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Cathryn Hinesley(NEW YORK) -- A 10-year-old girl born with no hands is this year's winner of a national handwriting competition.

Sara Hinesley, a third-grade student in Maryland, won the Nicholas Maxim Award in the 2019 Zaner-Bloser National Handwriting Contest. To be eligible for the Nicholas Maxim Award, a student must have a cognitive delay, or an intellectual, physical or developmental disability. A team of occupational therapists judged all of this year's entries.

"I felt excited and proud," Sara told "Good Morning America" about learning she won the award, which comes with a trophy and $500 in prize money as well as $500 in educational materials for her school.

Sara writes by gripping the pencil or pen with both of her arms. She loves to create art and sees writing cursive -- for which she won the award -- as an extension of art.

"Cursive is round and it's trying to connect [letters] so it’s art," she said.

Sara was born in China and adopted by the Hinesley family in the U.S. four years ago, at age six. She could only speak and write Mandarin when she arrived in the U.S., but quickly picked up English from her older sister, Veronica.

She figured out a method of writing on her own.

"Sara is very motivated and a disciplined student," said the girls' mother, Cathryn Hinesley. "She excels really at about anything she tries."

The third-grader has made the decision not to use prosthetic hands, according to Hinesley.

"All of her life she has figured out ways to overcome that challenge and it's really made her a very strategic thinker," Hinesley said. "Before she takes on a task she tends to plot out how she’s going to accomplish it and is usually successful."

She added, "Everything Sara does she really does to the best of her ability and on her own. She's a very independent, 'I can do it,' type of kid."

Sara will receive the award on June 13, the last school day of the year at her school, St. John’s Regional Catholic School in Frederick, Maryland. Sara is the first student from the school to win the Nicholas Maxim Award.

"Sara always has a smile on her face. Nothing gets her down at all," said the school's principal, Karen Smith. "She always seems to cope with whatever task is given. She always figures out a way to do it."

Sara won the Nicholas Maxim Award for excellence in cursive. Another student, in Ohio, won the award this year for excellence in manuscript (printing).

Sara's mom called her daughter's award-winning penmanship a "testament to the human spirit."

"It shows what perseverance and a positive attitude can do," Hinesley said. "Sara is a great example of that."

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Pornpak Khunatorn/iStock(NEW YORK) -- The number of measles cases in the U.S. so far this year is approaching the record for the decade -- and in just four months time, according to new data.

The Centers for Disease Control and Prevention reports that there have been 626 confirmed cases of measles so far this year, an increase of 71 new cases since last week. Two new states -- Iowa and Tennessee -- join the list, bringing the total to 22.

The only year when there were more cases reported in the United States since the disease was eliminated in the U.S. in 2000 was in 2014 -- 667.

"In the coming weeks, 2019 confirmed case numbers will likely surpass 2014 levels," the CDC said in its update Monday.

CDC

There are more cases in New York than in any other state, though the exact number of cases was not immediately known because the outbreak in some areas started at the end of 2018. The New York City Health Department noted that there have been 359 confirmed measles cases in Brooklyn and Queens from October 2018, to April 18, 2019.

Separately, officials in New York's Rockland County noted that there have been 194 confirmed cases there in 2019. Of those, 80.8% of the infected individuals never received the measles-mumps-rubella (MMR) vaccine, Rockland County officials report.

The number of confirmed cases in other states are still in the double-digits, including 74 cases in Washington, 43 cases in Michigan, 23 in California and 13 in New Jersey.

Officials in New York are trying to take action to curb the spread of the highly contagious disease, for example, by fining people who refused to get vaccinated in designated areas as mandated by the mayor's office.

ABC News, CDC

The spike in measles cases in the U.S. comes amid an uptick in global cases. The World Health Organization reported last week that the number of reported measles cases was up by 300% in the first three months of 2019 as compared to the same time period in 2018.

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katleho Seisa/iStock(NEW YORK) -- In spite of the fact that over six million women in America struggle with infertility, according to the U.S. Department of Health and Human Services, there remain boundless misconceptions about conception.

In honor of National Infertility Awareness week which kicks off Monday, Good Morning America and ABC News' Chief Medical Correspondent Dr. Jennifer Ashton teamed up to bust or break down some infertility myths about birth control, IVF treatments, age and more.

Infertility Myth 1: Using birth control for years can make you less fertile

Ashton, an OB-GYN, said this is one of the most common questions about infertility that she gets from patients. But rest assured, the answer is that using birth control for years does not make you less fertile.

Ashton says that no matter how long you have been on the pill, your ovaries will always be happy to have you back.

Birth control does not do anything to affect the quality of your eggs, and once the pills are out of your system -- which can only take 48 hours -- you can start a new ovulation cycle and get pregnant as soon as the first month you're off the pill.

Infertility Myth 2: Multiple rounds of IVF will not increase your chances of getting pregnant

Multiple rounds of IVF treatment will increase your chances of getting pregnant, according to Ashton. Studies show that if women do enough IVF cycles, the majority will conceive -- meaning the more rounds, the more chances.

The issue often arises because most women will drop out before that point because of the cost as well as the physical and emotional strain.

