Culture

Two Massachusetts General Hospital (MGH) physicians call on medical and public health communities around the world to condemn the attacks on health care facilities and services in Yemen conducted by the Saudi-led coalition in the three-year-old war. In their Perspectives article receiving early online publication in the New England Journal of Medicine, Amir Mohareb, MD, MGH Division of Infectious Diseases, and Louise Ivers, MD, MPH, DTM&H, executive director of the MGH Center for Global Health, write, "The Yemeni medical disasters are man-made, with outbreaks of infectious diseases and starvation following bombing. The war has been characterized by a violation of medical neutrality."

The physicians call on health care providers to take a role in condemning the war. They describe how hospitals and clinics in the capital city of Sana'a and other areas of the country "have continued to be destroyed, both indiscriminately and sometimes apparently deliberately," since the war began in March 2015. An outbreak of cholera - estimated to have infected more than 1.1 million people and led to more than 2,000 deaths, 20 percent in children under 5 - has been exacerbated by the bombing of water-treatment plants and a lack of fuel needed to operate remaining facilities. Both diphtheria and measles have also increased, probably because of a drop in immunizations, and concerns are rising about a polio outbreak.

The Saudi-led blockade of Yemeni ports has kept out international relief agencies and much-needed food supplies, leading to a near-famine that puts 14 million people at risk of starvation, the physicians write. Even after an easing of the blockade last year, "importation of essential medicines, vaccines and health care equipment remains limited." Citing the U.S. agreement to sell more than $100 billion in arms and provide other support to the Saudis, the authors stress that mounting evidence of attacks on civilians and on health facilities should induce suspension U.S. military support, as has been proposed by a bipartisan Senate resolution. Giving international humanitarian agencies the ability "to investigate attacks on medical facilities and personnel committed by parties on either side of the conflict" is also essential.

"These responses are, in our view, the only just course of action and are the way to erect necessary safeguards for the future," they write. "We rely on humanitarian programs and on the principal of medical neutrality as a salve for the painful consequences of armed conflict. The moral responsibility for this catastrophe is collective. Those of us whose governments support the war's attack on civilians and civilian infrastructure through their direct actions or through their inaction at the United Nations Security Council can do more than stand by silently wondering what the warring parties hope to inherit at the end of the day. A generation of Yemeni people is being sacrificed."

Ivers is an associate professor of Medicine, and Mohareb is a research fellow in Medicine at Harvard Medical School. Their article will appear in the January 10, 2019, print edition of NEJM. The MGH Center for Global Health serves the hospital's mission to contribute to improving the health of our global community through service, research and innovation, and medical education.

New research published in Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]) shows that non-invasive measurement of skin autofluorescence (SAF) can predict future risk of type 2 diabetes, cardiovascular disease (CVD) and mortality, independent of other measures such as measuring blood glucose levels.

This quick, non-invasive technique could be potentially used in non-medical settings or public locations such as supermarkets, pharmacies or drug stores as a first estimate of risk of these conditions, says study lead author Professor Bruce Wolffenbuttel, Department of Endocrinology, University of Groningen, University Medical Center Groningen, Netherlands, and colleagues.

The worldwide prevalence of type 2 diabetes is increasing rapidly; it is predicted to be close to 650 million in 2040. Cardiovascular complications are the main drivers of increased morbidity and premature mortality in diabetes. Several risk factors, such obesity and fasting blood glucose, predict the development of type 2 diabetes and CVD.

More recent research has shown that patients with type 2 diabetes have higher levels of chemicals called advanced glycation end-products (AGEs). Such patients also exhibit higher levels of skin autofluorescence, due to the build-up of some AGEs that fluoresce in the skin. In this study, the authors assess whether SAF was able to predict the development of type 2 diabetes, CVD and mortality in the general population.

For this prospective analysis, the authors included 72880 participants of the Dutch Lifelines Cohort Study, who underwent baseline investigations between 2007 and 2013, had validated baseline skin autofluorescence values available, and were not known to have diabetes or CVD.

Individuals were diagnosed with incident type 2 diabetes by self-report or by a fasting blood glucose ? 7.0 mmol/l or HbA1c ? 48 mmol/mol (?6.5%) at follow-up. Participants were diagnosed as having incident CVD by self-report. CVD includes myocardial infarction, coronary interventions, cerebrovascular accident, transient ischaemic attack, intermittent claudication or vascular surgery. Mortality was ascertained using the Dutch Municipal Personal Records Database.

The AGE Reader has a light source which illuminates the tissue of interest. This light excites fluorescent moieties in the tissue, and these will reflect the light with a different wavelength as a result. In the wavelength band used for this study, the major contribution in fluorescence comes from fluorescent AGEs. The emitted light was detected with the use of a spectrometer or photodiodes.

After a median follow-up of 4 years (range 0.5-10 years), 1056 participants (1.4%) had developed type 2 diabetes, 1258 individuals (1.7%) were diagnosed with CVD, while 928 (1.3%) had died. Baseline skin autofluorescence was higher in participants with incident type 2 diabetes and/or CVD and in those who had died compared with individuals who survived and remained free of either disease.

As a single measurement, a 1-unit higher skin autofluorescence was associated with a 3-fold increase in risk of type 2 diabetes or CVD, and a five times increased risk of death. The predictive value of skin autofluorescence for these outcomes was independent of several traditional risk factors, such as obesity, metabolic syndrome, glucose and HbA1c, and, after adjustment for these factors, a 1-unit higher SAF was associated with a 26%, 33% and 96% increased risk for T2D, CVD and mortality, respectively.*

The authors say: "This is the first prospective study to examine SAF as a predictor for type 2 diabetes, CVD and mortality in the general population."

