Culture

UNIVERSITY PARK, Pa. -- Warm, nurturing parents may pass along strategies for building and maintaining positive relationships to their kids, setting them up for healthier, less-violent romantic relationships as young adults, according to researchers.

Researchers found that when adolescents reported a positive family climate and their parents using more effective parenting strategies -- like providing reasons for decisions and refraining from harsh punishments -- those adolescents tended to go on to have better relationship problem-solving skills and less-violent romantic relationships as young adults.

Mengya Xia, graduate student in human development and family studies, Penn State, said the results -- recently published in the Journal of Youth and Adolescence -- give insight on how early family relationships can have long-term impacts on young adult romantic relationships.

"During adolescence, you're starting to figure out what you want in a relationship and to form the skills you need to have successful relationships," Xia said. "The family relationship is the first intimate relationship of your life, and you apply what you learn to later relationships. It's also where you may learn how to constructively communicate -- or perhaps the inverse, to yell and scream -- when you have a disagreement. Those are the skills you learn from the family and you will apply in later relationships."

Xia said the ability to form close relationships is an important skill for adolescents and young adults to learn. Previous research has found that when young adults know how to form and maintain healthy relationships, they tend to go on to be more satisfied with their lives and be better parents.

Hoping to learn more about how early family experiences affects later romantic relationships, the researchers recruited 974 adolescents for the study.

At three points in time between sixth and ninth grade, the participants answered several questions about their families and themselves. They reported their family climate (if they tend to get along and support each other or fight often), their parents' discipline strategies (how consistent and harsh they were), how assertive they were, and if they had positive interactions with their parents.

When the participants reached young adulthood, at an average age of 19.5, the researchers asked them about their romantic relationships. They answered questions about their feelings of love for their partner, if they could constructively solve problems in the relationship, and if they were ever violent with their partner, either physically or verbally.

The researchers found that a positive family climate and effective parenting in adolescence were associated with better problem-solving skills in young adults' romantic relationships. Additionally, kids who had more positive engagement with their parents during adolescence reported feeling more love and connection in their young adult relationships.

"I think it was very interesting that we found that positive engagement with parents in adolescence was linked with romantic love in early adulthood," Xia said. "And this is important because love is the foundation for romantic relationships, it's the core component. And if you have a predictor for that, it may open up ways to help adolescents to form the ability to love in romantic relationships."

The researchers also found that a more cohesive and organized family climate and more effective parenting during adolescence was associated with a lower risk of violence in young adult relationships.

"Adolescents from families that are less cohesive and more conflictual may be less likely to learn positive-problem solving strategies or engage in family interaction affectionately," Xia said. "So in their romantic relationships, they are also less likely to be affectionate and more likely to use destructive strategies when they encounter problems, like violence."

Xia said the findings suggest ways to help adolescents build positive relationship skills at an early age, including encouraging assertiveness.

"In the study, we saw kids who were more assertive had better problem-solving skills in their later relationships, which is so important," Xia said. "If you can't solve a problem constructively, you may turn to negative strategies, which could include violence. So I think it's important to promote constructive problem solving as a way to avoid or diminish the possibility of someone resorting to destructive strategies in a relationship."

Researchers led by the University of Leicester have devised a 'risk score' which will be used to help frail older people have better support in hospital.

Using the concept of frailty (which captures vulnerability), researchers from the Nuffield Trust and the Universities of Leicester, Newcastle, Southampton and the London School of Economics have created a risk score that will help identify older people who are more vulnerable.

This will help commissioners and hospitals identify this group of people, evaluate their outcomes and improve services to be more responsive to their needs.

Professor Simon Conroy, from the University of Leicester Department of Health Sciences and Geriatrician at Leicester's Hospitals, said: "Leicester researchers are leading the way in improving outcomes for older people with frailty who have to come to hospital. Many older people attend hospitals throughout the UK every day, but some are more vulnerable than others.

"The 'Hospital Frailty Risk Score' was able to identify older people at significantly increased risk of harms, longer stays in hospital and readmission following discharge from hospital.

"It is hoped that by identifying and focussing upon this high risk group that hospitals will be able to provide more holistic care to vulnerable older people to improve their outcomes."

The research, funded by NIHR, is published in The Lancet.

TORONTO, April 26, 2018 – In the largest study of its kind, a three-minute version of a brain stimulation treatment was shown to be just as effective as the standard 37-minute version for hard-to-treat depression.

These results were published in a new Canadian study in The Lancet co-led by the Centre for Addiction and Mental Health (CAMH) and the University Health Network’s Krembil Research Institute, in collaboration with the University of British Columbia.

The treatment is called repetitive transcranial magnetic stimulation (rTMS), which is a form of treatment that uses magnetic field pulses to non-invasively stimulate a part of the brain called the dorsolateral prefrontal cortex, which is associated with mood regulation. The study compared standard rTMS treatment, which uses high frequency (10 Hz) brain stimulation for 37.5 minutes per session, with a newer form of rTMS called intermittent theta burst stimulation (iTBS), that mimics the brain’s natural rhythms and takes just over three minutes per treatment.

