Culture

The more often adolescents say they have seen adverts for e-cigarettes, the more often they use both e-cigarettes and smoke tobacco cigarettes, according to a study published in ERJ Open Research [1].

The study took place in Germany, where regulations around tobacco and e-cigarettes advertising are more permissive than in other parts of Europe. Elsewhere there are firm bans on advertising tobacco but certain types of adverts and promotions for e-cigarettes are permitted.

Researchers say their work provides evidence that children and teenagers should be protected from the potential harms of smoking and using e-cigarettes by a comprehensive ban on adverts and promotions.

Dr Julia Hansen, a Senior Researcher at the Institute for Therapy and Health Research (IFT-Nord), Kiel, Germany was a co-researcher on the study. She said: "The World Health Organization recommends a comprehensive ban on tobacco advertising, promotion and sponsorship in its Framework Convention on Tobacco Control. Despite this, in Germany, tobacco and e-cigarettes can still be advertised in shops, on billboards and in cinemas after 6pm. Elsewhere, although tobacco advertising may be banned, the regulations on advertising e-cigarettes are more variable. We wanted to investigate the impact that advertising might be having on young people."

The researchers asked 6,902 pupils from schools in six German states to fill in anonymous questionnaires. They were aged between 10 and 18 years, with an average age of 13. They were asked about their lifestyle, including diet, exercise, smoking and use of e-cigarettes. They were also asked about their socioeconomic status and school performance.

The pupils were presented with pictures of real e-cigarette adverts with brand names removed and asked how often they had seen each one.

Overall 39% of the pupils said they had seen the adverts. Those who said they had seen the adverts were 2.3 times more likely to say that they use e-cigarettes and 40% more likely to say that they smoke tobacco cigarettes. The results also suggest a correlation between seeing more adverts and using e-cigarettes and smoking tobacco cigarettes more often. Other factors such as age, sensation-seeking tendency, the type of school the teenagers attended and having a friend who smokes were also all linked to the likelihood of using e-cigarettes and smoking.

Dr Hansen said: "In this large study of adolescents we clearly see a pattern: those who say they have seen e-cigarette adverts are more likely to say they have used e-cigarettes and conventional cigarettes.

"This type of research cannot prove cause and effect, but it does suggest that e-cigarette advertising is reaching these vulnerable young people. At the same time, we know that the makers of e-cigarettes are offering kid-friendly flavours such as gummi bear, bubblegum and cherry.

"There is evidence that e-cigarettes are not harmless, and this study adds to existing evidence that seeing e-cigarette advertising and using e-cigarettes might also be leading adolescents on to smoking. There are concerns that e-cigarette use might act as a 'gateway' to cigarette smoking and may contribute to the development of a new generation of cigarette smokers. So youth should be protected from any kind of marketing actions."

Dr Hansen hopes to continue to study this large group of school pupils to see if there are any changes over time. She says this may help clarify the cause and effect between exposure to adverts, using e-cigarettes and smoking.

Professor Charlotta Pisinger is Chair of the European Respiratory Society's Tobacco Control Committee and was not involved in the research. She said: "Producers of e-cigarettes may argue that advertising is a legitimate way to inform adult users about their products. However, this study suggests that children and young people may be suffering 'collateral damage' as a result of lax regulation of e-cigarette advertising. Policy makers need to realise that advertising is reaching adolescents and that this may not only be promoting the use of e-cigarettes, but also the likelihood of smoking and the health problems that brings."

The scene: a bitter divorce, and a custody battle over the couple's 7-year-old son. Awarded full custody, the mother - perhaps seeking revenge? - sets out to destroy the son's relationship with his father. The mother tells the son lies about the father's behavior, plants seeds of doubt about his fitness as a parent, and sabotages the father's efforts to see his son. The son begins to believe the lies; as he grows up, his relationship with his father becomes strained.

According to Colorado State University social psychologist Jennifer Harman, about 22 million American parents, like that fictional father, have been the victims of behaviors that lead to something called parental alienation. Having researched the phenomenon for several years, Harman is urging psychological, legal and child custodial disciplines to recognize parental alienation as a form of both child abuse and intimate partner violence.

An associate professor in CSU's Department of Psychology, Harman has authored a review article in Psychological Bulletin defining the behaviors associated with parental alienation and advocating for more research into its prevalence and outcomes. She and her co-authors explain how these behaviors are the source of long-term negative consequences for the psychological health and well-being of children and adults all over the world.

"We have to stop denying this exists," said Harman, who previously co-authored a book about parental alienation with Zeynep Biringen, a professor in the Department of Human Development and Family Studies. "You have to treat an alienated parent like an abused person. You have to treat the child like an abused child. You take the child out of that abusive environment. You get treatment for the abusive parent, and you put the child in a safe environment - the healthier parent."

In their new paper, Harman and co-authors Edward Kruk of University of British Columbia and Denise Hines of Clark University categorize parental alienation as an outcome of aggressive behaviors directed toward another individual, with the intent to cause harm. They draw direct lines between widely recognized patterns of abuse, like emotional or psychological aggression, and the behavior of alienating parents.

For example, psychological aggression is a common form of child maltreatment that involves "attacking a child's emotional and social well-being." In a similar manner, alienating parents terrorize their children by targeting the other parent, purposely creating fear that the other parent might be dangerous or unstable - when no evidence of such danger exists. Alienating parents will further reject, shame or guilt-trip their children for showing loyalty or warmth to the other parent.

The authors also argue that such alienating behaviors are abusive to the targeted parent, and they liken these behaviors to more familiar forms of intimate partner violence between spouses or dating partners.

Harman is an expert in power dynamics in human relationships. Her research has found that parental alienation is similar to what's known as "intimate terrorism." Intimate terrorism is chiefly characterized by a lopsided power dynamic, in which one partner subjugates the other through intimidation, coercion, or threats of (or actual) physical violence. Such a scenario is distinct from situational couple violence, in which both partners have relatively equal power in the relationship but cannot get along and resort to physical or emotional violence.

