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What’s the best diet for weight loss?
  + stars: | 2024-04-06 | by ( Andrea Kane | ) edition.cnn.com   time to read: +7 min
We delve into a wide range of topics, including the truth about menopausal weight gain and new weight loss drugs. (CNN) — With dieting, the conventional wisdom says a person needs to be in calorie-deficit mode to lose weight. If you eat more calories than you burn, you gain weight; if you eat fewer calories, you lose weight. — some people will lose weight, and others will gain. Show yourself some compassionAcknowledge it’s not easy to change eating habits to lose weight.
Persons: Sanjay Gupta, ” Christopher Gardner, Farquhar, Gardner, ” Gardner, , you’re, , , Don’t, it’s, Jameela Jamil Organizations: CNN, Stanford University, Stanford Prevention Research, JAMA, Netflix, American Heart Association, American College of Cardiology, Obesity Society
The study, published Saturday in the New England Journal of Medicine, showed how the drug helped people with Type 2 diabetes who also had one of the most common kind of heart failure, obesity-related heart failure with preserved ejection fraction. Obesity-related heart failure with preserved ejection fraction can severely limit a person’s ability to participate in the activities of daily life. Often, people with type 2 diabetes who have this kind of heart failure have a more severe form than those who don’t have diabetes. People with a more severe form of heart failure sometimes don’t respond as well to medication as those with less severe disease. One death in the Wegovy group and four in the placebo group were related to cardiovascular issues.
Persons: Wegovy, Ozempic, Dr, Mikhail Kosiborod, , ” Kosiborod, Naveed Sattar, ” Sattar, Sanjay Gupta, Kosiborod, Organizations: CNN, New England, of Medicine, Novo Nordisk –, US Food and Drug Administration, FDA, St, University of Glasgow, Science Media, CNN Health, American College of Cardiology Locations: Asia, Europe, North, South America, Kansas City , Missouri, Atlanta
CNN —A six-week ban on abortion set to take effect in Florida next month will severely limit abortion access in a state that is one of the country’s most populous and one that has become a key access point amid widespread restrictions in the region. In South Carolina, there was a 70% decrease in abortions just one month after the state enforced a six-week limit. Florida will join Georgia and South Carolina with a six-week ban. “This six-week ban leaves an even narrower window for people to access care, and I think it’s going to be too late for so many. “We plan to remain open and continue to provide abortion care as long as we can,” she said.
Persons: Court’s Dobbs, Roe, Wade, , , Amber Gavin, “ It’s, don’t, Bill, Isaac Maddow, Virginia –, Amy Hagstrom Miller, ” Hagstrom Miller, Qudsiyyah Shariyf, haven’t, ” Shariyf, “ We’re, Gavin, she’s, Dr, Sanjay Gupta, ” Gavin Organizations: CNN, Guttmacher Institute, Florida Supreme, ., Health, Chicago Abortion Fund, CNN Health Locations: Florida, North Carolina, Texas, South Carolina, Illinois , Kansas, Virginia, Georgia, Delaware, Maryland, Tennessee, ” Illinois, Chicago
Now, a report from the American Cancer Society projects that by 2050, the number of people with cancer could rise 77%. Overall, the top 10 cancer types in both men and women accounted for more than 60% of newly diagnosed cancer cases and cancer deaths, according to the report. Lung cancer was also the leading cause of cancer deaths, followed by colorectal, liver, breast in women, stomach, pancreatic, esophagus, prostate, cervical and leukemia. “While we do see lung cancers that are not related to smoking, the number one cause of lung cancer is smoking. “Interestingly, pollution and other airborne environmental exposures probably increase the risk of lung cancer in many parts of the world.
Persons: , William Dahut, ” Dahut, “ We’re, Lung, Ahmedin Jemal, Dr, Bilal Siddiqui, there’s, Harold Burstein, ” Burstein, , Sanjay Gupta, Burstein Organizations: CNN, American Cancer Society, Cancer, Global Cancer, Health, University of Texas, Anderson Cancer Center, Dana, Farber Cancer Institute, Harvard Medical School, CNN Health Locations: Saharan Africa, South America, Asia, China
CNN —Rick Slayman, the world’s first living recipient of a genetically edited pig kidney transplant, was discharged from the hospital Wednesday, two weeks after his operation, Massachusetts General Hospital said in a statement. “He is recovering well and will continue to recuperate at home with his family,” the hospital said on X, formerly Twitter. Rick Slayman in his hospital room at Massachusetts General Hospital before his discharge on Wednesday April 3, 2024. Michelle Rose/Massachusetts General HospitalHis surgery is the third such xenotransplant of a pig organ into a living human. The first two transplants were hearts transplanted into living patients that had run out of other transplant options.