“The main impact of this study is that the number of people who are able to be treated using theta burst stimulation compared to the standard form of rTMS can be increased by three to four fold,” says lead author Dr. Daniel Blumberger, Co-Director of the Temerty Centre for Therapeutic Brain Intervention at CAMH.

“These findings will have a significant impact on our ability to treat patients,” says Dr. Jonathan Downar, Co-Director, University Health Network’s rTMS Clinic; Scientist, Krembil Research Institute and senior author of the study. “This will allow every device in Canada to treat several times more people per day, meaning shorter wait lists and better access to this treatment.”

The study, conducted with Dr. Fidel Vila-Rodriguez, Assistant Professor, University of British Columbia, focused on people with treatment-resistant depression, defined as a condition whereby people do not experience a sufficient improvement in their symptoms after trying antidepressant medications. Up to 40 per cent of people with depression may experience treatment resistance.

In the study, 414 participants were randomly allocated to receive either the standard form of rTMS treatment or the shorter iTBS treatment for five days a week for up to six weeks.

For 49 per cent of study participants who had the iTBS treatment, depression symptoms reduced significantly, with 32 per cent reporting a remission of depression symptoms. Those who received standard rTMS had a remission rate of 27 per cent. Those results are consistent with previous large-scale studies and meta-analyses over the past 20 years that have confirmed the efficacy and safety of the standard form of rTMS.

rTMS treatment was approved for treating depression by Health Canada in 2002 and by the U.S. Food and Drug Administration in 2008. Due to the cost of treatment (it is not covered by public health insurance outside Quebec and Saskatchewan), it has only been made available to a fraction of the estimated 600,000 Canadians living with treatment-resistant depression each year.

"rTMS has changed my life in so many ways," says study participant Shelley Hofer, 43, who has had treatment-resistant depression for most of her life. "I really wish it had been around a long time ago because I believe it would have been my go-to treatment. In my personal opinion, I feel rTMS could improve the lives of so many people who are still struggling to find the answers to their own mental illness."

Older adults are more likely to stick with a group exercise program if they can do it with people their own age, a new University of British Columbia study has found.

Working out with peers of the same gender doesn't seem to make a difference - it's the age that counts.

"This study points to the importance of age-targeting, but perhaps not gender-targeting, when developing these programs," says UBC kinesiology professor Mark Beauchamp, the study's lead author.

Older adults worldwide are less active than they should be, with activity levels lowest in the Americas. In Canada, fewer than 15 per cent of people past age 59 meet international physical activity guidelines. Beauchamp and his international team of researchers have been looking for ways to keep people active into old age, because inactivity has been shown to increase risk of cardiovascular disease, obesity and arthritis. It can also lead to physical limitations that affect overall quality of life.

The researchers knew from earlier studies that older adults prefer to exercise within their own age group. They wanted to find out whether preferences expressed by older adults in surveys would actually lead to greater adherence in practice.

The study recruited 627 adults, averaging 72 years in age, for 12-week exercise classes at YMCA locations in Metro Vancouver. Participants had the option to extend participation for another 12 weeks afterward. Researchers divided participants into three workout groups. One group was consistent in age and gender, while another was consistent in age but not gender. Those groups were led by older adult instructors recruited and trained for the study. The third group worked out in a typical YMCA class that was open to all ages and genders, led by a YMCA instructor.

Over the 24-week period, participants who worked out with people their own age attended an average of 9.5 more classes than counterparts in the mixed-age group. Participants in the mixed-age group averaged 24.3 classes. Participants in the same-age, mixed-gender group averaged 33.8 classes, and participants in the same-age, same-gender group averaged 30.7 classes.

The researchers' prediction that same-gender classes would lead to even greater adherence wasn't borne out by the results. This is significant, as it could free facilitators from the cost of providing separate classes for each gender unnecessarily.

Age and gender groupings weren't the only strategies researchers used to try to strengthen participants' commitment. Participants also received custom T-shirts that identified them as members of a group, and were given opportunities to socialize over coffee following class.

"All of this together points to the power of social connections," Beauchamp said. "If you set the environment up so participants feel a sense of connection or belonging with these other people, then they're more likely to stick with it."

Such strategies would be easy to employ in a variety of physical activity settings such as community centres, fitness clubs and retirement communities, the researchers noted.

In this case, study participants didn't want the classes to end. Rather than continue their workouts in regular classes, they successfully lobbied the YMCA to continue age-specific sessions after the experiment was over.

The study appears in the May issue of Health Psychology and was funded by a grant from the Canadian Institutes of Health Research.

New research from the University of Adelaide has found that taking vitamin B6 could help people to recall their dreams.

The study published online ahead of print in Perceptual and Motor Skills, included 100 participants from around Australia taking high-dose vitamin B6 supplements before going to bed for five consecutive days.

"Our results show that taking vitamin B6 improved people's ability to recall dreams compared to a placebo," says research author Dr Denholm Aspy, from the University's School of Psychology.

"Vitamin B6 did not affect the vividness, bizarreness or colour of their dreams, and did not affect other aspects of their sleep patterns.

