During my freshman year in high school, my science teacher assigned us to interview people in the community about how they use science in their careers. Although I don’t remember most of the people I spoke with, I can tell you that I spent meaningful time with a local community pharmacist who changed my life.
What I saw was a man who loved his career and truly cared for his patients. In an instant, I knew that I wanted to become a pharmacist, and I never wavered from that goal throughout high school.
Knowing what you want to be when you grow up at age 14 is unusual, but it is very liberating. I simply had to work backwards to figure out how to achieve my goal of becoming a pharmacist.
After high school, I chose to attend Ohio Northern University (ONU) because it had a unique pharmacy program. Rather than attending college for 2 years and then applying to the pharmacy program, ONU students were admitted to the College of Pharmacy from day one.
Although it was expensive, being in pharmacy school from day one and avoiding the risk of rejection made it worthwhile for me.
In college, I spent a lot of time in the library. Although the classwork was difficult, I did well with one exception: organic chemistry.
I did fail organic chemistry—a notorious “weed out” course—but I successfully retook the class over the summer and graduated on time with the rest of my classmates. Failing a course is a difficult stumbling block, but I stood strong and persevered.
Today, I’m thankful for the wonderful pharmacy profession for so many reasons.
First, I’m thankful that community pharmacists are the health care professionals most accessible to the public. If my local pharmacist wasn’t accessible to me, then I likely would have taken a different career path.
Second, I’m proud of the work we pharmacists do, the diversity of our career options, and the relationships we share with our patients and fellow health care providers.
Pharmacy is a profession that makes a real difference in people’s lives. It certainly has made all the difference in mine.
An old fellow came into the hospital truly on death's door due to an infected gallbladder. The surgeon who removed the gallbladder was adamant that his patients be up and walking in the hall the day after surgery, to help prevent blood clots forming in the leg veins. The nurses walked the patient in the hall as ordered, and after the third day the nurse told how he complained bitterly each time they did. The surgeon told them to keep walking him.
After a week, the patient was ready to go. His family came to pick him up and thanked the surgeon profusely for what he had done for their father. The surgeon was pleased and appreciated the thanks, but told them that it was really a simple operation and we had been lucky to get him in time. "But doctor, you don't understand," they said, "Dad hasn't walked in over a year!"
A man goes to the eye doctor. The receptionist asks him why he is there. The man complains, "I keep seeing spots in front of my eyes."
The receptionist asks, "Have you ever seen a doctor?" and the man replies, "No, just spots."
A veterinarian was feeling ill and went to see her doctor. The doctor asked her all the usual questions, about symptoms, how long had they been occurring, etc., when she interrupted him: "Hey look, I'm a vet -- I don't need to ask my patients these kind of questions: I can tell what's wrong just by looking. Why can't you?"
The doctor nodded, looked her up and down, wrote out a prescription, and handed it to her and said, "There you are. Of course, if that doesn't work, we'll have to have you put down."
A chemist walks into a pharmacy and asks the pharmacist, "Do you have any acetylsalicylic acid?"
"You mean aspirin?" asked the pharmacist.
"That's it, I can never remember that word."
A physicist, biologist and a chemist were going to the ocean for the first time.
The physicist saw the ocean and was fascinated by the waves. He said he wanted to do some research on the fluid dynamics of the waves and walked into the ocean. Obviously he was drowned and never returned.
The biologist said he wanted to do research on the flora and fauna inside the ocean and walked inside the ocean. He too, never returned.
The chemist waited for a long time and afterwards, wrote the observation, "The physicist and the biologist are soluble in ocean water".
Marshall University Joan C. Edwards School of Medicine
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IMAGE: Viewing outside the knee, the tibial passing sutures, InternalBrace passing sutures, and femoral passing sutures can all be seen docked. view more
Credit: Chad Lavender, M.D., Marshall University
HUNTINGTON, W.Va. - An innovative procedure that explores the use of amnion, bone marrow concentrate and suture tape in anterior cruciate ligament (ACL) reconstruction may result in earlier return to play protocols for athletes, suggests a new Marshall University study published in the May 6, 2019, edition of Arthroscopy Techniques, a companion to Arthroscopy: The Journal of Arthroscopic and Related Surgery.
The ACL is one of four major ligaments that stabilize the knee. An ACL tear is one of the most common types of knee injuries, most often occurring during high-demand sports such as soccer or football. Traditional ACL reconstruction requires a graft to replace the ligament. Small tunnels are drilled into the bone above and below the knee for screws to keep the graft in place. Small buttons may also be used along the bone's edge to secure the graft.
In the Arthroscopy Techniques article, Chad D. Lavender, M.D., lead author and assistant professor of orthopaedic surgery at the Marshall University Joan C. Edwards School of Medicine, and Charles Bishop, M.D., a fifth-year orthopaedic resident at Marshall's School of Medicine, outline a new process that fills, or "fertilizes," these tunnels with a mixture of amnion, bone marrow concentrate and suture tape to speed up recovery and stabilize the knee. Amnion is used due to its potential to decrease adhesions, possibly protect ACL grafts and increase vascularization by acting as a scaffold. Bone marrow concentrate containing the patient's mesenchymal stem cells combined with Allosync has the potential to increase the speed and quality of graft bone incorporation, especially when used in the setting of a soft-tissue allograft. Using suture tape augmentation with the reconstruction has been thought to increase the early strength of the reconstruction.
"There are early advantages to fertilized ACL reconstruction such as decreased pain, and when this is combined with biologics, we may be able to accelerate rehabilitation and return to play more than previously anticipated," Lavender said.
The study builds off Lavender's previous approach using bone marrow concentrate and a suture tape, as published in the November 19, 2018, edition of Arthroscopy Techniques.