Analogously, children are used as weapons in the form of intimate terrorism known as parental alienation, Harman argues. The power imbalance in such intimate terrorism can be seen in custody disputes, in which one parent is awarded full custody of a child. This parent wields that court-ordained power to subjugate the other parent by withholding contact or actively seeking to destroy the other parent's relationship with the child.

The family court systems see these situations every day, Harman says, but judges, lawyers and social workers aren't attuned to the prevalence of parental alienation as child abuse or intimate partner abuse. Instead, such situations are regarded as simple custody disputes, or the inability of the parents to get along.

Harman says she's hopeful her reframing of parental alienation will spur other social scientists to continue studying the problem. More research into this particular form of family violence will bring greater awareness, and may marshal resources to better identify and stop such behaviors.

ANN ARBOR--An extremely messy personal space seems to lead people to believe the owner of that space is more neurotic and less agreeable, say University of Michigan researchers.

Psychologists from U-M's Flint and Ann Arbor campuses explored the degree of messiness in one's workspace and how it affects perceptions of the owner's personality.

In three experiments, about 160 participants were randomly assigned to sit in a researcher's office that was clean and uncluttered, or in another office that was either "somewhat" or "very" messy.

All offices were identically decorated to suggest that it belonged to a male researcher. They included various personal items, such as a baseball cap hanging on a door hook, a cup containing candy, a baby photo, and science books and academic journals in a bookcase.

In the neat office (office A), papers were neatly stacked on the desk, books and journals were upright on the bookshelves, file drawers had typewritten labels, and all garbage was in the wastebasket.

The "somewhat" messy office (office B in experiment 1) had books tilted over on the shelves, a textbook and papers lying on the floor, and a wall clock an hour off. The "very" messy office (office B in experiments 2 and 3) appeared even dirtier, more disorganized and had increased clutter.

Participants tried to guess the researcher's personality based on the office's appearance--rating the person's extraversion (social), agreeableness, conscientiousness, neuroticism and openness to experience. In each experiment, participants thought that the office B researcher (messy office) was less conscientious than the office A researcher (organized office).

"When there are cues related to less cleanliness, order, organization and more clutter in an owner's primary territory, perceivers' ascribe lower conscientiousness to the owner, whether that owner is a worker in the real world (office), a job-seeker (apartment), a student (bedroom) or a researcher at a university (lab office)," said lead author Terrence Horgan, professor of psychology at UM-Flint.

In everyday life, if people think that a person might be careless, cranky and uncaring because his/her office is very messy, then these impressions could subsequently impact how--or even whether--they decide to deal with him/her in the future, either on a personal or professional basis, the researchers say.

In experiments 2 and 3, participants also thought that the office B researcher was less agreeable and more neurotic than the office A researcher. The messier offices led to some participants thinking the owner possessed one or more negative personality traits.

The researchers said from the perspective of perceivers, high neuroticism, low conscientiousness and low agreeableness could signal potentially undesirable qualities in an employee. The bottom line: Perceivers' impressions of targets matter in terms of how they subsequently treat them.

"Once trait information about a target becomes activated in perceivers' minds, either consciously or unconsciously, that information can subsequently affect how they process information about, the types of questions they ask of, and how they behave toward the target, possibly bringing out the very trait information that they expected to see from the target in the first place," said study co-author Sarah Dyszlewski, a research technician in the Department of Psychology.

The findings appear in the journal Personality and Individual Differences.

Researchers from the Max-Planck-Institute for the Science of Human History and the University of Helsinki have analyzed the first ancient DNA from mainland Finland. As described in Nature Communications, ancient DNA was extracted from bones and teeth from a 3,500 year-old burial on the Kola Peninsula, Russia, and a 1,500 year-old water burial in Finland. The results reveal the possible path along which ancient people from Siberia spread to Finland and Northwestern Russia.

Researchers found the earliest evidence of Siberian ancestry in Fennoscandia in a population inhabiting the Kola Peninsula, in Northwestern Russia, dating to around 4,000 years ago. This genetic ancestry then later spread to populations living in Finland. The study also found that people genetically similar to present-day Saami people inhabited areas in much more southern parts of Finland than the Saami today.

For the present study, genome-wide genetic data from 11 individuals were retrieved. Eight individuals came from the Kola Peninsula, six from a burial dated to 3,500 years ago, and two from an 18th to 19th century Saami cemetery. "We were surprised to find that the oldest samples studied here had the highest proportion of Siberian ancestry," says Stephan Schiffels, co-senior author of the study, of the Max Planck Institute for the Science of Human History.

The other three individuals analyzed for the study came from a water burial in Levänluhta, Finland. Levänluhta is one of the oldest known burials in Finland in which human bones have been preserved. The bodies were buried in what used to be a small lake or a pond, and this seems to have contributed to exceptionally good preservation of the remains.

Siberian ancestry persists today

The study compared the ancient individuals not only to each other, but also to modern populations, including Saami, Finnish and other Uralic language speakers. Among modern European populations, the Saami have the largest proportion of this ancient Siberian ancestry. Worldwide, the Nganasan people, from north Siberia, have the largest proportion of ancient Siberian ancestry.

"Our results show that there was a strong genetic connection between ancient Finnish and ancient Siberian populations," says Thiseas Lamnidis, co-first author of the study, "suggesting that ancient populations from Siberia may have also shared a subsistence strategy, languages and/or cultural behaviours with Bronze Age and Iron Age Finns, despite the large geographical distance." Ancient Finnish populations possibly lived a mobile, nomadic life, trading and moving over a large range, with far-reaching contacts to other populations.

People found in Levänluhta, Finland, most resemble modern-day Saami

The researchers found that the population in Levänluhta was more closely related to modern-day Saami people than to the non-Saami Finnish population today.

"People closely related to the Saami inhabited much more southern regions of Finland than the Saami do today," explains Kerttu Majander, co-first author, of the University of Helsinki and the Max Planck Institute for the Science of Human History. Interestingly, a recent linguistic study suggested that the place names around Levänluhta trace back to Saami languages.

"This is the first exploration of ancient DNA from Finland and the results are very interesting," states Schiffels. "However more ancient DNA studies from the area will be necessary to better understand whether the patterns we've seen are representative of Finland as a whole."

