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ITHACA, N.Y. - Most sensible air travelers dread turbulence. A little atmospheric hiccup can shake airplanes, rattle nerves and spill beverages. A Cornell University-led study found that birds don't mind at all.

By combining wind speed data with the measured accelerations of a golden eagle outfitted with GPS tracking instruments, the researchers suggest that, rather than hindering flight, turbulence is a source of energy that birds may use to their advantage.

This counterintuitive discovery could revise what we know about avian flight, and help the aerospace industry develop faster, more efficient ways to fly in turbulent environments.

The paper, "Turbulence Explains the Accelerations of an Eagle in Natural Flight," published in PNAS. The lead author was doctoral student Kasey Laurent.

While the flight of birds may appear easy and graceful to earthbound spectators, winged animals are actually navigating air flow that is structured, textured and constantly in flux, according to Gregory Bewley, assistant professor in the Sibley School of Mechanical and Aerospace Engineering, who led the team.

In order to take his experiments out of the lab and into the sky, Bewley's team partnered with two groups - Conservation Science Global and Cellular Tracking Technologies. Scientists from these companies captured a female golden eagle in Alabama, rigged it with a solar GPS telemetry unit with an accelerometer weighing less than 3 ounces, then released the bird.

Over the course of 17 days, as the eagle migrated north along the Appalachian Mountains toward Canada, the GPS "backpack" transmitted more than 200 hours of data - including location coordinates, altitude, ground speed and tri-axial acceleration - via cellular networks.

Bewley's lab then obtained wind speed data from the National Centers for Environmental Prediction's weather history databases and mapped it onto the eagle's flight measurements, identifying the bird's various flying and nonflying behaviors.

They found a "highly irregular, fluctuating pattern" in the eagle's accelerations, which resembles the typical trajectories of particles in turbulent airflows. At timescales ranging from 0.5 to 10 seconds - which translates to approximately 1 to 25 wingbeats - the eagle's accelerations and atmospheric turbulence were completely in synch.

And just how intense are these accelerations? As a point of comparison, people riding in a car or aboard a commercial flight experience less than 0.1 g, or one factor of earth's gravitational acceleration. Meanwhile, the accelerations of birds exceed 1 g - which would throw those human passengers out of their seats.

Of course, aeronautical engineers strive to reduce turbulence as much as possible, and no airline passenger or pilot wants a bumpy ride. But Bewley believes there are opportunities to harness the energy of turbulence, particularly for person-less transport and small reconnaissance aircraft.

"If you could find a path in which every vortex is pushing you the right way, then obviously you get there a little faster with a little less energy," Bewley said. "We're still working hard to understand turbulence by itself. I think it's fascinating that there might be some practical empirical knowledge embodied in wildlife that we don't appreciate yet."

Pancreatic cancer is an aggressive disease in which malignant cells form in the tissues of the pancreas, a long and flat gland located behind the stomach that helps with digestion and blood sugar regulation. Because pancreatic cancer is difficult to detect early, it is associated with a low survival rate, accounting for just over 3% of all new cancer cases in the U.S., but leading to nearly 8% of all cancer deaths, according to the National Cancer Institute.

Through a pre-clinical study conducted in his former role at Moffitt Cancer Center and published in Clinical Cancer Research, Said Sebti, Ph.D., associate director for basic research at VCU Massey Cancer Center, discovered a vulnerability of pancreatic tumors addicted to the cancer-causing mutant KRAS gene and identified a drug that effectively thwarts these tumors. Sebti recently met with clinical colleagues at Massey to discuss evaluating the drug in clinical trials in patients whose pancreatic tumors harbor mutant KRAS.

"We discovered a link between hyperactivation of the CDK protein and mutant KRAS addiction, and we exploited this link preclinically to counter mutant KRAS-driven pancreatic cancer, warranting clinical investigation in patients afflicted with this deadly disease," said Sebti, who is also the Lacy Family Chair in Cancer Research at Massey and a professor of pharmacology and toxicology at the VCU School of Medicine. "Our findings are highly significant as they revealed a new avenue to combat an aggressive form of pancreatic cancer with very poor prognosis due mainly to its resistance to conventional therapies."

KRAS is mutated in 90 percent of pancreatic cancers. Previous research from the Sebti lab and other labs has demonstrated that some tumors that harbor mutant KRAS are actually addicted to the mutant gene, meaning they cannot survive or grow without it. Sebti set out to discover if there is a drug that can specifically kill tumors that are addicted to mutant KRAS.

Sebti and collaborators used three scientific approaches to try and answer this question.

