Culture

Older adults are more likely to stick with a group exercise program if they can do it with people their own age, a new University of British Columbia study has found.

Working out with peers of the same gender doesn't seem to make a difference - it's the age that counts.

"This study points to the importance of age-targeting, but perhaps not gender-targeting, when developing these programs," says UBC kinesiology professor Mark Beauchamp, the study's lead author.

Older adults worldwide are less active than they should be, with activity levels lowest in the Americas. In Canada, fewer than 15 per cent of people past age 59 meet international physical activity guidelines. Beauchamp and his international team of researchers have been looking for ways to keep people active into old age, because inactivity has been shown to increase risk of cardiovascular disease, obesity and arthritis. It can also lead to physical limitations that affect overall quality of life.

The researchers knew from earlier studies that older adults prefer to exercise within their own age group. They wanted to find out whether preferences expressed by older adults in surveys would actually lead to greater adherence in practice.

The study recruited 627 adults, averaging 72 years in age, for 12-week exercise classes at YMCA locations in Metro Vancouver. Participants had the option to extend participation for another 12 weeks afterward. Researchers divided participants into three workout groups. One group was consistent in age and gender, while another was consistent in age but not gender. Those groups were led by older adult instructors recruited and trained for the study. The third group worked out in a typical YMCA class that was open to all ages and genders, led by a YMCA instructor.

Over the 24-week period, participants who worked out with people their own age attended an average of 9.5 more classes than counterparts in the mixed-age group. Participants in the mixed-age group averaged 24.3 classes. Participants in the same-age, mixed-gender group averaged 33.8 classes, and participants in the same-age, same-gender group averaged 30.7 classes.

The researchers' prediction that same-gender classes would lead to even greater adherence wasn't borne out by the results. This is significant, as it could free facilitators from the cost of providing separate classes for each gender unnecessarily.

Age and gender groupings weren't the only strategies researchers used to try to strengthen participants' commitment. Participants also received custom T-shirts that identified them as members of a group, and were given opportunities to socialize over coffee following class.

"All of this together points to the power of social connections," Beauchamp said. "If you set the environment up so participants feel a sense of connection or belonging with these other people, then they're more likely to stick with it."

Such strategies would be easy to employ in a variety of physical activity settings such as community centres, fitness clubs and retirement communities, the researchers noted.

In this case, study participants didn't want the classes to end. Rather than continue their workouts in regular classes, they successfully lobbied the YMCA to continue age-specific sessions after the experiment was over.

The study appears in the May issue of Health Psychology and was funded by a grant from the Canadian Institutes of Health Research.

New research from the University of Adelaide has found that taking vitamin B6 could help people to recall their dreams.

The study published online ahead of print in Perceptual and Motor Skills, included 100 participants from around Australia taking high-dose vitamin B6 supplements before going to bed for five consecutive days.

"Our results show that taking vitamin B6 improved people's ability to recall dreams compared to a placebo," says research author Dr Denholm Aspy, from the University's School of Psychology.

"Vitamin B6 did not affect the vividness, bizarreness or colour of their dreams, and did not affect other aspects of their sleep patterns.

"This is the first time that such a study into the effects of vitamin B6 and other B vitamins on dreams has been carried out on a large and diverse group of people," Dr Aspy says.

The randomised, double-blind, placebo-controlled study saw participants taking 240mg of vitamin B6 immediately before bed.

Prior to taking the supplements, many of the participants rarely remembered their dreams, but they reported improvements by the end of the study.

"It seems as time went on my dreams were clearer and clearer and easier to remember. I also did not lose fragments as the day went on," said one of the participants after completing the study.

According to another participant of the study, "My dreams were more real, I couldn't wait to go to bed and dream!"

Dr Aspy says: "The average person spends around six years of their lives dreaming. If we are able to become lucid and control our dreams, we can then use our dreaming time more productively.

"Lucid dreaming, where you know that you are dreaming while the dream is still happening, has many potential benefits. For example, it may be possible to use lucid dreaming for overcoming nightmares, treating phobias, creative problem solving, refining motor skills and even helping with rehabilitation from physical trauma.

"In order to have lucid dreams it is very important to first be able to recall dreams on a regular basis. This study suggests that vitamin B6 may be one way to help people have lucid dreams."

Vitamin B6 occurs naturally in various foods, including whole grain cereals, legumes, fruits (such as banana and avocado), vegetables (such as spinach and potato), milk, cheese, eggs, red meat, liver, and fish.

"Further research is needed to investigate whether the effects of vitamin B6 vary according to how much is obtained from the diet. If vitamin B6 is only effective for people with low dietary intake, its effects on dreaming may diminish with prolonged supplementation," says Dr Aspy.

ABERDEEN PROVING GROUND, MD. (April 23, 2018) -- Army scientists recently found that the best, high-performing cybersecurity teams have relatively few interactions with their team-members and team captain. While this result may seem counterintuitive, it is actually consistent with major theoretical perspectives on professional team development.

"Successful cyber teams don't need to discuss every detail when defending a network; they already know what to do," said Dr. Norbou E. Buchler, team leader with the U.S. Army Research Laboratory's Cyber and Networked Systems Branch

In a recent study, "Sociometrics and observational assessment of teaming and leadership in a cyber security defense competition" published in the latest issue of the Journal of Computers & Security scientists from the ARL, the National Cyberwatch Center and Carnegie Mellon University examined how collegiate cyber defense teams coordinate to mount and conduct an effective cyber defense during head-to-head team competition at the Mid-Atlantic Collegiate Cyber Defense Competition.

These teams were scored on four performance metrics while they attempted to defend their network against a cyber-attack campaign designed to disrupt critical U.S. infrastructure: maintaining networked services, responding to scenario events, assigned tasks by a role-playing chief executive officer and submitting incident reports to authorities.