Persons: Rick Slayman, Slayman, I’ve, , Michelle Rose, Dr, Sanjay Gupta, ” Slayman Organizations: CNN, Massachusetts General Hospital, Massachusetts Department of Transportation, CNN Health, Procurement, Transplantation Network Locations: Massachusetts, U.S
Rising temperatures are also allowing plants to bloom earlier and longer, prolonging pollen seasons. Increased rainfall means plants release more pollen when they bloom, and higher numbers of thunderstorms cause pollen grains to burst, making them more irritating and worsening symptoms. Shifting wind patterns in some parts of the world are carrying pollen over longer distances, too. Experts think more exposure to pollen equals more chances to be sensitized, which equals more allergies. So someone in Illinois, for example, might be seeing bigger changes in pollen than somebody in Texas – although Texas gets blasted with pollen, too.
Persons: you’re, , Mary Margaret Johnson, Lewis Ziska, Joseph Inglefield III, he’s, , There’s, Ziska, Inglefield, Leonard Bielory, Dr, Sanjay Gupta, inhaler, that’s, ” Inglefield Organizations: CNN, Harvard, of Public Health, Mailman School of Public Health, Columbia University, Hickory Allergy, Asthma, Hackensack Meridian School of Medicine, CNN Health Locations: Chan, South Korea, Hickory , North Carolina, Illinois, Texas –, Texas, New Jersey
Less than 20% of adults who do not identify as LGBT say they have experienced any of these same interactions. Consequences resulting from these negative health care experiences are also more than twice as common among LGBT adults. About a quarter of LGBT adults say they’ve had a recent health care experience that caused their health to get worse, compared with less than 10% of other adults, the survey found. LGBT adults are consistently more likely than non-LGBT adults to experience discrimination in their daily lives at least a few times a year across demographics. But among LGBT adults, negative experiences are more likely among those who are younger, women and have lower income.
Persons: they’ve, ” Drew Altman, KFF, Dr, Sanjay Gupta, Organizations: CNN, Health, CNN Health Locations: KFF, U.S, United States
CNN —About 1 in every 10 people in the US who uses Adderall or similar combination drugs to treat attention-deficit/hyperactivity disorder (ADHD) has been affected by an ongoing shortage, a new analysis suggests. The US Food and Drug Administration announced that Adderall was in shortage in mid-October 2022, and the share of people with ADHD who filled their prescriptions for Adderall and related medications plunged in the following months. Patients were considered eligible for a monthly prescription fill if they had filled one within the previous two years. Prescriptions for medications used to treat ADHD surged during the Covid-19 pandemic, especially among young adults and women, one study found. But it’s been about a year and a half since she’s been able to fill her Adderall prescription in a “totally uneventful” way, she said.
Persons: Adderall, Robert Califf, Anne Milgram, David Goodman, , Mary Beth King, it’s, she’s, ” King, King, ” Goodman, John Mitchell, ” Mitchell, they’re, ’ ”, , , Dr, Sanjay Gupta, hasn’t Organizations: CNN, US Food and Drug Administration, Drug, of Psychiatry, Behavioral Sciences, Johns Hopkins School of Medicine, American Professional Society, New, Psychiatric Institute, Columbia University Irving Medical Center, Duke University School of Medicine, Get CNN, CNN Health Locations: Sweden
CNN —The US Food and Drug Administration is allowing the use of Rejoyn, the first prescription digital treatment for major depressive disorder. About 18% of American adults – more than 1 in 6 – say they are depressed or receiving treatment for depression, a 2023 Gallup report found. Rejoyn is designed to serve as an adjunct to antidepressants for these partial responders, according to the news release. They were assigned to use either the Rejoyn app or a sham app that gave memory tasks that did not involve cognitive-emotional training or cognitive behavioral therapy. There is also the question of how engaged patients will be with the app, Torous said.