The study was conducted as a collaboration between the SUGRIGE-project (Universities of Helsinki and Turku), and the Max Planck Institute for the Science of Human History. The archaeological materials and expertise were provided by the Peter the Great Museum of Anthropology and Ethnography (Kunstkamera) and the Levänluhta-project with the Finnish Heritage Agency.

CHICAGO - A minimally invasive procedure in which pulses of energy from a probe are applied directly to nerve roots near the spine is safe and effective in people with acute lower back pain that has not responded to conservative treatment, according to a study being presented today at the annual meeting of the Radiological Society of North America (RSNA).

Lumbar disk herniation is a common, often debilitating, condition that affects the disks that act as cushions between the vertebrae of the lower spine. Herniation occurs where the jelly-like material in the center of the disk bulges through a tear in the disk's tough exterior layer and puts pressure on the roots of the nerves. Herniated disks are often the source of sciatica, or pain that radiates downward from the lower back into the leg.

Conservative treatment options for herniated disks range from over-the-counter pain medications to injections of corticosteroids directly into the affected area of the spine. Those who don't respond may require surgery. In some cases, the entire disk must be removed and the vertebra fused together for stability.

An alternative technique, CT-guided pulsed radiofrequency (pRF), applies energy through an electrode under CT guidance to the portion of the nerve responsible for sending pain signals.

"Pulsed radiofrequency creates a nerve modulation, significantly reducing inflammation and its associated symptoms," said study senior author Alessandro Napoli, M.D., Ph.D., professor of interventional radiology at Sapienza University of Rome in Italy.

Dr. Napoli and colleagues studied the approach in patients with back pain from lumbar disk herniation that had not responded to prolonged conservative treatment. In 128 patients, the pRF treatment was delivered directly under CT guidance to the root of the nerve. The treatment was applied for 10 minutes.

For comparison, a group of 120 patients received one to three sessions of CT-guided steroid injection on the same anatomical target with no pRF.

The one-year outcomes demonstrated that CT-guided pRF was superior to the injection-only strategy. Patients who received pRF saw greater overall improvement in pain and disability scores during the first year. Relief of leg pain was faster in patients assigned to pRF, and they also reported a faster rate of perceived recovery. The probability of perceived recovery after one year of follow-up was 95 percent in the pRF group, compared with 61 percent in the injection only group.

"Given our study results, we offer pulsed radiofrequency to patients with herniated disk and sciatic nerve compression whose symptoms do not benefit from conservative therapy," Dr. Napoli said.

The results of the study are superior to those typically reported for usual care strategies and injections and may help a substantial number of patients with sciatic disk compression to avoid surgery, Dr. Napoli added.

The use of pRF also could improve outcomes for patients set to receive corticosteroid injections.

"We learned that when pulsed radiofrequency is followed by steroid injection, the result is longer lasting and more efficacious than injection only," Dr. Napoli said. "The effect of pulsed radiofrequency is fast and without adverse events."

Today, therapy for spine disorders allows for definitive treatment of symptoms and conditions using different techniques and technologies.

"Of the different therapies available, pulsed radiofrequency is among the least invasive," Dr. Napoli said. "Treatment lasts 10 minutes, and one session was enough in a large number of treated patients."

Co-authors are Roberto Scipione, M.D., Fabrizio Andrani, M.D., Susan Dababou, Cristina Marrocchio, Michele Anzidei, M.D., and Carlo Catalano, M.D.

Exploring objects through touch can generate detailed, durable memories for those objects, even when we don't intend to memorize the object's details, according to findings published in Psychological Science, a journal of the Association for Psychological Science.

"An especially interesting finding was that participants were able to visually identify an object they had never seen but only touched one week before without the intention of memorization," says researcher Fabian Hutmacher of the University of Regensburg. "This is even more remarkable as the competing objects in the recognition test belonged to the same basic-level category - that is, the previously presented object was only identifiable based on subtle touch-based details but not on much more salient visual details."

"The study challenges existing cognitive and neural models of memory storage and retrieval, as these models seem to be unable to account for the large amount of stored information," Hutmacher adds.

Compared with visual information, relatively little is known about long-term memory for information sensed through other modalities. Hutmacher and coauthor Christof Kuhbandner decided to focus specifically on haptic, or touch-based, experiences.

In one experiment, participants wore a blindfold as they explored 168 everyday objects, such as a pen, for 10 seconds each. The researchers told the participants they would be tested on the objects later, so they should pay close attention to the texture, shape, and weight of each object. The participants, still blindfolded, completed a haptic memory test for half of the objects immediately after exploring them. They held each object they had explored and a similar novel object that was distinguishable only by subtle details - their task was to indicate which object they had explored before. They completed the same test with the other half of the objects 1 week later.

Participants showed almost perfect recall on the test that followed the exploration period, correctly identifying the object they had explored 94% of the time. Remarkably, participants still showed robust memory for the original objects 1 week later, with 84% accuracy.

But would they still remember objects so well if they weren't intentionally memorizing them? And could objects that were explored by touch be recognized via a different sensory modality?

In a second experiment, a new group of participants explored the same 168 objects without knowing they would be tested on them. Instead, the experimenters said that they were investigating aesthetic judgments, and they asked the participants to rate the pleasantness of each object based on texture, shape, and weight.

Participants returned 1 week later for a surprise memory test, completing a blindfolded touch-based recognition task for half of the objects. For the rest of the objects, they completed a visual recognition task, in which they saw the original object and a similar object placed on a table, and indicated which one they previously explored. After each trial, the participants also reported if they answered based on recalling details of their touch-based exploration, feeling a vague familiarity, or simply guessing.

Again, the results showed that participants remembered the objects with high accuracy. In the blindfolded test, participants answered correctly on 79% of the trials. In the cross-modal visual test, participants identified the correct object 73% of the time.

For both tests, participants were most accurate for objects they said they recalled details for, moderately accurate for objects that seemed vaguely familiar, and least accurate for those they guessed on. Notably, participants showed better-than-chance recognition even when they reported that they had guessed.