They add: "Our study supports the clinical utility of SAF as a first screening method to predict type 2 diabetes, CVD and mortality. Other risk indicators, such as presence of the metabolic syndrome, require more extensive measurements...The quick, non-invasive measurement of skin autofluorescence may even allow use in non-medical settings or public locations such as supermarkets, pharmacies or drug stores as a first estimate of risk."

The researchers found that the risk of type 2 diabetes is actually higher than simply adding the individual risks associated with unhealthy lifestyle and shift work together, indicating that combining an unhealthy lifestyle with irregular night-time working adds a further risk.

It is well-established that unhealthy lifestyle behaviours such as smoking, a poor diet and little exercise, and being overweight or obese increase the risk of type 2 diabetes. Shift work, especially night shift work, has also been associated with a greater risk of type 2 diabetes.

However, the researchers believe this to be the first study to look at the combined impact of an unhealthy lifestyle and rotating night shift work on risk of type 2 diabetes.

They combined data from two long-term health studies in nurses - the Nurses' Health Study (NHS) and NHS II - which enrolled female US nurses in 1976 and 1989.

They extracted data on 143,410 women without type 2 diabetes, cardiovascular disease, or cancer who had filled out medical, food and lifestyle questionnaires at regular intervals.

Nursing care is required around the clock, which means nursing rotas include a mixture of day, evening and night shifts which can be disruptive to personal routines and biological rhythms.

For this study, working rotating night shift work was defined as working at least three night shifts per month in addition to day and evening shifts that month.

Unhealthy lifestyle was defined using four factors: being overweight or obese (body mass index of 25 or above), ever having smoked, doing less than 30 minutes per day of moderate to vigorous intensity exercise and having a poor diet (low in fruit, veg, nuts and whole grains, and high in processed meat, trans fats, sugar and salt).

Over 22-24 years of follow-up, 10,915 of the 143,410 nurses reported having a diagnosis of type 2 diabetes.

For every five years of working rotating night shifts the nurses were almost a third (31%) more likely to have been diagnosed with type 2 diabetes.

Each unhealthy lifestyle factor - ever being a smoker, being overweight or obese, having a low quality diet or a low level of physical activity - more than doubled (2.3 times) the risk of being diagnosed with type 2 diabetes.

Women who exhibited any of these four unhealthy lifestyle factors and also worked rotating night shifts faced an even higher risk of a diagnosis of type 2 diabetes: for each individual unhealthy lifestyle factor they had a 2.83 times higher risk.

This risk is higher than simply adding the two individual risks for rotating shifts and for poor lifestyle together, indicating that some kind of interaction of the two risk factors adds further risk.

The authors calculated that rotating night shift work accounted for approximately 17% of the combined higher risk of type 2 diabetes, unhealthy lifestyle for around 71%, and the remaining 11% was additional risk related to the interaction of the two.

"Most cases of type 2 diabetes could be prevented by adherence to a healthy lifestyle, and the benefits could be larger in rotating night shift workers," they conclude.

However, they point out that this is an observational study, so no firm conclusions can be drawn about cause and effect - and all the nurses were female and mostly white, so their findings may not be applicable to men and other racial or ethnic groups.

The additional risk of type 2 diabetes that occurs when rotating night shift workers follow an unhealthy lifestyle may be the result of disrupted sleep and circadian rhythms affecting hormones, other metabolic pathways or the balance of bacteria in the gut, the authors suggest. But they emphasise that further studies are needed to confirm and explain their findings.

Scientists at the RDECOM Research Laboratory, the Army's corporate research laboratory (ARL) have found a novel way to safeguard quantum information during transmission, opening the door for more secure and reliable communication for warfighters on the battlefield.

Recent advancements of cutting-edge technologies in lasers and nanophysics, quantum optics and photonics have given researchers the necessary tools to control and manipulate miniature quantum systems, such as individual atoms or photons - the smallest particles of light.

These developments have given rise to a new area of science - Quantum Information Science, or QIS, that studies information encoded in quantum systems and encompasses quantum computing, quantum communication and quantum sensing among other subfields.

Quantum Information Science is believed to have the potential to shape the way information is processed in the future.

The Army's corporate research laboratory invests in QIS research to guarantee continuous technological superiority in this rapidly developing field, which in turn will bring about multiple new technologies in computation, encryption, secure communication and precise measurements.

However, to utilize quantum information, scientists need to figure out robust ways to process and transmit it - a task being tackled by Drs. Daniel Jones, Brian Kirby, and Michael Brodsky from the laboratory's Computational and Information Sciences Directorate.

"In our classical world, information is often corrupted during manipulation and transmission - everyone is familiar with noisy cell phone connections in poor reception areas," Brodsky said. "Thus, communication engineers have been working on a variety of techniques to filter out the noise."

In classical communications, the filtering is rather straightforward as it is done locally, that is in the very place the information is received, such as directly in your phone or internet router.

In the quantum world, things become much more intricate.

The lab's research team has been looking into ways of filtering noise from little bits of quantum information - quantum bits or qubits sent across fiber-optic telecom links.

They discovered that the filtering does not necessarily need to be done by the receiving party.

"The nature of the quantum states in which the information is encoded is such that the filtering could be more easily done at a different location in the network," Kirby said.

That's right, to fix a qubit sent over a certain route, one could actually apply a filter to other qubits that traverse a different route.

