Culture

New research suggests that protecting the Amazon rainforest from deforestation may just be shifting the damage to a less renowned neighbor. The unintended consequences are profound.

Efforts to rein in agriculture activities in the Amazon have led to an 80 percent reduction in rainforest destruction between the early 2000s to 2015. Yet in this month's Journal of Geographic Sciences Michigan State University (MSU) researchers show that farming and ranching have caused 6.6 times more destruction of natural vegetation in the nearby Tocantins State of the Cerrado in central Brazil, without a corresponding uprising of concern.

"We are not saying reducing rainforest destruction in the Amazon shouldn't get attention," said Yue Dou, a research associate in MSU's Centers for Systems Integration and Sustainability (CSIS). "But attention has to be paid in the major destruction of another area which also has significant biodiversity."

Cerrado is a Brazilian savanna of varied, wooded grasslands that cover more than 20 percent of the country. Amazon's rainforest terrain of towering, ancient broadleaf trees, has a wide appeal and international fascination. The Cerrado, though a global biodiversity hotspot, hasn't commanded the same attention. Both areas of Brazil have been farmed aggressively. Two supply-chain agreements placed bans on purchasing soybeans grown on Amazonian lands after 2006 or beef raised on Amazon land deforested after 2009 vastly slowed deforestation. Researchers calculated that the policies reduced deforestation from 22,766 square miles to 11,013 square miles in the Amazon.

Yet destruction in the Cerrado surged as soybean farmers and cattle ranchers sought new places to produce highly demanded foods. In the state of Tocantins alone the conversion to agricultural land increased from 465 square miles to 3,067 square miles from 2007 to 2015.

The authors of "Spillover effect offsets the conservation effort in the Amazon" note that the reasons behind the hidden impacts are complex and can be difficult to understand - so it's hard to realize success in one part of the country can be spilling over with setbacks in a neighboring area. Colonization, road building, available infrastructure and effectiveness of law enforcement are among the many moving parts that cause people to cut down natural vegetation and farm. Comparing rainforest to Cerrado also is challenging.

That's why scientists worked with the telecoupling framework capable of examining many different factors. Telecoupling framework integrates many different scientific disciplines to allow scientists to holistically understand ecological and socioeconomic interactions over distances.

"In our increasingly complex world, we need to look at problems in new ways that can reflect subtleties and truths that are counterintuitive," said Jianguo "Jack" Liu, CSIS director and co-author. "Progress in sustainability must be genuine and we can't allow ourselves to be blinded by success in one place at the expense of invisible impacts on other places. The telecoupling framework helps to bring together many different kinds of information to fully understand important change in our telecoupled world."

ALEXANDRIA, VA--The latest research on ear health, head and neck cancer, sleep-disordered breathing, rhinology and allergy, facial plastics, laryngology and swallowing disorders, endocrine surgery, and other topics related to otolaryngology-head and neck surgery will be presented in Atlanta, GA, October 7-10, during the 2018 Annual Meeting & OTO Experience of the American Academy of Otolaryngology-Head and Neck Surgery Foundation.

Abstracts of all the research to be presented are now available online at http://journals.sagepub.com/doi/suppl/10.1177/OTOJ_159_1S/suppl_file/OTO_159_1S_fullissue.pdf.

The 2018 Annual Meeting includes hundreds of research presentations. The Program Advisory Committee, comprised of physician members, selected 21 Scientific Oral Presentations to highlight in recognition of outstanding scientific merit and innovation. The following selected studies will be presented during the "Best of Orals" session on Sunday, October 7, at 8:30 am in Building B, Room 312, in the Georgia World Congress Center (GWCC):

Do Surgeons' Biases Influence the Treatment Decisions in Patients with Recurring Tonsillitis?
Nish Mehta, PhD, MBBS, FRCS (ORL) (presenter)

Effectiveness of Non-opioid/Non-narcotic Postoperative Pain Management Regimen for Patients Undergoing Thyroidectomy and/or Parathyroidectomy
James Biery (presenter) and Phillip K. Pellitteri, DO

Epidemiology of Vestibular Schwannoma over the Past Half-Century: Population-Based Study in the United States
John P. Marinelli BS, (presenter), Christine Lohse, MS, and Matthew L. Carlson, MD

Evaluation of the Prognostic Utility of the Hemoglobin-to-Red Cell Distribution Width Ratio in Head and Neck Cancer: Multi-center Cohort Study
Tristan Tham, MD (presenter), Caitlin Olson, MD, Josephine Coury, Julian Khaymovich, Sireesha Teegala, Michael Wotman, and Peter D. Costantino, MD

Factors Affecting Failure to Complete Sleep Studies in Pediatric Patients with Sleep Disordered Breathing
Jocelyn L. Kohn, MD (presenter), Jessica R. Levi, MD, and Michael B. Cohen, MD