The fact that participants could recognize objects across sensory modalities is intriguing given that the familiar and novel objects only differed on subtle details that would have to be distinguished on the basis of haptic experiences.

"These results suggest that the human mind effortlessly and automatically stores detailed and durable representations of a vast amount of perceptual experiences, including haptic ones," says Hutmacher. "We want to explore the idea that storing such a vast amount of information may in fact be functional as it may guide our behavior and contribute to its fine-tuning without being accompanied by conscious experience."

Boston, Mass - Physicians at Massachusetts Eye and Ear have, for the first time, induced a sense of smell in humans by using electrodes in the nose to stimulate nerves in the olfactory bulb, a structure in the brain where smell information from the nose is processed and sent to deeper regions of brain. Reporting online today in International Forum of Allergy & Rhinology, the research team describes their results, which provide a proof of concept for efforts to develop implant technology to return the sense of smell to those who have lost it.

"Our work shows that smell restoration technology is an idea worth studying further," said corresponding author Eric Holbrook, MD, Chief of Rhinology at Mass. Eye and Ear and associate professor of otolaryngology at Harvard Medical School. "The development of cochlear implants, for example, didn't really accelerate until someone placed an electrode in the cochlea of a patient and found that the patient heard a frequency of some type."

Smell loss, or anosmia, has an estimated prevalence of 5 percent of the general population. While some cases of anosmia may be treated by caring for an underlying cause (often nasal obstruction, in which odors can't reach the nerves of the olfactory system due to swelling, polyps or sinus disease), other cases involving damage to the sensory nerves of the nose (i.e. head injury, viruses and aging) are much more complex. There are currently no proven therapies for these cases.

Our sense of smell not only contributes to our enjoyment of life, but also to our daily safety and well being. We rely on our sense of smell to make us aware of smoke in detecting a fire, natural gas leaks and to avoid eating rotten food. In the elderly, of whom there are estimates that greater than 50 percent of the population over the age of 65 has experienced smell loss, it can be difficult to get proper nutrition, as the sensation of flavor is closely tied to the sense of smell, and as flavor diminishes, appetite decreases in this population.

A Cochlear Implant for the Nose

Motivated by work conducted by research colleagues at Virginia Commonwealth University's School of Medicine, Mass. Eye and Ear physicians wanted to address the question of whether electrical stimulation of the olfactory bulb could induce the sense of smell in human subjects.

The findings described in the International Forum of Allergy & Rhinology report demonstrate this feasibility. In the report, the researchers describe endoscopic procedures to position electrodes in the sinus cavities of five patients with an intact ability to smell. Three patients described sensations of smell (including reports of onions, antiseptic, sour and fruity aromas) as a result of the stimulation.

This breakthrough in human patients opens the door for a "cochlear implant for the nose" to be developed -- though the study authors caution that the concept of an olfactory stimulator is more challenging than existing technologies. The most successful neuroprosthesic device in the world, cochlear implants have been on the market for more than three decades to electrically stimulate the auditory nerve to restore hearing in people with profound hearing loss.

"There's currently so little that we can do for these patients, and we hope to eventually be able to reestablish smell in people who don't have a sense of smell," Dr. Holbrook said. "Now we know that electrical impulses to the olfactory bulb can provide a sense of smell -- and that's encouraging."

Given the considerable costs of providing alternative sources of care, there is remarkably little good quality evidence to back this approach, conclude the researchers.

Redirecting low need patients from emergency care departments to alternative sources of care, has been proposed as a potential solution to tackling the overcrowding that often occurs in these facilities.

But it isn't clear whether this strategy actually works or is safe. The researchers therefore systematically reviewed and pooled the data from 15 relevant studies, evaluating the impact of redirecting patients to alternative sources of care before reaching, or once in, an emergency care department.

No strong evidence emerged to either back or refute the safety and effectiveness of this strategy, the data analysis showed.

What's more, the proportion of patients suitable for diversion was relatively low and a considerable proportion of those who were suitable didn't want to use alternative sources of care either.

Redirecting patients to alternative sources of care was twice as common among those who had already reached an emergency care department.

But compared with those who weren't redirected, doing this before the patient reached hospital didn't cut the proportion transferred to emergency care.

Nor did it stop them subsequently using emergency care services: their patterns of use didn't differ from those of patients who weren't redirected.

While only three studies looked at the costs involved, none found any difference in total healthcare spend between patients who were diverted away from emergency care departments and those who weren't.

The overall quality of the published evidence was not particularly good. This included varying definitions of low need; limited information on the outcomes of patients given standard care; the numbers of patients willing and able to accept alternative sources of care; or the costs involved.

"Despite the clear resource implications for implementing [emergency department] diversion strategies, including training and hiring additional staff, costs of implementing the diversion strategies were infrequently reported," they write.

All this makes it difficult to draw definitive conclusions, they caution, concluding: "At this time there is insufficient evidence to recommend the implementation of diversion protocols as effective and safe strategies to address emergency department overcrowding."

And in a linked podcast in discussion with the journal's editor, Professor Ellen Weber, lead author, Dr Brian Rowe, University of Alberta, isn't convinced 'the juice is worth the squeeze.'

"I am not sure the efforts involved in doing diversion are really worth all the costs, time, and surveillance," he says. And not all emergency department patients are the same, although the diversionary strategies to date tend to assume that they are, he says.

Surveys in Canada indicate that patients have often tried many other options before coming to an emergency department, or that they are there because the health system has failed them, he suggests.

What's more, he adds, patients like the 'one-stop shop' service provided by hospitals, and younger patients often don't register with a family doctor, leaving them with few other options.

CHICAGO - Left gastric artery embolization, a novel interventional procedure used to treat obesity, leads to the loss of both fat and muscle, according to a new study presented today at the annual meeting of the Radiological Society of North America (RSNA). Researchers said the loss of muscle mass is concerning and underscores the importance of proper nutritional counseling after the procedure.

Obesity is a major health issue worldwide, linked with serious conditions like heart disease, cancer and diabetes. First-line treatments such as diet and exercise often don't work, leading many patients to opt for gastric bypass surgery. The surgery, which reduces the size of the stomach, has been effective in treating obesity, but carries with it significant costs and potential complications.

