Body

June 7, 2019--E-cigarette vaping with nicotine appears to hamper mucus clearance from the airways, according to new research published online in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

In "Electronic Cigarette Vapor with Nicotine Causes Airway Mucociliary Dysfunction Preferentially via TRPA1 Receptors," a team of researchers from the University of Kansas, University of Miami and Mt. Sinai Medical Center in Miami Beach reports that exposing human airway cells to e-cigarette vapor containing nicotine in culture resulted in a decreased ability to move mucus or phlegm across the surface. This phenomenon is called "mucociliary dysfunction." The researchers report the same finding in vivo in sheep, whose airways mimic those of humans when exposed to e-cigarette vapor.

"This study grew out of our team's research on the influence of tobacco smoke on mucus clearance from the airways," said senior author Matthias Salathe, MD, chair of internal medicine and a professor of pulmonary and critical care medicine at the University of Kansas Medical Center. "The question was whether vape containing nicotine had negative effects on the ability to clear secretions from the airways similar to tobacco smoke. "

Mucociliary dysfunction is a feature of many lung diseases, including asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis. Specifically, the study found that vaping with nicotine impairs ciliary beat frequency, dehydrates airway fluid and makes mucus more viscous or sticky. These changes make it more difficult for the bronchi, the main passageways to the lung, to defend themselves from infection and injury.

The researchers note that a recent report found that young e-cigarette users who never smoked were at increased risk to develop chronic bronchitis, a condition characterized by chronic production of phlegm that is also seen in tobacco smokers.

Dr. Salathe said the newly published data not only support the earlier clinical report, but help explain it. A single session of vaping can deliver more nicotine to the airways than smoking one cigarette. Moreover, according to Dr. Salathe, absorption into the bloodstream is lower, possibly exposing the airways to high nicotine concentrations for prolonged periods of time.

The study also found that nicotine produced these negative effects by stimulating the ion channel transient receptor potential ankyrin 1 (TRPA1). Blocking TRPA1 reduced the effects of nicotine on clearance in both the human cells in culture and in the sheep.

"Vaping with nicotine is not harmless as commonly assumed by those who start vaping, At the very least, it increases the risk of chronic bronchitis." Dr. Salathe said. "Our study, along with others, might even question e-cigarettes as a harm reduction approach for current smokers with respect to chronic bronchitis/COPD."

SAN ANTONIO - A web-based caffeine optimization tool successfully designs effective strategies to maximize alertness while avoiding excessive caffeine consumption, according to preliminary results from a new study.

Using multiple sleep-deprivation and shift-work scenarios, the researchers generated caffeine-consumption guidance using the open-access tool 2B-Alert Web 2.0, and then they compared the results with the U.S. Army guidelines. Their analysis found that the solutions suggested by the quantitative caffeine optimization tool either required on average 40% less caffeine or enhanced alertness by an additional 40%.

"Our 2B-Alert Web tool allows an individual, in our case our service members, to optimize the beneficial effects of caffeine while minimizing its consumption," said principal investigator Jaques Reifman, Ph.D., a Department of the Army Senior Research Scientist for Advanced Medical Technology, serving at the U.S. Army Medical Research and Development Command at Ft. Detrick, Maryland.

According to the authors, caffeine is the most widely consumed stimulant to counter the effects of sleep deprivation on alertness. However, to be safe and most effective, the right amount must be consumed at the right time.

Last year at SLEEP 2018 in Baltimore, Reifman presented data comparing the algorithm with the caffeine dosing strategies of four previously published experimental studies of sleep loss. The current study extended his team's previous work by incorporating the automated caffeine-guidance algorithm in an open-access tool so that users can input several factors: the desirable peak-alertness periods within a sleep/wake schedule, the minimum desirable level of alertness, and the maximum tolerable daily caffeine intake.

With this added capability, the 2B-Alert Web 2.0 tool now allows users to predict the alertness of an "average" individual as a function of his or her sleep/wake schedule and caffeine schedule. It also enables users to automatically obtain optimal caffeine timing and doses to achieve peak alertness at the desired times.

This freely available tool will have practical applications that extend beyond the realms of the military and the research lab, noted Reifman.

"For example, if you pull an all-nighter, need to be at peak alertness between, say, 9 a.m. and 5 p.m., and desire to consume as little caffeine as possible, when and how much caffeine should you consume?" he said. "This is the type of question 2B-Alert was designed to answer."

