Tech

CORVALLIS, Ore. - A fresh look at how to best determine dietary guidelines for vitamin E has produced a surprising new finding: Though the vitamin is fat soluble, you don't have to consume fat along with it for the body to absorb it.

"I think that's remarkable," said the study's corresponding author, Maret Traber of Oregon State University, a leading authority on vitamin E who's been researching the micronutrient for three decades. "We used to think you had to eat vitamin E and fat simultaneously. What our study shows is that you can wait 12 hours without eating anything, then eat a fat-containing meal and vitamin E gets absorbed."

The study was published today in The American Journal of Clinical Nutrition.

Vitamin E, known scientifically as alpha-tocopherol, has many biologic roles, one of which is to serve as an antioxidant, said Traber, a professor in the OSU College of Public Health and Human Sciences, and Ava Helen Pauling Professor at Oregon State's Linus Pauling Institute.

Federal dietary guidelines call for 15 milligrams of vitamin E daily (by comparison, 65-90 milligrams of vitamin C are recommended). The new research could play a role in future vitamin E guidelines.

Vitamin E in human diets is most often provided by oils, such as olive oil. Many of the highest levels are in foods not routinely considered dietary staples, such as almonds, sunflower seeds and avocados.

"There's increasingly clear evidence that vitamin E is associated with brain protection, and now we're starting to better understand some of the underlying mechanisms," Traber said.

In this latest study, Traber and collaborators used a novel technique involving deuterium-labeled vitamin E, administered both orally and intravenously, to study fractional vitamin E absorption in a group of non-obese, non-diabetic women ages 18-40 with normal blood pressure.

Fractional absorption means just what you would think - the fraction of the dose absorbed by the body rather than metabolized and excreted. Fractional absorption dictates how much of something, in this case vitamin E, a person needs to take to maintain the correct level in his or her body.

Deuterium, the vitamin E marker in this study, is an isotope of hydrogen with double the atomic mass of the regular version; deuterium has both a proton and a neutron, compared to just a proton for normal hydrogen, and is a common tracer in investigations of biochemical reactions.

Study subjects at the National Institutes of Health Clinical Center were given both oral and IV vitamin E and drank a liquid meal containing either 40% fat or no fat. Researchers then used a combination of tightly controlled dietary intakes to determine the roles fat and fasting played in vitamin E absorption.

"What this study says is, vitamin E gets taken up into the intestinal cell and sits there and waits for the next meal to come along," Traber said. "It's in a fat droplet, sitting there, waiting to be picked up, like a cargo container, and loaded onto a chylomicron truck."

Chylomicrons are lipoprotein particles that transport dietary lipids - fats - around the body through the blood plasma.

The IV portion of the study, used in conjunction with the oral dosing to calculate fractional absorption, also yielded remarkable findings, Traber said.

"We injected the vitamin E in a lipid emulsion and expected it would take some time to disappear from the plasma and them come slowly back into circulation, but it was gone within 10 minutes," Traber said. "High-density lipoproteins quickly acquired the vitamin E, and the chylomicrons quickly disappeared from circulation into the liver.

"The IV vitamin E we put into the body over three days, almost none of it came out again, like 2% of the dose," she added. "No one had ever seen that before - normally you absorb about half of what you consume. That vitamin E that's staying in the body, we don't know where it goes, and finding that out is important for studying how much vitamin E you need to eat every day."

Vitamin E is a group of eight compounds - four tocopherols and four tocotrienols, distinguished by their chemical structure. Alpha-tocopherol is what vitamin E commonly refers to and is found in supplements and the European diet; gamma-tocopherol is the type of vitamin E most commonly found in the American diet.

"Plants make eight different forms of vitamin E and you absorb them all, but the liver only puts alpha-tocopherol back into the bloodstream," Traber said. "All of the other forms are metabolized and excreted. That tells us the body is working very hard to get all the nutrients it can and will sort out what the toxins are later. That's really exciting, because it explains why the liver needs an alpha-tocopherol transfer protein but the intestine does not."

Barcelona--Combining the PD-1 immune check point inhibitor nivolumab with the monoclonal antibody ipilimumab showed a consistent safety profile in special populations with advanced non-small cell lung cancer (NSCLC), according to research presented today by at the IASLC 2019 World Conference on Lung Cancer hosted by the International Association for the Study of Lung Cancer.

The research was presented by Dr. Fabrice Barlesi from Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Marseille, France.

Ipilimumab is a monoclonal antibody that works to activate the immune system by targeting CTLA-4, a protein receptor that downregulates the immune system.

CheckMate 817 was started because data are limited on safety and efficacy of immunotherapy in patients with advanced NSCLC with other comorbidities such as brain metastases, kidney and renal disease and HIV.