Five-Year Objective and Subjective Outcomes of Palatopharyngeal Surgery in Patients with Obstructive Sleep Apnea Hypopnea Syndrome
Jingying Ye, MD (presenter), Guoping Yin, and Yuhuan Zhang

If You're Happy, How Do You Show It? Dynamics of Spontaneous Smiles
Emily A Waselchuk, MD (presenter) and Sofia Lyford-Pike, MD

Increasing Resource Utilization in Treatment and Management of Pediatric Subglottic Stenosis
Feras Ackall, MD (presenter), Hui-Jie Lee, Belyu Liu, and Jeffrey Cheng, MD

Investigation of Association between Depression: Its Prophylaxis and Long-term Overall Survival for Head and Neck Cancer Survivors in a Randomized Controlled Trial
Trevon McGill, MD (presenter), William Lydiatt, MD, Oleg Militsakh, MD, Andrew M. Coughlin, MD, Harlan Sayles, MS, Robert Lindau, MD, Daniel Lydiatt, MD, and Aru Panwar, MD

Novel Transgenic Murine Model for Study of Peripheral Nerve Regeneration
Suresh Mohan, MD (presenter), Ivan Coto Hernandez, PhD, Shinsuke Shibata, and Nate Jowett, MD

Outcomes of Hypoglossal Nerve Upper Airway Stimulation in Patients with Isolated Retropalatal Collapse
Ahmad F. Mohmoud, MD (presenter), and Erica R. Thaler, MD

Outliers: Predicting High Cost of Care for Otolaryngology Patients
Karthik Balakrishnan, MD (presenter), James P. Moriarty, Jordan K. Rosedahl, Colin L.W. Driscoll, MD, and Bijan J. Borah, PhD

Pathologic Fibroblasts in Idiopathic Subglottic Stenosis Amplify Local Inflammatory Signals
Robert J. Morrison, MD (presenter), Nicolas-George Katsantonis, MD, Christopher Wootten, MD, Kevin M. Motz, MD, Alexander T. Hillel, MD, and Alexander Gelbard, MD

Postoperative Opioid Prescriptions and Corresponding Opioid Consumption after Septoplasty or Rhinoplasty
Alexander N. Rock, MD (presenter), Corey Cheresnick, MD, Kenneth Akakpo, Benjamin Zmistowski, MD, and Stephen Nogan, MD

Postoperative Pain Control and Opioid Usage Patterns Among Patients Undergoing Thyroidectomy and Parathyroidectomy
Theresa Tharakan, BA (presenter), Sydney T. Jiang, MD, Judd Fastenberg, MD, Thomas J. Ow, MD, MS, Richard V. Smith, MD, and Vikas Mehta, MD

Protective Role of N-Acetylcisteine from Cisplatin-Induced Ototoxicity in Patients with Head and Neck Cancer. Randomized Placebo Controlled Clinical Trial
Daniel Munoz, MD, MSc (presenter), Felipe Cardemil, MD, Andres Readi, and Jose Contreras

Relationship Between Nasal Steroid Choice and Industry Payments among Otolaryngologists
Elliot Morse (presenter), Rance Fujiwara, and Saral Mehra, MD, MBA

Resident Understanding of Laryngeal Stroboscopy: Needs Assessment
Joel W. Jones, MD (presenter), Mollie Perryman, Paul D. Judge, MD, Cristina Cabrera-Muffly, MD, James David Garnett, MD, Kevin J. Sykes, PhD, MPH, and Shannon M. Kraft, MD

Surgical Impact of an Endocrine Surgeon on an Academic Otolaryngology Department
Ayka J. Iwata, MD (presenter), Steven S. Chang, MD, Tamer Abdel-Halim Ghanem, MD, PhD, and Michael C. Singer, MD

There is No Difference in Tympanoplasty Closure Rates between Collagen Allografts and Temporalis Fascia or Perichondrium
Nathan D. Cass (presenter), Herman A. Jenkins, MD, and Stephen P. Cass, MD, MPH

Treatment Modalities in Sinonasal Adenoid Cystic Carcinoma: Clinicopathological Features and Comparative Analysis
Roshansa Singh (presenter), Sana H. Siddiqui, Loka Thangamathesvaran, MD, Suat Kilic, Wayne D. Hsueh, MD, and Jean Anderson Eloy, MD

DNA testing of more than 6,000 dogs has revealed that a duplication on canine chromosome 18 is strongly associated with blue eyes in Siberian Huskies, according to a study published October 4, 2018, in the open-access journal PLOS Genetics by Adam Boyko and Aaron Sams of Embark Veterinary, Inc., and colleagues. Embark is a dog DNA startup company headquartered in Boston, MA, and Ithaca, NY, and research partner of the Cornell University College of Veterinary Medicine. According to the authors, this represents the first consumer genomics study ever conducted in a non-human model and the largest canine genome-wide association study to date.

