User login
Lucas Franki is an associate editor for MDedge News, and has been with the company since 2014. He has a BA in English from Penn State University and is an Eagle Scout.
America’s peas problem and freshly grated tattoos
Hold the peas, pass the spiders
There’s an old saying – and by “old,” we mean that we just made it up – in the medical-humor business: When in doubt, find a survey.
Some group is always surveying somebody about something and coming up with a wacky assumption or misguided opinion held by a minority of the respondents. It’s a classic go-to move for the desperate writer.
And look, here’s one now. According to a recent survey conducted by OnePoll for VeggieTracker.com, 83% of Americans like – and this makes us feel oogie just thinking about it – peas. Blecch. Even more amazing? About a quarter of the 2,000 respondents said that they had never even eaten a vegetable. That might explain a good bit of the country’s obesity problem.
And then there’s the survey that OnePoll did for Mattress Advisor, which questioned 2,000 Americans about sleep science and myth. Among the results: 23% believe that an hour of sleep before midnight is worth more than two after, 25% think that sleeping on your left side helps digestion, and 15% said that circadian rhythm was the proper term for the body’s blood flow.
Our favorite, though, was the myth that you swallow eight spiders a year while you sleep. We’ve never heard that one, but 20% of respondents thought it was true.
We’re glad that it’s just a myth, but even spiders would be better than peas.
The politics of pretty
It’s an age-old political question: Did a majority of U.S. voters back Martin Van Buren in the 1836 presidential election because he pushed the popular policies of his boss, fellow Democrat Andrew Jackson? Or was it the suave sideburns of Jackson’s stylish vice president that trumped (see what we did there?) the clean-shaven Whig William Henry Harrison?
The evidence-backed answer: Probably both.
Researchers at the University of Freiburg in Germany conducted two style-or-substance studies to determine how much political advantage a pretty face confers. The first study examined the impact attractive looks and the ability to appear competent riding atop an Abrams tank (ooooh, sorry, Dukakis fans), er, the ability to look competent in photos had in Germany’s 2017 Bundestag elections.
The study’s precise answer: 3.8 percentage points. That’s the polling advantage candidates gained by being judged more attractive than their competitors. Admittedly, the researchers also found it helped to be more than just a pretty face – the unaesthetic quality of relative competence also played a positive role.
The second study took the same approach to U.S. House of Representatives races. In that research beauty contest, America’s aesthetically attuned voters delivered up to an 11-point advantage to the prettiest person.
Now, as anyone will tell you who’s watched congressional TMZ – a.k.a. C-SPAN – beauty in politics is a relative matter. As one of our colleagues noted after visiting the Bureau of LOTME’s Washington hometown and seeing several political stars up close and personal: “Washington is Hollywood for the not so good lookin’.”
Grate idea, or greatest idea?
Tattoo removal is a big part of business for quite a few dermatologists out there. In 2011, more than 100,000 tattoo removal procedures were performed, according to the American Society for Dermatologic Surgery.
But dermatologists beware, because an Argentinian man may have found a far cheaper method for getting rid of unwanted tattoos, one that would make all those fancy lasers obsolete.
And it all hinges on a humble kitchen utensil: the cheese grater.
The story began when our intrepid hero found out that he wouldn’t be able to work as airport police with a visible tattoo. Simultaneously, he decided that the detail on the week-old tattoo was not up to his standard. So, the man took to the Internet, searching for a cheap way to remove the offending mark. He tried a pumice stone but had no luck. So, next came the cheese grater.
And credit where credit’s due – he did get rid of the tattoo. He washed the wound, applied disinfectant, and everything was good.
Okay, he MAY have required a trip to his local emergency department because he needed a tetanus shot. And while the man isn’t sorry that he did what he did, he wouldn’t recommend the procedure to anyone else.
But consider yourselves on notice, dermatologists. There are always new ways to innovate.
Hold the peas, pass the spiders
There’s an old saying – and by “old,” we mean that we just made it up – in the medical-humor business: When in doubt, find a survey.
Some group is always surveying somebody about something and coming up with a wacky assumption or misguided opinion held by a minority of the respondents. It’s a classic go-to move for the desperate writer.
And look, here’s one now. According to a recent survey conducted by OnePoll for VeggieTracker.com, 83% of Americans like – and this makes us feel oogie just thinking about it – peas. Blecch. Even more amazing? About a quarter of the 2,000 respondents said that they had never even eaten a vegetable. That might explain a good bit of the country’s obesity problem.
And then there’s the survey that OnePoll did for Mattress Advisor, which questioned 2,000 Americans about sleep science and myth. Among the results: 23% believe that an hour of sleep before midnight is worth more than two after, 25% think that sleeping on your left side helps digestion, and 15% said that circadian rhythm was the proper term for the body’s blood flow.
Our favorite, though, was the myth that you swallow eight spiders a year while you sleep. We’ve never heard that one, but 20% of respondents thought it was true.
We’re glad that it’s just a myth, but even spiders would be better than peas.
The politics of pretty
It’s an age-old political question: Did a majority of U.S. voters back Martin Van Buren in the 1836 presidential election because he pushed the popular policies of his boss, fellow Democrat Andrew Jackson? Or was it the suave sideburns of Jackson’s stylish vice president that trumped (see what we did there?) the clean-shaven Whig William Henry Harrison?
The evidence-backed answer: Probably both.
Researchers at the University of Freiburg in Germany conducted two style-or-substance studies to determine how much political advantage a pretty face confers. The first study examined the impact attractive looks and the ability to appear competent riding atop an Abrams tank (ooooh, sorry, Dukakis fans), er, the ability to look competent in photos had in Germany’s 2017 Bundestag elections.
The study’s precise answer: 3.8 percentage points. That’s the polling advantage candidates gained by being judged more attractive than their competitors. Admittedly, the researchers also found it helped to be more than just a pretty face – the unaesthetic quality of relative competence also played a positive role.
The second study took the same approach to U.S. House of Representatives races. In that research beauty contest, America’s aesthetically attuned voters delivered up to an 11-point advantage to the prettiest person.
Now, as anyone will tell you who’s watched congressional TMZ – a.k.a. C-SPAN – beauty in politics is a relative matter. As one of our colleagues noted after visiting the Bureau of LOTME’s Washington hometown and seeing several political stars up close and personal: “Washington is Hollywood for the not so good lookin’.”
Grate idea, or greatest idea?
Tattoo removal is a big part of business for quite a few dermatologists out there. In 2011, more than 100,000 tattoo removal procedures were performed, according to the American Society for Dermatologic Surgery.
But dermatologists beware, because an Argentinian man may have found a far cheaper method for getting rid of unwanted tattoos, one that would make all those fancy lasers obsolete.
And it all hinges on a humble kitchen utensil: the cheese grater.
The story began when our intrepid hero found out that he wouldn’t be able to work as airport police with a visible tattoo. Simultaneously, he decided that the detail on the week-old tattoo was not up to his standard. So, the man took to the Internet, searching for a cheap way to remove the offending mark. He tried a pumice stone but had no luck. So, next came the cheese grater.
And credit where credit’s due – he did get rid of the tattoo. He washed the wound, applied disinfectant, and everything was good.
Okay, he MAY have required a trip to his local emergency department because he needed a tetanus shot. And while the man isn’t sorry that he did what he did, he wouldn’t recommend the procedure to anyone else.
But consider yourselves on notice, dermatologists. There are always new ways to innovate.
Hold the peas, pass the spiders
There’s an old saying – and by “old,” we mean that we just made it up – in the medical-humor business: When in doubt, find a survey.
Some group is always surveying somebody about something and coming up with a wacky assumption or misguided opinion held by a minority of the respondents. It’s a classic go-to move for the desperate writer.
And look, here’s one now. According to a recent survey conducted by OnePoll for VeggieTracker.com, 83% of Americans like – and this makes us feel oogie just thinking about it – peas. Blecch. Even more amazing? About a quarter of the 2,000 respondents said that they had never even eaten a vegetable. That might explain a good bit of the country’s obesity problem.
And then there’s the survey that OnePoll did for Mattress Advisor, which questioned 2,000 Americans about sleep science and myth. Among the results: 23% believe that an hour of sleep before midnight is worth more than two after, 25% think that sleeping on your left side helps digestion, and 15% said that circadian rhythm was the proper term for the body’s blood flow.
Our favorite, though, was the myth that you swallow eight spiders a year while you sleep. We’ve never heard that one, but 20% of respondents thought it was true.
We’re glad that it’s just a myth, but even spiders would be better than peas.
The politics of pretty
It’s an age-old political question: Did a majority of U.S. voters back Martin Van Buren in the 1836 presidential election because he pushed the popular policies of his boss, fellow Democrat Andrew Jackson? Or was it the suave sideburns of Jackson’s stylish vice president that trumped (see what we did there?) the clean-shaven Whig William Henry Harrison?
The evidence-backed answer: Probably both.
Researchers at the University of Freiburg in Germany conducted two style-or-substance studies to determine how much political advantage a pretty face confers. The first study examined the impact attractive looks and the ability to appear competent riding atop an Abrams tank (ooooh, sorry, Dukakis fans), er, the ability to look competent in photos had in Germany’s 2017 Bundestag elections.
The study’s precise answer: 3.8 percentage points. That’s the polling advantage candidates gained by being judged more attractive than their competitors. Admittedly, the researchers also found it helped to be more than just a pretty face – the unaesthetic quality of relative competence also played a positive role.
The second study took the same approach to U.S. House of Representatives races. In that research beauty contest, America’s aesthetically attuned voters delivered up to an 11-point advantage to the prettiest person.
Now, as anyone will tell you who’s watched congressional TMZ – a.k.a. C-SPAN – beauty in politics is a relative matter. As one of our colleagues noted after visiting the Bureau of LOTME’s Washington hometown and seeing several political stars up close and personal: “Washington is Hollywood for the not so good lookin’.”
Grate idea, or greatest idea?
Tattoo removal is a big part of business for quite a few dermatologists out there. In 2011, more than 100,000 tattoo removal procedures were performed, according to the American Society for Dermatologic Surgery.