Dr. Barlesi and researchers at other sites involved in CheckMate 817 tested two groups of patients who had previously untreated advanced NSCLC. Cohort A1 consisted of 198 patients with an Eastern Cooperative Oncology Group (ECOG) score of PS 2 or ECOG PS 0-1 with asymptomatic untreated brain metastases, hepatic or renal impairment, or HIV. An ECOG PS 2 score indicates the patient is ambulatory and able to take care of themselves but cannot engage in most work activities. An ECOG PS 1 score indicates the patient is ambulatory and able to conduct most activities while a patient with PS 0 has virtually no restrictions.

The other group of patients (Cohort A) totaled 391 and had an ECOG of PS 0-1. Patients with known EGFR mutations or ALK translocations sensitive to available targeted therapy were excluded from both cohorts. Each group received nivolumab flat dose plus ipilimumab weight-based low dose for two years or until the patients achieved disease progression or unacceptable toxicity.

Both groups of patients experienced similar rates of treatment-related adverse events but ORR was 25 percent in cohort A1 and 35 percent in cohort A. Progression-free survival was shorter in cohort A1 than cohort A.

"First-line flat-dose nivolumab plus weight-based ipilimumab showed a consistent safety profile in special populations with advanced NSCLC, including those with ECOG PS 2. Patients with either high TMB or higher tumor PD-L1 expression appeared to exhibit improved efficacy," Barlesi reported.

Barcelona--A clinical trial testing the toxicity of a KRAS inhibitor demonstrated early promising antitumor activity and few adverse side effects in patients with advanced non-small cell lung cancer harboring KRAS G12C mutation, according to research presented today at the IASLC 2019 World Conference on Lung Cancer, hosted by the International Association for the Study of Lung Cancer.

The KRASG12C mutation is found in approximately 14 percent of patients with lung adenocarcinoma and 11 percent of patients with non-small cell lung cancer but there are no therapies approved that target this mutation. KRAS G12C mutation has been identified as an oncogenic driver of tumorigenesis. KRAS is a guanine-nucleotide-binding protein that acts as a molecular switch inside cells and links to receptor tyrosine kinase activation to intracellular signaling.

To test this therapy, AMG 510, for safety and toxicity, Ramaswamy Govindan, M.D., from the Siteman Cancer Center at Washington University School of Medicine, St. Louis and colleagues enrolled 76 patients with locally advanced or metastatic malignancies who had received previous standard therapy. The research group's primary endpoint was toxicity and secondary research endpoints were objective response rate, duration of response, disease control rate, progression free survival and duration of stable disease.

Patients were enrolled in four dose cohorts: 180 mg, 360 mg, 720 mg and 960 mg, taken orally once a day for 21 days and followed up with radiographs and examinations. Initial data from the Phase one study were presented at the 55th Annual Meeting of the American Society of Clinical Oncology earlier this year. The additional follow-up in a larger group of patients being presented at WCLC includes a subset of 34 NSCLC patients enrolled, with 23 of the patients being evaluable for efficacy. Thirteen of the evaluable patients received the target dose of 960 mg once daily, with seven (54 percent) achieving a partial response at one or more timepoints and six (46 percent) achieving stable disease, for a disease control rate of 100 percent.

There were no dose-limiting toxicities and no adverse events leading to discontinuation in the 34 NSCLC patients enrolled. Twenty-seven of these patients remain on treatment. Of the 34 patients, only nine (26.5 percent) reported treatment-related adverse events (TRAEs) of grade one or two. Three patients reported grade three treatment-related adverse effects (anemia and diarrhea). There were no grade four or higher TRAEs.

"KRAS G12C mutant lung adenocarcinoma is one of the largest subsets of NSCLC potentially amenable to targeted therapies. I am pleased that we have a promising new oral therapy for this group of patients," Govindan said. "These data continue to show encouraging anti-tumor activity with AMG 510, underscoring the potential to close the treatment gap for non-small cell lung cancer patients with previously treated KRAS G12C-mutated NSCLC."

Barcelona--The International Association for the Study of Lung Cancer today used the platform of its largest international meeting to call attention to the importance of tobacco cessation after cancer diagnosis, and urged all physicians to screen cancer patients for tobacco use and recommend tobacco cessation.

Cancer patients who continue smoking after their diagnosis have a higher mortality rate and a higher risk for a second cancer development. The clinical effects of smoking after the diagnosis of cancer also has a substantial effect on increased cancer treatment costs, according to the Declaration.

The IASLC Tobacco Control and Smoking Cessation Committee has undertaken this initiative to raise physician involvement in tobacco control, said Dr. Jacek Jassem of the Medical University of Gdansk in Gdansk, Poland.

"For too long this has been a neglected problem in the education of health professionals. Many physicians still believe that it is too late to offer smoking cessation support at cancer diagnosis. Likewise, most patients believe that there is nothing to be gained from quitting once being diagnosed," Jassem said.