Consumer genomics enables genetic discovery on an unprecedented scale by linking very large databases of genomic data with phenotype information voluntarily submitted via web-based surveys. But the promise of consumer genomic data is not limited to human research. Genomic tools for dogs are readily available but the genetic underpinnings of many important traits remain undiscovered. Although two genetic variants are known to underlie blue eye color in some dogs, these do not explain the trait in some other dogs, like Siberian Huskies.

To address this gap in knowledge, Boyko, Sams and colleagues used a diverse panel of 6,070 genetically tested dogs with owners that contributed phenotype data via web-based surveys and photo uploads. They found that a 98.6-kilobase duplication on chromosome 18 near the ALX4 gene, which plays an important role in mammalian eye development, was strongly associated with variation in blue eye color, primarily in Siberian Huskies but also in non-merle Australian Shepherds. One copy of the variant was enough to cause blue eyes or heterochromia (blue and brown eyes), although some dogs with the variant did not have blue eyes, so other genetic or environmental factors are still involved. Future studies of the functional mechanism underlying this association may lead to the discovery of a novel pathway by which blue eyes develop in mammals. From a broader perspective, the results underscore the power of consumer data-driven discovery in non-human species, especially dogs, where there is intense owner interest in the personal genomic information of their pets, a high level of engagement with web-based surveys, and an underlying genetic architecture ideal for mapping studies.

Aaron J. Sams adds: "Using genetic data from the pets of our customers, combined with eye colors reported by customers for those same animals, we have discovered a genetic duplication that is strongly associated with blue eye color. This study demonstrates the power of the approach that Embark is taking towards improving canine health. In a single year, we collected enough data to conduct the largest canine study of its kind. Embark is currently pursuing similar research projects in a range of morphological and health-related traits and we hope to continue to use our platform to move canine genetics and health forward in a very real way."

What

People with prediabetes or new-onset type 2 diabetes who had gastric banding, a type of bariatric surgery for weight loss, had similar stabilization of their disease to those who took metformin alone, according to a study supported by the National Institutes of Health. These findings were published on October 3 in Diabetes Care (link is external), coinciding with a presentation during the European Association for the Study of Diabetes Annual Meeting in Berlin.

The Beta Cell Restoration through Fat Mitigation study, or BetaFat, enrolled 88 participants with mild to moderate obesity and either prediabetes or new-onset type 2 diabetes. Half of the participants were randomly assigned to receive a gastric banding procedure, involving placement of a band around the upper part of the stomach to slow digestion. The other participants received the drug metformin, the most common first-line medication for people with prediabetes and early type 2 diabetes. The BetaFat study was conducted at the University of Southern California, Los Angeles, in collaboration with Kaiser Permanente Southern California (NCT01763346).

After two years, people in the gastric banding group lost significantly more weight, an average of 23 pounds, compared to four pounds in the metformin group. The two treatment groups ended up with similar improvements in insulin sensitivity and relatively stable function of insulin-producing cells, with small improvements in blood glucose levels.

These results are part of the Restoring Insulin Secretion (RISE) study, a set of three clinical trials designed to find ways to reverse or slow the loss of insulin production and release in people at risk for type 2 diabetes or recently diagnosed with the disease so that they can stay healthier longer. While BetaFat compared results from surgical weight loss to medication, the two other RISE trials examine the effects of a variety of medications in youth and adults.

A first in human study of patients with both inflammatory bowel disease (IBD) and HIV found that administering a drug for IBD disrupts congregating T cells infected with HIV in the gut - which form a persistent reservoir of infection. The compound, called vedolizumab (VDZ), could someday help research efforts to develop a cure for HIV. Although modern antiviral medications can keep HIV at bay, there is still no treatment that eliminates the virus from the body. One key roadblock is the virus's ability to infect T cells that reside in the mucosal tissues of the gastrointestinal (GI) tract. Reducing or eliminating this viral reservoir is a major goal for HIV researchers, but additional investigation is needed to develop a safe and effective therapy. Here, Mathieu Uzzan et al. focused on T cells harboring a4ß7, a protein that mediates the migration of immune cells into certain portions of the GI tract. They administered VDZ - currently a frontline treatment for IBD that targets a4ß7 - to a group of six IBD patients who were also HIV positive and monitored them for 30 weeks through blood tests and colonoscopies carried out before and after treatment. VDZ thwarted formation of the T cell clusters in subjects' small intestines, and proved safe over the study's duration. These results support the idea that anti-a4ß7 therapy could be an important tool in the ongoing quest to eradicate HIV, the authors say.