Persons: Rejoyn, Dr, John Kraus, Otsuka, Brian Iacoviello, John Torous, Torous, , ” Otsuka, Sanjay Gupta, , ” Torous Organizations: CNN, Food and Drug Administration, Otsuka Pharmaceutical, Therapeutics, Gallup, Research, Click Therapeutics, Digital Psychiatry, Beth Israel Deaconess Medical, FDA, ” Otsuka Pharmaceutical, CNN Health
Dr. Mikhail Varshavski is known as Dr. Mike on social media. “Zoom out of just thinking about, ‘What I can take or what I can eat?’ and understand that there’s a lot of other things that impact your weight,” Dr. Mike said. “(Make) sure that you get help when it comes to mental health issues and concerns,” Dr. Mike said. For example, Dr. Mike said he recently had a guest on his podcast who tried to equate a chocolate kiss to a grape. While you may compare them based on their sugar content, that’s one way to categorize them,” Dr. Mike said.
Persons: Sanjay Gupta, what’s, Mikhail Varshavski, Mike, , Ponce de León, we’re, ” Dr, Dr, , ” “, edu ”, , That’s, “ It’s, You’re, Skip, you’re, Jennifer Lai Organizations: CNN, Facebook, YouTube, TED, Inc, US Centers for Disease Control, Harvard Medical Locations: Chatham , New Jersey, Ponce, “ .
CNN —Puerto Rico has declared a public health emergency due to a surging number of dengue cases. Puerto Rico Secretary of Heath Carlos Mellado said the health department has registered 549 cases of dengue so far this year, far exceeding historical numbers. Health officials in Puerto Rico are urging people to use insect repellent and eliminate possible mosquito breeding sites by preventing water from accumulating. Get CNN Health's weekly newsletter Sign up here to get The Results Are In with Dr. Sanjay Gupta every Tuesday from the CNN Health team. “There are indeed efforts from the health department and other organizations like the Puerto Rico vector control unit to control dengue in the area.”Climate change will also encourage the spread of dengue around the world, Paz-Bailey said.
Persons: Heath Carlos Mellado, ” Mellado, Dr, Sanjay Gupta, Gabriela Paz, Bailey, ” Paz, , Jamie Gumbrecht Organizations: CNN — Puerto, World Health Organization —, Virgin Islands, US Centers for Disease Control, Prevention, Health, Get CNN, CNN Health, Vector, CNN, Paz Locations: CNN — Puerto Rico, Puerto Rico, Virgin, American Samoa, United States, Florida
CNN —Health officials are alerting doctors to be on the lookout for certain types of rare, serious meningococcal infections that are on the rise in the United States. Typically, meningitis infections strike babies or adolescents and young adults. The CDC’s alert comes after the Virginia Department of Health warned about five deaths from the same rare, serious form of meningococcal disease in September. The infection can lead to both meningitis and a serious infection of the bloodstream called septicemia, or blood poisoning. Typical symptoms of meningitis infections include fever, headache, a stiff neck, an aversion to light and nausea.
Persons: Neisseria meningitidis, Dr, Sanjay Gupta, It’s Organizations: CNN — Health, US Centers for Disease Control, Prevention, Virginia Department of Health, CDC, United States —, CNN, CNN Health Locations: United States
CNN —American gamer and Twitch superstar Tyler “Ninja” Blevins revealed he was diagnosed with melanoma, a form of skin cancer. Skin cancer is the most common form of cancer in the United States; 1 in 5 Americans will develop skin cancer in their lifetime, according to the American Academy of Dermatology. Blevins was diagnosed with melanoma, which is a rare type of skin cancer — only about 1% of skin cancer cases — but accounts for a large majority of skin cancer deaths. However, if people do have suspicious skin spots or any other symptoms concerning for skin cancer, they should talk to their primary care doctor or dermatologist. How to perform a skin self-examAn important part of screening for skin cancer is to document moles and other skin spots and to notice changes, the association says.