First, they mapped out the blueprint of pancreatic cancer cells through global phosphoproteomics, which gave them a snapshot of how the addicted and non-addicted tumors differ at the phosphoprotein level. They found two proteins -- CDK1 and CDK2 -- which were indicative of which cells were addicted to mutant KRAS.

Additionally, they analyzed a comprehensive database from the Broad Institute of MIT and Harvard that contains genome-wide CRISPR gRNA screening datasets. They found that CDK1 and CDK2 as well as CDK7 and CDK9 proteins were associated with mutant KRAS-addicted tumors.

Lastly, they evaluated the ability of a library of 294 FDA drugs to selectively kill mutant KRAS-addicted cancer cells over non-KRAS-addicted cancer cells in the lab and determined the most effective drug in preclinical experiments was AT7519, an inhibitor of CDK1, CDK2, CDK7 and CDK9.

"Using three entirely different approaches, the same conclusion presented itself clearly to us: pancreatic cancer patients whose tumors are addicted to mutant KRAS could benefit greatly from treatment with the CDK inhibitor AT7519," Sebti said.

To further validate these findings in fresh patient-derived tumors from pancreatic cancer patients, Sebti collaborated on this study with Jose Trevino, M.D., surgeon-in-chief and the Walter Lawrence, Jr., Distinguished Professorship in Oncology at Massey who was at the University of Florida at the time. They found that AT7519 suppressed the growth of xenograft cells from five mutant KRAS pancreatic cancer patients who relapsed on chemotherapy and/or radiation therapies.

AT7519 has previously been tested unsuccessfully in a number of clinical trials, but none of the trials targeted pancreatic cancer.

"If our findings are correct and translate in humans, then we should be able to see a positive response in pancreatic cancer patients whose tumors are addicted to mutant KRAS," Sebti said.

The study authors believe that, in addition to pancreatic cancer, these findings may also have clinical implications for colorectal and non-small cell lung cancer patients where mutations in KRAS are prevalent.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen provide better pain control and have fewer adverse effects than codeine, a commonly prescribed opioid, when prescribed after outpatient surgery, according to new research published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.201915.

"In all surgery types, subgroups and outcome time points, NSAIDs were equal or superior to codeine for postoperative pain," writes Dr. Matthew Choi, Associate Professor of Surgery, McMaster University, with coauthors.

The researchers conducted a systematic review and meta-analysis of 40 high-quality randomized controlled trials (RCTs) involving more than 5100 adults to compare pain levels and safety of medications containing codeine, such as Tylenol #3, with NSAIDs. Patients who took NSAIDs had lower pain scores at 6 and 12 hours after treatment than patients taking codeine.

"We found that patients randomized to NSAIDs following outpatient surgical procedures reported better pain scores, better global assessment scores, fewer adverse effects and no difference in bleeding events, compared with those receiving codeine," write the authors.

Codeine is widely used for postoperative pain management and is the most commonly prescribed opioid in Canada. However, codeine is associated with a range of adverse effects and potential misuse or addiction. Alternatives such as NSAIDs can help reduce opioid use in patients after dental and surgical procedures.

Given the range of procedures and dosage combinations included in the high-quality RCTs, the authors suggest that their results have wide clinical application.

"These findings are of general importance to any clinician performing painful medical procedures. The various trials in our meta-analysis evaluated a range of procedures, different NSAID types and various degrees of acetaminophen administration."

The authors conclude that their findings "strengthen existing evidence and are broadly generalizable to patients across surgical disciplines."

What The Study Did: International medical graduates often practice as physicians in locations and specialties less preferred by U.S. medical graduates. This study reports on physician mortality from COVID-19, and on the mortality of international medical graduates in particular.

Authors: Abraham Verghese, M.D., of Stanford University in California, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamanetworkopen.2021.13418)

Editor's Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

What The Study Did: This autopsy study examines differences in skeletal muscle and myocardial inflammation in patients who died with COVID-19 versus other diseases.

Authors: Tom Aschman, M.D., and Werner Stenzel, M.D., of the Charite-Universitatsmedizin Berlin, are the corresponding authors.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamaneurol.2021.2004)

Editor's Note: The article includes conflicts of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

PISCATAWAY, NJ - Underage youth consumed $17.5 billion worth, or 8.6 percent, of the alcoholic drinks sold in 2016. Products from three alcohol companies--AB Inbev, MillerCoors and Diageo--accounted for nearly half of youth consumption, according to a new study published in the Journal of Studies on Alcohol and Drugs.

Data collected in a landmark study of youth alcohol consumption by brand enabled the authors to calculate the first estimate in nearly 20 years of the monetary value of youth alcohol consumption. And for the first time, they were able to attribute those revenues to specific companies.

