Culture

HONOLULU, Feb. 6, 2019 -- Lowering blood pressure in the ambulance with a nitroglycerin patch for suspected stroke didn't lessen post-stroke disability, according to late breaking science presented at the American Stroke Association's International Stroke Conference 2019, a world premier meeting for researchers and clinicians dedicated to the science and treatment of cerebrovascular disease.

Two previous small trials suggested that transdermal (skin patch) delivery of nitroglycerin (also called glyceryl trinitrate), a nitric oxide donor that lowers blood pressure, might improve functional outcome and reduce death if given very soon after clot-caused stroke (ischemic stroke) or bleeding in the brain (intracerebral hemorrhage).

In a multicenter prospective randomized single-masked, blinded-endpoint trial called Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2), United Kingdom researchers investigated whether it is safe and effective for paramedics to administer nitroglycerin.

The study included 1,149 patients (average age 73, 52 percent male) with presumed stroke and systolic blood pressure above 120 mm Hg. They were randomized to receive either a nitroglycerin patch or a sham patch within four hours of symptom onset. More than half (57percent) had been diagnosed with high blood pressure, 24 percent had a previous stroke, while 20 percent had diabetes or atrial fibrillation. The primary outcome was a shift in disability measured at three months.

"However, nitroglycerin did not improve overall outcome," said Philip Bath, D.Sc., Stroke Association Professor of Stroke Medicine at University of Nottingham, Nottingham, United Kingdom. "In patients with a brain bleed, the patch appeared to worsen outcomes. So, treatment with nitroglycerin cannot be recommended very early after stroke."

The study was funded by the British Heart Foundation.

Note: Scientific presentation is 11:35 a.m. Hawaii Time/4:35 p.m. Eastern Time, Wednesday, Feb. 6, 2019.

Adults who notice that they frequently lose their train of thought or often become sidetracked may in fact be displaying earlier symptoms of cerebral small vessel disease, otherwise known as a "silent stroke," suggests a recent study.

Researchers uncovered that individuals with damage to the brain's white matter, caused by silent strokes, reported poor attentiveness and being distracted more frequently on day-to-day tasks, according to a recently published paper in the journal Neurobiology of Aging. Despite these complaints, about half of the people with identified white matter damage scored within the normal range on formal laboratory assessments of attention and executive function (a person's ability to plan, stay organized and maintain focus on overall goals).

"Our results indicate that in many cases of people who were at a higher risk of silent stroke and had one, they saw a notable difference in their ability to stay focused, even before symptoms became detectable through a neuropsychological test," says Ayan Dey, lead author on the paper and a graduate student at Baycrest's Rotman Research Institute (RRI) and the University of Toronto. "If a person feels this may be the case, concerns should be brought to a doctor, especially if the person has a health condition or lifestyle that puts them at a higher risk of stroke or heart disease."

Cerebral small vessel disease is one of the most common neurological disorders of aging. This type of stroke and changes in the brain's blood flow (vascular changes) are connected to the development of vascular dementia and a higher risk of Alzheimer's disease and other dementias.

The strokes are "silent" since they don't cause lasting major changes seen with an overt stroke, such as affecting a person's ability to speak or paralysis. Despite a lack of obvious symptoms, cerebral small vessel disease causes damage to the brain's white matter (responsible for communication among regions), which can cause memory and cognitive issues over time.

Typically, this type of stroke is uncovered incidentally through MRI scans or once the brain damage has worsened, says Dey.

"There are no effective treatments for Alzheimer's disease, but brain vascular changes can be prevented or reduced through smoking cessation, exercise, diet and stress management, as well as keeping one's blood pressure, diabetes and cholesterol under control," says Dr. Brian Levine, senior author on the paper, RRI senior scientist and professor of Psychology and Neurology at the University of Toronto. "With the right diagnosis, these interventions and lifestyle changes give older adults who are at risk for cognitive decline some options for maintaining brain health."

The study looked at results from 54 adults (between the ages of 55 to 80), who also possessed at least one risk factor for a stroke, such as high blood pressure, high cholesterol, diabetes, sleep apnea, a history of smoking, past mini strokes and advanced age above 75.

Research participants had their brains scanned by MRI and scientists analyzed brain tissue damage, specifically in relation to white matter, to determine injuries caused by cerebral small vessel disease. They also took part in a number of neurocognitive tests and questionnaires that assessed their attention and executive function.

Following up on this study, researchers will analyze functional brain imaging and electrical brain activity from participants to look at the differences in brain networks. They hope to uncover why some people are still able to perform well on cognitive assessments, despite damage to the brain.

"The question that remains is whether overcoming these changes in the brain is a natural ability some people have or if this is something that can be built up over time," says Dey. "If it's something that can be developed, is it something we can train?"

The world's four major tobacco companies - two of which have HQs in the UK - are paying minimal UK corporation tax despite enormous reported profits, according to findings from new research published in the Journal of Public Health.

The study, authored by researchers at the University of Bath, suggests that the UK needs far better reporting standards for corporation tax in order to hold tobacco companies to account in meeting the enormous public health costs caused by their deadly product.