Persons: Tyler “, ” Blevins, “ I’m, , Blevins, biopsied, , Jessica Blevins, Dr, Sanjay Gupta Organizations: CNN, PSA, World Health Organization, American Academy of Dermatology, US Centers for Disease Control, American Cancer Society, US Preventive Services, Force, CNN Health Locations: American, United States
If the Supreme Court agrees with the appeals court, the approval of mifepristone could be reset to where it stood before 2016, limiting telehealth access to medication abortion and reimplementing other restrictions. “Nevertheless, drug developers invest in new medicines because, if their investments succeed, FDA’s rigorous drug approvals and subsequent regulatory actions are sturdy enough to facilitate reliable returns. “And without necessary investment, drug development would freeze, stifling innovation and limiting treatment options for patients.”Of course, if the Supreme Court upholds the appeals court decision, the most immediate impact would be to mifepristone itself. “It is both my hope and my ‘bet’ that the court doesn’t uphold the 5th Circuit on the standing argument,” Cohen wrote. “But I have learned the Supreme Court is hard to predict much of the time.”
Persons: thalidomide, mifepristone that’s, , Daniel Grossman, ” Grossman, ” PhRMA, Glenn Cohen, Dr, Sanjay Gupta, Cohen, ” Cohen Organizations: CNN, Food and Drug, Federal Food, FDA, US, University of California San, Reproductive, Guttmacher Institute, Circuit, Appeals, Pharmaceutical Research, Manufacturers of America, Harvard Law School, CNN Health Locations: Massengill, University of California San Francisco, Texas
These proteins cause the walls of a person’s blood vessels to keep growing and thicken over time. As the blood vessels narrow, the heart is forced to work harder to pump blood to the lungs. Treatment with a combination of drugs that dilate, or relax, blood vessels can improve this outlook, but they are not a cure. Both groups were also taking the standard medications for the condition, which help relax blood vessels to improve blood flow. But Galiatsatos said that as promising as the drug looks, there are still many unknowns, including whether the drug will benefit all PAH patients equally.
Persons: Katrina Barry, Barry, , , Winrevair, Merck Winrevair, Vallerie McLaughlin, Panagis, Galiatsatos, isn’t, ” Barry, I’m, fanny, She’s, sotatercept, PAH, Sotatercept, “ There’s, Kristin Highland, Highland, ” Merck, Merck, Dr, Sanjay Gupta, Aaron Waxman, Barry’s, he’s, they’ve, Johnson –, Waxman, “ I’ve, “ It’s, who’ve Organizations: CNN, American Lung Association, US Food and Drug Administration, Merck, FDA, University of Michigan, PAH, Johns Hopkins Bayview Medical Center, New England, of Medicine, Cleveland Clinic, Institute, Clinical, CNN Health, Brigham, Women’s Hospital, Johnson Locations: PAH, American, Greece, Boston
Some current and former CIA officers have raised concerns that a CIA task force in charge of investigating Havana syndrome soft-pedaled its investigation, CNN has previously reported. The control group was small and not perfectly matched to those with Havana syndrome. In the second study, researchers tested hearing, balance, eyesight and neuropsychological state, and they looked at blood biomarkers, in the two groups. Headache was a common concern among the participants with Havana syndrome. The study concluded that whatever caused Havana syndrome seems to create symptoms “without persistent or detectable physiologic changes.
Persons: David Relman, don’t, ” Relman, , AHIs, Relman, Trump, , Dr, Sanjay Gupta, ” Dr, Leighton Chan Organizations: CNN, National Institutes of Health, Stanford, CIA, AHIs, CNN Health, NIH Locations: Havana, Cuban, Bogota, Colombia, Vienna, Austria
The latest trends also suggest that medication abortion is a more common option than ever. Medication abortion has become more common than ever post-Roe, according to another new Guttmacher report. Nearly two-thirds of all abortions in the US in 2023 – an estimated 642,700 – were medication abortions, the report says. Medication abortion, also known as medical abortion, is a method by which someone ends their pregnancy by taking two pills – mifepristone and misoprostol – rather than having a surgical procedure. Misoprostol can be used on its own for a medication abortion and is a safe alternative, but research suggests that using both pills together is the gold standard.
Persons: Court’s Dobbs, , misoprostol, Dr, Sanjay Gupta, CNN’s Jen Christensen, Tierney Sneed Organizations: CNN, Guttmacher Institute, Guttmacher, US Food and Drug Administration, CNN Health Locations: United States
After treatment with targeted deep brain stimulation, she hopes to walk out soon and, for the first time in her adult life, live independently, in her own apartment. Doctors used a tube that led into her stomach through her nose to give her food and gave her fluids intravenously. Deep brain stimulation for severe obsessive-compulsive disorder helped Julia Hum earn her high-school equivalency certificate last year. Refining deep brain stimulationHum had a deep brain stimulator implanted in 2021. Deep brain stimulation can be life-changing, but it doesn’t work equally well for everyone, and researchers say they’re getting closer to understanding why.