But dermatologists beware, because an Argentinian man may have found a far cheaper method for getting rid of unwanted tattoos, one that would make all those fancy lasers obsolete.
And it all hinges on a humble kitchen utensil: the cheese grater.
The story began when our intrepid hero found out that he wouldn’t be able to work as airport police with a visible tattoo. Simultaneously, he decided that the detail on the week-old tattoo was not up to his standard. So, the man took to the Internet, searching for a cheap way to remove the offending mark. He tried a pumice stone but had no luck. So, next came the cheese grater.
And credit where credit’s due – he did get rid of the tattoo. He washed the wound, applied disinfectant, and everything was good.
Okay, he MAY have required a trip to his local emergency department because he needed a tetanus shot. And while the man isn’t sorry that he did what he did, he wouldn’t recommend the procedure to anyone else.
But consider yourselves on notice, dermatologists. There are always new ways to innovate.
FDA approves rivaroxaban for VTE prevention in hospitalized, acutely ill patients
The Food and Drug Administration has approved rivaroxaban (Xarelto) for the prevention of venous thromboembolism (VTE) in hospitalized, acutely ill patients at risk for thromboembolic complications who do not have a high bleeding risk, according to a release from Janssen.
FDA approval for the new indication is based on results from the phase 3 MAGELLAN and MARINER trials, which included more than 20,000 hospitalized, acutely ill patients. In MAGELLAN, rivaroxaban demonstrated noninferiority to enoxaparin, a low-molecular-weight heparin, in short-term usage, and it was superior over the long term, compared with short-term enoxaparin followed by placebo.
While VTE and VTE-related deaths were not reduced in MARINER, compared with placebo, patients who received rivaroxaban did see a significantly reduction in symptomatic VTE with a favorable safety profile.
According to the indication, rivaroxaban can be administered to patients during hospitalization and can be continued after discharge for 31-39 days. The safety profile in MAGELLAN and MARINER was consistent with that already seen, with the most common adverse event being bleeding.
The new indication is the eighth for rivaroxaban, the most of any direct oral anticoagulant; six of these are specifically for the treatment, prevention, and reduction in the risk of VTE recurrence.
“With this new approval, Xarelto as an oral-only option now has the potential to change how acutely ill medical patients are managed for the prevention of blood clots, both in the hospital and for an extended period after discharge,” said Alex C. Spyropoulos, MD, of Northwell Health at Lenox Hill Hospital, New York, and a member of the steering committee of the MAGELLAN trial.
Find the full press release on the Janssen website.
The Food and Drug Administration has approved rivaroxaban (Xarelto) for the prevention of venous thromboembolism (VTE) in hospitalized, acutely ill patients at risk for thromboembolic complications who do not have a high bleeding risk, according to a release from Janssen.
FDA approval for the new indication is based on results from the phase 3 MAGELLAN and MARINER trials, which included more than 20,000 hospitalized, acutely ill patients. In MAGELLAN, rivaroxaban demonstrated noninferiority to enoxaparin, a low-molecular-weight heparin, in short-term usage, and it was superior over the long term, compared with short-term enoxaparin followed by placebo.
While VTE and VTE-related deaths were not reduced in MARINER, compared with placebo, patients who received rivaroxaban did see a significantly reduction in symptomatic VTE with a favorable safety profile.
According to the indication, rivaroxaban can be administered to patients during hospitalization and can be continued after discharge for 31-39 days. The safety profile in MAGELLAN and MARINER was consistent with that already seen, with the most common adverse event being bleeding.
The new indication is the eighth for rivaroxaban, the most of any direct oral anticoagulant; six of these are specifically for the treatment, prevention, and reduction in the risk of VTE recurrence.
“With this new approval, Xarelto as an oral-only option now has the potential to change how acutely ill medical patients are managed for the prevention of blood clots, both in the hospital and for an extended period after discharge,” said Alex C. Spyropoulos, MD, of Northwell Health at Lenox Hill Hospital, New York, and a member of the steering committee of the MAGELLAN trial.
Find the full press release on the Janssen website.
The Food and Drug Administration has approved rivaroxaban (Xarelto) for the prevention of venous thromboembolism (VTE) in hospitalized, acutely ill patients at risk for thromboembolic complications who do not have a high bleeding risk, according to a release from Janssen.
FDA approval for the new indication is based on results from the phase 3 MAGELLAN and MARINER trials, which included more than 20,000 hospitalized, acutely ill patients. In MAGELLAN, rivaroxaban demonstrated noninferiority to enoxaparin, a low-molecular-weight heparin, in short-term usage, and it was superior over the long term, compared with short-term enoxaparin followed by placebo.
While VTE and VTE-related deaths were not reduced in MARINER, compared with placebo, patients who received rivaroxaban did see a significantly reduction in symptomatic VTE with a favorable safety profile.
According to the indication, rivaroxaban can be administered to patients during hospitalization and can be continued after discharge for 31-39 days. The safety profile in MAGELLAN and MARINER was consistent with that already seen, with the most common adverse event being bleeding.
The new indication is the eighth for rivaroxaban, the most of any direct oral anticoagulant; six of these are specifically for the treatment, prevention, and reduction in the risk of VTE recurrence.
“With this new approval, Xarelto as an oral-only option now has the potential to change how acutely ill medical patients are managed for the prevention of blood clots, both in the hospital and for an extended period after discharge,” said Alex C. Spyropoulos, MD, of Northwell Health at Lenox Hill Hospital, New York, and a member of the steering committee of the MAGELLAN trial.
Find the full press release on the Janssen website.
FDA approves Reyvow for acute migraine treatment
The Food and Drug Administration has approved lasmiditan (Reyvow) for acute treatment of migraines with and without auras in adults.
The agency’s Oct. 11 announcement said the approval is based on results from a pair of randomized, double-blind, placebo-controlled trials that included 3,177 adult patients with a history of migraine with and without aura. The percentage of patients whose pain and most bothersome migraine symptom (nausea, light sensitivity, or sound sensitivity) resolved after 2 hours was higher in patients receiving lasmiditan than in patients receiving placebo.
Lasmiditan is a serotonin 5-hydroxytryptamine1F–receptor agonist, giving it a unique mechanism of action as compared with other migraine treatments.
The most common adverse events associated with lasmiditan include dizziness, fatigue, paresthesia, and sedation. There is a risk of driving impairment while taking the medication, and patients are advised not to operate or drive machinery for 8 hours after taking lasmiditan.
“Reyvow is a new option for the acute treatment of migraine, a painful condition that affects one in seven Americans. We know that the migraine community is keenly interested in additional treatment options, and we remain committed to continuing to work with stakeholders to promote the development of new therapies for the acute and preventive treatment of migraine,” said Nick Kozauer, MD, acting deputy director of the division of neurology products in the FDA’s Center for Drug Evaluation and Research.
Eli Lilly, the drug’s manufacturer, said in a news release that “the recommended controlled substance classification for Reyvow is currently under review by the Drug Enforcement Administration and is expected within 90 days of today’s FDA approval, after which Reyvow will be available to patients in retail pharmacies” in oral doses of 50 mg, 100 mg, and 200 mg.
The Food and Drug Administration has approved lasmiditan (Reyvow) for acute treatment of migraines with and without auras in adults.
The agency’s Oct. 11 announcement said the approval is based on results from a pair of randomized, double-blind, placebo-controlled trials that included 3,177 adult patients with a history of migraine with and without aura. The percentage of patients whose pain and most bothersome migraine symptom (nausea, light sensitivity, or sound sensitivity) resolved after 2 hours was higher in patients receiving lasmiditan than in patients receiving placebo.
Lasmiditan is a serotonin 5-hydroxytryptamine1F–receptor agonist, giving it a unique mechanism of action as compared with other migraine treatments.
The most common adverse events associated with lasmiditan include dizziness, fatigue, paresthesia, and sedation. There is a risk of driving impairment while taking the medication, and patients are advised not to operate or drive machinery for 8 hours after taking lasmiditan.
“Reyvow is a new option for the acute treatment of migraine, a painful condition that affects one in seven Americans. We know that the migraine community is keenly interested in additional treatment options, and we remain committed to continuing to work with stakeholders to promote the development of new therapies for the acute and preventive treatment of migraine,” said Nick Kozauer, MD, acting deputy director of the division of neurology products in the FDA’s Center for Drug Evaluation and Research.
Eli Lilly, the drug’s manufacturer, said in a news release that “the recommended controlled substance classification for Reyvow is currently under review by the Drug Enforcement Administration and is expected within 90 days of today’s FDA approval, after which Reyvow will be available to patients in retail pharmacies” in oral doses of 50 mg, 100 mg, and 200 mg.
The Food and Drug Administration has approved lasmiditan (Reyvow) for acute treatment of migraines with and without auras in adults.
The agency’s Oct. 11 announcement said the approval is based on results from a pair of randomized, double-blind, placebo-controlled trials that included 3,177 adult patients with a history of migraine with and without aura. The percentage of patients whose pain and most bothersome migraine symptom (nausea, light sensitivity, or sound sensitivity) resolved after 2 hours was higher in patients receiving lasmiditan than in patients receiving placebo.
Lasmiditan is a serotonin 5-hydroxytryptamine1F–receptor agonist, giving it a unique mechanism of action as compared with other migraine treatments.
The most common adverse events associated with lasmiditan include dizziness, fatigue, paresthesia, and sedation. There is a risk of driving impairment while taking the medication, and patients are advised not to operate or drive machinery for 8 hours after taking lasmiditan.
“Reyvow is a new option for the acute treatment of migraine, a painful condition that affects one in seven Americans. We know that the migraine community is keenly interested in additional treatment options, and we remain committed to continuing to work with stakeholders to promote the development of new therapies for the acute and preventive treatment of migraine,” said Nick Kozauer, MD, acting deputy director of the division of neurology products in the FDA’s Center for Drug Evaluation and Research.