"This is the first time that such a study into the effects of vitamin B6 and other B vitamins on dreams has been carried out on a large and diverse group of people," Dr Aspy says.

The randomised, double-blind, placebo-controlled study saw participants taking 240mg of vitamin B6 immediately before bed.

Prior to taking the supplements, many of the participants rarely remembered their dreams, but they reported improvements by the end of the study.

"It seems as time went on my dreams were clearer and clearer and easier to remember. I also did not lose fragments as the day went on," said one of the participants after completing the study.

According to another participant of the study, "My dreams were more real, I couldn't wait to go to bed and dream!"

Dr Aspy says: "The average person spends around six years of their lives dreaming. If we are able to become lucid and control our dreams, we can then use our dreaming time more productively.

"Lucid dreaming, where you know that you are dreaming while the dream is still happening, has many potential benefits. For example, it may be possible to use lucid dreaming for overcoming nightmares, treating phobias, creative problem solving, refining motor skills and even helping with rehabilitation from physical trauma.

"In order to have lucid dreams it is very important to first be able to recall dreams on a regular basis. This study suggests that vitamin B6 may be one way to help people have lucid dreams."

Vitamin B6 occurs naturally in various foods, including whole grain cereals, legumes, fruits (such as banana and avocado), vegetables (such as spinach and potato), milk, cheese, eggs, red meat, liver, and fish.

"Further research is needed to investigate whether the effects of vitamin B6 vary according to how much is obtained from the diet. If vitamin B6 is only effective for people with low dietary intake, its effects on dreaming may diminish with prolonged supplementation," says Dr Aspy.

ABERDEEN PROVING GROUND, MD. (April 23, 2018) -- Army scientists recently found that the best, high-performing cybersecurity teams have relatively few interactions with their team-members and team captain. While this result may seem counterintuitive, it is actually consistent with major theoretical perspectives on professional team development.

"Successful cyber teams don't need to discuss every detail when defending a network; they already know what to do," said Dr. Norbou E. Buchler, team leader with the U.S. Army Research Laboratory's Cyber and Networked Systems Branch

In a recent study, "Sociometrics and observational assessment of teaming and leadership in a cyber security defense competition" published in the latest issue of the Journal of Computers & Security scientists from the ARL, the National Cyberwatch Center and Carnegie Mellon University examined how collegiate cyber defense teams coordinate to mount and conduct an effective cyber defense during head-to-head team competition at the Mid-Atlantic Collegiate Cyber Defense Competition.

These teams were scored on four performance metrics while they attempted to defend their network against a cyber-attack campaign designed to disrupt critical U.S. infrastructure: maintaining networked services, responding to scenario events, assigned tasks by a role-playing chief executive officer and submitting incident reports to authorities.

Army researchers made use of Sociometric Badges (Humanyze Inc.), a sensing and recording device that students wore on a lanyard hanging from their neck. These badges collected data on a number of dimensions; the most valuable being face-to-face interactions between team members (via infrared sensors). In addition, Army researchers developed a questionnaire to measure the leadership style, task distribution, team meetings, communication and collaboration based on the opinions of the observers assigned to each team.

Teams with effective leadership and functional specialization within the team were more successful. Face-to-face interactions, as measured by the sociometric badges, emerged as a strong negative predictor of success in the competition, explained Buchler, a cognitive scientists within ARL's Human Research and Engineering Directorate.

"In other words, the teams whose members interacted less during the exercise, were usually more successful," Buchler said.

He said the results demonstrate that human collaboration and leadership of cybersecurity teams are essential when responding during a realistic cyber-attack.

"These results are important because current training programs commonly emphasize cyber security knowledge and do not provide training on effective team management," he said.

"The research also demonstrated the value of measures derived from recent advancements in wearables technology by capturing face-to-face interactions. Increasingly, such social sensing platforms are being leveraged by Army researchers, industry and academia to enhance human measurement and validate and refine theories regarding the factors influencing human performance and teamwork over time," Buchler said.

"High-performing teams exhibit fewer team interactions because they function as purposive social systems, defined as people who are readily identifiable to each other by role and position and who work interdependently to accomplish one or more collective objectives," continued Buchler, who referenced Tuckman's model in this understanding. "The responsibility for performing the various tasks and sub-tasks necessary to accomplish the team's goal is divided and parceled-out among the team."

The research team is part of the Army Research Laboratory's Cybersecurity Collaborative Research Alliance seeking to advance a foundational science of cybersecurity that addresses the human dynamics of attacker, defender, and user interactions to support training effectiveness and improve the operational efficiency and effectiveness of cyber operations.

Yelp reviews of nursing homes tend to focus more on staff attitudes, staff responsiveness and the physical facility itself than government reviews, a new USC study finds.

"Yelp reviewers are looking at different aspects of care than the government reviews," said Anna Rahman, a corresponding author and assistant research professor at the USC Leonard Davis School of Gerontology. "People want to know: How homey is it? How nice is it inside?"

Rahman and a team of six other researchers evaluated 264 Yelp reviews of California facilities and grouped them into five categories: the quality of staff care and staffing, physical building and setting, resident safety and security, clinical care quality and financial issues.