Currently under investigation in clinical trials, left gastric artery embolization is a less invasive option to surgery. In the procedure, microscopic beads are injected under imaging guidance into the artery that supplies blood to the stomach. The beads block blood flow to the stomach and reduce the production of ghrelin, a hormone that stimulates hunger. Early studies have shown that embolization is effective in helping people lose weight, but information is lacking on how it might change a patient's composition of muscle and fat.

"There has been lots of research focused on the efficacy of gastric artery embolization for weight loss," said the study's lead author, Edwin A. Takahashi, M.D., vascular and interventional radiology fellow at the Mayo Clinic in Rochester, Minn. "However, there has been no data on what is contributing to the weight loss, whether the patients are losing fat, as desired, or muscle mass, or some combination of the two."

To learn more, Dr. Takahashi and colleagues studied CT scans of 16 overweight or obese patients who had undergone left gastric artery embolization to treat gastrointestinal bleeding. CT scans, when used in conjunction with special software, allow for measurements of body composition based on the different densities of tissues like fat and muscle.

The scans were done before and approximately 1.5 months after the procedure. The results were compared to those of a control group of 16 outpatients who did not undergo left gastric artery embolization but had CT scans at two different time periods for nonspecific abdominal pain.

All 16 individuals experienced significant weight loss after the embolization procedure, losing an average of 6.4 percent of their body weight over 1.5 months. Body mass index, a measure of body weight relative to a person's height, dropped by 6.3 percent.

While the weight loss was not surprising to the researchers, the changes in body composition were. The skeletal muscle index, a measure of the amount of muscle that connects to the skeleton and helps move the limbs, fell by 6.8 percent. Skeletal muscle is important to health, and loss of it can impair physical function and metabolism and put a person at higher risk of injury.

"The significant decrease in the amount of skeletal muscle highlights the fact that patients who undergo this procedure are at risk for losing muscle mass and need to be managed accordingly after procedure," Dr. Takahashi said. "We must make sure they receive adequate nutrition to minimize the amount of muscle tissue they lose."

The patients also lost a significant amount of body fat. Their overall body fat index dropped by an average of 3.7 percent. However, much of the fat loss was subcutaneous, or the fat that lies directly under the skin. Visceral fat, the more dangerous fat surrounding the organs and associated with serious health problems like heart disease and diabetes, did not decrease significantly over the course of follow-up.

The researchers plan to expand their studies in the future to include people who are specifically undergoing embolization as a treatment for obesity.

The livestock sector could use almost half of the 1.5 degree C greenhouse gas emission budget allowed by 2030, so addressing this should be a key part of the strategy to hit climate targets, according to a new study published in Climate Policy.

Dr Helen Harwatt, farmed animal law and policy fellow at Harvard Law School, advises that getting protein from plant sources instead of animal sources would drastically help in meeting climate targets and reduce the risk of overshooting temperature goals.

For the first time, Dr Harwatt proposes a three-step strategy to gradually replace animal proteins with plant-sourced proteins, as part of the commitment to mitigate climate change. These are:

1) Acknowledging that current numbers of livestock are at their peak and will need to decline ('peak livestock').

2) Set targets to transition away from livestock products starting with foods linked with the highest greenhouse gas emissions such as beef, then cow's milk and pig meat ('worst-first' approach).

3) Assessing suitable replacement products against a range of criteria including greenhouse gas emission targets, land usage, and public health benefits ('best available food' approach).

Harwatt further elaborates that recent evidence shows, in comparison with the current food system, switching from animals to plants proteins, could potentially feed an additional 350 million people in the US alone.

Previous studies suggested reducing meat and dairy consumption also provides a range of added benefits such as preserving biodiversity and improving human health.

The article reports that the current livestock population in the world is around 28 billion animals and constitutes the highest source of two major greenhouse gases - methane and nitrous oxide. The production of methane in particular is troublesome, as it has an 85 times greater global warming potential than carbon dioxide over a 20-year time frame. Methane emissions from the livestock sector are projected to rise by 60 percent by 2030 - the same time period over which strong and rapid reductions are needed.

"Given the livestock sector's significant contribution to global greenhouse gas emissions and methane dominance, animal to plant protein shifts make a much-needed contribution to meeting the Paris temperature goals and reducing warming in the short term, while providing a suite of co-benefits," Harwatt says.

She adds, "Failure to implement animal to plant protein shifts increases the risk of exceeding temperature goals and requires additional, and unrealistic, greenhouse gas reductions from other sectors. The current revision of national contributions to meeting the Paris Agreement from 2020 onwards should ideally integrate animal to plant-protein shifts. As a next step, the COP24 in December this year provides an excellent opportunity for policy makers to start this important conversation."

The article acknowledges establishments, such as businesses, can spearhead these efforts. As an example, Dr Harwatt is already putting her three-step animal to plant protein shift approach into practice in the food service sector in her role as Sustainable Food Policy Advisor to charity Humane Society International UK (HSI).

HSI run the Forward Food programme providing free plant-based culinary training for public and private sector chefs. Here, Dr Harwatt can, and other experts could too, assess food-related greenhouse gas emissions at the institutional level and apply the three-step strategy to identify opportunities for emissions reductions through peaking purchase of animal products, tackling the 'worst first' and replacing them with best available foods.

She comments, "The food sector is already making progress on these issues and demonstrating that it's commercially viable to incorporate animal to plant protein shifts. We need policy makers to enable the creation of Paris-compliant food systems on a much larger and faster scale - and animal to plant-protein shifts play a key role".

A new specialist programme at South London and Maudsley NHS Foundation Trust (SLaM) has been shown to significantly reduce the rate of hospital readmissions for people with bipolar disorder, in an early-stage audit funded by the NIHR Maudsley Biomedical Research Centre. The findings have been published in BJPsych Bulletin today.

