Body

Sweating is a natural function of the human body, allowing a body to cool itself as sweat emerges from glands and evaporates. Separately, this process may produce odors as bacteria present on the skin break down sweat proteins. A deodorant kills the bacteria that produce the odor, while an antiperspirant clogs sweat ducts to prevent sweat from emerging in the first place.

This clogging is commonly achieved by the use of metallic salts. There remains debate as to whether or not these metallic salts contribute to heath risks such as cancer, but demand by consumers for more natural alternatives to antiperspirants containing these metals (a sort of "just-in-case" scenario) is rapidly growing.

The Virginia Tech Nature-Inspired Fluids and Interfaces Lab, led by Associate Profesor Jonathan Boreyko, has just made a major breakthrough in the study of natural antiperspirants. Their theory is this: If the sweat can begin to evaporate while still inside of the sweat duct, before it emerges onto the skin, the sweat's own minerals will crystallize to clog the duct. In other words, the mixture of sodium, choride, potassium, calcium, urea, and bicarbonates naturally present in sweat can do the same work as the metallic salts used in commercial antiperspirants.

Testing the theory

To explore this idea, the group constructed an artificial "sweat rig" to investigate the possibilities. They used a microchannel made from pulled glass to serve as an artificial sweat duct, and created the function of a sweat gland by using pressurized gas to push synthetic sweat across tubing and into the connected glass duct.

To prove the concept, three different scenarios were tested. The first was a control, where no product was placed near the artificial sweat duct. For the second test, researchers placed a dry cube of the organic, silicon-based polymer PDMS near the exit of the duct. Finally, for the third test, the PDMS cube was infused with propylene glycol, a chemical that is highly attractive to water. These three scenarios allowed for a direct comparison of how sweat flowed when the duct was completely open, versus near a regular object, versus near an evaporation-inducing object.

The team observed the flow of the synthetic sweat, which has the same minerals as natural sweat, by focusing a microscope on the artificial duct. For the first two scenarios, the sweat flowed freely from the outlet of the sweat duct, which would correspond to sweat emerging onto the skin. But for the third scenario, where the duct was placed close to the evaporation-inducing material, the duct became clogged within seconds. A gel-like plug formed within the duct near the exit, creating a seal. Even when the pressure pushing the liquid was increased, the clog was able to maintain the seal.

"Over the past few years in particular, I've noticed that my wife and many of her friends have been transitioning to more natural cosmetic and cleaning products," said Boreyko. "There is also an increasing push from regulatory agencies, particularly in Europe, to restrict the use of metals in antiperspirants. Our research has discovered the most natural antiperspirant in existence: the minerals within the sweat itself! It is exciting to find that simply making the sweat evaporate faster can cause natural mineral plugs that have the potential of replacing metal-based products in the future."

With the concept proven, the team is moving toward application. Possibilities for extending the concept to human trials could include using an applicator stick, similar in form to current products, or a wearable adhesive. In either case, the next goal is to demonstrate in a human trial that the proper water-attracting product could facilitate natural clogging from the body's own sweat.

SALT LAKE CITY, November 16, 2020 - A new nationwide poll, the GeneSight Mental Health Monitor, shows that nearly two-thirds (61%) of Americans age 65 or older who have concerns about having depression will not seek treatment. In fact, nearly 1 in 3 (33%) seniors who are concerned they might be suffering from depression believe they can "snap out" of it on their own.

"The 'pull yourself up by your bootstraps' mindset of some seniors and reluctance to talk about mental health are hindering them from getting the help they need - especially now when the pandemic is having an enormous impact on the mental health of older Americans," said Dr. Mark Pollack, chief medical officer of Myriad Neuroscience, makers of the GeneSight test. "People will seek treatment for conditions like heart disease, high blood pressure or diabetes. Depression is no different. It is an illness that can and should be treated."

Yet, while depression is a condition that needs to be treated:

61% of respondents who are concerned they might have depression would not treat it because "my issues aren't that bad."

About 4 in 10 (39%) of these consumers think they can manage depression without a doctor's help.

"In my experience, there is a commonly held view that depression is a normal part of aging; it is not," said Dr. Parikshit Deshmukh, CEO and medical director of Balanced Wellbeing LLC in Oxford, Florida, which provides psychiatric and psychotherapy services to nursing and assisted living facilities. "I've found older adults have a very difficult time admitting that they have depression. When they do acknowledge it, they are still reluctant to start treatment for a wide variety of reasons."

Depression remains a taboo topic among older Americans, despite about one-third of those over the age of 65 who are concerned they have depression recognizing that depression has interfered with their relationships and their ability to enjoy activities.

"There is such a stigma about depression among people my age," said Carmala Walgren, a 74-year-old resident of New York. "I am proof that you do not have to accept living with depression. Although it may not be easy to find treatment that helps you with your symptoms without causing side effects, it is certainly worth it."

Walgren's doctor used information from the results of her GeneSight test, a genetic test that identifies potential gene-drug interactions for depression medications, to help inform Walgren's medication selection.

"The GeneSight test made such a difference in my life," said Walgren. "My doctor has used the test results to find medications that helped me."