Eli Lilly, the drug’s manufacturer, said in a news release that “the recommended controlled substance classification for Reyvow is currently under review by the Drug Enforcement Administration and is expected within 90 days of today’s FDA approval, after which Reyvow will be available to patients in retail pharmacies” in oral doses of 50 mg, 100 mg, and 200 mg.
Regional brain activation lower in bipolar disorder patients after multiple manic episodes
Patients with bipolar disorder who had undergone multiple manic episodes had significantly lower regional activation in the prefrontal‐striatal‐amygdala networks than single-episode patients, according to Logan Borgelt of the department of psychiatry and behavioral neuroscience at the University of Cincinnati and associates.
For the study, the investigators collected functional MRI data from 57 first‐episode manic patients (mean age, 19 years; mean Young Mania Rating Scale [YMRS] score, 26) and 50 multiepisode patients (mean age, 32 years; mean YMRS score, 21) who performed a continuous task with emotional distractions, as well as MR spectroscopy from 52 first-episode patients (mean age, 19 years; mean YMRS score, 26) and 54 multiepisode patients (mean age, 32 years; mean YMRS, 22). The study was published in Bipolar Disorders.
The investigation found that activation of the bilateral ventrolateral prefrontal cortex (P = .0122 for left; P = .0007 for right), anterior cingulate cortex (P less than .0001), orbitofrontal cortex (P = .0133), putamen (P = .0032), caudate (P = .0008), and amygdala (P = .0215) was significantly lower in multiepisode patients than in single-episode patients. Glutamate and N‐acetylaspartate concentration in the anterior cingulate cortex was also lower in multiepisode patients.
The age of multiepisode patients was, in general, not heavily associated with worse activation; only the right putamen (r = 0.30) and right thalamus (r = 0.30) reached a moderate effect size.
“Our findings are consistent with a hypothesized vicious cycle in which progressive atrophic changes in the prefrontal cortex are associated with functional decrements in affective networks, which in turn contribute to both further neuronal loss and clinical observations of accelerating symptomatic recurrence. ,” the investigators wrote.
Mr. Borgelt reported no conflicts. Three coauthors reported consulting with, receiving support and honoraria from, or serving on the speaker’s bureaus for numerous sources. The remaining coauthors did not report any conflicts of interest.
SOURCE: Borgelt L et al. Bipolar Disord. 2019 Apr 26. doi: 10.1111/bdi.12782.
Patients with bipolar disorder who had undergone multiple manic episodes had significantly lower regional activation in the prefrontal‐striatal‐amygdala networks than single-episode patients, according to Logan Borgelt of the department of psychiatry and behavioral neuroscience at the University of Cincinnati and associates.
For the study, the investigators collected functional MRI data from 57 first‐episode manic patients (mean age, 19 years; mean Young Mania Rating Scale [YMRS] score, 26) and 50 multiepisode patients (mean age, 32 years; mean YMRS score, 21) who performed a continuous task with emotional distractions, as well as MR spectroscopy from 52 first-episode patients (mean age, 19 years; mean YMRS score, 26) and 54 multiepisode patients (mean age, 32 years; mean YMRS, 22). The study was published in Bipolar Disorders.
The investigation found that activation of the bilateral ventrolateral prefrontal cortex (P = .0122 for left; P = .0007 for right), anterior cingulate cortex (P less than .0001), orbitofrontal cortex (P = .0133), putamen (P = .0032), caudate (P = .0008), and amygdala (P = .0215) was significantly lower in multiepisode patients than in single-episode patients. Glutamate and N‐acetylaspartate concentration in the anterior cingulate cortex was also lower in multiepisode patients.
The age of multiepisode patients was, in general, not heavily associated with worse activation; only the right putamen (r = 0.30) and right thalamus (r = 0.30) reached a moderate effect size.
“Our findings are consistent with a hypothesized vicious cycle in which progressive atrophic changes in the prefrontal cortex are associated with functional decrements in affective networks, which in turn contribute to both further neuronal loss and clinical observations of accelerating symptomatic recurrence. ,” the investigators wrote.
Mr. Borgelt reported no conflicts. Three coauthors reported consulting with, receiving support and honoraria from, or serving on the speaker’s bureaus for numerous sources. The remaining coauthors did not report any conflicts of interest.
SOURCE: Borgelt L et al. Bipolar Disord. 2019 Apr 26. doi: 10.1111/bdi.12782.
Patients with bipolar disorder who had undergone multiple manic episodes had significantly lower regional activation in the prefrontal‐striatal‐amygdala networks than single-episode patients, according to Logan Borgelt of the department of psychiatry and behavioral neuroscience at the University of Cincinnati and associates.
For the study, the investigators collected functional MRI data from 57 first‐episode manic patients (mean age, 19 years; mean Young Mania Rating Scale [YMRS] score, 26) and 50 multiepisode patients (mean age, 32 years; mean YMRS score, 21) who performed a continuous task with emotional distractions, as well as MR spectroscopy from 52 first-episode patients (mean age, 19 years; mean YMRS score, 26) and 54 multiepisode patients (mean age, 32 years; mean YMRS, 22). The study was published in Bipolar Disorders.
The investigation found that activation of the bilateral ventrolateral prefrontal cortex (P = .0122 for left; P = .0007 for right), anterior cingulate cortex (P less than .0001), orbitofrontal cortex (P = .0133), putamen (P = .0032), caudate (P = .0008), and amygdala (P = .0215) was significantly lower in multiepisode patients than in single-episode patients. Glutamate and N‐acetylaspartate concentration in the anterior cingulate cortex was also lower in multiepisode patients.
The age of multiepisode patients was, in general, not heavily associated with worse activation; only the right putamen (r = 0.30) and right thalamus (r = 0.30) reached a moderate effect size.
“Our findings are consistent with a hypothesized vicious cycle in which progressive atrophic changes in the prefrontal cortex are associated with functional decrements in affective networks, which in turn contribute to both further neuronal loss and clinical observations of accelerating symptomatic recurrence. ,” the investigators wrote.
Mr. Borgelt reported no conflicts. Three coauthors reported consulting with, receiving support and honoraria from, or serving on the speaker’s bureaus for numerous sources. The remaining coauthors did not report any conflicts of interest.
SOURCE: Borgelt L et al. Bipolar Disord. 2019 Apr 26. doi: 10.1111/bdi.12782.
FROM BIPOLAR DISORDERS
Printed meat in space and diesel-pattern baldness
If at first you don’t succeed …
Dozens of new drugs are approved every year, but for every promising new medication, there are far more that fail to get past the clinical trial stage. The causes can vary: The drug didn’t do enough, it caused too many adverse events, and so on.
DNA topoisomerase inhibitors have been extensively researched as an anticancer agent, but many examples failed their clinical trials. These molecules are flat and made up of neatly stacked columns of electrically conductive rings, and operate by inserting themselves into DNA to stop replication.
That molecular structure is what interested a team of researchers from the University of Illinois at Urbana-Champaign. In research published in Nature Communications, the researchers noted that DNA topoisomerase inhibitors are structured much like organic semiconductors, but with a bonus. Those columns that make up the molecule are linked by hydrogen bonds, which allow bridges to form across the entire molecule, transforming the entire thing into a semiconductor.
That property, along with their easy printability and their high-specificity interactions with biological material, make the inhibitors an excellent candidate for use in biosensors or biotransistors.
A word to the manufacturer of those topoisomerase inhibitors, though, now that we’ve gotten you all excited again: We doubt you’ll be able to charge as much for the molecule. Semiconductors are hardly as glamorous as treating cancer.
Houston, we have a cultivated meat product
The Delmonico brothers didn’t do it. Ronald McDonald didn’t do it. Neil Armstrong never even tried. Same goes for Julia Child.
None of these culinary giants or astronauts ever grew beef in space. That honor belongs to Aleph Farms of Rehovot, Israel. The company, a self-proclaimed “global leader in the cultivated meat industry,” collaborated with 3D Bioprinting Solutions of Moscow and others to produce slaughter-free beef in the Russian segment of the International Space Station in September.
The actual process of growing a steak mimics natural “muscle-tissue regeneration occurring inside the cow’s body” and somehow uses a 3-D bioprinter to assemble “a small-scale muscle tissue.” We don’t really understand it, but the scientists and engineers here at LOTME Co. assure us it makes sense.
But why, you may ask, did they do it on the space station? Think of it as a stand-in for New York City. You know … if you can make it there, you can make it anywhere. We’ll let Didier Toubia, cofounder and CEO of Aleph Farms, explain: “In space, we don’t have 10,000 or 15,000 liter (3962.58 gallon) of water available to produce 1 kilogram (2.205 pounds) of beef.” It’s all about sustainable food production.
The next phase of the project, we think, is going to be even more interesting. For a proper fine dining experience in space, they’re going to grow a snooty French waiter to serve cultivated steak to the astronauts.
Pollution Hair Club for Men
By now, most people are well aware that air pollution is linked with cancer. And chronic obstructive pulmonary disease. And asthma. And cardiovascular disease. And Germanic automotive emissions system cheating. Yawn.
But there’s a newly revealed association sure to make even the most jaded health news consumer’s hair stand on end: Exposure to pollution’s particulate matter is linked to ... hair loss.
Researchers from the Future Science Research Center in South Korea exposed cells from the base of human hair follicles to assorted concentrations of diesel and dust particulates. After 24 hours, the pollutants had suppressed production of beta-catenin, the primary protein crucial to the maintenance of George Clooney’s luxurious mane. And three other proteins supporting hair growth and hair retention also went AWOL in the presence of pollutants. Plus more particulate matter meant fewer hair-restoring proteins.
Diesel particulates and baldness? It all makes so much more sense now. Given the pollutant-rich Big Apple air in which lollipop-loving TV detective Theo Kojak’s smooth pate was steeped, is it any wonder he was famously so follicularly challenged? The Clean Air Act – who loves ya, baby?
If at first you don’t succeed …
Dozens of new drugs are approved every year, but for every promising new medication, there are far more that fail to get past the clinical trial stage. The causes can vary: The drug didn’t do enough, it caused too many adverse events, and so on.