Just over 53 percent of the Yelp reviewers posted comments about staff attitude and caring. About 29 percent posted comments about staff responsiveness. Twenty-five percent discussed matters with cleanliness. Nearly 14 percent rated issues with meals.

The study was published on Friday in the journal The Gerontologist.

A difference in tone and ratings

Last November, Rahman and a team of researchers published a study in BMJ Quality and Safety that showed nursing home Yelp reviews tended to be more negative than those on the federal ratings website, Nursing Home Compare (NHC). Both sites use a five-star rating system, with one star the lowest rating and five stars as the best.

There are pros and cons to each rating system. Recent news reports and studies suggest some nursing homes game the government system, receiving multiple stars regardless of citations or staffing levels. Yelp, on the other hand, is sometimes criticized for fake reviews and ratings.

"It is hard to tell if the NHC system has been gamed," Rahman said. "You don't feel qualified to judge. But everybody knows how to weed through the Yelp ratings."

Valeria Cardenas, a study co-author and an incoming doctoral candidate at the USC Leonard Davis School, said that consumers are probably looking to determine how their loved ones will be treated.

"I would be worried if there was a review that said that the staff isn't responsive or they didn't take care of my father when he had rung the bell," said Cardenas.

For the study, the USC Davis School research team used data collected in 2014 by the California Office of Statewide Health Planning and Development. The researchers drew a geographically dispersed sample of 51 skilled nursing facilities, small and large, that had been rated on both the federal site and Yelp. Small facilities had, on average, around 58 beds while large ones had about 116 beds.

The team's research confirms prior studies showing that Yelp reviewers tend to focus on subjective experiences of health care, such as a reviewer's personal assessment of staff attitudes, the physical setting or the cost of care.

The USC gerontologists noted that such aspects of nursing homes are not rated on the federal government's Nursing Home Compare site. Instead, the federal site focuses on matters such as staffing levels, clinical issues such as infections, and the use of restraints for some patients.

What matters clinically? Their health

"Yelp is not focused on the clinical aspects of care, such as how often are staff turning residents with pressure sores, and did patients get their pneumonia shot or the flu shot," Rahman said. "We found that what is most important clinically to Yelp reviewers is whether their loved one got better."

Nearly 15 percent of the Yelp reviews mentioned whether their loved ones worsened or improved while at a particular nursing home.

Study co-author and USC incoming doctoral candidate Yujun Zhu said the study emphasizes the importance of turning to multiple sources to make a well-informed decision for nursing home care.

"I would start with Yelp and then I would visit Centers for Medicare and Medicaid Services. On the government site, I would look through the inspection reports," Zhu said. "I would focus on things like abuse and other health care deficiencies that are important to residents and caregivers."

"Strikingly, we found no consumer guides on choosing a nursing home that pointed decision-makers to online reviews," Rahman said. "These guides may be overlooking the value of these increasingly popular information sources."

WASHINGTON, DC (April 26, 2018) -- Researchers at the George Washington University (GW) are at the forefront of analyzing how climate lawsuits shape the nation's response to climate change. A new analysis investigates the role of health concerns in climate litigation since 1990 and finds that although health is cited in a minority of cases, it may have critical potential for protecting communities from the effects of climate change and coal fired power plants.

"Many experts believe that climate change is the biggest threat to public health in the 21st century, and the courts have been and will continue to be a central avenue for the development of climate-related policy in the United States," says lead author Sabrina McCormick, PhD, an Associate Professor of Environmental and Occupational Health at Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University.

McCormick and her colleagues in the Milken Institute School of Public Health's Department of Epidemiology and Biostatistics, George Washington University Law School, and the university's Trachtenberg School of Public Policy and Public Administration looked at 873 judicial decisions related to climate change and coal-fired power plants between 1990 and 2016. They found that a minority of cases (16 percent) associated with those decisions referenced health issues. Health was most likely to be invoked in cases related to air pollution. Past research has linked air pollution to a wide range of health problems, including asthma, McCormick notes.

The GW researchers pointed to lawsuit types that might be supported with evidence regarding health, such as renewable energy and energy efficiency included health issues. An example, they say, is the ability of health claims to help litigants gain standing to bring a case to court. In their article, they recommend the explicit statement of health benefits from reductions in impacts associated with climate change. They argue that climate change may follow examples such as tobacco and other health protections in which the courts played a central role in protecting public health.

"The courts represent a pivotal branch of government in climate policy formation," McCormick and her co-authors say. "Increasing inclusion of health concerns in emergent areas of litigation could catalyze effective climate policy-making."

McCormick has been studying the impacts of climate change on human health for over a decade. Her experience includes serving as the lead author on the Special Assessment of the Nobel Prize-winning Intergovernmental Panel on Climate Change.

"The Role of Health in Climate Litigation" will appear online April 26 in The American Journal of Public Health.

NEW YORK (April 26, 2018)--Researchers at Columbia University's Mailman School of Public Health and the Columbia Aging Center found men with a stronger grip were more likely to be married than men with weaker grips. Grip strength was not a factor in the marital status of women. The findings are published online in the journal SSM-Population Health.