The first Canadian guideline for the care and management of patients with amyotrophic lateral sclerosis (ALS) -- Lou Gehrig's disease -- recommends a patient-focused approach, with attention to holistic and emotional aspects of well-being.

The guideline, published in CMAJ (Canadian Medical Association Journal), is intended for ALS clinicians, allied health professionals and primary care providers, and contains an easy-to-reference table with comprehensive recommendations. As new evidence may change management, the guideline will be updated every 5 years.

"These best practice recommendations are an important step forward in improving the lives of people living with ALS across the country and supporting their caregivers by addressing important issues," says Dr. Christen Shoesmith, neurologist and Motor Neuron Diseases Clinic director at London Health Sciences Centre in London, Ontario, and chair of the ALS guideline working group. "The emphasis on expert consensus relative to evidence-based recommendations highlights the need for more research in ALS management and underscores the challenges ALS clinicians face in managing patients with this complex and devastating disease."

About 3000 Canadians live with ALS, a debilitating degenerative disease affecting the brain and spinal cord that ultimately results in paralysis. ALS has no cure, and four out of five people with ALS will die within five years of being diagnosed.

The guideline is based on the best available evidence as well as expert consensus when evidence is lacking. It is intended to guide Canadian clinicians through issues unique to Canada and to update previous guidelines published in the United States and Europe.

Communications -- tailor the initial discussion about diagnosis to the patient's needs; information about ALS prognosis does not need to be provided at the time of diagnosis

Disease-modifying therapies -- have an open discussion with patients about the potential risks and benefits of both approved and unapproved therapies

Multidisciplinary care -- refer patients to specialized ALS multidisciplinary clinics for optimized health care delivery

Caregivers -- be attentive to the needs of caregivers and involve them in care planning

The guideline provides detailed recommendations for managing symptoms including pain, cramps, sleep disturbances, depression and anxiety as well as recommendations for respiratory management, nutrition, exercise, medication alignment, palliative care and more.

The authors emphasize the need for more research into ALS treatment and the challenges in caring for people with this disease.

Funding for the guideline was provided by the ALS Society of Canada and the Canadian ALS Research Network (CALS).

Listen to a podcast https://soundcloud.com/cmajpodcasts/191721-guide

"This guideline will enable ALS clinics across Canada to meet a common national standard, and to adapt as this standard continues to evolve over time. In doing so, ALS clinicians can offer the best possible care to their patients and help them to navigate this exceedingly complex and devastating disease," conclude the authors.

Children under age 2 who take antibiotics are at greater risk for childhood-onset asthma, respiratory allergies, eczema, celiac disease, obesity and attention deficit hyperactivity disorder, according to a paper written jointly by Mayo Clinic and Rutgers researchers.

In a study published in the journal Mayo Clinic Proceedings, the researchers looked at 14,572 children born in Olmsted County, Minn., between 2003 and 2011, 70 percent of whom received at least one antibiotic prescription during their first two years, primarily for respiratory or ear infections.

The findings are consistent with the hypothesis that the composition of the microbiome - the trillions of beneficial microorganisms that live in and on our bodies - plays a critical role in the early development of immunity, metabolism and behavior.

"The evolution of drug-resistant bacteria exemplifies one unintended consequence of antibiotic overuse," said co-author Martin Blaser, director of the Center for Advanced Biotechnology and Medicine at Rutgers. "The increasing prevalence of health conditions that start in childhood has triggered concern about antibiotic exposures during key developmental periods because of their impact on the microbiome."

While previous studies have looked at the association of antibiotics with single diseases, this is the first to look at the association across many diseases. The study found that antibiotics were associated with metabolic diseases (obesity, being overweight), immunological diseases (asthma, food allergies, hay fever and cognitive conditions or disorders (ADHD, autism), but effects varied among the different antibiotics. Cephalosporins were associated with the most risk for multiple diseases, and uniquely autism and food allergies.

Researchers also found that risk increased with more courses of antibiotics and when given earlier in life -- especially within the first 6 months.

"The findings from Olmsted County provide evidence for broad and delayed effects of early life antibiotic exposures, and should change doctors' practices in how often they prescribe antibiotics, especially for mild conditions," said Blaser.

Proper disposal of leftover medications can prevent overdoses and protect waterways from becoming polluted by pharmaceuticals. Drug take-back boxes are a safe and secure way to dispose of unwanted medications, but a new Portland State University study shows awareness of these dropboxes as well as knowledge about risks of improper disposal remain low.

Amy Ehrhart, a doctoral student in PSU's Earth, Environment and Society program and the study's lead author, said the findings suggest efforts to reduce improper disposal should focus on legislation that mandates dropboxes at pharmacies and pressure on the pharmaceutical industry to fund proper disposal of unused drugs.

Federal legislation in 2014 allowed retail pharmacies to establish dropboxes within stores to collect leftover medications year round. The drugs are then collected and typically incinerated or disposed of as hazardous waste, which is the Environmental Protection Agency's recommended approach. Flushing medications down the toilet and throwing them in the trash are discouraged because they pollute groundwater, rivers and oceans.