DNA topoisomerase inhibitors have been extensively researched as an anticancer agent, but many examples failed their clinical trials. These molecules are flat and made up of neatly stacked columns of electrically conductive rings, and operate by inserting themselves into DNA to stop replication.
That molecular structure is what interested a team of researchers from the University of Illinois at Urbana-Champaign. In research published in Nature Communications, the researchers noted that DNA topoisomerase inhibitors are structured much like organic semiconductors, but with a bonus. Those columns that make up the molecule are linked by hydrogen bonds, which allow bridges to form across the entire molecule, transforming the entire thing into a semiconductor.
That property, along with their easy printability and their high-specificity interactions with biological material, make the inhibitors an excellent candidate for use in biosensors or biotransistors.
A word to the manufacturer of those topoisomerase inhibitors, though, now that we’ve gotten you all excited again: We doubt you’ll be able to charge as much for the molecule. Semiconductors are hardly as glamorous as treating cancer.
Houston, we have a cultivated meat product
The Delmonico brothers didn’t do it. Ronald McDonald didn’t do it. Neil Armstrong never even tried. Same goes for Julia Child.
None of these culinary giants or astronauts ever grew beef in space. That honor belongs to Aleph Farms of Rehovot, Israel. The company, a self-proclaimed “global leader in the cultivated meat industry,” collaborated with 3D Bioprinting Solutions of Moscow and others to produce slaughter-free beef in the Russian segment of the International Space Station in September.
The actual process of growing a steak mimics natural “muscle-tissue regeneration occurring inside the cow’s body” and somehow uses a 3-D bioprinter to assemble “a small-scale muscle tissue.” We don’t really understand it, but the scientists and engineers here at LOTME Co. assure us it makes sense.
But why, you may ask, did they do it on the space station? Think of it as a stand-in for New York City. You know … if you can make it there, you can make it anywhere. We’ll let Didier Toubia, cofounder and CEO of Aleph Farms, explain: “In space, we don’t have 10,000 or 15,000 liter (3962.58 gallon) of water available to produce 1 kilogram (2.205 pounds) of beef.” It’s all about sustainable food production.
The next phase of the project, we think, is going to be even more interesting. For a proper fine dining experience in space, they’re going to grow a snooty French waiter to serve cultivated steak to the astronauts.
Pollution Hair Club for Men
By now, most people are well aware that air pollution is linked with cancer. And chronic obstructive pulmonary disease. And asthma. And cardiovascular disease. And Germanic automotive emissions system cheating. Yawn.
But there’s a newly revealed association sure to make even the most jaded health news consumer’s hair stand on end: Exposure to pollution’s particulate matter is linked to ... hair loss.
Researchers from the Future Science Research Center in South Korea exposed cells from the base of human hair follicles to assorted concentrations of diesel and dust particulates. After 24 hours, the pollutants had suppressed production of beta-catenin, the primary protein crucial to the maintenance of George Clooney’s luxurious mane. And three other proteins supporting hair growth and hair retention also went AWOL in the presence of pollutants. Plus more particulate matter meant fewer hair-restoring proteins.
Diesel particulates and baldness? It all makes so much more sense now. Given the pollutant-rich Big Apple air in which lollipop-loving TV detective Theo Kojak’s smooth pate was steeped, is it any wonder he was famously so follicularly challenged? The Clean Air Act – who loves ya, baby?
If at first you don’t succeed …
Dozens of new drugs are approved every year, but for every promising new medication, there are far more that fail to get past the clinical trial stage. The causes can vary: The drug didn’t do enough, it caused too many adverse events, and so on.
DNA topoisomerase inhibitors have been extensively researched as an anticancer agent, but many examples failed their clinical trials. These molecules are flat and made up of neatly stacked columns of electrically conductive rings, and operate by inserting themselves into DNA to stop replication.
That molecular structure is what interested a team of researchers from the University of Illinois at Urbana-Champaign. In research published in Nature Communications, the researchers noted that DNA topoisomerase inhibitors are structured much like organic semiconductors, but with a bonus. Those columns that make up the molecule are linked by hydrogen bonds, which allow bridges to form across the entire molecule, transforming the entire thing into a semiconductor.
That property, along with their easy printability and their high-specificity interactions with biological material, make the inhibitors an excellent candidate for use in biosensors or biotransistors.
A word to the manufacturer of those topoisomerase inhibitors, though, now that we’ve gotten you all excited again: We doubt you’ll be able to charge as much for the molecule. Semiconductors are hardly as glamorous as treating cancer.
Houston, we have a cultivated meat product
The Delmonico brothers didn’t do it. Ronald McDonald didn’t do it. Neil Armstrong never even tried. Same goes for Julia Child.
None of these culinary giants or astronauts ever grew beef in space. That honor belongs to Aleph Farms of Rehovot, Israel. The company, a self-proclaimed “global leader in the cultivated meat industry,” collaborated with 3D Bioprinting Solutions of Moscow and others to produce slaughter-free beef in the Russian segment of the International Space Station in September.
The actual process of growing a steak mimics natural “muscle-tissue regeneration occurring inside the cow’s body” and somehow uses a 3-D bioprinter to assemble “a small-scale muscle tissue.” We don’t really understand it, but the scientists and engineers here at LOTME Co. assure us it makes sense.
But why, you may ask, did they do it on the space station? Think of it as a stand-in for New York City. You know … if you can make it there, you can make it anywhere. We’ll let Didier Toubia, cofounder and CEO of Aleph Farms, explain: “In space, we don’t have 10,000 or 15,000 liter (3962.58 gallon) of water available to produce 1 kilogram (2.205 pounds) of beef.” It’s all about sustainable food production.
The next phase of the project, we think, is going to be even more interesting. For a proper fine dining experience in space, they’re going to grow a snooty French waiter to serve cultivated steak to the astronauts.
Pollution Hair Club for Men
By now, most people are well aware that air pollution is linked with cancer. And chronic obstructive pulmonary disease. And asthma. And cardiovascular disease. And Germanic automotive emissions system cheating. Yawn.
But there’s a newly revealed association sure to make even the most jaded health news consumer’s hair stand on end: Exposure to pollution’s particulate matter is linked to ... hair loss.
Researchers from the Future Science Research Center in South Korea exposed cells from the base of human hair follicles to assorted concentrations of diesel and dust particulates. After 24 hours, the pollutants had suppressed production of beta-catenin, the primary protein crucial to the maintenance of George Clooney’s luxurious mane. And three other proteins supporting hair growth and hair retention also went AWOL in the presence of pollutants. Plus more particulate matter meant fewer hair-restoring proteins.
Diesel particulates and baldness? It all makes so much more sense now. Given the pollutant-rich Big Apple air in which lollipop-loving TV detective Theo Kojak’s smooth pate was steeped, is it any wonder he was famously so follicularly challenged? The Clean Air Act – who loves ya, baby?
Histologic analysis of vaping-associated lung injury suggests chemical pneumonitis
Vaping-associated lung injury is likely a form of airway-centered chemical pneumonitis, not exogenous lipoid pneumonia, according to Yasmeen M. Butt, MD, of the University of Texas Southwestern Medical Center, Dallas, and associates.
Dr. Butt and associates performed a review of lung biopsies from 17 patients (13 men; median age, 35 years) with a history of vaping and either suspected or confirmed vaping-associated lung injury. All cases showed patterns of acute lung injury, including acute fibrinous pneumonitis, diffuse alveolar damage, or organizing pneumonia, the authors noted in a letter to the editor published in the New England Journal of Medicine.
While no histologic findings were specific, foamy macrophages and pneumocyte vacuolization were seen in all cases, the authors added. Pigmented macrophages were occasionally present but not dominant, neutrophils were often prominent, eosinophils were rare, and granulomas were not seen. Two patients eventually died, despite treatment with glucocorticoids and maximum supportive care.
“None of our cases showed histologic evidence of exogenous lipoid pneumonia and no radiologic evidence thereof has been found; this calls into question the diagnostic utility of identifying lipid-laden macrophages or performing oil red O staining on bronchioloalveolar lavage fluid as a marker of vaping-associated lung injury, as has been proposed,” Dr. Butt and associates wrote.
No conflicts of interest were reported.
SOURCE: Butt YM et al. N Engl J Med. 2019 Oct 2. doi: 10.1056/NEJMc1913069.
Vaping-associated lung injury is likely a form of airway-centered chemical pneumonitis, not exogenous lipoid pneumonia, according to Yasmeen M. Butt, MD, of the University of Texas Southwestern Medical Center, Dallas, and associates.
Dr. Butt and associates performed a review of lung biopsies from 17 patients (13 men; median age, 35 years) with a history of vaping and either suspected or confirmed vaping-associated lung injury. All cases showed patterns of acute lung injury, including acute fibrinous pneumonitis, diffuse alveolar damage, or organizing pneumonia, the authors noted in a letter to the editor published in the New England Journal of Medicine.
While no histologic findings were specific, foamy macrophages and pneumocyte vacuolization were seen in all cases, the authors added. Pigmented macrophages were occasionally present but not dominant, neutrophils were often prominent, eosinophils were rare, and granulomas were not seen. Two patients eventually died, despite treatment with glucocorticoids and maximum supportive care.
“None of our cases showed histologic evidence of exogenous lipoid pneumonia and no radiologic evidence thereof has been found; this calls into question the diagnostic utility of identifying lipid-laden macrophages or performing oil red O staining on bronchioloalveolar lavage fluid as a marker of vaping-associated lung injury, as has been proposed,” Dr. Butt and associates wrote.
No conflicts of interest were reported.
SOURCE: Butt YM et al. N Engl J Med. 2019 Oct 2. doi: 10.1056/NEJMc1913069.
Vaping-associated lung injury is likely a form of airway-centered chemical pneumonitis, not exogenous lipoid pneumonia, according to Yasmeen M. Butt, MD, of the University of Texas Southwestern Medical Center, Dallas, and associates.