Over the last year, the researchers have been looking into the problem of transmission of entangled pairs of photons over optical fibers.

"We started with developing an understanding of how physical properties of real telecom fibers, such as inherent residual birefringence and polarization dependent loss, or PDL, affect the quality of quantum communications," Jones said. "We exploited a novel mathematical approach, which has led to the development of a simple and elegant geometrical model of the PDL effects on polarization entanglement," Kirby added.

The developed model predicts both the quality of transmitted quantum states as well as the rate at which quantum information could be transmitted.

Furthermore, the lab's team invented a new technique that helps reduce the deleterious effects of the noise.

The developed models were experimentally validated using the recently built Quantum Networking Testbed at the lab, which simulates the practical telecom fiber infrastructure.

"We believe that this research has a potential to revolutionize cybersecurity and to enable secure secret sharing and authentication for the warfighter of the future," Brodsky said. "In addition, it will have an impact on developing better sensors for position navigation and timing as well as quantum computers that might result in the synthesis of novel special materials with on demand properties."

According to the researchers, in order to make quantum technology a reality, a large-scale field-deployed testbed must be built, thus guiding the development of both quantum hardware and software.

A journal paper documenting the research titled "Tuning quantum channels to maximize polarization entanglement for telecom photon pairs" is featured in the prestigious Nature Partner Journal Quantum Information.

Frogs from noisy ponds near highways have altered stress and immune profiles compared to frogs from more quiet ponds--changes that reduce the negative effects of traffic noise on the amphibians. According to a new study, when frogs from quiet ponds are experimentally exposed to traffic noise, the noise is stressful and impairs the production of antimicrobial peptides--an important defense mechanism against pathogens. However, frogs taken from ponds near highways show a dampened stress response and altered immune profile, both of which reduce the costs of traffic noise. The study appears online November 21, 2018, in the Royal Society journal Proceedings B.

"In the United States, traffic noise can be heard nearly everywhere," said Jennifer Tennessen, first author of the paper who was a graduate student at Penn State at the time of the research and is currently a research associate at Western Washington University. "Noise can have a number of negative consequences on wildlife, for example by interfering with communication and reducing the ability to find food. Frogs are particularly vulnerable to noise because they rely on sound to find mates and reproduce. Wood frogs travel to ponds in the spring to mate and lay their eggs, but many of these ponds are located near noisy roads. We wanted to know if traffic noise has negative physiological effects on wood frogs and, if so, whether they can adapt."

The researchers collected eggs from ponds located less than 300 feet from interstates and major highways and from ponds in more isolated settings, up to 3 miles from major roads. The eggs were raised through metamorphosis in the lab, and the resulting frogs were exposed either to traffic noise or to ambient noise similar to that at the quiet ponds for 8 days, about the length of time they would spend at breeding ponds.

The researchers found that frogs from the quiet ponds had increased levels of the stress hormone corticosterone after exposure to traffic noise for 8 days, indicating that the noise is stressful. Noise exposure also affected immune function in frogs from quiet sites, increasing counts of a type of white blood cell called monocytes - an indication of an immune response to noise -- and impairing the production of important compounds on the skin called antimicrobial peptides.

"In frogs from quiet ponds, exposure to traffic noise impaired the ability to produce antimicrobial peptides in the brevinin and temporin families," said Louise Rollins-Smith, professor of pathology, microbiology, and immunology at the Vanderbilt University School of Medicine and an author of the paper. "Antimicrobial peptides are components of the immune defense system that provide important protection against pathogens like bacteria and fungi. Brevinin-family peptides in particular strongly inhibit the fungal pathogen that causes the infectious disease chytridiomycosis, or chytrid, which is responsible for widespread mortality of amphibians around the world."

The researchers also investigated whether frogs have developed ways to deal with these negative consequences of traffic noise.

"Long term elevation of stress hormones can lead to negative immune consequences," said Tracy Langkilde, professor and head of biology at Penn State and senior author of the paper. "So we might expect to see suppression of the stress response after long-term stress exposure to reduce immune costs, such as the altered production of skin peptides that we documented here. In frogs from noisy ponds, we see just that."

Frogs from noisy ponds did not have elevated levels of corticosterone after exposure to traffic noise for 8 days, suggesting that frogs from ponds in high-noise areas have a suppressed stress response.

"We're not sure if the frogs from noisy sites have a suppressed stress response to noise specifically or if they have a suppressed stress response overall," said Langkilde. "Both offer the benefit of avoiding stress-related costs of noise, but having a dampened stress response in general could have other negative effects, for example not being able to properly mount a behavioral response to predators."

Unlike frogs from quiet ponds, which had increased monocyte counts when exposed to traffic noise, frogs from noisy ponds actually had increased monocyte counts when exposed to the ambient noise heard at quiet ponds. The researchers believe that this kind of immune response may happen in unfamiliar situations, and supports the idea that frogs from noisy sites have adapted to avoid the physiological costs of noise.

"In the future, we hope to pinpoint the mechanism of how frogs are adapting to noise," said Tennessen. "The roads near the ponds we studied were built between the 1940s and 1960s, so these changes may have occurred within 15 to 35 frog generations. People usually think of adaptation and evolution occurring over huge timescales, but here we see that animals can respond relatively quickly to new threats, though the consequences of that response are still unclear."

ANN ARBOR, Mich. - A significant proportion of suicidal teens treated in a psychiatric emergency department said that watching the Netflix series "13 Reasons Why" had increased their suicide risk, a University of Michigan study finds.