Infertility Myth 3: If you are under 30 you won't have fertility issues

While it is absolutely true that age is a massive factor when it comes to fertility (the older a woman gets, she has fewer eggs of lesser quality) there are also many younger women who face fertility issues, Ashton said.

If you are worried that you may be struggling with fertility and are over the age of 35, Ashton recommends getting tested for fertility problems after six months of trying to conceive naturally.

If you are under 35, Ashton recommends getting tested after a year of trying. It's not generally accepted to check your fertility status before trying to conceive, as tests can often be expensive and not covered by insurance, according to Ashton. If you are looking to be preventative and proactive when it comes to your fertility health, women should get screened frequently for STDs and maintain a healthy lifestyle.

What can decrease a woman's chance of becoming pregnant?

There are a few lifestyle factors that can decrease a woman's chances of getting pregnant. Those include being age 30 or over, smoking, heavy alcohol use, stress, poor diet, diabetes, or being significantly over or under weight, according to the Department of Health and Human Services.

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milanvirijevic/iStock(NEW YORK) -- Fundraising, grants, loans and credit card debt are now terms just as commonly associated with infertility as the words baby and pregnancy.

The average cost of one in vitro fertilization, or IVF, cycle in the United States is $12,400, according to the American Society for Reproductive Medicine, a non-profit organization founded by fertility experts in the 1940s.

Add to that the reality that most pregnancies require more than one IVF cycle, plus ancillary expenses including medication, doctors appointments, genetic testing and embryo storage, and then subtract the fact that insurance coverage for infertility treatments is limited, and you have what often becomes a cost-prohibitive, or financially crippling, scenario for women trying to get pregnant.

Still, more than seven million women, nearly 12 percent, have used infertility services in their lifetime, according to the Centers for Disease Control and Prevention.

As a result of the rising costs and rising frequency of fertility treatments, a whole separate industry has sprouted to just financially help people have children. Here is a look at some of the resources now available:

Grants and scholarships

Certain hospitals, foundations and even states, such as New York, now offer grants and scholarships to help cover the cost of infertility treatments.

Some require you to live in certain states and to meet certain requirements, and some charge fees for applying. Make sure to carefully vet the grant or scholarship-giving institution before you share any information online.

The Kevin J. Lederer Life Foundation in Chicago is one foundation that offers grants to cover the medical costs of IVF treatments.

Other resources include the Kyle Busch Foundation, the Baby Quest Foundation and the Cade Foundation.

The Baby Quest Foundation offers around 10 grants for every 300 to 400 applications it receives, according to Pamela Hirsch, who founded the charity in 2011 after watching her daughter go through unsuccessful IVF treatments before turning to surrogacy to have her two children.

"Infertility becomes an issue of class because it's only available to those people who can afford it," she said. "There so many different types of issues that we try to address and it's frustrating that we don't have the funds to help more people than we do."

Baby Quest gives scholarships that fill the gap, so if an IVF treatment costs $10,000 and a grant recipient can only contribute $2,000, the foundation will give them $8,000. Other grants and scholarships give certain amounts of money and have different requirements, so applicants must do their research first.

"All we can do is offer an opportunity to remove that financial burden to allow them to pursue IVF or surrogacy," Hirsch said.

FertilityIQ, an online resource started by a couple searching for a fertility doctor, offers a state-by-state guide to available grants and charities, mostly for IVF.

The National Infertility Association, aka RESOLVE, national patient advocacy organization founded by a woman, offers a list online of grant and scholarship opportunities.

Fertility Within Reach, a national non-profit organization, also offers an online guide for everything from infertility treatment grants to adoption grants, fertility medication grants and programs for veterans and current members of the military.

Employers and insurers

More than 400 U.S. companies offer benefits for fertility treatments, according to data collected by Fertility IQ, a fertility information website. Even with some employers adding such benefits, the majority of IVF patients treated last year paid for all or some of their treatment out-of-pocket, according to Fertility IQ.

Fertility-focused organizations have begun to offer tips for employees who want to ask their employers for IVF benefits.

ABC News Chief Business Correspondent Rebecca Jarvis, who became pregnant thanks to the help of infertility treatments, also shared these three tips for women.

1. Call your insurance provider
: [Call] whatever insurance you're getting through your company and ask them what fertility benefits they offer. Typically it's the insurance providers themselves that can explain which benefits you're eligible for. Also, ask your insurance provider about different plans -- sometimes it's different coverage depending on which plan you're on, and it might make sense to switch.

2. Look at your partner's insurance: In some cases that's going to be a bigger benefit than the one you're getting from your company.

3. Negotiate: When you're going out and talking to these various fertility providers, negotiate. Caution against just making choice on cheapest option. If they're not the strongest provider, you could be setting yourself up for multiple rounds of treatment which becomes more expensive.

Only a handful of states require insurance providers to cover infertility treatments. The American Society of Reproductive Medicine maintains an online database of state-specific insurance requirements so you can know your rights in your state.

Financing

Some fertility clinics offer their own discounted treatment packages and financing, and there are independent companies that offer financing and loans to cover the cost of treatments.

RESOLVE offers a comprehensive online guide to infertility financing programs.

