Body

CHICAGO, April 5, 2018 -- A new survey by The Associated Press-NORC Center for Public Affairs Research reveals the number of Americans who see opioid addiction as a significant issue for their community today is up significantly over just two years ago. Forty-three percent of Americans now say the misuse of prescription drugs is a serious problem, compared with 33 percent in 2016.

A majority of Americans report having experience with substance abuse of various types, and 13 percent have had a relative or close friend die from an opioid overdose. Although 53 percent of the public sees prescription drug addiction as a disease, many regard such addiction as a behavioral failing. Forty-four percent say opioid addiction indicates a lack of willpower or discipline; 32 percent say it is caused by a character defect or bad parenting, and less than 1 in 5 Americans are willing to associate closely with a friend, colleague or neighbor who is addicted to prescription drugs. This indicates that stigma surrounding opioid addiction is an issue.

The findings are among many in a survey exploring attitudes and awareness of Americans about the opioid epidemic in particular and drug misuse in general, as well as how to address the crisis.

"In the national effort to grapple with the enormous issue of opioid addiction, it is important to know the level of awareness and understanding of Americans who find themselves in the midst of an epidemic that is claiming growing numbers of lives," said Caitlin Oppenheimer, senior vice president of public health at NORC. "This survey provides important, and in some cases troubling, information."

Additional findings from the survey include:

Two-thirds of respondents say their community is not doing enough to make treatment programs accessible and affordable or to find improved methods of treating addiction.

Sixty-four percent would like to see more effort to crack down on drug dealers.

Fifty-seven percent of Americans have experience dealing with substance misuse ranging from taking a painkiller that wasn't prescribed to overdosing.

Twenty-four percent say they have an addicted relative, close friend, or that they themselves are addicted to opioids.

"The number of people who recognize how serious the opioid epidemic is in this nation is growing," said Trevor Tompson, vice president for public affairs research at NORC. "There is clearly a continuing challenge to ensure that what is learned about the crisis is grounded in fact."

Facebook is the dominant source of information on social media about the opioid crisis. Of the 74 percent of adults who use Facebook, 41 percent say they have seen messages about opioids or about death from overdoses. Fewer users of other platforms report seeing such information.

A new study has identified factors that lead to increased HIV testing among young adults, specifically how a person's race, sex/gender, and sexual orientation is connected to their likelihood of getting tested for HIV.

Using data from the National Health Interview Survey, Sirry Alang, assistant professor of sociology at Lehigh University and her co-author Sydney Bornstein, an undergraduate student in the biology and health, medicine and society programs at Lehigh University, analyzed responses from 18-24 year olds who were asked about HIV/AIDS, other health conditions, use of health care, and other social, demographic, and economic aspects.

They examined the differences in testing by race, gender and sexual orientation, and assessed whether the effects of sexual orientation on testing varied by race/ethnicity.

Although one in five new HIV diagnoses in the United States is among persons younger than 25 years old, the authors found that up to 70% of persons aged 18-24 have never been tested. In addition they found that young women were more likely than men to have been tested for HIV, blacks and Latinos were more likely to have been tested than whites, and being gay/bi increased chances of testing for men but not women.

"The most surprising finding was that gay/bi white men were less likely than gay/bi black and Latino men to have been tested," Alang, co-author of "HIV testing history among young adults: The roles of sex, race, and sexual orientation," published this January in the Journal of HIV/AIDS & Social Services, said.

"We expected that black and Latino gay and bisexual men would be less likely to have been tested because they might be less likely to access health services and are more likely to experience double sources of discrimination--racism and homophobia--factors that have been identified as barriers to testing in these populations," she explained.

Alang noted that higher rates of HIV testing among black and Latino gay and bisexual men is encouraging given that these populations are disproportionately affected by the disease. However, she added that routine testing by itself is not a sufficient strategy for reducing the number of new HIV infections among black and Latino gay and bisexual men.

In her research, Alang referenced studies that found black gay/bisexual men (as well as black women and black straight men) were less likely to engage in behavioral risk factors for HIV, such as substance use and multiple sexual partners, than their white counterparts. Given this information, the authors offer insight into why black and Latino gay and bisexual men remain disproportionately affected by HIV.

"Perhaps, vulnerability to HIV infection among people of color might be linked to racial discrimination which is a chronic stressor that increases the wear and tear of body systems, and decreases immune function. Disproportionate incarceration rates of black and Latino populations also directly increase exposure to HIV among people of color in the United States, and the stress associated to the carceral state might increase vulnerability to infections."

Alang added: "Research and policy interventions are needed to identify and break the links between structural racism and racial disparities in the prevalence of HIV."

For white gay and bisexual men who are less likely to have been tested for HIV but more likely to engage in HIV risk behaviors, the authors concluded that scaling up behavioral interventions to improve testing and to reduce risky behaviors is critical. In the era of the opioid epidemic especially among young adults, Alang anticipates that HIV infections from injection drug use might increase.

She said: "We must invest resources in the development, testing, and implementation of both structural and behavioral interventions to prevent new outbreaks of HIV, especially among people with substance use disorders."

The theory that cancer progression involves the acquisition by tumor cells of features similar to those of stem cells has gained strength in the scientific community.

According to this theory, tumor cells tend to "forget" the tissue from which they originated as the disease progresses, acquiring an undifferentiated phenotype associated with heightened aggressiveness and treatment resistance.

In a study whose findings were published in the journal Cell on Thursday, April 5, researchers at the University of São Paulo's Ribeirão Preto Medical School (FMRP-USP) in Brazil and collaborators in several other countries describe a method that objectively measures the degree of similarity between tumor samples and pluripotent stem cells (cells that can differentiate into nearly any type of tissue in the body).