Army researchers made use of Sociometric Badges (Humanyze Inc.), a sensing and recording device that students wore on a lanyard hanging from their neck. These badges collected data on a number of dimensions; the most valuable being face-to-face interactions between team members (via infrared sensors). In addition, Army researchers developed a questionnaire to measure the leadership style, task distribution, team meetings, communication and collaboration based on the opinions of the observers assigned to each team.

Teams with effective leadership and functional specialization within the team were more successful. Face-to-face interactions, as measured by the sociometric badges, emerged as a strong negative predictor of success in the competition, explained Buchler, a cognitive scientists within ARL's Human Research and Engineering Directorate.

"In other words, the teams whose members interacted less during the exercise, were usually more successful," Buchler said.

He said the results demonstrate that human collaboration and leadership of cybersecurity teams are essential when responding during a realistic cyber-attack.

"These results are important because current training programs commonly emphasize cyber security knowledge and do not provide training on effective team management," he said.

"The research also demonstrated the value of measures derived from recent advancements in wearables technology by capturing face-to-face interactions. Increasingly, such social sensing platforms are being leveraged by Army researchers, industry and academia to enhance human measurement and validate and refine theories regarding the factors influencing human performance and teamwork over time," Buchler said.

"High-performing teams exhibit fewer team interactions because they function as purposive social systems, defined as people who are readily identifiable to each other by role and position and who work interdependently to accomplish one or more collective objectives," continued Buchler, who referenced Tuckman's model in this understanding. "The responsibility for performing the various tasks and sub-tasks necessary to accomplish the team's goal is divided and parceled-out among the team."

The research team is part of the Army Research Laboratory's Cybersecurity Collaborative Research Alliance seeking to advance a foundational science of cybersecurity that addresses the human dynamics of attacker, defender, and user interactions to support training effectiveness and improve the operational efficiency and effectiveness of cyber operations.

Yelp reviews of nursing homes tend to focus more on staff attitudes, staff responsiveness and the physical facility itself than government reviews, a new USC study finds.

"Yelp reviewers are looking at different aspects of care than the government reviews," said Anna Rahman, a corresponding author and assistant research professor at the USC Leonard Davis School of Gerontology. "People want to know: How homey is it? How nice is it inside?"

Rahman and a team of six other researchers evaluated 264 Yelp reviews of California facilities and grouped them into five categories: the quality of staff care and staffing, physical building and setting, resident safety and security, clinical care quality and financial issues.

Just over 53 percent of the Yelp reviewers posted comments about staff attitude and caring. About 29 percent posted comments about staff responsiveness. Twenty-five percent discussed matters with cleanliness. Nearly 14 percent rated issues with meals.

The study was published on Friday in the journal The Gerontologist.

A difference in tone and ratings

Last November, Rahman and a team of researchers published a study in BMJ Quality and Safety that showed nursing home Yelp reviews tended to be more negative than those on the federal ratings website, Nursing Home Compare (NHC). Both sites use a five-star rating system, with one star the lowest rating and five stars as the best.

There are pros and cons to each rating system. Recent news reports and studies suggest some nursing homes game the government system, receiving multiple stars regardless of citations or staffing levels. Yelp, on the other hand, is sometimes criticized for fake reviews and ratings.

"It is hard to tell if the NHC system has been gamed," Rahman said. "You don't feel qualified to judge. But everybody knows how to weed through the Yelp ratings."

Valeria Cardenas, a study co-author and an incoming doctoral candidate at the USC Leonard Davis School, said that consumers are probably looking to determine how their loved ones will be treated.

"I would be worried if there was a review that said that the staff isn't responsive or they didn't take care of my father when he had rung the bell," said Cardenas.

For the study, the USC Davis School research team used data collected in 2014 by the California Office of Statewide Health Planning and Development. The researchers drew a geographically dispersed sample of 51 skilled nursing facilities, small and large, that had been rated on both the federal site and Yelp. Small facilities had, on average, around 58 beds while large ones had about 116 beds.

The team's research confirms prior studies showing that Yelp reviewers tend to focus on subjective experiences of health care, such as a reviewer's personal assessment of staff attitudes, the physical setting or the cost of care.

The USC gerontologists noted that such aspects of nursing homes are not rated on the federal government's Nursing Home Compare site. Instead, the federal site focuses on matters such as staffing levels, clinical issues such as infections, and the use of restraints for some patients.

What matters clinically? Their health

"Yelp is not focused on the clinical aspects of care, such as how often are staff turning residents with pressure sores, and did patients get their pneumonia shot or the flu shot," Rahman said. "We found that what is most important clinically to Yelp reviewers is whether their loved one got better."

Nearly 15 percent of the Yelp reviews mentioned whether their loved ones worsened or improved while at a particular nursing home.

Study co-author and USC incoming doctoral candidate Yujun Zhu said the study emphasizes the importance of turning to multiple sources to make a well-informed decision for nursing home care.

"I would start with Yelp and then I would visit Centers for Medicare and Medicaid Services. On the government site, I would look through the inspection reports," Zhu said. "I would focus on things like abuse and other health care deficiencies that are important to residents and caregivers."

"Strikingly, we found no consumer guides on choosing a nursing home that pointed decision-makers to online reviews," Rahman said. "These guides may be overlooking the value of these increasingly popular information sources."

WASHINGTON, DC (April 26, 2018) -- Researchers at the George Washington University (GW) are at the forefront of analyzing how climate lawsuits shape the nation's response to climate change. A new analysis investigates the role of health concerns in climate litigation since 1990 and finds that although health is cited in a minority of cases, it may have critical potential for protecting communities from the effects of climate change and coal fired power plants.

"Many experts believe that climate change is the biggest threat to public health in the 21st century, and the courts have been and will continue to be a central avenue for the development of climate-related policy in the United States," says lead author Sabrina McCormick, PhD, an Associate Professor of Environmental and Occupational Health at Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University.

McCormick and her colleagues in the Milken Institute School of Public Health's Department of Epidemiology and Biostatistics, George Washington University Law School, and the university's Trachtenberg School of Public Policy and Public Administration looked at 873 judicial decisions related to climate change and coal-fired power plants between 1990 and 2016. They found that a minority of cases (16 percent) associated with those decisions referenced health issues. Health was most likely to be invoked in cases related to air pollution. Past research has linked air pollution to a wide range of health problems, including asthma, McCormick notes.