The study examined customer disposal behavior, pharmacist recommendations and attitudes regarding disposal of leftover drugs, and proper disposal implementation challenges.

Among the study's findings:

Over a third of customers in the sample store their unused medications at home, and the most common disposal methods reported were throwing them in the trash (27.5%), flushing (15.8%) and using a dropbox (8.3%).

The presence of a dropbox at a pharmacy was associated with greater customer awareness of proper drug disposal and safer pharmacist recommendations to customers.

"The focus group brought up that consumer education wouldn't be successful until we have more dropbox availability," Ehrhart said. "From their anecdotal experience, those dropboxes fill up quickly and then can't be used until they are emptied."

The focus group also pointed to cost as a major hindrance to dropbox adoption, with participants heavily emphasizing that the pharmaceutical industry should be responsible for fronting the costs.

In 2019, Oregon joined five other states in approving a new law that requires drug manufacturers to pay for and run a statewide drug take-back program. The program is expected to be operational by July 2021. At the request of those pushing for the legislation, data collected from this and other PSU studies about the environmental effects of pharmaceutical pollution was shared with law and policymakers.

"Legislation that requires pharmaceutical manufacturers to pay for disposal or at least provide some kind of funding to have options for disposal is really important," Ehrhart said.

DALLAS, Nov. 15, 2020 -- A one-month treatment of dual anti-platelet therapy is safe and as effective as a longer duration of therapy at preventing cardiac events in patients one year after stent placement, according to late-breaking research presented today at the American Heart Association's Scientific Sessions 2020. The virtual meeting is Friday, November 13-Tuesday, November 17, 2020, and is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science for health care worldwide.

"This study is the first randomized trial comparing one-year clinical outcomes of one-month of dual anti-platelet therapy followed by aspirin monotherapy to the currently recommended dual anti-platelet therapy regimen in patients with coronary artery disease who are recovering from stent placement," said lead study investigator Myeong-Ki Hong, M.D., Ph.D., professor of cardiology at Yonsei University College of Medicine, Severance Cardiovascular Hospital in Seoul, Korea.

Patients recovering from artery-opening procedures involving a stent are prescribed one or more anti-platelet medications (to help keep platelets from sticking together), typically for months, along with aspirin to prevent blood from clotting in the stent. This is known as dual anti-platelet therapy. Dual anti-platelet therapy, also known as DAPT, can pose a significant risk of bleeding for patients who are already taking blood thinners.

Most studies evaluating a shorter course of DAPT have focused on patients at high-risk for bleeding. Additionally, many recent studies have also focused on patients receiving a class of antiplatelet known as a P2Y12 inhibitor monotherapy rather than aspirin monotherapy after a shorter course of DAPT.

Researchers in this study evaluated and compared the safety and effectiveness of two durations of dual anti-platelet therapy in patients who had drug-eluting stent placement or polymer-free drug-coated stent placement and were not at a high-risk of bleeding.

Across 23 medical centers in Korea, 3,020 Korean patients (mean age 67; 31% women) were randomly assigned to receive either:

one-month of dual anti-platelet therapy after polymer-free drug-coated stent placement followed by 11 months of aspirin alone;

or 6-12 months duration of anti-platelet therapy followed by 0-6 months of aspirin alone after drug-eluting stent placement procedure.

Drug-eluting stents are coated with a polymer that slowly releases medication designed to reduce the risk of the artery reclogging. Polymer-free drug-coated stents are a newer type of stent created to address potential inflammation caused by polymer.

Most of the patients (2,969) completed a one-year follow-up. Analysis found there was no significant difference in the number of cardiac events between the two groups: 5.9% of patients in the one-month treatment group died or had a heart attack, stroke, major bleeding or stent/ angioplasty procedure, compared to 6.5% in the 6- to 12-month treatment group.

"It is encouraging to see that one-month dual anti-platelet therapy, followed by aspirin monotherapy after polymer-free drug-coated stent is effective and safe in a diverse group of patients with coronary artery disease," Hong said. "These results also could lead to the suggestion for some patients to discontinue a P2Y12 inhibitor, rather than aspirin, in daily clinical practice, which could result in better patient compliance, lower costs, a lower risk of bleeding, and overall, more convenience for both patients and physicians."

Around 45% of children in Austrian day nurseries have a first language other than German. Those who our experiencing difficulty in learning the second language are often diagnosed as having a suspected "impairment of language acquisition". In fact, this often merely reflects the fact that they have not yet fully acquired the second language. A research team of linguists led by Brigitte Eisenwort from the "Outpatient clinic for children with suspected language acquisition impairments" at MedUni Vienna's Department of Pediatrics and Adolescent Medicine has now investigated the problem in the context of a case study. This study applied the "Vienna Model", which incorporates medical students who are native speakers of the child's first language to facilitate more accurate diagnosis. The study has now been published in the journal Neuropsychiatrie.