The research abstract was published recently in an online supplement of the journal Sleep and will be presented Wednesday, June 12, in San Antonio at SLEEP 2019, the 33rd annual meeting of the Associated Professional Sleep Societies LLC (APSS), which is a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society.

COLUMBUS, Ohio - Careful documentation of a hospice patient's end-of-life wishes - and prominently noting that information in health records early - could prevent unwanted hospitalizations and medical interventions, a new study suggests.

Researchers at The Ohio State University analyzed the health records of 1,185 cancer patients who had been referred to hospice and found that a verified do-not-resuscitate order, or DNR, before the last 30 days of life reduced the odds of hospitalization. A prominent note in the electronic health record indicating advanced care planning (for example, discussions with providers on legal directives, a living will or a health care power of attorney) also reduced the chances of admission - especially if that note was made at least six months prior to death.

Once a terminally ill patient transitions into hospice care, the goal is to avoid hospitalizations and procedures that are unnecessary and unwanted, said Laura Prater, the study's lead author and a postdoctoral researcher in the Division of General Internal Medicine at Ohio State's College of Medicine.

The aim is twofold: to respect the wishes of the patient and to focus on quality of life and pain management. On top of that, keeping hospice patients out of the hospital reduces medical costs.

"Our research supports the importance of sharing your wishes with your physician and your family, and suggests that doing that earlier can prevent unwanted procedures and hospitalizations that don't align with your priorities and deteriorate your quality of life," Prater said.

The study was recently published online in the American Journal of Hospice & Palliative Medicine.

It's important for physicians and others on a patient's care team to have conversations that address that person's values and goals, including what to do if his or her illness is no longer treatable, said Seuli Bose-Brill, the study's senior author and an Ohio State Wexner Medical Center primary care physician who specializes in internal medicine and pediatrics.

"These study results really support the idea that earlier is better for documenting these wishes. Those who had advanced care planning notes in their health records six months or more before a hospital trip were significantly less likely to be admitted," Prater said.

Specifically, the researchers looked at the "problem list" on the medical record - an easy-to-spot synopsis of that person's health status. When advanced care planning was noted there more than six months before the final month of life, hospitalization was least likely.

Previous studies have found that only 13 to 44 percent of terminally ill patients have documentation of advanced care planning in their electronic health records and that the location and ease of finding that documentation is inconsistent.

In times of crisis, hospice patients often are not in a position to advocate their own priorities and family members can be unsure, afraid or in disagreement about those wishes, complicating matters. When the medical team can easily see in the electronic health record that the patient has documented his or her wishes, it eases their ability to act in the patient's best interest, Bose-Brill said.

"I think everyone in medicine is aware that we need to do a better job documenting end-of-life wishes, but as a nation we haven't figured out how best to do that," she said.

Prater said this study could prompt discussions within medical practices and hospitals about how to consistently discuss and document advanced care planning for patients.

"It's important to make this part of the process, to look for ways to make sure that these conversations are happening consistently, early and often, even though they are complex and difficult conversations to have," Prater said.

And the topic shouldn't only come up when transitioning to hospice, Bose-Brill said, because that is a time that can be particularly fraught with emotion and grief and not always the best opportunity to broach the subject.

"The earlier we start this process, the more it normalizes it," she said.

"There are so many opportunities to explore these issues that patients and families are grappling with and we in health care need to not absolve ourselves of our responsibility to talk about these things."

Philadelphia, June 6, 2019 - Obese children are four times more likely to become obese adults making childhood obesity a significant health threat. A new study in the Journal of Nutrition Education and Behavior, published by Elsevier, found the Developing Relationships that Include Values of Eating and Exercise (DRIVE) curriculum mitigated weight gain in at-risk children as well as prompting their parents to lose weight.

"Parents typically are the most important and influential people in a child's environment," said authors Keely Hawkins, PhD, and Corby K. Martin, PhD, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA. "Adding this weight management strategy to existing state and federal home visitation programs could help address the current childhood obesity crisis."

Sixteen families participated in the study and were recruited from the community based on the child's obesity risk. Children 2-6 years of age with a body mass index greater than the 75th percentile enrolled. Families were randomly assigned to receive health information only or the DRIVE intervention.

The DRIVE curriculum was provided during 15 in-person sessions in the family's home. Sessions were 30 minutes long, during which parents and children practiced healthy daily routines including establishing regular snack and mealtimes, reducing screen time, and encouraging physically active play. Each session focused on a single health topic such as portion size, food preparation, how to discuss weight and growth concerns with the pediatrician, and effective parenting strategies. The group that did not receive in-home visits was mailed information on nutrition, physical activity, and parent-child interaction at the beginning of the study.

