University of Pittsburgh study: High social support associated with less violence among male teens in urban neighborhoods

15 Sep

Denise Williams had a hit with a catchy little tune, “let’s hear it for the boy.” The question for many parents and schools is how are boys doing? Boy Crisis is an organization which examines challenges faced by boys. According to Boy Crisis:

WHAT IS THE BOY CRISIS?

IT’S A CRISIS OF EDUCATION.                                                                                                    Worldwide, boys are 50 percent less likely than girls to meet basic proficiency in reading, math, and science.
IT’S A CRISIS OF MENTAL HEALTH.
ADHD is on the rise. And as boys become young men, their suicide rates go from equal to girls to six times that of young women.
IT’S A CRISIS OF FATHERING.
Boys are growing up with less-involved fathers and are more likely to drop out of school, drink, do drugs, become delinquent, and end up in prison.
IT’S A CRISIS OF PURPOSE.
Boys’ old sense of purpose—being a warrior, a leader, or a sole breadwinner—is fading. Many bright boys are experiencing a “purpose void,” feeling alienated, withdrawn, and addicted to immediate gratification.
SO, WHAT IS THE BOY CRISIS?
A comprehensive blueprint for what parents, teachers, and policymakers can do to help our sons become happier, healthier men and fathers and leaders worthy of our respect…. http://boycrisis.org/

Boys face different issues than those faced by girls.

Gary Wilson wrote thoughtful article about some of the learning challenges faced by boys. Boys Barriers to Learning He lists several barriers to learning in his article.

1. Early years
a. Language development problems
b. Listening skills development
2. Writing skills and learning outcomes
A significant barrier to many boys’ learning, that begins at quite an early age and often never leaves them, is the perception that most writing that they are expected to do is largely irrelevant and unimportant….
3. Gender bias
Gender bias in everything from resources to teacher expectations has the potential to present further barriers to boys’ learning. None more so than the gender bias evident in the ways in which we talk to boys and talk to girls. We need to be ever mindful of the frequency, the nature and the quality of our interactions with boys and our interactions with girls in the classroom….A potential mismatch of teaching and learning styles to boys’ preferred ways of working continues to be a barrier for many boys….
4.Reflection and evaluation
The process of reflection is a weakness in many boys, presenting them with perhaps one of the biggest barriers of all. The inability of many boys to, for example, write evaluations, effectively stems from this weakness….
5. Self-esteem issues
Low self-esteem is clearly a very significant barrier to many boys’ achievement in school. If we were to think of the perfect time to de-motivate boys, when would that be? Some might say in the early years of education when many get their first unwelcome and never forgotten taste of failure might believe in the system… and themselves, for a while, but not for long….
6. Peer pressure
Peer pressure, or the anti-swot culture, is clearly a major barrier to many boys’ achievement. Those lucky enough to avoid it tend to be good academically, but also good at sport. This gives them a licence to work hard as they can also be ‘one of the lads’. …To me one of the most significant elements of peer pressure for boys is the impact it has on the more affective domains of the curriculum, namely expressive, creative and performing arts. It takes a lot of courage for a boy to turn up for the first day at high school carrying a violin case….
7. Talk to them!
There are many barriers to boys’ learning (I’m currently saying 31, but I’m still working on it!) and an ever-increasing multitude of strategies that we can use to address them. I firmly believe that a close examination of a school’s own circumstances is the only way to progress through this maze and that the main starting point has to be with the boys themselves. They do know all the issues around their poor levels of achievement. Talk to them first. I also believe that one of the most important strategies is to let them know you’re ‘on their case’, talking to them provides this added bonus….

If your boy has achievement problems, Wilson emphasizes that there is no one answer to address the problems. There are issues that will be specific to each child. See, https://www.garywilsonraisingboysachievement.com/publications

Science Daily reported in High social support associated with less violence among male teens in urban neighborhoods:

Among teen boys in urban neighborhoods with low resources, the presence of adult social support is linked to significantly fewer occurrences of sexual violence, youth violence and bullying, and to more positive behaviors, including school engagement and future aspirations, according to a new study from researchers at UPMC Children’s Hospital of Pittsburgh and the University of Pittsburgh School of Medicine.
The study, published today in JAMA Network Open, suggests that prevention efforts that focus on adult support can mitigate patterns of co-occurring violent behavior.
“Teen boys in urban neighborhoods are disproportionately exposed to violence and consequently are at higher risk of violence perpetration and victimization,” said the study’s senior author Alison Culyba, M.D., Ph.D., M.P.H., a physician at UPMC Children’s Hospital and assistant professor of pediatrics at Pitt’s School of Medicine. “Historically, research often has focused on a single type of violence, but our study shows that there are complex co-occurring behavior patterns and shared protective factors that we need to pay attention to.”
The researchers analyzed survey data from a recently completed sexual violence prevention trial that enrolled 866 adolescent boys aged 13- to 19-years-old from lower-resource neighborhoods in the Pittsburgh region. More than three fourths of the participants self-identified as black and six percent self-identified as Hispanic.
The survey included data on 40 “risk” and 18 “protective” behaviors that were classified into one of seven categories — youth violence, bullying, sexual and/or dating violence, violence exposure and adversities, substance use, school engagement, and career and future aspirations. The participants also rated their personal level of dependable adult social support.
When it came to the data analysis, Culyba and her colleagues took a less conventional approach. “We borrowed methods that have proven effective for large scale genetic analyses,” she said.
The analysis revealed interesting patterns. Teen boys with high social support engaged in approximately eight of the 40 risk behaviors — significantly fewer than those with low social support who engaged in around 10 risky behaviors. Those who had high social support and reported more career and future aspirations were less likely to report all types of violent behavior. In contrast, among those with low social support, school engagement was an important protective factor. Feeling happy at a school that promoted diversity was strongly correlated with fewer instances of both physical and sexual partner violence and dating abuse.
The researchers also found patterns in how different violent behaviors co-occurred. The strongest correlations were between different types of sexual violence perpetration behaviors. For example, teens who endorsed posting sexual pictures of partners were 14 times more likely to also report having coerced someone who they were going out with to have sex. On the other hand, while gang involvement was infrequently associated with violence perpetration, it was more frequently reported among those who had been exposed to sexual violence, bullying or substance use.
“Our analysis revealed how interconnected these behaviors are,” said Culyba. “By creating programs that help parents and mentors support teen boys, we may be able to reduce multiple types of violence at once.”
The authors caution that the study is limited in that the findings don’t demonstrate causative links, and further analysis of the associations is required. “It’s a starting point for beginning to understand detailed patterns of violence at a much deeper level — and for offering new opportunities for prevention,” said Culyba…. https://www.sciencedaily.com/releases/2019/09/190913111348.htm

Citation:

High social support associated with less violence among male teens in urban neighborhoods
Date: September 13, 2019
Source: University of Pittsburgh
Summary:
Researchers find that the presence of adult social support is linked to less violence among at-risk teen boys.

Journal Reference:
Alison J. Culyba, Elizabeth Miller, Steven M. Albert, Kaleab Z. Abebe. Co-occurrence of Violence-Related Risk and Protective Behaviors and Adult Support Among Male Youth in Urban Neighborhoods. JAMA Network Open, 2019; 2 (9): e1911375 DOI: 10.1001/jamanetworkopen.2019.11375

Here is the press release from the University of Pittsburgh:

NEWS RELEASE 13-SEP-2019
High social support associated with less violence among male teens in urban neighborhoods
UNIVERSITY OF PITTSBURGH
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PITTSBURGH, Sept. 13, 2019 – Among teen boys in urban neighborhoods with low resources, the presence of adult social support is linked to significantly fewer occurrences of sexual violence, youth violence and bullying, and to more positive behaviors, including school engagement and future aspirations, according to a new study from researchers at UPMC Children’s Hospital of Pittsburgh and the University of Pittsburgh School of Medicine.
The study, published today in JAMA Network Open, suggests that prevention efforts that focus on adult support can mitigate patterns of co-occurring violent behavior.
“Teen boys in urban neighborhoods are disproportionately exposed to violence and consequently are at higher risk of violence perpetration and victimization,” said the study’s senior author Alison Culyba, M.D., Ph.D., M.P.H., a physician at UPMC Children’s Hospital and assistant professor of pediatrics at Pitt’s School of Medicine. “Historically, research often has focused on a single type of violence, but our study shows that there are complex co-occurring behavior patterns and shared protective factors that we need to pay attention to.”
The researchers analyzed survey data from a recently completed sexual violence prevention trial that enrolled 866 adolescent boys aged 13- to 19-years-old from lower-resource neighborhoods in the Pittsburgh region. More than three fourths of the participants self-identified as black and six percent self-identified as Hispanic.
The survey included data on 40 “risk” and 18 “protective” behaviors that were classified into one of seven categories — youth violence, bullying, sexual and/or dating violence, violence exposure and adversities, substance use, school engagement, and career and future aspirations. The participants also rated their personal level of dependable adult social support.
When it came to the data analysis, Culyba and her colleagues took a less conventional approach. “We borrowed methods that have proven effective for large scale genetic analyses,” she said.
The analysis revealed interesting patterns. Teen boys with high social support engaged in approximately eight of the 40 risk behaviors — significantly fewer than those with low social support who engaged in around 10 risky behaviors. Those who had high social support and reported more career and future aspirations were less likely to report all types of violent behavior. In contrast, among those with low social support, school engagement was an important protective factor. Feeling happy at a school that promoted diversity was strongly correlated with fewer instances of both physical and sexual partner violence and dating abuse.
The researchers also found patterns in how different violent behaviors co-occurred. The strongest correlations were between different types of sexual violence perpetration behaviors. For example, teens who endorsed posting sexual pictures of partners were 14 times more likely to also report having coerced someone who they were going out with to have sex. On the other hand, while gang involvement was infrequently associated with violence perpetration, it was more frequently reported among those who had been exposed to sexual violence, bullying or substance use.
“Our analysis revealed how interconnected these behaviors are,” said Culyba. “By creating programs that help parents and mentors support teen boys, we may be able to reduce multiple types of violence at once.”
The authors caution that the study is limited in that the findings don’t demonstrate causative links, and further analysis of the associations is required. “It’s a starting point for beginning to understand detailed patterns of violence at a much deeper level — and for offering new opportunities for prevention,” said Culyba.
Culyba notes that the findings align with the recommendations of the Centers for Disease Control and Prevention’s Connecting the Dots Initiative, which encourages prevention programs that identify and address these common underlying factors through community involvement to keep kids safe.
###
Additional authors on the study included Elizabeth Miller, M.D., Ph.D., of Pitt and UPMC Children’s Hospital, and Steven Albert, Ph.D., and Kaleab Abebe, Ph.D., both of Pitt.
The study was funded by National Institutes of Health Grant T21 TR001856, Centers for Disease Control and Prevention grant U01CE002528, and the Children’s Hospital of Pittsburgh Foundation.
To read this release online or share it, visit http://www.upmc.com/media/news/091319-culyba-jama [when embargo lifts].
About UPMC Children’s Hospital of Pittsburgh
Regionally, nationally, and globally, UPMC Children’s Hospital of Pittsburgh is a leader in the treatment of childhood conditions and diseases, a pioneer in the development of new and improved therapies, and a top educator of the next generation of pediatricians and pediatric subspecialists. With generous community support, UPMC Children’s Hospital has fulfilled this mission since its founding in 1890. UPMC Children’s is recognized consistently for its clinical, research, educational, and advocacy-related accomplishments, including ranking in the top 10 on the 2019-2020 U.S. News & World Report Honor Roll of America’s Best Children’s Hospitals. UPMC Children’s also ranks 15th among children’s hospitals and schools of medicine in funding for pediatric research provided by the National Institutes of Health (FY2018).
About the University of Pittsburgh School of Medicine
As one of the nation’s leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top 10 recipients of funding from the National Institutes of Health since 1998. In rankings recently released by the National Science Foundation, Pitt ranked fifth among all American universities in total federal science and engineering research and development support.
Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region’s economy. For more information about the School of Medicine, see http://www.medschool.pitt.edu.
http://www.upmc.com/media
Contact: Arvind Suresh
Office: 412-647-9966
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E-mail: SureshA2@upmc.edu
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E-mail: KunickyA@upmc.edu
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Some in society are pushing the concept of gender-neutral. Alina Tugend wrote Engendering Sons: Is It Doable—or Even Desirable—to Raise Gender-Neutral Children?