To date, Lavender has successfully completed more than 30 procedures using some form of the fertilized ACL. Patients have reported the same results as the standard ACL reconstruction with shorter recovery times, significantly less pain and no known additional risks. Future research will determine whether using this technique could shorten the return to play for athletes and reduce the use of opioids post-surgery
Climate action urgently required to protect human health in Europe
New EASAC report 'The imperative of climate action to protect human health in Europe' highlights an alarming range of health risks due to climate change and the benefits of rapid phase out of fossil fuels
European Academies' Science Advisory Council, Leopoldina - Nationale Akademie der Wissenschaften
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EASAC is the voice of independent science advice, mobilising Europe's leading scientists from 27 national science academies to guide EU policy for the benefit of society. By considering a large body of independent studies on the effects of climate change on health, and on strategies to address the risks to health, EASAC has identified key messages and drawn important new conclusions. The evidence shows that climate change is adversely affecting human health and that health risks are projected to increase. Solutions are within reach and much can be done by acting on present knowledge, but this requires political will. With current trends in greenhouse gas emissions, a global average temperature increase of over 3°C above pre-industrial levels is projected by the end of the century. The increase will be higher over land than the oceans, exposing the world population to unprecedented rates of climate change and contributing to the burden of disease and premature mortality. Health risks will increase as climate change intensifies through a range of pathways including:
•Increased exposure to high temperatures and extreme events such as floods and droughts, air pollution and allergens;
•Weakening of food and nutrition security;
•Increased incidence and changing distribution of some infectious diseases (including mosquito-borne, food-borne and water-borne diseases);
•Growing risk of forced migration.
EASAC emphasises that the top priority is to stabilise climate and accelerate efforts to limit greenhouse gas emissions. The economic benefits of action to address the current and prospective health effects of climate change are likely to be substantial.
Working Group co-chair, Professor Sir Andy Haines (London School of Hygiene & Tropical Medicine), comments, "If urgent action is not taken to reduce emissions in order to keep temperatures below the 2°C (or less) limit enshrined in the Paris Climate Agreement, we face potentially irreversible changes that will have wide ranging impacts on many aspects of health. The scientific community has an important role in generating knowledge and countering misinformation. We hope that this comprehensive report will act as a wake-up call and draw attention to the need for action, particularly by pursuing policies to decarbonise the economy. The protection of health must have a higher profile in policies aimed at mitigating or adapting to the effects of climate change". Key messages addressed in the report include:
•Several hundred thousand premature deaths annually in the EU could be averted by a 'zero-carbon' economy through reduced air pollution
Pollution endangers planetary health, damages ecosystems and is intimately linked to global climate change. Fine particulate and ozone air pollution arise from many of the same sources as emissions of greenhouse gases and short-lived climate pollutants. For the EU overall, fossil-fuel-related emissions account for more than half of the excess mortality attributed to ambient (outdoor) air pollution. A recent estimate suggests that about 350,000 excess deaths annually in the EU can be attributed to ambient air pollution from burning fossil fuels and a total of about 500,000 from all human-related activities.
Understanding of the range of health effects of air pollution on the health of children and adults is growing. Seven million babies in Europe are living in areas where air pollution exceeds WHO recommended limits and such exposure may affect brain development and cognitive function. Action to reduce pollution through decarbonisation of the economy must be viewed as a priority to address both climate change and public health imperatives.
•Promotion of healthier, more sustainable diets with increased consumption of fruit, vegetables and legumes and reduced red meat intake will lower the burden of non-communicable diseases and reduce greenhouse gas emissions.
Promoting dietary change could have major health and environmental benefits, resulting in significant reductions of up to about 40% in greenhouse gas emissions from food systems as well as reducing water and land use demands. Such diets can also lead to major reductions on non-communicable disease burden through reduced risk of heart disease, stroke and other conditions.
If food and nutrition security declines because of climate change, the EU can probably still satisfy its requirements by importing food. But this will have increasing consequences for the rest of the world; for example, by importing fodder for livestock from arable land that has been created through deforestation. It is therefore vital to develop climate-smart food systems to ensure more resilient agricultural production and to promote food and nutrition security, for the benefit of human health.
•Climate action could avert a significant increase in the spread of infectious diseases
The spread of infectious diseases in Europe could increase through climate change. These diseases include those that are spread by vectors (particularly mosquitos) and food- and water-borne infections. There is also an increased risk to animal health across Europe from conditions such as Blue tongue virus.
Distribution of the mosquito species Aedes albopictus, known to be a vector for diseases such as dengue, is already expanding in Europe and may extend to much of Western Europe within the next decade.
Water-borne infections such as diarrhoea may increase following heavy rainfall and flooding and higher temperatures may be associated with increased antibiotic resistance for pathogens such as E. coli. In the case of Salmonella species, an increase in temperature will increase multiplication and spread in food and increase the risks of food poisoning. There could also be an increase in Norovirus infections related to heavy rainfall and flooding. Strengthening communicable disease surveillance and response systems should be a priority for improving adaptation to climate change.
•Providing evidence of the health benefits of action on climate change may be instrumental in achieving rapid reductions in greenhouse gas emissions
Although the EU is actively engaged in efforts to reduce greenhouse gas emissions and to identify suitable adaptation measures, the impacts of climate change on health have been relatively neglected in EU policy. Recognising the serious challenges that climate change poses to the global health gains made in recent decades is key to promoting public engagement.
Furthermore, the impact of climate change in other regions can have tangible consequences in Europe and the EU has responsibilities in addressing problems outside its area.
The EU must do more to ensure that health impact assessment is part of all proposed initiatives, and that climate and health policy is integrated with other policy priorities including coordinating strategies at EU and national level. It is also vital that the steps are taken to counter misinformation about the causes and consequences of climate change which threaten to undermine the political will to act.
A little formula in first days of life may not impact breastfeeding at 6 months
But it might alter moms' attitudes to longer-term feeding, UCSF-led study shows
University of California - San Francisco
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A study has lodged a new kink in the breastfeeding dilemma that adds to the angst of exhausted new parents: While most newborns lose weight in the first days of life, do you or don't you offer a little formula after breastfeeding if the weight loss is more than usual?