Children in the DRIVE intervention maintained their body weight with a modest reduction in body mass index over the 19 weeks of the study, while the children who received health education significantly increased their body weight and body mass index. Additionally, parents who participated in the DRIVE sessions also decreased their body weight.

The study also reported that all 16 families completed the program. This level of participation is much higher than programs delivered through clinics or community programs, which can see as many as 75 percent of attendees leave the classes. There are many federal and state services already being provided through home-based visitation programs and this curriculum could be a valuable addition to those efforts.

Dr. Hawkins and Dr. Martin shared, "Our results showed that at the half-way point of the study, children were becoming healthier. Changes in the health of the parents, though, did not happen until the end of the study. This points to the need for long-term, family-based programs to support behavior change."

Chicago, June 6, 2019 - The confluence of two major health crises--the opioid epidemic and organ shortage--has moved surgeons to consider transplanting organs deemed as less than "perfect" in an effort to expand the donor pool and save more lives, according to research published online today in The Annals of Thoracic Surgery, published by Elsevier.

"The opioid epidemic has increased the proportion of hearts transplanted from overdose death donors (ODD)," said Nader Moazami, MD, of NYU Langone Medical Center in New York, NY, USA. "One of the roles of the transplant community is to at least partially mitigate the tragedy of this exponentially growing problem by maximizing the utilization of organs from ODD."

Dr. Moazami and colleagues evaluated trends in organ donation and transplants among drug overdose deaths using data from the Scientific Registry of Transplant Recipients for the years 2000 to 2017. Of the 15,904 isolated heart transplants from adult donors during this period, opioid overdoses (10.8 percent) were the fourth most common cause of death, behind blunt injury (30.5 percent), hemorrhage/stroke (22.1 percent), and gunshot wound (18.3 percent). In 2017, overdoses accounted for more than 20 percent of donor deaths in 11 states; whereas in 2000, the highest state's rate was 5.6 percent and 33 states had less than 1 percent of donor deaths attributed to overdoses. The researchers also identified a significant increase in the percentage of transplants that utilized ODD hearts: 1.1 percent in 2000; 6 percent in 2012; and 14.2 percent in 2017. The current rate of ODD utilized for heart transplantation is 16.9 percent--a 14-fold increase from 2000.

"The dramatic increase in the rate of ODD utilization was striking, and it has increased concordantly with the rate of overdose deaths," said Dr. Moazami. "The significant impact of the opioid epidemic on transplantation is one of the major reasons that organ transplant numbers have increased over the last several years."

In addition, the researchers found that donors who died from opioid overdoses were frequently younger than age 40 and had higher rates of substance abuse. However, they also had lower rates of diabetes and hypertension. As a result, the researchers found that ODD hearts had "favorable heart donor quality" and provided excellent outcomes equivalent to all other mechanisms of donor deaths (non-overdose).

"We do not believe that overdose status alone is a valid reason to discard an otherwise viable donor heart, and this study supports that ODD organs should not be rejected due to inappropriate bias," said Dr. Moazami. "With no significant difference in survival between ODD and non-ODD recipients, further expansion of this donor pool may be appropriate, with more hearts potentially used for transplantation."

For other organs, the opioid epidemic has also boosted the number available for donation in the US. In another study from Dr. Moazami and colleagues to be published in The Annals, opioid ODD provided 7 percent of the transplanted lungs from 2010-2017, up from 2 percent in 2000-2007. The overall findings also concurred with those of this recent study, suggesting that ODD lungs do not pose any extra safety risk to transplant recipients.

Impact of Hepatitis C virus on organ transplantation

The recent rise in opioid use has not only resulted in opioid-related overdose deaths, but also a surge in hepatitis C virus (HCV) cases due to injection drug use. In fact, the study showed HCV is often the reason why organs are discarded and not used. But in the current era, medical advances and sophisticated testing have helped minimize the risks associated with transplanting an organ that is hepatitis C positive, explained Dr. Moazami. In addition, hepatitis C is now a curable disease, so if organ recipients become infected, antiviral medication can be administered, making it especially important that efforts are made to minimize discarding HCV-positive organs and improve efficient utilization of them, according to the researchers.