They call for extension of the bank focused corporation tax surcharge to cover tobacco companies and also for mandated country by country reporting on tobacco sales and profits. The bank focused corporation tax surcharge currently adds an additional 8% tax on the profits of banks.

Previous work from the same authors shows that tobacco companies enjoy inordinate profits on their highly addictive product. Profits have increased over recent years despite declining sales because regular price increases on cigarettes have outpaced people's ability to give up smoking.

For the current study, which set out to identify profit earned and tax paid by the different tobacco companies operating in the UK, the team extracted profit and tax data from company annual financial statements covering 2009 to 2016.

Their work focused on the four big tobacco companies operating in the UK: Imperial Brands and British American Tobacco (BAT) (both headquartered in the UK); and the main UK subsidiaries of Philip Morris International (Philip Morris Limited) and Japan Tobacco International (Gallagher Ltd).

The findings reveal:

The reporting of Corporation Tax and company accounts in the UK is 'wholly inadequate':

-- From 2014, Imperial Brands were allowed to stop reporting UK-adjusted operating profits; BAT and PMI have never done so; and none of the four transnational tobacco companies (TTCs) reported profit before tax in the UK.

-- Companies have reorganised corporate structures to enable profits to be shifted overseas.

The major tobacco companies operating in the UK are not paying Corporation Tax at anything like the rate they should be:

-- In 2016, Imperial Brands, BAT, and Gallagher together made UK operating profits in excess of £1bn yet paid just £83.6m in corporation tax.

-- Over the last 7 years during which time Corporation Tax has varied between 20 - 28%, Imperial Tobacco paid, at most, an estimated effective rate of 13% and often much lower and BAT paid 'virtually no' corporation tax, including four consecutive years from 2011-14 where they paid nothing at all.

UK-based tobacco companies are paying significantly more in Corporation Tax overseas:

-- In 2016, Imperial Brands made £3.5bn in global adjusted operating profits, paying £467m in overseas profit taxation. On their estimated UK earnings for the same period of £937m it paid just £33m in UK corporation tax.

-- In 2016 BAT made £6.2bn in global operating profit before tax, paying £1.4bn in overseas profit taxation. BAT UK earnings could not be determined due to inadequate reporting, but it paid only £7m in UK corporation tax.

Lead author, Dr Rob Branston from the University of Bath School of Management said: "Taxes are the best weapon we have available to reduce the harms caused by smoking, both in terms of encouraging smokers to stop and in recouping the enormous costs to society. But despite the enormous profits these companies enjoy, levels of corporation tax paid are pitiful.

"The government must better hold these companies to account and an essential first step is the publication of accurate country by country information on sales and profits. We urge the government to consider an extension of the bank focused corporation tax surcharge to cover tobacco companies."

Co-author, Professor Anna Gilmore, Director of the Tobacco Control Research Group at the University of Bath and co-Director of STOP (Stopping Tobacco Organisations and Products), the new tobacco industry watchdog, added: "With the NHS under intense funding pressure, these findings need to be acted upon by the Treasury. It is unacceptable that tobacco companies, which are enormously profitable, are not paying for the harm they cause. Until they begin to do so, they remain incentivised to keep selling their uniquely deadly product."

According to recent government analysis the cost of smoking to the economy was £11bn a year to England alone in 2017. In that year, £9.5bn was generated in excise duty from tobacco products in the UK, leaving a deficit of at least £1.5bn, not met by current insufficient Corporation Taxes.

The authors acknowledge that the study is limited by the available public data on tobacco company profitability and tax liabilities/allowances, both globally and for the UK market in particular. The work was supported by a Cancer Research UK grant (C50816/A25745). The funder played no role in the study design, analysis and interpretation of data, writing, or the decision to submit this article for publication.

George Butterworth, Cancer Research UK's policy manager, said: "Preventable diseases caused by tobacco products cost the NHS billions each year. The tobacco industry is dodging its obligation to contribute to the UK tax system leaving the public to pay for clearing up the mess caused by its products. The government should impose a tobacco industry levy, considering a surcharge on corporation tax or other mechanisms, to help fund services to help smokers quit."

An analysis of data from almost 46,000 people has found that weight loss, nutrient boosting and fat reduction diets can all reduce the symptoms of depression.

Dr Joseph Firth, an Honorary Research fellow at The University of Manchester and Research Fellow at NICM Health Research Institute at Western Sydney University, says existing research has been unable to definitively establish if dietary improvement could benefit mental health.

But in a new study published in Psychosomatic Medicine, Dr Firth and colleagues brought together all existing data from clinical trials of diets for mental health conditions.

And the study provides convincing evidence that dietary improvement significantly reduces symptoms of depression, even in people without diagnosed depressive disorders.

Dr Firth said: "The overall evidence for the effects of diet on mood and mental well-being had up to now yet to be assessed.

"But our recent meta-analysis has done just that; showing that adopting a healthier diet can boost peoples' mood. However, it has no clear effects on anxiety."

The study combined data from 16 randomised controlled trials that examined the effects of dietary interventions on symptoms of depression and anxiety.