Fundraising

A quick search on GoFundMe, the crowdfunding platform, shows dozens and dozens of couples and individuals asking for financial help with their IVF journey. The website even has a page titled "Get help with IVF fundraising."

One couple profiled by ABC News, LaTanya and James Braxton, of Antioch, Tennessee, turned to GoFundMe after they realized the loan they took out to cover the $19,000 cost of their IVF treatment didn't account for the high cost of medicine that comes with an IVF cycle.

"We decided to be creative in exploring the different ways we could cover the difference and GoFundMe was one of the best opportunities we have," James said.

The Braxtons posted a video on their GoFundMe page explaining their decision to go this route. Using social media in addition to GoFundMe was a way for the couple to keep family and friends up to date on their IVF journey in a personable and relatable way.

The couple's GoFundMe page currently shows they have raised $10,685 of their $16,350 goal.

After experiencing a miscarriage with twins after their first round of IVF, the Braxtons still have nine frozen embryos and intend to try IVF again when LaTanya's body is ready.

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aprilante/iStock(NEW YORK) -- A so-called Sober Curious movement that's been gaining in popularity focuses on eliminating alcohol for health, sleep and wellness reasons, and its founder encourages people to participate by asking them to imagine "what it's like to live hangover free."

Ruby Warrington, author of the book Sober Curious: The Blissful Sleep, Greater Focus, Limitless Presence, and Deep Connection Awaiting Us All on the Other Side of Alcohol, told ABC News' Good Morning America that she believes sobriety "can be a lifestyle choice for anybody."

"We don't have to drink. There's nothing that says, as an adult being, you have to consume alcohol," she added. "And yet, our society doesn't really lead us to believe that. In fact, it's very much the norm to drink."

Her book encourages readers to be more mindful about consuming alcohol.

She also touched on the stigma of saying you're "sober," comparing it to "if you were telling them you weren't eating gluten, or you were taking a break from dairy, they wouldn't bat an eyelid."

"But if you tell them you're not drinking, it can bring up all these issues," she said, adding that our "society is on alcohol as a social lubricant."

Listen Bar in New York City is a pop-up watering hole that caters specifically to the growing Sober Curious movement. All of the drinks -- from the creative cocktails to the shots -- are non-alcoholic.

The bar aims to be a place where people looking for a night out can go without feeling the social pressure to drink.

A 2017 survey found that a third of people wanted to cut back on their alcohol consumption -- some because of regret or embarrassment -- and many others for health reasons.

There's even a new app called "Sober Grind" which helps connect you with people who chose not to drink.

ABC News' Chief Medical Correspondent Dr. Jennifer Ashton, who did her own variant of Sober Curious when she gave up alcohol for a month for wellness reasons during her Dry January challenge, came up with five "yes" or "no" questions she encourages you to ask yourself about alcohol -- especially keeping track of how many times you answer "yes."

Question 1: Have you had times when you ended up drinking more, or longer, than you intended?

Question 2: Have you gotten into situations while or after drinking that increased your chances of getting hurt?

Question 3: Have you had to drink much more than you once did to get the effect you want?

Question 4: Have you continued to drink even though it was making you feel depressed or anxious?

Question 5: Do you spend a lot of time drinking, being sick or getting over other after-effects?

If you answered "yes" to one or two of those questions, it could be a reason for concern, depending on your particular symptoms and their severity.

The earlier questions tend to be early signs of potential trouble, whereas the latter questions indicate that you have moved further down a risky path.

The questions are based on symptoms for alcohol use disorder in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The DSM is the most commonly used system in the United States for diagnosing mental health disorders.

If you answered "yes" to some of the questions or are simply interested in the Sober Curious movement, Ashton shared some tips to help you stay on track.

First, keep a calendar so you can keep track of how many nights a week you drink. Second, recruit some friends and hold each other accountable to feel less pressure to consume alcohol. Finally, be curious.

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Hailshadow/iStock(NEW YORK) -- New York City followed through on its threat to fine people who refused to get measles vaccines on Thursday.

The city's health department issued civil summons to three people a week after issuing an emergency order requiring anyone 6 months or older who lived in four specific zip codes -- all in Brooklyn -- to get the measles, mumps and rubella (MMR) vaccine within 48 hours. Each person will be on the hook for a $1,000 fine.

The zip codes -- 11205 in Clinton Hill, 11206 in Bushwick and 11211 and 11249 in Williamsburg -- are all in predominantly Orthodox Jewish communities.

"Since the Emergency Order took effect, the Health Department carefully investigated cases with the help of its disease detectives," the health department said in a press release. "Many of the people who were contacts of individuals with measles had proof of vaccination, however the Health Department identified three children who were exposed to the measles but still unvaccinated as of April 12."

In addition to the three people fined for being unvaccinated, the city also closed four additional schools for failure to provide vaccination and attendance records, the city said.

The health department had ordered United Talmudical Academy, a yeshiva preschool, closed on Tuesday, but it has now been allowed to reopen.

As of Thursday, there had been 359 measles cases in Queens and Brooklyn since the beginning of the outbreak last October, including 74 since the emergency order was issued on April 9.

"The initial child with measles was unvaccinated and acquired measles on a visit to Israel, where a large outbreak of the disease is occurring," according to the health department. "Since then, there have been additional people from Brooklyn and Queens who were unvaccinated and acquired measles while in Israel."