"In spite of the public crisis that the opioid overdose epidemic has created recently, the impact on organ transplantation and the unintended consequences of increasing the number of donor hearts is noteworthy," said Robert S.D. Higgins, MD, MSHA, Surgeon-in-Chief of The Johns Hopkins Hospital in Baltimore, STS President, and former president of the United Network for Organ Sharing (UNOS), who was not directly involved with this research. "Many of these donors have been associated with diseases that have historically been considered 'high risk' by public health services. This important study highlights the need for additional research in this area to further define the 'risk' as well as the reward of expanding the donor pool to save more lives."

According to UNOS, more than 36,500 transplants were performed in 2018--more transplants than ever before. Approximately 3,400 of those were heart transplantations. While 2018 was a record-breaking year, the need for organ donors remains massive. On average, 18 patients died every day waiting for a transplant in 2017.

DALLAS, June 6, 2019 -- People with type 2 diabetes are at an increased risk for heart failure and many people have both diseases, which requires careful medical management.

A scientific statement from the American Heart Association and the Heart Failure Society of America brings the management of both diabetes and heart failure into one document and describes new approaches to medications, lifestyle modifications as well as highlighting the importance of multi-disciplinary care that includes physicians, nurses, registered dieticians, social workers and other allied professionals.

The statement is published in the American Heart Association journal Circulation.

Many pesticides that have been banned or are being phased out in the EU, Brazil and China, are still widely used in the USA, according to a study published in the open access journal Environmental Health.

Study author Nathan Donley at the Center for Biological Diversity, USA said: "The USA is generally regarded as being highly regulated and having protective pesticide safeguards in place. This study contradicts that narrative and finds that in fact, in the last couple of decades, nearly all pesticide cancellations in the USA have been done voluntarily by the pesticide industry. Without a change in the US Environmental Protection Agency's current reliance on voluntary mechanisms for cancellations, the USA will likely continue to lag behind its peers in banning harmful pesticides."

Donley identified pesticides that are approved for outdoor agricultural use in the USA and compared them to pesticides approved in the EU, China and Brazil. The researcher found that 72, 17 and 11 pesticides are approved for use in the USA which are banned or in the process of being phased out in the EU, Brazil and China, respectively. In addition, Donley identified 85, 13 and two pesticides as being approved in the USA but banned or in the process of being phased out in at least one of the three, two of the three, or all three other agricultural nations, respectively.

Of the 1.2 billion pounds of pesticides used in US agriculture in 2016, approximately 322 million pounds were pesticides banned in the EU, 40 million pounds were pesticides banned in China and nearly 26 million pounds were pesticides banned in Brazil. More than ten percent of total pesticide use in the USA was from pesticide ingredients either banned, not approved or of unknown status in all three of the other nations.

Donley found that of 508 pesticide active ingredients that have been used in agriculture in the USA since 1970, 134 have been cancelled. Out of those, 97 have been voluntarily cancelled by pesticide registrants or were not renewed after their approval period ended. In 37 cases, the US Environmental Protection Agency took unilateral action to prohibit a pesticide from entering the market or cancel its approval.

The number of non-voluntary cancellations of pesticides in the USA initiated by the EPA (to withdraw approval for their use) has decreased substantially in recent years, whereas voluntary cancellations have greatly increased. They currently account for nearly all agricultural pesticide cancellations in the USA, according to Donley's research.

Donley said: "These findings suggest that the USA utilizes voluntary, industry-initiated cancellation as the primary method of prohibiting pesticides, which is different from the non-voluntary, regulator-initiated cancellations / bans that are predominant in the EU, Brazil and China."

He added: "Voluntary cancellations ultimately create bias towards pesticides that are easier to cancel because their use has dropped so much that they have become less economically viable to pesticides makers. They can also lead to a significantly longer phase-out period than the typical one year period for most non-voluntarily cancelled pesticides."

The author cautions that he did not seek to compare the effectiveness or robustness of pesticide regulations as a whole between nations and thus the conclusions may not be generalizable to other aspects of pesticide regulation, such as safeguards that do not involve the total banning of a pesticides.

WHAT:

Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

ART involves taking a combination (usually three) of drugs daily, often combined into a single pill. ART has transformed the lives of people with HIV, enabling those with access to the medications to live a near-normal lifespan. Despite this success, the side effects, pill fatigue, stigma and expense of taking daily ART for life have motivated researchers to find an alternative, write NIAID Director Anthony S. Fauci, M.D., and colleagues. Consequently, scientists are seeking ways to put HIV into full and sustained remission so daily ART is unnecessary. The authors say feasible approaches must involve minimal risk and manageable side effects for people with HIV and must be inexpensive and scalable to millions of individuals.

