Culture

Evidence of the sustained benefits of an investigational antipsychotic treatment for people with dementia-related psychosis has been published.

Up to half of the 45 million people worldwide who are living with Alzheimer's disease will experience psychotic episodes, a figure that is even higher in some other forms of dementia. Psychosis is linked to a faster deterioration in dementia.

Despite this, there is no approved safe and effective treatment for these particularly distressing symptoms. In people with dementia, widely-used antipsychotics lead to sedation, falls and increased risk of deaths.

Pimavanserin works by blocking serotonin 5HT2A receptors, and doesn't interact with the dopamine receptors. It is licensed in the US to treat hallucinations and delusions in people with Parkinson's disease psychosis.

A new paper published in the New England Journal of Medicine outlines a clinical trial, conducted in 392 people with psychosis associated with Alzheimer's disease, Parkinson's disease, Lewy body, frontotemporal, or vascular dementia. All participants were given pimavanserin for 12 weeks. Those who met a threshold of symptom improvement were then assigned to pimavanserin or placebo for up to 26 weeks.

The trial was stopped early for positive efficacy results. Of the 351 participants, 217 (61.8%) had a sustained initial treatment benefit, of whom 112 were assigned to placebo and 105 to pimavanserin. Relapse occurred in 28/99 (28.3%) of the placebo group, compared to 12/95 (12.6%) of the pimvanserin group, with pimvanserin more than halving the relapse rate and significantly improving the sustained benefit.

Professor Clive Ballard, Executive Dean of the University of Exeter Medical School, said: "Psychosis affects up to half of all people with dementia, and it's a particularly distressing symptom - yet there's currently no safe and effective treatment. Currently used antipsychotics are known to cause harms, and best practice guidelines recommend prescribing for no longer than 12 weeks for people with dementia as a result. We urgently need alternatives. It's exciting that the relapse rate in the pimavanserin group was lower than the placebo group, indicating that the treatment benefits may be sustained over time. We now need longer and larger scale trials to explore this further."

The trial found headache, urinary tract infection and constipation occurred more frequently in the pimavanserin group, but there was no increase in mortality or the other serious events, such as stroke, which are known to increase with other antipsychotics.

Every day, people are exposed to a variety of synthetic chemicals through the products they use or the food they eat. For many of these chemicals, the health effects are unknown. Now a new study shows that several hundred common chemicals, including pesticides, ingredients in consumer products, food additives, and drinking water contaminants, could increase the risk of breast cancer by causing cells in breast tissue to produce more of the hormones estrogen or progesterone.

"The connection between estrogen and progesterone and breast cancer is well established," says co-author Ruthann Rudel, a toxicologist and research director at Silent Spring Institute. "So, we should be extremely cautious about chemicals in products that increase levels of these hormones in the body."

For instance, in 2002, when the Women's Health Initiative study found combination hormone replacement therapy to be associated with an increased risk of breast cancer, women stopped taking the drugs and incidence rates went down. "Not surprisingly, one of the most common therapies for treating breast cancer is a class of drugs called aromatase inhibitors that lower levels of estrogen in the body, depriving breast cancer cells of the hormones they need to grow," adds Rudel.

To identify these chemical risk factors, Rudel and Silent Spring scientist Bethsaida Cardona combed through data on more than 2000 chemicals generated by the U.S. Environmental Protection Agency (EPA)'s ToxCast program. The goal of ToxCast is to improve the ability of scientists to predict whether a chemical will be harmful or not. The program uses automated chemical screening technologies to expose living cells to chemicals and then examine the different biological changes they cause.

Reporting in the journal Environmental Health Perspectives, Rudel and Cardona identified 296 chemicals that were found to increase estradiol (a form of estrogen) or progesterone in cells in the laboratory. Seventy-one chemicals were found to increase levels of both hormones. The chemicals included ingredients in personal care products such as hair dye, chemical flame retardants in building materials and furnishings, and a number of pesticides.

The researchers don't yet know how these chemicals are causing cells to produce more hormones. It could be the chemicals are acting as aromatase activators, for instance, which would lead to higher levels of estrogen, says Cardona. "What we do know is that women are exposed to multiple chemicals from multiple sources on a daily basis, and that these exposures add up."

