Brain

Among couples being treated for infertility, depression in the male partner was linked to lower pregnancy chances, while depression in the female partner was not found to influence the rate of live birth, according to a study funded by the National Institutes of Health.

The study, which appears in Fertility and Sterility, also linked a class of antidepressants known as non-selective serotonin reuptake inhibitors (non-SSRIs) to a higher risk of early pregnancy loss among females being treated for infertility. SSRIs, another class of antidepressants, were not linked to pregnancy loss. Neither depression in the female partner nor use of any other class of antidepressant were linked to lower pregnancy rates.

"Our study provides infertility patients and their physicians with new information to consider when making treatment decisions," said study author Esther Eisenberg, M.D., of the Fertility and Infertility Branch at NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), which funded the study.

Citing previous studies, the authors noted that 41 percent of women seeking fertility treatments have symptoms of depression. In addition, a study of men seeking IVF treatments found that nearly 50 percent experienced depression. The authors conducted the current study to evaluate the potential influence of depression in couples seeking non-IVF treatments.

The researchers combined data from two previous studies funded by NICHD's Reproductive Medicine Network. One study compared the effectiveness of two ovulation-inducing drugs for establishment of pregnancy and live birth in women with polycystic ovary syndrome. The other study compared the effectiveness of three ovulation-inducing drugs at achieving pregnancy and live birth in couples with unexplained infertility. In each study, men and women responded to a questionnaire designed to screen for depression. Only the women were asked whether they were taking any antidepressants.

From the two studies, the researchers analyzed data for 1,650 women and 1,608 men. Among the women, 5.96 percent were rated as having active major depression, compared to 2.28 percent of the men.

Women using non-SSRIs were roughly 3.5 times as likely to have a first trimester pregnancy loss, compared to those not using antidepressants. Couples in which the male partner had major depression were 60 percent less likely to conceive and have a live birth than those in which the male partner did not have major depression.

The study did not include couples who underwent in vitro fertilization because the authors thought that this procedure could potentially overcome some possible effects of depression, such as reduced sexual desire and lower sperm quality.

(Millbrook, NY) Ecologists have long known that agricultural and sewage pollution can cause low oxygen conditions and fish kills in rivers. A study published today in Nature Communications reports that hippo waste can have a similar effect in Africa's Mara River, which passes through the world renowned Maasai Mara National Reserve of Kenya, home to more than 4,000 hippos.

Co-author Emma Rosi, a Freshwater Ecologist at the Cary Institute of Ecosystem Studies, explains, "Together, the Mara's resident hippos add about 8,500 kg - or 9.3 tons - of partially digested plant material into the river each day. We were interested in how this massive influx of organic matter and nutrients influenced aquatic life."

Hippos spend their nights grazing in the savanna and their days wallowing in shallow pools to keep cool and escape the sun. As they wallow, they excrete waste, which depletes oxygen from the water as it decomposes. Microbial activity also produces chemicals like ammonium and sulfide, known to be toxic to fish.

"During dry periods, oxygen-poor water accumulates in hippo pools. Periodic intense rains eventually flush the water downstream. This sudden pulse of deoxygenated water can cause temporary hypoxia and fish kills," notes Rosi.

Over three years, the team monitored water chemistry and flow downstream from 171 hippo pools. Of the documented 55 flushing flows - defined as when rain events increased river flow to twice its normal rate - dissolved oxygen concentrations declined during 49 of the events, falling low enough to cause fish kills 13 times.

To understand the mechanisms driving dissolved oxygen crashes, the team undertook multiple experimental approaches. Because hippos are too dangerous to approach, sensors attached to a remote-controlled boat were used to measure water chemistry in hippo pools. To simulate stream flow and understand the effects of oxygen consumption by added hippo waste, experiments were conducted in bathtub-sized artificial streams. The team also manipulated a pool in the Mara to produce an experimental flushing flow.

Two distinct factors were linked to declines in dissolved oxygen. When low-oxygen water from hippo pools mixes with upstream river water, it reduces the river's overall dissolved oxygen concentration. At the same time, hippo pool sediments that are washed out during flushing flows continue to use up oxygen as they decompose downriver.

This research suggests that altering a river's flow regime through dams or water withdrawals could have ecological consequences in African rivers with hippos. Coauthor David Post of Yale University explains, "In the Mara River system, flushing flows are important for cleaning hippo waste out of pools, but the accumulated toxic chemicals and deoxygenated water have severe impacts on aquatic life downstream."

Although periodic fish kills might sound like a bad thing, the team observed that the dead fish provided a food source for scavengers like birds and crocodiles.

The study contributes to our understanding of a river system with large hippo populations, which was likely much more common before hippos were eliminated from much of their historical range.

Lead author Christopher Dutton of Yale University explains, "There's this idea that pristine rivers are not supposed to have dissolved oxygen crashes, but we think this is because generations of scientists have studied places that no longer have intact large wildlife populations, whereas the Mara River is unique because it does. This system offers a window into the past and illustrates how ecosystems might have functioned before human impacts."

Ibuprofen, given instead of antibiotics to women with uncomplicated urinary tract infection, (cystitis), leads to longer duration of symptoms and more serious adverse events related to the spread of the primary infection, according to a new study in PLOS Medicine by Ingvild Vik and colleagues from the University of Oslo, Norway.

More than half of all women will experience an uncomplicated urinary tract infection
during life, and most of these infections resolve without further complications. A short course of antibiotics is a widely accepted standard for the treatment of bacterial urinary tract infection, but antibiotic resistance is a growing, serious public health problem. Some prior studies have suggested that treatment with non-steroidal anti-inflammatory drugs such as ibuprofen may support recovery of a urinary tract infection, raising the possibility that antibiotic use could be reduced.