A major obstacle to sustained ART-free HIV remission is the persistence of viral reservoirs. These reservoirs consist of HIV-infected cells containing HIV genetic material that can generate new virus particles. The cells have entered a resting state that they maintain until they are activated to produce HIV.

The authors explain that two paths are being pursued toward sustained ART-free HIV remission: total eradication of the HIV reservoir, classically referred to as a "cure," and sustained virologic remission, which would control HIV replication but not eradicate the virus. The authors outline specific strategies under investigation to achieve these goals.

Several approaches to eradicating the HIV reservoir have been attempted, but none except stem cell transplantation from a donor with a specific genetic mutation has succeeded--and only in two cases. The risks, expense and complexity of stem cell transplants make them impractical for eradicating the HIV reservoir in people who do not require such a transplant for a separate underlying health condition, the authors write.

Many cutting-edge strategies to achieve sustained virologic remission are being studied. The authors describe how some of these strategies have the potential to replace daily ART with an intermittent or continual non-ART intervention, while others seek to induce permanent immune-mediated control of HIV without further intervention. Clinical trials of numerous different approaches are underway.

(CAMBRIDGE, Mass.) -- Since their invention in the late 1700s when French-born British physicist Denis Papin, the inventor of the pressure cooker, proposed the piston principle, pistons have been used to harness the power of fluids to perform work in numerous machines and devices.

Conventional pistons are made of a rigid chamber and a piston inside, which can slide along the chamber's inner wall while at the same time maintaining a tight seal. As a result, the piston divides two spaces, which are filled with two fluids and connected to two exterior fluid sources. If the fluids have different pressures, the piston will slide into the direction with the lower pressure and can at the same time drive the movement of a shaft or other device to do physical work. This principle has been used to design many machines, including various piston engines, hydraulic lifters and cranes such as the ones used on construction sites, and power-tools.

However, conventional pistons suffer from several shortcomings: the high friction between the moving piston and the chamber wall can lead to breakdown of the seal, leakage, and gradual or sudden malfunctions. In addition, especially in the lower pressure-spectrum, energy efficiencies and response speed often are limited.

Now, a team of roboticists at Harvard's Wyss Institute for Biologically Inspired Engineering, the Harvard John A. Paulson School of Engineering and Applied Sciences (SEAS), and Massachusetts Institute of Technology (MIT) has developed a new way to design pistons that replaces their conventional rigid elements with a mechanism using compressible structures inside a membrane made of soft materials.

The resulting 'tension pistons' generate more than three times the force of comparable conventional pistons, eliminate much of the friction, and at low pressures are up to 40 percent more energy efficient. The study is published in Advanced Functional Materials.

"These "tension pistons" fabricated with structures incorporating soft, flexible materials are a fundamentally new approach to piston architecture, that open an extensive design space. They could be dropped into machines, replacing conventional pistons, providing improved energy efficiency," said Wyss Institute Founding Core Faculty member and co-corresponding author Wood, Ph.D., who is also the Charles River Professor of Engineering and Applied Sciences at SEAS and co-lead of the Wyss Institute's Bioinspired Soft Robotics Initiative. "Importantly, this concept also enables a range of new geometries and functional variations that may empower engineers to invent new machines and devices and to miniaturize existing ones."

Wood led the study together with Daniela Rus, Ph.D., Professor and Director of MIT's Computer Science and Artificial Intelligence Laboratory (CSAIL) and Shuguang Li, Ph.D., a Postdoctoral Fellow mentored by Wood and Rus.

The tension piston concept builds on the team's 'fluid-driven origami-inspired artificial muscles' (FOAMs) that use soft materials to give soft robots more power and motion control while maintaining their flexible architectures. FOAMs are made of a folded structure that is embedded within a fluid in a flexible and hermetically sealed skin. Changing the fluid pressure triggers the origami-like structure to unfold or collapse along a pre-configured geometrical path, which induces a shape-shift in the entire FOAM, allowing it to grasp or release objects or to perform other kinds of work.

"In principle, we explored the use of FOAMs as pistons within a rigid chamber," said Li. "By using a flexible membrane bonded to a compressible skeletal structure inside, and connecting it to one of the two fluid ports, we can create a separate fluid compartment that exhibits the functionality of a piston."