The GW researchers pointed to lawsuit types that might be supported with evidence regarding health, such as renewable energy and energy efficiency included health issues. An example, they say, is the ability of health claims to help litigants gain standing to bring a case to court. In their article, they recommend the explicit statement of health benefits from reductions in impacts associated with climate change. They argue that climate change may follow examples such as tobacco and other health protections in which the courts played a central role in protecting public health.

"The courts represent a pivotal branch of government in climate policy formation," McCormick and her co-authors say. "Increasing inclusion of health concerns in emergent areas of litigation could catalyze effective climate policy-making."

McCormick has been studying the impacts of climate change on human health for over a decade. Her experience includes serving as the lead author on the Special Assessment of the Nobel Prize-winning Intergovernmental Panel on Climate Change.

"The Role of Health in Climate Litigation" will appear online April 26 in The American Journal of Public Health.

NEW YORK (April 26, 2018)--Researchers at Columbia University's Mailman School of Public Health and the Columbia Aging Center found men with a stronger grip were more likely to be married than men with weaker grips. Grip strength was not a factor in the marital status of women. The findings are published online in the journal SSM-Population Health.

Grip strength is an established measure of health and has previously been linked to one's ability to cope independently and predicts the risk of cardiovascular diseases and mortality.

"Our results hint that women may be favoring partners who signal strength and vigor when they marry," said Vegard Skirbekk, PhD, professor, Columbia Aging Center and Mailman School professor of Population and Family Health. "If longer-lived women marry healthier men, then both may avoid or defer the role of caregiver, while less healthy men remain unmarried and must look elsewhere for assistance."

Using a population-based study of 5,009 adults from the Norwegian city of Tromsø, the researchers examined the relationship of marital status to grip strength in two successive groups of people: those born 1923-35 and 1936-48, assessing the association between respondents' marital status and grip strength when respondents were aged 59 to 71. These data were matched with the Norwegian national death registry. Handgrip strength was assessed using a vigorimeter, a device that asks participants to squeeze a rubber balloon.

Grip strength is particularly important for older adults, and has implications for a host of health risks--for heart disease and factures, physical mobility, the capacity to be socially active and healthy, and to enjoy a good quality of life. At the same time, marriage confers many of these same benefits.

The researchers found greater numbers of unmarried men with low grip strength in the second cohort--those born 1936-48--than in the first cohort, reflecting societal trends that have increasingly deemphasized the importance of marriage. "In recent decades, women are less dependent on men economically. At the same time, men have a growing 'health dependence' on women," says Skirbekk. "The fact that many men are alone with a weak grip--a double burden for these men who lack both strength and a lack of support that comes from being married--suggests that more attention needs to be given to this group, particularly given their relatively poor health."

Policies to help this population might include housing arrangements that encourage social interaction and counselling to better prepare these individuals for old age and information on how to avoid negative health consequences of independent living. "New technologies may potentially offset some of the limitations that low grip strength may imply," says Skirbekk. "Social policies could also increasingly target this group by providing financial support for those who suffer the double-burden of low strength and lack of spousal support."

Skin cancer cases attributable to work-related sun exposure could be costing millions of dollars, and must be better addressed by policymakers.

A new study, published today in the Journal of Occupational and Environmental Hygiene, has estimated the total and per-case costs of newly diagnosed non-melanoma skin cancers (NMSCs) in Canada in 2011 caused by workplace sun exposure.

Using a range of secondary sources, including official government records and health surveys, researchers revealed the true economic burden of NMSCs, which cost $34.6 million in 2011 Canadian dollars.

These costs were made up of a range of lifetime costs, including healthcare treatment, the impact of time away from work, out-of-pocket expenses, and poor life quality.

Further analyses highlighted the sizeable cost per patient for the two most common types of non-melanoma skin cancer: basal-cell and squamous-cell carcinoma. The figure stood at $5,760 per case for basal-, and $10,555 per case for squamous-cell carcinoma.

One of the few cancers that are increasing in incidence, skin cancers are the most common form of cancer in Canada and other countries with large fair-skinned populations.
Roughly one in ten Canadian workers are exposed to solar ultraviolet (UV) radiation at work, and the majority of these spend six hours or more outdoors each day.

With solar UV radiation the main cause of skin cancer, the researchers hope that their landmark findings can persuade policymakers to give greater attention to reducing workplace sun exposure - both within and outside of Canada. The occupations deemed most at risk - construction, farming, and landscaping - are not exclusive to Canada.

As the study's principal investigator, Dr. Emile Tompa, a senior scientist at Canada's Institute for Work & Health, commented: "The findings suggest that policy-makers might give greater priority to reducing sun exposure at work by allocating occupational cancer prevention resources accordingly."

"The results can also raise awareness among policymakers, employers, unions and workers about the significant contribution of workplace sun exposure to skin cancers. These groups can now make a strong cost-benefit argument for inexpensive exposure reduction interventions, such as shade structures, hats and loose clothing, sunscreen, and shift scheduling to reduce the amount of time workers spend in the sun."

The study, which was funded by the Canadian Cancer Society, is the first to comprehensively estimate the economic burden of workplace NMSCs caused by sun exposure in Canada. It is hoped that the approach can be adapted to carry out similar economic burden estimates in other countries.

The research group of Alex Schier, Director of the Biozentrum, University of Basel, has investigated more closely how a single embryonic cell develops into a heart, nerve or blood cell. For the first time, the researchers have been able to reconstruct the developmental trajectories of individual embryonic cells. Their results also suggest that cells can change their path during their maturation process. The results of the study with around 40,000 cells have now been published in Science.

The origin of every cell of our body is a single cell, the fertilized egg. On the way to become a specialized cell, whether blood, heart or nerve cells, its descendants follow a genetic program. This program determines the identity of a cell, its features and function.