Sixteen eligible trials with outcome data for 45,826 participants were included; the majority of which examined samples with non-clinical depression.

The study found that all types of dietary improvement appeared to have equal effects on mental health, with weight-loss, fat reduction or nutrient-improving diets all having similar benefits for depressive symptoms.

"This is actually good news" said Dr Firth; "The similar effects from any type of dietary improvement suggests that highly-specific or specialised diets are unnecessary for the average individual.

"Instead, just making simple changes is equally beneficial for mental health. In particular, eating more nutrient-dense meals which are high in fibre and vegetables, while cutting back on fast-foods and refined sugars appears to be sufficient for avoiding the potentially negative psychological effects of a 'junk food' diet.

Dr Brendon Stubbs, co-author of the study and Clinical Lecturer at the NIHR Maudsley Biomedical Research Centre and King's College London, added: "Our data add to the growing evidence to support lifestyle interventions as an important approach to tackle low mood and depression.

"Specifically, our results within this study found that when dietary interventions were combined with exercise, a greater improvement in depressive symptoms was experienced by people. Taken together, our data really highlight the central role of eating a healthier diet and taking regular exercise to act as a viable treatment to help people with low mood."

Studies examined with female samples showed even greater benefits from dietary interventions for symptoms of both depression and anxiety.

Dr Firth added: "We're not yet sure why not know why some of our data showed significantly greater benefits from diets for women.

"So more research is needed on this. And we also need to establish how the benefits of a healthy diet are related to improvements in physical health

"It could be through reducing obesity, inflammation, or fatigue - all of which are linked to diet and impact upon mental health.

"And further research is still required to examine the effects of dietary interventions in people with clinically-diagnosed psychiatric conditions."

Researchers have found that the brain stores detailed information of a missing hand decades after amputation, regardless of whether amputees still experience phantom hand sensations.

Their study, published in eLife, revealed detailed hand information in the brains of amputees compared with people who had been born with a missing hand. The research could pave the way for the development of next-generation neuroprosthetics - prosthetic limbs that tap into the brain's control centre.

The findings build on the team's previous work where they used an ultra-high-power MRI scanner to look at the brain activity of two people who had lost their left hand through amputation between two and three decades ago. Although there was less brain activity related to the fingers of the left hand, they found that the specific patterns making up the composition of the hand picture in the brain were well matched to those of two-handed people.

"Our previous findings demonstrated the stability of the hand picture in the cortex despite decades of amputation," explains lead author Daan Wesselink, a PhD student at the University of Oxford and UCL Institute of Cognitive Neuroscience, UK. "However, we didn't know whether this hand representation in the brain reflects phantom sensations and therefore only persists in those few people who experience vivid sensations."

To address this question, they used a brain-decoding technique based on the pattern of brain activity in 18 amputees, who lost their hand to amputation on average 18 years ago and experience varying vividness of phantom sensations. The team also looked at whether development of the hand's neural fingerprints requires some prior experience of having a hand, by studying 13 people who were missing one hand from birth. They asked both groups to 'move' the fingers of their missing and intact hands while in an MRI scanner, and compared the results to two-handed participants.

They found that the brain activity of amputees who had the strongest sensations of being able to move each of their phantom fingers retained the clearest information of their missing hand in their brain. But even those who barely experience phantom hand sensations had the same information preserved in their brains, which was surprising because those amputees have no experiences during their daily life that their brain has held on to this information about their former limb.

By contrast, the group born with one hand showed some brain activity during phantom limb movement, but did not have the same neural fingerprint dedicated to their missing hand. This suggests it could be more challenging to design neuroprostheses or perform hand transplants for this group.

"We've shown that once the hand 'picture' in the brain is formed, it is generally unlikely to change, despite years of amputation and irrespective of the vividness of phantom sensations," concludes senior author Tamar Makin, Associate Professor and Sir Henry Dale Fellow at the UCL Institute of Cognitive Neuroscience. "Our work suggests that daily life experience could shape the fine-grained aspects of hand representation, but that the large-scale functional organisation of the hand area is fundamentally stable."

The rate of unmet need for mental health care is significant among Blacks, reducing quality of life and causing disability. Sirry Alang, assistant professor of sociology and health, medicine and society at Lehigh University says unmet healthcare needs should be seen as a threat to society. "It increases health care expenditures through emergency room visits and substance use disorders. It reduces productivity; and it burdens other systems such as child services, criminal justice and law enforcement."

In her latest research paper, titled, "Mental health care among blacks in America: Confronting
racism and constructing solutions," published recently in Health Services Research, Alang questions why there is a significant unmet need for mental health care among Blacks and identifies solutions among healthcare systems to fix it: teach the history of racism in medicine; and actively seek, privilege and legitimize the narratives of black people.

Using data from the 2011-2015 National Survey on Drug Use and Health and focus groups, Alang analyzed black adults with unmet mental health care needs. She looked at the factors that are associated with reasons for unmet mental health needs reported by Blacks. She then held focus groups to explore the role of racism and elaborate on the racial context of the results obtained in the first phase.

Racism, she confirmed in her research, is a fundamental cause of mistrust and racial inequities in mental health service systems.