Bipolar disorder is a condition in which an individual experiences recurrent episodes of mania, hypomania and depression. Bipolar disorder is fairly common: one in 50 adults will be diagnosed with the condition. An initial three-year audit of admissions at South London and Maudsley NHS Foundation Trust showed that there were approximately 500 hospital admissions of people with bipolar disorder each year. Two-thirds of these were re-admissions in that three year period, and approximately 150 people were admitted more than once a year. This audit strongly evidenced the need for a strong focus on effective preventative strategies in service users' recovery programmes.

The OPTIMA Mood Disorders Service was established in 2015 to address this need. The Core Programme is an intensive, specialist programme for people who have recently had frequent hospital admissions for manic or depressive episodes. At the time of the audit, 30 people had been through the OPTIMA programme. The average rates of hospital admission and home treatment for these 30 patients, over the three years prior to them beginning the programme, were calculated using their electronic health records. These were compared to the average rates of admission for the patients over their post-programme period (an average of 9.5 months).

The average rate of hospital readmission post-OPTIMA was substantially lower than the average rate over the three years pre-OPTIMA. The finding provides initial evidence that the treatments provided by the OPTIMA programme are successful in reducing hospital readmissions for frequently admitted patients.

The core programme is designed to consolidate recovery. It involves a range of treatments tailored to the individual, including frequent psychiatric review, expert pharmacotherapy (therapy using pharmaceutical drugs), specialist nursing interventions, occupational therapy and individual and group psychoeducation.

Psychoeducation helps people with bipolar disorder gain more control over their illness. It sensitively looks at the past course of illness to identify episode triggers and early warning signs of mania or depression. By recognising that an episode is just beginning and accessing help early, the development of full episodes can be prevented. Pragmatic planning on when and how to access help in a developing crisis is essential. The programme also offers occupational therapy, which helps service users find a balance between rest, work and leisure activity when building their functional recovery following a bipolar episode.

Senior author, Professor Allan Young, Director of the Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, said: "It is extremely encouraging to see that our specialist OPTIMA programme is successfully helping people with bipolar disorder, resulting in fewer readmissions to hospital. However, this early-stage audit does have some limitations. It examines a relatively small number of patients and a relatively short period of time post-programme, a more extensive study is required to confirm these benefits."

First author, Dr Karine Macritchie, Lead Consultant Psychiatrist at OPTIMA said: "The period immediately following hospital admission for bipolar depression or mania is often a very vulnerable time for people struggling with this illness. Our early results show that this period offers a valuable opportunity to optimise on-going treatment and to prevent loss of recovery, episode recurrence and re-admission.

"People with bipolar disorder can be given appropriate treatment, frequent support and a greater sense of agency over their condition at the time when they need these things the most. OPTIMA shows the very positive results that can be achieved when a flexible, responsive service is offered in a timely and targeted way."

A new analysis in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/lookup/doi/10.1503/cmaj.180897 outlines the potential government cost of a national Canadian pharmacare program and sets out approaches to shifting the funding for drugs in Canada to realize billions in savings.

"We believe there is a compelling argument for the federal government to raise the incremental revenues needed to implement this long-recommended expansion of Canadian medicare," write Drs. Michael Wolfson, Faculties of Medicine and Law, University of Ottawa, and Steven Morgan, School of Population and Public Health, University of British Columbia.

Implementing a national pharmacare program in 2020 would require $9.7 billion in public funding and result in $13.5 billion in savings to the private sector because of lower costs of private insurance, according to estimates from the Parliamentary Budget Officer.

The authors suggest using a mix of federal revenue sources, including relatively small increases in personal income taxes (0.5 percentage points), corporate tax rates (1 percentage point) and GST (0.25 percentage points).

For policy-makers, advanced modelling tools can help inform the different approaches to funding a national pharmacare program.

"Without national pharmacare by 2020, Canadians could be paying $4.2 billion more for medicines than they would need to under a universal, comprehensive public pharmacare plan," the authors write. "The question, therefore, isn't whether Canada can afford national pharmacare; rather, it is how government should raise the needed public revenues and, correspondingly, who should benefit from the billions of dollars in net savings as a result."

A new paper published by McGill University researchers in JAMA Internal Medicine suggests that some clinical trials may promote the use of ineffective and costly treatments. That's the opposite of what clinical trials are aimed at, namely preventing ineffective and costly treatments from being taken up by physicians and patients.

The researchers focused their attention on the blockbuster pain drug pregabalin (Lyrica). One of the world's bestselling drugs, pregabalin is widely used for conditions that are not approved by Health Canada or the FDA ("off-label"). Relying on the published record of trials, they reconstructed the timeline of pregabalin drug development to understand what evidence was available to clinicians and clinical guideline creators when they were making treatment decisions and recommendations, and how testing was coordinated. Their underlying finding was that after pregabalin received its first approval, research was often better at creating the perception that pregabalin might work against other diseases than it was at proving it. For example, they found that despite nearly a decade passing since the publication of a small study suggesting that pregabalin might work to treat patients with low back pain, no large, rigorous follow-up trials have been published to date.

McGill Professor Jonathan Kimmelman, Director of the Biomedical Ethics Unit in the Faculty of Medicine, and the study's senior author, first came up with the idea for the study after watching the documentary film "The Merchants of Doubt." The film showed how the tobacco, chemical, and oil industries have manipulated science to sow doubt among regulators and the public about the relationship between their products and public health. Prof. Kimmelman wondered whether there might be an analogous process going on in medicine. Instead of sowing doubt, he thought pharmaceutical companies might want to create the perception that their drugs might be useful for conditions other than those for which they are approved. The researchers found something more complex at work, however, with many of the studies in their sample being publicly funded and others not reporting any industry funding at all. "We were surprised to find that the problems we document are partly driven by researchers who are receiving funding from federal research agencies and/or their own medical centers," notes Carole Federico, a PhD student under Prof. Kimmelman's supervision and the study's lead author.

"Drug development is like a relay race, where the first runner is trying to show a drug might possibly work, and the second runner is proving that a drug really does work," explains Prof. Kimmelman. "This relay race works really well before a drug is approved, because drug regulators like Health Canada and the FDA prevent companies from marketing their drug until they have run the whole race. Once a drug is already approved, however, the second runner in the relay race, the one whose job it is to prove that drug works in another disease, often drops the baton. Physicians are free to use the drug for conditions other than what it is approved for and there are no obligations for companies to prove a drug works in other diseases. That means that research testing already approved drugs for new diseases often encourages the use of treatments that may not be effective."