The research team led by Alex Schier, Director of the Biozentrum, University of Basel, and currently still research group leader at Harvard University in Cambridge, has now developed a new method that enables the scientists for the first time to trace the entire history of the differentiation of individual cells. By combining the differentiation trajectories they have been able to construct a full developmental tree for embryogenesis. Furthermore, the team discovered that during differentiation, cells can leave their path and thus change their identity.

A widely branched tree for cell development

In their study, the team isolated around 40,000 cells and 25 different cell types that form in zebrafish over a period of nine hours. To investigate the maturation of these cells, they analyzed the RNA, a copy of the genetic material. "The RNA tells us, which genes are active and determines the function and characteristics of a cell", says Schier.

In order to merge and compare the data, Schier's team developed a new software (URD). While previous studies in this field are based on the examination of a handful of genes, the new high-throughput single-cell RNA sequencing method enables the analysis of all active genes during cell development. With this new technology, the team has been able to reconstruct, for the first time, a widely branched tree that traces the development of each individual cell, starting with the fertilized egg cell. In addition, they mapped the cells to their spatial origin in the early embryo.

Finding cell identity is more flexible than expected

The results show that the genetic program that a cell follows on the way to maturity is by no means set in stone. "It seems that the developmental path of a cell is more flexible than we previously expected", says Alex Schier. So far, it was assumed that developing cells follow a predetermined path, like marbles rolling down a hill until they stop at their predestined place. The study now suggests that signals from the environment can have such a strong influence on the cells, that they leave the initial trajectory and change their path, thus taking on a new identity.

Entire development as a cell lineage tree

In a next step, the research group will expand the cell lineage tree, investigate more cell types and follow the development of cells over a longer period of time. "My aim is to merge the developmental trajectories and the lineage trees to one complete whole. If we can understand the logic behind cell differentiation, we may, one day, be able to answer the question: How many ways are there to build a heart or a brain?"

Wines and beers labelled as lower in alcohol strength may increase the total amount of alcoholic drink consumed, according to a study published in the journal Health Psychology. The study was carried out by the Behaviour and Health Research Unit at the University of Cambridge in collaboration with the Centre for Addictive Behaviours Research at London South Bank University.

Alcohol is the fifth leading cause of disease and premature death both in the UK and globally. Reducing consumption of alcohol is a public health priority in many countries. In the UK, as part of a range of steps to reduce overall alcohol consumption, policymakers are currently interested in allowing industry to label a wider range of alcohol products as lower in alcohol.

Proposed legislative changes include extending the variety of terms that could be used to denote lower alcohol content, and extending the strength limit to include products lower than the current average on the market (12.9% ABV for wine and 4.2% ABV for beer*).

"For lower strength alcohol products to reduce consumption, consumers will need to select them in place of equal volumes of higher strength products," says Dr Milica Vasiljevic from the University of Cambridge. "But what if the lower strength products enable people to feel they can consume more?"

In this study, two-hundred and sixty-four weekly wine and beer drinkers - sampled from a representative panel of the general population of England - were randomised to one of three groups to taste test drinks in a laboratory designed to mimic a bar environment. The drinks varied only in the label displayed. In one group participants taste-tested drinks labelled 'Super Low' and '4%ABV' for wine or '1%ABV' for beer. In another group the drinks were labelled 'Low' and '8%ABV' for wine or '3%ABV' for beer. In the final group participants taste-tested drinks labelled with no verbal descriptors of strength, but displaying the average strength on the market - wine ('12.9%ABV') or beer ('4.2%ABV').

The results showed the total amount of drink consumed increased as the label on the drink denoted successively lower alcohol strength. The mean consumption of drinks labelled 'Super Low' was 214ml, compared with 177ml for regular (unlabelled) drinks. Individual differences in drinking patterns and socio-demographic indicators did not affect these results.

"Labelling lower strength alcohol may sound like a good idea if it encourages people to switch drinks, but our study suggests it may paradoxically encourage people to drink more," says Professor Theresa Marteau, senior author and Director of the Behaviour and Health Research Unit.

While this study shows that people may drink more if drinks are labelled as lower in strength, the researchers do not yet know if this effect is sufficient to result in the consumption of more units of alcohol overall from lower strength alcohol drinks. Furthermore, participants in this study were tested in a bar-laboratory setting. To learn more about the impact of lower strength alcohol labelling, research in real-world settings is needed.

The study was funded by the Department of Health.

A study led by Massachusetts General Hospital (MGH) investigators may lead to a significant expansion in the number of stroke patients who can safely be treated with intravenous tPA (tissue plasminogen activator), the "clot busting" drug that has greatly reduced stroke-related disability and deaths in eligible patients. The report, published online in Annals of Neurology, describes the results of a trial using MR-based imaging technologies to identify patients likely to be within 4.5 hours of stroke onset, even though their initial symptoms had not been witnessed.

"In up to 25 percent of stroke patients, the start of their symptoms is unwitnessed, preventing them from receiving tPA," says Lee Schwamm, MD, executive vice chair of the MGH Department of Neurology and director of the MGH Comprehensive Stroke Center, co-lead and corresponding author of the paper. "For many of these patients, the first time anything is noticed is when they get up from sleeping. Our study showed - for the first time - that tPA could be given safely to patients with stroke of unwitnessed onset if their imaging suggested the stroke was very early in its progression and they met other treatment criteria. These results pave the way for a large randomized trial of tPA in patients with unwitnessed strokes."

First approved by the FDA in 1996, tPA - also called alteplase - is used to treat ischemic strokes, which are caused when a blood clot blocks circulation within the brain. The safe use of tPA requires determining that the stroke was not caused by the rupture of a blood vessel, in which case tPA would make matters worse, and that too much time has not gone by between the onset of symptoms and tPA administration, since restoration of blood flow to tissue that has incurred too much damage may cause additional harm.

