times to more than a year.
The military is considering ways to ease the cleared-worker shortage, including by possibly allowing active-duty members to move more smoothly between civilian jobs and the armed services, said Navy Secretary Richard V. Spencer.
There should be enough talent for Amazon and other defense contractors, he said, adding that he doesn’t expect a competition.
However, recent changes to the military’s retirement plans could make it easier for veterans to enter the private sector. In 2018 the Pentagon created retirement accounts, much like 401(k) plans, that offer veterans benefits even if they serve only a few years. The new system frees them from a pension system that had required members to serve 20 years to qualify for benefits.