In 2019, an average of around 2.1 million Austrian inhabitants came from a migration background. Due to the changing demographic due to migration over the last few decades, more and more children are growing up multilingual. Many of them display problems in learning their second language (German) and are often diagnosed as having a suspected "impairment of language acquisition", whereas the real problem is that they have not yet fully acquired their second language. This is due to the similarity between the manifesting features, which can only be differentiated by specialists.

Seeking a more accurate diagnosis, many of these children with a migration background attend the Outpatient Clinic for Children with Suspected Language Acquisition Impairments at MedUni Vienna's Department of Pediatrics and Adolescent Medicine, which has capacity to assess four children per week. The clinic uses the "Vienna Model" of language assessment, which means that medical students, who are native speakers of the child's mother tongue, support MedUni Vienna linguists in analysing the child's language competence in their first language. This has the advantage that specific cultural aspects can be identified as well as grammatical skills. "While, in principle, we could also use native speakers studying other subjects to help us, involving medical students has the great advantage that it simultaneously gives them experience in doctor-patient communications and furnishes them with background knowledge about developmental disorders and in particular language acquisition impairments as part of their studies," explains study leader Brigitte Eisenwort.

Of around 40 children assessed in 2019, around half were found to have no clinically relevant language acquisition impairment. Instead, the problem lay with disruptive sociolinguistic factors, such as limited input in their mother tongue, for example.

Says Eisenwort: "Many children with a migration background receive a restricted input in their mother tongue, since the parents themselves had acquired a mother tongue that was suppressed for political reasons, for example, and therefore were unable to pass on a rich vocabulary or, in the process of migration, no longer have any need for complex sentence structures and sophisticated vocabulary, so that they are no longer able to pass these on to their children."

According to Eisenwort, a key factor in assessing a child is to first take a detailed language history and then assess the child in both or all languages. Eisenwort suggests that an important measure for improving language competence in the majority language would be to give children the opportunity to communicate with native German-speakers in small groups. The next research project, which will start shortly, is a joint project with the Acoustics Research Institute of the Austrian Academy of Sciences (ÖAW) looking at "Viennese children with a native language other than German", in which the focus will be on phonetic and phonological skills of children who grow up bilingual with a Bosnian-Croatian-Serbian mother tongue.

While the world's attention to public health remains focused on COVID-19, Berkeley Franz, Ph.D., assistant professor at the Ohio University Heritage College of Osteopathic Medicine, continues to focus her attention on one of the largest public health crises in the United States today - the opioid epidemic.

Franz, along with Cory Cronin, Ph.D., assistant professor in OHIO's College of Health Sciences and Professions, and José Pagán, Ph.D., professor of public health policy and management at New York University, co-authored the article, "What Strategies Are Hospitals Adopting to Address the Opioid Epidemic? Evidence From a National Sample of Nonprofit Hospitals," to identify what hospitals are doing to combat the opioid epidemic and how they could better address these problems in communities.

The study led by Franz is published in Public Health Reports, the official journal of the Office of the U.S. Surgeon General and the U.S. Public Health Service.

"Prior to the COVID-19 pandemic, the opioid epidemic was the most vexing health problem," Franz said. "High rates of addiction were cited as one of the main reasons that American life expectancy declined in multiple years, something we rarely see. At the same time, opioid misuse increased to be the greatest causes of preventable death. This study shows that hospitals can play a clear and important role in implementing interventions and effectively treating patients, especially if they are willing to do so on site."

This study is part of ongoing research Franz is doing to understand whether hospitals are addressing the most critical public health needs in their communities. She is also studying institutional barriers to adopting new programs to address opioid misuse, including the presence of bias/stigma among health care professionals.

Through their research, Franz, Cronin and Pagán found that hospitals often don't do evidence-based programs despite evidence that treating the patient at the hospital rather than through a referral leads to more effective treatment and reduces death from subsequent overdoses.

"With opioid misuse, people often end up in hospitals for care, which is a great place to address other, secondary health consequences that come from the misuse," Franz explained. "Aside from an actual overdose itself, people can get infections at the injection site, heart and skin infections, infectious diseases linked to intravenous drug use and more. By taking care of these individuals in a hospital setting, medical professionals can also address these issues as well as introduce treatment for the underlying substance use disorder."

To compile data, the researchers analyzed data from a 20% sample of all U.S. hospitals to determine what they were doing to address opioid abuse.

The researchers looked at whether hospitals offered specific kinds of services - and specifically whether the hospitals were directly addressing the issue or redirecting patients to primary care or other outpatient care.

"While individual health needs assessments and implementation strategies are publicly available, our hope is that by aggregating strategies and trends, we can provide a snapshot of the overall picture, which may be helpful to decision makers in health care organizations or public agencies," Cronin said.

The study shows that nonprofit hospitals invest in clinical strategies and risk education, but they could do more by initiating medication-assisted treatment at the hospitals and adopting harm reduction initiatives, such as distributing naloxone or offering syringe exchanges.

"We have created a great partnership between Ohio University and New York University researchers interested in the contribution of hospitals to improve the health of our communities," Pagán said. "I am very lucky to have had the opportunity to work with this great team and bring awareness to the important leadership role hospitals play in our communities to help reduce opioid abuse."