The Silent Spring researchers hope this study will be a wakeup call for regulators and manufacturers in how they test chemicals for safety. For instance, current safety tests in animals fail to look at changes in hormone levels in the animal's mammary glands in response to a chemical exposure. And, although high throughput testing in cells has been used to identify chemicals that activate the estrogen receptor, mimicking estrogen, the testing has not been used to identify chemicals that increase estrogen or progesterone synthesis.

"This study shows that a number of chemicals currently in use have the ability to manipulate hormones known to adversely affect breast cancer risk," says Dr. Sue Fenton, associate editor for the study and an expert in mammary gland development at the National Institute of Environmental Health Sciences. "Especially concerning is the number of chemicals that alter progesterone, the potential bad actor in hormone replacement therapy. Chemicals that elevate progesterone levels in the breast should be minimized."

The researchers outlined a number of recommendations in their study for improving chemical safety testing to help identify potential breast carcinogens before they end up in products, and suggest finding ways to reduce people's exposures, particularly during critical periods of development, such as during puberty or pregnancy when the breast undergoes important changes.

The project is part of Silent Spring Institute's Safer Chemicals Program which is developing new cost-effective ways of screening chemicals for their effects on the breast. Knowledge generated by this effort will help government agencies regulate chemicals more effectively and assist companies in developing safer products.

New research published in the European Journal of Clinical Investigation identifies cardiovascular test results that might help to identify patients hospitalized with COVID-19 who face an especially high risk of dying.

Out of 1,401 patients with a confirmed diagnosis of COVID-19 admitted to seven Italian centers, 226 (16.1%) underwent transthoracic echocardiography within 48 hours of admission. In-hospital death occurred in 68 patients (30.1%). Low left ventricular ejection fraction, low tricuspid annular plane systolic excursion, and acute respiratory distress syndrome were independently associated with in-hospital mortality.

"Clinical and echocardiographic parameters of disease severity might help to determine which patients with COVID-19 are at higher risk for in-hospital mortality," said lead author Angelo Silverio, MD, of the University of Salerno, in Italy.

The COVID-19 pandemic has strongly impacted our sleep and dream activity. In a recent study published in the Journal of Sleep Research, people had a higher number of awakenings, a harder time falling asleep, higher dream recall, and more lucid dreams during lockdown than after lockdown.

People also reported more dreams related to "being in crowded places" during post-lockdown than lockdown.

For the study, 90 adults in Italy recorded their dream experiences and completed a sleep-dream diary each morning.

"Our results... confirmed that both sleep and dream measures showed critical differences between lockdown and post-lockdown periods," the authors wrote.

New research published in the Journal of Bone and Mineral Research has found that cognitive decline is linked with accelerated bone loss and an increased fracture risk in women.

In the study of 1,741 women and 620 men aged ?65 years without dementia who were followed from 1997 through 2013, both genders experienced similar declines in cognitive function and bone mass.

After adjustments, cognitive decline was associated with bone loss in women but not men. Also, significant and clinical important cognitive decline in women was associated with a 1.7-fold higher risk of bone fractures over the subsequent 10 years.

Notably, the relationship between bone loss and cognitive decline was bidirectional with no evidence of one preceding the other. The relationship between cognitive decline, bone loss, and fracture risk in women may be driven by shared risk factors.

"These findings may help refine clinical practices guidelines regarding how bone loss and cognitive decline can be monitored in older age, to ensure appropriate and effective treatment," said lead author Dana Bliuc, PhD, MD, of the Garvan Institute of Medical Research, in Australia. "This is particularly important because both bone loss and cognitive decline are 'silent conditions' that can go undetected for long periods of time, often until the conditions have severely progressed."

When researchers evaluated consumers' understanding of allergy information on food labels, less than half of individuals found the information to be clear.

The study, which is published in Clinical & Experimental Allergy, involved two separate experiments with a total of 96 consumers with food allergies and 105 without. Investigators first randomly presented 18 different food products with labels suggesting peanut was, may be, or was not an ingredient, and then they presented three different formats of information: 'Produced in a Factory' and 'May contain' or 'Traces of'. Precautionary allergen labels (PALs) were especially problematic, with consumers attributing anything between 2% and 99% risk of a reaction and anything between 1% and 98% comprehensibility assessments. This suggests that precautionary statements such as 'may contain peanut' have little value for consumers and may lead to inappropriate dietary restrictions or risk-taking behavior.