The study focuses on "stemness", defined as the potential for self-renewal and differentiation from the cell of origin, and on "stemness indices" developed during postdoctoral research conducted by Tathiane Malta as part of a project ( supported by FAPESP and with Houtan Noushmehr, a professor in FMRP-USP's Genetics Department, as principal investigator.

"Our expectation is that in future stemness indices can be used in clinical practice as a prognostic aid, to help foresee the possibility of relapse, and to plan treatment," said Malta, lead author of the article.

To develop the methodology, the group analyzed the molecular profiles of human embryonic stem cells and compared them with data for 12,000 samples of 33 different tumor types held by The Cancer Genome Atlas (TCGA ), a US public database.

They processed data relating to genetics, including DNA sequences, and to gene expression, as well as epigenetic features - chemical reactions that influence genome functioning and hence phenotype by activating and deactivating genes.

One of the most important epigenetic mechanisms investigated in the study was DNA methylation, a chemical reaction that adds methyl groups (made up of hydrogen and carbon atoms) to the DNA base cytosine, potentially preventing the expression of certain genes.

Artificial intelligence

The molecular profiles of the embryonic stem cells and tumor cells were compared with the aid of machine learning algorithms, a form of artificial intelligence. These algorithms analyze masses of data by means of advanced statistical techniques in search of patterns that can be used to make determinations or predictions.

"We started out by assuming a degree of similarity between some sub-populations of tumor cells and pluripotent stem cells," Malta said. "We used the algorithms to identify typical molecular signatures of stem cells [stemness signatures] that could help us understand tumors and serve as predictors of aggressiveness or clinical outcome."

An index ranging from 0 to 1 was created for each tumor sample. "Tumor cells closer to 1 were more similar to stem cells and significantly more aggressive than tumor cells closer to 0," Malta said. "Metastatic tumors, for example, had high stemness indices. Furthermore, when we analyzed the clinical history of the sample donors we found an inverse correlation between stemness index and survival."

For some cancer types the researchers found that a high stemness index was associated with the presence of mutations. In the case of head and neck squamous cell carcinoma, for example, high stemness indices correlated with mutations in the gene NSD1.

The authors explain in the article that NSD1 mutation has recently been linked in the scientific literature to the blocking of cellular differentiation and the promotion of oncogenesis in this type of tumor.

The analysis also identified molecules whose expression was associated with dedifferentiation (loss of differentiated phenotype) for some cancer types. For example, higher levels of the protein FOXM1 were associated with reduced cell differentiation and increased cell proliferation in breast and lung cancer. Reduced expression of the protein ANNEXIN-A1 correlated with higher stemness indices in samples of lung adenocarcinoma.

"We believe the use of this index in future studies may help identify novel therapeutic targets against cancer," Noushmehr said. "If we can identify the point at which tumor cells acquire the characteristics of stem cells, it will be possible to look for ways to interrupt the process and avoid progression of the disease."

Noushmehr also stressed that the methodology is described in detail in the online supporting material that accompanies the article. "Any researcher interested in quantifying stemness indices for their own tumor samples can apply the method and contribute to its validation," he said.

The sarcoma research group of the Bellvitge Biomedical Research Institute (IDIBELL), led by Dr. Òscar Martínez-Tirado, has identified a potential new therapeutic target for Ewing sarcoma, the second most frequent bone cancer in children and adolescents, and a tumor known by its aggressiveness and tendency to metastasize. The research, published in International Journal of Cancer, has been funded almost entirely by the Alba Pérez Foundation, a non-profit organization dedicated to this disease.

For years, the main line of research of the Ewing sarcoma group focused on the caveolin 1 protein (CAV1), which has been associated to treatment resistance and metastasis, among other issues. However, the location of this protein in the cell makes its use as a therapeutic target virtually impossible. "That is why we were looking for a CAV1 cofactor with an equally relevant role but a more accessible location", explains Dr. Martínez-Tirado, "and the EphA2 membrane receptor, already described in previous studies, meets these requirements."

In their latest work, researchers not only demonstrate the connection between the EphA2 receptor and caveolin 1, but also establish a correlation between the phosphorylation of EphA2 and the aggressiveness of tumors in Ewing sarcoma. "In several in vitro and in vivo tests, we observed that this membrane receptor plays a key role in the migration of tumor cells."

Regarding in vivo studies, the research team used two different models. The artificial model of metastasis, more experimental, allows researchers to assess the ability of cells to adhere to the pulmonary epithelium in adverse conditions. On the other hand, the new orthotopic model developed by the same group a few months ago induces a spontaneous metastasis, much more similar to what can be observed in a clinical setting.

"In the lab, we have shown that the lack of EphA2 receptor significantly decreases the incidence and number of metastases", says Dr. Martínez-Tirado, "and thanks to our collaboration with Hospital Virgen del Rocío, we also saw that 90% of Ewing sarcoma patients express this receptor (mimicking caveolin 1), a fundamental fact when it comes to selecting EphA2 as a therapeutic target. At the same time, working with patient samples also allowed us to correlate EphA2 ligand-independent activity, associated with its phosphorylation, with lower survival. "

Thanks to the stable financial support of the Alba Pérez Foundation, IDIBELL researchers will keep on working on the development of treatments based on blocking the activity of this receptor. "Through drug nanoengineering techniques, we aim to develop a molecule with a double effect, capable of blocking EphA2 in tumor cells and delivering other targeted drugs at the same time", concludes the IDIBELL researcher.