In the current study, the authors randomized 383 women from 3 Scandinavian countries with uncomplicated urinary tract infections to received either standard treatment of antibiotics for 3 days, or ibuprofen as a symptomatic treatment without an antimicrobial effect. Women's symptoms, bacterial growth from urinary samples, and the occurrence of adverse events including systemic infection or hospitalization, were monitored during the study. The results showed that women assigned to receive ibuprofen without antibiotics took three days longer to get well on average. 70 out of 181 patients receiving ibuprofen (39%) compared to 131 out of 178 receiving antibiotics (74%) recovered from symptoms by day 4 (35% adjusted risk difference, 95% CI). Also, among women in the ibuprofen group, twelve (6.6%) developed a febrile urinary tract infection, with a smaller proportion (3.9%) developing a serious kidney infection which did not occur in the antibiotics group.

Although more than half of the patients initially treated with ibuprofen got well without taking antibiotics suggesting that this approach could potentially reduce overall antimicrobial usage, the study concludes, in confirmation of other recently reported trials, that it is not safe to recommend ibuprofen instead of antibiotics in uncomplicated cystitis, due to the increased risk of developing a serious upper urinary tract infection.

"Initial treatment with ibuprofen could reduce unnecessary use of antibiotics in this group. However, until we can identify those women in need of antibiotic treatment to prevent complications, we cannot recommend ibuprofen alone to women with uncomplicated UTIs," the authors state in their conclusion.

New Haven, Conn.-- In a pilot study published in JAMA Internal Medicine, Yale researchers significantly reduced doses of opioid painkillers given to hospital patients. By delivering the opioids with a shot under the skin or with a pill instead of an IV, the research team found they could decrease patient exposure to the medications while also maintaining or improving pain relief, they said.

The study, conducted by researchers at Yale School of Medicine and Yale New Haven Hospital, could lead to changes in how providers prescribe opioids to hospitalized patients, noted the researchers, who have recently completed the second and third phases of their trial.

To relieve pain in hospitalized patients, providers typically give prescription opioid drugs in one of three forms: via an IV, orally, or with a shot in the skin. The IV method carries greater risk of side effects because IV opioids rapidly penetrate the central nervous system. It has been shown that even one IV dose can cause changes in the brain that are associated with addiction, the researchers said.

To test a new standard of opioid prescribing that prefers the non-IV methods, the research team developed an intervention involving a few hundred hospital patients, and educating the providers and nurses about the new standard. Over the three-month intervention period, the researchers measured daily IV doses, non-IV doses, and overall opioid doses per patient. They also analyzed pain scores during the first five days of hospitalization.

After comparing outcomes with a control group, the team found that IV opioid dosing was reduced by 84% for the intervention group. The overall exposure to opioids substantially decreased as well. Unexpectedly, the researchers found that intervention-group patients had pain scores that were similar or improved, they said.

More research is needed to validate the findings, but the results "have the potential to be practice changing," said lead author Adam Ackerman, M.D., clinical instructor in internal medicine at Yale School of Medicine (YSM) and medical director of the pilot study inpatient unit at Yale New Haven Hospital.

"The data shows that the non-IV use of opioids can reduce overall opioid use in adult inpatients with no change in pain control, and potentially an improvement," said Robert Fogerty, M.D., associate professor of medicine at YSM and co-author on the study. "It's an example of less is more."

While IV opioids have a role in medicine for relieving acute pain, said Fogerty, the subcutaneous route can serve as a "bridge" to help hospital patients safely transition to pills.

A shift in how opioid painkillers are delivered in hospitals could help combat the crisis of addiction and overdose deaths, which continues to affect thousands of Americans each year, the researchers said.

"As physicians, we're obligated to provide help to the community. Part of that service is thinking analytically about how, when, and why we use opioids. The data show there are opportunities to improve the way we control pain and the way we impact the opioid crisis," Fogerty said.

"This study represents an important piece of the puzzle in terms of how opioids can be used more safely and effectively in clinical practice," said co-author Patrick G. O'Connor, M.D., the Dan Adams and Amanda Adams Professor of General Medicine and chief of general internal medicine at YSM. "It also represents a critical strategy for reducing the potential risk of opioid-related complications, including overdose and death."

SAN FRANCISCO - May 11, 2018 -- Researchers from Columbia University have developed a new technique for the powerful gene editing tool CRISPR to restore retinal function in mice afflicted by a degenerative retinal disease, retinitis pigmentosa. This is the first time researchers have successfully applied CRISPR technology to a type of inherited disease known as a dominant disorder. This same tool might work in hundreds of diseases, including Huntington's disease, Marfan syndrome, and corneal dystrophies. Their study was published online today in Ophthalmology, the journal of the American Academy of Ophthalmology.

Stephen H. Tsang, M.D., Ph.D., and his colleagues sought to create a more agile CRISPR tool so it can treat more patients, regardless of their individual genetic profile. Dr. Tsang calls the technique genome surgery because it cuts out the bad gene and replaces it with a normal, functioning gene. Dr. Tsang said he expects human trials to begin in three years.

"Genome surgery is coming," Dr. Tsang said. "Ophthalmology will be the first to see genome surgery before the rest of medicine."

Retinitis pigmentosa is a group of rare inherited genetic disorders caused by one of more than 70 genes. It involves the breakdown and loss of cells in the retina, the light sensitive tissue that lines the back of the eye. It typically strikes in childhood and progresses slowly, affecting peripheral vision and the ability to see at night. Most will lose much of their sight by early adulthood and become legally blind by age 40. There is no cure. It is estimated to affect roughly 1 in 4,000 people worldwide.

Since it was introduced in 2012, the gene editing technology known as CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) has revolutionized the speed and scope with which scientists can modify the DNA of living cells. Scientists have used it on a wide range of applications, from engineering plants (seedless tomatoes) to producing animals (extra lean piglets). But as incredible as genome surgery is, CRISPR has some flaws to overcome before it can live up to its hype of curing disease in humans by simply cutting out bad genes and sewing in good ones.