The IASLC Declaration makes several recommendations:

All cancer patients should be screened for tobacco use and advised on the benefits of tobacco cessation.

In patients who continue smoking after diagnosis of cancer, evidence-based tobacco cessation assistance should be routinely and integrally incorporated into multidisciplinary cancer care for the patients and their family members.

Educational programs regarding cancer management should include tobacco cessation training, empathetic communication around history of tobacco use and cessation and utilization of existing evidence- based tobacco cessation resources.

Smoking cessation counseling and treatment should be a reimbursable service.

Smoking status, both initially and during the study, should be a required data element for all prospective clinical studies.

Clinical trials of patients with cancer should consider designs that could also determine the most effective tobacco cessation interventions.

If you wanted to really mess with the world's food production, a good place to start would be in Morocco. They don't grow much here, but it is home to mines containing most of the world's known reserves of phosphate rock, the main source of the nutrient phosphorus. Most of us across the globe, most days, will eat some food grown on fields fertilized by phosphate rock from these mines.

Phosphorus is an essential mineral to grow food, but research suggests that this is being mined unsustainably. If reserves run low, food production will be constrained and starvation entirely possible.

Now, David Vaccari, an environmental engineer at Stevens Institute of Technology, and colleagues have developed a model to describe how phosphorus flows through the global food system. The model, reported in the Sept. 4 issue of Environmental Science & Technology, can predict how several different conservation approaches could reduce demand for a nonrenewable resource that is absolutely vital for feeding the world.

"Phosphate is spread across the planet but hardly recycled," said Vaccari, a pioneer in phosphate research who led the work. "The model allows us to answer specific 'what if' questions to see how certain changes in human behavior could significantly improve the conservation of this resource and by extension, help sustain the world's food production."

In the past, the phosphorus cycle was practically closed: crops were eaten by humans and livestock while their feces were used as natural fertilizers to grow crops again. These days, the cycle is broken. Each year phosphate rocks are mined and turned into fertilizer. This is converted into crops which are transported to cities for food. Some phosphorus is lost at every step along the way and winds up in the environment. Runoff from farms goes into waterways, food waste goes to landfills, and the human waste goes to the sewage disposal, most of which ultimately ends up in the sea. A cycle has become a linear process.

Vaccari and colleagues model this cycle, with "knobs" that can be turned up or down to create different conservation scenarios. When a knob is turned - e.g. fraction of animal meat in diet, fraction of food that is wasted, fraction of human waste recycled - the model, which factors in leaks and losses from the food system, loops back to calculate the degree to which phosphate mining could be reduced.

The model shows several interesting results:

Collective diet changes can reduce the demand for phosphate mining substantially. Since different animals have a different footprint on phosphate mining, these changes could include reducing total meat consumption or switching to meats that require less feed to produce; for example, it takes 32 pounds of feed to produce edible beef; 11 pounds to produce edible pork; and four to produce edible chicken and around one or two for milk and eggs. The fewer pounds of feed needed, the less demand for phosphate mining.

Dietary changes would reduce demand for mining phosphorus only up to a point; then, surprisingly, demand would increase. That's because eating less meat would necessarily lead to eating more crops and initially, crops could use phosphorus from non-mining resources such as natural mineral erosion in the soil. However, natural mineral erosion wouldn't be enough to sustain the increased demand for crops, so phosphate mines would again need to be tapped.

Calculations show that reducing the amount of food we waste is about 80 times more effective at conserving phosphorus than recycling that same waste.

Even if 100 percent of the phosphorus in our human waste was recycled, mining of phosphorus would only be reduced about 16 percent; recycling 100 percent of food waste would reduce mining by 5 percent. Recycling has such a low effect on conservation because recycled phosphorus is subject to much of the same losses in the food system as is fertilizer. Thus, although recycling is still part of the solution, it is much better to reduce the amount of waste we produce in the first place.

If the world had to depend entirely upon phosphorus other than from mining, it would only be able to support about one-third of the current world population, using current levels of usage and recycling efficiency.

However, if we substantially increased our efficiency, it would be possible to support about twice the current world population.

The world, however, is not about to run out of phosphorus. At current usage rates, known phosphorus reserves could sustain agricultural production for several centuries, according to Vaccari. But unlike nitrogen, which makes up 78 percent of the atmosphere (and a main ingredient in fertilizer), phosphate is a finite resource - and "new sources of phosphorus will be hard to come by," said Vaccari.

Reducing phosphate mining has other advantages. When phosphorus "leaks" from the agricultural, food production and waste disposal systems, it contributes to severe water pollution problems such as harmful algal blooms in lakes and in the coastal zone. Aside from the long known public health issues and economic impact of algal blooms in fishing communities, a deadly variety of algae has recently caused several dog deaths in the Southern United States.