Genetics isn't as important as once thought for the evolution of altruistic social behavior in some organisms, a new insight into a decade-long debate.

This is the first empirical evidence that suggests social behavior in eusocial species--organisms that are highly organized, with divisions of infertile workers--is only mildly attributed to how related these organisms are to each other.

In evolutionary biology, fitness refers to an organism's reproductive success and propagation of its genes. When researchers at Hokkaido University studied the foraging and nesting behaviors of the eusocial species Lasioglossum baleicum, commonly known as the sweat bee, they found that the fitness was more a result of the bees' cooperative behaviour than it was a result of their genetic similarity.

This evidence is contrary to earlier theories that attributed altruistic selfless behavior in eusocial species to genetic relatedness and a want to ensure the propagation of their genes. In some insect species, genetic similarity is higher between sisters than between a sister and its own offspring, and this has been considered the key driver to the formation of a eusociety.

Evolutionary biologist Eisuke Hasegawa and his colleagues studied five aggregations of sweat bee nests in various areas on the island of Hokkaido in Japan. In each aggregation, there were two types of nests: those in which multiple females worked together to take care of the offspring of a single queen, and those in which a mother bee took care of her offspring on her own.

Queen bees lay several eggs at a time. They hatch as predominantly infertile females, who grow to become workers. The team marked all the adult bees in the nests so they could identify them, then studied how often and for how long each adult female left the nest to forage over a 12-hour period.

They found that the females working in the cooperative nests foraged more often than the females from the solitary nests. In addition, solitary nests were devoid of adult females much more often than social nests, leaving the nests more vulnerable to predators.

Ants are the main predator of sweat bees. A female sweat bee protects the offspring in her nest from scout ants, which can recruit many other ants to attack, by plugging the nest opening with her head. This is why solitary adult females can only leave their nests for short periods of time. Cooperative nests, on the other hand, are more efficiently defended.

Individual females in social nests are known to have higher fitness than solitary females, meaning that social bees are more successful in propagating their genes. The team has found that 92% of the increase in fitness can be attributed to the benefit of grouping -- efficient foraging and defense -- while the rest is due to the genetic similarity between the individuals

The findings indicate that, contrary to previous theories, the main contributing aspect of fitness in a social nest comes from the benefit of grouping. "There has been a decade-long debate among scientists as to whether genetic similarity or the benefit of grouping is the primary drive of sociality. Our study could help reveal some of the factors behind the evolution of cooperation, including among humans, by quantifying how much cooperative behavior contributes to the increased fitness of altruistic individuals in a group," says Hasegawa.

Following surgery, some patients experience a broken bone around the implants of a total hip replacement--called a periprosthetic femoral fracture. In a study of such patients published in the Journal of Bone and Mineral Research, investigators found that 8.3% of patients had atypical femoral fractures, which are a rare type of femoral stress fracture. The researchers also found a strong association between use of bisphosphonates and risk of atypical femoral fractures.

Previous studies have linked bisphosphonates use to atypical femoral fractures in patients with osteoporosis. However, these are very rare events, which are overwhelmed by the fracture prevention effect of bisphosphonates.

"Fractures around orthopedic implants are becoming increasingly more frequent. Our work shines light on the necessity for clinicians to better identify this subgroup of patients with atypical fractures around a femoral implant as they may benefit from different therapies," said senior author Dr. Etienne Belzile, of CHU de Québec - Université Laval, in Canada.

New research from the University of British Columbia suggests that reducing mutated Huntington disease protein in the brain can restore cognitive and psychiatric impairments in mice.

Huntington disease (HD) is a genetic, progressive disorder that causes mental decline, psychiatric problems and uncontrolled movements. The disease is caused by mutant huntingtin (HTT) protein, with symptoms appearing in adulthood and worsening over time.

Scientists delivered gene therapy treatment to mice in the form of pieces of DNA, called antisense oligonucleotides, that decreased production of the toxic HTT protein. With this intervention, the researchers found mice regained cognitive performance and became less anxious and depressed.

"Being able to restore cognitive function and improve anxiety in an ill mouse is very exciting," said study lead author Amber Southwell, assistant professor at Burnett School of Biomedical Sciences, who conducted the research as a postdoctoral research fellow at the UBC Centre for Molecular Medicine and Therapeutics.

"Most Huntington disease studies have focused on motor performance, so we wanted to assess mood, learning and memory that represent significant burdens."

There is no cure for Huntington disease, but researchers are working towards preventative treatment, so people who have the HTT gene never develop the disease. Scientists hope people may one day be able to access ongoing treatment, much like those who suffer from asthma.