A lawsuit filed by five unnamed parents asking for the emergency order -- and mandatory vaccinations -- to be vacated "as arbitrary and capricious and contrary to law" was also shot down on Thursday.

"The pivotal question posed for this court's determination is whether Respondent Commissioner has a rational, non-pretextual basis for declaring a public health emergency and issuing the attendant orders challenged herein," Kings County Judge Lawrence Knipel wrote in his decision.

The judge found the emergency declaration to be well-founded, and followed up, writing, "A fireman need not obtain the informed consent of the owner before extinguishing a house fire. Vaccination is known to extinguish the fire of contagion."

Measles can cause fever, runny nose, diarrhea and pneumonia. Severe cases can even result in death, especially in infants, pregnant women, children and people with compromised immune systems.

The vaccine is considered "very safe" and effective by the Centers for Disease Control and Prevention (CDC), which also debunks any concerns -- often held by so-called anti-vaxxers -- that the vaccine could cause autism.

"Vaccine safety experts, including experts at CDC and the American Academy of Pediatrics (AAP), agree that MMR vaccine is not responsible for increases in the number of children with autism," the CDC states on its website.

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JasonDoiy/iStock(NEW YORK) -- Since 2010, 23andMe has charged people to test themselves for potentially harmful gene mutations, such as those in the BRCA1 and BRCA2 genes, which, when mutated, can dramatically increase a person’s risk for developing breast or ovarian cancer.

But while 23andMe can screen for the three most well-known BRCA mutations, the test is not approved by the Food and Drug Administration to test for the remaining 1,000-plus BRCA mutations. This presents a problem: As many as 94 percent of people carrying a BRCA mutation may receive a false-negative if they take the stripped-down test 23andMe offers, according to a recent study.

Dr. Pamela Munster, an oncologist and director of the Center for BRCA Research at UC San Francisco Medical Center, is one person who received one of these false-negatives. Two years after taking the 23andMe test in 2010, she was diagnosed with breast cancer.

“I never thought I would be at high risk for a BRCA mutation,” Munster told ABC News, noting that even if she had been concerned about carrying a BRCA mutation, she would not have qualified for screening. “I didn’t meet any criteria that made me high risk.”

23andMe has introduced warning labels since Munster took the genetic test. A spokesperson for the company told ABC News that test results clearly warn customers that these "1,000-plus alleles or variants [are] not captured, so [the] panel does not rule out a potentially high-risk mutation.”

The spokesperson also pointed out that “before customers can even access their results, they’re required to review an eight-page module.” That module highlights the limits of the 23andMe test, noting that the 23andMe test should not replace routine screening and that results should be reviewed with a clinician, who can help the patient get a complete test done.

Munster said that she doesn’t think 23andMe is trying to mislead its customers, but expressed fear that they may not be able to fully interpret abnormal test results on their own.

BRCA mutations are rare in the United States., occurring in one in 300-500 women. The U.S. Preventive Services Task Force recommends BRCA screening in people with a strong family history of breast or ovarian cancer, or relatives who have BRCA mutations.

23andMe’s spokesperson told ABC News that “a substantial fraction” of the company’s BRCA carriers did not report a high-risk family history, so they wouldn’t have met the criteria for traditional BRCA screening. After they discovered their BRCA mutations, many of them undertook prophylactic surgeries to mitigate their risk, the spokesperson said.

Unlike 23andMe’s test, the physician-prescribed blood test, called a multigene panel test, screens for many mutations beyond BRCA genes.

“[While] a lot of people think of the heredity of breast cancer as purely BRCA-related, 90% of our genetic testing includes genes other than BRCA,” Dr. June Hou, gynecologic oncologist and director of Columbia University’s Hereditary Breast and Ovarian Cancer Program, told ABC News.

BRCA mutations have also been linked to pancreatic cancer, colorectal cancer and skin cancers like melanoma, among others, Hou said. Because BRCA2 mutations have been linked to a higher risk of breast cancer in males, she said that she reminds female patients with BRCA2 mutations that the mutated gene might not only affect them but their male family members, too.

Case in point: Shortly after Munster discovered she had breast cancer, her father was diagnosed with pancreatic cancer. When she recommended that he get screened, he came back positive for a BRCA2 mutation.

As scientists continue to uncover the genetics of breast cancer, the popularity of sites like 23andMe underscore concerns about who should be screened. Until then, experts recommend that doctors provide their patients with a safe space to discuss the pros and cons of testing and to recognize that breast cancer screening is individualized and patient specific.

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Miami Valley Hospital(DAYTON, Ohio) -- Miami Valley Hospital in Dayton, Ohio, is about to turn it up to 11.

Eleven nurses in the hospital's labor and delivery unit are pregnant at the same time.

The due dates for the nurses, one a gestational carrier, span in time from early May to late October. All 11 of the nurses plan to deliver at their employer, Miami Valley Hospital, which oversees about 4,000 deliveries per year.

"Knowing that our coworkers are going to be there when we deliver is very comforting," said Lindsey Highley, who's due with her third child in May.