Diseases like autosomal dominant retinitis pigmentosa present a special challenge to researchers. In autosomal dominant disorders, the person inherits only one copy of a mutated gene from their parents and one normal gene on a pair of autosomal chromosomes. So, the challenge for CRISPR-wielding scientists is to edit only the mutant copy without altering the healthy one.

In contrast, people with autosomal recessive disorders inherit two copies of the mutant gene. When two copies of the gene are mutated, treatment involves a more straightforward, one-step approach of simply replacing the defective gene. Currently, there are six pharmaceutical firms pursuing gene therapies for the recessive form of retinitis pigmentosa; none are developing a therapy for the dominant form. But that may change soon.

That's because Dr. Tsang and colleagues have come up with a better strategy to treat autosomal dominant disease. It allowed them to cut out the old gene and replace it with a good gene, without affecting its normal function. This so called "ablate-and-replace" strategy can be used to develop CRISPR toolsets for all types of mutations that reside in the same gene and is not exclusive for a type of mutation. This is especially helpful when many types of mutations can lead to the same disorder. For example, any one of the 150 mutations in the rhodopsin gene can result in retinitis pigmentosa. Because Dr. Tsang's technique can be applied in a mutation-independent manner, it represents a faster and less expensive strategy for overcoming the difficulty of treating dominant disorders with genome surgery.

Typically, CRISPR researchers design a short sequence of code called guide RNA that matches the bit they want to replace. They attach the guide RNA to a protein called Cas9, and together they roam the cell's nucleus until they find a matching piece of DNA. Cas9 unzips the DNA and pushes in the guide RNA. It then snips out the bad code and coaxes the cell to accept the good code, using the cell's natural gene repair machinery.

Instead of using one guide RNA, Dr. Tsang designed two guide RNAs to treat autosomal dominant retinitis pigmentosa caused by variations in the rhodopsin gene. Rhodopsin is an important therapeutic target because mutations in it cause about 30 percent of autosomal dominant retinitis pigmentosa and 15 percent of all inherited retinal dystrophies.

This technique allowed for a larger deletion of genetic code that permanently destroyed the targeted gene. Dr. Tsang found that using two guide RNAs instead of one increased the chance of disrupting the bad gene from 30 percent to 90 percent. They combined this genome surgery tool with a gene replacement technique using an adeno-associated virus to carry a healthy version of the gene into the retina.

Another advantage is that this technique can be used in non-dividing cells, which means that it could enable gene therapies that focus on nondividing adult cells, such as cells of the eye, brain, or heart. Up until now, CRISPR has been applied more efficiently in dividing cells than non-dividing cells.

Dr. Tsang used an objective vision test to evaluate the mice after treatment to show a significant improvement in retinal function. An electroretinogram is typically used to evaluate retinal health in humans. It tests the health of the retina much like an electrocardiogram (EKG) tests the health of the heart.

Previous CRISPR studies for retinal diseases have relied on a less objective measure that involves evaluating how often the mouse turns its head in the direction of a light source. Dr. Tsang used electroretinography to show that retinal degeneration slowed in treated eyes compared with untreated eyes.

CORVALLIS, Ore. - Researchers at Oregon State University are challenging the premise that trophy hunting is an acceptable and effective tool for wildlife conservation and community development.

They argue that charging hunters to kill animals and claim body parts should be a last resort rather than a fallback plan.

In a paper published today in Conservation Letters, the researchers label the practice as morally inappropriate and say alternative strategies such as ecotourism should be fully explored and ruled out before trophy hunting is broadly endorsed.

"Trophies are body parts," said lead author Chelsea Batavia, a Ph.D. student in OSU's College of Forestry. "But when I read the literature, I don't see researchers talking about them like that. Nobody's even flinching. And at this point it seems to have become so normalized, no one really stops to think about what trophy hunting actually entails."

Furthermore, the authors point out, the notion that trophy hunting is imperative to conservation seems to have taken hold largely without compelling empirical evidence. Such an assumption is not only unsubstantiated but can also serve to squelch the search for alternatives.

"Rejecting trophy hunting could open up space for innovation and creativity," they write.

Batavia worked with colleagues in Oregon State's Department of Forest Ecosystems and Society and collaborators from Canada and Australia. The idea for the paper occurred to them over the course of a review of scholarly literature on trophy hunting.

"Conservation scientists commonly recognize strong public opposition to the practice, and at times even point to some sort of ethical tension, but they don't really define or address it," Batavia said.

She and her co-authors decided it was time to break the silence and highlight an issue they suspect may underpin the public discomfort around trophy hunting - that it involves a hunter paying a fee to kill an animal and subsequently retaining some or all of the animal's body as a trophy.

Part of the ongoing problem, the researchers write, is the word "trophy," a sanitized expression for the tusks, ears, feet, heads, etc. that hunters remove from the animals' bodies.

"It's almost like an ethical distraction, calling it by some other name," said co-author Michael Paul Nelson, a professor and the Ruth H. Spaniol Chair of Renewable Resources at OSU. "We have these metaphors that we hide behind. It's like we recognize it's an ethically loaded topic but we don't know what to do about it. And we've tied conservation to the practice of trophy hunting - how do we get off that train?"

Proponents argue that trophy hunting supports conservation goals by generating money and reducing poaching and also that it bolsters local economies.

Nelson, Batavia and their co-authors recognize these benefits, but they counter that "collecting bodies or body parts as trophies is an ethically inappropriate way to interact with individual animals, regardless of the beneficial outcomes that do or do not follow."

"We owe these animals some basic modicum of respect," the researchers suggest. "To transform them into trophies of human conquest is a violation of common decency, and to accept trophy hunting as the international conservation community seems to have done is to aid and abet an immoral practice."