Glenview, IL, April 4, 2018 - Finding ways to help patients with COPD improve their functional status is an area of interest for pulmonary healthcare providers. Currently, pulmonary rehabilitation (PR) is used where available to improve exercise capacity and quality of life, but the treatment requires access to trained staff and specialized facilities. A new study in the journal CHEST® looked at Tai Chi as a lower cost, more easily accessed treatment option. Investigators found that this slow, methodical form of exercise is equivalent to PR for improving respiratory function in patients with COPD.

Tai Chi, an ancient martial art that involves significant levels of physical exertion, is gaining popularity, especially among older people, across the globe. Originating in China, Tai Chi incorporates stretching, breathing, and coordinated movement and requires no special equipment. "Knowing the potential benefits of Tai Chi, we hypothesized that, in patients being treated with medication to manage their COPD symptoms, it could help improve the quality of life when compared to a course of classical western style PR," noted Professor Nan-Shan Zhong, MD, State Key Laboratory of Respiratory Disease, Guangzhou, China.

The study tracked 120 patients with COPD in rural China who had never used a bronchodilator. After beginning daily treatment with indacaterol, subjects were randomly assigned to groups receiving traditional PR or Tai Chi. Both the Tai Chi and PR groups showed similar improvements in Saint Georges Respiratory Questionnaire (SGRQ) scores, a standard measure of health status in patients with diseases causing airway obstruction. However, after twelve weeks, a clinically significant difference in SGRQ scores emerged favoring Tai Chi. Similar trends were noted in performance of a six-minute walk test.

"Tai Chi is an appropriate substitute for PR," explained lead investigator Professor Yuan-Ming Luo, PhD, also of the State Key Laboratory of Respiratory Disease. "While neither training approach differed from the other by more than the minimal clinically important difference of four SGRQ points at the end of this 12-week study, an additional 12 weeks after discontinuation of formal training, improvements emerged in favor of Tai Chi in SGRQ score, six-minute walk distance, modified Medical Research Council dyspnea score, and quadriceps strength. We conclude that Tai Chi is equivalent to PR and may confer more sustained benefit."

Subjects in the Tai Chi group met for formal instruction five hours per week for 12 weeks and were taught the 24 form Yang style. The results of the Tai Chi group were compared to that of another group of subjects who received PR three times a week for 12 weeks. After the initial 12 weeks, participants were encouraged to continue their Tai Chi either alone or with a group in their community; however, no formal assistance was provided to patients during this period. Those in the PR group received verbal encouragement to remain as physically active as possible. Final analysis of all data was conducted 12 weeks after the formal training had concluded.

For many patients, reducing the symptoms of COPD can greatly improve their quality of life. While medication continues to play an important role in treating COPD, the cost of those medicines can be a barrier for some patients, especially for treating a chronic illness like COPD.

"This study demonstrates that a low-cost exercise intervention is equivalent to formal pulmonary rehabilitation, and this may enable a greater number of patients to be treated," concluded lead author of the study Michael I. Polkey, PhD, NIHR Respiratory Biomedical Research Unit, The Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom. "Physical activity is key to reducing symptoms in COPD. We do recommend PR, but our study shows that Tai Chi is a viable alternative when there is no local PR service. We encourage pulmonary rehabilitation providers to consider offering Tai Chi as an alternative therapy that patients would then be able to continue unsupervised in their own home."

COLUMBUS, Ohio -- Quantum fluids may mix in very weird ways, according to new computer simulations of exotic states of matter known as Bose-Einstein condensates (BECs).

Far in the future, BECs may enable new kinds of ultra-fast computers. But for now, researchers are just trying to understand the basic physics of how they work.

That's what an Ohio State University visiting scholar in the Department of Physics, Kui-Tian Xi, and his colleagues were doing when they used a supercomputer to simulate what would happen if someone mixed two magnetically polarized BECs.

Snapshots from the simulations, published in the journal Physical Review A, resemble ink blot tests that can be interpreted in any number of ways. As one fluid percolated up through the other, Xi first saw the blobs form a turtle (that is, a pattern with six finger-like shapes that looked like a head, tail and four legs, similar to a turtle), then a frog (back legs akimbo) and finally an explosion of mushroom shapes.

It might not have been exactly what he expected, but Xi said he wasn't all that surprised, either.

"To be honest, I did expect that I may see some interesting dynamical properties. But when I first saw the turtle, I thought I might have calculated the parameters of the simulation wrong," he said. "Then I realized there might be some kind of instability at the interface of the fluids, just like those of classical fluids."

Bose Einstein Condensates are gases made of atoms that are so cold, all of their motion nearly ceases. As the Indian physicist Satyendra Nath Bose and Albert Einstein predicted in the 1920s--and experiments eventually proved in the 1990s--BECs display strange properties because all the atoms occupy the same quantum state.

As such, BECs are superfluids. They are supposed to be frictionless, so they should flow together with zero viscosity. Yet, when Xi adjusted parameters of the simulation, such as the strength of the magnetic interactions, the two fluids mixed as if one was more viscous than the other--the way viscous hot wax bobs through less viscous water inside a lava lamp.

Xi and his colleagues, including Hiroki Saito, study leader and professor of engineering science at the University of Electro-Communications in Japan, believe that the simulations offer clues to phenomena that physicists have seen in actual experiments. Under certain circumstances, BECs do seem to behave like normal matter.

In particular, Xi points to recent numerical simulations at Newcastle University where another superfluid, liquid helium, formed waves of turbulence as it flowed over the rough surface of a wire.