The hit drama, widely popular among teens, has generated controversy for its depiction of suicide. Its story centers around a 17-year-old student, who, before her death, recorded cassettes that detail 13 reasons why she took her own life.

The show has raised concerns among mental health experts about its potentially negative impact on vulnerable youths.

Which is why Michigan Medicine researchers asked suicidal adolescents whether the show had contributed to suicide-related symptoms.

The findings, published in the journal Psychiatric Services, add to the body of literature about how at-risk teens may be reacting to the program.

"This show has been a real phenomenon, especially among teenagers," says lead author Victor Hong, M.D., medical director of psychiatric emergency services at Michigan Medicine. "Its depiction of teen suicide has raised great concern among parents, health providers and educators."

Of the 87 youths who participated in the survey between 2017 and 2018, half had watched at least one episode of the show, mostly teens ages 13 to 17. Among the 43 who had watched it, about half (21) said it heightened their suicide risk.

"Our study doesn't confirm that the show is increasing suicide risk, but it confirms that we should definitely be concerned about its impact on impressionable and vulnerable youth," says Hong.

"Few believe this type of media exposure will take kids who are not depressed and make them suicidal. The concern is about how this may negatively impact youth who are already teetering on the edge."

Parental viewership absent

The idea for the study stemmed from anecdotal narratives shared among colleagues at different children's hospitals, says Hong, noting that providers were hearing more teens being treated for suicidal symptoms talk about "13 Reasons Why."

The study also found that the majority of surveyed youth who had seen the show viewed it alone and were more likely to discuss their reactions with peers (81 percent) than with a parent (35 percent).

A second season of "13 Reasons Why," which debuted in May, opens with a disclaimer urging young viewers to watch the show with a trusted adult -- and the importance of seeking help.

Still, very few parents in the U-M sample had watched the series themselves; some were unaware that their child had watched it.

The findings clash with a previous Netflix-commissioned report that found 71 percent of youths in a U.S. community sample talked to a parent about the series. Hong says this possibly indicates some differences in the ability or desire of youths at high risk of suicide to have such discussions with their parents.

"The data from our sample of teens demonstrated that kids who were at high risk of suicide did not reach out to adults," he adds. "They mostly watched the show alone or talked to friends, but they weren't talking to parents, teachers or school counselors.

"Youths who are in greatest need of adult support may be less likely to seek it out."

Diligence, conversation crucial

Of the teen viewers who said they believed the series increased their suicide risk, the majority strongly identified with the lead female character, Hannah Baker.

"The main character is easy to identify with," Hong says. "She's a teen girl who has suffered from sexual assault, bullying and anxiety -- which, unfortunately, impact too many of our youth today."

Researchers developed a 44-item questionnaire to assess several aspects of youths' interactions with "13 Reasons Why," using caution to avoid advertising the series to those who were not already aware of it. Teens unfamiliar with the show weren't asked additional questions.

Authors say further research is needed to accurately gauge how media content that focuses on youth suicide can influence the mental health and suicide risk of its viewers.

But in the meantime, there are plenty of red flags for parents to watch for.

"Our findings support the need for tailored prevention programming for vulnerable youths and education and training for their parents," says study senior author Cheryl King, Ph.D., a child and adolescent psychologist at U-M's C.S. Mott Children's Hospital.

"Parents whose kids may be vulnerable or at a high risk for suicide should be even more diligent about what their kids watch and if they are being exposed to content that could trigger them," she adds. "They also shouldn't shy away from open, honest and difficult conversations with their kids about these topics."

Cognitive difficulties in patients with diabetes, caused by repeated episodes of low blood sugar, could be reduced with antioxidants, according to a new study presented at the Society for Endocrinology annual conference in Glasgow. The study findings suggest that stimulating antioxidant defences in mice reduces cognitive impairments caused by low blood sugar, which could help to improve the quality of life for diabetic patients.

Long-term decline in cognitive function, with everyday learning and memory tasks becoming harder and taking longer to complete, is a common consequence for patients who frequently experience low blood sugar levels when using insulin to manage their diabetes. Previous studies in mice have shown that reoccurring episodes of low blood sugar leads an accumulation of cell damaging free radicals in the brain. Whether this build-up of free radical stress directly effects cognitive function, and if the body's own antioxidative systems, which can remove free radicals, can be harnessed to counteract these changes and improve quality of life is not known.

In this study, Dr Alison McNeilly and colleagues at the University of Dundee used insulin to induce repeated bouts of low blood sugar in a mouse model of type-1 diabetes. In the experiment, one group of mice were also dosed with the vegetable derived antioxidant sulforaphane (SFN). Mice treated with SFN showed increased expression of antioxidant markers, decreased free radical cell damage and had significantly improved cognitive ability in memory tasks.

Dr McNeilly commented, "Low blood sugar is an almost unavoidable consequence of insulin therapy. This work demonstrates that by improving the body's own antioxidant defence system we can reverse some of the side effects associated with diabetes, such as poor cognitive function."

Dr McNeilly and her colleagues now intend to find out if boosting the body's antioxidative system can minimise cognitive decline associated with low blood sugar in humans, by using drugs based on the chemical structure of SFN.

Dr McNeilly said, "The concentration of SFN used in this study would not be attainable in a normal diet rich in vegetables. However, there are numerous highly potent compounds in clinical trials which may prevent cognitive impairments caused by free radicals to help diabetes patients."

New research by the Work Foundation finds that while businesses increasingly recognise employee benefits as vital in the global race for talent, many are failing to maximise their value for low earners amongst their workforce.