"The alcohol industry has said they don't want minors to drink, but when we counted up the drinks, it was clear that they were making billions of dollars from these sales," said co-lead author Pamela J. Trangenstein, Ph.D., assistant professor of health behavior at the University of North Carolina Gillings School of Global Public Health. "There is a clear disconnect when an industry advocates prevention but then makes billions of dollars from prevention's failure."

Alcohol is the number one drug used among people ages 12 to 20. Although underage consumption has been falling in recent years, alcohol is still responsible for approximately 3,500 deaths per year among people younger than age 21, according to the Centers for Disease Control and Prevention.

"Our prior studies have repeatedly shown that youth are exposed to and influenced by alcohol marketing," said co-author David H. Jernigan, Ph.D., professor at Boston University and co-author on the study. "If alcohol companies are truly committed to preventing youth drinking, they should be willing to put these revenues into an independent agency able to address underage drinking without a conflict of interest."

The Institute of Medicine and National Research Council, the science advisory body for Congress, made that recommendation in their 2003 report on underage drinking. In 2006, Congress passed unanimously the first legislation solely devoted to reducing underage drinking. While that legislation authorized $18 million in spending, Congress has never spent the full amount. In fact, Congress recently made permanent the tax break provided to alcohol companies in the 2017 tax cuts.

"Community coalitions in North Carolina and across the country are constantly begging for dollars to support their work on underage drinking," said Trangenstein. "Our study identifies a clear source for that badly needed funding. Families and communities are paying the price, while big alcohol companies are reaping all the benefits."

PITTSBURGH – Americans are consuming more craft beer with higher alcohol content but are drinking less beer by volume, according to a new analysis led by epidemiologists at the University of Pittsburgh Graduate School of Public Health. 

The study, published online and in a coming issue of the journal Substance Use & Misuse, looked at beer purchased in stores between 2004 and 2014. This is the first study to examine trends not only in the volume of beer purchased, but also the “beer specific” alcohol content.

“With the rise in popularity of craft breweries and the acquisition of such breweries by large-scale industry and investment companies, we’ve seen steady growth in consumption of higher alcohol content beer,” said senior author Anthony Fabio, Ph.D., M.P.H., associate professor of epidemiology at Pitt Public Health. “It is important that public health messaging include an emphasis on knowing the alcohol content of beer, not just the number of beers consumed, to ensure healthy alcohol consumption.”

The research team obtained data from the 2004-2014 Nielsen Consumer Panel, which is an annual survey of about 35,000 to 60,000 American households with information on purchasing. Researchers then meticulously matched the types of beer purchased with their alcohol content, grouping beers with 4.5% or less alcohol as “lower alcohol content” beers; with 4.5-5% alcohol as “regular” and beers with greater than 5% as “higher alcohol content.”

They found that in 2004, 9.6% of household beer consumed was of higher alcohol content; in 2014, that grew to 21.6%. Meanwhile, the number of 12-ounce beers each household purchased annually decreased from 169.4 in 2004 to 150.8 in 2014.

“We were pleasantly surprised to learn that—at least in terms of household beer consumption—Americans seem to be self-regulating. Households are buying higher alcohol content beer, but drinking less beer overall,” said lead author Mary Schiff, M.P.H., graduate student in Pitt Public Health’s Department of Epidemiology. 

Federal health authorities have long addressed the importance of understanding the amount of alcohol in a “standard drink.” Different types of beer have very different amounts of alcohol content, and the amount of liquid in a glass, can or bottle does not tell how much alcohol is actually in a drink.  

“That’s why it’s important to know how many standard drinks you consume,” Schiff said. “In the U.S., one ‘standard’ drink contains roughly 14 grams of pure alcohol, which is found in 12 ounces of regular, 5% alcohol beer. With the introduction of these higher alcohol content beers into the marketplace, this rule of thumb no longer holds as beers can be 8% or more alcohol. So, four bottles of regular beer equals four drinks, but four bottles of an India Pale Ale could be six-and-a-half regular beers.” 

The research team couldn’t determine in this study if their findings translate to bars and restaurants. It’s possible that people are able to look at labels and determine the alcohol content of beer they purchase from the store or distributor, but that may be more difficult to do when the beer is served in a pint glass.

Consumption of higher-alcohol content beer grew notably starting in 2011, while lower-alcohol content beer consumption declined. This was when large-scale acquisition of craft breweries ramped up. For example, only 16 such acquisitions occurred in the 21 years from 1988 to 2010, yet in a quarter of that time, 20 acquisitions occurred between 2010 and 2014. 

“During that time, Americans also shifted toward wine and spirits, and may have been drinking less beer for that reason,” said Fabio. “We didn’t examine purchases of alcoholic beverages other than beer, but national reports show steady increases in wine consumption.”