For years, the answer has been "no," as infant formula was seen as a deterrent to breastfeeding. The American Academy of Pediatrics recommends exclusive breastfeeding until 6 months of age, and continuing breastfeeding until 12 months while transitioning to solids. But according to the Centers of Disease Control and Prevention, just over one-third of infants in the United States are breastfeeding at 12 months.
The answer is no longer clear-cut, say researchers of the UCSF Benioff Children's Hospitals - led study, publishing in JAMA Pediatrics on June 3, 2019. It depends on breastfeeding duration goals and attitudes, and needs to be balanced against the risks that newborns face in the first days of life when their weight is dropping.
In the study, the researchers tracked the long-term feeding habits of 164 babies born at UCSF Benioff Children's Hospitals and Penn State Children's Hospital. The infants had been breastfed between 1-to-3 days old, and their weight loss had been in the 75th percentile or above for age. Half of the mothers added syringe-fed formula after each breastfeeding, which stopped when the mother's milk came in at two-to-five days after delivery. The other half had continued to breastfeed exclusively.
Marital Status, Breastfeeding Goals Are Factors in Weaning
The researchers found that at 6 months of age, the infants in the supplemented group were as likely to breastfeed as those who had exclusively breastfed. But by 12 months of age, that had changed. In the supplemented group, 21 of the 12-month-olds (30 percent) were still breastfeeding, versus 37 of the infants (48 percent) in the non-supplemented group. The disparity between the two groups was less marked when the researchers accounted for married status and longer breastfeeding duration goals, both of which are associated with longer-term breastfeeding.
"The results suggest that using early, limited formula may not have a negative impact on infants, but it may alter maternal attitudes toward breastfeeding," said first author Valerie Flaherman, MD, a pediatrician at UCSF Benioff Children's Hospitals and associate professor in the UCSF departments of pediatrics, and epidemiology and biostatistics.
While limited formula in the first days of life did not seem to change feeding habits among newborns that were exclusively breastfed, "it's possible that supplementation reduced commitment, by the mother or other family members, to avoid it later in infancy," she said.
An earlier study of the same 164 infants, also led by Flaherman, found that the supplemented newborns may have been at lower risk for hyperbilirubinemia, a condition that leads to jaundice and may be caused by inadequate nutrition. Of the five infants readmitted to the hospital by 1 month of age, four were in the non-supplemented group.
"Our study's results show that early, limited formula may have significant benefits as well as risks for subsequent breastfeeding duration," said Flaherman.
"Counseling that implies all formula is harmful would be inaccurate and may be detrimental to long-term breastfeeding success," she said. However, if formula is used in the first few days after birth to prevent hyperbilirubinemia or dehydration, "it should be discontinued as soon as possible, since ongoing use at 1 week of age indicates a mother is at high risk of early breastfeeding cessation."
Senior author Ian M. Paul, MD, of Penn State College of Medicine, emphasized that a "rigid, one-size-fits-all approach" was inappropriate. "Guidelines for care and standards set by hospital accreditation agencies should consider these data and how best to support babies and their mothers," he said.
IMAGE: Callitrichids, like these common marmosets, usually give birth to two infants. The father and the other group members help the female rear her young. view more
Credit: Judith Burkart
The bigger the brain in relation to body size, the more intelligent a living organism is. This means that mammalian species with large brains are smarter than small-brained mammals. However, developing a large brain comes at a price: An infant expends around two-thirds of its energy alone on supplying nourishment to its brain. That huge amount of energy must be continually available in the form of milk and, later on, through the intake of food. The females of many large-brained animal species cannot bear the energetic costs of rearing offspring on their own - they are reliant on additional help.
Fathers help dependably
Previously, it was generally assumed that it is immaterial whether it is the father or other members of the group who assist the mother in caring for offspring. However, evolutionary biologist Sandra Heldstab and her colleagues Karin Isler, Judith Burkart and Carel van Schaik from the University of Zurich's Department of Anthropology have now demonstrated for the first time that it very well does matter who helps the mother. Animal species with paternal care of offspring are particularly able to energetically afford bigger brains. Help from other group members is far less essential to the evolution of a large brain. In their study, the researchers compared brain sizes and the extent and frequency of paternal and alloparental care in around 480 mammalian species.
"Fathers help consistently and dependably with the rearing of offspring, whereas assistance from other group members, such as elder siblings for instance, is far less reliable," Sandra Heldstab explains. For example, in the case of wolves and African wild dogs - two mammal species with large brains -, elder siblings often help out less, and they look out for themselves first when food is scarce. Sometimes they even steal the prey that parents bring for the infants. The father, in contrast, actually steps up his willingness to help his young offspring when environmental conditions worsen.
Bigger brains or bigger litters
In the case of other species like meerkats and prairie voles, for instance, elder siblings often defect to a different group when they reach puberty and, unlike the father, are no longer available to help the mother. Moreover, the quality of the paternal help is usually superior to help provided by other group members, who are often young and inexperienced. "A female cannot energetically afford offspring with large brains unless she can rely on help, and such dependable help only comes from the father," Heldstab says.
If the assistance that the female receives for rearing her young is inconsistent, evolution takes an alternative path. In mammalian species that fit this bill - such as lions and red-ruffed lemurs for example -, mothers do not give birth to few offspring with large brains, but to many with small brains. If there is plenty of help in caring for the young, the entire litter survives. If the female receives little support, some of the young die. This is evolution's way of making certain that at least some of the young survive even in the event of scant help and ensuring that the female doesn't needlessly invest energy in an offspring with a large brain that will die in the absence of dependable helpers. The study demonstrates once more that only a stable and dependable supply of energy - procured through paternal help, for instance - enables a large brain to develop in the course of evolution.