Michael Hayden, study senior author, University Killam Professor, senior scientist and founder of the UBC Centre for Molecular Medicine and Therapeutics, said the symptom that is most apparent in HD patients is the uncontrolled dance like movements, but the psychiatric symptoms and cognitive decline are particularly debilitating.

"This study reinforces the potential of huntingtin lowering not only on the movement disorder but also on psychiatric and cognitive features, assuming adequate lowering of huntingtin in the appropriate regions is achieved," said Hayden.

Approximately one in 7,000 people in Canada has HD and every child of a person with the disease has a 50 per cent chance of inheriting the gene that causes the illness.

In most industry funded trials reported in high impact medical journals, all aspects of the trial involved the industry funder, finds a study published by The BMJ today.

The results show that, although both funder and academic authors were involved in the design, conduct, and reporting of most trials, few industry funded trials were completely independently conducted by academics, and sometimes industry involvement was downplayed or omitted.

They also show that while most academics view collaboration with industry as beneficial, some report loss of academic freedom.

Collaboration between industry and academics is common in the development of vaccines, drugs, and devices, as it can be mutually beneficial, but the degree of independence and the roles of academics and industry vary across trials.

There is also some evidence that industry funders may influence how trials are designed and reported, sometimes serving financial rather than public interest.

To better understand the nature of these collaborations, researchers set out to determine the role of academic authors, funders, and contract research organisations (CROs) in industry funded trials of vaccines, drugs, and devices and to determine lead academic authors' experiences with industry funder collaborations.

The researchers analysed the most recent 200 trials of vaccines, drugs, and devices with full industry funding, at least one academic author, published in one of the top seven high impact general medical journals.

Trials from all over the world were included. Most trials were published in the New England Journal of Medicine (NEJM) and the Lancet and 83% were drug trials.

In most trials, both funder and academic authors were involved in the design, conduct, and reporting. Nevertheless, the role of academic authors, funders, and CROs varied greatly.

For example, 183 (92%) trials reported funder involvement in design and 167 (84%) academic author involvement. Trial reporting involved the funder in 173 (87%) trials and academic authors in 197 (99%), while contract research organisations were involved in the reporting of 123 (62%) trials.

In contrast, the results show that data analysis was most often done by funder or CRO employees, without academic involvement. For example, data analysis involved the funder in 146 (73%) trials and the academic authors in 79 (40%).

Only 8 (4%) trials were classified as independent trials (that is, all aspects of the industry funded trial were carried out by academic authors without involvement of the funder or a CRO).

The researchers then surveyed the lead academic author of each trial. Questions covered design, analysis, and reporting of the trial, data access, trial agreements, and experience with the collaboration.

Eighty (40%) responded, of whom 29 (33%) reported that academics had final say on the design. Ten described involvement of an unnamed funder and/or CRO employee in the data analysis and/or reporting.

Most of the authors reported access to data, but the researchers say that reported access to data does not always mean access to the entire trial dataset.

Most authors found the collaboration with industry funder beneficial, but 3 (4%) experienced delay in publication due to the industry funder and 9 (11%) reported disagreements with the industry funder, mostly concerning trial design and reporting, although disagreements were generally described as minor.

This is an observational study, so no firm conclusions can be drawn about cause and effect, but the findings should prompt more accurate reporting of contributorship "to give patients greater confidence in trial results and conclusions," say the researchers.

Trials from high impact journals have important effect on clinical decisions, yet only a few of the included trials had independent analysis, they note. "However, academics can demand control over design, data storage, and full data ownership, analysis, and reporting, thereby improving independence and greater reliability of trial results," they conclude.

"Independent trials are the way forward," add the researchers in a linked opinion article. "Our clinical recommendations depend on clinical trials being reliable and conducted in the patients' best interests, without commercial considerations ... the academic community should refuse collaboration where industry demands control over trial design, conduct, data, statistical analysis, or reporting."

People with diabetes from deprived backgrounds in England are twice as likely to end up in hospital with a major cardiovascular event such as a heart attack or stroke as those from more affluent communities, according to new research being presented at this year's European Association for the Study of Diabetes (EASD) Annual Meeting in Berlin, Germany (1-5 October).

The nationwide study found that despite improvements in cardiovascular disease outcomes in the general population over the past decade, socioeconomic inequalities have persisted in hospital admissions for major cardiovascular causes across England among people with diabetes.

Differences in health outcomes amongst different socioeconomic groups have been shown in many areas and have provided the focus for national initiatives in the UK to reduce inequalities.

Recent studies have shown that cardiovascular disease and mortality from heart disease in the general population has been steadily declining over the past few decades because of risk factor reductions in the population and improvements in medical treatments. However, little is known about how people with diabetes from different socioeconomic groups have benefited from this reduction in cardiovascular disease.