The researchers showed that a rise in driving pressure in the second fluid reservoir surrounding the membrane in the chamber increases the tension forces in the membrane material that are directly transmitted to the bonded skeletal structure. By physically linking the skeleton with an actuating element that reaches out of the chamber, compression of the skeleton is coupled to a mechanical movement outside the piston.

"Better pistons could fundamentally transform the way we design and utilize many types of systems, from shock absorbers and car engines to bulldozers and mining equipment," says Rus, the Andrew (1956) and Erna Viterbi Professor of Electrical Engineering and Computer Science at MIT. "We think that an approach like this could help engineers devise different ways to make their creations stronger and more energy-efficient."

The team tested their piston against a conventional piston in a object-crushing task, and showed that it broke objects like wooden pencils at much lower input pressures (pressures generated in the skin-surrounding fluid compartment). At the same input pressures, particularly in the lower pressure range, the tension pistons developed more than three times greater output forces and display more than 40 percent higher energy efficiency by harnessing the fluid-induced tension in their flexible skin materials.

"By configuring the compressible skeletons with very different geometries such as a series of discrete discs, as hinged skeletons, or as spring skeletons, the output forces and motions become highly tunable," said Li. "We can even incorporate more than one tension piston into a single chamber, or go a step further and also fabricate the surrounding chamber with a flexible material like an air-tight nylon fabric."

For several decades, the number of chronicle diseases has been growing. The main reason for this is the imbalanced diet. Biologists and chemists study natural foods concerning the fact that it can help strengthen health and prevent numerous diseases. They have designed a new concept, which is "functional food products".

Wild growing raw materials are the prospective sources of biologically active compounds. The Russian Federation has one of the biggest reserves of raw materials. The Eastern Siberia has endless cedar forests that cover territories of the Tyva Republic, Krasnoyarsk Region, Altai Region and the Republic of Buryatia, which is 18 million hectares. Annually, more than 1 million tons of pine nuts are harvested in Siberia.

Pine nut shells are the source of carbohydrates, minerals and various organic compounds.

Olga Babich, Svetlana Noskova and Stanislav Sukhikh, the researchers of the Immanuel Kant Baltic Federal University, together with their colleagues from Kemerovo State University have studied the processed product of pine nut shells. The carbohydrate-mineral complex is rich in fibres and vitamins. The researchers have also discovered that it is non-toxic and increases physical endurance, which is why it is recommended as a sports nutrition product.

Lately, the authoritative scientific journal Bioactive Carbohydrates and Dietary Fibre has published the article under the title "Bioactive Carbohydrates and Dietary Fibre". According to the article, dietary fibres are necessary for the health of the digestive system. They have a positive effect on blood vessels and lower blood sugar level.

Some deer are more susceptible to chronic wasting disease that is spreading through herds of white-tailed deer across much of the United States, according to Penn State researchers, who have identified a panel of genetic markers that reliably predict which animals are most vulnerable to the contagious neurological disorder.

"The genetic variants that would make deer less susceptible to chronic wasting disease are in much lower frequency in the East, likely because they weren't needed," said David Walter, adjunct assistant professor of wildlife ecology. "Over a long period of time, their survivability may have been somehow favored by losing these genotypes. They weren't important until a disease like chronic wasting disease showed up. We have seen that deer with the more susceptible genotypes are in the majority."

Over the last decade or so, Walter's research group in the College of Agricultural Sciences has been studying how the movement, behavior and genetics of wild deer are affecting the spread of chronic wasting disease. Often referred to as CWD, it is a fatal prion disease affecting the deer family, and belongs to a group of similar diseases, such as mad cow disease and scrapie in sheep, called transmissible spongiform encephalopathies.

After testing more than 2,200 deer killed by hunters in Virginia, West Virginia, Maryland and Pennsylvania, researchers identified 11 different subpopulations of deer in the Mid-Atlantic region where a chronic wasting disease outbreak is occurring. The researchers used than 700 DNA samples from Pennsylvania deer to assess genetic susceptibility to the disease in the subpopulations, and those results were published earlier this year in the journal Prion.

"Deer in the Mid-Atlantic region have a higher proportion of the genotypes most susceptible to CWD than deer populations to the west that have been tested in other states," said Walter.