Fundamentals such as uniform, equipment, training required to do the job, pension and insurance schemes and flexibility should automatically be given to employees in any modern workplace to ease financial burdens on families and to help them balance work and family life, researchers say. However, an in-depth study working with businesses and employees from the retail and social care sector reveals that despite the broad variety of employee benefits available, in reality, low earners prefer and use a very limited number.

In 2015/16, 13.9 million people were living in poverty in the UK - 22% of the population - and more than half were in working families. With such high levels of in-work poverty, attention has shifted to focus on the quality of work and how that might be improved, which led to the report being commissioned by the Joseph Rowntree Foundation.

Researchers assessed the market and identified more than 50 different types of employee benefits in the UK, varying from those that offer increased job security, flexibility or discounts on household essentials, to lifestyle perks such as sporting or recreational facilities. However, the research found benefits relating to food and leisure, travel, childcare and housing and utilities were most valued by low earners, as well as those that provide financial education and support.

Heather Carey, Deputy Director of the Work Foundation co-authored the report. She said: "Improving wages will always be vital to tackling in-work poverty, but there are other steps that businesses can take to improve working practices and lend greater support to low-earners. Employee benefits can be extremely valuable - particularly schemes that help to mitigate living costs. But despite rapid expansion of the employee benefits market, our research finds that many employers are failing to maximise their value for low earners which is bad for employees, and bad for business.

"It's so important that employers recognise the business benefits these can bring - the firms embracing fringe benefits are reaping the rewards of better employee engagement, productivity and performance - as well as having happier staff."

The report, Improving Fringe Benefit Schemes for Low-earners, written by the Work Foundation and commissioned by the Joseph Rowntree Foundation, points employers to a 'framework of good practice' which outlines 7 steps to take to maximise the value of employee benefit schemes. Experts also say there is a need for better incentives and support to enable businesses to embed this framework, suggesting new resources, business advice services, mentoring, professional membership organisations or networks could be made available to help businesses progress.

Louise Woodruff, Policy and Partnerships Manager at the Joseph Rowntree Foundation, said: "It's not right that 3.7 million workers live in poverty. Businesses can help right the wrong of in-work poverty by making sure their fringe benefits schemes help with the cost of living for their lowest paid employees. It's great that employers invest in extra support for their employees but by thinking much more about design, uptake and digital skills they can maximise the potential for these schemes to help their lowest earning colleagues."

Heather Carey continues: "The UK needs to raise the bar in terms of job quality for low paid roles and establish a new minimum standard of benefits that employers should offer. This should be supported by new incentives that recognise and reward businesses that offer 'good work', including greater transparency in financial reporting and stronger 'kite-marking' to identify true responsible business."

While this finding is open to interpretation, the trend might have been prompted by the increased uncertainty experienced by some sectors of the population, in the wake of the vote, suggest the researchers.

Mental health service provision may need to be strengthened during such periods they add.

When the UK voted to leave the EU on 23 June 2016, the result was unexpected, and considerable uncertainty ensued as to how this would affect the British economy and society, say the researchers.

The evidence suggests that major societal events can affect a nation's mental health, and the researchers wanted to find out if the vote for Brexit might have had a similar impact.

They therefore compared official monthly prescribing data for antidepressants for all 326 voting areas in England with other classes of drugs for conditions less likely to be immediately affected by changes in mood.

These included drugs to treat iron deficiency anaemia, gout, insulins, thyroid problems, drugs to lower blood glucose and blood fats, and muscle relaxants.

The researchers looked at prescribing patterns specifically for the month of July for every year between 2011-16, to capture the immediate aftermath of the referendum result, and across each of those years to see if there were any discernible trends.

To ensure they could compare the different types of drugs, they calculated a 'defined daily dose,' or DDD for short, reached by quantifying the number of milligrams prescribed--derived from the number of pills in a box, multiplied by the strength of each pill.

The 326 voting areas were home to an average of 36.6 general (family doctor) practices, with an average population of 169,534 people in each area.

The number of DDDs prescribed was then divided by each voting area's population to estimate average prescribing levels per head, and these data were then combined with the referendum results for each area.

Analysis of the data showed that before the referendum, DDDs for antidepressants rose during the month of July year on year, as did prescribing for insulins and gout, iron deficiency anaemia, and blood fat and glucose drugs.

In the month after the referendum, DDDs for antidepressants continued to rise, albeit at a slower pace, but those for the other drugs fell, having experienced a period of growth. The only exception were prescriptions for muscle relaxants, which had already been in decline.

The researchers calculated that after the referendum the volume of antidepressants prescribed increased by 13.4 per cent relative to the other classes of drugs studied.

This is an observational study, and as such, can't establish cause. Antidepressants aren't prescribed to everyone, so the results can't be taken to mean that the mood worsened across the whole of England, nor can they rule out that mood actually improved for some people, emphasise the researchers.

"Overall, while our findings point towards a relative increase in antidepressant prescribing as measured by DDDs per capita, results should be interpreted with caution, and further research is needed to examine whether there is any short-term relationship between the referendum result and mental health," they write.

But they say: "Our study focused on an event that was unexpected, leading to an immediate shock. From a more general perspective, this paper shows that shocks nationally can affect health, and that uncertainty about, and expectations of, future effects can have an impact on health in the short term."

And they suggest: "Policies supporting mental health should be intensified in periods of uncertainty."

Policy makers may underestimate the potential costs of Brexit if they focus purely on the impact on the economy or immigration, and ignore any changes in psychological wellbeing that may ultimately affect economic performance and social cohesion, they add.