Pagán added that state support is important, as hospitals are more likely to adopt harm reduction programs and other strategies in states that take the lead encouraging the use of these strategies.

Although some hospitals are adopting evidence-based strategies to address opioid misuse, the pandemic is affecting how hospitals can implement such programs effectively. For instance, many hospitals are currently focused on fighting COVID 19, so they may have fewer opportunities to offer substance abuse services. At the same time, the added societal stress of the pandemic can actually exacerbate substance misuse. Also, some hospitals do not offer direct services for those who misuse substances.

BOSTON - Short bursts of physical exercise induce changes in the body's levels of metabolites that correlate to, and may help gauge, an individual's cardiometabolic, cardiovascular and long-term health, a study by Massachusetts General Hospital (MGH) has found. In a paper published in Circulation, the research team describes how approximately 12 minutes of acute cardiopulmonary exercise impacted more than 80% of circulating metabolites, including pathways linked to a wide range of favorable health outcomes, thus identifying potential mechanisms that could contribute to a better understanding of cardiometabolic benefits of exercise.

"Much is known about the effects of exercise on cardiac, vascular and inflammatory systems of the body, but our study provides a comprehensive look at the metabolic impact of exercise by linking specific metabolic pathways to exercise response variables and long-term health outcomes," says investigator Gregory Lewis, MD, section head of Heart Failure at MGH and senior author of the study. "What was striking to us was the effects a brief bout of exercise can have on the circulating levels of metabolites that govern such key bodily functions as insulin resistance, oxidative stress, vascular reactivity, inflammation and longevity."

The MGH study drew on data from the Framingham Heart Study to measure the levels of 588 circulating metabolites before and immediately after 12 minutes of vigorous exercise in 411 middle-aged men and women. The research team detected favorable shifts in a number of metabolites for which resting levels were previously shown to be associated with cardiometabolic disease. For example, glutamate, a key metabolite linked to heart disease, diabetes and decreased longevity, fell by 29%. And DMGV, a metabolite associated with increased risk of diabetes and liver disease, dropped by 18%. The study further found that metabolic responses may be modulated by factors other than exercise, including a person's sex and body mass index, with obesity possibly conferring partial resistance to the benefits of exercise.

"Intriguingly, our study found that different metabolites tracked with different physiologic responses to exercise, and might therefore provide unique signatures in the bloodstream that reveal if a person is physically fit, much the way current blood tests determine how well the kidney and liver are functioning," notes co-first author Matthew Nayor, MD, MPH, with the Heart Failure and Transplantation Section in the Division of Cardiology at MGH. "Lower levels of DMGV, for example, could signify higher levels of fitness."

The Framingham Heart Study, which began in 1948 and now embraces three generations of participants, allowed MGH researchers to apply the same signatures used in the current study population to stored blood from earlier generations of participants. By studying the long-term effects of metabolic signatures of exercise responses, researchers were able to predict the future state of an individual's health, and how long they are likely to live.

"We're starting to better understand the molecular underpinnings of how exercise affects the body and use that knowledge to understand the metabolic architecture around exercise response patterns," says co-first author Ravi Shah, MD, with the Heart Failure and Transplantation Section in the Division of Cardiology at MGH. "This approach has the potential to target people who have high blood pressure or many other metabolic risk factors in response to exercise, and set them on a healthier trajectory early in their lives."

WASHINGTON -- Researchers have developed an extremely sensitive, yet simple optical method for detecting formaldehyde in a person's breath. Because formaldehyde is being studied as a potential biomarker for lung and breast cancer, the new method could one day lead to an inexpensive and fast way to screen for cancer.

"Measuring biomarkers in exhaled breath is noninvasive, painless and fast and could be used to screen for cancer even at very early disease stages, which is crucial for successful treatment," said research team leader Mateusz Winkowski from the University of Warsaw in Poland. "The optical method we developed could make this type of measurement more practical and inexpensive."

In The Optical Society (OSA) journal Biomedical Optics Express, Winkowski and Tadeusz Stacewicz show that their new optical sensing method based on multipass spectroscopy can detect the presence of 1 molecule of formaldehyde in a million air particles, or 1 part per million, even in the presence of gasses that can interfere with optical measurements.

"Our dream is to one day build a table-top device that would be inexpensive and could be used for cancer screening in any medical consulting room," said Winkowski. "During a basic medical examination, the patient could blow into the device, and within a minute the doctor would know if the patient might need additional conventional examinations."

Boosting sensitivity

Spectroscopy can be used to identify the chemical composition of a substance by measuring the color of light absorbed or emitted from a sample. A spectroscopy approach known as multipass is useful for detecting low concentrations of gas molecules because it increases the extent to which the light interacts with the sample. This setup uses an experimental cell with a mirror on each end. A laser introduced through a small hole in one mirror then bounces back and forth in the cell, creating interaction lengths tens or hundreds of times the length of the cell.

When trying to detect extremely low concentrations, noise can be a problem with multipass spectroscopy. This is because the multiple laser beams create a type of optical interference called fringe interference that decreases sensitivity and makes it impossible to precisely determine the biomarker concentration. To reduce this optical interference, the researchers developed a method called optical fringe quenching.