Dr. Butt and associates performed a review of lung biopsies from 17 patients (13 men; median age, 35 years) with a history of vaping and either suspected or confirmed vaping-associated lung injury. All cases showed patterns of acute lung injury, including acute fibrinous pneumonitis, diffuse alveolar damage, or organizing pneumonia, the authors noted in a letter to the editor published in the New England Journal of Medicine.
While no histologic findings were specific, foamy macrophages and pneumocyte vacuolization were seen in all cases, the authors added. Pigmented macrophages were occasionally present but not dominant, neutrophils were often prominent, eosinophils were rare, and granulomas were not seen. Two patients eventually died, despite treatment with glucocorticoids and maximum supportive care.
“None of our cases showed histologic evidence of exogenous lipoid pneumonia and no radiologic evidence thereof has been found; this calls into question the diagnostic utility of identifying lipid-laden macrophages or performing oil red O staining on bronchioloalveolar lavage fluid as a marker of vaping-associated lung injury, as has been proposed,” Dr. Butt and associates wrote.
No conflicts of interest were reported.
SOURCE: Butt YM et al. N Engl J Med. 2019 Oct 2. doi: 10.1056/NEJMc1913069.
FROM THE NEW ENGLAND JOURNAL OF MEDICINE
Measles 2019: Most cases occurred in close-knit, undervaccinated communities
While 22 outbreaks were reported in 17 states during 2019, the majority of measles cases occurred in a pair of outbreaks that started in late 2018, one in New York City and the other in New York state. Theses two outbreaks, which occurred in underimmunized, close-knit communities, accounted for 934 (75%) of the 2019 total. An additional six outbreaks in similar communities accounted for nearly half of the remaining reported cases.
The overall median patient age was 6 years, with 31% being children aged 1-4 years, 27% being school-age children aged 5-17 years, and 29% were adults aged at least 18 years. However, when excluding the New York City (NYC) and New York state outbreaks, the median patient age was 19 years. Outbreak length also differed significantly between the NYC and New York state outbreaks, compared with all other outbreaks; the NYC outbreak lasted for 9.5 months, involving 702 patients from start to finish, the New York state outbreak lasted for 10.5 months and involved 412 cases.
The rate of patients who were either unvaccinated or had unknown vaccination status was similar in the New York outbreaks and in the other U.S. outbreaks, ranging from 87% to 91%. A total of 119 patients were hospitalized, 20% of whom were younger than 1 year; no deaths were reported. A total of 81 cases were internationally imported; the rate of patients who were unvaccinated or had unknown status in this group was 90%.
While most outbreaks in 2019 were similar to those previously seen, the outbreaks in NYC and New York state were more sustained for three reasons, the CDC investigators said: pockets of low vaccination coverage and variable vaccine acceptance, relatively high population density and closed social nature of the community, and repeated importations of measles cases among unvaccinated persons traveling internationally and returning to or visiting the affected communities.
“Public health authorities need to identify pockets of undervaccinated persons to prevent these outbreaks, which require substantial resources to control. A preventive strategy to build vaccine confidence is important, especially one that uses culturally appropriate communication strategies to offset misinformation and disseminate accurate information about the safety and importance of vaccination in advance of outbreaks,” the CDC investigators concluded.
The CDC investigators reported that they had no conflicts of interest.
[email protected]
SOURCE: Patel M et al. MMWR Morb Mortal Wkly Rep. 2019 Oct 4. doi: 10.15585/mmwr.mm6840e2.
While 22 outbreaks were reported in 17 states during 2019, the majority of measles cases occurred in a pair of outbreaks that started in late 2018, one in New York City and the other in New York state. Theses two outbreaks, which occurred in underimmunized, close-knit communities, accounted for 934 (75%) of the 2019 total. An additional six outbreaks in similar communities accounted for nearly half of the remaining reported cases.
The overall median patient age was 6 years, with 31% being children aged 1-4 years, 27% being school-age children aged 5-17 years, and 29% were adults aged at least 18 years. However, when excluding the New York City (NYC) and New York state outbreaks, the median patient age was 19 years. Outbreak length also differed significantly between the NYC and New York state outbreaks, compared with all other outbreaks; the NYC outbreak lasted for 9.5 months, involving 702 patients from start to finish, the New York state outbreak lasted for 10.5 months and involved 412 cases.
The rate of patients who were either unvaccinated or had unknown vaccination status was similar in the New York outbreaks and in the other U.S. outbreaks, ranging from 87% to 91%. A total of 119 patients were hospitalized, 20% of whom were younger than 1 year; no deaths were reported. A total of 81 cases were internationally imported; the rate of patients who were unvaccinated or had unknown status in this group was 90%.
While most outbreaks in 2019 were similar to those previously seen, the outbreaks in NYC and New York state were more sustained for three reasons, the CDC investigators said: pockets of low vaccination coverage and variable vaccine acceptance, relatively high population density and closed social nature of the community, and repeated importations of measles cases among unvaccinated persons traveling internationally and returning to or visiting the affected communities.
“Public health authorities need to identify pockets of undervaccinated persons to prevent these outbreaks, which require substantial resources to control. A preventive strategy to build vaccine confidence is important, especially one that uses culturally appropriate communication strategies to offset misinformation and disseminate accurate information about the safety and importance of vaccination in advance of outbreaks,” the CDC investigators concluded.
The CDC investigators reported that they had no conflicts of interest.
[email protected]
SOURCE: Patel M et al. MMWR Morb Mortal Wkly Rep. 2019 Oct 4. doi: 10.15585/mmwr.mm6840e2.
While 22 outbreaks were reported in 17 states during 2019, the majority of measles cases occurred in a pair of outbreaks that started in late 2018, one in New York City and the other in New York state. Theses two outbreaks, which occurred in underimmunized, close-knit communities, accounted for 934 (75%) of the 2019 total. An additional six outbreaks in similar communities accounted for nearly half of the remaining reported cases.
The overall median patient age was 6 years, with 31% being children aged 1-4 years, 27% being school-age children aged 5-17 years, and 29% were adults aged at least 18 years. However, when excluding the New York City (NYC) and New York state outbreaks, the median patient age was 19 years. Outbreak length also differed significantly between the NYC and New York state outbreaks, compared with all other outbreaks; the NYC outbreak lasted for 9.5 months, involving 702 patients from start to finish, the New York state outbreak lasted for 10.5 months and involved 412 cases.
The rate of patients who were either unvaccinated or had unknown vaccination status was similar in the New York outbreaks and in the other U.S. outbreaks, ranging from 87% to 91%. A total of 119 patients were hospitalized, 20% of whom were younger than 1 year; no deaths were reported. A total of 81 cases were internationally imported; the rate of patients who were unvaccinated or had unknown status in this group was 90%.
While most outbreaks in 2019 were similar to those previously seen, the outbreaks in NYC and New York state were more sustained for three reasons, the CDC investigators said: pockets of low vaccination coverage and variable vaccine acceptance, relatively high population density and closed social nature of the community, and repeated importations of measles cases among unvaccinated persons traveling internationally and returning to or visiting the affected communities.
“Public health authorities need to identify pockets of undervaccinated persons to prevent these outbreaks, which require substantial resources to control. A preventive strategy to build vaccine confidence is important, especially one that uses culturally appropriate communication strategies to offset misinformation and disseminate accurate information about the safety and importance of vaccination in advance of outbreaks,” the CDC investigators concluded.
The CDC investigators reported that they had no conflicts of interest.
[email protected]
SOURCE: Patel M et al. MMWR Morb Mortal Wkly Rep. 2019 Oct 4. doi: 10.15585/mmwr.mm6840e2.
FROM THE MMWR
Neanderthal otitis media and why you can’t chillax
Dude, just chill out and relax ... or not
It’s been a tough week. You’ve struggled to get all your work done on time, you’ve had to put in long hours, you’re exhausted and stressed out, and you know that next week will be just as tough. But for now, it’s the weekend. Time to relax, right?
According to research from Penn State University published in the Journal of Affective Disorders, if you have anxiety disorder, not only will you have difficulty relaxing (hence the anxiety disorder), you may actually actively resist it, experiencing something called “relaxation-induced anxiety.”
The researchers recruited a group of students, some with anxiety disorder, some with major depressive disorder, and a control group, and administered a series of relaxation exercises both before and after watching a series of potentially upsetting videos. The people with anxiety disorders were more likely to experience spikes of negative emotion after the second relaxation exercise than the other two groups; these spikes were linked to a feeling of anxiety during relaxation exercise.
The researchers theorized that people with anxiety disorder were attempting to avoid large jumps in their stress level by remaining stressed at all times. But the investigators also noted that experiencing a range of emotions is natural and far healthier.
So, as annoying as it is to suffer through constant “stop worrying, just live in the moment” speeches from that one dudebro acquaintance who spends all his free time partying, he does have a point. We don’t recommend participating in the Edward Fortyhands game, though. Leave that to your “friend.” He’s used to it.
A salty surgeon general’s warning
Grab a pack of Marlboro Reds at the corner convenience store, and you’ll find the iconic red and white box adorned with dire warnings from the surgeon general.
Grab a salt shaker at the corner diner, and you’ll find ... salt. In a shaker. Perhaps adorned with the red residue from a prior diner’s ketchup addiction.
The World Hypertension League would like to make that salt shaker look a lot more like those Marlboros.
In a position statement in the Journal of Clinical Hypertension, the league outlined the case for giving sodium chloride the cancer-stick treatment. Exhibit A: “Unhealthy diets are a leading cause of death globally, and excess salt consumption is the biggest culprit, estimated to cause over 3 million deaths globally in 2017.”
Despite that tobacco-rivaling body count, the league says no country has demanded that salt containers wear warning labels.
But isn’t it enough to list sodium levels on food labels? Well, when’s the last time you studied the salty facts before binging on that entire party-size bag of Cheetos, Chester? (You’ll be hotboxing 4,500 mg of sodium, by the way.) The league rests its case.