"Also, many consumers interpret 'Produced in a factory' to reflect a weaker warning than 'May contain,'" said lead author Bregje Holleman, PhD, of Utrecht University, in The Netherlands. "From a communication perspective, it's logical for consumers to attribute different risk levels to warnings worded differently. But since producers probably mean to communicate the exact same level of risk with each of these different warnings, we advise to use only PAL wording."

A systematic review and meta-analysis published in Campbell Systematic Reviews identified and examined more than 100 risk and protective factors for radical attitudes, intentions, and behaviors (including terrorism) in democratic countries.

The factors can be grouped into five domains:

socio-demographic and background factors,

psychological and personality trait factors,

attitudinal and subjective belief related factors,

experiential factors, and

traditional criminogenic factors

While there is great variation, the most significant factors are traditional criminogenic and social-psychological factors.

"Our results suggest that some of the factors most commonly targeted by counter violent extremism interventions, such as social integration, have only small relationships with radicalization. On the other hand, traditional criminogenic factors, such as low self-control, have far more robust relationships," said lead author Michael Wolfowicz, PhD, of The Hebrew University of Jerusalem. He noted that the findings suggest that interventions commonly used to combat criminological outcomes may also be useful for fighting radicalization.

"Additionally, our results suggest a need to revamp the way that risk assessment tools are constructed, as not all factors included in such tools should be given the same weight," said Dr. Wolfowicz. "We hope that our results will contribute to the development of more evidence-based practice in this field."

Researchers led by the Garvan Institute of Medical Research have discovered a link between cognitive decline and a faster rate of bone loss, and found that cognitive decline over five years increased future fracture risk in women. The association between cognitive decline and bone loss was weaker in men.

The study of individuals aged 65 and older was carried out over 16 years and has revealed a potential new approach to help identify older people who may be at risk of fracture.

"Bone loss and cognitive decline are major public health issues, but both are 'silent diseases' that can go undetected and untreated for long periods, often until the conditions are severely progressed," says Professor Jacqueline Center, Head of the Clinical Studies and Epidemiology lab at Garvan, endocrinologist at St Vincent's Hospital and senior author of the findings published in the Journal of Bone and Mineral Research.

"Our study has revealed a link between the two in women, which suggests that cognition should be monitored together with bone health, as a decline in one could mean a decline in the other. These findings may help refine best practice guidelines of how cognition and bone health are monitored in older age, to ensure appropriate treatment can be more effectively administered."

New insights on major public health issues

Around the world, 200 million people are affected by osteoporosis and more than 35 million by dementia - numbers which are expected to double over the next two decades due to a global increase in life expectancy.

"Cognitive decline and bone loss both result in increased disability, loss of independence and an increased risk of mortality. There is some evidence that older individuals with dementia have a higher risk of hip fractures, but whether the decline of both bone and cognitive health are linked over time has not been studied," says Dr Dana Bliuc from the Garvan Institute, who is first author of the paper.

"We set out to understand the long-term association, with our study the first to investigate both cognitive and bone health data over more than 15 years."

The team used data from the Canadian Multicentre Osteoporosis Study (CaMos), which documented skeletal health in people living in the community since 1995. The researchers looked at cognitive and bone health measurements of 1741 women and 620 men aged 65 years and older, who had no symptoms of cognitive decline at the beginning of the study.

Linking cognition and bone health

"After adjusting for all other variables, we observed a significant link between a decline in cognitive health and bone loss in women. This association was weaker and not statistically significant in men," says Dr Bliuc.

"Interestingly, we also saw that cognitive decline over the first five years was associated with a 1.7-fold increase in future fracture risk in women in the subsequent 10 years. This was independent of the level of bone loss," adds Dr Bliuc.

"While this study could not identify a causal link - whether a decline in cognitive function leads to a decline in bone loss, or vice versa - it suggests that cognitive decline should be monitored along with bone health, as a decline in one may signal the need for increased vigilance in the other," says Professor Center.

The researchers add that the link could potentially be mediated by a third factor, such as estrogen deficiency, which affects women after menopause and has been independently associated with both bone loss and cognitive decline. This research also opens the door for additional studies into what the link between these two common conditions may be.

"What our study highlights is that cognitive health is potentially an important factor for providing more information to individuals and their health professionals on fracture risk, and ultimately improve health outcomes for our older population," says Professor Center.