Overcoming gender disparities may require us to take a more nuanced approach to problem solving. For example, if we want more girls and women, who are now woefully underrepresented, to take more science, technology, engineering, and math classes, and we agree that it’s not innate ability holding them back, the answer might be to show scientists, engineers, and mathematicians to be attractive and caring rather than nerdy. Or change the physical environment of classrooms and laboratories to make them more appealing to girls.
Then again, does this counter or reinforce gender stereotypes? Good people disagree.
One thing that’s easy to forget, as Janet Hyde points out, is that variations within genders are greater than variations between them. I see the truth of that in my own home. Both my boys are into sports, but one is far more talkative and intellectually curious, while the other ranks higher on intuition and emotional intelligence. If they were a boy and a girl, it would be easy to attribute these differences to gender. As it is, I guess I’ll have to blame—or credit—the vast and ever-shifting mishmash of biology, parenting, peer influence, and culture. http://alumni.berkeley.edu/california-magazine/winter-2014-gender-assumptions/engendering-sons-it-doable-or-even-desirable
One study points to the idea that gender concept starts early.

Science Daily reported in Infants prefer toys typed to their gender:

Children as young as 9 months-old prefer to play with toys specific to their own gender, according to a new study from academics at City University London and UCL.
The paper, which is published in the journal of Infant and Child Development, shows that in a familiar nursery environment significant sex differences were evident at an earlier age than gendered identity is usually demonstrated.
The research therefore suggests the possibility that boys and girls follow different developmental trajectories with respect to selection of gender-typed toys and that there is both a biological and a developmental-environmental components to the sex differences seen in object preferences.
To investigate the gender preferences seen with toys, the researchers observed the toy preferences of boys and girls engaged in independent play in UK nurseries, without the presence of a parent. The toys used in the study were a doll, a pink teddy bear and a cooking pot for girls, while for boys a car, a blue teddy, a digger and a ball were used.
The 101 boys and girls fell into three age groups: 9 to 17 months, when infants can first demonstrate toy preferences in independent play (N=40); 18 to 23 months, when critical advances in gender knowledge occur (N=29); and 24 to 32 months, when knowledge becomes further established (N=32).
Stereotypical toy preferences were found for boys and girls in each of the age groups, demonstrating that sex differences in toy preference appear early in development. Both boys and girls showed a trend for an increasing preference with age for toys stereotyped for boys….
“Our results show that there are significant sex differences across all three age groups, with the finding that children in the youngest group, who were aged between 9-17months when infants are able to crawl or walk and therefore make independent selections, being particularly interesting; the ball was a favourite choice for the youngest boys and the youngest girls favoured the cooking pot.”
https://www.sciencedaily.com/releases/2016/07/16

See Dr. Wilda https://drwilda.com/tag/gender/ , https://drwilda.com/tag/gender-differences/

The only thing that is certain is the PC class will hate this post.

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Rice University study: When physicians integrate with hospitals, costs go up

7 Sep

The American Medical Association wrote in 5 ways to improve access to health care:

Stabilize individual insurance marketplaces and retain ACA market reforms. The AMA advocates these actions to foster a stronger health insurance marketplace and ensure that low- and moderate-income patients are able to secure affordable and adequate coverage:
• Support expanding eligibility for premium tax credits up to 500% of the federal poverty level. Support providing young adults with enhanced premium tax credits while maintaining the current premium tax credit structure that is inversely related to income.
• Encourage state innovation, including considering state-level individual mandates, auto-enrollment and/or reinsurance, to maximize the number of individuals covered and stabilize health insurance premiums without undercutting any existing patient protections.
• Support the establishment of a permanent federal reinsurance program.
• Oppose the sale of health insurance plans in the individual and small-group markets that do not guarantee pre-existing condition protections along with coverage of essential health benefits and their associated protections against annual and lifetime limits, and out-of-pocket expenses (with the exception of short-term, limited duration insurance offered for no more than three months).
Address physician shortages. Grow the clinical workforce by expanding the number of available graduate medical education residency slots, expand medical school loan-forgiveness programs, and remove barriers to physician immigration for foreign-trained physicians to practice in the U.S.
Telehealth and remote patient monitoring will become an essential, cost-effective and reliable means to expand capacity in a health system marked by significant and persistent specialty shortages and geographic disparities. Physicians should get assurances that digital health solutions are cost-effective and provide a path to payment.
Increase efficiency of the existing workforce by instituting common-sense medical liability reforms and reducing government and insurance industry regulatory burdens—such as prior authorization—that detract from patient care and increase costs. Also, there should be advancement of new physician-led payment models to achieve better outcomes at lower cost.

https://www.ama-assn.org/delivering-care/patient-support-advocacy/5-ways-improve-access-health-care

One model of health care is associated with higher costs.

Science Daily reported in When physicians integrate with hospitals, costs go up:

When physicians integrate with hospitals, the cost of health care rises even though there’s no evidence patients get better treatment, according to a new paper by experts at Rice University and Blue Cross and Blue Shield of Texas (BCBSTX).
As hospitals gain more control over physicians, they may incentivize delivery of more services but not necessarily higher quality care, the researchers said in the paper, which appears in the Journal of General Internal Medicine.
“When we launched this study, we hypothesized that tighter integration of physicians with hospitals would improve care coordination,” said Vivian Ho, lead author and the James A. Baker III Institute Chair in Health Economics and director of the Center for Health and Biosciences at Rice’s Baker Institute for Public Policy. “For example, less duplicate testing might occur, which would lower costs. That hypothesis didn’t play out in the data.”
The tightest form of integration occurs when hospitals directly employ physicians, but physicians also become integrated with hospitals when they jointly contract for services with an insurer.
In 2003, approximately 29% of U.S. hospitals employed physicians, a number that rose to 42% by 2012. The share of physician practices owned by hospitals rose from 14% in 2012 to 29% in 2016. Economists refer to these relationships between hospitals and physicians as vertical integration, because they represent hospitals exerting more control over physicians as an essential part of inpatient care.
The researchers analyzed all preferred provider organization (PPO) insurance claims processed for care through BCBSTX from 2014 through 2016 in Texas’ four largest metropolitan areas — Dallas, Houston, San Antonio and Austin. The population in these areas totaled 18.9 million in 2017, greater than the population of 46 U.S. states. The sample included all claims for health care services for patients aged 19 to 64 except for prescription drugs.
Several studies have found that vertical integration of physicians with hospitals is associated with higher annual spending, but none of these studies concurrently measured the relation between vertical integration and quality, the researchers said.
In their study, they examined claims to determine whether patients had visited a primary care physician (PCP) and, if so, which PCP they saw most frequently. The researchers attributed roughly 500,000 to 600,000 patients to a PCP for each year and used BCBSTX contracting data to determine whether each of these physicians worked in a physician-owned practice or one that was hospital-owned. The researchers then compared the annual spending for patients treated by doctors in physician- versus hospital-owned practices.
They found patients with PPO insurance coverage incur spending that is 5.8 percentage points higher when treated by doctors in hospital-owned versus physician-owned practices. The difference appears attributable to greater service use rather than higher prices. For four out of five common diagnostic tests (for example, X-rays and MRIs), claims per patient were equal to or higher in hospital- versus physician-owned practices. There was no consistent difference in quality of care (for example, 30-day hospital readmission rates, diabetic care or screening mammography) for hospital-owned versus physician-owned practices.
“Healthcare costs continue to rise faster than the growth rate of the overall economy,” said Ho, who is also a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. “Tighter integration of physicians with hospitals appears to be contributing to that cost growth, with no evidence of better quality.”
Higher spending ultimately translates into higher insurance premiums for customers, said Leanne Metcalfe, executive director of research and strategy at BCBSTX and a co-author of the study…. https://www.sciencedaily.com/releases/2019/09/190905161406.htm

Citation:

When physicians integrate with hospitals, costs go up

Date: September 5, 2019
Source: Rice University
Summary:
When physicians integrate with hospitals, the cost of health care rises even though there’s no evidence patients get better treatment, according to a new article.