Jessica Piddock, due in July, described the baby boom at the hospital as "completely crazy," while Charlotte Phillips, due in May, called it "really exciting."

All three nurses said they and their pregnant coworkers are comparing notes, sympathizing with each other through difficulties and mostly just looking ahead to having 11 more kids on board.

"I think we all just really look forward to watching each other's children grow and getting motherhood advice as well," Highley said.

The baby boom at the Ohio hospital comes just weeks after nurses in Maine, teachers in Kansas and firefighters' wives in North Carolina each made headlines for the same thing: A large group of coworkers expecting babies at the same time.

Earlier this year, a group of eight nurses in one obstetrics unit made headlines for giving birth over a span of five months.

Last year, five coworkers at a doctor's office in Ohio were all pregnant at the same time too and, in Kentucky, seven dads and one mom in a police department welcomed new babies at the same time.

Some may be wondering: Can there really be something in the water at these employers? Is there some way to medically explain the phenomenon?

The answer, doctors say, is no.

"More likely, I think it's people who are around the same age, going through the same thing, and they see people getting pregnant and being able to handle it," said Dr. Joanne Stone, director of maternal-fetal medicine at Mt. Sinai Hospital. "It's more of an atmospheric thing than there's any medical reason for it."

Stone said baby booms are more likely a sign that the women and men's employers are doing something right, in providing a positive workplace environment for expectant parents.

"Unfortunately, there are some where [pregnancy] is looked down upon," she added.

Dr. Richard Beckerman, chairman of the Department of Obstetrics and Gynecology at Sibley Memorial Hospital in Washington, D.C., agreed with Stone.

"I don't think it's a medical marvel as much as it's a really neat and fun-loving incident," he said. "It's a great human interest story and a nice thing to see."

And scientific or not, it's still beneficial for the expectant mothers, Stone and Beckerman added.

"I think it's always nice," Stone added, "to get that support and to be able to share how you feel and to feel validated -- to not feel so bad if you're tired and you need to put your feet up for a moment. Everyone understands. It's a positive feeling."

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Kevin Winter/PW18/Getty Images for Parkwood Entertainment(NEW YORK) -- Along with footage of rehearsals, intimate family moments and reflections on her 2018 monumental Coachella performance, Beyoncé opened up about a very personal aspect of her health in her new documentary.

The 23-time Grammy winner and mother of three shared in the Netflix documentary Homecoming that she had an "extremely difficult" pregnancy with twins Rumi and Sir in 2017, suffering from preeclampsia among other conditions.

Preeclampsia, also known as toxemia, is a rare pregnancy complication "characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys," according to the Mayo Clinic.

Beyoncé said she got pregnant "unexpectedly" and added, "My body went through more than I knew it could."

"I was 218 pounds the day I gave birth," she shared. "I had high blood pressure. I developed toxemia, preeclampsia, and in the womb, one of my babies' heartbeats paused a few times, so I had to get an emergency C-section."

Some symptoms of preeclampsia include high blood pressure, swelling or weight gain, headaches and protein in urine. The condition affects 5 to 8 percent of all births in the United States, according to the Preeclampsia Foundation.

The foundation says 76,000 maternal and 500,000 infant deaths are estimated to be caused by the condition.

The Centers for Disease Control and Prevention also reports that African-American women have a three to four times higher risk of pregnancy-related death than white women.

Beyoncé previously spoke about her pregnancy complications in Vogue in August 2018.

"I was in survival mode and did not grasp it all until months later. Today I have a connection to any parent who has been through such an experience," she said.

She also expanded on how her c-section changed her.

"My core felt different. It had been major surgery. ... I needed time to heal, to recover," she told the outlet.

"During my recovery, I gave myself self-love and self-care, and I embraced being curvier," she added. "I accepted what my body wanted to be."

Homecoming features footage of Beyoncé in her first rehearsal post-pregnancy, as she speaks about the challenges of getting back into it after undergoing a difficult pregnancy.

"It's my first time back home on the stage after giving birth. I'm creating my own homecoming, and it's hard," she said. "There were days that I thought I'd never be the same, I'd never be the same physically, my strength and endurance would never be the same."

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Pornpak Khunatorn/iStock(SEATTLE) -- After 74 confirmed cases of measles, Washington state politicians are taking action.

The state Senate has passed a bill that, if enacted, would revoke the state's vaccination exemption for those who have a personal or philosophical opposition to vaccines.

If enacted, the bill wouldn't apply to all vaccines but only the measles, mumps and rubella (MMR) vaccine that helps prevent the spread of those three diseases.

The bill narrowly passed the state Senate in a 25-22 vote Wednesday, and a very similar version passed the state House in early March, meaning that the finalized version is set to head to the governor's desk soon.

A spokesperson for Gov. Jay Inslee, who is also part of the crowded field of Democratic presidential candidates, told ABC News that the governor has previously expressed his support for the bill, but noted that he always reviews legislation "carefully before taking action."

This action comes amid an ongoing measles outbreak across the country, where 20 states -- including Washington -- have confirmed cases. All told, there have been 555 confirmed cases of measles in the U.S. so far this year, according to the Centers for Disease Control.