But why?

She found stigma to be highest among African Americans with a college education. She also found that women are more likely to minimize symptoms and not seek care even when they think they should.

"These results are all explained by racism," she explains. "For example, the fear of double discrimination--racial discrimination and mental illness discrimination--is exacerbated among Blacks in higher socioeconomic positions where they work, compete and are evaluated side by side whites."

When African Americans experience racism in other institutions such as education, work and the criminal justice system, they anticipate these experiences in health care settings.

Historical institutional betrayal has bread mistrust in mental health systems, and sometimes not seeking care is an effort to avoid exposure to racial microaggressions, Alang says.

Her research has strong implications for practice, policy, and education. She suggests first teaching about the history of racism in medicine and the contemporary forms of racism to clinicians. She says, "Provide anti-racism education. Make this part of the centralized curriculum."

She says that in addition to this, "researchers, clinicians and policy makers should actively seek, privilege and legitimize the narratives of black people. We should be able to document that this process has happened for any policy or research on marginalized groups. It serves the dual purpose of building trust in institutions and provides services that are relevant to the experiences and meets the needs of Black and other marginalized communities."

We cannot change a person's race to reduce the risk of having unmet needs for healthcare, Alang says. "but we certainly can eliminate racism, the fundamental cause of racial inequities."

When we think of life on Earth, we might think of individual examples ranging from animals to bacteria. When astrobiologists study life, however, they have to consider not only individual organisms, but also ecosystems, and the biosphere as a whole.

In astrobiology, there is an increasing interest in whether life as we know it is a quirk of the particular evolutionary history of the Earth or, instead, if life might be governed by more general organizing principles.

If general principles exist that can explain properties common to all life on Earth, scientists hypothesize, then they may be universal to all life, even life on other planets. If a "universal biology" exists, it would have important implications for the search for life beyond Earth, for engineering synthetic life in the lab, and for solving the origin of life, enabling scientists to predict at least some properties of alien life.

Previous research in this area has primarily focused on specific levels of organization within biology such as individual organisms or ecological communities. These levels form a hierarchy where individuals are composed of interacting molecules and ecosystems are composed of interacting individuals.

An interdisciplinary team of researchers at Arizona State University (ASU) has gone beyond focusing on individual levels in this hierarchy to study the hierarchy itself, focusing on the biosphere as a whole. The results of their study have been recently published Science Advances.

"To understand the general principles governing biology, we must understand how living systems organize across levels, not just within a given level," says lead author Hyunju Kim of ASU's Beyond Center and the School of Earth and Space Exploration.

Through this study, the team found that biochemistry, both at the level of organisms and ecosystems, is governed by general organizing principles. "This means there is a logic to the planetary-scale organization of biochemistry," says co-lead author Harrison Smith of ASU's School of Earth and Space Exploration. "Scientists have talked about this type of logic for a long time, but until now they have struggled to quantify it. Quantifying it can help us constrain the way that life arises on a planet."

For this research, the team constructed biochemical networks using a global database of 28,146 annotated genomes and metagenomes and 8,658 catalogued biochemical reactions. In so doing, they uncovered scaling laws governing biochemical diversity and network structure that are shared across levels of organization from individuals to ecosystems, to the biosphere as a whole.

"Quantifying general principles of life--not restricted to a domain on the tree of life, or a particular ecosystem--is a challenge," says Smith. "We were able to do that by combining tools from network science and scaling theory, while simultaneously leveraging large genomic datasets that researchers have been cataloging."

The research team, led by Kim and Smith under supervision of Sara Walker of the ASU School of Earth and Space Exploration and the Beyond Center, also includes Cole Mathis of the Beyond Center and the ASU Department of Physics (now at the University of Glasgow), and Jason Raymond of the School of Earth and Space Exploration.

"Understanding the organizing principles of biochemistry at a global scale better enables us to understand how life operates as a planetary process" says Walker. "The ability to more rigorously identify universal properties of life on Earth will also provide astrobiologists with new quantitative tools to guide our search for alien life - both in the lab on other worlds"

Research has told us that school disciplinary practices lead to juvenile justice interventions, and that both school exclusion and juvenile justice intervention lead to adversities like drug use in adolescence and adulthood. Yet it's unclear which form of intervention--being suspended and expelled from school or being arrested by police--is more likely to lead youth to use drugs. A new longitudinal study found that practices that exclude youth from school appear to predict drug use more than arrests by police, especially among minority youth.

The study, by researchers at George Mason University and the University of Florida, appears in Justice Quarterly, a publication of the Academy of Criminal Justice Sciences.

"Our findings add to growing concerns about school disciplinary practices that exclude youth," according to Beidi Dong, assistant professor in the Department of Criminology, Law, and Society at George Mason University, who led the study. "Amid alarm about the school-to-prison pipeline, the conclusion that school exclusion is even more problematic for students' well-being than police arrest highlights the need to find alternative methods to discipline students so exclusion is used only as a last resort."