WASHINGTON (July 21, 2021) - Twenty-nine percent of Americans are taking more supplements today than they were before the COVID-19 pandemic, bringing the percentage of U.S. supplement-takers to 76%, according to a new survey conducted by The Harris Poll on behalf of Samueli Foundation. Nearly two-thirds of those who increased supplement use (65%) cited a desire to enhance their overall immunity (57%) or protection from COVID-19 (36%) as reasons for the increase. Other common reasons for increasing supplement use were to take their health into their own hands (42%), improve their sleep (41%), and improve their mental health (34%).

"The COVID-19 pandemic is a catalyst for increased supplement use," said Wayne Jonas, MD, executive director of Integrative Health Programs at Samueli Foundation. "Supplements--when used under the guidance of health care professionals--can be beneficial for one's health. Unfortunately, however, many people are unaware of the risks and safety issues associated with their use."

More than half of Americans taking supplements (52%) mistakenly believe that most dietary supplements available for purchase have been declared safe and effective by the Food and Drug Administration, according to the June 2021 online survey of more than 2,000 U.S. adults. Nearly one-third of supplement-takers (32%) believe that if a supplement could be dangerous, it would not be allowed to be sold in the U.S.

"Contrary to what many believe, the FDA does not regulate supplements. In fact, many supplements are not identified as dangerous until after people are negatively affected by them," said Jonas. "There are benefits to one's health from supplements, but also risks, so I encourage anyone who is taking a supplement or thinking of taking one to discuss it with your health care provider first."

Fewer than half of Americans who use supplements (47%) say they consulted with their health care provider before use, despite national guidelines that strongly recommend doing so. Further, 46% of Americans currently taking prescription medications say they have not discussed with their health provider the potential interactions that supplements could have with their prescriptions. But the desire to speak to their physicians is there.

Four in five Americans said they would feel comfortable sharing which supplements they take with their health care provider (81%) and say it is important to tell their health care provider whether or not they are taking supplements (80%). They also identified various barriers to discussing supplements with their health care providers:

-41% of those currently taking supplements said that it hasn't occurred to them to discuss their supplement use with their health care provider, including half of those ages 18-34 (49%).

-35% of all Americans said they don't think their health care provider is interested in whether or not they are taking supplements.

-32% of Americans don't think their health care provider knows enough about supplements to advise them properly.

-26% of those currently taking supplements are worried that their health care provider will judge them based on the supplements they are taking.

"As more people begin taking supplements, we need to be sure that they have the information needed to make informed and healthy decisions," said Jonas. "My obligation, as a physician, is to help patients understand which supplements can play a safe and effective part of their overall health and well-being goals. The good news is that patients are willing to discuss this topic, but it is up to providers to ask."

Other findings from the survey showed further differences based on race and ethnicity:

-86% of White (non-Hispanic) Americans said they would be comfortable sharing which supplements they take with their health care provider, compared to only 67% of Hispanics and 75% of Blacks.

-Black (49%) and Hispanic (50%) supplement users were more likely than Whites (36%) to say that it hasn't occurred to them to discuss their supplement use with their health care provider.

-More than 1 in 3 Hispanic adults (35%) said they worry that their health care provider will judge them based on the supplements they take, and 46% said they don't think their health care provider is interested (compared to 31% of White (non-Hispanic) adults).

Oncotarget published "Genomic clustering analysis identifies molecular subtypes of thymic epithelial tumors independent of World Health Organization histologic type" which reported that genomic information from 102 evaluable TETs from The Cancer Genome Atlas dataset and from the IU-TAB-1 cell line underwent clustering analysis to identify molecular subtypes of TETs.

Six novel molecular subtypes of TETs from the TCGA were identified, and there was no association with WHO histologic subtype.

The IU-TAB-1 cell line clustered into the TH4 molecular subtype and in vitro testing of candidate therapeutics was performed.

Sensitivity to nelfinavir was due to the IU-TAB-1 cell line's gain-of function mutation in PIK3CA and amplification of genes observed from array comparative genomic hybridization, including AURKA, ERBB2, KIT, PDGFRA and PDGFB, that are known upregulate AKT, while resistance to everolimus was primarily driven by upregulation of downstream signaling of KIT, PDGFRA and PDGFB in the presence of mTORC1 inhibition.

The Oncotarget authors present a novel molecular classification of TETs independent of WHO histologic subtype, which may be used for preclinical validation studies of potential candidate therapeutics of interest for this rare disease.