Federico is quick to add that, "there is nothing inherently wrong with off-label use of drugs. In fact, many drugs that are given off-label are supported by strong evidence. However, when drugs are prescribed off-label based on weak evidence, patients might be harmed because they are taking drugs that are ineffective for their condition. Likewise, healthcare systems are harmed if they are reimbursing for the costs of such ineffective treatments."

"We want to underscore that probably most, if not all researchers would argue that all of the individual trials in our sample were both reasonable and ethical," says Prof. Kimmelman. "Our point is not to condemn these individual trials. Instead, we are saying that--when you zoom out and look at what's happening at the level of the forest--the trees begin to look less healthy."

As physicians attempt to decrease antipsychotic use in seniors with dementia, they need to be aware that trazadone, frequently used as an alternative, is associated with a similar risk of falls and major fractures as atypical antipsychotics, according to new research in CMAJ (Canadian Medical Association Journal).

"As clinicians move to decrease antipsychotic use, we should not consider trazadone as a uniformly safer alternative to atypical antipsychotics, because trazadone use was associated with a comparable risk of falls and major osteoporotic fractures to atypical antipsychotics -- drugs associated with these adverse outcomes in our patient population," writes Dr. Jennifer Watt, St. Michael's Hospital, Toronto, Ontario, with coauthors.

The rate of dementia in Canada is 7%, but it approaches almost 25% in people older than age 85. In long-term care facilities, 62% of residents have dementia, and many exhibit aggressive behaviour. Although evidence is limited on efficacy, antipsychotics and trazadone, an antidepressant also used for sleep issues, are commonly prescribed for patients with dementia.

Using linked data from ICES, researchers looked at data on 6588 seniors newly dispensed trazadone and 2875 newly dispensed an atypical antipsychotic. They found that patients dispensed trazadone had a rate of falls and major fractures, including hip fractures, similar to that of the group receiving atypical antipsychotics. However, trazadone was associated with a lower risk of death in these patients.

"We hope this information can be used to inform conversations that patients and caregivers are having with clinicians about the benefits and risks of different treatment options," says Dr. Watt.

"Watt and colleagues also underscore the importance of prioritizing nonpharmacological approaches for the management of behavioural and psychological symptoms of dementia," writes Dr. Elia Abi-Jaoude, The Hospital for Sick Children (SickKids) and University Health Network, Toronto, Ontario, with coauthors in a related commentary http://www.cmaj.ca/lookup/doi/10.1503/cmaj.181486. "Nonpharmacological approaches comprise a variety of behavioural, environmental and caregiver-supportive interventions, and existing evidence suggests that these show greater effect than many psychotropic drug therapies."

"Comparative risk of harm associated with trazodone or atypical antipsychotic use in older adults with dementia: a retrospective cohort study" is published November 26, 2018.

Fred Hutchinson Cancer Research Center's latest findings on cancer immunotherapies, CRISPR for blood disorders, stem cell transplantation and insights on the immune system and cancer will be featured at the 60th annual meeting of the American Society of Hematology, which will be held Dec. 1-4 in San Diego. See highlights below.

ASH PRESS BRIEFING

This year's ASH press program will include a press briefing, "CAR T-Cell Therapies: New Research and Updates from Pivotal Trials," featuring Fred Hutch research on a combination therapy for chronic lymphocytic leukemia (more details below). The briefing will take place at 11:30 a.m. PST, Saturday, Dec 1, in Room 23 of the San Diego Convention Center. It is open to all media registered to attend the meeting. More details will be available in an ASH press release to be distributed at the briefing.

CAR T-cell combination therapy for chronic lymphocytic leukemia. Dr. Jordan Gauthier will describe how patients with relapsed, refractory chronic lymphocytic leukemia (CLL) treated with the drug ibrutinib before, during and after CAR T-cell therapy may experience fewer side effects and may be more likely to see their cancer go into remission compared with patients who received CAR T alone. Gauthier calls the results promising, though he cautions that at this point the study is small (fewer than 20 patients in each group). Ibrutinib is a small-molecule drug that keeps CLL cells from growing, and the CAR T-cell therapy targeted the CD19 protein on leukemia cells. Gauthier is a Fred Hutch senior research fellow and clinician working in the lab of Dr. Cameron Turtle. The study to be presented at ASH is an extension of the team's 2017 study published in the Journal of Clinical Oncology that showed how the CD19 CAR T-cell therapy led to durable molecular remissions in CLL patients who had failed other treatments.

CAR T-CELL THERAPY

With the success of CAR T-cell therapies for some blood cancers, Fred Hutch physician-scientists are taking a closer look at characteristics and outcomes of patients who have received the therapy with the aim of making the therapy work better for more people. Other CAR T-cell therapy work featured at this year's meeting includes taking a deep dive into how the cells behave and early findings on a new CAR T for multiple myeloma.

Factors impacting survival in adults treated with CD19 CAR T-cell therapy for acute lymphoblastic leukemia. Dr. Kevin Hay, a Fred Hutch research fellow and clinician working in the Turtle lab, will present data on characteristics of patients who have a lasting remission following CD19 CAR T-cell therapy for acute lymphoblastic leukemia. He found that disease-related factors, pre-CAR T-cell conditioning and hematopoietic cell transplantation performed after CAR T-cell therapy impacted survival. The findings from about 50 patients contribute to emerging evidence that CAR T-cell therapy can be used to get patients with difficult-to-treat disease into remission and that subsequent stem cell transplantation may enable them to survive longer without their disease returning.