If it's determined that saving wildlife is inexorably linked to trophy hunting, conservationists should then "accept the practice only with a due appreciation of tragedy, and proper remorse," the researchers write. They do acknowledge the possibility that future scientific research may suggest trophy hunting is in fact critical to the conservation mission in certain contexts.

"In that case trophy hunting should be used reluctantly," they write. "The enthusiasm with which trophy hunting has already been championed as a potential conservation success story is misplaced. Trophy hunting violates the dignity of individual nonhuman animals, and is beneath our dignity as human beings. Continuing complicity by conservationists without fully exhausting other options is not now appropriate nor has it ever been."

Teachers who antagonize their students by belittling them, showing favoritism, or criticizing their contributions can damage their learning potential, a new study warns.

Investigating the influence of teacher 'misbehavior' on student learning, a team of communication experts set up a teaching experiment in which almost 500 undergraduate students watched a video of a lecture.

Randomly split into two groups, the participants watched either a lesson with teacher antagonism present, or a standard lesson, without antagonism. They then answered a series of questions about the content, before completing a multiple-choice test.

Comparing the test scores of the two groups, researchers found that the antagonism group performed worse than the standard group. Test scores were up to 5% lower for those who watched the lesson with antagonism because they disliked what they were learning.

What's more, students who faced teacher hostility were less likely to put as much effort into learning, and were unwilling to take part in future courses taught by that teacher.

Study leader Dr Alan Goodboy stressed the negative longer-term consequences of this teacher misbehavior for student learning: "Even slight antagonism, coupled with otherwise effective teaching, can demotivate students from being engaged and hinder their learning opportunities. So even one bad day of teaching can ruin a student's perception of the teacher and create an unnecessary roadblock to learning for the rest of the term."

Teachers should therefore be especially careful to prevent negative behaviour seeping into the classroom.

"Antagonism can come into classrooms unexpectedly and suddenly, even without the knowledge of the teachers themselves," Goodboy added.

"We therefore need to ensure that future teachers are better equipped to recognize when antagonism may be creeping in, focusing on how antagonism manifests itself and working on developing more positive ways of interacting with students, even during times of disagreement."

The evolution of wild species, adapting them to human management practices, can cause localised extinctions when those practices rapidly change. And in a new study published in Nature, Professors Michael C. Singer and Camille Parmesan have used more than 30 years of research to fully document an example of this process.

A large, isolated population of a North American butterfly evolved complete dependence on an introduced European weed to the point where the continued existence of the butterfly depended on the plant's availability. The insects then became locally extinct when humans effectively eliminated that availability, confirming a prediction made by the same authors in a 1993 Nature paper.

Thus the advent of cattle ranching more than 100 years ago set an eco-evolutionary trap that the insects obligingly fell into, and the trap was sprung when humans suddenly removed the cattle, withdrawing their 'gift', and driving the butterflies to extinction.

European conservation biologists have long believed this to be the process underlying many local extinctions across Europe, and this study provides the first hard evidence of the process in action in real time. It also foreshadows an increasing importance of maintaining historical land use practices, including cattle ranching, as conservation measures in North America.

The authors, affiliated to the University of Plymouth, the University of Texas at Austin and CNRS Moulis, have spent more than three decades studying changes in the diet of Edith's checkerspot (Euphydryas editha) in a spring-fed meadow surrounded by semi-desert sagebrush and pine forest on a family-run ranch in Nevada.

In particular, the authors assessed the impact of narrow-leaved plantain (Plantago lanceolata), which was introduced to the USA in hay brought from Europe and flourished under cattle-grazing, probably arriving in Nevada more than 100 years ago.

As soon as the butterflies encountered the plantain, their caterpillars survived better on it than on their traditional host, Blue-Eyed Mary (Collinsia parviflora), causing the adults to evolve preference for laying eggs on the plantain. By the mid-2000s, they were 100% reliant on the plantain and the Collinsia had been abandoned.

However, within three years of the ranch's cattle being removed due to financial pressures, the butterflies became locally extinct as the grasses around their favoured new host were no longer grazed, and the plantains became embedded in those grasses, cooling the micro-environment. The Collinsia was unaffected by removal of cattle, so if the butterflies had not evolved so rapidly in response to the introduction of the plantain, they would most likely have survived.

Around five years after the extinction, Edith's checkerspots recolonized the meadow. Since they were all found feeding on Collinsia, the original host plant, scientists believe these colonists to be a new population, and that the lineage which had called the ranch home for several decades no longer exists.

They say the results are similar to that seen in British species such as the large blue butterfly, which went extinct across southern England following a reduction of grazing by both rabbits and sheep. Once this process was understood, the butterflies could be successfully re-introduced.

Professor Singer, who has been studying the diet of Edith's checkerspot for more than 50 years and led the current study, said: "This is a clear example of how humans are able to change habitats faster than even rapidly-evolving species can change their behaviour. This cannot be not an isolated phenomenon, so unless we become aware of the potential consequences of such actions we will continue to inadvertently cause population extinctions of native species, without recognizing what we are doing. Species-level extinctions are possible when human activities are synchronized across wide areas."

Professor Parmesan, a lead contributor to the Intergovernmental Panel on Climate Change which was awarded the Nobel Peace Prize in 2007, said the study had potentially wider implications beyond the scope of changes to farming practices.

She added: "Climate warming is another form of anthropogenic change that is occurring faster than past natural changes, and is likely to cause problems for species whose evolution is unable to keep pace. If climate change were natural, it is likely that many wild species would be able to adapt, both through current evolution and through flexible changes in behaviour and life history. But human-driven climate change is occurring at a much faster rate than most past major climatic shifts. Ecologists have long been arguing that this is likely to lead to more extinctions than have happened with past climatic changes and this study supports the arguments that rapid climate change will prove detrimental to biodiversity both in the short and long term."