The cause of the strange simulated BEC behavior remains to be seen, but Xi said that current technology would allow experimental physicists to conduct the experiment for real. As a theorist, though, he's going to focus on the possible implications of an increasing connection between the behavior of quantum and classical fluids.

DALLAS, April 4, 2018 -- Elderly Australian women who ate more vegetables showed less carotid artery wall thickness, according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.

Cruciferous vegetables including broccoli, cauliflower, cabbage and Brussels sprouts proved the most beneficial.

"This is one of only a few studies that have explored the potential impact of different types of vegetables on measures of subclinical atherosclerosis, the underlying cause of cardiovascular disease," said Lauren Blekkenhorst, study lead author and Ph.D. candidate at the University of Western Australia in Crawley.

Researchers distributed food frequency questionnaires to 954 Australian women aged 70 and older. The women noted their vegetable intake in a range from "never eating vegetables" to "three or more times per day". Vegetable types included cruciferous, allium (for example, onions, garlic, leeks and shallots), yellow/orange/red, leafy green and legumes. Sonograms were used to measure carotid artery wall thickness and entire carotid trees were examined to determine carotid plaque severity.

Researchers observed a 0.05 millimeter lower carotid artery wall thickness between high and low intakes of total vegetables. "That is likely significant, because a 0.1 millimeter decrease in carotid wall thickness is associated with a 10 percent to 18 percent decrease in risk of stroke and heart attack," Blekkenhorst said.

In addition, each 10 grams per day higher in cruciferous vegetable intake was associated with 0.8 percent lower average carotid artery wall thickness. Other vegetable types did not show an association with carotid artery wall thickness in this study.

"After adjusting for lifestyle, cardiovascular disease risk factors (including medication use) as well as other vegetable types and dietary factors, our results continued to show a protective association between cruciferous vegetables and carotid artery wall thickness," Blekkenhorst said.

However, due to the observational nature of this study a causal relationship cannot be established. "Still, dietary guidelines should highlight the importance of increasing consumption of cruciferous vegetables for protection from vascular disease," Blekkenhorst said.

OAKLAND, Calif., April 3, 2018 — Death rates from heart disease and stroke in adults under age 65 are lower and dropping faster for Kaiser Permanente members in Northern California than in the rest of the United States, according to new research published today in the American Journal of Medicine.

Heart disease and stroke are leading causes of death in the United States. The new study, “Comparative Trends in Heart Disease, Stroke, and Total Mortality in the United States and a Large, Integrated Healthcare Delivery System,” reinforces the effectiveness of Kaiser Permanente’s ongoing cardiovascular care initiatives.

The researchers compared mortality data from the Centers for Disease Control and Prevention with Kaiser Permanente Northern California data. They found heart disease death rates among adults aged 45 to 65 fell by 48.3 percent in 3.2 million Kaiser Permanente members from 2000 to 2015, compared to a 23.6 percent decline nationwide. Stroke-related deaths for the same age group fell by 55.8 percent among Kaiser Permanente members compared to a nationwide drop of 26.0 percent.

The study also showed that overall rates of heart disease and stroke mortality are lower for these Kaiser Permanente members than in the rest of the country. In 2000, for instance, U.S. heart disease mortality was 39.3 percent higher than the Kaiser Permanente group, while stroke mortality was about the same for both. But by 2015, U.S. heart disease mortality was 43.2 percent higher and stroke mortality 13.3 percent higher than among the Kaiser Permanente members.

“We think elements of Kaiser Permanente’s approach can be replicated by other health care systems to lower mortality rates,” said lead author Stephen Sidney, MD, MPH, senior research scientist with the Kaiser Permanente Northern California Division of Research. “Most heart disease and stroke-related deaths occur in people over 65, but mortality is still high for middle-aged members, so focusing on this vulnerable group could save many lives.”

Dr. Sidney believes improved management of high blood pressure could be especially effective, given the condition’s prevalence and the relative ease and affordability of treatment. Introduced in 2001, Kaiser Permanente’s hypertension management program in Northern California nearly doubled the rate of blood pressure control in adults with hypertension by 2009. Likewise, two previous studies showed that the rate of more severe but less common heart attacks fell about three quarters from 1999 to 2014 among the region’s members.

“These studies add to a growing body of evidence in support of Kaiser Permanente’s comprehensive approach to cardiovascular health, which combines high-quality preventive and therapeutic interventions,” said senior author Jamal S. Rana, MD, PhD, cardiologist at Kaiser Permanente Oakland Medical Center and adjunct researcher at the Division of Research.

In addition to its hypertension management program, Kaiser Permanente’s cardiovascular care initiatives include the Preventing Heart Attacks and Strokes Every day (or PHASE) program, which uses medications and lifestyle changes to improve heart health.

This study was conducted in the Cardiovascular Research Network, a consortium within the Health Care Systems Research Network.

In addition to Drs. Sidney and Rana, co-authors were Michael E. Sorel, MPH, Charles P. Quesenberry, PhD, Matthew D. Solomon, MD, PhD, Mai N. Nguyen-Huynh, MD, MAS, and Alan S. Go, MD, of the Kaiser Permanente Northern California Division of Research; and Marc G. Jaffe, MD, of Kaiser Permanente South San Francisco Medical Center.

ANN ARBOR, MI - Few older adults use medical marijuana, a new national poll finds, but the majority support its use if a doctor recommends it, and might talk to their own doctor about it if they developed a serious health condition.

Four out five of poll respondents between the ages of 50 and 80 said they support allowing medical marijuana if it's recommended by a physician. Forty percent support allowing marijuana use for any reason.

And two-thirds say the government should do more to study the drug's health effects, according to the new findings from the National Poll on Healthy Aging.