He noted that the disease was first seen in mule deer in Colorado in 1967 and has been spreading eastward across the continent since. It now infects deer and elk in 24 states and several Canadian provinces, and has been found in reindeer, moose and red deer in three Scandinavian countries.

"In the U.S., CWD spreads differently in the East than in the West, because deer numbers and densities are so much higher in the East," said Walter, assistant unit leader of Penn State's Pennsylvania Cooperative Fish and Wildlife Research Unit. "We have been trying to unravel the genetic nuances to understand where chronic wasting disease is likely to show up."

In earlier published studies, Walter and colleagues determined that geographical features such as rivers, mountain ranges and high ridges have channeled CWD spread in the East. Even manmade features such as highways appear to have influenced deer movement, guiding where CWD in deer has been discovered.

The Walter group's latest research consolidates the numerous genetic resources for white-tailed deer into a manageable panel of 11 genetic markers to provide a uniform methodology that is likely to improve genetic comparisons. Researchers reviewed "microsatellite" panels from 58 previous or ongoing studies of deer in CWD outbreaks in other regions.

In findings published today (June 6) in BMC Genetics, they describe a protocol to differentiate subpopulations of deer and evaluated its efficacy using 720 DNA samples collected from whitetails in the Mid-Atlantic region. In the study, researchers analyzed 2,200 samples from deer in four states to evaluate microsatellites.

"The 11 markers we selected are easy to interpret and are likely to provide a common platform to benefit future genetic studies such as those for CWD," said lead researcher William Miller, former Penn State doctoral student, now an assistant professor of biology at Calvin College in Michigan.

Miller pointed out that many genetic studies conducted previously used different suites of genetic markers.

"We wanted a core panel that will be broadly useful and effective across the white-tailed deer's range, and we included many of the markers that have been used in studies from states in the Midwest and West," Miller said. "This panel includes markers that are likely to be useful for evaluating genetic patterns."

Follow-on studies nearly complete by Miller and Walter's lab outline a genetic method to determine when a CWD-positive deer is discovered, where it came from and whether it is a wild or captive-bred animal. That information will guide wildlife managers' reaction to the discovery, as they decide whether to establish disease-management areas and targeted removals of deer to slow the spread of CWD.

Also involved in the research were Jessie Edson, genetics laboratory manager in the Department of Ecosystem Science and Management; and Peter Pietrandrea, undergraduate researcher, and Cassandra Miller-Butterworth, assistant professor of biology, both at Penn State Beaver.
The Pennsylvania Game Commission, the Maryland Department of Natural Resources and the Virginia Department of Game and Inland Fisheries supported this research.

WEST LAFAYETTE, Ind. -- A 62-year-old with stage IV lung cancer that has spread to his bones, causing unspeakable pain, is trying to convince his physician to prescribe pain medicine. What happens next?

It actually could depend on if the patient is black or white. Or if the physician is a primary care provider or an oncologist.

Yes, race and other factors could play a role, according to a new study conducted by researchers and recently published in the Journal of General Internal Medicine.

Historically, black patients report greater pain, mostly due to undertreatment, and are less likely to receive adequate pain management, said Cleveland Shields, a professor in Purdue University's College of Health and Human Sciences' Department of Human Development and Family Studies, who specializes in physician-patient communication, as well as health disparities due to race, poverty and geography.

Dr. Ronald Epstein, of the University of Rochester School of Medicine, who served as the co-principal investigator said, "We know that race affects the quality of care that patients receive. Our study clarifies when, how and under what circumstances racial bias enters into the picture. Our findings will help train the next generation of physicians to be more aware of their biases and provide more equitable care."

Shields added, "Racial disparities in pain control are well-documented. There is plenty of evidence that black patients receive less adequate pain management than white patients."

To conduct the five-year study, the group enlisted and trained standardized patients or "secret shoppers" who visited 96 primary care physicians and oncologists in urban and rural settings across Indiana, Michigan and New York. The physicians participating in the study did not know on what topics or aspect of patient care they were being observed.

As the study proceded, researchers also found that some physicians were increasingly reluctant to prescribe opioids as the nation found itself debating the use and amount of pain medication.

According to Shields, the use of standardized patients is a common technique used in medical schools as a way for medical students to learn how to interact with people in a patient care setting.

The group assigned either two black patients or two white patients to a physician's office. The visits were separated by four or more months and were mixed in with new and regular patients.

Half of the standardized patients were activated or trained to interact, ask questions, express opinions with the physicians involved in the study. The other half were not activated. Activated patients saw an improvement in the physicians' communication and interaction.