Washington is currently one of 18 states that allow for philosophical exemptions to vaccinations, according to the National Conference of State Legislatures. Missouri allows a philosophical exemption for child care facilities, but not for public schools.

All states allow exemptions for medical reasons, and that is not expected to change anytime soon, but states could be targeting both philosophical exemptions and religious exemptions.

Religious exemptions are in place in 47 states and the District of Columbia.

There are only three states that have no religious or personal exemptions: California, Mississippi and West Virginia.

The proposed bill in Washington state would not change the religious exemption in the state, but according to state figures, that exemption does not lead to a high number of unvaccinated children.

According to data from Clark County, where the majority of Washington state’s measles cases were found, 7.9 percent of kindergarten students were exempted from vaccinations in the 2017-2018 school year.

The reason? Personal exemptions.

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ABC News(NEW YORK) -- Fashion maven Nina Garcia, the editor-in-chief of Elle magazine and a judge on Project Runway opened up about her decision to undergo a preventative double mastectomy earlier this year, saying she felt in her industry it was "very important to stand up and be like, 'You know what? We are not perfect.'"

Garcia told ABC News' Robin Roberts that she underwent the preventative surgery after taking a test to see if she had BRCA-genetic mutation.

"To my surprise and horror, I got that envelope that said positive," she said.

The two BRCA genes (BRCA1 and BRCA2) normally help protect women from cancer, however, some women may have mutations to their BRCA genes, which can actually lead to cancer, according to the U.S. Centers for Disease Control and Prevention. If untreated, women with a BRCA gene mutation are seven times more likely to get breast cancer before the age of 70, when compared with women without the gene mutations, according to the CDC.

When she first received the positive test results for the mutation, Garcia said, "So many thoughts raced through my mind."

"I was like, 'Oh, my -- why me?" she said. "What does this mean?"

"And then I kind of switched, and I was like, 'How lucky ... that I was able to know this so early on,'" she said.

Although not a cancer diagnosis, the positive BRCA test is a marker for an increased risk of breast cancer and requires constant vigilance.

"Every six months I would get tested," Garcia said.

Over the last three years she said there was some "ambiguous information" and "abnormal cells," until soon there was a "radical scar" and a "lumpectomy."

"The news started to get worse. In January, I decided I wanted to opt for a double mastectomy," Garcia said.

"I don't think it's a choice that every woman should make," she added. "But with my history, it was the right decision for me ... it was my personal choice."

After making the difficult decision to have a double mastectomy, Garcia, who lives her life in the public eye, had the added challenge of grappling with revealing something so private.

"I feel like I'm carrying this big secret," she said of her time during February, when Fashion Week was about to begin and she announced she would be missing some major shows as she recovered.

She said she struggled with wondering, "Will I look weaker to my staff? Will I miss such a important moment that is Fashion Week for me, as the editor of Elle, a fashion magazine?"

Garcia said she found solace confiding in her husband, who she says was "very encouraging" through the whole process.

"He was the first one that said, 'You've gotta share this. This is important,'” she said.

Garcia said she is now sharing her own story in hopes of offering comfort and support to other women.

"I am in a business that ... is so about perfection," she said. "And it's changing ... thankfully it's changing."

"I also thought it was very important to stand up and be like, 'You know what? We are not perfect,'" she said, adding that her story is such a "real health issue for women."

Garcia added that going through something like this with the right attitude also makes all the difference, mentally and physically.

"I'm not going to lie. A double mastectomy is a very big surgery," she said. "But the mindset of being grateful, of not being, 'Why did it happen to me,' but, 'I am so thankful that I was able to do something about it.'"

Garcia is now back at work at Elle and back to judging the next generation of fashionista's on the upcoming season of Project Runway, but said she is carrying with her a new perspective.

"I learned that I could be very brave. I learned that ... I'm strong," she said. "I think the most invaluable lesson is that you got to share your stories."

"The message is the technology and the science is there especially for breast cancer. For that woman at home that hasn't had her mammogram, that hasn't had a sonogram, to get tested, for that woman at home that has a history of breast cancer in their family to get the BRCA gene test," she said. "I think it's so important."

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Hailshadow/iStock(NEW YORK) -- The man who is believed to have brought the ongoing measles outbreak to Michigan thought he was immune to the disease, according to a doctor who spoke with him.

The man, who remains unidentified but is believed to be "patient zero" in Michigan, traveled to the Great Lake state from New York in March.

The man had previously traveled to the U.S. from Israel in November, making it unlikely that he was infected then, and more likely that he caught the disease while in New York, according to Steve McGraw, the emergency medical services director for Oakland County, Michigan, who spoke to him days after he was diagnosed.

It is not clear if the man is a U.S. citizen.

There have been hundreds of confirmed cases of measles in New York since an outbreak started there in 2018, and has continued into 2019.

During the roughly 15-hour drive from New York to Michigan, the man felt fine, but "he got sick when he arrived, started having a fever, cough and headache," McGraw said. He added that in early March, it isn’t uncommon for people in Michigan to have those symptoms.

After seeking a doctor’s opinion, the man was misdiagnosed with bronchitis, but according to McGraw, the man returned the next day. That's when the doctor became concerned when he saw a rash on the man’s face.