Finally, the research team found that more beer consumption was associated with being white, lower-income and of lower educational attainment, all consistent with previous studies.

Prostate cancer is the most common form of cancer among Canadian men and the third leading cause of cancer death. Abdominal obesity appears to be associated with a greater risk of developing aggressive prostate cancer. This link was demonstrated in a study led by Professor Marie-Élise Parent of Institut national de la recherche scientifique (INRS) and published in the journal Cancer Causes & Control.

Over the years, several studies have shown that obesity is a major risk factor for prostate cancer. To further explore the link between disease incidence and body mass, the research team studied data from a survey conducted in Montréal between 2005 and 2012. Researchers observed that abdominal obesity was associated with an increased risk of aggressive cancer.

"Pinpointing the risk factors for aggressive cancer is a big step forward in health research because it's the hardest to treat," said Prof. Parent. "This data creates an opportunity to work preventively, by monitoring men with this risk factor more closely," she added.

Abdominal and general obesity

The actual distribution of body fat appears to be a significant factor in the development of the disease: the impact on a person's health can vary depending on whether the fat is concentrated around the abdomen or distributed throughout the body. According to Éric Vallières, a Université de Montréal student conducting his doctoral research at INRS and the study's main author, "Abdominal obesity causes hormonal and metabolic variations that can promote the growth of hormone-dependent cancer cells. Abdominal obesity is believed to be associated with a decrease in testosterone, as well as a state of chronic inflammation linked to the development of aggressive tumours."

General obesity did not show the same correlation as abdominal fat. This may result from a detection bias and possible biological effects. "In obese people, the protein used to detect prostate cancer at an early stage, prostate-specific antigen (PSA), is diluted in the blood," Mr. Vallières says. "This hemodilution makes cancer more difficult to detect."

The research team believes that studies on the timing of obesity exposure over a lifetime should be prioritized, and that a more in-depth analysis of body fat distribution could provide greater insight into the risks of developing prostate cancer.

Scientists at the Centro Nacional de Investigaciones Cardiovasculares (CNIC) have described a potential disease-causing mechanism in hypertrophic cardiomyopathy (HCM), the most frequent hereditary disease of the heart. The study, published in the journal ACS Nano, provides the first description of an association between this disease and mechanical alterations to a component of the contractile machinery of the heart.

The heart muscle is under constant mechanical stress throughout life as it contracts to pump blood to the body. The laboratory led by Dr. Jorge Alegre-Cebollada investigates how the mechanical properties of the cardiac proteins determine the physiological behavior of this muscle and how alterations to these properties lead to the appearance of diseases like HCM. In this disease, the most frequent hereditary disease affecting the heart, the left ventricle becomes enlarged, and severe manifestations include heart failure and sudden death.

Scientists have known for more than 20 years that HCM is caused by mutations in proteins with a mechanical function in the heart. One of the challenges of cardiovascular genetics is to identify which among the genetic variants found in patients and their families cause disease. Knowing if a mutation is disease-causing or not is important because this information will determine the clinical follow-up of family members and, potentially, their treatment.

The new study, coordinated by Dr. Jorge Alegre-Cebollada, analyzed cardiac myosin-binding protein C (cMyBP-C).

First author Carmen Suay-Corredera explained that cMyBP-C, which regulates heart contraction, is the most frequently mutated protein in HCM patients. "A high proportion of mutations in the cMyBP-C gene cause amino-acid changes in the protein; however, the mechanisms by which these mutations cause HCM are not precisely known."

Dr. Alegre-Cebollada's group, in close partnership with clinical and molecular researchers in Europe and the US, set up a database of cMyBP-C variants with a clear link to HCM in order to define the molecular defects underlying the disease.

Using bioinformatics and experimental approaches, the research team discovered that around half of these mutations affect the integrity of cMyBP-C messenger RNA (mRNA) or protein. These results have already been accepted for publication in the Journal of Biological Chemistry and have been the subject of a commentary article in the leading medical genetics journal Genetics in Medicine.

While alterations to mRNA or protein integrity could explain the pathogenicity of half the mutations analyzed in the earlier study, Suay-Carredera pointed out that the other half do not cause disease via this route.

"It is precisely these variants, which cause HCM through unknown mechanisms, that we analyzed in the new study," explained Dr. Alegre-Cebollada, who leads the Molecular Mechanics of the Cardiovascular System group at the CNIC.

Using advanced biophysical techniques based on atomic force microscopy, the team showed that some of the disease-causing mutations in cMyBP-C produce defects in the mechanical properties of the protein that can alter the contractile function of cardiomyocytes in HCM patients.