"Phosphorus is essential for life," said Vaccari. "So the plan is to keep it around for a long time by mining phosphate sustainably and responsibly - and this model helps us look at optimal ways on how to do that."

Tropical Storm Akoni had a quick life as a tropical storm before transitioning into a post-tropical storm. NASA captured a visible image of as it was becoming a tropical storm and an infrared image after it transitioned.

Akoni developed as Tropical Depression 12E on Sept. 4 in the far eastern Pacific Ocean. On Sept. 5 it strengthened into a tropical storm at 7 p.m. EDT. That's when it became Akoni. By 5 a.m. EDT on Sept. 6, Akoni had transitioned into a post-tropical storm.

The Moderate Resolution Imaging Spectroradiometer or MODIS instrument aboard NASA's Aqua satellite provided a visible image of Akoni as it was strengthening into a tropical storm. The image was taken at 4:30 p.m. EDT (2230 UTC) on Sept. 5, 2019 and it revealed a rounded storm.

An infrared image from MODIS was taken later on Sept. 6 at 6:45 a.m. EDT (1045 UTC) once Akoni had become Post-Tropical. That infrared MODIS image showed just a small area of strong storms located just southeast of center where cloud top temperatures were near minus 70 degrees Fahrenheit ( minus 56.6 degrees Celsius).

A Post-Tropical Storm is a generic term for a former tropical cyclone that no longer possesses sufficient tropical characteristics to be considered a tropical cyclone. Former tropical cyclones can become fully extratropical, subtropical, or remnant lows, and all three are classes of post-tropical cyclones. In any case, they no longer possesses sufficient tropical characteristics to be considered a tropical cyclone. However, post-tropical cyclones can continue carrying heavy rains and high winds.

NOAA's National Hurricane Center (NHC) said, "Although showers and thunderstorms continue to pulse near Akoni's elongated low-level circulation center (LLCC), they have not been sufficiently persistent or organized to continue to classify the system as a tropical cyclone, and Akoni is being downgraded to a post-tropical remnant low."

At 5 a.m. EDT (0900 UTC), NHC reported in their final advisory on the system that "the center of Post-Tropical Cyclone Akoni was located near latitude 11.2 degrees north and longitude 149.7 degrees west. That's about 690 miles (1,105 km) south-southeast of Hilo, Hawaii. Maximum sustained winds are near 35 mph (55 kph) with higher gusts. Little change in strength is forecast during the next couple of days. The estimated minimum central pressure is 1007 millibars."

The post-tropical cyclone is moving toward the west near 16 mph (26 kph), and this motion is expected to continue the next couple of days, with some increase in forward speed over the weekend.

The Global Precipitation Measurement mission or GPM core satellite passed over the Eastern Atlantic Ocean and observed that Tropical Storm Gabrielle had become post-tropical. GPM also gathered data on rainfall rates occurring in transformed and elongated storm.

NOAA's National Hurricane Center (NHC) said at 5 a.m. EDT on Sept. 6 that Gabrielle has become a post-tropical cyclone over the eastern Atlantic, because "Poorly defined Gabrielle has not produced any organized deep convection (strong thunderstorms) since Thursday morning." However, regeneration into a tropical storm is expected to occur over the weekend.

A Post-Tropical Storm is a generic term for a former tropical cyclone that no longer possesses sufficient tropical characteristics to be considered a tropical cyclone. Former tropical cyclones that have become fully extratropical, subtropical, or remnant lows, are three classes of post-tropical cyclones. In any case, they no longer possesses sufficient tropical characteristics to be considered a tropical cyclone. However, post-tropical cyclones can continue carrying heavy rains and high winds.

The GPM satellite passed over Gabrielle on Sept. 6 at 3:30 a.m. EDT (0730 UTC). GPM found the heaviest rainfall in nearly 200 miles north of the elongated center, where it was falling at a rate of over 36 mm (about 1.4 inch) per hour. Areas of rainfall of about 25 mm (1 inch per hour) surrounded those stronger storms. GPM is a joint mission between NASA and the Japan Aerospace Exploration Agency, JAXA.

At 5 a.m. EDT (0900 UTC), NHC reported the center of Post-Tropical Cyclone Gabrielle was located near latitude 25.5 degrees north and longitude 37.6 degrees west. That is about 1,095 miles (1,760 km) northwest of the Cabo Verde Islands. The post-tropical cyclone is moving toward the northwest near 12 mph (19 kph).  A turn to the west-northwest with a slight increase in forward speed is expected over the next couple of days.  A decrease in forward speed and a turn to the north are forecast to occur by Sunday morning. Maximum sustained winds are near 40 mph (65 kph) with higher gusts.