The study used data from the longitudinal Rochester Youth Developmental Study (RYDS) to examine both the immediate, concurrent influence of school and police interventions on drug use during adolescence and the long-term, cumulative effect of these interventions during adolescence on subsequent drug use in young adulthood. The RYDS began in 1988 with 1,000 seventh- and eighth-grade students in Rochester, NY. It included students from a range of races and ethnicities, and featured more males and more youth from high-crime neighborhoods to over-represent high-risk youth.

This study used data covering ages 14 to 31 of the RYDS sample. Researchers collected information on students' drug use, self-esteem, and parents' supervision, as well as whether students had been disciplined at school and been arrested.

School exclusionary practices appeared to predict drug use more than police arrests during both adolescence and young adulthood, the study found. The negative effects were especially pronounced among minority youth. The results differed for males and females, with school exclusion predictive of concurrent drug use for females but not for males, and predictive of subsequent adult drug use for males but not for females.

"Removing adolescents from school provides unstructured and unsupervised time that can facilitate drug use, while being arrested does not necessarily do so," notes Marvin D. Krohn, professor in the Department of Sociology and Criminology and Law at the University of Florida, who coauthored the study. "This should be kept in mind as educators and others consider other ways to discipline students."

Long before human ancestors began hunting large mammals for meat, a fatty diet provided them with the nutrition to develop bigger brains, posits a new paper in Current Anthropology.

The paper argues that our early ancestors acquired a taste for fat by eating marrow scavenged from the skeletal remains of large animals that had been killed and eaten by other predators. The argument challenges the widely held view among anthropologists that eating meat was the critical factor in setting the stage for the evolution of humans.

"Our ancestors likely began acquiring a taste for fat 4 million years ago, which explains why we crave it today," says Jessica Thompson, the paper's lead author and an anthropologist at Yale University. "The reservoirs of fat in the long bones of carcasses were a huge calorie package on a calorie-poor landscape. That could have been what gave an ancestral population the advantage it needed to set off the chain of human evolution."

Thompson, who recently joined Yale's faculty, completed the paper while on the faculty at Emory University.

While focusing on fat over meat may seem like a subtle distinction, the difference is significant, Thompson says. The nutrients of meat and fat are different, as are the technologies required to access them. Meat eating is traditionally paired with the manufacture of sharp, flaked-stone tools, while obtaining fat-rich marrow only required smashing bones with a rock, Thompson notes.

The authors review evidence that a craving for marrow could have fueled not just a growing brain size, but the quest to go beyond smashing bones with rocks to make more sophisticated tools and to hunt large animals.

"That's how all technology originated -- taking one thing and using it to alter something else," Thompson says. "That's the origin of the iPhone right there."

Co-authors of the paper include anthropologists Susana Carvalho of Oxford University, Curtis Marean of Arizona State University, and Zeresenay Alemseged of the University of Chicago.

The human brain consumes 20% of the body's energy at rest, or twice that of the brains of other primates, which are almost exclusively vegetarian. It's a mystery to scientists how our human ancestors met the calorie demands to develop and sustain our larger brains.

A meat-centered paradigm for human evolution hypothesizes that an ape population began more actively hunting and eating small game, which became an evolutionary stepping stone to the human behavior of hunting large animals.

The paper argues that this theory does not make nutritional sense. "The meat of wild animals is lean," Thompson says. "It actually takes more work to metabolize lean protein than you get back."

In fact, eating lean meat without a good source of fat can lead to protein poisoning and acute malnutrition. Early Arctic explorers, who attempted to survive on rabbit meat exclusively, described the condition as "rabbit starvation."

This protein problem, coupled with the energy required for an upright ape with small canines to capture and eat small animals, would seem to rule out eating meat as a pathway to fueling brain growth, Thompson says.

The new paper presents a new hypothesis, going back about 4 million years, to the Pliocene. As the human ancestor began walking primarily on two legs, heavily forested regions of Africa were breaking into mosaics, creating open grasslands.

"Our human ancestors were likely awkward creatures," Thompson says. "They weren't good in trees, like chimpanzees are, but they weren't necessarily all that good on the ground either. So, what did the first upright walking apes in our lineage do to make them so successful? At this stage, there was already a small increase in the size of the brains. How were they feeding that?"

Thompson and her co-authors propose that our early ancestors wielded rocks as they foraged on open grassland. After a predator had finished eating a large mammal, these upright apes explored the leftovers by smashing them and discovered the marrow hidden in the limb bones.

"The bones sealed up the marrow like a Tupperware container, preventing bacterial growth," Thompson says. And the only things that could crack open these containers, she adds, were the bone-cracking jaws of hyenas or a clever ape wielding a rock.

The hypothesis offers an explanation for how the human ancestor may have garnered the extra calories needed to foster a larger brain, long before there is evidence for controlled fire, which could have mitigated the problem of bacteria in rotting, scavenged meat. The fat hypothesis also predates by more than 1 million years most evidence for even basic toolmaking of simple stone flakes.

Scientists ought to begin looking for evidence of bone-smashing behavior in early human ancestors, Thompson said.

"Paleoanthropologists are looking for mostly complete bones, and then concentrating on identifying the animal that died," Thompson says. "But instead of just wondering about the bone's creature of origin, we should be asking, 'What broke this bone?' We need to start collecting tiny pieces of shattered bone to help piece together this kind of behavioral information."