"We are now investigating the disease-causing mechanisms of those variants that have not been linked to any relevant alteration in previous studies," said Dr. Alegre-Cebollada. For this project, the scientists are working with a range of experimental systems, from molecular systems to animal models of HCM.

Identifying the molecular mechanisms underlying HCM is essential for determining which cMyBP-C mutations cause the disease. This knowledge is therefore also crucial for the clinical follow-up and possible treatment of patients and their families, say the authors.

People who smoke, suffer from high blood pressure, obesity, or diabetes are not only at greater risk of suffering a stroke, heart attack, or dementia. For them, the risk of being affected by depressive mood or depression also increases. The more risk factors a person has, the more likely this is. Until now, however, it was unclear whether this probability also depends on their age. Earlier studies had already shown for other diseases such as dementia or stroke that a combination of several risk factors leads to a more frequent onset of the disease between the ages of 40 and 65 than in old age. Until now, however, it was unclear whether this also applies to depression.

Researchers at the Max Planck Institute for Human Cognitive and Brain Sciences (MPI CBS) in Leipzig and the University of Münster have now found out: The extent to which smoking and other risk factors increase the risk of suffering a depressive mood also depends on age. According to the study, people between the ages of 50 and 80 who fulfil several of the critical points, e.g. they smoke and are overweight, suffer more frequently from a depressive mood than those who are exposed to fewer risk factors. However, it was also shown that although depressive moods are particularly severe in middle-aged people exposed to risk factors, they decrease again with increasing age.

"The risk factors also lead to changes in the brain structure," Maria Blöchl from the MPI CBS and the University of Münster and first author of the underlying study explains, as one possible reason for the connection between risk factors and depression. She adds, "If regions responsible for emotion regulation change in the process, the mood of those affected probably deteriorates and this can eventually lead to depression." In addition, there is probably a psychological component. According to the study, these factors usually lead to physical and psychological stress, which in turn can lead to a depressive mood. Blöchl suggests, "The general health status is then often not very good and people take more medication. That is often psychologically stressful."

Why the influence of risk factors on depression and other diseases decreases in older age can also be for various reasons. Again, one could be psychological. "Previous research has shown that older people are better able to cope with stress. Certain effects of risk factors, such as high blood pressure on mood, may therefore no longer be so pronounced," says Blöchl. In addition, those affected can cope better with existing ailments and, in comparison with their peers, see that they may not be doing so badly. "This can lead to a different way of dealing with symptoms of illness and prevent depressive moods."

Another reason could be of a medical nature: serious illnesses such as dementia, which often occur in old age, cause blood pressure to drop several years before the onset of the disease, and with it the danger posed by elevated blood pressure. In addition to this, phenomena such as diabetes or high blood pressure are usually treated more and more intensively in older age than in middle age. Finally, many people who had been exposed to a plethora of risk factors in middle age may already have died.

The researchers investigated these relationships with the help of the longitudinal study "English Longitudinal Study of Ageing", in which more than 18,000 people in Great Britain participated over a period of 12 years. For the present results, they analyzed the data of more than 7,000 people over the age of 50 who had not yet suffered a heart attack, stroke, or dementia. They considered high blood pressure, smoking, diabetes, obesity, and high cholesterol levels as risk factors. Every two years, they recorded the extent of depressive mood and calculated the course of depressive symptoms as a function of risk factors and age. For this purpose, they used growth models in which they calculated the development of individual persons over the years. Finally, this resulted in an individual curve for each person, whose different courses could be explained by adding or removing risk factors. The influence of gender and education was removed accordingly.

Black people have a higher risk of colorectal cancer than white people, but this risk is likely not due to genetics. Data from a recent study by researchers from the U.S. Department of Veterans Affairs, Regenstrief Institute and Indiana University School of Medicine adds more data to the existing evidence.

"The next step is determining what is behind this increased risk," said lead author Thomas Imperiale, M.D., Regenstrief Institute research scientist, VA investigator and professor of gastroenterology and hepatology at IU School of Medicine. "Lifestyle and healthcare-related behaviors may explain some of the difference."

In the study, the research team looked at more than 90,000 veterans who underwent a colonoscopy at 18 VA facilities during a seven-year period. In the overall study population, Black veterans had a higher risk of colorectal cancer. However, in a subgroup of people who got routine screenings, the risk was equal for Black patients and white patients, which suggests that the difference is not biological.

"It could be that Black patients are not getting screened, as suggested by guidelines, or that they respond to early symptoms differently, perhaps delaying seeking treatment for symptoms of colorectal cancer longer than white patients do," said Dr. Imperiale. "Screening is one of the most powerful tools for preventing or detecting colorectal cancer early, when it is curable."