Humans are the exception
Humans are unique in this respect: Paternal assistance in child rearing is very reliable, but so is childcare help from other relatives and non-relatives. This circumstance enabled humans to develop the largest brain relative to body size in the animal kingdom and nonetheless to considerably shorten the time span between births compared to that for our closest relatives, apes. "In the world of mammals, only help from fathers is dependable. We humans, though, fortunately can also count on help from others," Sandra Heldstab says.
Immunotherapy drug found safe in treating cancer patients with HIV
Researchers seek to break down HIV exclusions in cancer clinical trials
Fred Hutchinson Cancer Research Center
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IMAGE: Dr. Tom Uldrick of Fred Hutchinson Cancer Research Center led the study. view more
Credit: Robert Hood / Fred Hutch
SEATTLE -- June 2, 2019 --The results of a study led by physicians at Fred Hutchinson Cancer Research Center showed that patients living with HIV and one of a variety of potentially deadly cancers could be safely treated with the immunotherapy drug pembrolizumab, also known by its brand name, KEYTRUDA®.
During an ASCO presentation concurrent with release of a study in JAMA Oncology, Fred Hutch researcher and lead author Dr. Tom Uldrick said that in nearly all cases it was safe to use the drug in patients with cancer and HIV. The "adverse events profile," a measure of the safety of the drug in the study, was not substantially different from prior studies that excluded such patients. The results, study authors said, are likely applicable to five similar drugs that block receptors known as PD-1 or PD-L1 on the surface T cells.
"Our conclusion is that anti-PD-1 therapy is appropriate for cancer patients with well-controlled HIV, and that patients with HIV and cancer can be treated with the drug and should be included in future immunotherapy studies," Uldrick said.
The 30-patient trial studied only pembrolizumab, the anti-PD-1 therapy manufactured by Merck. Merck provided the study drug to the National Cancer Institute (NCI). The NCI sponsored the trial. HIV-positive patients with different cancers that might respond to the drug were included in the trial. Among the cancers treated were lung cancer; Kaposi sarcoma, or KS; non-Hodgkin lymphoma; liver cancer; anal cancer and advanced squamous cell skin cancer.
Fred Hutch immunotherapy researcher Dr. Mac Cheever is director of the NCI-funded Cancer Immunotherapy Trials Network, which carried out the trial, and he is senior author of the JAMA Oncology paper. The study was conducted at seven different cancer centers across the United States, including the HIV and AIDS Malignancy Branch of the National Cancer Institute, in Bethesda, Maryland.
Overall, the safety profile of pembrolizumab in people with HIV and cancer was similar to that noted in clinical trials in the general population. Although the primary purpose of the study was to evaluate safety, it also provided a snapshot of the anti-cancer activity of the drug on these patients. One patient with lung cancer had a complete response to treatment, and activity was also noted in important HIV-associated cancers, including non-Hodgkin lymphoma, Kaposi sarcoma and liver cancer.
An unexpected death on study from a rare KSHV-associated B-cell lymphoproliferation was noted in one patient and while the association with therapy is still unclear, it has led to recommendations to use substantial caution if anti-PD-1 therapy is considered in the setting of KSHV-associated multicentric Castleman disease. The researchers concluded that anti-PD-1 therapy may be considered for FDA approved indications in patients with HIV who are on antiretroviral therapy and have a CD4 count above a certain threshold (100 cells per microliter of blood). However, more research is needed as to its effectiveness in the setting of HIV infection.
The FDA, Friends of Cancer Research, and the American Society of Clinical Oncology have all recommended that HIV patients should be included in more clinical trials. The NCI has generally allowed patients with HIV to enroll on the immuno-oncology studies that it sponsors with PD-1 and PD-L1 inhibitors. However, this trial was one of only two trials sponsored by the NCI to focus exclusively on patients living with HIV, and it has been the first prospective trial to report its results.
"Exclusion of people with HIV in clinical trials is a longstanding problem that grew out of the poor outcomes of AIDS patients with cancer, before there were effective antiviral therapies for HIV," Uldrick said. In prior research, Uldrick surveyed 46 recent clinical trials that led to approval of cancer drugs, and found 30 contained explicit exclusions for patients with HIV, and nine others where an exclusion was implied.
This study was sponsored by the National Cancer Institute Cancer Therapy Evaluation Program (CTEP). Study drug was provided to the NCI by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., via a collaborative research and development agreement. It was supported by U.S. federal funds from the National Cancer Institute (NCI), National Institutes of Health (NIH), under Contract No.HHSN261200800001E , NIH Intramural Research Program Support ZIA BC011700 to Dr. Uldrick and ZIA BC010885 to Dr. Robert Yarchoan, and 1U01CA154967 to Dr. Cheever for the Cancer Immunotherapy Trials Network.
Dr. Uldrick reported the following disclosures: Merck & Co. during the conduct of the study, and Celgene and Roche outside the submitted work. In addition, Dr. Uldrick had a patent to the NCI and Celgene issued. Dr. Cheever reported the following disclosures: grants from NIH, NCI during the conduct of the study; as well as others from Merck, Horizon, Dendreon and Celldex outside the submitted work.
Using facial recognition technology to continuously monitor patient safety in the ICU
ESA (European Society of Anaesthesiology)
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A team of Japanese scientists has used facial recognition technology to develop an automated system that can predict when patients in the intensive care unit (ICU) are at high risk of unsafe behaviour such as accidentally removing their breathing tube, with moderate (75%) accuracy.
The new research, being presented at this year's Euroanaesthesia congress (the annual meeting of the European Society of Anaesthesiology) in Vienna, Austria (1-3 June), suggests that the automated risk detection tool has the potential as a continuous monitor of patient's safety and could remove some of the limitations associated with limited staff capacity that make it difficult to continuously observe critically-ill patients at the bedside.
"Using images we had taken of a patient's face and eyes we were able to train computer systems to recognise high-risk arm movement", says Dr Akane Sato from Yokohama City University Hospital, Japan who led the research.