For the new optical fringe quenching technique, the researchers slightly change, or modulate, the emission of the laser over a range of wavelengths and then average the light emitted from the sample over these wavelengths. This helps eliminate the optical interference enough to allow detection of formaldehyde. The researchers also selected a spectral range and sample pressure that helped reduce interference from other constituents found in breath samples.

Optical sensing of formaldehyde

The researchers tested their new approach using calibrated artificial mixtures of formaldehyde in air. Their results showed that the approach was more than sufficient to detect formaldehyde in breath at levels that might indicate the presence of disease.

"Our optical fringe quenching technique can be used to improve any optical system that uses a multipass cell," said Winkowski. "It could also be useful for measuring formaldehyde gas emitted from household materials or industrial sources to better understand its effects on human health."

Next, the researchers plan to test their analysis approach's ability to measure ethane gas in breath. Study findings have suggested that ethane might also be used as a biomarker for cancer and other diseases.

Crossing international borders can be dangerous, if not deadly, for refugees and asylum seekers, who have been displaced by conflict or a humanitarian crisis. According to data from the International Organization for Migration, from January 2014 to December 2018, there were more than 16,300 forced migrant deaths. These deaths did not occur at random but occurred in clusters reflecting distinct patterns in space and time that can be addressed by humanitarian interventions, according to a Dartmouth-led research team. The results are published in BMJ Global Health.

In mapping the countries and locations where forced migrant deaths occurred, the researchers found that the deaths occurred in 12 spatial-temporal clusters, which were often located close to national borders, conflict intensities and/or along migration routes.

The team identified the top five locations of forced migrant deaths per year from 2014 to 2018. Deaths at sea topped the list each year, accounting for 26 to 54 percent across the five years for a total of over 5,800 deaths.

The data revealed just how dangerous crossing the U.S. - Mexico border can be. The U.S., specifically, the U.S. side of the U.S.-Mexico border, is the only country that made the list for each of the five years with a total of over 1400 deaths. Mexico made the list for 2014, 2015, 2016, and 2018 with a total of over 800 deaths.

"The places where forced migrant deaths are occurring are not exactly making it into the news," explained co-author Danielle Poole, a Neukom fellow in the department of geography at Dartmouth. "In addition to the U.S. and Mexico, Libya, Sudan, Mozambique, Uganda, and Malaysia also made the list of locations on land with the highest number of forced migrant deaths."

"If our findings were to be combined with a real-time analysis of migration patterns, this could provide insight into where clusters of forced migrant deaths may occur in the future," said Poole. Identifying some of the similarities, where forced migrant deaths are occurring in the meantime, allows us to monitor and better respond to migration areas that are especially hazardous," she added.

The results can be used to help inform immigration and humanitarian policies but also demonstrate the need for further research in this area. The forced migrant mortality rates demonstrate how during periods of conflict, there is a need on a global scale for humanitarian assistance such as search and rescue operations, which could help save lives and potentially reverse the death trends.

DALLAS, Nov. 16, 2020 -- Even when risk factors associated with cardiovascular disease are optimally controlled, adults with Type 2 diabetes still have a greater risk of developing cardiovascular disease compared to the general population, according to new research published today in the American Heart Association's flagship journal Circulation.

"Previous studies have shown that people with Type 2 diabetes had little or no excess risk of cardiovascular disease events or death when all risk factors are optimally controlled," said Alison Wright, Ph.D., first author and research associate at the Centre for Pharmacoepidemiology and Drug Safety at the University of Manchester in the United Kingdom. "Our team sought to determine how the degree of risk factor control in people with Type 2 diabetes impacted CVD risk and mortality compared to people with Type 2 diabetes who had all risk factors optimally controlled and to people who do not have Type 2 diabetes."

Researchers analyzed data between 2006 and 2015 using two sources: The Clinical Practice Research Datalink (CPRD) and the Scottish Care Information-Diabetes (SCI-Diabetes) dataset with linkage to hospital and mortality data. More than 101,000 people with Type 2 diabetes were identified and matched with nearly 379,000 people without diabetes in CPRD and nearly 331,000 with Type 2 diabetes in SCI-Diabetes.

Researchers focused on five cardiovascular risk factors: blood pressure, smoking, cholesterol, triglycerides and blood glucose, and examined the association to future cardiovascular events and death among these risk factors that were optimally controlled. Additionally, they examined if the presence of cardiorenal (heart and kidney) disease impacted these connections.

Their analysis found:

Only 6% of participants with Type 2 diabetes had all five risk factors within target range.

Even when all five cardiovascular risk factors were optimally controlled, people with Type 2 diabetes still had a 21% higher risk for CVD and 31% higher risk for heart failure hospitalization than people without diabetes.

The association among the number of elevated risk factors and CVD event risk was stronger in people with Type 2 diabetes who did not also have cardiorenal disease.