The doctor "did a heroic thing and he called the health department," McGraw said. Officials then had trouble finding the man with measles because he "did not have a reliable cell phone" and "wasn’t really on any particular itinerary."

McGraw said that the patient was fundraising on behalf of Orthodox Jewish charities and "he would be in, sometimes, three different synagogues in a day."

Once it was determined where the man was, McGraw, who is also the medical director of the Detroit-area Hatzalah, which is an emergency medical service for Orthodox Jews, met with him. After communicating with him through a translator -- because the man does not read or speak English -- McGraw was able to tell him that "this was definitely measles."

"He was really upset," McGraw said. "He really had no idea he had been sick that way, especially that he had been contagious."

The outbreak in Michigan’s Oakland County started in mid-March, and 39 cases have been confirmed since then. There have also been three other individual measles cases in three other counties.

Michigan is one of 20 states where there have been confirmed cases of measles this year. According to the Centers for Disease Control and Prevention, there have been 555 confirmed cases nationwide.

Many of those connected to the outbreaks have ties to communities with low vaccination rates, and Orthodox Jewish communities in New York have been impacted extensively.

McGraw said that the Orthodox Jewish community in Oakland County was very receptive to treating the measles outbreak and having individuals get vaccinated. Rabbis worked with local synagogues to open vaccination clinics, leading to "hundreds and hundreds of people waiting in line just to get their vaccination," McGraw said.

The individual who brought the disease to Michigan suffered from what McGraw said is a common misconception -- the man, who is in his 40s or 50s, believed that he was immune from the disease because he said he had it when it was younger.

"He was told he was immune because he had the measles [when he was younger], that’s why initially he completely discounted his [the doctor’s] suggestion," McGraw said.

"I know people who believed they were fully immune because they had measles, and then they had measles in the past month and a half," McGraw said, referring to other cases.

The timing and widespread roll out of the measles vaccine can also play a role in whether or not someone has full immunity. Prior to 1989, doctors typically only issued one vaccination, but after that date, two vaccinations for measles became standard. One immunization is 93 percent effective while two are 97 percent effective, according to the CDC.

McGraw’s advice is to get another immunization if there is any question as to whether or not you had two doses.

"Nothing is as good as certainty. Unless you know you’ve had two, just get a second one," McGraw said.

The CDC considers anyone who had two doses as a child as protected for life from the disease, and said that adults only need one dose, but there are cases where a second adult dose would be helpful.

"Adults who are going to be in a setting that poses a high risk for measles transmission should make sure they have had two doses separated by at least 28 days,” the CDC’s website reads. “These adults include students at post-high school education institutions, healthcare personnel, and international travelers."

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chemicalbilly/iStock(NEW YORK) -- “Cure” is an elusive word, but it’s exactly what researchers at St. Jude Children’s Research Hospital are calling their treatment for the most common form of severe combined immunodeficiency (SCID), a group of rare immune diseases that you might know better as “bubble boy” disease.

This form of the disease, SCID-X1, first made headlines in the 1970s and 80s with David Vetter -- the original “bubble boy” -- who spent 12 years in strict isolation to protect himself from infections. His story inspired several films about the disease, including the 1976 film The Boy in the Plastic Bubble starring John Travolta.

The disease, which is caused by genetic mutations, is characterized by a lack of immune function, which makes it easy to develop life-threatening infections. The rare disease is estimated to affect only one in 50,000 to 100,000 newborns, many of whom are expected to die from infections early on.

“Because infants with this disorder have no functioning immune system, without treatment, a diagnosis of SCID is a true death sentence,” said Dr. Ewelina Mamcarz of the Department of Bone Marrow Transplantation and Cellular Therapy at St. Jude’s during a press conference. “A simple infection like the common cold could be fatal. If left untreated, patients rarely live past their second birthday.”

Mamcarz and her team, however, recently discovered a technique that could save these children. They published the results in the New England Journal of Medicine.

For years, stem-cell transplantation from a matched sibling was a patient’s best hope for survival, Mamcarz said.

“[But] more than 80% of patients lack such donors,” she said. “They must rely on stem cells from other donors. This process is less likely to cure SCID, and more likely to lead to serious treatment-related side effects.”

With this in mind, the researchers at St. Jude turned to gene therapy -- an experimental technique whereby a reengineered virus is used as a vehicle “to introduce a normal copy of the mutated gene into patients’ blood stem cells,” said Dr. Steven Gottschalk, a co-author of the study from the same department at St. Jude as Mamcarz.

The trial involved harvesting blood stem cells from the bone marrow of eight infants newly diagnosed with SCID-X1. Then, with the help of an inactivated lentivirus, they inserted a healthy copy of the mutated gene into the stem cells and reimplanted them into the infants. Prior to reimplantation, the infants were given low-dose chemotherapy to “make space in the bone marrow for the gene-corrected cells,” Mamcarz said.

“This approach has shown outstanding results,” James Downing, the president and CEO of St. Jude, said during the conference. “The treatment has fully restored the immune system, which wasn’t possible before, and has no immediate side effects. These infants are able to respond to vaccination and are [living] normal and healthy lives.”