Ever since Darwin first set foot on the Galapagos, evolutionary biologists have long known that the geographic isolation of archipelogos has helped spur the formation of new species.

Now, an international research team led by Theresa Cole at the University of Otago, New Zealand, has found the same holds true for penguins. They have found the first compelling evidence that modern penguin diversity is driven by islands, despite spending the majority of their lives at sea.

"We propose that this diversification pulse was tied to the emergence of islands, which created new opportunities for isolation and speciation," said Cole.

Over the last 5 million years, during the Miocene period, (particularly within the last 2 million years), island emergence in the Southern Hemisphere has driven several branches on the penguin evolutionary tree, and also drove the more recent influence of human-caused extinctions of two recently extinct penguin species from New Zealand's Chatham Islands.

"Our findings suggest that these taxa were extirpated shortly after human settlement on the Chatham Islands," said Cole. "These findings thus potentially represent important new examples of human-driven, Holocene extinction in the Pacific."

"While our results reinforce the importance of islands in generating biodiversity, they also underscore the role of humans as agents of biodiversity loss, especially via the extinction of island-endemic taxa," said Cole. As many of the bones were from middens, our results provide direct evidence that our newly discovered extinct taxa was hunted by humans."

The publication appears in the advanced online edition of the journal Molecular Biology and Evolution.

About 20 modern penguin species exist, from the Antarctic emperor penguin, the forest dwelling Fiordland penguin and the tropical Galapagos penguin. A fossil record of more than 50 species can trace back penguin history to more than 60 million years ago - indicating that penguin diversity may have once been much higher than today.

Using historical skin samples and subfossils from natural history museums, along with blood samples, the researchers performed the largest survey to date, across all penguin taxa.

The team tested their island hypotheses using 41 near-complete mitochondrial genomes, representing all extant and recently extinct penguin taxa. They calibrated their mitogenomic evolution to make an evolutionary clock based on the fossil record.

"By using well-justified fossil calibrations, we resolve the timing and mechanisms of modern penguin diversification," said Cole.

They found that the two largest-bodied and most polar-adapted penguins are sister to all other living penguins. The DNA evidence also showed that genetically similar penguin species may be at the earlies stages of diversification.

The study provides important new data and perspectives to the debate on the origins of penguin diversity. It will also help better understand the role of islands as drivers of speciation to other animals and marine life.

The new taxa have been named Eudyptes warhami and Megadyptes antipodes richdalei after John Warham and Lance Richdale, pioneers in penguin biology.

CHARLOTTESVILLE, VA (FEBRUARY 5, 2019). In the article "Golf: a contact sport. Repetitive traumatic discopathy may be the driver of early lumbar degeneration in modern-era golfers" published today in the Journal of Neurosurgery: Spine, Drs. Corey T. Walker, Juan S. Uribe, and Randall W. Porter from Barrow Neurological Institute describe the biomechanics of modern-era golf and its clinical consequences.

The authors point out that "among professional and amateur golfers, back disorders remain the most common injury, comprising 55% and 35% of injuries in these groups, respectively." They also note that modern professional golfers are experiencing back problems at far younger ages than the general population. To explain this, they focus on how the golf swing of present-day professionals, such as Tiger Woods, differs from that employed by golf legends Jack Nicklaus and Ben Hogan.

As golf has evolved over the last two decades, the golf swing has become more powerful. To keep up, modern-era professional golf players participate in intensive strength-training sessions. And the techniques of the swing have also changed. During the downswing, greater compressive force is directed toward the spinal disc and facet joints, and this affects these structures asymmetrically. With more than 300 swings per golf-playing day, the golfer repeatedly experiences minor traumatic injuries to the spine, which over time can result in a pathogenic process that the authors have termed "repetitive traumatic discopathy" (RTD).

To illustrate how this can occur, the authors discuss Woods' years of debilitating spine pain.

In this paper Walker and colleagues discuss modern-day golf swing biomechanics and how they relate to the development of RTD, earlier ages of players exhibiting RTD, and the possibility that golfer's athletic strength training may contribute to RTD. They also address treatment of patients with this repetitive spinal injury.

When asked about the study, Dr. Walker said, "We believe Tiger Wood's experience with spinal disease highlights a real and under-recognized issue amongst modern era golfers. Repetitive traumatic discopathy (RTD) results from years of degenerative 'hits' or strains on the spine resulting in early onset breakdown, instability, and pain. We hope medical practitioners, and surgeons in particular, will be able to diagnose and treat golfers with RTD in a specialized fashion going forward."

Medications improve health and saves lives, but they are not risk-free. The modern pharmacist is largely responsible for helping patients navigate an increasingly complex and costly health care system, particularly with respect to medications. And with significant changes in population demographics, technology, and the upsurge in the use of health services across the sector, a group of pharmacist-researchers from the Ontario Pharmacy Evidence Network is calling for the profession to make fundamental changes to effectively and safely meet society's health care needs.

An overview of these recommendations is captured in a peer-reviewed paper published earlier this month in the Canadian Pharmacists Journal (CPJ/RPC).