Regenstrief Research Scientist NiCole Keith, PhD, who was not involved in this project, studies health disparities.

"Often, Black patients do not have access to screening or the ability to attend an appointment. Historically, this population has also had trust issues with healthcare, all of which could contribute to these disparities," said Dr. Keith. "We need to develop a way to make these important tests more accessible to everyone and improve trust in healthcare."

The study also found that the risk of colorectal cancer increases for all patients with age.

Surgeons can ease their patients' pain from common operations without prescribing opioids, and avoid the possibility of starting someone on a path to long-term use, a pair of new studies suggests.

Treating post-surgery pain with non-opioid pain medications such as ibuprofen or acetaminophen didn't lead to higher pain levels or more serious issues during recovery, and didn't dampen patients' satisfaction with their care, according to new results from a study of more than 22,000 patients who had one of seven common operations at 70 hospitals.

The team behind the study has also produced a free, evidence-based guide for surgeons and other acute care providers, to help them treat patients' pain without the risk of persistent use that opioids carry.

The new study is published in the Annals of Surgery by a team from Michigan Medicine, the University of Michigan's academic medical center. They analyzed 2019 data from a Michigan-wide surgical care registry, and surveyed patients about their experience after they'd had a chance to recover.

Similar outcomes & experiences with and without opioids

The vast majority - 86% -- of the patients received a prescription for an opioid after they had hernia, gallbladder, appendix, bowel, thyroid or gynecological operations.

But when the researchers compared those patients' experiences and survey responses with data from the 14% of patients who only got non-opioid painkiller prescriptions, they found little difference.

In all, an equal percentage -- 12% -- of both groups of patients had a major adverse event within 30 days of their initial operation. Specifically, there was no difference in complications, emergency department visits, or reoperations between groups. Patients not prescribed opioids were slightly more likely to be readmitted to the hospital, but rarely due to pain-related issues.

There was also no difference in the percentage who sought emergency care for pain.

The survey, carried out one month to three months after their operation, asked patients about their pain in the first seven days after they left the hospital, their satisfaction with their care, their quality of life and their level of regret about having surgery. Nearly 60% of patients completed it.

In all, 82% of both groups - patients who got an opioid prescription, and those who did not - said they were highly satisfied with their care. An even higher, but still equal, percentage of both groups (93%) said they had no regret about their surgery.

Those who didn't receive opioid prescriptions were actually more likely to report no pain in the first week after surgery than those who did (12% vs 7%). The non-opioid patients were also slightly more likely to say they had the best possible quality of life after surgery (66% vs 63%).

"Opioids have been a routine part of post-surgical pain care for decades, but the risk that they could lead to persistent use has been clearly documented," said Ryan Howard, M.D., the study's lead author and a surgical resident at Michigan Medicine who is also a fellow at the Center for Healthcare Outcomes and Policy. "Perhaps it's time to make them the exception, not the rule."

Senior author Mark Bicket, M.D., Ph.D., a co-director of the Michigan Opioid Prescribing Engagement Network, or Michigan OPEN, is senior author of the new paper and a pain medicine specialist in the Department of Anesthesiology at Michigan Medicine.

He notes that 16% of the patients in the study were taking opioids on an ongoing basis before they had their operations. Long-term opioid use is known to increase risks from surgery.

"This study clearly shows no difference in pain, major adverse events or patient-centered outcomes when opioids aren't prescribed," he said. "The growing body of evidence about the risks of opioid medications to the patient, and to others who might misuse leftover pills from the patient's prescriptions, has to be considered together with evidence about their relative effectiveness for pain control."

Post-surgery persistent use and costs

Another new paper, led by Michigan OPEN co-director Chad Brummett, M.D., uses national insurance claims data to document new persistent opioid use and costs of care for surgical patients who had not been taking opioids before their operations. It's published in the June issue of the Journal of Managed Care and Specialty Pharmacy.

That study shows that between 4% and 7% of all patients who had surgery that required a hospital stay went on to fill opioid prescriptions months after their surgical pain should have faded, which the authors called new persistent opioid use. The same was true for between 1.5% and 6.4% of patients who had an outpatient operation. In this study, none of the patients had been filling opioid prescriptions before their operation.

These patients went on to have more hospital and emergency care in the following year, compared with those who didn't fill a single opioid prescription immediately after their operation.

While some of the patients who didn't fill an opioid prescription after surgery did go on to receive opioids for other reasons later in the follow-up year, those who started on opioids after surgery received five times more opioid prescriptions and much higher overall health care costs.

Prescribing guidelines and tools

The Michigan OPEN team has published research on the use of opioids for acute pain for several years, and used it to develop opioid prescribing recommendations for specific operations and procedures.