"We were surprised about the high degree of accuracy that we achieved, which shows that this new technology has the potential to be a useful tool for improving patient safety, and is the first step for a smart ICU which is planned in our hospital."
Critically ill patients are routinely sedated in the ICU to prevent pain and anxiety, permit invasive procedures, and improve patient safety. Nevertheless, providing patients with an optimal level of sedation is challenging. Patients who are inadequately sedated are more likely to display high-risk behaviour such as accidentally removing invasive devices.
The study included 24 postoperative patients (average age 67 years) who were admitted to ICU in Yokohama City University Hospital between June and October 2018.
The proof-of-concept model was created using pictures taken by a camera mounted on the ceiling above patients' beds. Around 300 hours of data were analysed to find daytime images of patients facing the camera in a good body position that showed their face and eyes clearly.
In total, 99 images were subject to machine learning--an algorithm that can analyse specific images based on input data, in a process that resembles the way a human brain learns new information. Ultimately, the model was able to alert against high-risk behaviour, especially around the subject's face with high accuracy.
"Various situations can put patients at risk, so our next step is to include additional high-risk situations in our analysis, and to develop an alert function to warn healthcare professionals of risky behaviour. Our end goal is to combine various sensing data such as vital signs with our images to develop a fully automated risk prediction system", says Dr Sato.
The authors note several limitations including that more images of patients in different positions are needed to improve the generalisability of the tool in real life. They also note that monitoring of the patient's consciousness may improve the accuracy in distinguishing between high-risk behaviour and voluntary movement
IMAGE: Congenital six-fingered hand with additional muscles to move the extra finger which yield augmented manipulation abilities. The muscles controlling the additional finger (in green) are distinct from the thumb muscles... view more
Polydactyly is the extraordinary condition of someone being born with more than five fingers or toes. In a case study published in Nature Communications, researchers from the University of Freiburg, Imperial College London, the University Hospital of Lausanne, and EPFL have for the first time examined the motor skills and sensorimotor brain areas in people with polydactyly. The results show that an extra finger can significantly extend the manipulation abilities and skill. It enables people with six fingers to perform movements with one hand where people with only five fingers would need two hands. The augmented motor abilities observed in the polydactyly subjects are made possible by dedicated areas in the sensorimotor brain areas. These findings may serve as blueprint for the development of additional artificial limbs extending motor abilities.
The case study of the researchers from Freiburg, London and Lausanne investigates for the first time the movement abilities of people with six fingers per hand. In the case of the two examined subjects, an additional finger between thumb and forefinger is fully formed on each hand. "We wanted to know if the subjects have motor skills that go beyond people with five fingers and how the brain is able to control the additional degrees of freedom," explains Prof. Dr. Carsten Mehring from the University of Freiburg and the Bernstein Center Freiburg.
To find out the extent of their abilities, the researchers had the subjects perform several behavioural experiments, and their brain activity was monitored using functional magnetic resonance imaging (fMRI). The results show that the subjects' extra fingers are moved by own muscles. This allows the subjects to move their extra fingers as far as possible independently of all other fingers. "Our subjects can use their extra fingers independently, similar to an additional thumb, either alone or together with the other five fingers, which makes manipulation extraordinary versatile and skilful. For instance, in our experiments subjects can carry out a task with one hand, for which we normally need two hands," summarises Professor Mehring. "Despite the extra finger increasing the number of degrees of freedom that the brain has to control, we found no disadvantages relative to five-finger people. In a nutshell, it is amazing that the brain has enough capacity to do it without sacrificing elsewhere. That's exactly what our subjects do," says Prof. Dr. Etienne Burdet of Imperial College London.
To understand how the brain of polydactyly subjects controls the additional fingers, the scientist used high-resolution functional magnetic resonance imaging (fMRI). "We found dedicated neural resources that control the sixth finger, and the somatosensory and motor cortex are organized exactly to allow for the additional motor skills observed," comment Prof. Dr. Andrea Serino and Dr. Michael Akselrod, who carried out the neuroimaging studies at EPFL and Lausanne University Hospital.
The study of these polydactyly hands could advance the development of additional artificial limbs to expand people's motor skills. For example, an extra arm to help working alone in a narrow environment, or to enable a surgeon carrying out operations without an assistant. However, the scientists note, "The additional extremities have been trained in the subjects since birth. This does not necessarily mean that similar functionality can be achieved when artificial limbs are supplemented later in life. Yet, people with polydactyly provide a unique opportunity to analyse the neuronal control of extra limbs and the possibilities of sensorimotor skills."
Large national study tracks veterans' health, highlights areas of unmet needs
Brief survey allows identification of health disparities in veterans relative to the general population
Northwestern University
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•Novel data describes use of instrument that encourages vets to report on their health using a brief survey
•PROMIS self-reported outcomes matched physician diagnoses documented in medical records
•This tool may serve as a motivator for some veterans who are hesitant to seek medical care
•Findings provide fuller picture of national health, allow health professionals to see how everyone, including veterans, is doing
CHICAGO --- For the first time, a large national population of United States veterans used the same standardized tool that the general population uses for tracking health.
More than 3,000 veterans from across the country used the tool to self-report their health in the study led by a researcher from Northwestern Medicine and the U.S. Department of Veterans Affairs. Findings showed that veterans scored worse in several areas, including feeling more anxiety, depression, fatigue, sleep disturbance and pain compared to people in the general population.
These self-reported outcomes were valid because they matched physician diagnoses documented in medical records, the study found.
The study's scientists believe patient self-reporting will be a successful way to track the health of veterans, who may be hesitant to seek medical care.
The self-reporting tool - a survey called PROMIS-29 - is commonly used in the general population but not widely or systematically offered to veterans. The scientists mailed the survey to veterans for this study, which is the first to report PROMIS-29's use in a large national cohort of veterans.