Dr. Sukhmani K. Padda from The Stanford University School of Medicine/Stanford Cancer Institute said, "Thymic epithelial tumors (TETs) are rare tumors that represent a wide spectrum of disease from the indolent thymoma to the more aggressive thymic carcinoma."

Thymoma subtypes include A, AB, B1, B2, B3, and other rare categories; in addition, there are TET subtypes of thymic carcinoma and thymic neuroendocrine tumor.

There have been several molecular analyses performed on TETs, with the The Cancer Genome Atlas reporting on a comprehensive multi-omic analysis of 117 TETs.

Despite the advancement in molecular diagnostics, the molecular aberrations and molecular subtypes discovered from the TCGA have not yet affected therapeutic decisions.

These Oncotarget results may reflect the unselected patient population enrolled in these studies, including no selection for WHO histologic subtype or molecular aberrations.

The goals were to identify novel molecular subtypes of TETs and examine their association with WHO histologic subtypes, and to present a proof-of-concept approach of preclinical validation of candidate therapeutics in a molecularly classified cell line for potential further clinical investigation in this rare disease.

The Padda Research Team concluded in their Oncotarget Research Output that preclinical models for TETs are limited to a handful of cell lines and clinical trials are limited to single-arm phase II studies.

This computational analysis involves data available from tests used routinely in the clinical setting such as targeted next generation sequencing assays, including gene mutations, copy number variations, and chromosomal aberrations.

In this study, computational analysis of the TCGA dataset reveals an updated molecular classification of TETs and identifies 6 unique molecular subtypes; importantly, these subtypes are independent of WHO histologic subtypes.

Only the IU-TAB-1 cell line underwent clustering analysis and was used for preclinical testing of candidate therapeutics for one of the six identified molecular subtypes from the TCGA. Although the IU-TAB-1 cell line reflects the predominant histotype of type AB thymoma from the TCGA dataset and has been extensively characterized by both whole exome sequencing and aCGH, its inherent limitations include generation from an early stage tumor and representation of a histotype that portends a better prognosis and less metastatic potential.

Therefore, future work should involve further genomic characterization and clustering analyses of TETs, particularly from metastatic tumors, and generation of diverse TET cell lines to evaluate whether this proof-of-concept approach of preclinical candidate therapeutic testing in molecularly classified cell lines is promising for clinical translation in patients with this rare disease.

New research from Bocconi University in Milan highlights that, contrary to received wisdom, connections to organized crime harm a company's financial performance and increase by 25.5% its likelihood to go bust.

Using a novel dataset from AISI, the Italian Internal Intelligence and Security agency, Bocconi professors Antonio Marra, Donato Masciandaro, and Nicola Pecchiari in a paper co-authored with Pietro Bianchi (Florida International University) published online in The Accounting Review, identify 1,840 criminally connected firms headquartered in Italy's Lombardy region.

Lombardy, the Northern Italian region around Milan, is not one of the regions where organized crime traditionally emerged. However, it accounts for 25% of the Italian GDP and it has recently become a central target of organized crime's economic activities.

The authors identify directors and shareholders undergoing investigations for crimes attributable to criminal organizations (eg. mafia-type associations, false invoices, usury and smuggling) from 2006 - 2013. A firm with a director undergoing investigation is deemed connected from the time of the director's appointment.

With this data, they provide the first large-scale evidence of the effects of mafia connections on company performance and show that contrary to popular belief, such connections drain firm resources. As the authors noted in an interview, "if the unintentional effect of the literature on the Mafia entrepreneurship has been to create a sort of mystique around the concept of the criminal businessmen, our results are definitely against such a mystique."

Notably, they find that while connected firms may report higher sales and have lower labor costs, they exhibit 15.6% lower return on assets than unconnected firms. The authors attribute this surprisingly lower profitability to money laundering, where funds are moved in and out of cash-intensive businesses and among company headquarters in different jurisdictions, to make the funds' criminal origins harder to trace. This can be done through false invoices which inflate costs, thus lowering profitability.

They also find that connected firms have 8.4% higher levels of debt. The firms suspiciously used more bank loans at far lower interest rates despite being less profitable, indicating the presence of fictitious loans. And with 5.9% lower cash holdings, these firms face liquidity constraints due to their resource-draining criminal connections. Being connected also allows firms to sell their inventory faster through coercion, bribery, and converting their sales to cash. Quantitatively this implies a 4.02% shorter operating cycle (ie. firms convert current assets to cash and pay current liabilities faster). Strikingly, being connected increases the firm's probability of default - filing for bankruptcy, insolvency or liquidation - by 25.5%.