Journal Reference:
Vivian Ho, Leanne Metcalfe, Lan Vu, Marah Short, Robert Morrow. Annual Spending per Patient and Quality in Hospital-Owned Versus Physician-Owned Organizations: an Observational Study. Journal of General Internal Medicine, 2019; DOI: 10.1007/s11606-019-05312-z

Here is the press release from Rice University:

When physicians integrate with hospitals, costs go up, Rice study says

JEFF FALK

– SEPTEMBER 4, 2019POSTED IN: CURRENT NEWS

When physicians integrate with hospitals, the cost of health care rises even though there’s no evidence patients get better treatment, according to a new paper by experts at Rice University and Blue Cross and Blue Shield of Texas (BCBSTX).
As hospitals gain more control over physicians, they may incentivize delivery of more services but not necessarily higher quality care, the researchers said in the paper, which appears in the Journal of General Internal Medicine.
“When we launched this study, we hypothesized that tighter integration of physicians with hospitals would improve care coordination,” said Vivian Ho, lead author and the James A. Baker III Institute Chair in Health Economics and director of the Center for Health and Biosciences at Rice’s Baker Institute for Public Policy. “For example, less duplicate testing might occur, which would lower costs. That hypothesis didn’t play out in the data.”
The tightest form of integration occurs when hospitals directly employ physicians, but physicians also become integrated with hospitals when they jointly contract for services with an insurer.
In 2003, approximately 29% of U.S. hospitals employed physicians, a number that rose to 42% by 2012. The share of physician practices owned by hospitals rose from 14% in 2012 to 29% in 2016. Economists refer to these relationships between hospitals and physicians as vertical integration, because they represent hospitals exerting more control over physicians as an essential part of inpatient care.
The researchers analyzed all preferred provider organization (PPO) insurance claims processed for care through BCBSTX from 2014 through 2016 in Texas’ four largest metropolitan areas — Dallas, Houston, San Antonio and Austin. The population in these areas totaled 18.9 million in 2017, greater than the population of 46 U.S. states. The sample included all claims for health care services for patients aged 19 to 64 except for prescription drugs.
Several studies have found that vertical integration of physicians with hospitals is associated with higher annual spending, but none of these studies concurrently measured the relation between vertical integration and quality, the researchers said.
In their study, they examined claims to determine whether patients had visited a primary care physician (PCP) and, if so, which PCP they saw most frequently. The researchers attributed roughly 500,000 to 600,000 patients to a PCP for each year and used BCBSTX contracting data to determine whether each of these physicians worked in a physician-owned practice or one that was hospital-owned. The researchers then compared the annual spending for patients treated by doctors in physician- versus hospital-owned practices.
They found patients with PPO insurance coverage incur spending that is 5.8 percentage points higher when treated by doctors in hospital-owned versus physician-owned practices. The difference appears attributable to greater service use rather than higher prices. For four out of five common diagnostic tests (for example, X-rays and MRIs), claims per patient were equal to or higher in hospital- versus physician-owned practices. There was no consistent difference in quality of care (for example, 30-day hospital readmission rates, diabetic care or screening mammography) for hospital-owned versus physician-owned practices.
“Healthcare costs continue to rise faster than the growth rate of the overall economy,” said Ho, who is also a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. “Tighter integration of physicians with hospitals appears to be contributing to that cost growth, with no evidence of better quality.”
Higher spending ultimately translates into higher insurance premiums for customers, said Leanne Metcalfe, executive director of research and strategy at BCBSTX and a co-author of the study.
“Centers for Medicare and Medicaid Services regulators should be wary of the burden that increasing reporting requirements place on physicians in small, independent practices,” Metcalfe said. “In the long run, these requirements may have the unintended consequence of raising health care costs.”
The paper, “Annual Spending per Patient and Quality in Hospital-Owned versus Physician-Owned Organizations: An Observational Study,” was also co-authored by Lan Vu, lead actuarial systems analyst at BCBSTX; Marah Short, associate director of the Center for Health and Biosciences at the Baker Institute; and Dr. Robert Morrow, Southeast Texas market president at BCBSTX.
TAGS: Baker Institute, Economics, Research, RNH, RNhome, Social Sciences
About Jeff Falk
Jeff Falk is associate director of national media relations in Rice University’s Office of Public Affairs.

The Healthcare Transformation Institute listed different models of healthcare.

According to Healthcare Transformation Institute, among models of healthcare are:

Healthcare Delivery Models
Please check back often for updates
ACO
• The ACO Model — A Three-Year Financial Loss?
• Accountable Care Organizations: The Case for Flexible Partnerships Between Health Plans and Providers
• The Collaborative Payer Model
• Continuous Innovation in Health Care: Implications of the Geisinger Experience
• Driving Population Health Through Accountable Care Organizations
• Growing an ACO-Easier Said Than Done
• Grand Junction, Colorado: A Health Community that Works
• Grand Junction, Colorado: How a Community Drew on its Values to Shape a Superior Health System
• Higher Health Care Quality and Bigger Savings Found at Large Multispecialty Medical Groups
• The Hot Spotters: Lower Costs and Better Care for Neediest Patients
• Improving The Coordination of Care for Medicaid Beneficiaries in Pennsylvania
• A National Strategy to Put Accountable Care into Practice
• Predictive Modeling and Team Care for High-Need Patients at HealthCare Partners
• How the Stars Aligned to Make Grand Junction a Success
Care Transitions
• Connected For Health – A Community-Based Care Transition Project
• Improving Care Transitions and Reducing Hospital Readmissions: Establishing the Evidence for Community-Based Implementation Strategies Through the Care Transitions Theme
• Preparing Patients and Caregivers to Participate in Care Delivered Across Settings: The Care Transitions Intervention
Disease Management
• ICC Asthma Program Evaluation 2007-2009
• German Diabetes Management Programs Improve Quality of Care and Curb Costs
• A Home-Based Diabetes Education Program and Its Approach to Disease Management
• How Direct Primary Care Reduces Primary Care Costs
• At Martin’s Point in Maine, Primary Care Teams for Chronic Disease Patients
• Primary Care Redesign: Delivering a Value Based Population Program for Chronic Disease
• Successful Models of Comprehensive Care for Older Adults with Chronic Conditions: Evidence for the Institute of Medicine’s “Retooling for an Aging America” Report
• Taking Public Health Approaches to Care in Massachusetts
Medical Home
• American Medical Home Runs
• Changing the Conversation in California About Care Near the End of Life
• Community-Centered Health Homes: Bridging the Gap Between Health Services and Community Prevention
• The ‘GRACE’ Model: In-Home Assessments Lead to Better Care for Dual Eligibles
• The Group Health Medical Home at Year Two: Cost Savings, Higher Patient Satisfaction, and Less Burnout for Providers
• A Health Plan Spurs Transformation of Primary Care Practices Into Better-Paid Medical Homes
• Medical “Extensivists” Care for High-Acuity Patients Across Settings, Leading to Reduced Hospital Use
• A New Care Paradigm Slashes Hospital Use and Nursing Home Stays for the Elderly and the Physically and Mentally Disabled
• Restructuring Care in a Federally Qualified Health Center to Better Meet Patients’ Needs
• Transforming Physician Practices to Patient-Centered Medical Homes: Lessons from The National Demonstration Project
• Vermont’s Blueprint for Medical Homes, Community Health Teams, and Better Health at Lower Cost
Medication Management
• Medication Adherence Leads to Lower Health Care use and Costs Despite Increased Drug Spending
• Thinking Outside the Pillbox — Medication Adherence as a Priority for Health Care Reform
• Medication Adherence Leads to Lower Health Care Use and Costs Despite Increased Drug Spending
Elements of Healthcare Transformation
• Alignment of incentives
• Connectivity among caregivers and patients
• Leadership assessment and development
• Business plans and models
• Metrics and evaluation
• Medication management
• In-home care
ASU Healthcare Delivery and Policy Program
Read about our affiliated program at Arizona State University.
http://healthcaretransformationinstitute.org/page/healthcare-delivery-models

Faith Abubey of WFMY News reported on a healthcare delivery system outside the traditional insurance model.

Abubey reported in New Model: Triad Doctor Offers Unlimited Visits For $50 Monthly Fee:

But a growing number of family doctors say they have found a way to make routine doctor visits cheap and give you better care.
In some cases, you pay as low as $25 a month and still see a doctor whenever you want with no extra costs.
The idea is called Direct Primary Care (DPC).
Think of it like a gym membership.
You pay a monthly fee and you get to go as often as you want.
It’s the same idea.
In this case you get unlimited visits to your family doctor.
Access to that doctor by phone or a secure messaging system — 24/7.
You get same day or next-day appointments.
Discounts on things like labs and your prescription medicine.
All for a monthly fee of anywhere between $25 and $85 a month.
That’s it.
No extra costs. No co-pays. No insurance involved.
If you’re thinking this sounds too good to be true, even the Triad doctor who’s offering it agrees.
“It does sound too good to be true. And I think that that’s the hardest thing about selling people on this model. Because they just don’t understand how it could be that easy,” Dr. James Breen said.
Dr. Breen and his wife, Dr. Dayarmys Piloto de la Paz, who is also a doctor, opened their direct primary care practice just over a month ago in Greensboro.
It is called Vitral Family Medicine.
It is the only clinic of its kind we know of in the Triad.
But according to the Journal of Medical Economics, there are more than 300 doctors’ offices across the country using the same model.
“A lot of people describe direct primary care as do it yourself health care reform,” Dr. Breen said.
He explains that in this model, your doctor visits are longer, patients get better care and there is no red tape from insurance companies about what he can and can’t do…. https://www.wfmynews2.com/article/news/local/2-wants-to-know/new-model-triad-doctor-offers-unlimited-visits-for-50-monthly-fee/266503909

Access to healthcare for the greatest number is an important concept, but as with many things, the devil is in the details. What is the definition, cost and the population defined are questions that are political difficult to build a consensus.

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Washington State University study: Hand- versus machine-harvested juice and cider apples: A comparison of phenolic profiles

1 Sep

James Thorne wrote in the Geek Wire article, Apple-picking robots gear up for U.S. debut in Washington state:

Next fall, as you browse the produce section at your local grocery store, pay close attention to the apples. You might be witnessing American history.
For the first time, some of the apples sold in the U.S. will be picked by a robot rather than human hands. That’s thanks to agricultural automation startup Abundant Robotics, the maker of apple harvesting machines that will partake in Washington state’s next harvest.
“This will be the first season that we’re actually ready to harvest commercially,” said Abundant CEO Dan Steere. “It’s incredibly exciting.”
Abundant’s picker has more in common with a really smart Hoover vacuum than a human hand. The robot moves down rows of orchards and uses artificial intelligence with a dash of LIDAR to search for ripe apples. Once spotted, a robotic arm with a vacuum gently sucks the apples from the tree into a bin.
The achievement is owed to advances not only in machine learning and robotics but also in agriculture. The architecture of apple trees has evolved over the decades, and it’s now common to grow them on trellises like you would tomatoes or cucumbers. Modern apple trees are also smaller, derived from dwarf varietals that yield more per acre and produce fruit more quickly after being planted.
These horticultural leaps have allowed farmers to double their apple yields. They’ve also made the job of picking easier for humans and, now, for robots.
Karen Lewis, a tree fruit specialist at Washington State University who has worked with Abundant and other robotics startups, said that apple trees have reached a “sweet spot” for robotic harvesting. Orchards are now sufficiently uniform and predictable for machines to reliably pick fruit, and canopies are narrow enough for sunlight, the human eye and vision systems to penetrate.
Tech companies that are successful in agriculture, she said, are the ones that listen to what farmers need. “We’re not going to let technology be the driver here. Horticulture needs to be the driver.” https://www.geekwire.com/2019/apple-picking-robots-gear-u-s-debut-washington-state/

There are at least two issues regarding mechanical harvesting. The first is whether mechanical harvesting damages crops or results is lesser quality of the final product quality. The second is whether employment in agriculture will decline.