Persons: Julia Hum, Hum, , Doctors, it’s, ” Hum, Andreas Horn, “ I’ll, I’ll, Darin Dougherty, didn’t, they’re, ” Horn, Sameer Sheth, , Sheth, Dougherty, “ It’s, she’s, Dr, Sanjay Gupta, “ Hope Organizations: CNN, General Hospital, Doctors, Mass General Research Institute, Baylor College of Medicine, CNN Health Locations: Massachusetts, Houston
We delve into a wide range of topics, including the science behind new weight loss drugs, weight gain around menopause, and the evolutionary reasons behind why losing weight is so hard. Yeo truth No. 1: Losing weight ‘ain’t supposed to be easy’Losing weight goes against our self-preservation mechanisms. “I think we do have to fix our food environment; I think some people need to eat less food. But I think we need to love our food.”We hope these five tips help you think about food (and eating) in a more productive and less toxic way.
Persons: Sanjay Gupta, ” Giles Yeo, ” Yeo, Yeo, — Yeo, , , , Gene, it’s, “ Don’t, , Sanjay Gupta’s, Lindy West Organizations: CNN, American Medical Association, US Centers for Disease Control, University of Cambridge, Genetics, Obesity
KQED/KFF Health News —A much-awaited treatment for postpartum depression, zuranolone, hit the market in December, promising an accessible and fast-acting medication for a debilitating illness. Miriam McDonald, who developed severe postpartum depression and suicidal ideation after giving birth in late 2019, battled Kaiser Permanente for more than a year to find effective treatment. Her doctors refused to prescribe brexanolone, the only FDA-approved medication specifically for postpartum depression at the time. Insurers’ policies for zuranolone will be written at a time when the regulatory environment around mental health treatment is shifting. In the meantime, Burkhard said, patients suffering from postpartum depression should not hold back from asking their doctors about zuranolone.
Persons: , Meiram Bendat, , Joy Burkhard, KP’s, Kaiser, Miriam McDonald, ” McDonald, KP, Nico, Keith McDonald, brexanolone, “ Kaiser Permanente, ” “ Kaiser, Burkhard, “ It’s, Dr, Sanjay Gupta, ” Burkhard Organizations: KQED, KFF, brexanolone, FDA, zuranolone, OB, Center, Maternal Mental, Kaiser Permanente, NPR, Department of Labor, Maternal Mental Health, Medicaid, Cal, U.S . Department of Labor, CNN, CNN Health, KFF Health Locations: , “ Kaiser, California
CNN —Although morels are generally considered safe, the mushrooms were at the heart of a deadly illness outbreak in Montana last year. In the end, 51 people reported getting sick after eating there, and 45 of them reported eating the morels during March and April of last year. Most of the customers who got sick reported vomiting and serious/severe diarrhea. The CDC investigation determined that the morel mushrooms were cultivated and imported fresh from China. “A lot of mushrooms have various toxins that get broken down when they’re cooked, and that makes them safer.
Persons: , , Greg Mueller, they’re, Matthew Nelsen, morel, ” Mueller, Dr, Sanjay Gupta, “ It’s, Nelsen, “ There’s, ” Muller Organizations: CNN, US Centers for Disease Control, Chicago Botanic Garden, Field Museum, CDC, Investigators, CNN Health Locations: Montana, Chicago, Bozeman , Montana, China, California, morel, morels
CNN —Paul Alexander, who spent the vast majority of the past 70 years in an iron lung and defied expectations by becoming a lawyer and author, died Monday afternoon at the age of 78, according to his brother Philip Alexander. He was placed in an iron lung, a large metal cylinder that varies air pressure to stimulate breathing, according to his autobiography. Our neighbors would run over and help us pump it.”Paul spent the next seven decades in an iron lung. In March 2023, he was declared the longest surviving iron lung patient in the world by the Guinness World Records. He learned breathing techniques that allowed him to leave the iron lung for a few hours at a time.