The Philippines teems with biodiversity: 657 bird species roam and fly throughout the country's 7,641 islands, and over 2,000 fish species swim in the surrounding seas. But beyond these beaked and scaly creatures, the Philippines is also home to the world's greatest concentration per square mile of unique mammal species.

One of these species -- a shrew found around 5,000 feet above sea level -- may give us some clues as to what makes the Philippines an ideal environment for mammals.

Palawanosorex muscorum, known more informally as the Palawan moss shrew, was recently identified by a team of researchers, including Larry Heaney, Negaunee Curator of Mammals at the Field Museum in Chicago, in a Journal of Mammalogy paper.

First spotted in 2007 by the late Danilo "Danny" Balete, field survey leader and research associate at the Field Museum, the Palawan moss shrew has a slender, pointed snout and dark coat. Unlike other shrews, its tail is covered in dense fur rather than visible scales. With broad forefeet and long claws, the Palawan moss shrew digs through humus in search of its favorite snack: earthworms. Rainer Hutterer, the paper's lead author, analyzed these anatomical traits to determine that the Palawan moss shrew was a distinct species.

Heaney emphasizes that the Philippines is such a hotbed for mammalian biodiversity that finding the Palawan moss shrew didn't exactly shock him and his team: "In many ways, finding this species was exactly what we had expected."

Co-author Jacob Esselstyn from the LSU Museum of Natural Science adds, "It provides some clues about how small mammals have evolved and moved between Asia and Africa." In other words, the Palawan moss shrew might help us figure out how the Philippines' many mammal species got there in the first place.

Another clue: The Palawan moss shrew's home is a hotbed within a hotbed. Mt. Mantalingahan, a mountain on Palawan Island in the Philippines, is habitat to three unique mammal species, including the shrew.

"There are entire countries that don't have three unique mammal species -- so for there to be three species on one mountain, on one island, in one country is really something," Heaney emphasizes.

What accounts for this species richness? Mt. Mantalingahan, Heaney explains, is a "sky island."

While that might sound like something straight out of a sci-fi novel, "sky islands" are real ecological phenomena -- isolated mountaintops home to distinct habitats separate from the lowlands and neighboring mountains. These "sky islands" create hubs of biodiversity, allowing for multiple ecosystems -- and, by extension, a wider range of species -- to coexist within a single geographic area.

These "sky islands" might help explain why mammalian biodiversity thrives in the Philippines specifically. "There could be many new species on these high mountainous regions in the Philippines, but because they are so high, and hard to get to, knowledge of their existence is awfully limited," Heaney says.

Learning what species dwell in these mountains, Heaney notes, isn't only helpful for zoologists and ecologists. For those who live and work in Palawan, which constitutes the Philippines' largest province, protecting the Palawan moss shrew and Mt. Mantalingahan hits even closer to home -- it's a matter of personal and economic safety.

Mt. Mantalingahan, in addition to being a "sky island," functions as a crucial watershed, regulating the flow of water in Palawan through natural processes. In Mt. Mantalingahan's case, humus -- the low-density mountainous soil the Palawan moss shrew digs through -- acts as a sponge, holding water from the frequent rainfall high-elevation places tend to experience.

Deforesting these "sky islands" bears grave repercussions. "That's where most of the water comes from that people in the lowlands depend on," Heaney warns. "In deforested areas, when a typhoon hits, it kills thousands of people and animals, and destroys buildings. And if water isn't being released slowly from the mountains, you'll have less of it in the dry season, causing drought. If you want to protect your watersheds, you've got to protect your habitats."

Built on agriculture, fishing, and tourism, Palawan's economy depends greatly on the steady flow of water -- from where the Palawan moss shrew lives, to where nearly three-quarters of a million people live.

Today, much of the Palawan moss shrew's habitat remains undisturbed by human activity. And both it -- and we -- stand to benefit from keeping it that way.

"Sometimes it's presented that environmental concerns and economic development are at odds with each other. That's false," Heaney asserts. "Smart economic development means not creating situations that cause mass damage as a result."

Beyond the economic implications of the shrew's discovery, Heaney says he hopes the new species sparks excitement among the Filipino and international scientific communities, which in turn can help encourage research, conservation, and advocacy efforts.

"People in the world get excited about the cool things that live in their country," Heaney says. "The fact that the Philippines is such a unique hotspot for mammalian diversity is something people should be aware of, something that people can take pride in."

LAWRENCE -- In education circles, it is widely accepted that minorities are overrepresented in special education. New research from the University of Kansas has found, in terms of autism, minorities are widely underrepresented in special education. The underrepresentation varies widely from state to state and shows that students from all backgrounds are not being identified accurately, resulting in many students, especially those from minority backgrounds, not receiving services that are crucial to their education.

Jason Travers, associate professor of special education at KU, led a study that analyzed autism identification rates for every state. Travers then compared the percentage of minority students with autism to the percentage of white students with autism in each state and compared rates for each group to the rate for white students with autism in California. The analyses looked at data from 2014, which was three years after federal regulations changed from five racial categories to seven. It was also the most current year for data analyzed by the Centers for Disease Control on the prevalence of autism. Travers' research had previously shown underrepresentation of minorities in autism, but the change warranted a renewed look.

"A considerable change in demographic reporting happened at the federal all the way down to the local level," Travers said. "So individual schools had to change their reports and send them to the state, who then sent them to the federal government. So, for several years we've had an incomplete picture of autism identification rates."

The change allowed schools to report students, including those with autism, as belonging to "two or more races" for the first time, and also established two separate categories for Pacific Islander and Asian students who previously were reported as one group. The report, co-authored with Michael Krezmien of the University of Massachusetts-Amherst, was published in the journal Exceptional Children.