Grip strength is an established measure of health and has previously been linked to one's ability to cope independently and predicts the risk of cardiovascular diseases and mortality.

"Our results hint that women may be favoring partners who signal strength and vigor when they marry," said Vegard Skirbekk, PhD, professor, Columbia Aging Center and Mailman School professor of Population and Family Health. "If longer-lived women marry healthier men, then both may avoid or defer the role of caregiver, while less healthy men remain unmarried and must look elsewhere for assistance."

Using a population-based study of 5,009 adults from the Norwegian city of Tromsø, the researchers examined the relationship of marital status to grip strength in two successive groups of people: those born 1923-35 and 1936-48, assessing the association between respondents' marital status and grip strength when respondents were aged 59 to 71. These data were matched with the Norwegian national death registry. Handgrip strength was assessed using a vigorimeter, a device that asks participants to squeeze a rubber balloon.

Grip strength is particularly important for older adults, and has implications for a host of health risks--for heart disease and factures, physical mobility, the capacity to be socially active and healthy, and to enjoy a good quality of life. At the same time, marriage confers many of these same benefits.

The researchers found greater numbers of unmarried men with low grip strength in the second cohort--those born 1936-48--than in the first cohort, reflecting societal trends that have increasingly deemphasized the importance of marriage. "In recent decades, women are less dependent on men economically. At the same time, men have a growing 'health dependence' on women," says Skirbekk. "The fact that many men are alone with a weak grip--a double burden for these men who lack both strength and a lack of support that comes from being married--suggests that more attention needs to be given to this group, particularly given their relatively poor health."

Policies to help this population might include housing arrangements that encourage social interaction and counselling to better prepare these individuals for old age and information on how to avoid negative health consequences of independent living. "New technologies may potentially offset some of the limitations that low grip strength may imply," says Skirbekk. "Social policies could also increasingly target this group by providing financial support for those who suffer the double-burden of low strength and lack of spousal support."

Skin cancer cases attributable to work-related sun exposure could be costing millions of dollars, and must be better addressed by policymakers.

A new study, published today in the Journal of Occupational and Environmental Hygiene, has estimated the total and per-case costs of newly diagnosed non-melanoma skin cancers (NMSCs) in Canada in 2011 caused by workplace sun exposure.

Using a range of secondary sources, including official government records and health surveys, researchers revealed the true economic burden of NMSCs, which cost $34.6 million in 2011 Canadian dollars.

These costs were made up of a range of lifetime costs, including healthcare treatment, the impact of time away from work, out-of-pocket expenses, and poor life quality.

Further analyses highlighted the sizeable cost per patient for the two most common types of non-melanoma skin cancer: basal-cell and squamous-cell carcinoma. The figure stood at $5,760 per case for basal-, and $10,555 per case for squamous-cell carcinoma.

One of the few cancers that are increasing in incidence, skin cancers are the most common form of cancer in Canada and other countries with large fair-skinned populations.
Roughly one in ten Canadian workers are exposed to solar ultraviolet (UV) radiation at work, and the majority of these spend six hours or more outdoors each day.

With solar UV radiation the main cause of skin cancer, the researchers hope that their landmark findings can persuade policymakers to give greater attention to reducing workplace sun exposure - both within and outside of Canada. The occupations deemed most at risk - construction, farming, and landscaping - are not exclusive to Canada.

As the study's principal investigator, Dr. Emile Tompa, a senior scientist at Canada's Institute for Work & Health, commented: "The findings suggest that policy-makers might give greater priority to reducing sun exposure at work by allocating occupational cancer prevention resources accordingly."

"The results can also raise awareness among policymakers, employers, unions and workers about the significant contribution of workplace sun exposure to skin cancers. These groups can now make a strong cost-benefit argument for inexpensive exposure reduction interventions, such as shade structures, hats and loose clothing, sunscreen, and shift scheduling to reduce the amount of time workers spend in the sun."

The study, which was funded by the Canadian Cancer Society, is the first to comprehensively estimate the economic burden of workplace NMSCs caused by sun exposure in Canada. It is hoped that the approach can be adapted to carry out similar economic burden estimates in other countries.

The research group of Alex Schier, Director of the Biozentrum, University of Basel, has investigated more closely how a single embryonic cell develops into a heart, nerve or blood cell. For the first time, the researchers have been able to reconstruct the developmental trajectories of individual embryonic cells. Their results also suggest that cells can change their path during their maturation process. The results of the study with around 40,000 cells have now been published in Science.

The origin of every cell of our body is a single cell, the fertilized egg. On the way to become a specialized cell, whether blood, heart or nerve cells, its descendants follow a genetic program. This program determines the identity of a cell, its features and function.

The research team led by Alex Schier, Director of the Biozentrum, University of Basel, and currently still research group leader at Harvard University in Cambridge, has now developed a new method that enables the scientists for the first time to trace the entire history of the differentiation of individual cells. By combining the differentiation trajectories they have been able to construct a full developmental tree for embryogenesis. Furthermore, the team discovered that during differentiation, cells can leave their path and thus change their identity.