Science Daily reported in Hand- versus machine-harvested juice and cider apples: A comparison of phenolic profiles:

A study out of Washington State University sought to determine if there is a measurable impact of harvest method on the phenolic profile of ‘Brown Snout’ juice and cider to better inform equipment adoption.
Travis Alexander, Thomas Collins, and Carol Miles also evaluated whether different extraction methods would yield differing output in either quantity or quality of ‘Brown Snout’ apple juice and cider. Their comprehensive findings are illustrated in their article, “Comparison of the Phenolic Profiles of Juice and Cider Derived from Machine- and Hand-Harvested ‘Brown Snout’ Specialty Cider Apples in Northwest Washington” as found in the open-access journal HortTechnology, published by the American Society for Horticultural Science.
Phenolics are secondary metabolites that have attracted increasing interest in science and industry in recent years due to their beneficial health effects, primarily for their antioxidant properties. They have been proven to act as reducing agents to free radicals. Phenolics contribute significantly to the sensory profile of fermented cider, especially in those made from cider apple fruit. “Phenolics can impact the pressing of fruit, the clarification of juice, the maturation of cider, and final cider quality, including the attributes of aroma, color, taste, and mouthfeel. And so, we wanted to determine if there was a change in phenolics due to harvest method” stated Collins….’
To carry out their research, Miles said they planted a block of ‘Brown Snout’ apple trees on a low trellis system so that trees were a suitable size to fit the over-the-row small fruit harvester. Each of the eight main plots consisted of an average of nine trees. When the fruit was fully ripe, harvesting was divided equally between hand harvesting by four relatively unskilled agricultural workers and machine harvest by an over-the-row small fruit harvester. When application of the two harvest methods was complete, equal qualities of ‘Brown Snout’ apples were randomly selected from each yield supply for further evaluation.
The selected fruit were pressed separately and fermented and allowed to mature for 5 months before final assessments were conducted. At that time, the researchers determined that harvest method and duration of storage were nonsignificant for all parameters measured on juice and cider samples.
Over-the-row machine harvesting resulted in a final product of similar quality at reduced labor costs, and thus shows potential for increasing the commercial sustainability of cider apple operations.
https://www.sciencedaily.com/releases/2019/08/190830162305.htm

Citation:

Hand- versus machine-harvested juice and cider apples: A comparison of phenolic profiles
Machine-harvested apples offer cost-effective option for growers and cider makers
Date: August 30, 2019
Source: American Society for Horticultural Science
Summary:
Study conducted to determine if there is a measurable impact of harvest method on the phenolic profile of ‘Brown Snout’ juice and cider to better inform equipment adoption. Over-the-row machine harvesting resulted in a final product of similar quality at reduced labor costs, and thus shows potential for increasing the commercial sustainability of cider apple operations.

Journal Reference:
Travis R. Alexander, Thomas S. Collins, Carol A. Miles. Comparison of the Phenolic Profiles of Juice and Cider Derived from Machine- and Hand-harvested ‘Brown Snout’ Specialty Cider Apples in Northwest Washington. HortTechnology, 2019; 29 (4): 423 DOI: 10.21273/HORTTECH04342-19

Here is the press release from American Society for Horticultural Science:

NEWS RELEASE 30-AUG-2019
Hand- versus machine-harvested juice and cider apples: A comparison of phenolic profiles
Machine-harvested apples offer cost-effective option for growers and cider makers
AMERICAN SOCIETY FOR HORTICULTURAL SCIENCE
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MOUNT VERNON, WASHINGTON–Hand-harvested versus Machine-harvested Juice and Cider Apples: A Comparison of Phenolic Profiles
A study out of Washington State University sought to determine if there is a measurable impact of harvest method on the phenolic profile of ‘Brown Snout’ juice and cider to better inform equipment adoption.
Travis Alexander, Thomas Collins, and Carol Miles also evaluated whether different extraction methods would yield differing output in either quantity or quality of ‘Brown Snout’ apple juice and cider. Their comprehensive findings are illustrated in their article, “Comparison of the Phenolic Profiles of Juice and Cider Derived from Machine- and Hand-Harvested ‘Brown Snout’ Specialty Cider Apples in Northwest Washington” as found in the open-access journal HortTechnology, published by the American Society for Horticultural Science.
Phenolics are secondary metabolites that have attracted increasing interest in science and industry in recent years due to their beneficial health effects, primarily for their antioxidant properties. They have been proven to act as reducing agents to free radicals. Phenolics contribute significantly to the sensory profile of fermented cider, especially in those made from cider apple fruit. “Phenolics can impact the pressing of fruit, the clarification of juice, the maturation of cider, and final cider quality, including the attributes of aroma, color, taste, and mouthfeel. And so, we wanted to determine if there was a change in phenolics due to harvest method” stated Collins.
“The ‘Brown Snout’ specialty cider apple is desired by cider makers for its relatively high levels of phenolics, and over-the-row machine harvesting of ‘Brown Snout’ has been demonstrated to provide similar yield to hand harvest at a significantly lower cost” says Alexander.
To carry out their research, Miles said they planted a block of ‘Brown Snout’ apple trees on a low trellis system so that trees were a suitable size to fit the over-the-row small fruit harvester. Each of the eight main plots consisted of an average of nine trees. When the fruit was fully ripe, harvesting was divided equally between hand harvesting by four relatively unskilled agricultural workers and machine harvest by an over-the-row small fruit harvester. When application of the two harvest methods was complete, equal qualities of ‘Brown Snout’ apples were randomly selected from each yield supply for further evaluation.
The selected fruit were pressed separately and fermented and allowed to mature for 5 months before final assessments were conducted. At that time, the researchers determined that harvest method and duration of storage were nonsignificant for all parameters measured on juice and cider samples.
Over-the-row machine harvesting resulted in a final product of similar quality at reduced labor costs, and thus shows potential for increasing the commercial sustainability of cider apple operations.
###
The complete article is available on the ASHS HortTechnology electronic journal web site: https://journals.ashs.org/horttech/view/journals/horttech/29/4/article-p423.xml. DOI: https://doi.org/10.21273/HORTTECH04342-19 . Or you may contact Travis Alexander of Washington State University at travis.alexander@wsu.edu or call him at (360) 848-6120.
Founded in 1903, the American Society for Horticultural Science (ASHS) is the largest organization dedicated to advancing all facets of horticulture research, education, and application. More information at ashs.org.
Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.
David Meyer wrote in the Fortune article, Robots May Steal As Many As 800 Million Jobs in the Next 13 Years:
A new study by the McKinsey Global Institute estimates that between 400 million and 800 million of today’s jobs will be automated by 2030.
The research adds fresh perspective to what is becoming an increasingly concerning picture of the future employment landscape. “We’re all going to have to change and learn how to do new things over time,” institute partner Michael Chui told Bloomberg.
In the U.S., it seems it’s the middle class that has the most to fear, with office administrators and construction equipment operators among those who may lose their jobs to technology or see their wages depressed to keep them competitive with robots and automated systems…. https://fortune.com/2017/11/29/robots-automation-replace-jobs-mckinsey-report-800-million/

 

Think not of yourself as the architect of your career but as the sculptor. Expect to have to do a lot of hard hammering and chiseling and scraping and polishing.-
B.C. Forbes

Resources:

In Praise of Short-Term Thinking
For hundreds of years, economic observers have feared that machines were making human workers obsolete. In a sense, they’ve been right. https://www.theatlantic.com/business/archive/2015/09/jobs-automation-technological-unemployment-history/403576/

Will robots and AI take your job? The economic and political consequences of automation                                               https://www.brookings.edu/blog/techtank/2018/04/18/will-robots-and-ai-take-your-job-the-economic-and-political-consequences-of-automation/

Will machines eventually take on every job?              http://www.bbc.com/future/story/20150805-will-machines-eventually-take-on-every-job

Every study we could find on what automation will do to jobs, in one chart: There are about as many opinions as there are experts. https://www.technologyreview.com/s/610005/every-study-we-could-find-on-what-automation-will-do-to-jobs-in-one-chart/

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Central Michigan University study: Plant-based fire retardants may offer a less toxic way to tame flames

28 Aug

Green Sciences Policy Institute provided an overview of retardants:

Flame retardant chemicals are used in commercial and consumer products (like furniture and building insulation) to meet flammability standards. Not all flame retardants present concerns, but the following types often do:
• Halogenated flame retardants (also known as organohalogen flame retardants) containing chlorine or bromine bonded to carbon.
• Organophosphorous flame retardants containing phosphorous bonded to carbon.
For these types of flame retardants:
• Some are associated with health and environmental concerns
• Many are inadequately tested for safety
• They provide questionable fire safety benefits as used in some products
Major uses
The major uses of flame retardant chemicals by volume in the U.S. are:
• Electronics
• Building insulation
• Polyurethane foam
• Wire and cable
Properties of Concern
Organohalogen and organophosphorous flame retardants often have one or more of the following properties of concern. Chemicals with all these properties are considered Persistent Organic Pollutants (POPs) and present significant risks to human health and environment. https://greensciencepolicy.org/topics/flame-retardants/

See, University of Massachusetts – Amherst study: New process discovered to completely degrade flame retardant in the environment https://drwilda.com/tag/tetrabromobisphenol-a/

Maria Temming of Science News reported in Plant-based fire retardants may offer a less toxic way to tame flames:

Flame retardants are going green.
Using compounds from plants, researchers are concocting a new generation of flame retardants, which one day could replace the fire-quenching chemicals added by manufacturers to furniture, electronics and other consumer products.
Many traditional synthetic flame retardants have come under fire for being linked to health problems like thyroid disruption and cancer (SN: 3/16/19, p. 14). And flame retardants that leach out of trash in landfills can persist in the environment for a long time (SN: 4/24/10, p. 12).
The scientists have not yet performed toxicity tests on the new plant-based creations. But “in general, things derived from plants are much less toxic … they’re usually degradable,” says Bob Howell, an organic chemist and polymer scientist at Central Michigan University in Mount Pleasant.
Howell’s team presented the work August 26 in San Diego at the American Chemical Society’s national meeting.
The raw ingredients for these plant-based flame retardants were gallic acid — found in nuts and tea leaves — and a substance in buckwheat called 3,5-Dihydroxybenzoic acid. Treating these compounds with a chemical called phosphoryl chloride converted them into flame-retardant chemicals named phosphorus esters. Since these plant-based ingredients are common, and the chemical treatment process is straightforward, it should be relatively easy to manufacture these flame retardants on a large scale, Howell says.
Howell and colleagues tested the flame retardants in a resin used to make electronics, cars and planes. Compared with chips of pure resin, the resin laced with flame retardant took longer to go up in flames. And “it doesn’t burn for very long, once you get it going,” Howell says. Treated chips were snuffed out in less than 10 seconds, whereas untreated chips blazed until no resin remained. The experiments did not compare the plant-based flame retardants with traditional fire-resistant substances…. https://www.sciencenews.org/article/plant-based-fire-retardants-may-offer-less-toxic-way-tame-flames

Here is the press release from the American Chemical Society:

AUGUST 26, 2019

Flame retardants—from plants

by American Chemical Society

Flame retardants are present in thousands of everyday items, from clothing to furniture to electronics. Although these substances can help prevent fire-related injuries and deaths, they could have harmful effects on human health and the environment. Of particular concern are those known as organohalogens, which are derived from petroleum. Today, scientists report potentially less toxic, biodegradable flame retardants from an unlikely source: plants.
The researchers will present their results at the American Chemical Society (ACS) Fall 2019 National Meeting & Exposition.
“The best flame-retardant chemicals have been organohalogen compounds, particularly brominated aromatics,” says Bob Howell, Ph.D., the project’s principal investigator. “The problem is, when you throw items away, and they go into a landfill, these substances can leach into the environment.”
Most organohalogen flame retardants are very stable. Microorganisms in the soil or water can’t degrade them, so they persist for many years in the environment, working their way up the food chain. In addition, some of the compounds can migrate out of items to which they are added, such as electronics, and enter household dust. Although the health effects of ingesting or breathing organohalogen flame retardants are largely unknown, some studies suggest they could be harmful, prompting California to ban the substances in children’s products, mattresses and upholstered furniture in 2018.
“A number of flame retardants are no longer available because of toxicity concerns, so there is a real need to find new materials that, one, are nontoxic and don’t persist, and two, don’t rely upon petroleum,” Howell says. His solution was to identify compounds from plants that could easily be converted into flame retardants by adding phosphorous atoms, which are known to quench flames. “We’re making compounds that are based on renewable biosources,” he says. “Very often they are nontoxic; some are even food ingredients. And they’re biodegradable—organisms are accustomed to digesting them.”
To make their plant-derived compounds, Howell and colleagues at the Center for Applications in Polymer Science at Central Michigan University began with two substances: gallic acid, commonly found in fruits, nuts and leaves; and 3,5-dihydroxybenzoic acid from buckwheat. Using a fairly simple chemical reaction, the researchers converted hydroxyl groups on these compounds to flame-retardant phosphorous esters. Then, the team added the various phosphorous esters individually to samples of an epoxy resin, a polymer often used in electronics, automobiles and aircraft, and examined the different esters’ properties with several tests.
In one of these tests, the researchers showed that the new flame retardants could strongly reduce the peak heat release rate of the epoxy resin, which reflects the intensity of the flame and how quickly it is going to spread. The plant-derived substances performed as well as many organohalogen flame retardants on the market. “As a matter of fact, they may be better,” Howell says. “Because gallic acid has three hydroxyl groups within the same molecule that can be converted to phosphorous esters, you don’t have to use as much of the additive, which reduces cost.”
The researchers also studied how the new compounds quench flames, finding that the level of oxygenation at the phosphorous atom determined the mode of action. Compounds with a high level of oxygenation (phosphates) decomposed to a substance that promoted char formation on the polymer surface, starving the flame of fuel. In contrast, compounds with a low level of oxygenation (phosphonates) decomposed to species that scavenged combustion-promoting radicals.
Howell’s team hasn’t yet performed toxicity tests, but he says that other groups have done such studies on similar compounds. “In general, phosphorous compounds are much less harmful than the corresponding organohalogens,” he notes. In addition, the plant-derived substances are not as volatile and are less likely to migrate from items into household dust. Howell hopes that the new flame retardants will attract the attention of a company that could help bring them to market, he says.
________________________________________
Explore further
Debate on banning organohalogen flame retardants heats up

More information: Phosphorus flame retardants from crop plant phenolic acids, the American Chemical Society (ACS) Fall 2019 National Meeting & Exposition.
Abstract
While polymeric materials have had an enormously positive impact on the development of modern society, for most applications they must be flame-retarded. This may be accomplished in a variety of ways, most notably by introduction of a suitable additive during processing. Traditionally, organohalogen compounds, particularly brominated aromatics, have been effective, affordable, popular gas-phase flame retardants. However, these compounds readily migrate from a polymer matrix into which they have been incorporated, persist in the environment, tend to bioaccumulate and may pose risks to human health. For this reason, the use of these compounds is coming under increasing regulatory pressure worldwide. Phosphorus compounds derived from renewable biosources provide attractive alternatives to these traditional organohalogen flame retardants. Precursors to biobased organophosphorus flame retardants are generally nontoxic and readily available at modest cost. Phenolics are ubiquitous in nature and may be isolated from numerous plants. Gallic acid (3,4,5-trihydroxybenzoic acid) is a constituent many edible plants, nuts and legumes. 3,5-Dihydroxybenzoic acid may be found in several plants, principally buckwheat. Both of these compounds may serve as the base for the generation of a series of phosphorus esters, both phosphonate and phosphate, that display good flame retardancy in DGEBA epoxy.
Provided by American Chemical Society https://phys.org/news/2019-08-flame-retardantsfrom.html
The Environmental Protection Agency (EPA) lists risks in Fact Sheet: Assessing Risks from Flame Retardants https://www.epa.gov/assessing-and-managing-chemicals-under-tsca/fact-sheet-assessing-risks-flame-retardants

Resources:

COMPOUND SUMMARY – Tetrabromobisphenol A https://pubchem.ncbi.nlm.nih.gov/compound/Tetrabromobisphenol-A

Is the flame retardant, tetrabromobisphenol A (TBBPA), a reproductive or developmental toxicant?
Date:
February 18, 2015
Source:
Toxicology Excellence for Risk Assessment
Summary:
Two studies examined the effects of tetrabromobisphenol A (TBBPA) at oral doses of 10,100 or 1000 mg/kg bw/day over the course of 2 generations on growth as well as behavioral, neurological and neuropathologic functions in offspring. https://www.sciencedaily.com/releases/2015/02/150218092044.htm
Global Tetrabromobisphenol-A Market is Evolving with Chemicals and Materials Industry in 2019 | Get Strategic Insights. https://theindustryforecast.com/2019/07/24/global-tetrabromobisphenol-a-insights-market-sp/

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Medical University of South Carolina study: How gonorrhea develops resistance to antibiotics

25 Aug

Medline summarized sexually transmitted diseases (STD):

Summary
Sexually transmitted diseases (STDs) are infections that are passed from one person to another through sexual contact. The causes of STDs are bacteria, parasites, yeast, and viruses. There are more than 20 types of STDs, including
• Chlamydia
• Genital herpes
• Gonorrhea
• HIV/AIDS
• HPV
• Syphilis
• Trichomoniasis
Most STDs affect both men and women, but in many cases the health problems they cause can be more severe for women. If a pregnant woman has an STD, it can cause serious health problems for the baby.
Antibiotics can treat STDs caused by bacteria, yeast, or parasites. There is no cure for STDs caused by a virus, but medicines can often help with the symptoms and keep the disease under control.
Correct usage of latex condoms greatly reduces, but does not completely eliminate, the risk of catching or spreading STDs. The most reliable way to avoid infection is to not have anal, vaginal, or oral sex.
Centers for Disease Control and Prevention https://medlineplus.gov/sexuallytransmitteddiseases.html

Helen Adams reported in Skyrocketing STDs have doctors urging sexually active young people to be tested:

MUSC Health obstetrician and gynecologist Jessica Tarleton has seen a lot in her role as a reproductive infectious disease specialist, but even she is stunned by new STD statistics released by the Centers for Disease Control and Prevention. “A lot of these infections are in young people, very young people.”
This week, the CDC reported there were almost 2.3 million cases of chlamydia, gonorrhea and syphilis in the United States last year….
• Chlamydia is the most common, with more than 1.7 million cases last year.
• Gonorrhea diagnoses rose 67 percent between 2013 and 2017, hitting 555,608 last year.
• Syphilis jumped 76 percent during that same time period, hitting 30,644 cases last year.

Here’s why getting tested matters. A lot of people who have STDs don’t have any symptoms or don’t realize their rashes and other issues are linked to STDs. So if they don’t get tested regularly, the disease can progress. Chlamydia and gonorrhea can cause infertility in women if left untreated. Syphilis can cause neurological problems in both women and men, Tarleton says. And it can do more than that.

“One of the things that’s most upsetting to me is the rate of syphilis we’re seeing in pregnant women, because that can have severe effects on the fetus and baby. Babies can have congenital birth defects, some bone malformations, blindness and deafness. Sometimes it can lead to miscarriage or fetal death in utero. This can happen in moms who don’t know they have it.”

The good news is, all three STDs are treatable with antibiotics, although there is concern that gonorrhea is becoming antibiotic resistant.

So what’s going on? Why is the U.S. seeing a surge in STDs to the point that it’s being called a public health crisis?

Tarleton says part of the problem is some of the people at risk of getting STDs, young people, don’t know enough to worry about them. “Our teenagers are kind of going out unequipped to protect themselves from getting these infections.”

Other factors causing the rise in STDs, cited in a national discussion this week at the CDC’s 2018 STD Prevention Conference, include:

• A lack of funding for prevention programs.
• The opioid epidemic, which is causing some women to trade sex for drugs.
• Methamphetamines and other drugs, which are linked to forced sex, sex for money and sex with people who inject drugs.
• Doctors and patients who are reluctant to talk about STDs….

Tarleton says the best way to prevent STDs is to use condoms. “Condoms are still a very effective way of preventing the spread of sexually transmitted infections. And we want people to take seriously the need for screening and treatment of themselves and their sexual partners. I don’t think the message has been getting out, and it’s becoming a bigger and bigger problem.”
https://web.musc.edu/about/news-center/2018/08/31/skyrocketing-stds-have-doctors-urging-sexually-active-young-people-to-be-tested

Resources:

Your Guide to Sexually Transmitted Diseases                                            https://www.webmd.com/sexual-conditions/guide/sexual-health-stds#1

Sexually Transmitted Diseases                                                     https://www.drugs.com/cg/sexually-transmitted-diseases.html

Symptoms and Signs of Sexually Transmitted Diseases (STDs)
Privacy & Trust Info
Doctor’s Notes on Sexually Transmitted Diseases (STDs) https://www.emedicinehealth.com/sexually_transmitted_diseases/symptom.htm

Sexually Transmitted Diseases (STDs)                                        https://www.cdc.gov/std/default.htm

Science Daily reported in How gonorrhea develops resistance to antibiotics:

Steadily and relentlessly, the bacterium that causes gonorrhea has slipped past medicine’s defenses, acquiring resistance to once-reliable drugs, including penicillin, tetracycline, and ciprofloxacin. These former stalwarts are no longer used to treat the sexually transmitted disease.
In 2010, after some strains of Neisseria gonorrhoeae, the bacterium responsible for gonorrhea, began showing resistance to one of the last remaining classes of antibiotics, the Centers for Disease Control and Prevention began recommending “dual therapy,” meaning that doctors now prescribe two drugs at the same time to fight gonorrhea. Currently, those two drugs are ceftriaxone, a member of the cephalosporin class of antibiotics, and azithromycin.
With fears increasing that gonorrhea could breach these last defenses, the work of researchers like crystallographer Christopher Davies, Ph.D., is crucial.
“We’re looking at a molecular level at the events that have got everybody worried out there in the clinics,” said Davies, a professor in the Department of Biochemistry & Molecular Biology and director of the MUSC Center for Structural Biology.
Davies’ team has just published a paper showing how cephalosporins bind and inactivate a gonococcal protein dubbed penicillin-binding protein 2 (PBP2). Led by postdoctoral fellow Avinash Singh, Ph.D., the researchers showed the protein undergoes key structural changes, including twisting and rolling of a loop to bind the antibiotic, that enhance the reaction with cephalosporins. Without these changes, the protein would react much more slowly with the antibiotic.
Davies explained that all antibiotics work by targeting essential functions in a particular bug. Cephalosporins work by attacking the bacterial cell wall.
Normally, PBP2 moves along the bacterial cell’s cytoplasmic membrane, reaching out into the space between the cytoplasmic membrane and the outer membrane, looking for peptides to bind to. The protein joins peptides together to create a mesh — just like an onion bag at the grocery store, Davies said. But antibiotics jump in to bind to the protein before it can get to a peptide.
“The protein is walking around the membrane layer as normal, but its active site is blocked by antibiotic, so all those potential interactions with the peptide substrate are fruitless,” Davies said.
With the protein out of commission and not building the mesh, holes start to appear in the cell wall. Cytoplasm starts to leak out, and the cell bursts and dies, Davies said.
Yet the resistant strains, which have been identified in Japan, France, Spain and most recently in Canada, evade the lethal action of cephalosporins by preventing the antibiotic from binding to the protein target. How they achieve this is a major focus of Davies’ research.
There are 60-some mutations on the PBP2 protein in the resistant strains of gonorrhea. Davies’ team has identified six mutations that are at the root of the resistance and is looking at how the mutations change the way the protein reacts to antibiotics…. https://www.sciencedaily.com/releases/2019/08/190823140704.htm

Citation:

How gonorrhea develops resistance to antibiotics
Date: August 23, 2019
Source: Medical University of South Carolina
Summary:
As public health officials worry about the emergence of antibiotic-resistant gonorrhea, researchers are tracing how antibiotics bind to a gonococcal protein, information that can help lead to new antimicrobials.

Journal Reference:
Avinash Singh, Joshua Tomberg, Robert A Nicholas, Christopher Davies. Recognition of the β-lactam Carboxylate Triggers Acylation of Neisseria gonorrhoeae Penicillin-Binding Protein 2. Journal of Biological Chemistry, 2019; jbc.RA119.009942 DOI: 10.1074/jbc.RA119.009942

Here is the press release from Medical University of South Carolina:

Researcher works to understand how gonorrhea develops resistance to antibiotics

Leslie Cantu

August 23, 2019

Steadily and relentlessly, the bacterium that causes gonorrhea has slipped past medicine’s defenses, acquiring resistance to once-reliable drugs, including penicillin, tetracycline and ciprofloxacin. These former stalwarts are no longer used to treat the sexually transmitted disease.
In 2010, after some strains of Neisseria gonorrhoeae, the bacterium responsible for gonorrhea, began showing resistance to one of the last remaining classes of antibiotics, the Centers for Disease Control and Prevention began recommending “dual therapy,” meaning that doctors now prescribe two drugs at the same time to fight gonorrhea. Currently, those two drugs are ceftriaxone, a member of the cephalosporin class of antibiotics, and azithromycin.

With fears increasing that gonorrhea could breach these last defenses, the work of researchers like crystallographer Christopher Davies, Ph.D., is crucial.

“We’re looking at a molecular level at the events that have got everybody worried out there in the clinics,” said Davies, a professor in the Department of Biochemistry & Molecular Biology and director of the MUSC Center for Structural Biology.

Davies’ team has just published a paper showing how cephalosporins bind and inactivate a gonococcal protein dubbed penicillin-binding protein 2 (PBP2). Led by postdoctoral fellow Avinash Singh, Ph.D., the researchers showed the protein undergoes key structural changes, including twisting and rolling of a loop to bind the antibiotic, that enhance the reaction with cephalosporins. Without these changes, the protein would react much more slowly with the antibiotic.

Davies explained that all antibiotics work by targeting essential functions in a particular bug. Cephalosporins work by attacking the bacterial cell wall.

Normally, PBP2 moves along the bacterial cell’s cytoplasmic membrane, reaching out into the space between the cytoplasmic membrane and the outer membrane, looking for peptides to bind to. The protein joins peptides together to create a mesh – just like an onion bag at the grocery store, Davies said. But antibiotics jump in to bind to the protein before it can get to a peptide.

“The protein is walking around the membrane layer as normal, but its active site is blocked by antibiotic, so all those potential interactions with the peptide substrate are fruitless,” Davies said.

With the protein out of commission and not building the mesh, holes start to appear in the cell wall. Cytoplasm starts to leak out, and the cell bursts and dies, Davies said.

Yet the resistant strains, which have been identified in Japan, France, Spain and most recently in Canada, evade the lethal action of cephalosporins by preventing the antibiotic from binding to the protein target. How they achieve this is a major focus of Davies’ research.
There are 60-some mutations on the PBP2 protein in the resistant strains of gonorrhea. Davies’ team has identified six mutations that are at the root of the resistance and is looking at how the mutations change the way the protein reacts to antibiotics.

Once researchers understand how the mutations are preventing antibiotics from doing their work, new drugs can be developed, Davies said. Knowing which mutations are important may also allow a diagnostic test to be developed to tell doctors whether a particular patient has a resistant strain and, therefore, which drugs to prescribe.

Davies said it appears that the mutations restrict the protein’s flexibility, preventing the structural changes needed to bind the antibiotic. That triggers a new mystery. If those movements are critical to its job of binding to peptides and building the mesh that keeps the cell wall intact, how can the mutations block the antibiotic but still allow the normal reaction? “This is the most fascinating aspect of our research,” Davies said.

“It’s an essential function, so the mutations can’t change the protein too much. It must be able to discriminate. Discriminating against an antibiotic while still retaining the normal binding and reaction with their substrate is a delicate balancing act they have to negotiate,” he said.

This balancing act might be the reason that antibiotic-resistant gonorrhea hasn’t spread as quickly as anticipated.

“There’s a fitness cost. They don’t function quite as well as their susceptible counterparts, and it’s probably for that reason they’re not spreading as fast as people feared they would,” Davies said.

Although the resistant-type gonorrhea isn’t spreading as quickly as public health officials feared, there have been increases in the number of cases of susceptible gonorrhea, as well as other sexually transmitted diseases.

Gonorrhea diagnoses increased by 67% between 2013 and 2017, according to the CDC.

“We expect gonorrhea will eventually wear down our last highly effective antibiotic, and additional treatment options are urgently needed,” said Gail Bolan, M.D., director of the CDC’s Division of STD Prevention, when it released those figures.

South Carolina has the fourth highest rate of gonorrhea in the U.S., according to an analysis of CDC numbers by Health Testing Centers, a lab testing service.
MUSC infectious disease specialist Eric Meissner, M.D., Ph.D., said it’s not entirely clear why the rates of STDs are increasing.

“We know that there are proven interventions that individuals can use, including regular use of condoms, that markedly reduce the odds of acquiring a sexually transmitted disease. So the rise in STD rates suggests there’s a need for more public health interventions and education,” he said.

Although gonorrhea isn’t fatal, it can cause lifelong problems if left untreated, including infertility and susceptibility to other sexually transmitted diseases, like HIV.

“An important thing for people to know is you can have gonorrhea and not have symptoms, so you can’t rely upon the absence of symptoms alone to provide reassurance that you or your sexual partner do not have gonorrhea,” Meissner said. “Sexually active people at risk for gonorrhea exposure should get regular testing”.

Meanwhile, Davies and his team are continuing their work in the lab. The next step is understanding how the protein can still perform its normal essential function while eluding the antibiotics. The group has some ideas that it will put to the test, he said.

Meissner said antibiotic resistance is concerning to doctors in the clinic.

“Even though the specific strain Dr. Davies is studying is rare, it is important to note that the emergence of resistance in gonorrhea is a real concern,” Meissner said.

About the Author
Leslie Cantu
Keywords: Research
Contact Us 843-792-2300 https://web.musc.edu/about/news-center/2019/08/23/antibiotic-resistant-gonorrhea-research

The Mayo Clinic summarized treatment for STDs:

Diagnosis
Tests
If your sexual history and current signs and symptoms suggest that you have a sexually transmitted disease (STD) or a sexually transmitted infection (STI), laboratory tests can identify the cause and detect coinfections you might also have.
• Blood tests. Blood tests can confirm the diagnosis of HIV or later stages of syphilis.
• Urine samples. Some STIs can be confirmed with a urine sample.
• Fluid samples. If you have open genital sores, your doctor may test fluid and samples from the sores to diagnose the type of infection.
Screening
Testing for a disease in someone who doesn’t have symptoms is called screening. Most of the time, STI screening is not a routine part of health care, but there are exceptions:
• Everyone. The one STI screening test suggested for everyone ages 13 to 64 is a blood or saliva test for human immunodeficiency virus (HIV), the virus that causes AIDS. Experts recommend that people at high risk have an HIV test every year.
• Everyone born between 1945 and 1965. There’s a high incidence of hepatitis C in people born between 1945 and 1965. Since the disease often causes no symptoms until it’s advanced, experts recommend that everyone in that age group be screened for hepatitis C.
• Pregnant women. All pregnant women will generally be screened for HIV, hepatitis B, chlamydia and syphilis at their first prenatal visit. Gonorrhea and hepatitis C screening tests are recommended at least once during pregnancy for women at high risk of these infections.
• Women age 21 and older. The Pap test screens for cervical abnormalities, including inflammation, precancerous changes and cancer, which is often caused by certain strains of human papillomavirus (HPV). Experts recommend that women have a Pap test every three years starting at age 21. After age 30, experts recommend women have an HPV DNA test and a Pap test every five years. A Pap test every three years is also acceptable.
• Women under age 25 who are sexually active. Experts recommend that all sexually active women under age 25 be tested for chlamydia infection. The chlamydia test uses a sample of urine or vaginal fluid you can collect yourself.
Some experts recommend repeating the chlamydia test three months after you’ve had a positive test and been treated. Reinfection by an untreated or undertreated partner is common, so you need the second test to confirm that the infection is cured. You can catch chlamydia multiple times, so get retested if you have a new partner.
Screening for gonorrhea is also recommended in sexually active women under age 25.
• Men who have sex with men. Compared with other groups, men who have sex with men run a higher risk of acquiring STIs. Many public health groups recommend annual or more-frequent STI screening for these men. Regular tests for HIV, syphilis, chlamydia and gonorrhea are particularly important. Evaluation for hepatitis B also may be recommended.
• People with HIV. If you have HIV, it dramatically raises your risk of catching other STIs. Experts recommend immediate testing for syphilis, gonorrhea, chlamydia and herpes after being diagnosed with HIV. They also recommend that people with HIV be screened for hepatitis C.
Women with HIV may develop aggressive cervical cancer, so experts recommend they have a Pap test within a year of being diagnosed with HIV, and then again six months later.
• People who have a new partner. Before having vaginal or anal intercourse with new partners, be sure you’ve both been tested for STIs. However, routine testing for genital herpes isn’t recommended unless you have symptoms.
It’s also possible to be infected with an STI yet still test negative, particularly if you’ve recently been infected.
More Information
• STD testing
• Complete blood count (CBC)
• HIV testing
Show More
Treatment
Sexually transmitted diseases (STDs) or sexually transmitted infections (STIs) caused by bacteria are generally easier to treat. Viral infections can be managed but not always cured. If you are pregnant and have an STI, getting treatment right away can prevent or reduce the risk of your baby becoming infected.
Treatment for STIs usually consists of one of the following, depending on the infection:
• Antibiotics. Antibiotics, often in a single dose, can cure many sexually transmitted bacterial and parasitic infections, including gonorrhea, syphilis, chlamydia and trichomoniasis. Typically, you’ll be treated for gonorrhea and chlamydia at the same time because the two infections often appear together.
Once you start antibiotic treatment, it’s necessary to follow through. If you don’t think you’ll be able to take medication as prescribed, tell your doctor. A shorter, simpler course of treatment may be available.
In addition, it’s important to abstain from sex until seven days after you’ve completed antibiotic treatment and any sores have healed. Experts also suggest women be retested in about three months because there’s high chance of reinfection.
• Antiviral drugs. If you have herpes or HIV, you’ll be prescribed an antiviral drug. You’ll have fewer herpes recurrences if you take daily suppressive therapy with a prescription antiviral drug. However, it’s still possible to give your partner herpes.
Antiviral drugs can keep HIV infection in check for many years. But you will still carry the virus and can still transmit it, though the risk is lower.
The sooner you start treatment, the more effective it is. If you take your medications exactly as directed, it’s possible to reduce your virus count so low that it can hardly be detected.
If you’ve had an STI, ask your doctor how long after treatment you need to be retested. Getting retested will ensure that the treatment worked and that you haven’t been reinfected.
Partner notification and preventive treatment
If tests show that you have an STI, your sex partners — including your current partners and any other partners you’ve had over the last three months to one year — need to be informed so that they can get tested. If they’re infected, they can then be treated.
Each state has different requirements, but most states require that certain STIs be reported to the local or state health department. Public health departments often employ trained disease intervention specialists who can help notify partners and refer people for treatment…. https://www.mayoclinic.org/diseases-conditions/sexually-transmitted-diseases-stds/diagnosis-treatment/drc-20351246