The data showed dramatic underrepresentation of minority students with autism in the majority of states, especially for African-American and Hispanic students. Forty states underidentified African-American students with autism when compared to white students in the same state, and 43 states underidentified Hispanic students. When the rate for each minority was compared to the rate for white students with autism in California, the data showed nearly every state underidentified minority students with autism.

Not one state had higher percentages of students from those minority groups identified at higher rates than whites, and no state had African-American or Hispanic students listed at the same percentage of white students with autism in California.

"We suspected that, although the U.S. has a similar amount of Hispanic and African-American people, children with autism in both groups would be underrepresented compared to white students. We also didn't know what the rates would be for students identified as being two or more races, Pacific Islander and Asian students due to these being new federal reporting categories," Travers said.

California was used as a comparison for the other states as it is both the largest state by population and widely considered to have outstanding infrastructure for identifying and serving students with autism. The identification rate in California also was similar to the prevalence rate recently reported by the CDC. As the largest state, it is also the state least vulnerable to statistical fluctuation in data, Travers said.

While underrepresentation of minority students with autism was common, there was wide variance from state to state. For example, in Kansas, African-American students were overrepresented. Iowa was the only other state where that was also the case. No states overidentified Hispanic students, and 42 states underidentified them.

"Almost every state in the nation underidentified African-Americans. We're not sure why that happened, but it did," Travers said. "Another notable finding about Kansas is Hispanic students continued to be underidentified."

Students of two or more races were proportionately identified in the majority of states, though a handful showed both under and overidentification. Forty-six of 49 states, including the District of Columbia, had a lower percentage of white students identified than California. No states identified Asian students with autism at the same percentage as white students in California, the comparison group. For its part, California significantly underidentified every minority group when compared with their white peers with autism. Numerous other fluctuations in representation were found in the data as well.

The wide variance of representation shows a number of factors at play. States are identifying minority students with autism in ways different from white students, but also in ways different from those in California, Travers said.

"Some of that just may be statistics, but when you see almost all states identify children with autism at rates that are about or less than half of the rate for white kids in California, that seems pretty concerning," Travers said. "Fundamentally, that means there are kids with autism who are not being identified, and therefore probably aren't receiving the kinds of services we know can help. But there are also specific groups of minority children who are being identified at rates significantly lower than their white peers."

The findings counter the prevailing notion in special education that minority students are overrepresented in special education because the system is being used as a tool of oppression. Instead, it could mean school officials are not identifying minority students with autism due to longstanding concerns about placing too many minority students in special education, at least in terms of autism, Travers said. Worse yet, the problem appears to be nationwide. If the data showed underrepresentation in only a few states or in one geographic region it could reasonably be explained as caused by that states' policies or regional factors. Instead, Travers said, the findings suggest inaccurate autism identification is a more important problem than overrepresentation in special education, and that more must be done to ensure equitable access to specialized treatment.

White students and families traditionally have more access to autism diagnoses and interventions, which can be expensive, Travers said. However, he doesn't believe white students are overrepresented in the autism category. Instead, Travers suspects well-intentioned school leaders may be inadvertently denying minority students an autism eligibility due to concerns about exacerbating the widely perceived problem of minority overrepresentation. Travers hopes to study whether students are being accurately identified within their states in future research. He also hopes to determine if certain factors can more accurately predict autism identification by using a more sophisticated analysis of regional, school district, school and student-level factors.

For now, the data shows that underidentification of minority students with autism is happening across the country and that a better understanding of accurate identification is needed.

"These trends are prevalent across the country," Travers said. "I think the focus on overrepresentation of minority students in special education overlooks the more important issue of accurate identification. The field should focus on ensuring accurate identification of minority students with disabilities, including those who need autism-specific services."

A novel marmoset model of human Zika virus infection offers new opportunities for better understanding of how the virus causes congenital disease in humans. The researchers found that infection of marmoset dams recapitulates the human infection more faithfully than infections in other animal models, providing opportunities to study disease repercussions in ways that were not previously available. The study appears in the journal Scientific Reports.

"We were interested in using primate models to better understand how the Zika virus spreads from the mom to the fetus," said first author Dr. Maxim Seferovic, a postdoctoral associate in obstetrics and gynecology at Baylor College of Medicine. "We found that the available models, including several mouse models as well as rhesus, pigtail and macaque models, were not accurately replicating what we see in humans and had several limitations."

The researchers decided to work with the common marmoset, a non-human primate, because their work had previously shown that the marmoset offered several advantages over other animal models. For instance, other human viral infections, such as those caused by Lassa virus, Ebola/Marbug virus and dengue and West Nile virus, can be reproduced in the common marmoset. Also, the researchers had shown before that Zika virus infection in male common marmosets resembles many aspects of the infection seen in humans. When combined with the research team's previous work showing the importance of relatively longer periods of placental growth in successful marmoset pregnancies, these small New World monkeys were ideal models to study congenital Zika syndrome.

"We had previously demonstrated that Zika virus replicates in placental cells isolated from normal human term pregnancies, enabling the placenta to serve as a reservoir for the virus and an eventual portal to the developing fetus. When combined with our initial infection data in male marmosets, we were encouraged to determine whether infection of marmoset dams would more faithfully recapitulate maternal infection observed in humans when compared to mouse models," said corresponding author Dr. Kjersti Aagaard, professor of obstetrics and gynecology at Baylor and Texas Children's Hospital.

A novel animal model for Zika virus congenital syndrome

"We found that the common marmoset does faithfully recapitulate the human disease, including spontaneous demise and pregnancy loss, which is accompanied by infection and destruction in the brain of the fetus. We also learned something new -- that the marmoset presented with an unexpectedly high rate of pregnancy loss. This will now prompt us to look back carefully for additional evidence of pregnancy loss and miscarriage in infected human patient populations," said Aagard, who also is professor of molecular and human genetics, molecular and cell biology and molecular physiology and biophysics.