A widely branched tree for cell development

In their study, the team isolated around 40,000 cells and 25 different cell types that form in zebrafish over a period of nine hours. To investigate the maturation of these cells, they analyzed the RNA, a copy of the genetic material. "The RNA tells us, which genes are active and determines the function and characteristics of a cell", says Schier.

In order to merge and compare the data, Schier's team developed a new software (URD). While previous studies in this field are based on the examination of a handful of genes, the new high-throughput single-cell RNA sequencing method enables the analysis of all active genes during cell development. With this new technology, the team has been able to reconstruct, for the first time, a widely branched tree that traces the development of each individual cell, starting with the fertilized egg cell. In addition, they mapped the cells to their spatial origin in the early embryo.

Finding cell identity is more flexible than expected

The results show that the genetic program that a cell follows on the way to maturity is by no means set in stone. "It seems that the developmental path of a cell is more flexible than we previously expected", says Alex Schier. So far, it was assumed that developing cells follow a predetermined path, like marbles rolling down a hill until they stop at their predestined place. The study now suggests that signals from the environment can have such a strong influence on the cells, that they leave the initial trajectory and change their path, thus taking on a new identity.

Entire development as a cell lineage tree

In a next step, the research group will expand the cell lineage tree, investigate more cell types and follow the development of cells over a longer period of time. "My aim is to merge the developmental trajectories and the lineage trees to one complete whole. If we can understand the logic behind cell differentiation, we may, one day, be able to answer the question: How many ways are there to build a heart or a brain?"

Wines and beers labelled as lower in alcohol strength may increase the total amount of alcoholic drink consumed, according to a study published in the journal Health Psychology. The study was carried out by the Behaviour and Health Research Unit at the University of Cambridge in collaboration with the Centre for Addictive Behaviours Research at London South Bank University.

Alcohol is the fifth leading cause of disease and premature death both in the UK and globally. Reducing consumption of alcohol is a public health priority in many countries. In the UK, as part of a range of steps to reduce overall alcohol consumption, policymakers are currently interested in allowing industry to label a wider range of alcohol products as lower in alcohol.

Proposed legislative changes include extending the variety of terms that could be used to denote lower alcohol content, and extending the strength limit to include products lower than the current average on the market (12.9% ABV for wine and 4.2% ABV for beer*).

"For lower strength alcohol products to reduce consumption, consumers will need to select them in place of equal volumes of higher strength products," says Dr Milica Vasiljevic from the University of Cambridge. "But what if the lower strength products enable people to feel they can consume more?"

In this study, two-hundred and sixty-four weekly wine and beer drinkers - sampled from a representative panel of the general population of England - were randomised to one of three groups to taste test drinks in a laboratory designed to mimic a bar environment. The drinks varied only in the label displayed. In one group participants taste-tested drinks labelled 'Super Low' and '4%ABV' for wine or '1%ABV' for beer. In another group the drinks were labelled 'Low' and '8%ABV' for wine or '3%ABV' for beer. In the final group participants taste-tested drinks labelled with no verbal descriptors of strength, but displaying the average strength on the market - wine ('12.9%ABV') or beer ('4.2%ABV').

The results showed the total amount of drink consumed increased as the label on the drink denoted successively lower alcohol strength. The mean consumption of drinks labelled 'Super Low' was 214ml, compared with 177ml for regular (unlabelled) drinks. Individual differences in drinking patterns and socio-demographic indicators did not affect these results.

"Labelling lower strength alcohol may sound like a good idea if it encourages people to switch drinks, but our study suggests it may paradoxically encourage people to drink more," says Professor Theresa Marteau, senior author and Director of the Behaviour and Health Research Unit.

While this study shows that people may drink more if drinks are labelled as lower in strength, the researchers do not yet know if this effect is sufficient to result in the consumption of more units of alcohol overall from lower strength alcohol drinks. Furthermore, participants in this study were tested in a bar-laboratory setting. To learn more about the impact of lower strength alcohol labelling, research in real-world settings is needed.

The study was funded by the Department of Health.

A study led by Massachusetts General Hospital (MGH) investigators may lead to a significant expansion in the number of stroke patients who can safely be treated with intravenous tPA (tissue plasminogen activator), the "clot busting" drug that has greatly reduced stroke-related disability and deaths in eligible patients. The report, published online in Annals of Neurology, describes the results of a trial using MR-based imaging technologies to identify patients likely to be within 4.5 hours of stroke onset, even though their initial symptoms had not been witnessed.

"In up to 25 percent of stroke patients, the start of their symptoms is unwitnessed, preventing them from receiving tPA," says Lee Schwamm, MD, executive vice chair of the MGH Department of Neurology and director of the MGH Comprehensive Stroke Center, co-lead and corresponding author of the paper. "For many of these patients, the first time anything is noticed is when they get up from sleeping. Our study showed - for the first time - that tPA could be given safely to patients with stroke of unwitnessed onset if their imaging suggested the stroke was very early in its progression and they met other treatment criteria. These results pave the way for a large randomized trial of tPA in patients with unwitnessed strokes."