CHICAGO - MRI brain scans perform better than common clinical tests at predicting which people will go on to develop Alzheimer's disease, according to a study being presented next week at the annual meeting of the Radiological Society of North America (RSNA).

Alzheimer's disease is a progressive, irreversible brain disorder that destroys memory and thinking skills. The disease affects 5.5 million Americans, according to the National Institutes of Health.

"Alzheimer's disease is the most common cause of dementia in the world and is expected to increase globally, and especially in the U.S., as the population gets older," said the study's lead author Cyrus A. Raji, M.D., Ph.D., assistant professor of radiology at the Mallinckrodt Institute of Radiology at Washington University School of Medicine in St. Louis. "As we develop new drug therapies and study them in trials, we need to identify individuals who will benefit from these drugs earlier in the course of the disease."

Common predictive models like standardized questionnaires used to measure cognition and tests for the APOE4 gene, a gene variant associated with a higher risk of Alzheimer's disease, have limitations and--with accuracy rates of about 70-71 percent--fail to identify many people who go on to develop the disease.

MRI exams of the brain using diffusion tensor imaging (DTI) are a promising option for analysis of dementia risk. These exams assess the condition of the brain's white matter.

"With DTI you look at the movement of water molecules along white matter tracts, the telephone cables of brain," Dr. Raji said. "When these tracts are not well connected, cognitive problems can result."

DTI provides different metrics of white matter integrity, including fractional anisotropy (FA), a measure of how well water molecules move along white matter tracts. A higher FA value indicates that water is moving in a more orderly fashion along the tracts, while a lower value means that the tracts are likely damaged.

For the new study, Dr. Raji and colleagues set out to quantify differences in DTI in people who decline from normal cognition or mild cognitive impairment to Alzheimer's dementia compared to controls who do not develop dementia. They performed brain DTI exams on 61 people drawn from the Alzheimer's Disease Neuroimaging Initiative, a major, multisite study focusing on the progression of the disease.

About half of the patients went on to develop Alzheimer's disease, and DTI identified quantifiable differences in the brains of those patients. People who developed the disease had lower FA compared with those who didn't, suggesting white matter damage. They also had statistically significant reductions in certain frontal white matter tracts.

"DTI performed very well compared to other clinical measures," Dr. Raji said. "Using FA values and other associated global metrics of white matter integrity, we were able to achieve 89 percent accuracy in predicting who would go onto develop Alzheimer's disease. The Mini-mental State Examination and APOE4 gene testing have accuracy rates of about 70 - 71 percent."

The researchers conducted a more detailed analysis of the white matter tracts in about 40 of the study participants. Among those patients, the technique achieved 95 percent accuracy, Dr. Raji said.

While more work is needed before the approach is ready for routine clinical use, the results point to a future role for DTI in the diagnostic workup of people at risk for Alzheimer's disease. Many people already receive MRI as part of their care, so DTI could add significant value to the exam without substantially increasing the costs, Dr. Raji said.

Perhaps most importantly, MRI measures of white matter integrity could speed interventions that slow the course of the disease or even delay its onset.

"Research shows that Alzheimer's disease risk can be reduced by addressing modifiable risk factors like obesity and diabetes," Dr. Raji said. "With early detection, we can enact lifestyle interventions and enlist volunteers into drug trials earlier."

Rutgers scientists have developed catalysts that can convert carbon dioxide - the main cause of global warming - into plastics, fabrics, resins and other products.

The electrocatalysts are the first materials, aside from enzymes, that can turn carbon dioxide and water into carbon building blocks containing one, two, three or four carbon atoms with more than 99 percent efficiency. Two of the products created by the researchers - methylglyoxal (C3) and 2,3-furandiol (C4) - can be used as precursors for plastics, adhesives and pharmaceuticals. Toxic formaldehyde could be replaced by methylglyoxal, which is safer.

The discovery, based on the chemistry of artificial photosynthesis, is detailed in the journal Energy & Environmental Science.

"Our breakthrough could lead to the conversion of carbon dioxide into valuable products and raw materials in the chemical and pharmaceutical industries," said study senior author Charles Dismukes, Distinguished Professor in the Department of Chemistry and Chemical Biology and Department of Biochemistry and Microbiology at Rutgers University-New Brunswick. He is also a principal investigator at Rutgers' Waksman Institute of Microbiology.

Previously, scientists showed that carbon dioxide can be electrochemically converted into methanol, ethanol, methane and ethylene with relatively high yields. But such production is inefficient and too costly to be commercially feasible, according to study lead author Karin Calvinho, a chemistry doctoral student in Rutgers' School of Graduate Studies.

However, carbon dioxide and water can be electrochemically converted into a wide array of carbon-based products, using five catalysts made of nickel and phosphorus, which are cheap and abundant, she said. The choice of catalyst and other conditions determine how many carbon atoms can be stitched together to make molecules or even generate longer polymers. In general, the longer the carbon chain, the more valuable the product.

Based on their research, the Rutgers scientists earned patents for the electrocatalysts and formed RenewCO2, a start-up company. The next step is to learn more about the underlying chemical reaction, so it can be used to produce other valuable products such as diols, which are widely used in the polymer industry, or hydrocarbons that can be used as renewable fuels. The Rutgers experts are designing, building and testing electrolyzers for commercial use.

WASHINGTON, D.C., November 20, 2018 -- When professional divers jump from a springboard, their hands are perpendicular to the water, with wrists pointed upward, as they continue toward their plunge at 30 mph.

As they complete what's known as a rip dive, their hands remove water in front of the body, creating a cavity that reduces the initial impact force. The rest of the body, from head to toe, is aligned to shoot through the same cavity created by the hands.