"These are our nation's veterans. They served our country, and they deserve access to things made available to everyone," said lead author Sherri LaVela, a research associate professor of physical medicine and rehabilitation at Northwestern University Feinberg School of Medicine and a department of veterans affairs scientist. "The PROMIS instrument is being used more and more for health care, and we hope to see it integrated into veteran care as well."
The instrument used in the study may be a useful tool for health care providers to assess veteran patient's physical and mental health, as indicated by the positive associations between scores and clinical documentation which suggests clinical validity for targeted measures, LaVela said.
The study was published last week in the Journal of General Internal Medicine.
The VA serves more than 8.3 million veterans in the U.S. annually.
"Seeing how veterans fare relative to population norms is important because it gives us a fuller picture of their health and allows us a cursory glance at how they are doing in general," LaVela said. "Estimates like this are important because they provide normal ranges for health measures across cohorts.
"Veterans have enhanced options of seeking care outside the VA, which makes it crucial to have an accurate measurement of health status and symptoms among population-based samples. Being able to simply, yet effectively, collect these data will identify unmet needs in which to intervene."
Patients using PROMIS-29 answered a short series of questions about their health and quality of life. The survey is scored to indicate if they are experiencing disturbed sleep, anxiety, depression or pain, for instance. Given the responses, the patient and their health care team can follow up and schedule a doctor's appointment.
"If a veteran has poor scores, we want to get them in and take a look," LaVela said.
Veterans in the study also scored lower for physical function than civilians and lower for satisfaction with social role, such as being satisfied with their ability to work, do regular personal and household responsibilities, and perform daily routines.
Patient-reported data can be used to inform health care providers about symptoms, perceived state of health and are especially important to understand patient experiences among people with chronic diseases.
The ability to quickly and easily identify health disparities in veterans is important because it can prompt health care providers to intervene. For example, the study found that relative to general population norms, veterans reported worse scores for pain interference. The VA has been integrating innovative, patient-centric approaches ways into treatment options. Using pain as an example, the VA has a stepped-care pain management approach that can be used for intervention, and recently the VA implemented mindfulness types of interventions to help veterans with pain, post-traumatic stress disorder, and other conditions that may afflict veterans, LaVela said.
Former Marine Dustin Lange said seeing how a veteran's health stacks up against the general population can serve as much-needed motivation for a veteran to go see the doctor.
"A lot of times, veterans might be hesitant to go to the hospital or not get proper checkups," said Lange, a U.S. Veteran who spent eight years in the Marines and is now the associate director of the Chez Center for Wounded Veterans in Higher Education at University of Illinois, Urbana-Champaign.
Lange has taken the PROMIS-29 survey, though not for this study. His score indicated some disturbances in his sleep, which prompted him to schedule a doctor's appointment. His clinical checkup validated his PROMIS-29 results. Lange said he hopes PROMIS-29 becomes more widely available for veterans, because he thinks it could motivate veterans to see a doctor.
"As a vet, you're able to see, 'Am I having similar problems to the general population? Do I have higher sleep or pain problems?" Lange said. "Seeing that difference from the general population could prompt a vet to visit the VA and get help
Hormone produced during pregnancy repurposed to treat painful joint condition
Multiple injections of ligament-loosening relaxin restored range of motion in animal model of "frozen shoulder" syndrome
Beth Israel Deaconess Medical Center
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BOSTON - Beginning in the first trimester of pregnancy, the body begins to produce the hormone relaxin, which loosens the expectant mother's muscles, joints and ligaments to help her body accommodate a growing baby and prepare for birth. When Edward Rodriguez, MD, PhD, Chief of Orthopedic Trauma in the Department of Orthopedic Surgery at Beth Israel Deaconess Medical Center (BIMDC) observed that patients with a common and painful joint condition called arthrofibrosis experienced long-lasting relief during and after pregnancy, he reached out to his colleagues in the lab to confirm his suspicion that relaxin could explain the phenomenon.
In a first-of-its-kind study, Rodriguez collaborated with Ara Nazarian, PhD, a principal investigator in the Center for Advanced Orthopaedic Studies at BIDMC, and Mark Grinstaff, PhD, Professor of Chemistry at Boston University, to investigate whether relaxin's joint-loosening properties could be applied to alleviate symptoms of arthrofibrosis. The team found that multiple injections of human relaxin directly into the afflicted joint restored range of motion and improved tissue health in an animal model of frozen shoulder, a painful and debilitating form of arthrofibrosis particularly common among middle aged, often diabetic women. The findings are published in the journal Proceedings of the National Academies of Sciences.
"Current treatment options for arthrofibrosis, such as physical therapy and medication provide only marginal or temporary relief and do not address the source of the pain and stiffness," said Nazarian, who is also Associate Professor of Orthopaedic Surgery at Harvard Medical School. "While more research is needed, repurposing this pregnancy hormone as a treatment for arthrofibrosis could provide an unprecedented opportunity."
Most common in the shoulders, knees, hips, wrists and ankles, arthrofibrosis affects more than five percent of the general population. Characterized by pain accompanied by a reduction in range of motion, arthrofibrosis is caused by an excessive build-up of scar tissue in the joint, triggered by injury, trauma, long-term immobility, or surgery. Up to a third of patients who have undergone ACL reconstruction surgery can end up with arthrofibrosis.
In the new study, using human cells in vitro, Nazarian and colleagues showed that a specific version of the hormone, human relaxin-2, inhibits cells' production of scar tissue and by indirectly downregulating production of collagen - the strong protein that supports joints and other tissues throughout the body, but is overproduced in scarring. Next they showed in an animal model of frozen shoulder that multiple injections to the joint resulted in significant and lasting improvements in range of motion, while a single injection to the joint, or systemic treatment did not. Similarly, when the scientists looked at the joint tissues, the animals that received multiple injections of relaxin to the joint appeared to undergo changes indicating restorative healing.