Whereas prior attempts to use gene therapy unintentionally resulted in leukemia, the researchers reported that none of the patients have shown even the earliest signs of the blood cancer. Gottschalk said it was because the lentivirus was designed “with insulators” to prevent the activation of any genes that could cause cancer.

In the wake of their success, Mamcarz said the team is hopeful that their experimental treatment will be applied to other genetic diseases, such as the blood disorder sickle cell disease.

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Moussa81/iStock(WASHINGTON) -- The Justice Department announced Wednesday that 60 people across five states, including more than 30 physicians, were charged in connection with millions of illegal prescription opioids in a takedown by its "Appalachian Regional Prescription Opioid Strike Force."

The states are Alabama, Kentucky, Louisiana, Ohio, Pennsylvania, Tennessee and West Virginia. Some cases were developed years ago and are being brought to light with the new cases being unsealed on Wednesday.

“The opioid epidemic is the deadliest drug crisis in American history, and Appalachia has suffered the consequences more than perhaps any other region,” Attorney General William P. Barr said in a release.

According to the Justice Department, the suspects wrote some 350,000 prescriptions and distributed 32 million pills.

In Tennessee, according to prosecutors, a doctor known as the "Roc Doc," 'allegedly prescribed powerful and dangerous combinations of opioids and benzodiazepines, sometimes in exchange for sexual favors.'

The Justice Department said over three years the doctor "allegedly prescribed approximately 500,000 hydrocodone pills, 300,000 oxycodone pills, 1,500 fentanyl patches, and more than 600,000 benzodiazepine pills."

The Western District of Tennessee saw the most number of individuals and doctors charged.

In another instance, in the Western District of Kentucky, according to the DOJ, a doctor would provide pre-signed blank prescriptions to office staff who used them to prescribe drugs while he was out of the office.

In a case out of Dayton, Ohio, the DOJ said a doctor who is alleged to have been the highest prescriber of controlled substances in the state, and several pharmacists, are charged with operating an alleged “pill mill.” According to the indictment, the DOJ says, "between October 2015 and October 2017 alone, the pharmacy allegedly dispensed over 1.75 million pills."

The Department of Justice worked alongside the Department of Health and Human Services as well.

“It is also vital that Americans struggling with addiction have access to treatment and that patients who need pain treatment do not see their care disrupted, which is why federal and local public health authorities have coordinated to ensure these needs are met in the wake of this enforcement operation," HHS Secretary Alex Azar said in a release.

"The Trump Administration’s law enforcement and public health leaders will continue to work hand in hand to end this crisis that has hit Appalachia hard and steals far too many lives across America every day," Azar continued.

According to NIH's National Institute on Drug Abuse, Ohio and West Virginia rank at the top of opioid overdoses in the country.

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yaoinlove/iStock(EDMONTON, Alberta) -- The next time you think about passing your preschooler a smartphone or tablet at the dinner table to keep them entertained, you might want to think twice.

A new study out of the University of Alberta has found that by the age of 5, children who spent two hours or more looking at a screen each day were 7.7 times more likely to meet the criteria for a diagnosis of attention deficit hyperactivity disorder (ADHD) when compared to children who spent 30 minutes or less each day on a screen.

“Children should develop a healthy relationship with screens as young as 3 to 5 years of age,” Dr. Piush Mandhane, lead researcher of the study and an associate professor of pediatrics at the University of Alberta in Edmonton, Canada, told ABC News. “Our data suggests that between zero and 30 minutes per day is the optimal amount of screen time.”

The American Academy of Pediatrics currently recommends limiting screen use to a maximum of one hour a day of high-quality programming for preschool children ages 2 to 5, and encourages parents to watch with their children and guide them through the experience.

As an investigator on the nationwide Canadian CHILD study, Mandhane has been following children from mid-pregnancy into childhood and adolescence. With screen time on the rise among children, Mandhane said it came as no surprise when parents began asking, “How much is too much for our children?”

The current study was conducted by gathering information from parents about their children’s screen time during their 3- and 5-year follow-ups. The research team also collected comprehensive behavioral assessments at the 5-year visit.

The researchers found that children with reported screen time in excess of two hours a day were more likely to exhibit behavioral problems by the time they turned 5, particularly poorer attention. Conversely, children who spent two hours or more each week participating in a form of structured physical activity were less likely to experience mental health issues.

Although the study could not establish a clear cause-and-effect relationship between the two, it suggests that a child’s preschool years may be a vital time for providing proper guidance on screen time limits.

Mandhane said that next, his team plans to take a closer look at how the content on children’s screens as well as the time of day in which they use devices influences their behavior.

Mandhane also suggested three tips for promoting healthy behaviors in preschoolers:

Take advantage of built-in apps to monitor screen time exposure.

Mandhane pointed out that parents can either turn off the device themselves or set the device to automatically turn off when kids have reached their daily limit.

Set a regular bedtime.

It’s best to avoid screens at least one hour before bed, Mandhane said.

“More screen time equals less sleep time,” he said. “A bedtime that is structured will go a long way.”

Encourage organized physical activity.


Enrolling children in a baseball, soccer or hockey league, or even gymnastics, provides a structured form of physical activity outside of school that helps promote an active lifestyle, Mandhane said, adding that it might also improve their focus and allow them to get better, longer sleep.

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