Using the hands to create cavities in the water's surface is similar to the concept behind the fluid-structure studies that researchers at Utah State University are conducting using spheres.

Utah State researcher Rafsan Rabbi will present his team's research at the American Physical Society's Division of Fluid Dynamics 71st Annual Meeting, which will take place Nov. 18-20 at the Georgia World Congress Center in Atlanta, Georgia.

In one study, two consecutive spheres falling into a water tank were tested. The first sphere dropped into the water to create the cavity was made of steel. Five different sizes were used. The diameters ranged from 10 millimeters to 38 millimeters, but they were always smaller than the second sphere.

The second sphere, which went through the cavity, was made from 3D-printed Vero plastic. These spheres had a fixed diameter of 50 mm (or about 2 inches). Attached to each of these plastic objects was an accelerometer.

The researchers investigated how much acceleration the plastic spheres experienced as they went through the cavity created by the first steel spheres and calculated the force reductions from that. They found that the impact force of the plastic spheres was reduced by the steel ones by 40-60 percent.

"We have found that this 'free surface preparation' phenomenon can have a huge impact in reducing the initial high-impact force any object experiences while falling into a body of water," Rabbi said.

The research could have practical applications, such as lessening the blow of rockets landing unintentionally into the ocean.

A second study used Worthington jets instead of cavities to reduce the impact force. Such a jet results from a cavity collapsing on itself. The spacing between the two spheres were fixed in such a way that after the cavity collapses, the second sphere falls through the jet.

"This also reduced the impact force dramatically by up to 60 percent," said Tadd Truscott, director of the Splash Lab at Utah State who heads the research team. "Our studies show that prior preparations to the surface create a disturbance in the water surface to help cushion the impact of any falling object."

PROVIDENCE, R.I. [Brown University] -- On March 3, 2018, a liquid nitrogen storage tank at the University Hospitals Fertility Center in Cleveland failed. Dr. Eli Adashi, a professor of medical science at Brown University's Warren Alpert Medical School, characterized the event as a "tragic accident" in which 950 patients lost more than 4,000 frozen eggs and embryos.

However, one couple's wrongful death lawsuit following the incident, which seeks to establish that embryos should be treated as "persons" under the law, could have "a chain of profound implications for other families," Adashi says.

In an "Ideas and Opinions" article published on Nov. 20 in Annals of Internal Medicine, Adashi and co-authors I. Glenn Cohen, a professor of law at Harvard University, and Dov Fox, a professor of law policy and bioethics at the University of San Diego, wrote about the potential implications should the Ohio court hearing the case rule in favor of the couple. They argue that a ruling in favor of the plaintiffs could lead to limits on abortion, stem cell research and in vitro fertilization (IVF).

"It would be a sad irony if a legal claim aimed at protecting the rights of those who lost their ability to reproduce had the effect of limiting the reproductive rights of countless others," the authors wrote.

The plaintiffs in the case, Wendy and Rick Penniman, are challenging a legal precedent in Ohio establishing that "a fetus that is not yet viable is not a 'person' under its wrongful death law," the authors wrote. The challenge is based on "the grounds that the 'life of a person begins at the moment of conception,'" the article notes.

A ruling that embryos are "persons" could be used as grounds to limit abortion rights, the authors say, as well as to potentially restrict research on embryonic stem cells. There could be implications for the future of IVF as well.

"IVF would be significantly compromised," Adashi said. "If a clinician were to freeze embryos, and some do not survive the process, how would that be dealt with? Would that be manslaughter? One needs to view this suit in that context. The implications are of national interest. They go beyond the pro-life / pro-choice debate and reach into the very conduct of IVF and other fertility promotion techniques."

Legal limitations

The authors also discuss the limitations of conventional legal strategies tried in similar cases, including breach of contract, medical malpractice, negligent infliction of emotional distress, and loss of property.

Many fertility clinics require patients to sign waivers that explicitly excuse liability for storage failures due to negligence, limiting breach of contract suits, the authors wrote. Medical malpractice also doesn't apply in a case such as this, because the egg-harvesting procedures were performed properly. And in Ohio, negligent infliction of emotional distress requires the plaintiffs to be "bystanders" to a physical threat to another person; in this case, they did not witness the tank failure, the authors wrote.

The last strategy, loss of property and medical costs, doesn't fully capture the painful disruption of "family-building plans," Adashi said. However, these are the legal grounds the other 70 other patients affected by the accident are pursing in their class-action lawsuit.

The legal system hasn't established appropriate venues for seeking damages for the destruction of eggs or embryos, he added. "At this point, there's no clarity in the courts as to how to deal with cases like this."

Revising regulations

Accidents happen, but more needs to be done to limit and track them, Adashi said.

"It was a wake-up call for a lot of people in the field," he said. "How do we deal with something like this? How do we prevent something like this? Who should be in charge?"

Professional societies in the fertility field are evaluating the root cause of the incident and are working on new recommendations and guidelines, Adashi said, in an effort to avoid similar situations in the future.

The authors note that currently there are few federal regulations pertaining to assisted reproduction technologies and there is no system for tracking reproductive errors in the U.S. Because agents from the U.S. Food and Drug Administration (FDA) already visit IVF labs to screen donated human tissues for communicable diseases, Adashi says the FDA would be the most relevant agency to assume responsibility for the liquid nitrogen freezers involved in assisted reproduction clinics and track accidents involving eggs and embryos.