When CAR T-cell therapy fails: Treatment strategies in lymphoma. CD19 CAR T-cell therapy has shown promise for patients with relapsed or refractory B-cell non-Hodgkin lymphomas, a population with historically poor outcomes and few treatment options. But up to 60 percent of patients do not achieve long-term remission after the therapy and there is no clear standard of what treatments to pursue when CAR T-cell therapy does not work. Dr. Victor Chow, a senior Hematology-Oncology fellow working with Dr. Ryan Lynch, an assistant professor and clinician at Hutch's clinical care partner, Seattle Cancer Care Alliance, and University of Washington, examined patient outcomes for a group of about 60 patients treated in the past five years whose disease progressed after CD19 CAR T-cell therapy. Chow will report on how the disease progressed following the failed therapy. While most of the patients who went on to receive additional treatment lived longer, their outcomes were still poor. The physicians hope these data will generate new ideas and inform future clinical trial strategies for this population without clear treatment options.

Profiling the anti-cancer behavior of CD19 CAR T cells. Little is known about the gene signatures of the engineered CAR T cells after they've been infused into patients. Dr. Alyssa Sheih, a postdoctoral researcher working in the Turtle lab, will speak about how she used TCR sequencing to track how the cells changed in patients who received the 1:1 ratio of millions of CD4 and CD8 CAR T cells. She compared the gene signatures of CAR T cells from the infused product and from blood samples from patients at different time points after receiving the therapy. Sheih discovered patterns of gene expression that corresponded with cells that expanded more than others after infusion. The researchers are using the proof-of-principle study to gain insight into strategies to improve CAR T-cell immunotherapy.

Early results from a new CAR T-cell therapy for multiple myeloma. CAR T cells targeted to a protein called BCMA on multiple myeloma cells is an emerging treatment strategy for this typically incurable blood cancer. Dr. Damian Green, a physician-scientist at Fred Hutch and Seattle Cancer Care Alliance will present early findings from a phase 1 first-in-human clinical trial which showed that all patients who had not responded to frontline therapies responded to the lowest dose of the experimental BCMA CAR T-cell therapy administered in a 1:1 ratio of engineered CD4 and CD8 cells. Green describes the findings as showing early promise; the therapy could be safe and effective and may represent a treatment option that improves the long-term prospects for patients with multiple myeloma.

GENE THERAPY

CRISPR-edited cells persist, effectively boost fetal hemoglobin in genetic blood disorders. Dr. Stefan Radtke, of Fred Hutch's Stem Cell and Gene Therapy Program led by Dr. Hans-Peter Kiem, will discuss CRISPR editing in a specialized subset of blood stem cells identified in 2017 by the Fred Hutch team as capable of repopulating the entire blood and immune system. The approach reduces by 90 percent the amount of reagents needed to carry out the gene modification (currently a bottleneck in the field) and has the potential to make gene therapy faster and safer. The ASH presentation, of work led by Dr. Olivier Humbert, a staff scientist in the Kiem Lab, is a first proof-of-principle that the edited cell subset persisted for at least a year in a large animal model and was able to increase fetal hemoglobin to counteract the defective hemoglobin produced in the genetic blood disorders sickle cell and beta thalassemia. Humbert and colleagues presented preliminary findings earlier this year.

STEM CELL TRANSPLANTATION

Bone marrow transplantation in older, frail adults with acute myeloid leukemia. Survival rates continue to improve for patients treated for AML, but treatment options for older and more frail patients have been limited, and these patients are often left out of clinical trials due to comorbidities. Dr. Mohamed Sorror, a Fred Hutch blood cancer physician and outcomes research scientist, is an expert in identifying patients in this demographic who would fare well - or not - in hematopoietic cell transplantation, which is considered the standard curative treatment for the disease. He will present on survival differences among some 700 patients enrolled on a multicenter trial.

ON THE HORIZON

Other notable experts and newsy topics being presented at ASH:

Regenerating immune function in the thymus. The thymus is a gland in the chest that acts like a boot camp for T cells, training them to identify and kill foreign invaders. The gland wears out with stress, infection and age, and finding ways to boost its productivity could help sustain human health. Dr. Jarrod Dudakov, a Fred Hutch immunologist, studies the signaling pathways of the thymus, and he and members of his lab will present the latest chapter in his quest to find master regulators that could be targets for helping the thymus to repair itself. In this video, Dudakov talks about how the thymus degenerates and the cells and molecules involved in repairing it, a mechanism he described earlier this year in Science Immunology.

The role of the microbiome in recovering from stem cell transplantation. The population of gut microbes changes when patients go through blood stem cell transplants as a result of antibiotics and other agents they receive as part of the life-saving treatment. Fred Hutch researchers are investigating how the microbiome interacts with immune cells in hopes of better understanding and treating graft vs. host disease, a common side effect of transplantation that occurs when the newly transplanted immune system attacks healthy tissue. Dr. Alyssa Sheih, postdoctoral fellow working in the Turtle Lab, will present a poster on how a common type of T cell called MAIT cells is linked to the populations of different microbes in stool samples of patients before, during and after stem cell transplantation. She says that the regrowth of MAIT cells -- which can comprise up to 10 percent of T cells -- accompanies the presence of gut bacteria species that are linked to not developing GVHD. The project is part of the Fred Hutch Microbiome Research Initiative, which is led by infectious disease expert Dr. David Fredricks.

Cord blood transplantation for cancer and other blood disorders. Transplantation of blood stem cells from umbilical cord blood can treat blood disorders in patients who have not been able to find a suitable match among other donor sources, which is particularly difficult for patients of mixed ethnicity. Dr. Filippo Milano is associate director of Fred Hutch's Cord Blood Program, and he cares for patients at Seattle Cancer Care Alliance. He will be available at the ASH meeting to discuss cord blood transplantation for cancer and other blood disorders. He was lead author of a 2016 New England Journal of Medicine study which found that high-risk leukemia patients who received cord blood transplants had a lower risk of relapse. He will lead a newly funded clinical trial for HIV-positive patients with leukemia, which has the potential to treat both cancer and HIV by using donor cells that are resistant to the virus.

Long-term outcomes for patients receiving stem cell transplantation. Dr. Stephanie Lee, vice president of ASH, is a physician-scientist at Fred Hutch who cares for stem cell transplant patients at Seattle Cancer Care Alliance. She will become president of ASH in 2020. Lee is an expert in chronic graft vs. host disease and long-term survivorship following transplantation.