The original time limit for tPA administration was 3 hours from symptom onset, and the results of a subsequent clinical trial expanded that window to 4.5 hours in 2009. But for patients whose initial symptoms were not witnessed and who were more than 4.5 hours since they were last known to be well, tPA is not approved for use; and this restriction can affect the care of 25 to 30 percent of ischemic stroke patients arriving at hospital emergency departments. A few small studies have reported good outcomes when such patients, specifically those with so-called wake-up strokes, were administered tPA on the basis of MRI studies consistent with the early effects of ischemic stroke.

In the current study, 80 patients with imaging-confirmed ischemic stroke of unwitnessed onset, who were less than 24 hours since they were last known to be well, were enrolled at 14 centers across the U.S. Study eligibility was determined by a mismatch between two types of MR imaging studies - FLAIR, which typically only shows stroke effects on brain tissue after several hours of reduced blood flow, and diffusion-weighted imaging (DWI), a technique first applied to stroke patients at the MGH-based Athinoula A. Martinos Center for Biomedical Imaging that is extremely sensitive to changes beginning in the first minutes or hours after stroke onset.

Study co-lead author Ona Wu, PhD, of the Martinos Center explains, "Brain tissue that is abnormal on DWI but not yet abnormal on FLAIR has been seen in patients that were 4 hours or less after known symptom onset. That discrepancy provides a snapshot of tissue evolution as the stroke progresses in the first few hours, and that is the pattern we used to select patients for treatment, since they were likely to be similar to patients with known symptom onset who have benefited from tPA. Essentially we used an MR Witness - the name of the trial - to identify patients who might be treated with tPA because their strokes had not progressed to the point of irreversible injury."

The outcomes for study participants - all of whom received tPA on the basis of the strategy that the research team calls qDFM, for quantitative DWI FLAIR Mismatch - were similar to those previously reported for patients receiving tPA within 4.5 hours of witnessed strokes. The authors note that more than 70 percent of study participants had experienced wake-up strokes, and that the onset of symptoms may have led to the patients' awakening. On the basis of these results, the researchers hope to conduct a follow-up, placebo-controlled trial that will also compare MR with CT imaging for the identification of patients with unwitnessed strokes who could safely and effectively be treated with tPA.

"If that phase 3 study is successful, it would lead to a paradigm shift in the way acute stroke patients are treated," says Schwamm, who is a professor of Neurology at Harvard Medical School. "Rather than treating based on the number of hours since a stroke began, we can treat based on how much damage the stroke has already caused and how much brain can still be saved. Because the imaging methods we will use in our phase 3 study are available on any MRI or CT scanner in use today, if the results of that trial are positive, the approach could be put into practice immediately."

Long-term use of some anticholinergic medications are associated with an increased risk of dementia - according to a new study led by the University of East Anglia (UK).

Anticholinergic antidepressants have been found to be linked with dementia, even when taken up to 20 years before a diagnosis. Examples of frequently-prescribed anticholinergic antidepressants include Amitriptyline, Dosulepin and Paroxetine.

The research, funded by Alzheimer's Society and published today in the BMJ, also shows a dementia risk associated with medications prescribed for bladder conditions (for example Tolterodine, Oxybutynin and Solifenacin), and Parkinson's (for example Procyclidine).

However several other anticholinergic medications, including anti-histamines and those used for abdominal cramps, were not found to be linked to dementia - despite previous research suggesting that any anticholinergic might represent a risk.

Anticholinergic drugs are used to treat a variety of conditions and work by blocking a key messenger (neurotransmitter) in the body called acetylcholine.

The research team studied the medical records of 40,770 patients aged over 65 diagnosed with dementia, and compared them to the records of 283,933 people without dementia. More than 27 million prescriptions were analysed.

This is the largest and most detailed study of its kind into the long-term impact of anticholinergic use in relation to dementia.

The team drilled down to see whether there were links between different classes of anticholinergic medication and incidence of dementia diagnosis.

They found that there was a greater incidence of dementia among patients prescribed greater quantities of anticholinergic antidepressants, and anticholinergic medication for bladder conditions and Parkinson's.

The link between these medications and dementia cannot tell us that they are directly causing the condition, but this work does suggests a potential preventative approach to reduce dementia which is a priority.

The study concludes that clinicians should consider long-term anti-cholinergic effects when prescribing.

Patients with concerns should continue taking their medicines until they have consulted their doctor or pharmacist.

Lead researcher Dr George Savva from UEA's School of Health Sciences said: "More than 50 million people worldwide are affected by dementia and this number is estimated to be 132 million by 2050. Developing strategies to prevent dementia is therefore a global priority.

"We studied patients with a new dementia diagnosis and looked at what anticholinergic medication they were prescribed between four and 20 years prior to being diagnosed.

"We found that people who had been diagnosed with dementia were up to 30 per cent more likely to have been prescribed specific classes of anticholinergic medications. And the association with dementia increases with greater exposure to these types of medication.

"What we don't know for sure is whether the medication is the cause. It could be that these medications are being prescribed for very early symptoms indicating the onset of dementia.

"But because our research shows that the link goes back up to 15 or 20 years before someone is eventually diagnosed with dementia, it suggests that reverse causation, or confounding with early dementia symptoms, probably isn't the case.

"This research is really important because there are an estimated 350 million people affected globally by depression, and bladder conditions requiring treatment are estimated to affect over 13 per cent of men and 30 per cent of women in the UK and US.

"Many of the treatment options for these conditions involve medication with anticholinergic effects.

Dr Doug Brown, Chief Policy and Research Officer at Alzheimer's Society, said: "This large study confirms that some anticholinergic drugs can raise the risk of dementia - but it should also put minds at ease as there appears to be no dementia risk with anticholinergic drugs used to treat common conditions like hayfever, travel sickness and stomach cramps.

"Current guidelines for doctors say that anticholinergic drugs should be avoided for frail older people because of their impact on memory and thinking, but doctors should consider these new findings for all over-65s as long-term use could raise the risk of dementia."