"People with Type 2 diabetes should be treated for cardiovascular risk factors as early as possible, regardless of whether they have cardiovascular disease or not," Wright said. "There is real potential here to reduce the overall impact of Type 2 diabetes on future cardiovascular events, especially for patients with Type 2 diabetes who have not yet been diagnosed with CVD."

While researchers noted that this research demonstrated the importance of risk factor control overall, future research will explore which individual factors have the greatest impact on cardiovascular risk, and, therefore, are the most important to target with interventions. According to the American Heart Association's Life's Simple 7®, the seven risk factors that people can improve through lifestyle changes to achieve ideal cardiovascular health are managing blood pressure, controlling cholesterol, reducing blood sugar, increasing physical activity, eating healthy foods, losing weight and quitting smoking.

A strength highlighted by the researchers is that the results can also apply to the United States population, as treatment and management guidelines are similar to the UK population studied. A limitation of this study is that it is an observational study, using data from primary care medical records that may be incomplete. Therefore, the data may not provide the full picture of the health status for these patients.

Boston, MA-- Early life risk factors in the first 1000 days cumulatively predict higher obesity and cardiometabolic risk in early adolescence, according to new research led by the Harvard Pilgrim Health Care Institute. The study is the first to evaluate the combined influence of early life risk factors with direct measures of adiposity (body mass index, fat-mass index) and metabolic risk in early adolescence.

The findings were published November 12 in the American Journal of Clinical Nutrition.

The rapid rise in the global prevalence of childhood obesity, a strong predictor of metabolic syndrome and related diseases such as type 2 diabetes mellitus, is an important public health challenge. The first 1000 days, spanning from conception to age 24 months, represents an important period of risk for the development of later childhood obesity. Certain prenatal and postpartum factors encompassing this period, such as maternal smoking, excessive gestational weight gain, maternal gestational diabetes, maternal diet during pregnancy, short breastfeeding duration, and short infant sleep duration have been shown to be associated with subsequent risk of childhood obesity.

"Most of these factors are modifiable and may provide insight into intervention strategies for childhood obesity prevention in early life," said lead author Izzuddin Aris, PhD, Assistant Professor of Population Medicine at the Harvard Pilgrim Health Care Institute and Harvard Medical School. "Our study assesses the impact of these risk factors in combination, which is more relevant to real-life behavior, and could translate to a larger public health impact."

For this study, the research team studied 1038 mother-child pairs in Project Viva, a prospective, observational pre-birth cohort study of gestational factors, pregnancy outcomes, and o?spring health, based in eastern Massachusetts. They measured six modifiable risk factors: smoking during pregnancy; gestational weight gain; sugar-sweetened beverage consumption during pregnancy; breastfeeding duration; timing of complementary food introduction and infant sleep duration.

After adjusting for sociodemographic characteristics and parental body mass index, the researchers found increases in indicators of adiposity such as body mass index and fat-mass index as well as increases in metabolic risk markers such as triglyceride levels and insulin resistance with increasing number of risk factors. Children with 5?6 risk factors versus those with 0-1 risk factors also had the highest risk of overweight or obesity and being in the highest metabolic risk score quartile in early adolescence.

"Our study findings not only suggest targets for future early life interventions, they also indicate that interventions to prevent later obesity and cardiometabolic risk may be more effective if conducted early in the lifecourse and target multiple factors," said Emily Oken, Professor of Population Medicine at the Harvard Pilgrim Health Care Institute and Harvard Medical School and senior author of the study.

Wearing a facemask helps limit the spread of COVID-19 by reducing respiratory droplets and aerosols spewed into the air when people breathe, talk, laugh, sneeze or cough. But the physical barrier created by masks has prompted concerns that they might impair the cardiopulmonary system by making it harder to breathe, by altering the flow of inhaled oxygen and exhaled carbon dioxide and by increasing dyspnea -- a medical term that describe shortness of breath or difficulty breathing, especially during physical activity.

In a new study, published November 16, 2020 in the Annals of the American Thoracic Society, a team of American and Canadian researchers concluded that while sensations of dyspnea might increase, there is little empirical evidence that wearing a facemask significantly diminishes lung function, even when worn during heavy exercise.

"There might be a perceived greater effort with activity, but the effects of wearing a mask on the work of breathing, on gases like oxygen and CO2 in blood or other physiological parameters are small, often too small to be detected," said the study's first author Susan Hopkins, MD, PhD, professor of medicine and radiology at University of California San Diego School of Medicine.

"There's also no evidence to support any differences by sex or age in physiological responses to exercise while wearing a facemask," added Hopkins, who specializes in exercise physiology and the study of lungs under stress.

The single exception, the authors note, may be persons with severe cardiopulmonary disease in which any added resistance to breathing or minor changes in blood gases could prompt dyspnea great enough to affect exercise capacity.

"In such cases, these individuals might feel too uncomfortable to exercise, and that should be discussed with their doctor," Hopkins said. "However, the fact that these individuals are at great risk should they contract COVID-19 must also be considered"

The researchers came to their conclusions following a review of all known scientific literature published that examined the effects of various facemasks and respiratory loading devices on physiological and perceptual responses to physical activity. These studies assessed multiple factors, such as work of breathing (the quantified energy expended to inhale and exhale), arterial blood gases, effects on muscle blood flow and fatigue, cardiac function and flow of blood to the brain.