Gabrielle is expected to weaken into a post-tropical remnant low by tonight. Thereafter, slow strengthening is expected to occur over the weekend, and the remnants of Gabrielle is forecast to regenerate into a tropical cyclone at that time.

As Hurricane Dorian continued to lash the coast of the Carolinas NASA's IMERG assessed the rainfall the storm generated and NASA's Aqua satellite provided a look at the temperatures of the cloud tops to assess strength.

NASA's IMERG Analyzes Rainfall

By Friday morning, September 6, Hurricane Dorian was located off the coast of North Carolina, having generated tornadoes the previous day as the northern rainband came ashore in North Carolina. NASA's satellite-based real time precipitation estimates suggest that, during the past day, most of the areas experiencing over 10 inches of rain accumulation remained offshore, while Dorian did drop heavy rain on South Carolina and North Carolina.

IMERG showed largest rainfall amounts of more than 36 inches over the Bahamas and in an area off the coast of northeastern Florida. A large area of rainfall between 16 and 24 inches fell off the coast from South Carolina to the Bahamas and in a small area far off the North Carolina coast.

The National Weather Service in Charleston, South Carolina noted that 3.06" fell yesterday, Sept. 5. In Wilmington, North Carolina, a rainfall record was set when Dorian dropped 8.58 inches. New Bern, North Carolina also set a rainfall record, when Dorian dropped 2.95 inches there.

The near-realtime rain estimates come from the NASA's IMERG algorithm, which combines observations from a fleet of satellites, in near-realtime, to provide global estimates of precipitation every 30 minutes.  The storm-total rainfall at a particular location varies with the forward speed of the hurricane, with the size of the hurricane's wind field, and with how vigorous the updrafts are inside the hurricane. This graphic only shows precipitation that fell starting at 0000 UTC on September 1, and therefore does not show the precipitation that fell in late August, prior to Hurricane Dorian's approach to the Bahamas.

More Rainfall Forecast from NHC

Using data from the GPM and other satellites, forecasters can estimate rainfall that Dorian will generate along its path.

The NHC said Dorian is expected to produce the following rainfall totals through Saturday: In northeastern North Carolina and additional 3 to 8 inches is forecast with isolated storm totals to 15 inches. Far southeast Virginia can expect 3 to 8 inches, extreme southeastern New England...2 to 4 inches, Nova Scotia and Prince Edward Island...3 to 5 inches and Newfoundland...1 to 2 inches.

Tornado Possibilities

NHC said a few tornadoes were possible during the morning of Sept. 6 across eastern North Carolina into southeastern Virginia.

As Hurricane Dorian interacted with the U.S. East Coast, the only tornado reports occurred from 4:50 a.m. to 5 p.m. EDT on September 5 in North and South Carolina.  Scientists think of a hurricane as a heat engine that converts the warmth of the sun-warmed ocean into the kinetic energy of the hurricane's strong, horizontal wind. When these strong winds reach land, the increased friction of the land surface vs. the ocean surface can convert some of this kinetic energy into tornadoes within the hurricane.

For information about Dorian's winds, dangerous surf and storm surge, visit http://www.nhc.noaa.gov.

NASA's Aqua Satellite Double View

Two instruments aboard NASA's Aqua satellite used infrared light to analyze the strength of storms Dorian. Infrared data provides temperature information, and the strongest thunderstorms that reach high into the atmosphere have the coldest cloud top temperatures.

On Sept. 6 at 3:20 a.m. EDT (0720 UTC), NASA's Aqua satellite provided temperature data on Hurricane Dorian to show where strongest storms were located with cloud top temperatures as cold as minus 70 degrees Fahrenheit (minus 56.6 Celsius).

On Sept. 5 at 8:15 a.m. EDT (1215 UTC), the Moderate Imaging Spectroradiometer or MODIS instrument that flies aboard NASA's Aqua satellite found strongest thunderstorms had cloud top temperatures as cold as or colder than minus 70 degrees Fahrenheit (minus 56.6 Celsius). Those temperatures were in cloud tops of storms around the low-level center of circulation and in a thick band of thunderstorms that wrapped around the storm from west to north to east. Cloud top temperatures that cold indicate strong storms with the potential to generate heavy rainfall.

A second instrument aboard NASA's Aqua satellite called the Atmospheric Infrared Sounder or AIRS instrument also provided infrared data. That data was false-colored in an infrared image created at NASA's Jet Propulsion Laboratory in Pasadena, Calif.  AIRS gathered that data on Sept. 6 at 3:17 a.m. EDT (0717 UTC). The strongest storms were mostly over the Atlantic Ocean and east of the center.