Dr Noll Campbell, a collaborator and co-author on the paper, said: "These results suggest we should prioritise safer alternatives to anticholinergic medications long before symptoms of dementia are recognised." Dr Campbell is an investigator with the Regenstrief Institute and Indiana University Center for Aging Research and is an assistant professor with Purdue University College of Pharmacy in the United States.

The study used data from Clinical Practice Research Datalink which includes anonymised diagnosis, referral and prescription records for more than 11 million patients from 674 primary care practices across the UK. The data is broadly representative of the UK population in terms of age, sex and ethnicity.

Prof Chris Fox, Professor of Clinical Psychiatry at UEA's Norwich Medical School and Consultant Psychiatrist, said: "While the associations are moderate, given the high incidence of dementia, they reflect a potentially important risk to patients.

"Doctors and patients should therefore be vigilant about using anticholinergic medications.

"They need to consider the risk of long-term cognitive effects, as well as short-term effects, associated with specific drugs when weighing up risks and benefits.

"We don't know exactly how anticholinergics might cause dementia. Further research is needed to understand possible reasons for this link. In the meantime, I strongly advise patients with any concerns to continue taking their medicines until they have consulted their doctor or pharmacist."

Dr Ian Maidment, Senior Lecturer in Clinical Pharmacy at Aston University and lead pharmacist on the study, said: "We already have strong evidence that anticholinergics cause confusion and in the short-term will potentially worsen the symptoms of dementia. Long-term data is more difficult to obtain, because clinical trials tend be short term.

"This study shows that some anticholinergics may cause long-term harm in addition to short-term harm.

"Other recent research has shown a dramatic increase in polypharmacy - the number of older people taking five or more medicines has quadrupled over 20 years to nearly half of all older people.

"With many different medicines having at least some anticholinergic activity, one focus should be de-prescribing. Doctors, nurses and pharmacists need to work with older people and their carers to ensure that they only take medication if the benefits clearly outweigh the harms."

SAN DIEGO - The Society for Cardiovascular Angiography and Interventions (SCAI) has released new guidelines to address the selection of specific categories of devices when endovascular therapy (EVT) is indicated. The purpose of this document, which is the first of its kind, is to provide a review of comparative effectiveness data, including safety and efficacy of femoral-popliteal (FP) devices, and to provide clinicians with guidance and recommendations for device selection when these devices are intended as the definitive or adjunctive therapy. The document is available in early-view online in SCAI's official journal, Catheterization and Cardiovascular Interventions.

There is widespread uncertainty about device selection for EVT due to clinicians having many options and opinions with limited data to distinguish between them. The SCAI writing group reviewed and considered data on safety, efficacy, and cost-effectiveness when making device-specific recommendations. Data sources included randomized clinical trials, meta-analyses, nonrandomized trials, observational studies, case series and registry data.

"SCAI has a long history of prioritizing quality initiatives in the field of endovascular therapy for peripheral artery disease. Device choices for endovascular therapy, particularly in the femoral-popliteal interventions, remain challenging due to a wide spectrum of available device options and a paucity of comparative effectiveness data," said Dmitriy Feldman, MD, FSCAI, chair of the writing group. "Current guidelines do not address the selection of specific devices when endovascular therapy is indicated. This is the first SCAI-led device-focused consensus guidelines document, which provides a focused review of comparative effectiveness and safety data for femoral-popliteal devices," Dr. Feldman continued.

The document, which makes recommendations for both definitive and adjunctive therapy scenarios, identified several areas for future research, including trials on value and cost-effectiveness of devices in specific clinical circumstances and lesion subsets. In addition, the guidelines recommend that future studies adopt the Peripheral Academic Research Consortium (PARC) definitions for clinically meaningful outcomes and endpoints. The recommendations in this consensus guidelines document are a first step to provide clinicians with relevant anatomical scenarios to guide device selection based on strength and quality of evidence for comparative effectiveness, durability, and expert opinion.

Advances in genetic testing offer new insights to parents who have a child with a rare but serious form of epilepsy, epileptic encephalopathy (EE), found in one of about every 2,000 births and characterized by developmental disabilities as well as horrible seizures.

New ways of sequencing the human genome mean geneticists and genetic counselors have much more to say to parents who wonder if future children might carry the disease, says Dr. Heather Mefford, associate professor of pediatrics (genetic medicine) at University of Washington School of Medicine and Deputy Scientific Director of the Brotman Baty Institute for Precision Medicine, co-senior author of findings published this week in the New England Journal of Medicine.

These advances offer insights for all of us because they are part of the growing study of mosaicism - the fact that many of us do not in fact have just one genome in us. We are what scientists call mosaics - bunches of cells that may have different genotypes buried deep within us.

"A mosaic mutation happens some time after fertilization when cells are dividing, which requires copying all of the DNA. If one of those cells makes a copying error, that introduces a mutation. All the cells that come from that cell will carry the same mutation. So you end up with a mosaic pattern where some cells have the mutation and some cells don't. That's the mosaic," Mefford said.

The fact that, say, 10 percent of your cells scattered throughout your body might be different than other cells may be completely unimportant. But if 10 percent of your sperm or oocytes have the mutation, that could be a big problem if that mutation affects the brain development of the child.

A big question from any parent of a child with EE is, What are the odds that our other children might have this condition? For decades, parents whose child had epilepsy were told there's a 1 to 5 percent chance that other children might inherit the mutation. This was based on clinical evidence - the numbers of reoccurrences physicians saw in the clinic.

But armed with more precise testing, the geneticists found parental mosaicism that wasn't easily detected before in about 10 percent of families, putting these families at higher risk of passing the mutation to another child. What this means in practical terms is that this small group probably accounts for most of the reoccurrences. For some parents, there's good news: if this parental mosaicism was not detected, your odds of having another such child with epilepsy could be much less than 1 percent.

"We have the technology to pick out mosaic cells in a sea of otherwise normal cells. The percentage of families where we can identify mosaicism in the parent is higher than most of us thought it would be. While the overall recurrence risk (across all families) is about 1 percent, for those families where we can find the mosaic mutation in the parents, it's not a 1 percent risk. It's much higher than that. And we now have the tools to help give them that information, and help them with better family planning and decision-making down the road," Mefford said.