They've also created tools to help prescribers set patients' expectations around pain control before they receive care. This can help patients understand how to use any opioids they might be prescribed wisely, and dispose of them safely.

The group's new guidebook provides a comprehensive toolkit and additional information for prescribers and patients.

Philadelphia, June 10, 2021 - A new study from researchers at Children's Hospital of Philadelphia (CHOP) and the University of Pennsylvania's Annenberg Public Policy Center found that 18- to 24-year-olds who use cell phones while driving are more likely to engage in other risky driving behaviors associated with "acting-without-thinking," a form of impulsivity. These findings suggest the importance of developing new strategies to prevent risky driving in young adults, especially those with impulsive personalities. The study was recently published in the International Journal of Environmental Research Public Health.

Cell phone use while driving has been linked to increased crash and near-crash risk. Despite bans on handheld cell phone use while driving in many states, crash reduction results are inconsistent. One explanation may be that those who use cell phones while driving are more likely to engage in other intentionally risky behaviors. Instead of solely addressing the use of cell phones while driving, the authors suggest training young drivers to avoid all risky behaviors associated with impulsivity and sensation seeking.

"This study found that frequent cell phone use while driving was only one indicator of a more general pattern of risky driving practices associated with prior crashes in young drivers," said lead study author Elizabeth Walshe, PhD, a research scientist at the Center for Injury Research and Prevention (CIRP) at CHOP and co-leader of CHOP's Neuroscience of Driving research program. "Assessment of personality traits, such as impulsivity and sensation seeking, may be helpful to identify drivers most at risk in order to provide more targeted interventions promoting safe driving."

This retrospective study recruited 384 young drivers from across the U.S. to complete an online survey measuring risky driving practices - including cell phone use - as well as history of crashes and impulse-related personality traits. The study found that 44.5% of drivers reported being in at least one crash, and 73% of them reported cell phone use while driving. Those who used cell phones while driving were also more likely to participate in other risky driving behaviors, including ignoring speed limits, aggressively passing vehicles going in the same direction, and running red lights. The use of cell phones was not uniquely associated with prior crashes but was one of several risky activities related to crashes.

"It may be useful to treat cell phone use while driving as part of a group of risky driving behaviors, such as driving while impaired by alcohol," said study co-author Dan Romer, PhD, research director of the Annenberg Public Policy Center of the University of Pennsylvania and a senior fellow at CIRP. "For example, messages to enhance driver safety might focus on a larger range of hazardous practices that place the driver and others at risk rather than citing only one, like cell phone use."

Obesity is generally linked to poor eating habits and the availability of tasty, high-calorie foods. However, a new study led by researchers from the Magnetic Resonance Imaging Research Unit in the Department of Radiology at Hospital del Mar and the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation, has found that more elements are involved. Thanks to images obtained by functional magnetic resonance imaging, the researchers found that certain parts of the brains of obese children show alterations with respect to normal-weight or overweight children of the same age. The study findings were published in the journal Cerebral Cortex.

"Obesity in general, and childhood obesity in particular, is seen as a bad habit and certain foods are blamed for it, but this is not entirely true," commented Dr. Jesús Pujol, co-author of the study and head of the Magnetic Resonance Imaging Research Unit. The study, he explained, found "a qualitative leap, in which what is viewed as a bad habit in overweight children becomes a brain 'disease' in the form of functional alterations when overweight becomes obesity. It is clearly an obsession with food."

A brain unlike that of normal-weight and overweight children

The brains of obese children were found to have different features from those of normal-weight or overweight children. The researchers analysed images of the brains of 230 children aged 8-12 years (volunteers in the BREATHE study led by ISGlobal) using techniques developed by the Hospital del Mar team and determined that two areas of the brain were altered and hyperexcited. The affected regions were the orbitofrontal cortex and the amygdala, the centres that regulate reward and punishment sensations and their relationship to the part of the brain that regulates basic needs, such as food and emotions, and the somatosensory cortex, where the brain represents body image. The study is the first of its kind in children and the first to provide evidence of these alterations in obese children.

The alterations found in the study are consistent with the changes seen in people with obsessive-compulsive disorder and Prader-Willi syndrome, a genetic disorder that causes obsessive symptoms and leads to obesity. "Obese children suffer greatly from their problem and from the obsessive idea of food," explained co-author Laura Blanco-Hinojo, a researcher in the Magnetic Resonance Imaging Research Unit. "Moreover, food does not calm them down, they do not enjoy it, and it only partially alleviates their anxiety." In other words, the obsession with eating invades the mind and the child experiences this negatively and with suffering, which is not the case for normal-weight or overweight children.