While more than two-thirds of those polled said they thought that marijuana can ease pain, about half said they believed prescription pain medications were more effective than marijuana.

The poll was conducted in a nationally representative sample of 2,007 Americans between the ages of 50 and 80 by the University of Michigan Institute for Healthcare Policy and Innovation. It was sponsored by AARP and Michigan Medicine, U-M's academic medical center.

"While just six percent of our poll respondents said they'd used marijuana for medical purposes themselves, 18 percent said they know someone who has," says U-M's Preeti Malani, M.D., director of the poll and a specialist in treatment of older patients. "With medical marijuana already legal in 29 states and the District of Columbia, and other states considering legalizing this use or all use, this is an issue of interest to patients, providers and policymakers alike."

She notes that the poll results indicate older Americans have a sense of wariness, rather than wholehearted acceptance, around medical use of marijuana. This may be surprising to those who think of the Baby Boom generation - who are now in their mid-50s to early 70s -- as embracing marijuana use in their youth in the 1960s and 1970s.

Marijuana and pain

The poll sheds new light on older Americans' attitudes toward the use of marijuana to control pain - one of the most common conditions cited in state medical marijuana statutes. Just under one-third of respondents said they feel that marijuana definitely provides pain relief, and another 38 percent said it probably does. But only 14 percent thought marijuana was more effective than prescription pain medication, while 48 percent believed the opposite and 38 percent believed the two were equally effective. When it came to controlling dosages for pain relief, though, prescription pain medicine won out: 41 percent thought it would be easier to control dosage with medication.

The poll also asked respondents about negative effects of both substances. In all, 48 percent thought prescription pain medicines are more addictive than marijuana, and 57 said that such medicines have more side effects than marijuana.

"These perceptions of relative safety and efficacy are important for physicians, other providers and public health regulators to understand," says Malani. Marijuana use, particularly long-term use, has been associated with impaired memory, decision making and ability to perform complex tasks.

The widespread support by older Americans for more research on the effects of marijuana is especially significant, she says, given the growing legalization trend in states and the continued federal policy that marijuana use is illegal.

"Although older adults may be a bit wary about marijuana, the majority support more research on it," says Alison Bryant, Ph.D., senior vice president of research for AARP. "This openness to more research likely speaks to a desire to find safe, alternative treatments to control pain."

Research on marijuana's effects and related issues can be done under carefully controlled circumstances, but few studies have included older adults. The new poll results indicate an appetite for further government-sponsored research, including government-standardized dosing.

Malani, a professor of internal medicine at the U-M Medical School who specializes in infectious diseases and geriatrics, notes that providers should be routinely asking older patients about marijuana use.

Only one in five poll respondents said their primary health care provider had asked whether they use marijuana. A slightly lower percentage said they thought their provider was knowledgeable about medical marijuana - but three-quarters said they simply didn't know how much their provider knows about the topic.

Still, 70 percent of those who answered the poll said they would definitely or probably ask their provider about marijuana if they had a serious medical condition that might respond to it. That means providers need to be ready to answer questions and provide counseling to patients, especially in states where medical marijuana is legal.

The poll results are based on answers from a nationally representative sample of 2,007 people ages 50 to 80. The poll respondents answered a wide range of questions online. Questions were written, and data interpreted and compiled, by the IHPI team. Laptops and Internet access were provided to poll respondents who did not already have it.

With research showing that male circumcision reduces the odds of getting HIV through heterosexual sex by 60 percent, more boys and young men -- primarily those between the ages of 10 and 19 -- are having the procedure done, largely in eastern and southern African nations where circumcision is rarely performed at birth.

But researchers, reporting April 3 in a special supplement of the journal Clinical Infectious Diseases, suggest that a focus on boys and young men is needed to continue progress in reducing new HIV infections. Since 2007, when the World Health Organization began recommending what is known as (VMMC) in countries with high HIV prevalence and low circumcision rates, more than 14.5 million procedures have been performed for HIV prevention in 14 countries in eastern and southern Africa. Nearly 3 million were done in 2016 alone. The WHO expects more than 500,000 new HIV infections will be averted through 2030.

The supplement focuses on the successes of VMMC, particularly in South Africa, Zimbabwe and Tanzania, but also looks at the lessons learned and improvements still needed in those nations.

Little is known about the quality of health counseling received by boys and young men in sub-Saharan Africa. Reproductive health and HIV prevention services traditionally target women, and the VMMC experience gives providers an opportunity to engage young males in a lifetime of prevention activities. Researchers found there were missed opportunities with boys who chose circumcision to fully educate them about other steps they can take to prevent HIV throughout their lives.

"These VMMC-related counseling experiences may be more effective in providing complete HIV prevention and care messaging if all adolescents are given age- and sexual experience-appropriate information during counseling sessions," says Lynn Van Lith, who directs HIV programming at the Johns Hopkins Center for Communication Programs and who led the research project. "This research shows that, while we are very successful at providing a positive circumcision experience, there is more we can do to set these young men on a path toward a healthy life free of HIV."

Among the topics covered in the supplement are the roles of parents and peers in determining whether a boy chooses to become circumcised; whether boys are being properly counseled about HIV and health risks before the procedure; and whether their counselors are properly trained to provide vital information about condoms and other family planning to boys following the procedure.

For the study, researchers from the Johns Hopkins Center for Communication Programs and the Johns Hopkins University School of Medicine surveyed 1,526 adolescent males between the ages of 10 and 19 who underwent circumcision at 14 sites across South Africa, Tanzania and Zimbabwe between June 2015 and September 2016.