Interestingly, the researchers also observed that the virus replicates the most in the marmoset placenta; however, they saw no evidence of robust inflammation in the placenta itself. On the other hand, they did see evidence that the dam can recognize and fight the virus; they determined the presence of antibodies against the virus and an inflammatory response in the dam's blood. These results support previous observations by Aagaard's team and others studying Zika infection in human pregnancies, but more studies are needed to explain the lack of immune response in the marmoset placenta.

"Importantly, this study provides a novel model that faithfully recapitulates human congenital Zika syndrome," said Aagaard, who also is a maternal-fetal medicine specialist working with high-risk pregnancies at Ben Taub and Texas Children's Hospital. "We anticipate that the marmoset model will likely provide new insights into Zika congenital infections that would potentially lead to effective preventive and therapeutic strategies in the future."

Boulder, Colo., USA: Over the last 5000 years, Mount Taranaki volcano, located in the westernmost part of New Zealand's North Island, produced at least 16 Plinian-scale explosive eruptions, the latest at AD 1655. These eruptions had magnitudes of 4 to 5, eruptive styles, and contrasting basaltic to andesitic chemical compositions comparable to the eruptions of Etna, 122 BC; Vesuvius, AD79; Tarawera, 1886; Pelée, 1902; Colima, 1910; Mount Saint Helens, 1980; Merapi, 2010; and Calbuco, 2015.

In this work, Rafael Torres-Orozco and colleagues combined geological mapping and lithostratigraphic analyses to define the possible hazard scenarios in case of Taranaki's explosive reawakening.

The results indicate that, during a future Plinian event, bursting of both long-lasting, large-volume lava domes and transient, small-volume lava plugs from Taranaki's andesitic summit crater would be typical, and these would produce different types of pyroclastic density currents (PDCs) flowing down the volcano flanks mainly due to gravity.

The most deadly "blast-type" PDCs would first explode and expand laterally, and then would flow downstream, reaching urban areas located at up to 18 km distance from the crater. Eruptive columns following or accompanying PDCs are ubiquitous to every scenario. These columns would inject ash and gas into the atmosphere, and could disperse 10-cm-thick layers of volcanic material over the most populated areas at 20-30 km from the crater. In the scenario of eruptions produced from vents different to the summit-crater, these would be expected to be basaltic and lack major PDCs.

These scenarios highlight the major role that PDCs must have in evaluating the hazardscape of Taranaki and of other similar volcanoes. The scenarios can be tailored to different sites around the world by localized studies, and can also be used to plan emergency management.

According to new public opinion research released today and commissioned by Nationwide Children's Hospital, 87 percent of Americans agree there needs to be more mental health support (including increased treatment, therapy and prevention resources) available to help children and adolescents in their communities.

The Harris Poll, one of the longest running surveys tracking public opinion in the United States, conducted the survey in February and March of this year.

Of the 2,000 total respondents, 500 were parents with children younger than 18. One-third of these parents (37 percent) say there is a child or adolescent in their life who they think may need mental health support.

"The survey confirms the public knows what the research shows and what we see in clinic - the need for pediatric behavioral health services is significant," said David Axelson, MD, chief of Psychiatry and Behavioral Health and medical director of Big Lots Behavioral Health Services at Nationwide Children's.

In the survey, families identified expense (37 percent) and insurance coverage (33 percent) as the primary barriers to accessing to pediatric mental health services. This is why a critical area of focus for Nationwide Children's Behavioral Health is prevention. Pediatric mental health experts meet kids where they are in their communities and classrooms. For example, Early Childhood Mental Health provides consultation and training for preschool and homecare providers to prevent preschool expulsion due to behavior issues. Expulsion rates of children prior to kindergarten are at rates up to 34 times higher than the rates of children expelled from kindergarten through 12th grade, combined. The Center for Suicide Prevention and Research offers an evidenced-based suicide prevention program for area middle and high schools.

"The goal of programs like these is to remove barriers and intervene before a family ever needs to come to a provider's office," said Dr. Axelson.

Nationwide Children's is working toward increasing access to mental health services by opening the Big Lots Behavioral Health Pavilion, a freestanding facility fully dedicated to children and adolescents with behavioral health conditions. Thanks to a transformational $50 million gift from Big Lots and Big Lots Foundation, upon completion in 2020 it will be the largest behavioral health treatment and research center dedicated to children and adolescents on a pediatric medical campus in the U.S.

Solely devoted to children and adolescents with behavioral health challenges and mental illnesses, the Pavilion will be nine stories at completion. The space will house behavioral health researchers and foster collaboration between community partner agencies. It will also provide the opportunity for expanded education and training for those in the mental and behavioral health field. The approximately 386,000 sq. ft. building will be home to integrated behavioral health services including a Psychiatric Crisis Center with an Extended Observation Unit, a Crisis Stabilization Unit, inpatient units and intensive outpatient programs. The hospital will continue to grow services across their multiple community locations and increase attention to integrating behavioral health care in to primary health care settings.

"There has been growing awareness of the importance of behavioral health disorders in children, which have the potential for long-term, negative impact on their health and society," said Dr. Axelson. "Many communities like ours are thinking about how to improve access to high quality behavioral health services because it is the right thing to do."

For high school baseball pitchers, limiting throws during a game helps to prevent fatigue and injuries. But nearly half the number of pitches -- ones thrown during warm-ups and in the bullpen -- are typically not counted, adding significantly to a pitcher's risk of injury, new findings by University of Florida Health researchers show.