What’s needed is a message that stops you mid fistful. It’s time to add warning labels to all salt packaging, implores the league. Even to that communal salt shaker. Helpfully, the league’s offering suggested wording for that harbinger-of-doom missive: “Excess sodium can cause high blood pressure and promote stomach cancer. Limit your use.”
Catchy, right? But we at the Bureau of LOTME believe a picture is worth a thousand words of warning. Which is why we’ve taped a simple biohazard logo to our office Cheetos stash. Because of the sodium, you ask? Hardly. But just imagine that much optic-orange food coloring finding its way into the groundwater.
The anatomy of extinction
Barely a day goes by without a new theory about What Killed the Dinosaurs. A meteor killed the dinosaurs. Volcanoes killed the dinosaurs. Donald Trump asked the Ukrainians to kill the dinosaurs. Hilary Clinton’s emails killed the dinosaurs. Donald Trump asked the Australians to say that Robert Mueller killed the dinosaurs. The liberal media are covering up the existence of dinosaurs.
Enough already. What about the primates? We humans are still around – at least for the time being. But when was the last time you heard a good theory about what killed the Neanderthals?
Well, hang on to your earmuffs, because here comes one now.
Researchers have reconstructed the Neanderthal Eustachian tubes and determined that those early rivals of Homo sapiens were done in by … chronic ear infections.
The Neanderthal Eustachian tubes were very similar to those of human infants, and “middle ear infections are nearly ubiquitous among infants because the flat angle of an infant’s Eustachian tubes is prone to retain the otitis media bacteria that cause these infections – the same flat angle we found in Neanderthals,” coauthor Samuel Márquez, PhD, of the State University of New York said in a statement.
Unlike modern humans, however, the Neanderthal eustachian tube did not change with age, so middle ear infections were a lifelong threat.
“It’s not just the threat of dying of an infection,” said Dr. Márquez. “If you are constantly ill, you would not be as fit and effective in competing with your Homo sapiens cousins for food and other resources. In a world of survival of the fittest, it is no wonder that modern man, not Neanderthal, prevailed.”
In other words, it wasn’t brains that beat the big, bad Neanderthals; it was their own baby ears.
H. sapiens, raise a glass: Ears to you, Charles Darwin.
Dude, just chill out and relax ... or not
It’s been a tough week. You’ve struggled to get all your work done on time, you’ve had to put in long hours, you’re exhausted and stressed out, and you know that next week will be just as tough. But for now, it’s the weekend. Time to relax, right?
According to research from Penn State University published in the Journal of Affective Disorders, if you have anxiety disorder, not only will you have difficulty relaxing (hence the anxiety disorder), you may actually actively resist it, experiencing something called “relaxation-induced anxiety.”
The researchers recruited a group of students, some with anxiety disorder, some with major depressive disorder, and a control group, and administered a series of relaxation exercises both before and after watching a series of potentially upsetting videos. The people with anxiety disorders were more likely to experience spikes of negative emotion after the second relaxation exercise than the other two groups; these spikes were linked to a feeling of anxiety during relaxation exercise.
The researchers theorized that people with anxiety disorder were attempting to avoid large jumps in their stress level by remaining stressed at all times. But the investigators also noted that experiencing a range of emotions is natural and far healthier.
So, as annoying as it is to suffer through constant “stop worrying, just live in the moment” speeches from that one dudebro acquaintance who spends all his free time partying, he does have a point. We don’t recommend participating in the Edward Fortyhands game, though. Leave that to your “friend.” He’s used to it.
A salty surgeon general’s warning
Grab a pack of Marlboro Reds at the corner convenience store, and you’ll find the iconic red and white box adorned with dire warnings from the surgeon general.
Grab a salt shaker at the corner diner, and you’ll find ... salt. In a shaker. Perhaps adorned with the red residue from a prior diner’s ketchup addiction.
The World Hypertension League would like to make that salt shaker look a lot more like those Marlboros.
In a position statement in the Journal of Clinical Hypertension, the league outlined the case for giving sodium chloride the cancer-stick treatment. Exhibit A: “Unhealthy diets are a leading cause of death globally, and excess salt consumption is the biggest culprit, estimated to cause over 3 million deaths globally in 2017.”
Despite that tobacco-rivaling body count, the league says no country has demanded that salt containers wear warning labels.
But isn’t it enough to list sodium levels on food labels? Well, when’s the last time you studied the salty facts before binging on that entire party-size bag of Cheetos, Chester? (You’ll be hotboxing 4,500 mg of sodium, by the way.) The league rests its case.
What’s needed is a message that stops you mid fistful. It’s time to add warning labels to all salt packaging, implores the league. Even to that communal salt shaker. Helpfully, the league’s offering suggested wording for that harbinger-of-doom missive: “Excess sodium can cause high blood pressure and promote stomach cancer. Limit your use.”
Catchy, right? But we at the Bureau of LOTME believe a picture is worth a thousand words of warning. Which is why we’ve taped a simple biohazard logo to our office Cheetos stash. Because of the sodium, you ask? Hardly. But just imagine that much optic-orange food coloring finding its way into the groundwater.
The anatomy of extinction
Barely a day goes by without a new theory about What Killed the Dinosaurs. A meteor killed the dinosaurs. Volcanoes killed the dinosaurs. Donald Trump asked the Ukrainians to kill the dinosaurs. Hilary Clinton’s emails killed the dinosaurs. Donald Trump asked the Australians to say that Robert Mueller killed the dinosaurs. The liberal media are covering up the existence of dinosaurs.
Enough already. What about the primates? We humans are still around – at least for the time being. But when was the last time you heard a good theory about what killed the Neanderthals?
Well, hang on to your earmuffs, because here comes one now.
Researchers have reconstructed the Neanderthal Eustachian tubes and determined that those early rivals of Homo sapiens were done in by … chronic ear infections.
The Neanderthal Eustachian tubes were very similar to those of human infants, and “middle ear infections are nearly ubiquitous among infants because the flat angle of an infant’s Eustachian tubes is prone to retain the otitis media bacteria that cause these infections – the same flat angle we found in Neanderthals,” coauthor Samuel Márquez, PhD, of the State University of New York said in a statement.
Unlike modern humans, however, the Neanderthal eustachian tube did not change with age, so middle ear infections were a lifelong threat.
“It’s not just the threat of dying of an infection,” said Dr. Márquez. “If you are constantly ill, you would not be as fit and effective in competing with your Homo sapiens cousins for food and other resources. In a world of survival of the fittest, it is no wonder that modern man, not Neanderthal, prevailed.”
In other words, it wasn’t brains that beat the big, bad Neanderthals; it was their own baby ears.
H. sapiens, raise a glass: Ears to you, Charles Darwin.
Dude, just chill out and relax ... or not
It’s been a tough week. You’ve struggled to get all your work done on time, you’ve had to put in long hours, you’re exhausted and stressed out, and you know that next week will be just as tough. But for now, it’s the weekend. Time to relax, right?
According to research from Penn State University published in the Journal of Affective Disorders, if you have anxiety disorder, not only will you have difficulty relaxing (hence the anxiety disorder), you may actually actively resist it, experiencing something called “relaxation-induced anxiety.”
The researchers recruited a group of students, some with anxiety disorder, some with major depressive disorder, and a control group, and administered a series of relaxation exercises both before and after watching a series of potentially upsetting videos. The people with anxiety disorders were more likely to experience spikes of negative emotion after the second relaxation exercise than the other two groups; these spikes were linked to a feeling of anxiety during relaxation exercise.
The researchers theorized that people with anxiety disorder were attempting to avoid large jumps in their stress level by remaining stressed at all times. But the investigators also noted that experiencing a range of emotions is natural and far healthier.
So, as annoying as it is to suffer through constant “stop worrying, just live in the moment” speeches from that one dudebro acquaintance who spends all his free time partying, he does have a point. We don’t recommend participating in the Edward Fortyhands game, though. Leave that to your “friend.” He’s used to it.
A salty surgeon general’s warning
Grab a pack of Marlboro Reds at the corner convenience store, and you’ll find the iconic red and white box adorned with dire warnings from the surgeon general.
Grab a salt shaker at the corner diner, and you’ll find ... salt. In a shaker. Perhaps adorned with the red residue from a prior diner’s ketchup addiction.
The World Hypertension League would like to make that salt shaker look a lot more like those Marlboros.
In a position statement in the Journal of Clinical Hypertension, the league outlined the case for giving sodium chloride the cancer-stick treatment. Exhibit A: “Unhealthy diets are a leading cause of death globally, and excess salt consumption is the biggest culprit, estimated to cause over 3 million deaths globally in 2017.”
Despite that tobacco-rivaling body count, the league says no country has demanded that salt containers wear warning labels.
But isn’t it enough to list sodium levels on food labels? Well, when’s the last time you studied the salty facts before binging on that entire party-size bag of Cheetos, Chester? (You’ll be hotboxing 4,500 mg of sodium, by the way.) The league rests its case.
What’s needed is a message that stops you mid fistful. It’s time to add warning labels to all salt packaging, implores the league. Even to that communal salt shaker. Helpfully, the league’s offering suggested wording for that harbinger-of-doom missive: “Excess sodium can cause high blood pressure and promote stomach cancer. Limit your use.”
Catchy, right? But we at the Bureau of LOTME believe a picture is worth a thousand words of warning. Which is why we’ve taped a simple biohazard logo to our office Cheetos stash. Because of the sodium, you ask? Hardly. But just imagine that much optic-orange food coloring finding its way into the groundwater.
The anatomy of extinction
Barely a day goes by without a new theory about What Killed the Dinosaurs. A meteor killed the dinosaurs. Volcanoes killed the dinosaurs. Donald Trump asked the Ukrainians to kill the dinosaurs. Hilary Clinton’s emails killed the dinosaurs. Donald Trump asked the Australians to say that Robert Mueller killed the dinosaurs. The liberal media are covering up the existence of dinosaurs.
Enough already. What about the primates? We humans are still around – at least for the time being. But when was the last time you heard a good theory about what killed the Neanderthals?
Well, hang on to your earmuffs, because here comes one now.