For healthy persons, the effects of wearing a mask on these physiological markers were minimal, no matter what type of mask was worn or the degree of exercise. The authors also said age played no significant influencing role among adults. Gender differences were deemed inconsequential.

"Wearing a facemask can be uncomfortable," said Hopkins. "There can be tiny increases in breathing resistance. You may re-inhale warmer, slightly enriched CO2 air. And if you're exercising, the mask can cause your face to become hot and sweaty.

"But these are sensory perceptions. They do not impact cardiopulmonary function in healthy people. So while dyspnea might be increased with a mask, you have to weigh that against the reduced risk of contracting COVID-19, knowing that the physiology is essentially unchanged."

Boston, MA -- Less than a decade ago, the Food and Drug Administration approved drugs for treating type 2 diabetes in an entirely new way. Since that time, evidence in favor of the use of sodium/glucose cotransporter 2 (SGLT2) inhibitors has been mounting, with studies showing better blood glucose control, cardiovascular benefits, weight loss and more for patients with diabetes taking SGLT2 inhibitors. Now, two large clinical trials, conducted by investigators at Brigham and Women's Hospital and sponsored by Lexicon Pharmaceuticals, add new evidence about the benefits for patients with diabetes and chronic kidney disease as well as those with diabetes and recent worsening heart failure. In these two paired trials, teams of investigators led by Brigham cardiologist Deepak L. Bhatt, MD, MPH, evaluated sotagliflozin, a drug that inhibits SGLT2 and SGLT1. Results of the trials are both published in The New England Journal of Medicine and presented by Bhatt simultaneously at the Late-Breaking Clinical Trial Sessions of the American Heart Association Scientific Sessions.

"With the results of these large two trials, adding to other recent data about drugs in this class, it is now clear that most patients with type 2 diabetes and either kidney disease or heart failure should be on an SGLT2 inhibitor," said Bhatt, the executive director of Interventional Cardiovascular Programs at the Brigham. "SCORED provides further randomized clinical trial evidence that SGLT2 inhibitors should be part of the standard of care for patients with type 2 diabetes mellitus and kidney disease. And SOLOIST demonstrates that early, in-hospital initiation of SGLT2 inhibitors is safe, effective, and should become the standard of care in patients with type 2 diabetes mellitus and heart failure."

Sotagliflozin, developed by Sanofi and transferred to Lexicon Pharmaceuticals, inhibits not only SGLT2 but also SGLT1. SGLT2 inhibition helps the body eliminate blood sugar via urine, while SGLT1 inhibition leads to blood sugar reduction via the digestive tract.

In the Effect of Sotagliflozin on Cardiovascular and Renal Events in Patients With Type 2 Diabetes and Moderate Renal Impairment Who Are at Cardiovascular Risk (SCORED) trial, investigators evaluated whether sotagliflozin could prevent cardiovascular events in patients with diabetes with chronic kidney disease. They performed a multicenter, double-blind trial, which enrolled 10,584 patients who were followed for an average of 16 months. The trial ended early due to COVID-related loss of funding. While blinded to data, the authors changed the primary endpoint; however, the initial endpoint also reached statistical significance.

Unlike previous trials, SCORED enrolled patients across the full range of albuminuria -- leakage of protein into the urine that can happen when a person has diabetes. Sotagliflozin significantly reduced the primary endpoint of total occurrences of cardiovascular deaths, hospitalizations for heart failure, or urgent visits for heart failure regardless of the patient's degree of albuminuria by about 26 percent. As well, sotagliflozin reduced the rate of cardiovascular death, myocardial infarction, or stroke, with an early benefit potentially mediated by the SGLT1 action. There was also a reduction in the total number of fatal or non-fatal heart attacks and the total number of fatal or non-fatal strokes by 32 percent and 34 percent, respectively.

"SCORED is the first trial to show the benefits of SGLT2 inhibitors across the full range of albuminuria," said Bhatt. "It is also the first trial of an SGLT2 inhibitor to show a beneficial effect on stroke."

The Effect of Sotagliflozin on Cardiovascular Events in Patients With Type 2 Diabetes Post Worsening Heart Failure (SOLOIST-WHF) trial enrolled 1,222 patients with type 2 diabetes mellitus and recent worsening heart failure requiring hospitalization. Patients were randomized to sotagliflozin or placebo and followed for an average of nine months. The trial was ended early due to loss of funding from the sponsor during the COVID-19 pandemic. Data from the patients who took part in the trial showed a significant 33 percent reduction in the study's primary endpoint -- the total occurrences of cardiovascular deaths, hospitalizations for heart failure, and urgent visits for heart failure -- for patients with either heart failure with reduced or preserved ejection fraction. Taking the drug prior to hospital discharge was safe and effective.

"SOLOIST is the first large randomized trial to show the safety and efficacy of SGLT2 inhibitors when initiated in patients hospitalized with acute heart failure," said Bhatt. "Thus, it really changes the field and supports early initiation of this class of drugs."