Warnings and Watches on Sept. 6

The NHC posted many warnings and watches on Sept. 6. A Storm Surge Warning is in effect for Salter Path, NC to Poquoson, VA, for the Pamlico and Albemarle Sounds, the Neuse and Pamlico Rivers and the Hampton Roads area of Virginia. A Hurricane Warning is in effect from Surf City to the North Carolina/Virginia border and for the Pamlico and Albemarle Sounds. A Hurricane Watch is in effect for Nova Scotia, Canada.

A Tropical Storm Warning is in effect for the North Carolina/Virginia border to Fenwick Island, DE, for the Chesapeake Bay from Drum Point southward, for the Tidal Potomac south of Cobb Island, for Woods Hole to Sagamore Beach, MA, and for Nantucket and Martha's Vineyard, MA. A Tropical Storm Watch is in effect for Prince Edward Island, Canada, the Magdalen Island, Fundy National Park to Shediac, and Francois to Boat Harbour.

The Hurricane Warning and the Tropical Storm Warning have been discontinued west of Surf City, North Carolina. The Storm Surge Warning south of Salter Path, North Carolina has been discontinued.

Hurricane Dorian's Eye Near Cape Hatteras on Sept. 6

At 8 a.m. EDT on Sept. 6, the National Hurricane Center said the eye of Dorian was near Cape Hatteras, North Carolina. It was located near latitude 35.2 degrees north and longitude 75.7 degrees west. Dorian is moving toward the northeast near 14 mph (22 km/h) and this general motion with an increase in forward speed is expected through Saturday, Sept. 7.

Maximum sustained winds are near 90 mph (150 kph) with higher gusts. Dorian is forecast to become a post-tropical cyclone with hurricane-force winds by Saturday night as it approaches Nova Scotia, Canada.

The estimated minimum central pressure based on data from the Air Force Hurricane Hunters and surface observations is 956 millibars.

On the NHC forecast track, the center of Dorian should move to the southeast of extreme southeastern New England tonight and Saturday morning, and then across Nova Scotia late Saturday or Saturday night.

Hurricane Juliette has been weakening and NASA-NOAA's Suomi NPP satellite provided a look at the strength of storms within.

At 5:00 a.m. EDT (11:00 PM HST) on Sept. 6, the National Hurricane Center (NHC) projected that Hurricane Juliette would decline to a tropical storm sometime on Friday and NASA had satellites hovering overhead revealed the hurricane's slow decline.

The NOAA-NASA Suomi NPP satellite passed over the decaying storm on Sept. 5 at 4:42 p.m. EDT (20:42 UTC) and observed the storm using the Visible Infrared Imaging Radiometer Suite (VIIRS) instrument. VIIRS showed the strongest storms were located in the western quadrant of Juliette. The National Hurricane Center noted 18 minutes later, "Deep convection associated with Juliette has decreased in coverage over the past 24 hours, however, the remaining convection still wraps completely around the center."

Infrared imagery reveals cloud top temperatures, and the higher the cloud top, the colder it is, and the stronger the storm. Coldest cloud top temperatures were as cold as minus 70 degrees Fahrenheit (minus 56.6 Celsius) and found west of the center of circulation. Storms with cloud tops that cold have been found to generate heavy rainfall. Probably due to the fact that Juliette is decaying, the eye is not well-defined in this image and the strongest storms are no longer ringing the eye.

The NHC reported that at 5 a.m. EDT "(0900 UTC), the center of Hurricane Juliette was located near latitude 22.4 degrees north and longitude 122.7 degrees west which is about 815 miles (1,315 km) west of the southern tip of Baja, California. The maximum sustained winds are 80 mph (130 kph). Juliette is moving toward the northwest near 10 mph (17 kph). A motion toward the west-northwest should begin later tonight or Friday. A turn toward the west is forecast on Saturday and a general westward motion should continue through the weekend. The estimated minimum central pressure is 984 millibars."

NHC predicts that additional weakening during the next few days, and Juliette is expected to become a tropical storm by Friday night, and degenerate into a remnant low pressure area on Sunday.

The Global Precipitation Measurement mission or GPM core satellite analyzed the rainfall rates happening within Typhoon Lingling and found the heaviest precipitation on its northern side.

The GPM core satellite passed over Typhoon Lingling in the South China Sea on Sept. 6 at 2:16 a.m. EDT (0616 UTC). GPM found the heaviest rainfall at a rate greater than 1.6 inches (40 mm) per hour, falling northwest and northeast of center in fragmented thunderstorms. The heaviest rain areas were surrounded by less heavy rain, falling at a rate of 20 mm (about 0.8 inch) per hour. Lighter rainfall rates around those areas was between 0.2 and 0.4 inches (5 and 10 mm) per hour. NASA and the Japan Aerospace Exploration Agency, JAXA.

NASA researches tropical cyclones and provides data to international partners to use in their forecasting.