One set of findings published in the journal suggests that a driving factor for adolescents undergoing the procedure is pressure, from friends and parents and from girls who prefer boys who have been circumcised because they know it reduces HIV risk.

"I have heard some girls saying, 'We now want guys who are circumcised, we no longer want the uncircumcised ones as they may have [HIV/AIDS]'," one uncircumcised 16-year-old from Zimbabwe told researchers.

"Circumcised males are clean and they are attractive; a person who is uncircumcised carries a lot of infections on his foreskin, he must be very dirty and girls run away from him," a 19-year-old woman from Tanzania said.

Across all countries and age groups, nearly all of the clients interviewed said they were satisfied with the experience, and between 88 and 100 percent said they would likely recommend the procedure to their peers.

At minimum, the WHO recommends that males undergoing VMMC receive HIV testing, HIV prevention counseling, screening/treatment for sexually transmitted infections, condom promotion and the VMMC procedure itself. One study in the supplement found that many younger boys were not receiving the whole package of services, with providers seemingly reluctant to discuss sexually transmitted infections with them.

"The young ones do not even know what condoms are; although the guidelines tell us to discuss condoms even with children, we do not discuss them with young children," one provider from Zimbabwe told researchers.

A provider from Tanzania said: "We teach the children about HIV, but I think this is a bit [beyond their understanding]. ... There must be a language that we can use with children and a language which we can use with adults. The language used in the guidelines is sufficient for adults, but I stammer when I talk to children."

Another paper in the supplement found that older adolescents were more likely to report receiving HIV test education and promotion (42.7 percent vs 29.5 percent for boys 10-14) and a condom demonstration with condoms to take home (16.8 percent vs 4.4 percent). Overall, very few young men, regardless of age, received complete information about wound care, risks and benefits of VMMC and the reasons why HIV testing is important.

"There were many inconsistencies among age groups when it came to counseling," says Aaron A.R. Tobian, the Johns Hopkins physician who helped lead the study. "Incomplete information was given to younger males especially. This is a lost opportunity for HIV prevention."

ATHENS, Ohio (April 3, 2018) - A recent study released by the Journal of Occupational and Environmental Medicine shows a stunning number of participants not only experienced concussion-related symptoms and head impacts but also continued performing either without reporting the incident or without receiving the recommended care. These participants were not taking part in any sporting contest at the time, however. They are theater personnel.

The study is co-authored by Jeff Russell, an assistant professor in Ohio University's College of Health Sciences and Professions and director of the Clinic for Science and Health in Artistic Performance (SHAPe Clinic), and Brooke Daniell, who collected data for the study as a senior athletic training undergraduate in the School of Applied Health Sciences and Wellness honors program.

Their research revealed 67 percent of those surveyed had experienced at least one theater-related head impact. Astonishingly, 39 percent of respondents sustained more than five head injuries and 77 percent had more than three head impacts during their time in theater. Of those who experienced a head impact, 70 percent had concussion-related symptoms but continued working.

"There are probably several reasons for non-reporting," said Russell, the lead author for the study. "In this particular industry, they don't recognize how serious the injury is and they're not accustomed to having healthcare close by like a sports team would. Some will keep going because if they don't work, they don't get paid. Some don't want to be seen as not tough enough, particularly in the stunt industry."

Fior Tat, a sophomore studying theater and stage management at OHIO, said she is not surprised by the study's result and said she once slipped and fell, hitting her head and "felt really off." She said she had a sensitivity to light and noise and took some time to rest since it was the end of a semester and there wasn't much work left to do. Even though she was eventually diagnosed with a concussion, Tat admits that if her injury had occurred during a show, she would have kept working.

"You just don't want someone to tell you that you can't do it," she said.

Russell said that for all of the attention mainstream sports such as football and hockey get when it comes to concussions, performing arts is a "hidden industry behind the scenes."

"You don't think of performing artists the same way you do sports athletes. Football is about collision. You don't think about that in performing arts. They're doing their work where they're building things, moving equipment and often working backstage where it's dark," he said. "There are a variety of 'booby traps' in the arts world where an injury is likely to occur."

Russell points out that a 251-page guide on health and safety in theater contains just two-thirds of a page on head protection. He said the results from his and Daniell's study -- particularly that showed so many individuals with concussion-related symptoms continued to work -- are "very scary."
While the respondents were above the age of 18 and the majority were from the production side of theater, it's not out of the question to consider similarities to youth participating in theater.

"It's hard to say if the numbers would be different. Teenagers are still at risk because of the kinds of things they do but I would hope for increasing education and healthcare access for everyone in the professional and university ranks so the culture filters down into the high school ranks," Russell said.

Whether high schoolers, college students or professionals, Russell said anyone involved in theater production needs to wear the proper head protection, emphasizing that production students at OHIO are required to do so. Treatment of head injuries must be handled with guidance from current research and practices utilized in sports as well.

The study showed Russell that "we have a substantial amount of work to do." He said supervisory personnel in theater such as directors need to understand the high risk of concussion and need to create an environment in which protection and proper management are emphasized.

"It has to be made OK that if you have a head injury it'll be taken care of properly. That has to be OK with everybody," Russell said. "Severe consequences can occur when concussions are not managed correctly. The brain is more important than a production or a performance."

AUGUSTA, Ga. (April 3, 2018) - Mouse genes that make human T cells powerful at fighting liver cancer could one day help patients do the same, scientists report.

Georgia Cancer Center scientists exposed mice genetically manipulated to respond to human antigens to a common antigen found in human liver cancer.

The antigen got the attention of the immune system, and the result was some of the mouse T cells developed the ability to target a cancer that's incidence and death rates are on the rise in the United States.