"Our study focused on patients with severe epilepsy. But the finding that 10 percent of the parents have mosaicism may actually apply to a broad range of other disorders, including autism and intellectual disability," Mefford added.

Use of certain anticholinergic drugs - that help to control involuntary muscle movements for conditions such as Parkinson's disease - is associated with an increased risk of dementia, finds a UK study published by The BMJ today.

The study is the largest of its kind to date and the findings prompt the researchers to say that clinicians should avoid long term prescribing of some anticholinergics to patients aged 45 and over.

Anticholinergic drugs block chemical signals to the brain that control muscle movements. They are often used for conditions linked to involuntary muscle movements, such as urinary incontinence and Parkinson's disease, as well as for depression, chronic lung disease (COPD) and asthma.

Several studies have reported associations between use of anticholinergics and future cognitive decline and dementia, but it is not clear whether this is due to the drugs themselves or the underlying conditions for which they were prescribed.

So a research team led by George Savva at the University of East Anglia, set out to estimate the association between duration and level of exposure to different classes of anticholinergic drugs and subsequent dementia.

They analysed data from the UK's Clinical Practice Research Database for 40,770 patients aged 65 to 99 years who were diagnosed with dementia between April 2006 and July 2015. Each case patient was matched to up to seven control patients of similar age and sex, but without dementia.

Drugs were scored according to their anticholinergic activity using the Anticholinergic Cognitive Burden (ACB) scale. An ACB score of 1 was classed as possibly anticholinergic, while a score of 2 or 3 was definitely anticholinergic.

Daily doses of each drug were then compared for both cases and controls over an exposure period of 4 to 20 years before a diagnosis of dementia.

A total of 14,453 (35%) cases and 86,403 (30%) controls were prescribed at least one anticholinergic drug with an ACB score of 3 during this period.

After taking account of potentially influential factors, the researchers found that definite anticholinergic antidepressants, antiparkinson drugs, and drugs to treat urinary incontinence (ABC score of 3) were linked to increased dementia risk up to 20 years after exposure.

However, no increased risk was found for drugs with possible anticholinergic activity (ACB score of 1) - and for anticholinergic gastrointestinal or respiratory drugs (ACB score of 3).

Other antidepressants (mainly selective serotonin reuptake inhibitors) with an ACB score of 1 were linked to dementia, but only close to the time of prescription, which the researchers say is unlikely to represent a direct (causal) link.

This is an observational study, so no firm conclusions can be drawn about cause and effect, and the authors outline some limitations, such as possible misclassification of dementia cases and a lack of information on depression severity. Nevertheless, the study was large and was able to account for several potentially influential factors.

They suggest that the association "could be caused by a class specific effect, or by drugs being used for very early symptoms of dementia" and they call for further research into the effects of specific drug classes.

In the meantime, they say clinicians "should continue to be vigilant with respect to the use of anticholinergic drugs, and should consider the risk of long term cognitive effects, as well as short term effects, associated with specific drug classes when performing their risk-benefit analysis."

In a linked editorial, Professor Shelly Gray at the University of Washington and Professor Joseph Hanlon at the University of Pittsburgh, say this research "raises important issues about the best way to summarise anticholinergic burden for future research."

In the meantime, they agree that anticholinergics in general should be avoided in older adults. "Specifically, for most highly anticholinergic drugs, non-pharmacological and pharmacological alternatives are available and should be considered," they conclude.

A University of Cincinnati geology student is helping NASA determine whether life existed on other planets.

Doctoral candidate Andrew Gangidine is working with UC geology professor Andrew Czaja to develop a marker for ancient bacterial life on Mars. The research could help scientists put to rest one of our most fundamental mysteries.

"We're trying to answer the question: How rare is life in the universe?" Gangidine said.

Czaja, an assistant professor in UC's McMicken College of Arts and Sciences, serves on a NASA advisory committee that will decide where on Mars to send the next remote-controlled rover. Among other objectives, the rover will look for evidence that life once existed on the red planet. The advisory committee has narrowed the list of landing-site candidates to three and will recommend a finalist later this year.

Meanwhile, Gangidine is studying microbial life in silica hot springs to come up with a useful indicator of life on Mars. For the past two years, he has conducted fieldwork in the geyser basins of Wyoming's Yellowstone National Park to examine what elements are associated with bacteria that live in these geothermal pools.

"We want to remain objective. Some people think there has to be life on Mars," Gangidine said. "Others think there certainly isn't life on Mars. And either side has a good chance of being correct. Both have valid arguments. Which is why if we go there and don't see anything, it won't be 'mission fail.'"

Gangidine presented his research April 25 at the Second International Mars Sample Return conference in Berlin, Germany.

Today, we know that life cannot exist on Mars, at least not on its dry surface. Solar radiation split most of its surface water into its elemental parts nearly 3 billion years ago when the red planet lost its protective magnetic field.

But scientists are debating whether life might exist somewhere deep underground, among pockets of water trapped around geothermal areas similar to Yellowstone's geysers.

Finding evidence of life on Mars is surprisingly complicated.

If Mars ever sustained life, it's possible that it was wiped out when most of its atmosphere vanished in the solar wind, Czaja said.

So NASA scientists must be prepared to look for fossil evidence of bacterial life dating back that far. Gangidine said the good news is that similar fossils of early bacterial life more than 3.5 billion years ago have been found on Earth. This makes him optimistic that if similar life ever existed on Mars, NASA has a chance of finding a fossil record of it.

"We can look at life being preserved in these silica deposits today. We have evidence of this happening throughout geologic time," Gangidine said. "What we're trying to do is catch fossilization as it happens. What happens to the microbes themselves? And what happens to the trace elements we think are associated with them while they're alive?"

To unearth clues about ancient life on Mars, geologists look to hot springs such as those found in America's first national park.