The authors validate their findings by using a 2011 amendment to Italy's Anti-Money Laundering regulation, which lowered the limit for cash-based transactions and improved auditing. Limitations on cash transactions and ability to use false invoices made connected firms more similar to their unconnected counterparts in terms of sale revenues and costs of goods sold, thus corroborating their findings on the negative effects of Mafia connections.

New University of Otago research has been examining how alpine-based hedgehogs hibernate from a different perspective - their backs.

Dr Nick Foster from the Department of Zoology has been involved with the Te Manahuna Aoraki project and has been attaching small transmitting 'backpacks' onto hedgehogs in the Mackenzie Basin's alpine zones. The mammals are considered pests in New Zealand for the damage they cause to native insects and wildlife throughout the country.

The goal of this study, which has just been published in the New Zealand Journal of Ecology, was to find out whether hedgehogs, which can be found up to 2000 metres in summer, travel to lower elevations when winter threatens.

"We thought that hedgehogs could be making short distance movements downhill, which would extend their foraging and breeding season and avoid the harsh winter conditions of the high alpine zone," Dr Foster says.

However instead of moving to lower and warmer areas, Foster found hedgehogs stayed put and hibernated in the colder areas in the elevated alpine areas, which are up to 1800 metres above sea level. Some of the females were found rearing young, too.

"They entered hibernation in the same areas they used in the summer, and while we only tracked a small sample of females, they all did the same thing," he says.

"This is pretty convincing evidence that hedgehogs aren't just visitors in these zones: they're residents."

While imagining a hedgehog with a backpack going on an adventure is a cute idea, Dr Foster says the mammals need to be seen as harmful to our environment.

"When we think of predators, we think of stoats, possums and rats. In dryland environments, hedgehogs and feral cats are among the worst."

At the centre of the research are the GPS transmitters that were fixed onto the back of the hedgehogs as they hibernated.

While a little prickly to handle and quite thin on the ground in the alpine zone, Foster says hedgehogs are very easy animals to work with.

"You can attach a transmitter directly to their spines. There is no collar, no contact with the skin, and there is no feeling in their spines, which are a similar material to our fingernails. Spines regrow after they are clipped and devices fall off as they naturally shed.

"Hedgehogs carry devices well, too. This is a species that piles on fat every year to hibernate, so their bodies can deal with fluctuations in weight."

Dr Foster says the devices had to be up to the task.

"It's very cold in that area, and there's a lot of wear and tear. However, once we got started it was pretty smooth going."

He says there are some important conclusions that can be drawn from this relatively simple study.

"Finding that hedgehogs persist in alpine zones means that if we want to remove hedgehogs from areas, we have to factor in populations living high in the mountains. Otherwise they'll be around forever and act as a source of reinvasion for lower areas."

On a positive note, once removed, it may be some time for hedgehog populations to spread up to these areas again.

"This is good news for our strategy of using mountain ranges to keep them out."

The future of Samoa's electricity system could go green, a University of Otago study has shown.

Pacific Island nations are particularly susceptible to climate change and face high costs and energy security issues from imported fossil fuels.

For these reasons many Pacific Island nations have developed ambitious 100 per cent renewable energy targets. However, they have not been subject to rigorous peer-reviewed studies to help develop these targets and pathways for achieving them in the same way as more developed countries.

To meet this need, Otago Energy Science and Technology Masters student Tupuivao Vaiaso mapped future scenarios for Samoa's electricity system by carefully balancing renewable supply and electricity demand.

The study, published in Renewable and Sustainable Energy Reviews, shows high proportions (above 90 per cent) of renewable generation coupled with battery or pumped hydro energy storage is technically feasible, and economically viable - it would cost far less than current electricity production.

A special combination of characteristics makes this possible: great solar resources with very little seasonal variation; little variation in demand due to constant seasonal conditions; and high electricity prices from the current use of diesel.

However, the results also show there is a significant trade-off between percentage of renewable supply and affordability. To counter this, Mr Vaiaso says targets should be set just below 100 per cent for it to be economically attractive and/or biomass options (like the recent biomass gasification plant) could potentially be considered for the last few percent.