The scientists took the genes for the most effective liver cancer antigen receptors on those T cells, put those receptors on human T cells and the resulting engineered human T cells eradicated the cancer as well, without hurting normal liver cells, they report in the journal Hepatology.

"These T cells are very potent and can kill human liver cancer both in a dish and in a mouse," says corresponding author Dr. Yukai He.

In fact, large human liver cancer tumors on comparatively small mice started regressing about 20 days after treatment, and were eradicated by day 41 with the help of one of the targeted receptors.

"Now that we have these T-cell receptor genes, we may be able to humanize the genes to help patients," says He, immunologist at the Georgia Cancer Center and Department of Medicine at the Medical College of Georgia at Augusta University. He also is a Georgia Research Alliance Distinguished Investigator.

Next steps include He's collaboration with Piedmont Atlanta Hospital to retrieve T cells, liver cancer cells and healthy tissue normally removed from patients during surgery, put the mouse receptor genes on these T cells and monitor in a dish both how those cells now fight the tumor and react to healthy human tissue.

If the engineered human T cells do produce a robust cancer attack - and don't generate toxicity by also attacking healthy cells - the next step would be clinical trials, He says.

T cells have receptors that should recognize invaders like an infection or a cancer as foes.

But these drivers of the immune response often are not that effective at attacking cancer, likely because of the reality that cancer cells are mostly a mutation of our own cells, He says.

"Most cancers are self-antigens," He says. "Our body's immune cells are not supposed to fight them, otherwise it becomes autoimmune disease."

Newer cancer treatments, like adoptive T cell therapy, use a variety of ways to strengthen T cells for the fight and He says the mouse receptor genes could be another way to do that.

The mice they studied are engineered to express human leukocyte antigen, which helps regulate the human immune system, and, in this case, helped the mice produce the powerful T cells again human cancer. They immunized them with the antigen α-fetoprotein, which is found in 70-80 percent of human liver cancers, and serves as both a biomarker for diagnosing and a target for treating the sixth most common cancer worldwide, He says.

"For the T cell to recognize the tumor cell, it has to have a receptor for that tumor cell," He says. The mouse T cells developed receptors for this clearly suspicious invader and the genes for the receptors is what He later put on human T cells.

Cancer vaccines, engineered to continue to train T cells to mount a strong immune response against your cancer, also haven't been very effective at mounting a strong fight, says He, and likely one weak point is the lack of strong receptors.

Rates of new liver cancer cases went up 38 percent from 2003 to 2012, according to the Centers for Disease Control and Prevention. Almost 23,000 people died from liver cancer in 2012, a 56 percent increase in deaths since 2003. Men died from liver cancer at more than twice the rate of women.

DALLAS, April 2, 2018 - Elevated blood pressure before becoming pregnant and early in pregnancy may increase the risk of pregnancy loss, even if the woman doesn't have a hypertension diagnosis, according to new research in the American Heart Association's journal Hypertension.

"Elevated blood pressure among young adults is associated with a higher risk of heart disease later in life, and this study suggests it may also have an effect on reproductive health," said Carrie J. Nobles, Ph.D., lead author of the study and a postdoctoral fellow in the Epidemiology Branch of the Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD) in Bethesda, Maryland.

The study - which cannot reach a cause-and-effect conclusion - is the first to look at preconception blood pressure and reproductive outcomes in healthy women not diagnosed with high blood pressure or heart disease.

Researchers studied 1,228 women (average age 28.7 years, 95 percent white) who had already experienced 1-2 pregnancy losses and were currently trying to become pregnant. The women were part of a clinical trial to determine whether taking low-dose aspirin might reduce the risk of miscarriage.

During the study, women had their blood pressure measured when they were trying to become pregnant and again during early pregnancy. Average blood pressure prior to pregnancy was 111.6 mm Hg /72.5 mm Hg. Of the 797 women who conceived within six months, 24 percent suffered a pregnancy loss.

Researchers also found:

Every 10-point increase in diastolic blood pressure (lower number) was associated with an 18 percent increased risk of pregnancy loss.

Every 10-point increase in mean arterial pressure (an average of the lower and higher numbers) was associated with a 17 percent increased risk of pregnancy loss.

The findings were similar for preconception and early-pregnancy blood pressure.

"The impact of cardiovascular risk factors starts really early in life. Physicians treating women of reproductive age should pay attention to slightly elevated blood pressure because it may have other not-well-recognized effects, such as adverse pregnancy outcome," said Enrique F. Schisterman, Ph.D., senior author of the study and Senior Investigator and Chief of the Epidemiology Branch of NICHD. "Preconception is a previously unrecognized critical window for intervention such as lifestyle changes that can help prevent later heart disease and may also improve reproductive health."

Whether women had been randomly assigned to take low-dose aspirin as part of this clinical trial (Effects of Aspirin in Gestation and Reproduction) made no difference in the impact of blood pressure on pregnancy loss, the researchers found.

Because the study was conducted in women who already had experienced a miscarriage, it is unclear whether the results can be generalized to all young women. Additionally, the study was mostly composed of white participants, and further research is needed to ensure the results apply to women of different races.

Elevated blood pressure before conception may increase the chances for pregnancy loss, according to an analysis by researchers at the National Institutes of Health. The authors conclude that lifestyle changes to keep blood pressure under control could potentially reduce the risk of loss. The study appears in Hypertension.