Researchers have reconstructed the Neanderthal Eustachian tubes and determined that those early rivals of Homo sapiens were done in by … chronic ear infections.
The Neanderthal Eustachian tubes were very similar to those of human infants, and “middle ear infections are nearly ubiquitous among infants because the flat angle of an infant’s Eustachian tubes is prone to retain the otitis media bacteria that cause these infections – the same flat angle we found in Neanderthals,” coauthor Samuel Márquez, PhD, of the State University of New York said in a statement.
Unlike modern humans, however, the Neanderthal eustachian tube did not change with age, so middle ear infections were a lifelong threat.
“It’s not just the threat of dying of an infection,” said Dr. Márquez. “If you are constantly ill, you would not be as fit and effective in competing with your Homo sapiens cousins for food and other resources. In a world of survival of the fittest, it is no wonder that modern man, not Neanderthal, prevailed.”
In other words, it wasn’t brains that beat the big, bad Neanderthals; it was their own baby ears.
H. sapiens, raise a glass: Ears to you, Charles Darwin.
FDA adds diabetic kidney disease, heart failure indications to canagliflozin
The Food and Drug Administration has approved canagliflozin (Invokana) for the treatment of diabetic kidney disease and for reduction of the risk of hospitalization for heart failure in patients with type 2 diabetes and diabetic kidney disease, which makes it the first drug indicated for diabetic kidney disease treatment in 20 years.
FDA approval, which was announced in a press release by Janssen, the drug’s manufacturer, is based on results from the phase 3 CREDENCE trial. In that study patients with type 2 diabetes and chronic diabetic kidney disease received either 100 mg canagliflozin or placebo. Patients who received canagliflozin experienced a 30% reduction in the risk of the primary composite endpoint, which included end-stage kidney disease, doubling of serum creatinine, and renal or cardiovascular death. The risk of secondary outcomes were also reduced in patients receiving canagliflozin, including a 39% reduction in the risk of hospitalization for heart failure.
The most common adverse events associated with canagliflozin, according to the label, are female genital mycotic infections, urinary tract infection, and increased urination. Serious adverse events associated with canagliflozin include ketoacidosis, kidney problems, serious urinary tract infections, hypoglycemia, necrotizing fasciitis, serious allergic reaction, and bone fractures.
“The real battle to turn the tide on kidney disease is in early detection and slowing its progression so that patients stay healthier and fewer patients reach kidney failure,” LaVerne A. Burton, president and CEO of the American Kidney Fund, said in the press release. “We are so grateful that advances in kidney disease research are producing treatment options that help to slow the progression of diabetic kidney disease and reduce the risk of hospitalization for heart failure.”
Find the full press release on the Janssen website.
The Food and Drug Administration has approved canagliflozin (Invokana) for the treatment of diabetic kidney disease and for reduction of the risk of hospitalization for heart failure in patients with type 2 diabetes and diabetic kidney disease, which makes it the first drug indicated for diabetic kidney disease treatment in 20 years.
FDA approval, which was announced in a press release by Janssen, the drug’s manufacturer, is based on results from the phase 3 CREDENCE trial. In that study patients with type 2 diabetes and chronic diabetic kidney disease received either 100 mg canagliflozin or placebo. Patients who received canagliflozin experienced a 30% reduction in the risk of the primary composite endpoint, which included end-stage kidney disease, doubling of serum creatinine, and renal or cardiovascular death. The risk of secondary outcomes were also reduced in patients receiving canagliflozin, including a 39% reduction in the risk of hospitalization for heart failure.
The most common adverse events associated with canagliflozin, according to the label, are female genital mycotic infections, urinary tract infection, and increased urination. Serious adverse events associated with canagliflozin include ketoacidosis, kidney problems, serious urinary tract infections, hypoglycemia, necrotizing fasciitis, serious allergic reaction, and bone fractures.
“The real battle to turn the tide on kidney disease is in early detection and slowing its progression so that patients stay healthier and fewer patients reach kidney failure,” LaVerne A. Burton, president and CEO of the American Kidney Fund, said in the press release. “We are so grateful that advances in kidney disease research are producing treatment options that help to slow the progression of diabetic kidney disease and reduce the risk of hospitalization for heart failure.”
Find the full press release on the Janssen website.
The Food and Drug Administration has approved canagliflozin (Invokana) for the treatment of diabetic kidney disease and for reduction of the risk of hospitalization for heart failure in patients with type 2 diabetes and diabetic kidney disease, which makes it the first drug indicated for diabetic kidney disease treatment in 20 years.
FDA approval, which was announced in a press release by Janssen, the drug’s manufacturer, is based on results from the phase 3 CREDENCE trial. In that study patients with type 2 diabetes and chronic diabetic kidney disease received either 100 mg canagliflozin or placebo. Patients who received canagliflozin experienced a 30% reduction in the risk of the primary composite endpoint, which included end-stage kidney disease, doubling of serum creatinine, and renal or cardiovascular death. The risk of secondary outcomes were also reduced in patients receiving canagliflozin, including a 39% reduction in the risk of hospitalization for heart failure.
The most common adverse events associated with canagliflozin, according to the label, are female genital mycotic infections, urinary tract infection, and increased urination. Serious adverse events associated with canagliflozin include ketoacidosis, kidney problems, serious urinary tract infections, hypoglycemia, necrotizing fasciitis, serious allergic reaction, and bone fractures.
“The real battle to turn the tide on kidney disease is in early detection and slowing its progression so that patients stay healthier and fewer patients reach kidney failure,” LaVerne A. Burton, president and CEO of the American Kidney Fund, said in the press release. “We are so grateful that advances in kidney disease research are producing treatment options that help to slow the progression of diabetic kidney disease and reduce the risk of hospitalization for heart failure.”
Find the full press release on the Janssen website.
Universal ASD screening is feasible, but M-CHAT/F underperforms
, especially in children of color and in those from lower-income households, new research found.
Guidelines for universal autism spectrum disorder (ASD) screening currently conflict, Whitney Guthrie, PhD, of the Children’s Hospital of Philadelphia, and associates wrote in Pediatrics. The American Academy of Pediatrics recommends universal screening in children aged 18 months and 24 months to expedite earlier identification and diagnosis. However, the U.S. Preventive Services Task Force has concluded that “there is insufficient evidence to recommend universal screening, in part because of limited data on outcomes for children who screen negative and from diverse samples.”
Dr. Guthrie and associates conducted a study of 25,999 children aged 16-26 months who had a well-child visit between January 2011 and July 2015 at a Children’s Hospital of Philadelphia site that had implemented universal electronic screening. Of this group, 43% were white, 37% were black, and the remainder were Asian or of other/multiple races; 92% were non-Hispanic. The median parental income was $59,597, 54% had private insurance and 45.3% had public insurance/Medicaid, and 42% came from an urban primary care site while the rest came from suburban primary care.
Screening rates were good over the study period, with 91% of children undergoing at least one screen with the Modified Checklist for Autism in Toddlers with Follow-Up (M-CHAT/F). While 50% were screened more than once, only 48% of children were screened at 18 and 24 months, as per the AAP guideline. Children who were screened multiple times were more likely to be white and non-Hispanic, to be from a suburban site, and to have higher incomes and private insurance.
After the first M-CHAT/F screen, 9.5% of children were positive, a rate comparable with that seen in other large-scale, U.S.-based studies. Of the 2,256 children who tested positive, 41% received a second screen; 782 (95%) of these children tested negative.
After the study period, most children (n = 20,437; 87%) continued receiving care with the Children’s Hospital of Philadelphia system and had diagnostic data available past the age of 4 years. ASD prevalence was 2%, giving the M-CHAT/F a sensitivity of 39%, a specificity of 95%, a positive predictive value of 15%, and a negative predictive value of 99%.
M-CHAT/F sensitivity was higher in older children (49% at 21-26 months vs. 35% at 16-20 months) and with repeated screenings (40% vs. 32%), and positive predictive value was lower in girls (8% vs. 20%). Specificity and positive predictive value were higher in white children (98% and 24%, respectively), compared with black children (92% and 12%, respectively), Asian children (90% and 11%, respectively), and those from other/multiple racial groups (94% and 13%, respectively). Higher-income families also saw increased specificity (97% vs. 92%) and positive predictive value (20% vs. 12%), compared with lower-income families.
While Dr. Guthrie and associates wrote of new methods of screening, such as parental reporting tools supported by picture or video and “direct data-gathering methods that leverage technological advances in computing and machine learning,” Lonnie Zwaigenbaum, MD, MSc, and Jonathon Maguire, MD, MSc, argued in an editorial, also published in Pediatrics, that the M-CHAT/F “remains a strong candidate” for universal ASD screening, despite the notable weaknesses.
“Ultimately, the potential added value of ASD screening must be considered relative to what would occur in its absence,” wrote Dr. Zwaigenbaum of the Women’s and Children’s Health Research Institute at the University of Alberta, Edmonton, and Dr. Maguire of St Michael’s Hospital, Toronto, and the University of Toronto. “Although it is difficult to object to the guidance from the U.S. Preventive Services Task Force to listen carefully to parents’ concerns, we must acknowledge the false dichotomy between screening and surveillance in this context. ... Why not use the best available measurement tools to identify developmental concerns with the highest possible accuracy?”
The study was funded by the Allerton Foundation, Eagles Charitable Foundation, and the National Institute of Mental Health; the study investigators reported that they had no conflicts of interest. Dr. Zwaigenbaum is a member of an independent data monitoring committee for a Roche-funded medication trial and Dr. Maguire reported receiving nonfinancial support from Ddrops for an investigator-initiated study on vitamin D and respiratory tract infections. Dr Zwaigenbaum is supported by the Stollery Children’s Hospital Foundation Chair in Autism Research. Dr Maguire is supported by St. Michael’s Hospital and the Hospital for Sick Children.
SOURCEs: Guthrie W et al. Pediatrics. 2019 Sep 27. doi: 10.1542/peds.2018-3963; Zwaigenbaum L, Maguire J. Pediatrics. 2019 Sep 27. doi: 10.1542/peds.2019-0925.