The alteration of the behaviour-regulating system can be considered pathological, a fact that must be taken into account when dealing with these cases. "Therapeutic intervention is absolutely necessary and should not be foregone," explained co-author Gerard Martínez-Vilavella, a psychologist in the Magnetic Resonance Imaging Research Unit at Hospital del Mar. "In overweight children, there are quantitative alterations that indicate that the brain is functioning differently, but in obese children, it falls into the category of pathology," he added.

The hyperexcitement of these areas of the brain causes permanent anxiety in obese children and, at the same time, alters and magnifies their perception of their own body. These cases therefore require a multidisciplinary approach, given that the children are still in the process of forming their personality as well as their brain structures and connections.

The researchers noted that the study does not reach a conclusion on whether obesity causes the brain alterations or the alterations cause overweight and obesity. In any case, both factors--diet and brain pathology--must be taken into account. Jordi Sunyer, ISGlobal researcher and last author of the study, commented: "The high prevalence of childhood obesity is one of the biggest epidemics of the 21st century. The discovery of functional alterations in brain regions related to reward and body image in these children indicates that treatment must be targeted at the individual level. The fact that these alterations are also found in brain diseases and mental illnesses provides a clue as to what sort of therapeutic practices are necessary. However, the widespread availability of high-calorie food, excessive screen time and indoor life, and passive mobility are environmental determinants that must also be addressed."

Childhood obesity

In Catalonia, 38% of girls and 40% of boys aged 6-11 years are overweight or obese, according to a study of more than one million children by ISGlobal and the IDIAPJGol Institute. (The study was published in Jama Network Open and is available at the following link: https://bit.ly/3vsICaI.) The prevalence of overweight and obesity has fallen overall but has risen in the most deprived urban areas. Childhood obesity is defined as a weight at or above the 95th percentile for the child's age.

BOSTON - In the three months since Johnson & Johnson's COVID-19 vaccine received emergency use authorization from the U.S. Food and Drug Administration, more than 10 million Americans have received the vaccine, according to the Centers for Disease Control and Prevention. The single-shot viral vector vaccine -- developed in collaboration with Beth Israel Deaconess Medical Center (BIDMC) immunologist Dan Barouch, MD, PhD -- was authorized for use based on clinical trial data showing strong clinical efficacy against symptomatic COVID-19 in the United States, Latin America and South Africa.

In a new study published in Nature, Barouch, Director of BIDMC's Center for Virology and Vaccine Research, and colleagues report on the antibody and cellular immune responses generated by the Ad26.COV2.S vaccine against the original viral strain and against SARS-CoV-2 variants of concern. The team found that this vaccine induced immune responses against all the viral variants.

"The concern is whether SARS-CoV-2 variants may reduce the efficacy of current vaccines that were designed to protect against the original SARS-CoV-2 strain at the beginning of the pandemic," said Barouch, senior author of the study and also Professor of Medicine at Harvard Medical School. "These findings therefore have important implications for vaccine protection against SARS-CoV-2 variants of concern."

To explore the immunogenicity of Ad26.COV2.S, Barouch and colleagues at BIDMC administered one or two doses of Johnson & Johnson's investigational vaccine to 20 volunteers between the ages of 18 and 55. All volunteers were participants of a larger multicenter, randomized, double-blind, placebo-controlled Phase 1/2a study to evaluate the vaccine at various doses and schedules. The researchers then used multiple methods to assess antibody and cellular immune responses against the original viral strain (WA1/2020) and against the viral variants first identified in South Africa (B.1.1351), the United Kingdom (B.1.1.7), Brazil (P.1) and California (CAL.20C).

Compared to antibody responses against WA1/2020, the data showed reductions in neutralizing antibodies against the B.1.1351 and P.1 strains. In contrast, non-neutralizing antibody responses and T cell responses were minimally impacted or not impacted by SARS-CoV-2 variants. Given the vaccine's protective efficacy as demonstrated in Phase 3 clinical trials, non-neutralizing antibodies and/or T cell responses may contribute to protection against COVID-19.

The published Phase 3 efficacy data showed that the Ad26.COV2.S vaccine offered strong protection against symptomatic COVID-19 in South Africa and in Brazil where most sequenced COVID-19 cases were caused by variants. The findings contribute to our understanding of vaccine protection against SARS-CoV-2 variants of concern.

"Although the mechanistic correlates of protection for COVID-19 are not yet known, the vaccine's robust protective efficacy in these regions raises the possibility that non-neutralizing antibodies and/or T cell responses may also
contribute to protection," said Barouch, who is also a member of the Ragon Institute of MGH, MIT, and Harvard. "Alternatively, it is possible that low levels of neutralizing antibodies are sufficient for protection against COVID-19."