Co-author Associate Professor Michael Jack, Director of the Energy Management programme in the Department of Physics, says the study shows an affordable pathway to achieve renewable energy targets which is important as cutting emissions must be achieved in a way that does not increase energy hardship.

"These results have important implications for energy policy directions for Samoa and are directly applicable to many other countries in the Pacific," he says.

He believes the study also suggests Pacific Island nations are an important option for the growing trend in international sustainable finance.

"The high price of electricity means that renewable options are much more economically attractive than many other countries. These are essentially low hanging fruit that provide multiple benefits and, I imagine, would be attractive to these funding bodies."

WASHINGTON - A peer-reviewed study by the Environmental Working Group recommends stringent health-based exposure standards for both children and adults for radiofrequency radiation emitted from wireless devices. EWG's children's guideline is the first of its kind and fills a gap left by federal regulators.

The study, published in the journal Environmental Health, relies on the methodology developed by the Environmental Protection Agency to assess human health risks arising from toxic chemical exposures. EWG scientists have applied the same methods to radiofrequency radiation from wireless devices, including cellphones and tablets.

EWG recommends the Federal Communications Commission, or FCC, adjust its woefully outdated health standards for wireless radiation, last revised a quarter-century ago, well before wireless devices became ubiquitous, heavily used appliances synonymous with modern life. The recommendation draws on data from a landmark 2018 study from the National Toxicology Program, or NTP, one of the largest long-term studies on the health effects of radiofrequency radiation exposure.

EWG's new guidelines, the first developed in the U.S. to focus on children's health, recommend that children's exposure overall be 200 to 400 lower than the whole-body exposure limit set by the FCC in 1996.

The EWG recommended limit for so-called whole-body Specific Absorption Rate, or SAR, for children is 0.2 to 0.4 milliwatts per kilogram, or mW/kg. For adults, EWG recommends a whole-body SAR limit of 2 to 4 mW/kg, which is 20 to 40 times lower than the federal limit.

The FCC has not set a separate standard for children. Its standards for radiofrequency radiation set a maximum SAR of 0.08 watts per kilogram, or W/kg, for whole-body exposure and an SAR for localized spatial peak - the highest exposure level for a specific part of the body, such as the brain - of 1.6 W/kg for the general population.

The NTP studies examined the health effects of 2G and 3G wireless radiation and found there is "clear evidence" of a link between exposure to radiofrequency radiation and heart tumors in laboratory animals. Similar results were reported by a team of Italian scientists from the Ramazzini Institute.

Cellphone radiation was classified a "possible carcinogen" in 2011 by the International Agency for Research on Cancer, part of the World Health Organization, a conclusion based on human epidemiological studies that found an increased risk of glioma, a malignant brain cancer, associated with cellphone use.

EWG scientists say that more research is needed on the health impacts of the latest generation of communication technologies, such as 5G. In the meantime, EWG's recommendation for strict, lower exposure limits for all radiofrequency sources, especially for children.

When the FCC established its radiofrequency radiation limits, following the passage of the 1996 Telecommunications Act, relatively few Americans, and likely no children, owned and used cellphones.

Much has changed since the federal limits were set, including technology and how these devices are used. A survey completed by the nonprofit Common Sense Media in March 2020, just before the start of the Covid-19 spread in the U.S., found that 46 percent of 2- to 4-year-olds, and 67 percent of 5- to 8-year-olds, had their own mobile devices, such as a tablet or smartphone.

With remote learning, a necessity during the Covid-19 pandemic, phones, tablets and other wireless devices became a part of life for young children, tweens and teens nationwide.

"The FCC must consider the latest scientific research, which shows that radiation from these devices can affect health, especially for children," said Uloma Uche, Ph.D., EWG environmental health science fellow and lead author of the study.

"It has been 25 years since the FCC set its limits for radiofrequency radiation. With multiple sources of radiofrequency radiation in the everyday environment, including Wi-Fi, wireless devices and cell towers, protecting children's health from wireless radiation exposures should be a priority for the FCC," she added.

"We have grave concerns over the outdated approach the federal government has relied on to study the health effects of cellphone radiation and set its current safety limit and advice for consumers," said EWG President Ken Cook. "Government guidelines are a quarter-century old and were established at a time when wireless devices were not a constant feature of the lives of nearly every American, including children."