To explore this further, researchers from Imperial College, London, UK identified all patients with diabetes aged 45 years or older admitted to hospital in England for major cardiovascular events and procedures between 2004-2005 and 2014-2015, and calculated diabetes-specific admission rates for each year according to deprivation quintile. Socioeconomic position was classified using the Index of Multiple Deprivation that uses seven dimensions of deprivation including income, employment, education, health, housing, crime and living environments.

Over the decade, admission rates rose steadily with increasing levels of deprivation. People with diabetes from the most deprived quintile were around twice as likely to be admitted to hospital with a heart attack, stroke, percutaneous coronary intervention, or coronary artery bypass graft compared to the most affluent groups.

The results did however show that while absolute differences in admission rates between the least and the most deprived groups didn't change significantly for heart attack over the study period, they fell for stroke (by 17.5 per 100,000 people with diabetes), percutaneous coronary intervention (11.8 per 100,000 people with diabetes), and coronary artery bypass graft (15 per 100,000 people with diabetes).

Additionally, the findings indicated no difference in in-hospital outcomes--trends in inpatient mortality did not vary widely between the least and the most deprived groups over the study period, and inpatient mortality rates fell for all outcomes except percutaneous coronary intervention.

"Our findings indicate profound socioeconomic differences in outcomes, with cardiovascular disease among people with diabetes concentrated in those from socioeconomically disadvantaged backgrounds. These findings highlight the need for strengthened efforts to prevent and reduce cardiovascular risk in populations living in more deprived areas", says Dr Eszter Vamos from Imperial College, London, who led the research.

"Our findings underscore the importance of improved risk stratification strategies considering socio-economically defined needs, and wide-reaching population-based policy interventions to reduce inequalities in diabetes outcomes."

Published today in the Journal of the American Geriatrics Society (JAGS), two new research articles and a corresponding commentary from preeminent geriatrics leaders describe ways to make person-centered care--a novel approach to health that puts personal values and preferences at the forefront of decision-making--more actionable for older people. With our national health system at a tipping point favoring care focused on personal priorities, these new studies are among the first to celebrate "thoughtful, systematic, and incremental" approaches to ending care long fragmented and fraught with the potential for poor communication between patients, caregivers, and health professionals.

"Making person-centered care a reality for older adults with complex care needs will take time and effort, including significant research to move promising approaches from the lab bench to the clinic," said William B. Applegate, MD, MPH, AGSF, Editor-in-Chief of JAGS and lead author on the editorial addressing the two new studies (DOI: 10.1111/jgs.15536). "This work is helping test innovative strategies, which will move us toward a broader and more balanced approach to care while also providing an impetus to reengineer our care systems."

Though critically important to the quality of care, eliciting and documenting personal values remains uncommon in routine older adult care, particularly for people with multiple health concerns that complicate pinpointing broader health priorities. In "Development of a Clinically Feasible Process for Identifying Patient Health Priorities" (DOI: 10.1111/jgs.15437) a research team led by Aanand Naik, MD, describes Patient Priorities Care, a novel process to identify health goals and care preferences for older people with multiple health conditions. For a patient population accustomed to lengthy visits with multiple providers, the process introduced by Dr. Naik and his colleagues used expertly trained facilitators to help older adults and caregivers work through health priorities sensitively, but in a process that could be completed across just two sessions totaling 45 minutes or less. According to the research team: "Results of this study demonstrate that healthcare professionals can be trained to perform the patient priorities identification process as part of their clinical encounters...[through a process that is] rewarding and enjoyable but requires training and formal feedback."

Separately, a team led by Caroline Blaum, MD, MS, put the processes described by Dr. Naik and his colleagues into practice, reporting their findings in "Feasibility of Implementing Patient Priorities Care for Patients with Multiple Chronic Conditions" (DOI: 10.1111/jgs.15465). Their feasibility study involved using Patient Priorities Care among more than 100 patients working with nine primary care providers and five cardiologists based in Connecticut. While researchers still hope for improvements in the time needed to complete the process and in avenues for embedding it within practice workflows, they noted that the vast majority of patients returned to their physician with clear goals and care preferences. Follow-up discussions between patients and providers suggest that moving from disease-based to priorities-aligned decisions is "challenging but feasible," which represents an important and now researched shift for the whole of our health system.

This work represents several of the latest steps forward for high-quality, person-centered care for older people, and also builds on an even lengthier legacy at JAGS and the AGS. In 2016, for example, JAGS published findings from an expert panel convened by the AGS with support from The SCAN Foundation to define person-centered care and its essential elements (DOI: 10.1111/jgs.13866). According to the panel, person-centered care "means that individuals' values and preferences are elicited and, once expressed, guide all aspects of their care, supporting their realistic health and life goals. Person-centered care is achieved through a dynamic relationship among individuals, others who are important to them, and all relevant providers. This collaboration informs decision-making to the extent that the individual desires." Many of these attributes are already on display in the work of Dr. Naik, Dr. Blaum, and their colleagues, pointing to the high value but also the high priority placed on accelerating person-centered care in geriatrics and beyond.