Resources:

What are the treatments for sexually transmitted diseases and sexually transmitted infections (STDs/STIs)? https://www.nichd.nih.gov/health/topics/stds/conditioninfo/treatments

Treatments for Sexually Transmitted Diseases (STDs)                   https://www.webmd.com/sexual-conditions/guide/std-treatments#1

IF YOU ARE AT RISK FOR A SEXUALLY TRANSMITTED DISEASE OR FEEL YOU HAVE ALREADY CONTRACTED AN STD – SEEK MEDICAL ATTENTION.

Where information leads to Hope. © Dr. Wilda.com

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Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
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http://drwildareviews.wordpress.com/

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University of Amsterdam study: MRI scans show how ADHD medication affects brain structure in children

19 Aug

The National Institute of Mental Health defined ADHD:

Attention-Deficit/Hyperactivity Disorder
Overview
Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
• Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.
• Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.
• Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm; or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.
Signs and Symptoms
Inattention and hyperactivity/impulsivity are the key behaviors of ADHD. Some people with ADHD only have problems with one of the behaviors, while others have both inattention and hyperactivity-impulsivity. Most children have the combined type of ADHD.
In preschool, the most common ADHD symptom is hyperactivity.
It is normal to have some inattention, unfocused motor activity and impulsivity, but for people with ADHD, these behaviors:
• are more severe
• occur more often
• interfere with or reduce the quality of how they functions socially, at school, or in a job…. https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

Resources:

What Is Attention Deficit Hyperactivity Disorder?                                         https://wb.md/2NvF1Dx

Attention-Deficit/Hyperactivity Disorder https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml#part_145450

What Is ADHD?                                                                                   https://www.psychiatry.org/patients-families/adhd/what-is-adhd

What is ADHD? https://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/ADHD_Resource_Center/ADHD_A_Guide_for_Families/What_is_ADHD.aspx

Lois Zoppi, BA Reviewed by Kate Anderton, B.Sc. (Editor) reported in the Medical Life Sciences News article, MRI scans show how ADHD medication affects brain structure in children:

Attention deficit/hyperactivity disorder (ADHD) affects an increasing number of people worldwide, with an estimated 6.1 million children were living with ADHD in 2016, according to the National Survey of Children’s Health.
Now, MRI scans have revealed that children taking the common medication methylphenidate experience alterations in the distribution of white matter in the brain. This has led to the researchers warning doctors not to over-prescribe the medication and only use it when it is absolutely necessary, as the long-term effects of the medication are not yet known.
Methylphenidate is a stimulant medication commonly prescribed for ADHD and works by blocking norepinephrine and dopamine transporters. Deficits in the prefrontal cortex are associated with ADHD symptoms, and increased dopamine and norepinephrine levels in the prefrontal cortex may have beneficial effects on the condition.
White matter is tissue found in the deepest part of the brain and facilitates quick thinking, learning, co-ordination between different parts of the brain, and the ability to walk and balance. The effects of methylphenidate on white matter, and by extension brain development, is not fully understood….
To chart any changes seen in the participants’ brains, they all underwent an MRI scan one week before their treatment began, and one week after their treatment stopped. Changes were found in the left hemisphere of the brain, with approximately double the rate of fractional anisotropy (nerve fiber density, size, and myelination).
The results suggest that the brain is susceptible to structural changes while it is still developing during childhood and adolescence, with the authors writing:
“The adolescent brain is a rapidly developing system maintaining high levels of plasticity. For instance, the maturation and development of white matter continues well into adulthood.”
“The results show that ADHD medications can have different effects on the development of brain structure in children versus adults. In adult men with ADHD, and both boys and adult men receiving placebo, changes in FA [fractional anisotropy] measures were not present, suggesting that the effects of methyphenidate on brain white matter are modulated by age,” Reneman said.
Reneman warned that they “do not yet know whether these effects are reversible or not and whether they are related to functional or behavioral changes over a longer period of time.”
“What our data already underscores is that the use of ADHD medications in children must be carefully considered until more is known about the long-term consequences of prescribing methylphenidate at a young age,” she said.
The study highlights the key results it produced through its experiments.
“In boys with attention-deficit/hyperactivity disorder (ADHD), four months of treatment with methylphenidate (MPH) was associated with increased white matter fractional anisotropy (FA) after 16 weeks.
“In adult men with ADHD and in both boys and adult men receiving placebo, changes in FA measures were not present, suggesting that the effects of MPH on brain white matter are modulated by age….” https://www.news-medical.net/news/20190815/MRI-scans-show-how-ADHD-medication-affects-brain-structure-in-children.aspx

Citation

Journal reference:
Bouziane, C., et al. (2019). White Matter by Diffusion MRI Following Methylphenidate Treatment: A Randomized Control Trial in Males with Attention-Deficit/Hyperactivity Disorder. RSNA Radiology. https://doi.org/10.1148/radiol.2019182528.

Here is the abstract and key results:

Original ResearchFree Access
Neuroradiology
White Matter by Diffusion MRI Following Methylphenidate Treatment: A Randomized Control Trial in Males with Attention-Deficit/Hyperactivity Disorder
Cheima Bouziane*, Olena G. Filatova*, Anouk Schrantee, Matthan W. A. Caan, Frans M. Vos, Liesbeth Reneman
* C.B. and O.G.F. contributed equally to this work.
Author Affiliations
Published Online:Aug 13 2019https://doi.org/10.1148/radiol.2019182528
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Abstract
Background
Methylphenidate (MPH) is highly effective in treating attention-deficit/hyperactivity disorder (ADHD). However, not much is known about its effect on the development of human brain white matter (WM).
Purpose
To determine whether MPH modulates WM microstructure in an age-dependent fashion in a randomized double-blind placebo-controlled trial (Effects of Psychotropic Medication on Brain Development–Methylphenidate, or ePOD-MPH) among ADHD referral centers between October 13, 2011, and June 15, 2015, by using diffusion-tensor imaging (DTI).
Materials and Methods
In this prospective study (NTR3103 and NL34509.000.10), 50 stimulant treatment–naive boys and 49 young adult men diagnosed with ADHD (all types) according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria were randomized to undergo treatment with MPH or placebo for 16 weeks. Before and 1 week after treatment cessation, study participants underwent MRI, including DTI. The outcome measure was change in fractional anisotropy (FA), which was assessed in three regions of interest (ROIs), as well as in a voxel-based analysis in brain WM. Data were analyzed by using intention-to-treat linear mixed models for ROI analysis and a permutation-based method for voxel-based analysis with family-wise error correction.
Results
Fifty boys (n = 25 MPH group, n = 25 placebo group; age range, 10–12 years) and 48 men (n = 24 MPH group, n = 24 placebo group; age range, 23–40 years) were included. ROI analysis of FA yielded no main effect of time in any of the conditions. However, voxel-based analysis revealed significant (P < .05) time-by-medication-by-age interaction effects in several association tracts of the left hemisphere, as well as in the lateral aspect of the truncus of the corpus callosum, due to greater increase in FA (standardized effect size, 5.25) in MPH-treated boys. Similar changes were not present in boys receiving a placebo, nor in adult men.
Conclusion
Four months of treatment with methylphenidate affects specific tracts in brain white matter in boys with attention-deficit/hyperactivity disorder. These effects seem to be age dependent, because they were not observed in adults treated with methylphenidate.
© RSNA, 2019
Online supplemental material is available for this article.
Download as PowerPointOpen in Image Viewer
Summary
This randomized clinical trial on the influence of methylphenidate on brain development using diffusion-tensor MRI found fractional anisotropy to increase in specific brain areas of boys with attention-deficit/hyperactivity disorder but not in young adult men or boys receiving a placebo.
Key Results
• ■ In boys with attention-deficit/hyperactivity disorder (ADHD), 4 months of treatment with methylphenidate (MPH) was associated with increased white matter fractional anisotropy (FA) after 16 weeks (standardized effect size of 5.25 at whole-brain voxel-based analysis)
• ■ In adult men with ADHD and in both boys and adult men receiving placebo, changes in FA measures were not present, suggesting that the effects of MPH on brain white matter are modulated by age.
https://pubs.rsna.org/doi/10.1148/radiol.2019182528

If you suspect that your child might have ADHD, you should seek an evaluation from a competent professional who has knowledge of this specialized area of medical practice.