"Patients, families and other health care providers rely on pharmacists to support safe and effective medication use and we need to think seriously about how we can shift and adapt our practice to meet changing health care trends," says lead author Lisa Dolovich, professor at the Leslie Dan Faculty of Pharmacy, University of Toronto. "We feel that transformational change in the profession of pharmacy is essential in all practice settings including community, hospital, primary care or other organizations."

Watch Video: The Future of Pharmacy

For example, in the future, dispensing medication may not be a significant component of on-site pharmacy services, the authors write. Recognizing that dispensing and front-store products are increasingly managed by off-site storage and delivery, pharmacies should look to repurpose physical layout and optimize workflow processes to better support patient assessment and communication, including the use of eHealth technology, private rooms and interprofessional teamwork.

"This type of organizational-level change will better support pharmacists' ability to be integrated into a patient's overall care plan, more effectively work with other primary care providers and open opportunities for pharmacists to expand disease monitoring and prevention services," says Nancy Waite, professor and associate director of clinical education at University of Waterloo's School of Pharmacy.

Pharmacists, particularly those who work in the community, are also well positioned to support better integration of patient care across the health care system. But this requires better use of technology to collaborate with other care providers and with pharmacists in other care settings, the authors write. In the future, pharmacists should be able to easily triage or refer patients to other health and community organizations and also have a system in place to receive referrals. Pharmacists should have access to and interpret clinical information from other services including lab and diagnostic test results.

The authors note that in many recent policy discussions about the future direction of health care services, the voice of pharmacists has been largely absent. This is surprising given total drug spending in Canada was estimated to be $39.8 billion in 2017 and made up the second largest share of health care expenditures.

"Pharmacists are an under-utilized resource in health care and we see opportunities for pharmacists to really become a patient's partner in preventing and managing illness, improving transitions between different levels of care, as well as their medication use," says Dolovich. "There is much more pharmacists can do to help build an integrated care system that is centred on individual patients' needs, within their community, and throughout every stage of life."

CHARLOTTESVILLE, VA (FEBRUARY 5, 2019). As we all know, opioid addiction in the US has reached epidemic proportions. In 2017 alone, opioids were involved in the overdose deaths of 47,600 people. Many victims of opioid abuse began their journey with physician-prescribed medications that initially were provided for the management of acute or chronic pain. Often the source of this pain is damage to the lumbar spine or a temporary side effect of lumbar spine surgery.

Physicians and medical institutions are actively seeking solutions to lower the risks of opiate addiction. One focus is reducing the amounts of opioids that are initially prescribed for patients in acute pain. Excess opioid medication has the potential to lead to addiction in patients or misuse by family members or others with access to leftover opioid pills.

At Hospital for Special Surgery (HSS) in New York City (ranked Number 1 in orthopedics 2018-19 by U.S. News & World Report), a task force developed a 1-hour educational program on opiate use and misuse, the role of the orthopedic prescriber, multimodal analgesia, and state laws regarding opioid prescription. All opioid prescribers at the institution were mandated to attend the program in person or via an online presentation. A committee composed of spine surgeons, pain management physicians, anesthesiologists, and nurse managers established guidelines for prescribing opioids following spine surgery. These qualitative guidelines, based on individual patients' consumption of opioids while in the hospital, were disseminated throughout the hospital early in 2017.

In the article "An institutional intervention to modify opioid prescribing practices after lumbar spine surgery," published today in the Journal of Neurosurgery: Spine, Francis Lovecchio, MD, and colleagues address the question of whether this intervention--mandatory provider education together with prescription guidelines--could change prescriber behavior, resulting in a lower amount of opioids prescribed at hospital discharge after lumbar surgery.

Lovecchio and colleagues compared opioid prescription data in the electronic medical records of 1177 patients treated by lumbar surgery before the intervention (March 1-November 1, 2016) with similar data in the electronic medical records of 1302 patients treated after the intervention (February 1-October 1, 2017). Because a variety of opioid medications with different strengths had been prescribed, the researchers converted the amount of opioid per prescription into an oral morphine equivalent (OME) to make comparisons possible.

The researchers found a statistically significant reduction in both the mean amount of opioid (629 ± 294 OME pre-intervention vs. 490 ± 245 OME post-intervention, p

The researchers estimate that in the 8 months following dissemination of the guidelines, "the change in prescribing practices may have saved the dispensing of over 26,000 narcotic pills."

Lovecchio and colleagues show how the intervention at HSS changed prescriber behavior, resulting in a lower amount of prescribed opioids. They suggest that future studies should be undertaken to focus on how these changes in prescriber behavior may affect patient outcomes.

When asked about the importance of the study, Dr. Lovecchio said, "While we have been able to show that qualitative prescribing guidelines work to change prescriber behavior, the most practical solution to overprescribing is to define the 'minimum necessary quantity' of opioid to prescribe for the average patient after a given spine procedure. This will prove challenging, as postoperative opioid consumption likely depends on a complex interplay of biological, psychosocial, and surgery-related factors, and patient expectations. Our group and many others are working toward this end, and I look forward to finding solutions."