In a Pigment Cell & Melanoma Research article, world-leading experts identify emerging frontiers in skin cancer and pigment diseases.

Melanoma is a deadly type of skin cancer that arises from pigment-forming cells. The article challenges the field by addressing provoking questions in melanoma immunotherapy, cancer systems biology, medical and surgical oncology, pigment biophysics, and precision prevention of skin diseases such as melanoma.

"Diversity and individuality, but also health disparities, are fundamental topics rooted in the research, which focuses on melanocytes, the pigment-producing cells of the skin," said lead author Dr. Fabian Filipp, of the University of California, Merced.

In a joint effort, the pigment cell research community tackles timely aspects of big data science across international boundaries, health care reforms, bioethical considerations of direct-to-consumer diagnostics, health disparities among underserved minorities, and precision medicine based on individuality.

"A key realization is that successes in the translational arena of melanoma need to be duplicated in other key areas of pigment cell research, including vitiligo, melasma, albinism, and other pigmentary diseases," Dr. Filipp explained. He noted that collaborative, cross-disciplinary team science is exemplified by the International Federation of Pigment Cell Societies. This forum promotes global scientific interchange among basic and clinical investigators working on cutting-edge aspects of melanocyte biology and disease, and is unified around a passion for understanding pigmentation and pigmentary diseases.

One of the weirdest objects in the Milky Way just got weirder. Scientists have discovered a new source of the highest-energy photons in the cosmos: a strange system known as a microquasar, located in our neck of the galaxy a neighborly 15,000 light years from Earth. The discovery could shed light on some of the biggest, baddest phenomena in the known universe.

Their findings appear in the Oct. 4, 2018, issue of Nature. Among the coauthors are Petra Huentemeyer, a professor of physics; Henrike Fleischhack, a postdoctoral research associate; and PhD candidates Chad Brisbois and Binita Hona, all of Michigan Technological University.

The gamma rays beaming from this microquasar, known as SS 433, are among the brawniest photons ever observed--about 25 trillion times more energetic than visible light--and were detected at the High-Altitude Water Cherenkov Gamma-Ray (HAWC) Observatory, in Mexico. Such photons are born only in the most extreme environments, including quasars, the massive black holes at the centers of galaxies billions of light years away. But if you wanted to find a gamma-ray birthplace closer to home, microquasars might be one of the first places you'd look.

Microquasars behave like quasars, but in miniature. Quasars suck up dust and gas, while astronomers believe that SS 433 contains a black hole that sucks up stuff from a nearby companion star. They both blast out powerful jets of material in opposite directions. SS 433's jets extend over 130 light years into space. To put that into perspective, our entire solar system is not quite two light years across.

Scientists have been studying SS 433 since the 1980s and have already detected electromagnetic radiation in the form of X-rays and radio waves coming from the ends of its jets. But they had not found any high-energy gamma rays until now and HAWC's technology made it possible.

"The HAWC Observatory is the most sensitive instrument for photons at these very high energies, and it did not begin collecting data until 2015," Huentemeyer says, the HAWC science coordinator.

The new evidence strongly suggests that the powerful gamma rays were produced at the ends of the jets and not another source nearby.

"SS 433 is located in the same region of the sky as other bright sources that also emit gamma rays," Hao Zhou says, galactic science coordinator of HAWC and a lead author on the Nature paper. "With its wide field of view, HAWC is uniquely capable of separating the gamma-ray emission due to SS 433 from other background photons." Zhou is a former doctoral student of Huentemeyer and a 2015 Michigan Tech PhD graduate now at Los Alamos National Laboratory.

In addition, the data show that the high-energy gamma rays were generated by electrons colliding with background microwave radiation left over from the Big Bang. That means that electrons in the SS 433 jets attain energies that are about 1,000 times higher than those achieved by the most powerful earthbound particle accelerators, such as the city-sized Large Hadron Collider, in Switzerland. This is a new mechanism for generating high-energy gamma rays in this type of system and is different than what scientists have previously observed.

The finding is also somewhat mysterious. "These electrons are some of the highest-energy particles in our galaxy, and it's hard to explain how something that small got so much energy," Huentemeyer says. "However, the electromagnetic radiation emitted by SS 433 over a broad energy range is consistent with a single population of electrons."

Scientists hope that studying messengers from this microquasar may offer a glimpse into the secrets of their larger cousins. Quasars are millions of times bigger than the sun and the brightest known objects in the universe. Most have been found billions of light years away, and because it takes light time to travel, studying them is like going back in a time machine; we see the object as it was billions of years ago.