At 11 a.m. EDT (1500 UTC), Typhoon Lingling had maximum sustained winds near 100 knots (115 mph/185 kph). It was centered near 31.2 degrees north latitude and 125.0 degrees east longitude, about 293 nautical miles south-southwest of Kunsan Air Base, South Korea.

The Joint Typhoon Warning Center forecast calls for Lingling to move north through the Gulf of Tonkin. The Gulf of Tonkin is located off the coast of northern Vietnam and southern China. It is considered a northern arm of the South China Sea. Lingling is forecast to make landfall near Pyongyang, North Korea.

WINSTON-SALEM, N.C. - Sept. 6, 2019 - Speed, agility and strength are definitely assets on the football field. But when it comes to hits to the head, those talents may actually increase exposure for the young athletes who account for about 70% of this country's football players.

A study of youth league football players by researchers at Wake Forest School of Medicine, part of Wake Forest Baptist Health, found that higher vertical jumping ability and faster times in speed and agility drills were generally associated with higher head impact exposure, especially in games as compared to practices.

"Previous studies have shown the severity and number of head impacts increases with the level of play in football, but we have found that there is significant variability in head impact exposure among individuals playing at the same level," said Jillian E. Urban, Ph.D., assistant professor of biomedical engineering at Wake Forest School of Medicine and the study's senior author. "Differences in position account for some of that variation at the high school and college levels, but less so in youth football. Our objective was to see if there is a relationship in youth football between head impact exposure and physical ability as measured by commonly used drills, and our results suggest there is."

The study, published in the current issue of the journal Medicine & Science in Sports & Exercise, quantified head impact exposure in terms of the number of hits experienced by players, the severity of each hit in terms of peak linear and rotational head acceleration and a measure that combines the number and severity of hits recorded in a season, known as risk-weighted cumulative exposure.

The researchers analyzed performance on four physical ability tests (vertical jump, 40-yard dash and two agility drills) and on-field head impact data from all practices and games in one season for 51 players age 9 to 13. These players were members of four teams in leagues in the same region operating under the same national youth football organization. A total of 13,770 head impacts were measured with the Head Impact Telemetry (HIT) System, which includes sensors embedded in football helmets and a sideline data-collection unit plus a video-confirmation component.

The study found that all four physical performance measures were significantly correlated with the total number of head impacts measured during practices and games over the course of a season and with the risk-weighted cumulative exposure measured during games. The strongest relationships were between 40-yard dash speed and the risk-weighted cumulative exposure measured during games.

The relationships between physical performance measures and head impact exposure during practices were not as strong as those with head impact exposure during games.

"Players with higher measures of physical performance may experience greater head impact exposure because they are on the field for more plays, engage in more contact while playing, arrive at points of contact at higher speeds and may prioritize using their athletic ability over technical skill when engaging in contact," Urban said. "Physical performance measures may aid in identifying young athletes at greater risk of head impact exposure but additional research is needed to better understand if this could be part of intervention strategies for reducing the risk of head injuries in youth football."

Urban said further research in this area should include a larger number of players from a variety of different organizations, regions, and demographic backgrounds; additional assessments of physical abilities, such as upper-body strength; and consideration of other factors, including playing time in games, player aggression and attitudes and behaviors related to tackling.

NASA's Aqua satellite passed over the Northwestern Pacific Ocean and looked at comma-shaped Tropical Storm Faxai in infrared light.

At 11 a.m. EDT (1500 UTC), the Joint Typhoon Warning Center or JTWC reported that Tropical Storm Faxai had maximum sustained winds near 55 knots (63 mph/102 kph). JTWC said the storm is intensifying and that is evident by the powerful thunderstorms that NASA's Aqua satellite found using infrared imagery.

Faxai was located near 24.7 degrees north latitude and 148.1 degrees east longitude, about 371 nautical miles east of Iwo To Island, Japan. Faxai was moving to the west-northwest.

On Sept. 6 at 11:40 a.m. EDT (1540 UTC), the Moderate Imaging Spectroradiometer or MODIS instrument that flies aboard NASA's Aqua satellite used infrared light to analyze the strength of storms within the storm.

NASA researches tropical cyclones with satellites, field missions and computer modeling to determine how they rapidly intensify, develop and behave.

Tropical cyclones are made of up hundreds of thunderstorms, and infrared data can show where the strongest storms are located. They can do that because infrared data provides temperature information, and the strongest thunderstorms that reach highest into the atmosphere have the coldest cloud top temperatures.

MODIS found those strongest storms were around the center of circulation where cloud top temperatures were as cold as minus 80 degrees Fahrenheit (minus 62.2 Celsius). NASA research has found that cloud top temperatures that cold indicate strong storms with the potential to generate heavy rainfall. Those strong storms were surrounded by slightly less powerful storms that also extended in a band of thunderstorms that formed a "tail" stretching from the north to the east. That large, thick band of strong thunderstorms helped give Faxai the comma shape.