First approved by the FDA in 1996, tPA - also called alteplase - is used to treat ischemic strokes, which are caused when a blood clot blocks circulation within the brain. The safe use of tPA requires determining that the stroke was not caused by the rupture of a blood vessel, in which case tPA would make matters worse, and that too much time has not gone by between the onset of symptoms and tPA administration, since restoration of blood flow to tissue that has incurred too much damage may cause additional harm.

The original time limit for tPA administration was 3 hours from symptom onset, and the results of a subsequent clinical trial expanded that window to 4.5 hours in 2009. But for patients whose initial symptoms were not witnessed and who were more than 4.5 hours since they were last known to be well, tPA is not approved for use; and this restriction can affect the care of 25 to 30 percent of ischemic stroke patients arriving at hospital emergency departments. A few small studies have reported good outcomes when such patients, specifically those with so-called wake-up strokes, were administered tPA on the basis of MRI studies consistent with the early effects of ischemic stroke.

In the current study, 80 patients with imaging-confirmed ischemic stroke of unwitnessed onset, who were less than 24 hours since they were last known to be well, were enrolled at 14 centers across the U.S. Study eligibility was determined by a mismatch between two types of MR imaging studies - FLAIR, which typically only shows stroke effects on brain tissue after several hours of reduced blood flow, and diffusion-weighted imaging (DWI), a technique first applied to stroke patients at the MGH-based Athinoula A. Martinos Center for Biomedical Imaging that is extremely sensitive to changes beginning in the first minutes or hours after stroke onset.

Study co-lead author Ona Wu, PhD, of the Martinos Center explains, "Brain tissue that is abnormal on DWI but not yet abnormal on FLAIR has been seen in patients that were 4 hours or less after known symptom onset. That discrepancy provides a snapshot of tissue evolution as the stroke progresses in the first few hours, and that is the pattern we used to select patients for treatment, since they were likely to be similar to patients with known symptom onset who have benefited from tPA. Essentially we used an MR Witness - the name of the trial - to identify patients who might be treated with tPA because their strokes had not progressed to the point of irreversible injury."

The outcomes for study participants - all of whom received tPA on the basis of the strategy that the research team calls qDFM, for quantitative DWI FLAIR Mismatch - were similar to those previously reported for patients receiving tPA within 4.5 hours of witnessed strokes. The authors note that more than 70 percent of study participants had experienced wake-up strokes, and that the onset of symptoms may have led to the patients' awakening. On the basis of these results, the researchers hope to conduct a follow-up, placebo-controlled trial that will also compare MR with CT imaging for the identification of patients with unwitnessed strokes who could safely and effectively be treated with tPA.

"If that phase 3 study is successful, it would lead to a paradigm shift in the way acute stroke patients are treated," says Schwamm, who is a professor of Neurology at Harvard Medical School. "Rather than treating based on the number of hours since a stroke began, we can treat based on how much damage the stroke has already caused and how much brain can still be saved. Because the imaging methods we will use in our phase 3 study are available on any MRI or CT scanner in use today, if the results of that trial are positive, the approach could be put into practice immediately."

Long-term use of some anticholinergic medications are associated with an increased risk of dementia - according to a new study led by the University of East Anglia (UK).

Anticholinergic antidepressants have been found to be linked with dementia, even when taken up to 20 years before a diagnosis. Examples of frequently-prescribed anticholinergic antidepressants include Amitriptyline, Dosulepin and Paroxetine.

The research, funded by Alzheimer's Society and published today in the BMJ, also shows a dementia risk associated with medications prescribed for bladder conditions (for example Tolterodine, Oxybutynin and Solifenacin), and Parkinson's (for example Procyclidine).

However several other anticholinergic medications, including anti-histamines and those used for abdominal cramps, were not found to be linked to dementia - despite previous research suggesting that any anticholinergic might represent a risk.

Anticholinergic drugs are used to treat a variety of conditions and work by blocking a key messenger (neurotransmitter) in the body called acetylcholine.

The research team studied the medical records of 40,770 patients aged over 65 diagnosed with dementia, and compared them to the records of 283,933 people without dementia. More than 27 million prescriptions were analysed.

This is the largest and most detailed study of its kind into the long-term impact of anticholinergic use in relation to dementia.

The team drilled down to see whether there were links between different classes of anticholinergic medication and incidence of dementia diagnosis.

They found that there was a greater incidence of dementia among patients prescribed greater quantities of anticholinergic antidepressants, and anticholinergic medication for bladder conditions and Parkinson's.

The link between these medications and dementia cannot tell us that they are directly causing the condition, but this work does suggests a potential preventative approach to reduce dementia which is a priority.

The study concludes that clinicians should consider long-term anti-cholinergic effects when prescribing.

Patients with concerns should continue taking their medicines until they have consulted their doctor or pharmacist.

Lead researcher Dr George Savva from UEA's School of Health Sciences said: "More than 50 million people worldwide are affected by dementia and this number is estimated to be 132 million by 2050. Developing strategies to prevent dementia is therefore a global priority.

"We studied patients with a new dementia diagnosis and looked at what anticholinergic medication they were prescribed between four and 20 years prior to being diagnosed.