Because they are so far away, most of the quasars detected by telescopes have their jets aimed at Earth, so observing them is like looking directly into a flashlight. In contrast, SS 433's jets are oriented sideways, pointing away from Earth, which makes them easier to study.

"The new findings improve our understanding of particle acceleration in the jets of microquasars," Zhou says. "They may also shed light on the physics underlying the much larger and more powerful extragalactic jets in quasars."

The genomes of 25 UK species* have been read for the first time by scientists at the Wellcome Sanger Institute and their collaborators**. The 25 completed genome sequences, announced today (4 October) on the Sanger Institute's 25th anniversary, will lead to future studies to understand the biodiversity of the UK and aid the conservation and understanding of our species.

The newly-sequenced genomes will enable research into why some brown trout migrate to the open ocean, whilst others don't, or investigations into the magneto receptors in robins' eyes that allow them to 'see' the magnetic fields of the Earth. The genomes could also help to shed light on why red squirrels are vulnerable to the squirrel pox virus, yet grey squirrels can carry and spread the virus without becoming ill.

The Sanger Institute was founded in 1993 by Professor Sir John Sulston as part of the Human Genome Project. The Institute made the largest single contribution*** to the gold- standard sequence of the first human genome, which was published in 2003.

A genome is an organism's complete set of genetic instructions written in DNA. Each genome contains all of the information needed to build that organism and allow it to grow and develop.

Since the landmark completion of the human genome, the Sanger Institute has become a globally recognised leader in the field of genomics. Many more important reference genomes have already been sequenced - from the mouse and zebrafish genomes to the pig, gorilla, mosquito and many others. Beyond animal species, infectious diseases and bacteria also feature prominently on the list of reference genomes, from salmonella and MRSA to chlamydia and malaria. All of these have offered up important insights about these species in health and disease.

Now, the Sanger Institute and its partners have comprehensively sequenced 25 UK species for the first time. The first human genome took 13 years and billions of dollars to complete. With the great advances in technology and falling costs of sequencing, scientists have been able to newly sequence 25 species' genomes in less than one year and at a fraction of the cost.

Dr Julia Wilson, associate director of the Sanger Institute, said: "We are thrilled to announce the completion of 25 genomes from UK species. Sequencing these species for the first time didn't come without challenges, but our scientists and staff repeatedly came up with innovative solutions to overcome them. We have learned much through this project already and this new knowledge is flowing into many areas of our large scale science. Now that the genomes have been read, the pieces of each species puzzle need to be put back together during genome assembly before they are made available."

Dan Mead, co-ordinator of Sanger's 25 Genomes Project, said: "We are already discovering the surprising secrets these species hold in their genomes. We've found that King scallops are more genetically diverse than we are, and the Roesel's bush cricket's genome is four times the size of the human genome. Similar to when the Human Genome Project first began, we don't know where these findings could take us."

The 25 Genomes Project has been made possible by PacBio® long-read sequencing technology, which generates high-quality genomes. The Institute partnered with PacBio and other leaders in the technology sector, 10x Genomics and Illumina, to create the most comprehensive view of these genomes.

The high-quality genomes will be made freely available to scientists to use in their research. Researchers could discover how UK species are responding to environmental pressures, and what secrets they hold in their genetics that enables them to flourish, or flounder.

Dr Tim Littlewood, Head of Life Sciences at the Natural History Museum, London and a partner of the 25 Genomes Project, said: "The 25 Genomes Project has uncovered the blueprints of a diversity UK life, which will effectively re-write what we know about these species. By comparing those blueprints within and between species we can understand the genetic diversity of fauna and flora from the UK and beyond. These newly-sequenced genomes are a starting point that will reveal aspects of evolution we've not even dreamt of."

This project is a small contribution to a much larger undertaking, where scientists from around the world are coming together to form a plan to sequence all life on Earth.

Professor Sir Mike Stratton, director of the Sanger Institute, said: "DNA sequencing technology has advanced over the last number of years to a point at which we can at least discuss the possibility of sequencing the genomes of all of life on Earth. From those DNA sequences we will obtain inestimable insights into how evolution has worked, and to how life has worked."

By analysing survey data from 1999-2001 and 2010-2012, researchers have estimated the demand for commercial sex among British men.

The Scottish Journal of Political Economy study found that men traveling abroad, men living in London, drug users, religious men, and men with middle-class income are more often together with prostitutes than other men.

The most notable finding from a policy point of view was that learning about sex in school had a significant and sizeable negative effect on the expected number of times with a prostitute. The authors noted that requiring sex education in all schools could therefore help in reducing prostitution in Britain.