Excessive pitching is one of the main risk factors for elbow and shoulder injuries among high school baseball players. That's why the Florida High School Athletic Association limits 17- and 18-year-old players to 105 pitches a day. After observing and counting nearly 14,000 pitches by 115 starting pitchers in North and Central Florida during the 2017 high school baseball season, the researchers found that 42.4 percent of the players' throws were unaccounted for in teams' pitch counts.

This is how uncounted pitches add up: The typical player threw about 69 pitches during game action, the researchers found. When warm-ups and bullpen activity were counted, the mean number of pitches per game swelled to more than 119. The findings were published recently in the Orthopaedic Journal of Sports Medicine.

All of those extra pitches should be counted to determine the true number of pitches thrown and to possibly reduce the risk of overuse injury, said Jason Zaremski, M.D., an assistant professor of orthopaedics in the UF College of Medicine and the study's lead author. The study is the first to reveal the true volume of pitches that players throw, he said.

The stakes are high for pitchers. Previous research has found they suffer the majority of shoulder and elbow injuries among high school players, typically from overuse. Zaremski and his colleagues wanted to know why pitching injuries haven't decreased despite pitch-count limits enacted in 2016 and better awareness of other known risk factors.

"The volume of pitches being thrown is much greater that what is being counted. It's not just the effect of one game. Overuse has a cumulative effect over the course of a month, a season or a career," Zaremski said.

In addition to making pitchers more susceptible to injury, Zaremski said excessive throwing can have other effects, such as changing their pitching motion, reducing their pitch velocity or reducing their ball control.

The study did not make a correlation between pitch counts and injuries. Next, Zaremski plans to begin studying the forces that are put on pitchers' arms based on how they are pitching.

Knowing pitchers' true workloads, he said, can be a useful tool for making changes to their regimens that will help them avoid injuries.

"This re-emphasizes the importance of preparing your arm in the off-season and preseason for the rigors of the regular season. If you don't do that, your arm is going to break down -- particularly as you get older and can start throwing harder," he said.

One possibility is building up pitchers more in the off season so their arms are better prepared for the regular season. Another potential approach is having pitchers build themselves up more slowly at the beginning of the season. Zaremski said this idea may be bolstered by data from Major League Baseball, where the lowest injury rates occur in August and September, when the season is winding down.

"Their bodies have become used to the season," he said. "They've become used to the workload."

For high school athletes, their coaches and parents, Zaremski stresses several things: Prepare players' arms for an upcoming season with a comprehensive pitching program; participate in a full-body, "kinetic chain" training program that optimizes energy transfer and efficient, effective movement; and use high-speed video or video analysis of the pitching motion.

While resources can be scarce at the high school level, Zaremski said those practices could reduce injuries that result from chronic overuse. Coaches, players and parents also need to be keenly aware of the total number of pitches on game day -- not just the ones during game play.

Still, monitoring a player's pitches is just one part of avoiding injuries, he noted. Other factors also are at work, including players' participation in other sports that can limit their time to prepare for baseball season. Likewise, overuse injuries can be more of a hazard in warm-weather states where high school-age athletes play baseball nearly year-round.

SAN DIEGO - May 1, 2018 - The increase in opioid deaths in the last 20 years led a medical student at the University of Michigan Medical School and colleagues to look at excessive opioids prescribed to treat acute surgical pain following various procedures. Alyssa A. Mazurek presented a study during the American Association for Thoracic Surgery's 98th Annual Meeting that assessed patterns of opioid prescribing for open and laparoscopic hiatal hernia repair (HHR) and found that patients used far fewer opioids than were actually prescribed.

"The deadliness of the opioid epidemic has become one of the largest public health crises of our time, and its devastating effects are felt throughout the country," explains Mazurek, who presented the study results during a moderated poster session. "However, there has been very little investigation into opioid prescribing practices after thoracic surgeries. Further investigation is needed to understand what mechanisms are contributing to excessive prescribing and morbidity, such as opioid dependence, addiction, and narcotic diversion, associated with postoperative opioid use."

Investigators reviewed the charts of 89 "opioid naïve" patients who underwent open (including transthoracic and transabdominal) or laparoscopic HHR between January and December 2016, and who had received an opioid prescription after surgery. "Opioid naïve" was defined as patients not taking an opioid at the time of their preoperative history and physical. Their objective was to describe the patterns of opioid prescribing and consumption after open and laparoscopic hiatal hernia repair (HHR); and to characterize the practices that may contribute to excessive opioid prescribing and morbidity of postoperative opioid use.

Patients were surveyed regarding postoperative opioid use, opioid disposal habits, and any narcotic education received. Sixty-nine percent of patients completed the survey, of whom 27 had open surgery and 34 had laparoscopic surgery. Thoracic physician assistants and nurses (RNs) were surveyed regarding factors that contribute to their opioid prescribing and counseling practices.

The results showed that patients used far fewer opioids than were prescribed after both open and laparoscopic HHR. Patients only used 52 percent of narcotics prescribed to them, with a significant number of patients reporting leftover pills due to lack of proper disposal, a combination that provides a dangerous source for narcotic diversion. The investigators identified several factors that may be contributing to over-prescribing of opioids and the associated morbidity of postoperative opioid use, including: wide variation within prescribing; variety of factors influencing prescribing practices that differ among providers; inadequate patient education; inadequate and improper use of adjunct pain medications; and leftover pills not disposed of properly.

"It has become clear that surgeons and other healthcare providers play a major role in the over-prescribing of opioids after surgery," says Mazurek. Various studies have demonstrated the high prevalence of and detrimental long-term consequences of continuing to use opioids after surgery, such as opioid dependence/addiction, opioid overdose, and narcotic diversion.

Mazurek concludes that, "Given the growing awareness of this epidemic and the willingness of surgeons around the country to address it means we can also play a huge role in reducing excessive opioid prescribing and the number of unused pills that permeate into the community by further understanding prescribing practices and creating procedure-specific guidelines."