"When you have improved communication about pain control, it increases appropriate prescribing," Shields said. "We expected to find direct racial differences, but we only found racial differences with the oncologists."

Bethesda, MD (June 6, 2019) -- For patients taking proton pump inhibitors (PPIs) to treat gastroesophageal disease (GERD) or other acid-related conditions, new research puts safety concerns to rest. In a large, multi-year, randomized trial studying the safety of proton pump inhibitors (PPIs), researchers find no evidence to support claims that PPIs cause serious health issues such as pneumonia, chronic kidney disease, diabetes and dementia. This research is published in Gastroenterology, the official journal of the American Gastroenterological Association, as an article in press.

PPIs are one of the most widely used classes of drugs in the U.S. PPIs are the most effective drugs for treating GERD, which occurs in over 25 percent of the population, and are recommended in many other acid-related conditions. As with all drugs, PPI therapy should only be used when the benefits are expected to outweigh the risks and should be used according to recommended dose and duration of treatment. However, this new research suggests that limiting prescriptions of PPI therapy because of concerns of long-term harm is not appropriate.

"Our research provides welcomed news for the countless patients who rely on PPIs to control their symptoms, as well as the physicians who prescribe this medication," said lead study author Paul Moayyedi, MB, ChB, PhD, The Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada. "To our knowledge, this is the first prospective randomized trial to evaluate the many long-term safety concerns related to PPI therapy. It is reassuring that there was no evidence for harm for most of these events."

The trial included 17,598 patients assigned to groups given the PPI pantoprazole or placebo. The researchers collected data on development of pneumonia, Clostridium difficile infection, other enteric infections, fractures, gastric atrophy, chronic kidney disease, diabetes, chronic obstructive lung disease, dementia, cardiovascular disease, cancer, hospitalizations, and all-cause mortality every six months. The results show that pantoprazole is not associated with any adverse event when used for 3 years, with the possible exception of an increased risk of enteric infections. However, this risk is lower than estimated by previous systematic reviews of observational studies and should be interpreted with caution.

Tips for patients taking PPIs

1. Talk to your doctor before making any changes to your medication. You have been prescribed PPIs for a reason, to treat a diagnosed medical condition. You and your doctor can discuss the reason for your prescription, the dose and the timeframe for treatment.

2. Consider life-style modifications that may reduce or eliminate the need for PPIs for long-term use. These may include weight loss, avoiding tobacco or a change in your eating patterns. Your doctor can help you determine the changes that are right for you.

3. Keep in touch with your doctor. Research continues to be done on PPI use. While headlines on PPIs may seem scary, this research reaffirms that patients who have a diagnosed condition that is helped by PPIs should stay on them, as benefits can outweigh risks.

Cell-free DNA (cfDNA) testing, which involves analyzing fetal DNA in a maternal blood sample, is a non-invasiveness and highly accurate test for Down syndrome in singleton pregnancies, but its effectiveness in twin pregnancies has been unclear. A new analysis published in Ultrasound in Obstetrics & Gynecology reveals that cfDNA testing for Down syndrome in twins is just as effective as in singletons, with a detection rate of 98% and only a 0.05% rate of misdiagnosis.

The analysis combined information from a dataset of 997 twin pregnancies in addition to results from seven previously published studies.

In many countries, including the United States, cfDNA testing is not recommended for use in twin pregnancies. These latest findings provide compelling evidence that mothers carrying twins should not be denied this safe and effective test.

New research suggests that state alcohol policies may be effective in reducing aggression-related and driving-related harms due to other drinkers, mainly in younger adults.

The Alcoholism: Clinical and Experimental Research study looked at each U.S. state's Alcohol Policy Scores (which characterizes the strength of 29 alcohol policy elements that an expert panel deemed effective for reducing binge drinking) and focused on the potential for stronger state alcohol policies to reduce the victimization of people by other heavy drinkers--in other words, to lower the extent of secondhand aggression-related and driving-related harms due to someone else's drinking.

For each 10 point increase in policy restrictiveness, the odds of experiencing these harms was reduced by approximately 16%. Associations between states' alcohol policy measures and harms from other drinkers were limited to those under 40 years of age.

"States that enact more restrictive, stronger alcohol policies may be able to drop the level of harm that younger people are experiencing, especially in those jurisdictions that now have weaker, less effective laws," said lead author Thomas Greenfield, PhD, of the Alcohol Research Group.