Workplace health promotion programs that encourage employees to take responsibility for their own weight may have detrimental effects for employees with obesity, reveals a new study. These range from feeling increasingly responsible for their weight but perceiving they have less control over it, to increased workplace weight stigma and discrimination. Ironically, these effects could even lead to increased obesity and decreased wellbeing. Published in Frontiers in Psychology, the study finds these pitfalls could be avoided through programs focusing on the employer's responsibility to maintain employee health.

"Who is responsible for obesity?" asks Professor Laetitia Mulder, of the University of Groningen in the Netherlands. "We are often told that it's someone's own responsibility, but people tend to forget that the institutions that shape our immediate environment strongly influence our behavior."

The workplace can have a huge impact on health, including weight. For instance, a canteen where healthy food is scarce or expensive compared with unhealthy food is likely to lead to unhealthy choices. From this perspective, employers bear some responsibility for employee health and weight.

In response to the high prevalence of obesity, employers are increasingly implementing workplace health promotion programs. However, many such programs highlight employee responsibility for obesity and ignore employer responsibilities. For instance, a sign in a canteen stating, "Watch your weight and choose healthy options!" is employee-focused, whereas an employer-focused policy would involve offering only healthy food options to support healthy eating.

Previous studies examining the effectiveness of workplace health promotion programs (many of which are employee-focused) have reported negligible or modest effects on employee weight. Mulder and colleagues believed that employee-focused programs may contribute to weight stigma and discrimination in the workplace and make employees with obesity feel that their weight is blameworthy. This could produce a range of adverse effects in affected people and ironically could lead to binge eating and increased obesity.

To investigate the phenomenon, the research team conducted a series of surveys and psychological tests on employees and a group of undergraduate student volunteers. They found that when people are confronted with concepts from an employee-focused health program, this increases weight stigma and weight-based discrimination compared with concepts from an employer-focused program. So, what does this mean?

"In general, people judged a woman with obesity in a photo to be lazy, unattractive, slow and as having less will-power compared with a woman without obesity," says Mulder. "However, this effect became stronger when people had been confronted with concepts from an employee-focused program."

Strikingly, this effect even extended to outright weight discrimination: people exposed to employee-focused health promotion concepts were more likely to prefer hiring a woman without obesity over a woman with obesity. This increased discrimination did not occur in people exposed to employer-focused health promotion concepts.

People with obesity found themselves in a catch-22 situation after exposure to employee-focused health promotion concepts, by feeling more responsible for their weight but less able to control it. This did not occur with employer-focused health promotion.

The researchers did not test the effects of a mix of employer- and employee-focused health promotion concepts, so further research may reveal whether a combination of approaches might work without the negative side-effects.

"When developing a health program, organizations should not solely focus on employee responsibility, but should look at what the organization can do to bring about healthy behavior," explains Mulder.

While obesity is a major health challenge, acknowledging where responsibility lies, while avoiding blame and stigmatization, is likely to provide an effective roadmap to better health.

ANN ARBOR, Mich. -- Parents who decline to get their child vaccinated against the flu may be exposed to a limited range of information, a new national poll suggests.

And depending on which sources parents turn to the most, inaccurate information may influence their decision about flu vaccine for their child.

Annual flu vaccination is recommended for all children six months and older, but nearly a third of parents say they are not planning to get their child the vaccine this year, according to the C.S. Mott Children's Hospital National Poll on Children's Health at the University of Michigan. The nationally-representative report is based on responses from 1,977 parents with at least one child ages 1-18.

Four in 10 parents overall say they base their decisions about the flu vaccine on what they read and hear - and those who do are less likely to have their child vaccinated than parents who follow their health care provider's recommendation.

Among parents who decided to get flu vaccine for their child, the most common source of information that made them want the vaccine was their child's health care provider, nurses and medical staff. However, 1 in 5 parents polled said their child's provider did not make any recommendations about the vaccination.

"Child health providers are a critical source of information to explain the rationale for annual flu vaccination and to address parents' questions about flu vaccine safety and effectiveness," says poll co-director Sarah Clark. "Without clear guidance from the provider, parents may be left with misinformation, such as the suggestion that flu vaccine causes the flu."

Parents who were unlikely to get flu vaccine for their child cited family, close friends, and other parents as the most common sources that made them either question the flu vaccine or opt against vaccinating their child.

And it wasn't just the source of the information. Parents who said they would not get flu vaccine for their child reported seven times as many sources that made them question or not want the vaccine as sources in support of vaccination. The volume of negative information may make it less likely that they will change their minds.

"There appears to be an echo chamber around flu vaccine," Clark says. "Parents who are not choosing flu vaccination for their child report hearing or reading opinions that question or oppose the vaccine. At the same time, parents who decided their child will get flu vaccine report opinions that largely support vaccination."

Clark says there are several possible explanations for this echo chamber. Some parents may seek out specific people and information sources who support their overall position on vaccines, so that what they hear and read is largely in line with their established opinions.

Other parents may encounter a broader range of information and opinions, but selectively remember only those that support their decision on whether their child will get flu vaccine.

"It's important to acknowledge that for some parents, child health providers are not the sole influence, or even the primary influence, on decisions about the flu vaccine," Clark says. "For these families, we need to explore other mechanisms to convey accurate information and allow parents to hear a more balanced viewpoint."

Despite the recommendation to get children vaccinated against the flu, the vaccine rate among U.S. children is much lower for flu than for other childhood vaccines. In the last flu season between fall 2017 through spring 2018, a record-setting 180 children died from influenza. Less than 60 percent of the children had received the flu vaccine.