More studies will be necessary before investigating relaxin's efficacy for treatment of arthrofibrosis in humans, but the team is optimistic that the naturally-occurring and well-tolerated hormone could offer relief for millions of people.
"Arthrofibrosis is a widespread disease, occurring in all joints, and its high incidence, limited treatment options and poor patient outcomes call for alternative and effective non-surgical solutions," said Rodriguez, who is also an Associate Professor of Orthopaedic Surgery at Harvard Medical School. "The local delivery of relaxin-2 offers a potential paradigm shift in the treatment for the millions of individuals who are affected by arthrofibrosis every year."
Trap-and-release accelerates study of swimming ciliated cells
Researchers use ultrasound to streamline measurement of movement
Washington University in St. Louis
Researchers at Washington University in St. Louis have been studying cilia for years to determine how their dysfunction leads to infertility and other conditions associated with cilia-related diseases. Now, they will be able to perform these studies more rapidly through a new method that uses sound waves to momentarily trap cells propelled by cilia, then releases them to measure their movement as they swim away.
An interdisciplinary team led by J. Mark Meacham, assistant professor of mechanical engineering & materials science in the McKelvey School of Engineering, and students in his lab used an acoustic microfluidic approach that uses ultrasonic standing waves within a small fluid-filled chamber to collect groups of the single-cell green algae cells Chlamydomonas reinhardtii, a model organism for studying human cilia. The so-called acoustic trap takes advantage of material properties of the cell bodies to hold them in place without damaging them. By first collecting the cells, the team can efficiently analyze hundreds of cells in minutes. Results were published in and featured on the inside back cover of the journal Soft Matter in the June 12, 2019, print edition.
"Think of it as a tiny cage made by the ultrasound field," Meacham said. "The cells are trying to find a way to escape but are pushed back by the waves that make up the cage walls. When the walls are removed, they are free to run."
Cilia are tiny hair-like structures in cells that line our lungs, nose, brain and reproductive systems. They are designed to sweep out fluids and microbes to keep people healthy. When they malfunction, infertility, chronic middle-ear infections, water on the brain and other conditions can develop.
Susan Dutcher, professor of genetics and of cell biology and physiology at the School of Medicine and a co-author on the paper, works with C. reinhardtii and hundreds of its genetic variants, or mutants, to study ciliary behavior and dysfunction. Analyzing so many variants using current methods, which manually trace individual cells, would take a very long time, Meacham said.
"It is useful for Dr. Dutcher to rapidly classify her cells based on swimming effectiveness and to choose those that are of most interest for the more laborious and tedious, detailed analysis," Meacham said. "That's what this type of population-based method really helps with, allowing us to analyze a large number of given mutants in a short time."
For this work, the team used three genetic variants of C. reinhardtii cells from Dutcher's lab as models.
Meacham and a doctoral student, Minji Kim, first author on the paper, developed the microfluidic chip, which is small enough that two of them fit on a 1- by 3-inch glass slide. Cells entered and exited through inlet and outlet channels connected to a circular chamber at the center of the device -- which is like a large, open holding pen for the cells -- before the ultrasound is turned on. Kim and Meacham inserted fluid containing the cells into the device, then activated the ultrasound via a piezoelectric transducer. The ultrasonic waves reflect off of the chamber walls to create pressure wells within the circular chamber, which trap the cells into a group at the chamber's center.
After imaging the cells, the researchers turn off the ultrasound, effectively opening the cage door and allowing the cells to swim off.
"This acoustic trap allows us to do this interesting type of analysis that we couldn't do any other way," Meacham said. "We can trap and release a cell population, analyze it, load up the next population, trap, release, analyze, and load up the next one in a matter of tens of seconds to a minute per sample to get a graded measure of swimming capability for the different cell types."
Analysis of spreading cells is easily automated because swimming starts from a single location, Meacham said. Cells appear as black pixels in successive images of the released cells. The change in shape of the cells is then related to swimming speed.
"We observe them swimming for one to three seconds, then once we have those images, the process of analyzing them is automated," Kim said. "We can get the motility measurement from about 50 cells in an automated way considerably faster than by having to track individual cells."
Ultimately, the team seeks to provide researchers with a tool that categorizes cells based on their movement capability, whether for cataloging C. reinhardtii mutants or for assessing sperm cell motility, Meacham said
Bạn có biết thói quen ăn 3 bữa một ngày tiềm ẩn nhiều nguy cơ gây hại tới sức khỏe, hăy điều chỉnh ngay một cách khoa học nhất!
Ăn uống cần khoa học để đảm bảo sức khỏe
Theo nhà nghiên cứu lịch sử Abigail Carroll, những bữa ăn ngày nay xuất phát từ ảnh hưởng cấu trúc văn hóa của người di cư châu Âu tác động đến người Mỹ bản địa.
Thói quen ăn ba bữa một ngày bắt nguồn từ sự áp đặt của người di cư Châu Âu khi họ đến Mỹ định cư.
Những người bản địa Mỹ thường ăn bất cứ khi nào họ đói chứ không phải lúc đồng hồ chỉ giờ sáng, trưa hay tối.
Sau cuộc cách mạng công nghiệp, con người bắt đầu biến bữa giữa ngày thành bữa trưa chính và bữa sau giờ làm thành bữa tối, rồi dành chỗ cho bữa ăn sau giấc ngủ vào buổi sáng.
Trong cuốn sách mới của ḿnh tên là "Three Squares: The Invention of the American Meal", bà Carroll nói rằng người châu Âu định cư trên đất Mỹ ăn vào những giờ quy củ.
Họ xem điều này là văn minh hơn người bản địa - những người ăn uống theo ư thích, dùng thực phẩm theo mùa và thi thoảng c̣n nhịn đói.
Đến nay chưa có bằng chứng nào cho thấy việc ăn uống đúng giờ, đủ bữa đảm bảo cho sức khỏe.