Gangidine and his colleagues need permits to collect samples in the park's backcountry. But exploring the geyser basins can be tricky and dangerous. A tourist died in 2017 after falling into one of the basin's boiling pools while hiking off-trail.

"These things really can strip the flesh off your bones," Gangidine said. "At the bottom of hot springs we study you see skulls of bison and other animals that were unfortunate enough to wander too close."

Gangidine's team includes an experienced backcountry field researcher, UC postdoctoral fellow Jeff Havig who is now with the University of Minnesota. They pick their way carefully across the caldera. Sometimes, they can see where a bison's hoof has broken through the thin crust to reveal steaming mud.

The geology work takes them across "quaking bogs," a thin layer of peat and grass covering deep shifting mud. Gangidine was walking alongside a colleague on one such hike when he sank above his knees in the treacherous mire.

"Luckily, that place wasn't super hot. But I was walking just a foot away from someone else. The ground can really change quickly," he said. "When we go into these settings, we have to be very careful."

Boiling acid and lava-like mud aren't the only hazards for researchers in the geyser basins. They also have to be careful not to spend too long around the steam vents, which contain a mix of gases such as carbon dioxide, hydrogen sulfide and methane that can asphyxiate a person under the right conditions.

The U.S. Geological Survey documented this phenomenon in 1888 in part of the park nicknamed "Death Gulch," a natural depression between two steep hills where toxic gases bubble up from Cache Creek. Harvard University geologist T.A. Jaggar Jr. returned to the area in 1899 and found six bears, an elk and various small animals that died apparently after succumbing to the toxic fumes.

But even in the fresh air, the gas rising from the ground can have a cumulative effect, Gangidine said.

"These hot springs emit a lot of gases you don't want to breathe in. They bind to the hemoglobin that carries oxygen through your body. Breathing that in, you get very fatigued," Gangidine said.

"That's why we try to schedule a day out of the field for every three days we work in the field. If you're there for four days, you can really feel like a zombie. It's really hard to think, hard to move."

As a biology undergraduate at UC, Gangidine worked with UC biology professor Dennis Grogan to examine microbial life called extremophiles that live in hostile places such as Yellowstone's acidic or alkaline hot springs. Now as a geologist, Gangidine is studying the fossils these hardy single-celled creatures leave behind.

"Hot springs make silica deposits that preserve life really well," Gangidine said. "When left exposed on a planet's surface, it doesn't crystallize and doesn't metamorphose. So these samples should be relatively well preserved if we find them."

In UC professor Czaja's geology lab, Gangidine peers through a microscope at slides he prepared from chunks of Yellowstone silica he took from a mountainous steam cone geyser.

The bacterial filaments from samples taken at the top of the geyser are full of color. But the older samples, some perhaps thousands of years old, are colorless, even if they hold their shape. So for more clues about this basic form of life, Gangidine subjects the bacterial samples to elemental analysis using a secondary ion mass spectrometer. The analysis renders the elements in vivid color: deep yellows, reds and greens representing chromium or gallium perhaps associated with the bacterial life.

If Gangidine finds a correlation between the concentrations and spatial distributions of particular elements and the bacteria, it might serve as a biosignature that scientists can use to identify past life on Mars.

"The reason we chose gallium is it's not known to be associated with life. But when we look at the fossilized bacterial samples, we find it, so there must be something going on," Gangidine said. "Do the bacteria store certain elements preferentially as opposed to what you would find elsewhere in these rocks?"

Gangidine is working with researchers in Australia, home to some of the world's oldest fossils, some dating back 3.5 billion years.

"If I want to create a biosignature, I have to prove that it persists throughout time," Gangidine said. "It exists in these relatively younger samples. But does it exist in these ancient samples, too? That will be crucial to figure out."

Gangidine also plans to build an artificial hot spring in a lab aquarium using similar elements found in geysers. By introducing a super-saturation to the water, the excess silica will precipitate much the same way it does in nature. Then he can add trace chemicals associated with life and study what happens in a miniature world absent of life.

"To prove we found a biosignature, we have to prove the signature doesn't occur without life," he said.

"Gallium is the one we were surprised by," Czaja said. "It is associated with silica near the bacteria but isn't in the bacteria."

Like Gangidine, Czaja got his start in the sciences by studying biology before pursuing a career in paleontology.

Czaja's NASA advisory committee will meet in October to decide where on Mars they would like to send the rover among the three preferred destinations. The rover is tentatively slated for launch in July or August of 2020, arriving on Mars about seven months later.

"NASA tends to like to go new places to push the frontier. Geologists like to go back to the same places over and over to ask new questions," Czaja said.

The rover will collect samples in sealed containers for shipping back to Earth in a later mission. So it could be many years before geologists such as Czaja and Gangidine know whether their hunches about where best to look for life on Mars were correct.

Helping to frame a question that you may never live to see answered is one of science's most selfless pursuits, Czaja said.

"One thing I like about these NASA missions is the long-term thinking and planning," he said. "People working on these projects now may never see the results. But they're still willing to put in the work because it's such a fascinating question."

The Mars 2020 mission will not be a failure if scientists find no evidence of life. Quite the contrary, Gangidine said.

"If we find it, we can say maybe life is not that rare among planets," Gangidine said. "But if we don't find life in places that would be the most ideal and best preserved candidates, then maybe life is pretty rare."

But if NASA does find evidence of life on Mars, that might suggest that sparking life from a primordial soup isn't so extraordinary after all. And the first question will be how life on Mars compares to life on Earth, Czaja said. Was there a common ancestor?

"Maybe we're all Martians," Czaja said.

Any claim about the existence or absence of life on Mars will be subjected to worldwide scrutiny and skepticism. Czaja said researchers must be prepared to provide a wealth of evidence to fortify their findings.

"It's not nearly enough to find something that looks like a bacterial cell," Czaja said. "There are nonbiological things that could look like that. But if you have a cascade of traits -- this and this and this added together -- it's hard to explain it any other way except for life."