, especially in children of color and in those from lower-income households, new research found.
Guidelines for universal autism spectrum disorder (ASD) screening currently conflict, Whitney Guthrie, PhD, of the Children’s Hospital of Philadelphia, and associates wrote in Pediatrics. The American Academy of Pediatrics recommends universal screening in children aged 18 months and 24 months to expedite earlier identification and diagnosis. However, the U.S. Preventive Services Task Force has concluded that “there is insufficient evidence to recommend universal screening, in part because of limited data on outcomes for children who screen negative and from diverse samples.”
Dr. Guthrie and associates conducted a study of 25,999 children aged 16-26 months who had a well-child visit between January 2011 and July 2015 at a Children’s Hospital of Philadelphia site that had implemented universal electronic screening. Of this group, 43% were white, 37% were black, and the remainder were Asian or of other/multiple races; 92% were non-Hispanic. The median parental income was $59,597, 54% had private insurance and 45.3% had public insurance/Medicaid, and 42% came from an urban primary care site while the rest came from suburban primary care.
Screening rates were good over the study period, with 91% of children undergoing at least one screen with the Modified Checklist for Autism in Toddlers with Follow-Up (M-CHAT/F). While 50% were screened more than once, only 48% of children were screened at 18 and 24 months, as per the AAP guideline. Children who were screened multiple times were more likely to be white and non-Hispanic, to be from a suburban site, and to have higher incomes and private insurance.
After the first M-CHAT/F screen, 9.5% of children were positive, a rate comparable with that seen in other large-scale, U.S.-based studies. Of the 2,256 children who tested positive, 41% received a second screen; 782 (95%) of these children tested negative.
After the study period, most children (n = 20,437; 87%) continued receiving care with the Children’s Hospital of Philadelphia system and had diagnostic data available past the age of 4 years. ASD prevalence was 2%, giving the M-CHAT/F a sensitivity of 39%, a specificity of 95%, a positive predictive value of 15%, and a negative predictive value of 99%.
M-CHAT/F sensitivity was higher in older children (49% at 21-26 months vs. 35% at 16-20 months) and with repeated screenings (40% vs. 32%), and positive predictive value was lower in girls (8% vs. 20%). Specificity and positive predictive value were higher in white children (98% and 24%, respectively), compared with black children (92% and 12%, respectively), Asian children (90% and 11%, respectively), and those from other/multiple racial groups (94% and 13%, respectively). Higher-income families also saw increased specificity (97% vs. 92%) and positive predictive value (20% vs. 12%), compared with lower-income families.
While Dr. Guthrie and associates wrote of new methods of screening, such as parental reporting tools supported by picture or video and “direct data-gathering methods that leverage technological advances in computing and machine learning,” Lonnie Zwaigenbaum, MD, MSc, and Jonathon Maguire, MD, MSc, argued in an editorial, also published in Pediatrics, that the M-CHAT/F “remains a strong candidate” for universal ASD screening, despite the notable weaknesses.
“Ultimately, the potential added value of ASD screening must be considered relative to what would occur in its absence,” wrote Dr. Zwaigenbaum of the Women’s and Children’s Health Research Institute at the University of Alberta, Edmonton, and Dr. Maguire of St Michael’s Hospital, Toronto, and the University of Toronto. “Although it is difficult to object to the guidance from the U.S. Preventive Services Task Force to listen carefully to parents’ concerns, we must acknowledge the false dichotomy between screening and surveillance in this context. ... Why not use the best available measurement tools to identify developmental concerns with the highest possible accuracy?”
The study was funded by the Allerton Foundation, Eagles Charitable Foundation, and the National Institute of Mental Health; the study investigators reported that they had no conflicts of interest. Dr. Zwaigenbaum is a member of an independent data monitoring committee for a Roche-funded medication trial and Dr. Maguire reported receiving nonfinancial support from Ddrops for an investigator-initiated study on vitamin D and respiratory tract infections. Dr Zwaigenbaum is supported by the Stollery Children’s Hospital Foundation Chair in Autism Research. Dr Maguire is supported by St. Michael’s Hospital and the Hospital for Sick Children.
SOURCEs: Guthrie W et al. Pediatrics. 2019 Sep 27. doi: 10.1542/peds.2018-3963; Zwaigenbaum L, Maguire J. Pediatrics. 2019 Sep 27. doi: 10.1542/peds.2019-0925.
, especially in children of color and in those from lower-income households, new research found.
Guidelines for universal autism spectrum disorder (ASD) screening currently conflict, Whitney Guthrie, PhD, of the Children’s Hospital of Philadelphia, and associates wrote in Pediatrics. The American Academy of Pediatrics recommends universal screening in children aged 18 months and 24 months to expedite earlier identification and diagnosis. However, the U.S. Preventive Services Task Force has concluded that “there is insufficient evidence to recommend universal screening, in part because of limited data on outcomes for children who screen negative and from diverse samples.”
Dr. Guthrie and associates conducted a study of 25,999 children aged 16-26 months who had a well-child visit between January 2011 and July 2015 at a Children’s Hospital of Philadelphia site that had implemented universal electronic screening. Of this group, 43% were white, 37% were black, and the remainder were Asian or of other/multiple races; 92% were non-Hispanic. The median parental income was $59,597, 54% had private insurance and 45.3% had public insurance/Medicaid, and 42% came from an urban primary care site while the rest came from suburban primary care.
Screening rates were good over the study period, with 91% of children undergoing at least one screen with the Modified Checklist for Autism in Toddlers with Follow-Up (M-CHAT/F). While 50% were screened more than once, only 48% of children were screened at 18 and 24 months, as per the AAP guideline. Children who were screened multiple times were more likely to be white and non-Hispanic, to be from a suburban site, and to have higher incomes and private insurance.
After the first M-CHAT/F screen, 9.5% of children were positive, a rate comparable with that seen in other large-scale, U.S.-based studies. Of the 2,256 children who tested positive, 41% received a second screen; 782 (95%) of these children tested negative.
After the study period, most children (n = 20,437; 87%) continued receiving care with the Children’s Hospital of Philadelphia system and had diagnostic data available past the age of 4 years. ASD prevalence was 2%, giving the M-CHAT/F a sensitivity of 39%, a specificity of 95%, a positive predictive value of 15%, and a negative predictive value of 99%.
M-CHAT/F sensitivity was higher in older children (49% at 21-26 months vs. 35% at 16-20 months) and with repeated screenings (40% vs. 32%), and positive predictive value was lower in girls (8% vs. 20%). Specificity and positive predictive value were higher in white children (98% and 24%, respectively), compared with black children (92% and 12%, respectively), Asian children (90% and 11%, respectively), and those from other/multiple racial groups (94% and 13%, respectively). Higher-income families also saw increased specificity (97% vs. 92%) and positive predictive value (20% vs. 12%), compared with lower-income families.
While Dr. Guthrie and associates wrote of new methods of screening, such as parental reporting tools supported by picture or video and “direct data-gathering methods that leverage technological advances in computing and machine learning,” Lonnie Zwaigenbaum, MD, MSc, and Jonathon Maguire, MD, MSc, argued in an editorial, also published in Pediatrics, that the M-CHAT/F “remains a strong candidate” for universal ASD screening, despite the notable weaknesses.
“Ultimately, the potential added value of ASD screening must be considered relative to what would occur in its absence,” wrote Dr. Zwaigenbaum of the Women’s and Children’s Health Research Institute at the University of Alberta, Edmonton, and Dr. Maguire of St Michael’s Hospital, Toronto, and the University of Toronto. “Although it is difficult to object to the guidance from the U.S. Preventive Services Task Force to listen carefully to parents’ concerns, we must acknowledge the false dichotomy between screening and surveillance in this context. ... Why not use the best available measurement tools to identify developmental concerns with the highest possible accuracy?”
The study was funded by the Allerton Foundation, Eagles Charitable Foundation, and the National Institute of Mental Health; the study investigators reported that they had no conflicts of interest. Dr. Zwaigenbaum is a member of an independent data monitoring committee for a Roche-funded medication trial and Dr. Maguire reported receiving nonfinancial support from Ddrops for an investigator-initiated study on vitamin D and respiratory tract infections. Dr Zwaigenbaum is supported by the Stollery Children’s Hospital Foundation Chair in Autism Research. Dr Maguire is supported by St. Michael’s Hospital and the Hospital for Sick Children.
SOURCEs: Guthrie W et al. Pediatrics. 2019 Sep 27. doi: 10.1542/peds.2018-3963; Zwaigenbaum L, Maguire J. Pediatrics. 2019 Sep 27. doi: 10.1542/peds.2019-0925.
FROM PEDIATRICS
Key clinical point: Universal screening for autism in a primary care setting is possible, but accuracy of the Modified Checklist for Autism in Toddlers with Follow-Up (M-CHAT/F) tool was low, especially for children of color and those from lower-income households.
Major finding: Just over 90% of children received screening, with an autism spectrum disorder prevalence of 2%. The M-CHAT/F screen had a sensitivity of 39% and a positive predictive value of 15%
Study details: A total of 25,999 children aged 16-26 months who had a well-child visit between January 2011 and July 2015 at a Children’s Hospital of Philadelphia site that had implemented universal electronic screening.
Disclosures: The study was funded by the Allerton Foundation, Eagles Charitable Foundation, the National Institute of Mental Health, and the National Institutes of Health. The study investigators reported they had no conflicts of interest. Dr. Zwaigenbaum is a member of an independent data monitoring committee for a Roche-funded medication trial and Dr. Maguire reported receiving nonfinancial support from Ddrops for an investigator-initiated study on vitamin D and respiratory tract infections. Dr. Zwaigenbaum and Dr. Maguire receive hospital-supported funding.
Sources: Guthrie W et al. Pediatrics. 2019 Sep 27. doi: 10.1542/peds.2018-3963; Zwaigenbaum L, Maguire J. Pediatrics. 2019 Sep 27. doi: 10.1542/peds.2019-0925.