The analysis found that for every 10 mmHg increase in diastolic blood pressure (pressure when the heart is resting between beats), there was an 18-percent-higher risk for pregnancy loss among the study population. Millimeter of mercury, or mmHg, is the unit of measure used for blood pressure. The researchers also found a 17 percent increase in pregnancy loss for every 10 mmHg increase in mean arterial pressure, a measure of the average pressure in the arteries during full heart beat cycles. The study was conducted by researchers at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

"Elevated blood pressure is linked to heart disease, stroke, and kidney disease" said the study's senior author, Enrique Schisterman, Ph.D., chief of the Epidemiology Branch at NICHD. "Our findings suggest that attaining a healthy blood pressure before pregnancy could not only have benefits later in life, but also reduce the chances for pregnancy loss."

NICHD researchers analyzed data collected as part of the Effects of Aspirin in Gestation and Reproduction (EAGeR) trial, which sought to determine if daily low-dose aspirin (81 milligrams) could prevent miscarriage in women who had a history of pregnancy loss.

The EAGeR trial enrolled more than 1,200 women ages 18 to 40 years and took blood pressure readings before the women were pregnant and again in the fourth week of pregnancy. Average diastolic blood pressure for the women in the study was 72.5 mmHg; normal blood pressure in adults is a diastolic reading of below 80 mmHg. The authors began to see an increase in pregnancy loss among women who had a diastolic reading above 80 mmHg (approximately 25 percent of the participants). None of the women in the study had stage II high blood pressure (above 90 mmHg in systolic high blood pressure or above 140 mmHg in systolic blood pressure).

The researchers note that the study does not prove that elevated blood pressure causes pregnancy loss. It is possible that another, yet-to-be identified factor could account for the findings. They added, however, that the relationship between preconception blood pressure and pregnancy loss remained the same when they statistically accounted for other factors that could increase pregnancy loss, such as increasing maternal age, higher body mass index or smoking.

"Our results suggest that further research could help determine if treating elevated blood pressure and other health risks before conception improves pregnancy outcomes," said the study's first author, Carrie Nobles, Ph.D., a postdoctoral fellow in the NICHD Epidemiology Branch.

Dynamic advances

Case Western Reserve University researchers achieve cat-like 'hearing' with device 10,000,000,000,000 times smaller than human eardrum

CLEVELAND-Researchers at Case Western Reserve University are developing atomically thin "drumheads" able to receive and transmit signals across a radio frequency range far greater than what we can hear with the human ear.

But the drumhead is tens of trillions times (10 followed by 12 zeros) smaller in volume and 100,000 times thinner than the human eardrum.

The advances will likely contribute to making the next generation of ultralow-power communications and sensory devices smaller and with greater detection and tuning ranges.

"Sensing and communication are key to a connected world," said Philip Feng, an associate professor of electrical engineering and computer science and corresponding author on a paper about the work published March 30 in the journal Science Advances. "In recent decades, we have been connected with highly miniaturized devices and systems, and we have been pursuing ever-shrinking sizes for those devices."

The challenge with miniaturization: Also achieving a broader dynamic range of detection, for small signals, such as sound, vibration, and radio waves.

"In the end, we need transducers that can handle signals without losing or compromising information at both the 'signal ceiling' (the highest level of an undistorted signal) and the 'noise floor' (the lowest detectable level)," Feng said.

While this work was not geared toward specific devices currently on the market, researchers said, it was focused on measurements, limits and scaling which would be important for essentially all transducers.

Those transducers may be developed over the next decade, but for now, Feng and his team have already demonstrated the capability of their key components-the atomic layer drumheads or resonators-at the smallest scale yet.

The work represents the highest reported dynamic range for vibrating transducers of their type. To date, that range had only been attained by much larger transducers operating at much lower frequencies-like the human eardrum, for example.

"What we've done here is to show that some ultimately miniaturized, atomically thin electromechanical drumhead resonators can offer remarkably broad dynamic range, up to ~110dB, at radio frequencies (RF) up to over 120MHz," Feng said. "These dynamic ranges at RF are comparable to the broad dynamic range of human hearing capability in the audio bands."

New dynamic standard

Feng said the key to all sensory systems-from naturally occurring sensory functions in animals to sophisticated devices in engineering-is that desired dynamic range.

Dynamic range is the ratio between the signal ceiling over the noise floor and is usually measured in decibels (dB).

Human eardrums normally have dynamic range of about 60 to 100dB in the range of 10Hz to 10kHz, and our hearing quickly decreases outside this frequency range. Other animals, such as the common house cat or beluga whale (see illustration), can have comparable or even wider dynamic ranges in higher frequency bands.

The vibrating nanoscale drumheads developed by Feng and his team are made of atomic layers of semiconductor crystals (single-, bi-, tri-, and four-layer MoS2 flakes, with thickness of 0.7, 1.4, 2.1, and 2.8 nanometers), with diameters only about 1 micron.

They construct them by exfoliating individual atomic layers from the bulk semiconductor crystal and using a combination of nanofabrication and micromanipulation techniques to suspend the atomic layers over micro-cavities pre-defined on a silicon wafer, and then making electrical contacts to the devices.

Further, these atomically thin RF resonators being tested at Case Western Reserve show excellent frequency "tunability," meaning their tones can be manipulated by stretching the drumhead membranes using electrostatic forces, similar to the sound tuning in much larger musical instruments in an orchestra, Feng said.

The study also reveals that these incredibly small drumheads only need picoWatt (pW, 10^-12 Watt) up to nanoWatt (nW, 10^-9 Watt) level of RF power to sustain their high frequency oscillations.

"Not only having surprisingly large dynamic range with such tiny volume and mass, they are also energy-efficient and very 'quiet' devices", Feng said, "We 'listen' to them very carefully and 'talk' to them very gently."