Reference Links:

Edge Foundation ADHD Coaching Study Executive Summary
http://edgefoundation.org/wp-content/uploads/2011/01/Edge-Foundation-ADHD-Coaching-Research-Report.pdf

Edge Foundation ADHD Coaching Study Full Report
http://edgefoundation.org/wp-content/uploads/2011/01/Edge-Foundation-ADHD-Coaching-Research-Report.pdf

ADHD and College Success: A free guide
http://www.edgefoundation.org/howedgehelps/add-2.html

ADHD and Executive Functioning
http://edgefoundation.org/blog/2010/10/08/the-role-of-adhd-and-your-brains-executive-functions/

Executive Function, ADHD and Academic Outcomes
http://www.helpforld.com/efacoutcomes.pdf

Related:
Louisiana study: Fit children score higher on standardized tests
https://drwilda.com/2012/05/08/louisiana-study-fit-children-score-higher-on-standardized-tests/

Studies: ADHD drugs don’t necessarily improve academic performance
https://drwilda.com/2013/07/14/studies-adhd-drugs-dont-necessarily-improve-academic-performance/

ADHD coaching to improve a child’s education outcome
https://drwilda.com/2012/03/31/adhd-coaching-to-improve-a-childs-education-outcome/

An ADHD related disorder: ‘Sluggish Cognitive Tempo’
https://drwilda.com/2014/04/12/an-adhd-related-disorder-sluggish-cognitive-tempo/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

University of Washington Health Sciences/UW Medicine study: Scientists can now manipulate brain cells using smartphone

11 Aug

The staff of Mayo Clinic wrote an excellent synopsis about Deep brain stimulation:

Overview
Deep brain stimulation involves implanting electrodes within certain areas of your brain. These electrodes produce electrical impulses that regulate abnormal impulses. Or the electrical impulses can affect certain cells and chemicals within the brain.
The amount of stimulation in deep brain stimulation is controlled by a pacemaker-like device placed under the skin in your upper chest. A wire that travels under your skin connects this device to the electrodes in your brain.
Deep brain stimulation is approved to treat a number of conditions, such as:
• Dystonia
• Epilepsy
• Essential tremor
• Obsessive-compulsive disorder
• Parkinson’s disease
Deep brain stimulation is also being studied as a potential treatment for:
• Addiction
• Chronic pain
• Cluster headache
• Dementia
• Depression (major)
• Huntington’s disease
• Multiple sclerosis
• Stroke recovery
• Tourette syndrome
• Traumatic brain injury
Why it’s done
Deep brain stimulation is an established treatment for people with movement disorders, such as essential tremor, Parkinson’s disease and dystonia, and psychiatric conditions, such as obsessive-compulsive disorder. It’s also approved for use by the Food and Drug Administration to reduce seizures in difficult-to-treat epilepsy.
This treatment is reserved for people who aren’t able to get control of their symptoms with medications…. https://www.mayoclinic.org/tests-procedures/deep-brain-stimulation/about/pac-20384562

Resources:

What is deep brain stimulation?                 https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/deep-brain-stimulation

Wireless communication with implanted medical devices using the conductive properties of the body https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4156009/

Science Daily reported the University of Washington Health Sciences/UW Medicine study, Scientists can now manipulate brain cells using smartphone:

A team of scientists in Korea and the United States have invented a device that can control neural circuits using a tiny brain implant controlled by a smartphone.
Researchers, publishing in Nature Biomedical Engineering, believe the device can speed up efforts to uncover brain diseases such as Parkinson’s, Alzheimer’s, addiction, depression, and pain.
The device, using Lego-like replaceable drug cartridges and powerful bluetooth low-energy, can target specific neurons of interest using drug and light for prolonged periods.
“The wireless neural device enables chronic chemical and optical neuromodulation that has never been achieved before,” said lead author Raza Qazi, a researcher with the Korea Advanced Institute of Science and Technology (KAIST) and University of Colorado Boulder.
Qazi said this technology significantly overshadows conventional methods used by neuroscientists, which usually involve rigid metal tubes and optical fibers to deliver drugs and light. Apart from limiting the subject’s movement due to the physical connections with bulky equipment, their relatively rigid structure causes lesion in soft brain tissue over time, therefore making them not suitable for long-term implantation. Though some efforts have been put to partly mitigate adverse tissue response by incorporating soft probes and wireless platforms, the previous solutions were limited by their inability to deliver drugs for long periods of time as well as their bulky and complex control setups.
To achieve chronic wireless drug delivery, scientists had to solve the critical challenge of exhaustion and evaporation of drugs. Researchers from the Korea Advanced Institute of Science and Technology and the University of Washington in Seattle collaborated to invent a neural device with a replaceable drug cartridge, which could allow neuroscientists to study the same brain circuits for several months without worrying about running out of drugs.
These ‘plug-n-play’ drug cartridges were assembled into a brain implant for mice with a soft and ultrathin probe (thickness of a human hair), which consisted of microfluidic channels and tiny LEDs (smaller than a grain of salt), for unlimited drug doses and light delivery.
Controlled with an elegant and simple user interface on a smartphone, neuroscientists can easily trigger any specific combination or precise sequencing of light and drug deliveries in any implanted target animal without need to be physically inside the laboratory. Using these wireless neural devices, researchers could also easily setup fully automated animal studies where behaviour of one animal could positively or negatively affect behaviour in other animals by conditional triggering of light and/or drug delivery.
“This revolutionary device is the fruit of advanced electronics design and powerful micro and nanoscale engineering,” said Jae-Woong Jeong, a professor of electrical engineering at KAIST. “We are interested in further developing this technology to make a brain implant for clinical applications.”
Michael Bruchas, a professor of anesthesiology and pain medicine and pharmacology at the University of Washington School of Medicine, said this technology will help researchers in many ways.
“It allows us to better dissect the neural circuit basis of behaviour, and how specific neuromodulators in the brain tune behaviour in various ways,” he said. “We are also eager to use the device for complex pharmacological studies, which could help us develop new therapeutics for pain, addiction, and emotional disorders….” https://www.sciencedaily.com/releases/2019/08/190805143525.htm

Citation:

Scientists can now manipulate brain cells using smartphone
Date: August 5, 2019
Source: University of Washington Health Sciences/UW Medicine
Summary:
A team of scientists have invented a device that can control neural circuits using a tiny brain implant controlled by a smartphone. The device could speed up efforts to uncover brain diseases such as Parkinson’s, Alzheimer’s, addiction, depression, and pain.

Journal Reference:
Raza Qazi, Adrian M. Gomez, Daniel C. Castro, Zhanan Zou, Joo Yong Sim, Yanyu Xiong, Jonas Abdo, Choong Yeon Kim, Avery Anderson, Frederik Lohner, Sang-Hyuk Byun, Byung Chul Lee, Kyung-In Jang, Jianliang Xiao, Michael R. Bruchas, Jae-Woong Jeong. Wireless optofluidic brain probes for chronic neuropharmacology and photostimulation. Nature Biomedical Engineering, 2019; DOI: 10.1038/s41551-019-0432-1

Here is the press release from the University of Washington:

NEWS RELEASE

August 5, 2019

For immediate release

Scientists manipulate brain cells using a smartphone

A soft neural implant, capable of delivering multiple drugs and color lights, might speed research on diseases such as Parkinson’s, Alzheimer’s, addiction, depression and pain.

MEDIA CONTACT:
Bobbi Nodell, bnodell@uw.edu, 206.543.7129
Email Facebook Twitter Share

A team of scientists in South Korea and the United States have invented a device that can control neural circuits by using a tiny brain implant managedby a smartphone.
Publishing in Nature Biomedical Engineering, the researchers said the soft neural implant is the first wireless neural device capable of delivering multiple drugs and color lights. The device could speed up efforts to uncover brain diseases, such as Parkinson’s, Alzheimer’s, addiction, depression, and pain.
“The wireless neural device enables chronic chemical and optical neuromodulation that has never been achieved before,” said lead author Raza Qazi, a researcher with the Korea Advanced Institute of Science and Technology and University of Colorado Boulder.
Co-author Michael Bruchas, a professor of anesthesiology and pain medicine and pharmacology at the University of Washington School of Medicine, said this technology will help researchers in many ways.
“It allows us to better dissect the neural circuit basis of behavior, and how specific neuromodulators in the brain tune behavior in various ways,” he said. “We are also eager to use the device for complex pharmacological studies, which could help us develop new therapeutics for pain, addiction and emotional disorders.”
The device uses Lego-like replaceable drug cartridges and powerful bluetooth low-energy to deliver drugs and light to specific neurons of interest.
Resarchers said this technology significantly overshadows conventional neuroscience methods, which usually involve rigid metal tubes and optical fibers. Apart from limiting the subject’s movement due to the physical connections with bulky equipment, their relatively rigid structure causes lesion in soft brain tissue over time, therefore making them not suitable for long-term implantation. Though some efforts have partly mitigate adverse tissue response by incorporating soft probes and wireless platforms, the previous solutions were limited by their inability to deliver drugs for long periods of time as well as their bulky and complex control setups.
To achieve chronic wireless drug delivery, scientists had to solve the critical challenge of exhaustion and evaporation of drugs. The researchers collaborated to invent the neural device, which could allow neuroscientists to study the same brain circuits for several months without worrying about running out of drugs.
These “plug and play” drug cartridges were assembled into a brain implant for mice with a soft and ultrathin probe, the thickness of a human hair, which consisted of microfluidic channels and tiny LEDs, smaller than a grain of salt, for unlimited drug doses and light delivery.
Controlled with an elegant, simple user interface on a smartphone, the device can easily trigger any specific combination or precise sequencing of light and drug deliveries in any implanted target animal without need to be inside the laboratory. Using these wireless neural devices, researchers could also easily setup fully automated animal studies where behavior of one animal could positively or negatively affect behaviour in other animals by conditional triggering of light and/or drug delivery.
“This revolutionary device is the fruit of advanced electronics design and powerful micro and nanoscale engineering,” said Jae-Woong Jeong, a professor of electrical engineering at KAIST. “We are interested in further developing this technology to make a brain implant for clinical applications.”
The researchers at the Jeong group at KAIST, South Korea, develop soft electronics for wearable and implantable devices. The neuroscientists at the Bruchas Lab in Seattle study brain circuits that control stress, depression, addiction, pain and other neuropsychiatric disorders. This collaborative effort among engineers and neuroscientists over three years and tens of design iterations led to the successful validation of this brain implant in freely moving mice.
This work was supported by grants from the National Research Foundation of Korea, the National Institutes of Health, National Institute on Drug Abuse, and Mallinckrodt Professorship.

Resources:

Deep Brain Stimulation                                                   https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Deep-Brain-Stimulation

Ethical Issues in Deep Brain Stimulation https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096836/

Deep Brain Stimulation for Mental Illnesses Raises Ethical Concerns https://leapsmag.com/deep-brain-stimulation-mental-illnesses-raises-ethical-concerns/

Ethical Considerations in Deep Brain Stimulation Treatment https://pjb.mycpanel2.princeton.edu/wp/index.php/2016/03/09/ethical-considerations-in-deep-brain-stimulation-treatment/

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