"We found that people who had been diagnosed with dementia were up to 30 per cent more likely to have been prescribed specific classes of anticholinergic medications. And the association with dementia increases with greater exposure to these types of medication.

"What we don't know for sure is whether the medication is the cause. It could be that these medications are being prescribed for very early symptoms indicating the onset of dementia.

"But because our research shows that the link goes back up to 15 or 20 years before someone is eventually diagnosed with dementia, it suggests that reverse causation, or confounding with early dementia symptoms, probably isn't the case.

"This research is really important because there are an estimated 350 million people affected globally by depression, and bladder conditions requiring treatment are estimated to affect over 13 per cent of men and 30 per cent of women in the UK and US.

"Many of the treatment options for these conditions involve medication with anticholinergic effects.

Dr Doug Brown, Chief Policy and Research Officer at Alzheimer's Society, said: "This large study confirms that some anticholinergic drugs can raise the risk of dementia - but it should also put minds at ease as there appears to be no dementia risk with anticholinergic drugs used to treat common conditions like hayfever, travel sickness and stomach cramps.

"Current guidelines for doctors say that anticholinergic drugs should be avoided for frail older people because of their impact on memory and thinking, but doctors should consider these new findings for all over-65s as long-term use could raise the risk of dementia."

Dr Noll Campbell, a collaborator and co-author on the paper, said: "These results suggest we should prioritise safer alternatives to anticholinergic medications long before symptoms of dementia are recognised." Dr Campbell is an investigator with the Regenstrief Institute and Indiana University Center for Aging Research and is an assistant professor with Purdue University College of Pharmacy in the United States.

The study used data from Clinical Practice Research Datalink which includes anonymised diagnosis, referral and prescription records for more than 11 million patients from 674 primary care practices across the UK. The data is broadly representative of the UK population in terms of age, sex and ethnicity.

Prof Chris Fox, Professor of Clinical Psychiatry at UEA's Norwich Medical School and Consultant Psychiatrist, said: "While the associations are moderate, given the high incidence of dementia, they reflect a potentially important risk to patients.

"Doctors and patients should therefore be vigilant about using anticholinergic medications.

"They need to consider the risk of long-term cognitive effects, as well as short-term effects, associated with specific drugs when weighing up risks and benefits.

"We don't know exactly how anticholinergics might cause dementia. Further research is needed to understand possible reasons for this link. In the meantime, I strongly advise patients with any concerns to continue taking their medicines until they have consulted their doctor or pharmacist."

Dr Ian Maidment, Senior Lecturer in Clinical Pharmacy at Aston University and lead pharmacist on the study, said: "We already have strong evidence that anticholinergics cause confusion and in the short-term will potentially worsen the symptoms of dementia. Long-term data is more difficult to obtain, because clinical trials tend be short term.

"This study shows that some anticholinergics may cause long-term harm in addition to short-term harm.

"Other recent research has shown a dramatic increase in polypharmacy - the number of older people taking five or more medicines has quadrupled over 20 years to nearly half of all older people.

"With many different medicines having at least some anticholinergic activity, one focus should be de-prescribing. Doctors, nurses and pharmacists need to work with older people and their carers to ensure that they only take medication if the benefits clearly outweigh the harms."

SAN DIEGO - The Society for Cardiovascular Angiography and Interventions (SCAI) has released new guidelines to address the selection of specific categories of devices when endovascular therapy (EVT) is indicated. The purpose of this document, which is the first of its kind, is to provide a review of comparative effectiveness data, including safety and efficacy of femoral-popliteal (FP) devices, and to provide clinicians with guidance and recommendations for device selection when these devices are intended as the definitive or adjunctive therapy. The document is available in early-view online in SCAI's official journal, Catheterization and Cardiovascular Interventions.

There is widespread uncertainty about device selection for EVT due to clinicians having many options and opinions with limited data to distinguish between them. The SCAI writing group reviewed and considered data on safety, efficacy, and cost-effectiveness when making device-specific recommendations. Data sources included randomized clinical trials, meta-analyses, nonrandomized trials, observational studies, case series and registry data.

"SCAI has a long history of prioritizing quality initiatives in the field of endovascular therapy for peripheral artery disease. Device choices for endovascular therapy, particularly in the femoral-popliteal interventions, remain challenging due to a wide spectrum of available device options and a paucity of comparative effectiveness data," said Dmitriy Feldman, MD, FSCAI, chair of the writing group. "Current guidelines do not address the selection of specific devices when endovascular therapy is indicated. This is the first SCAI-led device-focused consensus guidelines document, which provides a focused review of comparative effectiveness and safety data for femoral-popliteal devices," Dr. Feldman continued.

The document, which makes recommendations for both definitive and adjunctive therapy scenarios, identified several areas for future research, including trials on value and cost-effectiveness of devices in specific clinical circumstances and lesion subsets. In addition, the guidelines recommend that future studies adopt the Peripheral Academic Research Consortium (PARC) definitions for clinically meaningful outcomes and endpoints. The recommendations in this consensus guidelines document are a first step to provide clinicians with relevant anatomical scenarios to guide device selection based on strength and quality of evidence for comparative effectiveness, durability, and expert opinion.