Persons: Paul Alexander, Philip Alexander, Paul, ” Philip, Philip said, “ Paul, ” Christopher Ulmer, ” Doris Alexander, Paul’s, ” Paul, , , Dr, Sanjay Gupta, “ I’ve, I’m, Paul ” Organizations: CNN, US Centers for Disease Control, CDC, Guinness World Records, CNN Health Locations: United States
CNN —The Biden administration launched an initiative Wednesday that it describes as a nationwide call to increase training on and access to life-saving opioid overdose reversal medications, dubbed the Challenge to Save Lives from Overdose. Naloxone, sometimes sold under the brand name Narcan, is a medication that can rapidly reverse the effects of an opioid overdose. Although the number of overdose deaths in the US has held steady recently, the nation has many more than other high-income countries, research shows. Almost half of adults in the US say they personally know at least one person who died from a drug overdose, according to a survey released this year. Drug overdose deaths reached a significant high in 2022 with more than 109,000, according to provisional data from the CDC, and fentanyl had been a significant factor contributing to the rise.
Persons: CNN —, Neera Tanden, Biden, Tanden, naloxone, ” Tanden, ” Ryan, Brian Murray, Dr, Sanjay Gupta Organizations: CNN, Biden, US Food and Drug Administration, White, , Ryan Companies, American Library Association, Southwest Airlines, Los Angeles Unified School District, CNN Health, US Centers for Disease Control, CDC
Only 3% to 5% of people who are diagnosed with this type of brain tumor will be alive three years later. Now, an experimental therapy that reprograms a person’s own immune cells to attack these tumors is showing some exciting promise. Doctors first harvested immune fighters called T-cells from his blood and then genetically modified them in a lab so they’d recognize and bind to specific proteins on the surface of the brain tumor cells. After a single 10-milliliter infusion of about 10 million CAR-T cells, Fraser’s tumor began to shrink. Three-quarters of the participants had had their brain tumors come back at least twice.
Persons: , Otis Brawley, , they’ll, ” Brawley, Tom Fraser, Brigham, Debbie Fraser, Fraser, He’s, Marcela Maus, ” Fraser, Maus, , ” Maus, Christine Brown, ’ Brown, ” Brown, hasn’t, Brown, Dr, Donald O’Rourke, “ They’re, O’Rourke, ” O’Rourke, Sanjay Gupta, you’re, they’re, it’s Organizations: CNN, Johns Hopkins University, American Cancer Society, City of Hope Cancer Center, University of Pennsylvania, Massachusetts General, Mass, New England, of Medicine, Doctors, Mass General Cancer Center, Tv3, Cell Therapeutics Research, of, Nature, Penn, Excellence, University of Pennsylvania Perlman School of Medicine, CNN Health Locations: City, Duarte , California, Massachusetts, Rochester , New York, Boston, of Hope, Hope
The “X-Men: Apocalypse” star, 43, wrote in an Instagram post Wednesday that she was diagnosed with breast cancer last year and would not have discovered it if her physician, Dr. Thaïs Aliabadi, had not calculated her breast cancer risk score. A breast cancer risk assessment tool uses a statistical model to estimate a woman’s risk of developing breast cancer over the next five years as well as over her lifetime, or up to about age 90, according to the National Cancer Institute. Two models are commonly used as breast cancer risk assessment tools: the Gail Model and the Tyrer-Cuzick Risk Assessment Calculator. An online version of the breast cancer risk assessment tool, using the Gail Model, is available for anyone to take at bcrisktool.cancer.gov. In fact, some women who do not develop breast cancer have higher risk estimates than some women who do develop breast cancer,” according to the National Cancer Institute’s website.
Persons: Olivia Munn’s, Thaïs Aliabadi, Aliabadi, Munn, Gail, Jennifer Plichta, , ” Plichta, they’re, , Plichta, I’ve, they’ve, Otis Brawley, ” Brawley, Larry Norton, Evelyn H, ” Norton, Robert Smith, Ruth Oratz, NYU Langone Health’s, Dr, Sanjay Gupta, ” Oratz Organizations: CNN, National Cancer Institute, National Cancer, Duke Cancer Institute, Johns Hopkins University, Lauder Breast Center, Memorial Sloan Kettering Cancer Center, American Cancer Society, US Preventive Services Task Force, NYU, Cancer Center, NYU Grossman School of Medicine, CNN Health Locations: United States, Durham , North Carolina
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