A new study in JNCI Cancer Spectrum has identified a connection between prolonged time spent sitting while watching TV and increased risk of colorectal cancer for younger Americans.

Young-onset colorectal cancer, diagnosed under age 50, is increasing in the US and globally, sharply contrasting with the dramatic decreases among older people, largely as a result of cancer screening initiatives. Young-onset colorectal cancer has potentially different molecular characteristics compared to those of late-onset, and is typically more aggressive and found at a more advanced stage than those in older patients, resulting in greater years of life lost. Despite these trends, researchers have identified few risk factors specific to young-onset colorectal cancer.

Researchers here studied sedentary TV reviewing time, as well as other sedentary behaviors, in 89,278 American women in the Nurses' Health Study II. Of the 118 cases of young-onset colorectal cancer diagnosed over two decades of follow up, more than one hour of daily TV viewing time was associated with a 12% increase in risk compared to those who watched less. The results were even more striking for those watching more than two hours/day with a nearly 70% increase in risk. This association was independent of BMI and exercise and was consistently observed among women without a family history of colorectal cancer. The association was also more pronounced for rectal cancer compared to colon cancer.

These findings are among the first to link specific sedentary behavioral patterns with risk of young-onset colorectal cancer. "This study may help identify those at high risk and who might benefit more from early screening," said Yin Cao, Assistant Professor of Surgery at Washington University School of Medicine, and the study's co-senior author. "The fact that these results were independent of BMI and physical activity suggests that being sedentary may be an altogether distinct risk factor for young-onset colorectal cancer."

COLUMBUS, Ohio - During a study spanning nearly a decade, researchers at The Ohio State University College of Medicine, Houston Methodist Research Institute and Houston Methodist Cancer Center have linked the protein clusterin - for the first time -- to many different facets of cardiometabolic syndrome risk through its actions in the liver.

Cardiometabolic syndrome (CMS) is a cluster of conditions occurring together that increase a person's risk of heart disease, stroke and diabetes. These conditions include high blood pressure, high blood sugar, excess body fat around the waist and abnormal cholesterol or triglyceride levels. The risk of developing CMS is even greater for patients who are physically inactive or smoke,

Findings of the study that involved humans and mice are published online in the journal Diabetes Care.

"Our goal was to discover new factors produced by the cells in fat tissue that have an impact on cardiometabolic disease. In particular, we wanted to identify those important to maintaining the framework of fat tissue, called the extracellular matrix, which becomes dysfunctional in obesity," said first author Dr. David Bradley, assistant professor in the Division of Endocrinology, Diabetes and Metabolism at The Ohio State University Wexner Medical Center and a member of Ohio State's Diabetes and Metabolism Research Center.

The study found that a particular extracellular matrix protein called clusterin, which is overproduced from the fat cells of obese patients, is strongly related to insulin resistance. It's also linked to increased cardiovascular disease risk and mortality, high blood pressure, harmful cholesterol levels and fatty liver disease.

Insulin resistance is a major cause of Type 2 Diabetes, and patients with obesity commonly have both metabolic and cardiovascular complications.

During the study, researchers performed gene expression, correlation analyses and blood measurements in 54 obese and 18 lean patients undergoing elective surgery at Ohio State's Wexner Medical Center. The study also involved human cultured cells and mice prone to developing obesity-associated complications.

"This collaborative research is shedding new light on the importance of clusterin on "cardiometabolic syndrome," which may eventually lead to developing new treatments for this life-threatening combination of diabetes, high blood pressure and obesity," said Dr. K. Craig Kent, dean of the Ohio State College of Medicine. "Previously this protein clusterin has been mostly studied for its role in neurodegenerative diseases such as Alzheimer's but it now appears to have a broader role in human physiology and disease."

CMS, which affects about 25 percent of the world's population, is now recognized as a disease entity by the World Health Organization and the American Society of Endocrinology. People with CMS are two times more likely to die from coronary heart disease and three times more likely to have a heart attack or stroke than those who do not have the syndrome.

"This study shows the hypothesis generation power of emerging systems biology approaches in discovering novel targets and mechanisms on complex diseases such as CMS. The clusterin protein is a key component of the extracellular matrix, so this work opens up a new vista to understand the role of clusterin in inter-cellular crosstalk of tissue microenvironments of various diseases, including diabetes, cancer and neurodegeneration," said the co-corresponding author, Dr. Stephen T. C. Wong, professor and chair of the Department of Systems Medicine and Bioengineering at Houston Methodist.

Further translational research involving mouse models is needed to learn more about how clusterin impacts each of the CMS components and whether administrating clusterin-inhibiting antibodies inhibits CMS.

"A critical issue has been to identify a unifying mechanism for components of cardiometabolic syndrome, " said lead researcher Dr. Willa Hsueh, director of the Diabetes and Metabolism Research Center and professor of medicine in the Division of Endocrinology, Diabetes, and Metabolism at Ohio State's Wexner Medical Center. "Fat cells increase clusterin production as they enlarge in obesity. Clusterin may be a biomarker of disease, as well as a therapeutic target to potentially prevent this disease."