Chẳng hạn, theo bà Carroll, bữa sáng được coi là bữa ăn quan trọng trong ngày có thể là hệ quả từ các chiến dịch quảng cáo của các công ty ngũ cốc và nước trái cây.
Hăy ăn uống một cách khoa học nhất để đảm bảo sức khỏe.
Chúng ta nên ăn mỗi ngày bao nhiêu bữa ăn?
Nếu như một số người phụ nữ đang t́m kiếm biện pháp giảm cân , dựa trên chiều cao/ trọng lượng, mức độ hoạt động hiện tại và di truyền học, nó có thể là lượng calo của bạn sẽ cần phải có khoảng 1200 - 2000 calo mỗi ngày.
Để t́m cách xây dựng cơ bắp dựa trên chiều cao/ trọng lượng, mức độ hoạt động hiện tại và di truyền học, th́ có thể lượng calo của bạn sẽ cần phải được giữa 3000 - 4000 calo mỗi ngày.
Đừng quên bổ sung sữa protein vào một trong các bữa ăn trong ngày của ḿnh.
Thực tế, một nghiên cứu năm 2014 do Đại học Bath (Anh) cho thấy, một người dù ăn sáng hay không cũng chẳng ảnh hưởng đến tổng lượng calo họ tiêu thụ trong ngày.
Những người ăn sáng nạp nhiều calo hơn người bỏ bữa nhưng lại loại bỏ lượng calo thừa vào cuối ngày, nghĩa là tổng lượng tiêu thụ calo như nhau.
Nghiên cứu mới cho thấy bỏ bữa và nhịn đói có thể thực sự có lợi cho sức khỏe, giúp giảm cân và củng cố hệ thống miễn dịch.
Nghiên cứu tương tự của Đại học Alabama (Anh) cho thấy ăn sáng hay không chẳng tạo sự khác biệt nào đến người ăn kiêng đang cố gắng giảm cân.
Nghiên cứu mới cho thấy, việc nhịn ăn có thể thực sự tốt cho sức khỏe.
Phe ủng hộ chế độ ăn theo tỷ lệ 5:2, tức giới hạn thực phẩm chỉ 500 calo vào hai ngày trong một tuần, nói rằng việc hạn chế thức ăn này giúp giảm cân, tăng tuổi thọ và làm huyết áp thấp hơn.
Một nghiên cứu cho thấy nhịn đói hai ngày hay hơn nữa có thể giúp khởi động lại hệ thống miễn dịch, đặc biệt nếu nó đă bị hư hỏng do tuổi tác hay điều trị ung thư.
WVU study: Diabetics exposed to common household chemicals have lower heart disease rates
MORGANTOWN, W.Va.--Chemicals found in nonstick cookware, cleaning products and paint may help lead to new treatments for heart disease in diabetic adults, according to a West Virginia University epidemiologist's research.
Kim Innes, of the WVU School of Public Health, and her colleagues recently discovered that greater exposure to perfluoroalkyl substances was associated with lower rates of existing coronary heart disease in adults with diabetes. PFAS, considered a public health threat by the Centers for Disease Control and Prevention, are manufactured chemicals that were popularized by various industries in the 1940s because of their ability to repel oil and water.
In this study, researchers investigated the association of blood PFAS levels to coronary heart disease using data gathered as part of the C8 Health Project. A large, community-based study launched in 2005, the C8 Health Project was created to address the potential health effects stemming from contamination of West Virginia and Ohio drinking water with the PFAS perfluorooctanoic acid (also called C8) between 1950 and 2004.
Of the 5,270 adults with diabetes in this study--led by Baqiyyah Conway, University of Texas Health Science Center at Tyler--1,489 had been diagnosed with coronary heart disease previously, and 3,781 had not. The researchers investigated the relation between blood levels of four PFAS and coronary heart disease, considering the participants' age, sex, race, BMI, smoking history, duration of diabetes, kidney function, chronic kidney disease and other traits.
"In this cross-sectional study of adults with diabetes, the likelihood of reporting a diagnosis of coronary heart disease declined with increasing blood levels of four PFAS after adjustment for demographics, BMI and other factors," Innes said.
The four PFAS were also inversely related to the likelihood of coronary heart disease in adults without diabetes, but these associations were far less pronounced than in people with the condition.
It remains unknown exactly how PFAS might lower heart disease risk, but as Innes pointed out, "several factors could explain the inverse association." For example, PFAS may reduce inflammation. It's also possible that PFAS increases the body's sensitivity to insulin or ability to transport oxygen. All of these effects might promote heart health.
Because the study used data collected at a single point in time--rather than multiple times, over several years--it could not determine whether exposure to PFAS caused heart disease rates to drop. It could only establish an association between PFAS exposure and lower heart disease rates. But the research team is planning studies to fill this knowledge gap.
"The next step will be to conduct additional longitudinal studies in the C8 and other cohorts in order to assess the relation of baseline PFAS blood levels to subsequent risk for incident coronary heart disease in those with and without diabetes," Innes said. "Such research will help determine if the inverse association observed in this study might reflect a causal association between PFAS and the development of coronary heart disease."
If longitudinal studies bear out the current findings, they may inform new therapies for preventing coronary heart disease in people with diabetes.
"The findings of this paper in no way suggest that PFAS should be released into drinking water or the environment," Innes said. "With few exceptions, you wouldn't want any substance--including those with certain established health benefits, such as coffee and aspirin--contaminating the water. It is important to remember that PFAS are complex compounds that may have both positive and negative effects on health."
Diễn Đàn Người Việt Hải Ngoại. Tự do ngôn luận, an toàn và uy tín. V́ một tương lai tươi đẹp cho các thế hệ Việt Nam hăy ghé thăm chúng tôi, hăy tâm sự với chúng tôi mỗi ngày, mỗi giờ và mỗi giây phút có thể. VietBF.Com Xin cám ơn các bạn, chúc tất cả các bạn vui vẻ và gặp nhiều may mắn.
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