Reviewing 5G and other aspects of wireless technology should be the focus of public health agencies, noted Cook. "It is long past time the federal government made exposure to 5G wireless devices safe. We strongly believe those exposures deserve far more investigation and scientific rigor than has been applied to date."

"The evidence shows that children absorb more radiofrequency radiation than adults, and the developing body of a child is more vulnerable to such effects," said Olga Naidenko, Ph.D., EWG's vice president for science investigations and co-author of the study.

"More research on the safety and sustainability of wireless technology is essential," added Naidenko. "Meanwhile, there are simple steps everyone can take to protect their health, such as keeping wireless devices farther from their bodies."

There are a number of easy, precautionary steps consumers can take until the government conducts the rigorous scientific assessment the issue deserves, which should have occurred years ago.

"Based on our review of the health risks and the inadequacy of current standards to protect children, while the science evolves, it is perfectly reasonable for parents to consider minimizing or eliminating radiofrequency radiation sources at home by relying more on wired internet access, and to urge schools to take comparable steps to reduce classroom and campus exposure," said Cook.

Other health-protective tips for consumers who want to reduce radiofrequency radiation from wireless devices include using a headset or speaker, texting instead of talking, and limiting the time children spend on smart phones.

Find all of EWG's tips to reduce exposure to wireless radiation here.

EWG's recommendation for limits for radiofrequency radiation exposure is its latest effort to advance the public dialogue about science-based standards that protect public health.

ROCHESTER, Minn. -- Mayo Clinic researchers have found that acute kidney injury associated with COVID-19 resembles sepsis-caused kidney injury, and the immune response triggered by the infection plays a pivotal role.

The findings, published in Mayo Clinic Proceedings, also suggest that mitochondrial dysfunction -- a loss of function in cellular energy production -- is commonly found in kidney injury related to COVID-19. More than one-third of hospitalized COVID-19 patients report acute kidney injury, and sudden kidney failure is a risk factor for in-hospital mortality, according to studies published last year.

"These findings suggest that COVID-19 can induce a robust immune response in patients that contributes to the kidney injury, and kidney-supportive treatments should be initiated early for these patients," says Mariam Alexander, M.D., a renal pathologist at Mayo Clinic and the study's lead author. "Our data point to mitochondrial injury as a potential target for therapies, some of which recently have been developed and tested in preclinical models."

Severe COVID-19 disease is known to be associated with a systemic inflammatory response, as well as inflammation in the heart and lungs. Little research is available about immune response in the kidneys, and molecular studies on the renal pathology of COVID-19 patients have been limited.

"To our knowledge, this is the first in-depth study investigating the molecular and cellular changes seen in COVID-19-related kidney injury," says Dr. Alexander.

The Mayo Clinic study evaluated the kidneys of 17 adults who died from COVID-19 and had an autopsy performed at Mayo between April 2020 and October 2020. Researchers described the pathological spectrum of the kidney injury related to COVID-19 and characterized its molecular profile, compared with sepsis-associated injury.

The morphological and molecular profile of severe COVID-19 renal injury resembles sepsis renal injury, including microvascular dysfunction, inflammation and metabolic reprogramming, the study finds.

"The acute kidney injury seen in COVID-19 is likely secondary to activation of the immune system, similar to what is observed in patients with sepsis," Dr. Alexander says. "COVID-19 kidneys are inflamed and show an increased rate of cell death and notably more mitochondrial injury, compared to kidneys with injury not related to COVID-19." Mitochondria are cell structures that generate much of the chemical energy needed for proper cell function.

Of COVID-19 patients admitted to hospital ICUs, 76% have acute kidney injury. Hospitalized COVID-19 patients with secondary acute kidney injury have a nearly 50% risk of death, compared with 8% among those without kidney injury, according to data published in the Journal of the American Society of Nephrology.

The 17 patients in the Mayo Clinic study had a median age of 78 years, and 15 were male. Most had been hospitalized more than five days before death, and 53% reported hypertension as a comorbidity. Other leading comorbidities included diabetes and cardiovascular disease.

"The complex integrated imaging and molecular tests used in this study pave the way to perform similar molecular analyses in different disease conditions to study immune-mediated renal injuries in both native and transplant settings," says Timucin Taner, M.D., Ph.D., a Mayo Clinic transplant surgeon, immunologist and senior author. "We currently have several projects using this approach, with the goal being to identify the underlying mechanisms of different diseases, so we can help physicians treat these conditions more effectively."