Faxai is forecast to move to the west-northwest and turn north after three days where it is forecast to make landfall near Tokyo at 80 knots (92 mph) on Sept. 8.

Chronic conductive hearing loss, which can result from middle-ear infections, has been linked to speech recognition deficits, according to the results of a new study, led by scientists at Massachusetts Eye and Ear and published September 6 in the journal Ear and Hearing.

This study suggests that not properly treating infections or other conditions that chronically affect the middle ear may lead to neural deficits and increased difficulties hearing in noisy environments.

"Our results suggest that chronic sound deprivation can lead to speech recognition difficulties consistent with cochlear synaptopathy, a condition also known as "hidden hearing loss." Accordingly, clinicians should consider providing amplification in the management of unilateral conductive hearing loss," said Stéphane F. Maison, PhD, a Principal Investigator and hearing scientist in the Eaton-Peabody Laboratories at Mass. Eye and Ear and an Assistant Professor of Otolaryngology Head-Neck Surgery at Harvard Medical School.

Sound waves travel through the ear canal before reaching the eardrum and the tiny bones of the middle ear, where they are converted into electrical signals in the inner ear and transmitted to the brain via the auditory nerve. Conductive hearing loss occurs when sound transmission from the ear canal to the inner ear is impaired, leading to a reduction in sound levels and an inability to hear soft sounds. Sensorineural hearing loss, on the other hand, occurs in the inner ear when the conversion of sound-induced vibrations into electrical signals in the auditory nerve is impaired.

Middle-ear infections are the most common cause for doctor visits and medication prescriptions among U.S. children, with about 75 percent of kids experiencing one or more bout of ear infections before age 3. These infections can re-occur and persist for many months, resulting in communication difficulties that can persist after the disease has resolved.

In the new study, researchers retrospectively reviewed the hearing profiles of 240 patients who visited the Audiology department at Mass. Eye and Ear with either an acute or chronic conductive hearing loss but with normal sensorineural function on hearing tests. The researchers found that patients with a longstanding conductive hearing impairment of moderate, to moderately severe degree had lower speech-recognition scores on the affected side than the healthy side, even when the speech was loud enough to be clearly audible.

The new study validates previous research led by Dr. Maison in adult mice in 2015, showing that longstanding conductive impairment leads to loss of the synaptic connections between the inner ear's sensory cells and the auditory nerve that relays the electrical signals to the brain. Prior research at the Mass. Eye and Ear first identified this novel type of sensorineural damage after noise exposure, and dubbed it "cochlear synaptopathy", or "hidden hearing loss."

"People with hearing loss in one ear are often reluctant to engage in rehabilitation or treatment as they still can rely on the better ear. Our study suggests that, in absence of treatment, speech perception may worsen in time," said Dr. Maison. "If what we have observed in mice is applicable to humans, there is a possibility that unilateral sound deprivation may affect the good ear as well."

The findings are especially important considering that children with asymmetric hearing loss have higher rates of academic, social, and behavioral difficulties according to the authors.

Bottom Line: Black and Hispanic Medicare patients transported by emergency medical services (EMS) to an emergency department (ED) were less likely to go to the same ED as white Medicare patients living in the same area. Evidence from previous studies has suggested differences in hospitals where racial/ethnic minorities receive care. Using Medicare claims data, this study looked at patterns of ED destination of EMS transport according to patient race/ethnicity and by zip code. The analysis included nearly 865,000 Medicare patients from 4,175 zip codes who had about 460,000 ED visits using EMS transport from 2006 to 2012. Authors report the proportion of white patients transported to the most frequent ED destination was 61.3%, while the proportion was 5.3% lower for black patients and 2.5% lower for Hispanic patients. A similar pattern was found among patients with high-risk acute conditions. Black and Hispanic Medicare patients also were more likely to be transported to a safety-net ED compared to white Medicare patients from the same zip code. Study limitations include that for certain clinical conditions (such as trauma, stroke and cardiac events), guidelines may require transportation to a suitable ED, which may not be near a patient's home.

Authors: Amresh D. Hanchate, Ph.D., Boston University School of Medicine, and coauthors

(doi:10.1001/jamanetworkopen.2019.10816)

Editor's Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

What The Study Did: This study examined patterns of suicide in the United States at the county level during an 18-year period and looked at associated geographic and community-level factors. Between 1999 and 2016, 453,577 people ages 25 to 64 died by suicide.

Authors: Danielle L. Steelesmith, Ph.D., of the Ohio State University Wexner Medical Center in Columbus, is the corresponding author

(doi:10.1001/jamanetworkopen.2019.10936)

Editor's Note: The article includes conflict of interest disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.