Childhood abuse may impair weight-regulating hormones

Childhood abuse or neglect can lead to long-term hormone impairment that raises the risk of developing obesity, diabetes or other metabolic disorders in adulthood, according to a new study published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM).The study examined levels of the weight-regulating hormones leptin, adiponectin and irisin in the blood of adults who endured physical, emotional or sexual abuse or neglect as children. Leptin is involved in regulating appetite and is linked to body-mass index (BMI) and fat mass. The hormone irisin is involved in energy metabolism. Adiponectin reduces inflammation in the body, and obese people tend to have lower levels of the hormone. The study found dysregulation of these hormones in people who had been abused or neglected as children.”This study helps illuminate why people who have dealt with childhood adversity face a higher risk of developing excess belly fat and related health conditions,” said one of the study’s authors, Christos S. Mantzoros, MD, DSc, PhD, of Beth Israel Deaconess Medical Center and the VA Boston Healthcare System, both affiliated with Harvard Medical School in Boston, MA. “The data suggest that childhood adversity places stress on the endocrine system, leading to impairment of important hormones that can contribute to abdominal obesity well into adulthood.”The cross-sectional study examined hormone levels in the blood of 95 adults ages 35 to 65. Using questionnaires and interviews, each participant was assigned a score based on the severity of the abuse or neglect experienced during childhood. Researchers divided the participants into three groups and compared hormone levels in people with the highest adversity scores to the other two-thirds of the participants.Participants with the highest adversity scores tended to have higher levels of leptin, irisin and the inflammatory marker C-reactive protein in their blood. All of these markers are linked to obesity. …

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Eyemusic sensory substitution device enables the blind to ‘see’ colors and shapes

Using auditory or tactile stimulation, Sensory Substitution Devices (SSDs) provide representations of visual information and can help the blind “see” colors and shapes. SSDs scan images and transform the information into audio or touch signals that users are trained to understand, enabling them to recognize the image without seeing it.Currently SSDs are not widely used within the blind community because they can be cumbersome and unpleasant to use. However, a team of researchers at the Hebrew University of Jerusalem have developed the EyeMusic, a novel SSD that transmits shape and color information through a composition of pleasant musical tones, or “soundscapes.” A new study published in Restorative Neurology and Neuroscience reports that using the EyeMusic SSD, both blind and blindfolded sighted participants were able to correctly identify a variety of basic shapes and colors after as little as 2-3 hours of training.Most SSDs do not have the ability to provide color information, and some of the tactile and auditory systems used are said to be unpleasant after prolonged use. The EyeMusic, developed by senior investigator Prof. Amir Amedi, PhD, and his team at the Edmond and Lily Safra Center for Brain Sciences (ELSC) and the Institute for Medical Research Israel-Canada at the Hebrew University, scans an image and uses musical pitch to represent the location of pixels. The higher the pixel on a vertical plane, the higher the pitch of the musical note associated with it. Timing is used to indicate horizontal pixel location. Notes played closer to the opening cue represent the left side of the image, while notes played later in the sequence represent the right side. Additionally, color information is conveyed by the use of different musical instruments to create the sounds: white (vocals), blue (trumpet), red (reggae organ), green (synthesized reed), yellow (violin); black is represented by silence.”This study is a demonstration of abilities showing that it is possible to encode the basic building blocks of shape using the EyeMusic,” explains Prof. Amir Amedi. …

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Targeted treatment plus chemotherapy could benefit women with ovarian cancer

Oct. 11, 2013 — Conventional chemotherapy could further extend life in some women with ovarian cancer when used in tandem with a new type of targeted treatment, a new international study shows.The research, published in the October issue of the journal Clinical Cancer Research, provides important evidence that PARP inhibitor drugs and chemotherapy can both be effective in the same patients, helping women live longer than they would if treated with chemotherapy alone.The study, in women with mutations to BRCA genes — which increase the risk that ovarian cancer will relapse after treatment, as well as being linked to breast and other cancers — showed that ovarian cancers that have become resistant to PARP inhibitors often remain sensitive to conventional chemotherapy.The study was led by researchers at The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust, and looked at follow-up data from patients who had previously taken part in clinical trials sponsored by pharmaceutical company AstraZeneca. The research was supported by grants from the Experimental Cancer Medicine Centre and a range of institutions including Cancer Research UK, the National Institute for Health Research and the Wellcome Trust.The researchers monitored 89 patients with BRCA-mutated ovarian cancer at The Royal Marsden and other hospitals in the UK, Australia, Belgium, Israel and North America, all of whom received chemotherapy following the development of resistance to a PARP inhibitor called olaparib.Almost half (49 per cent) of olaparib-resistant patients showed a significant decrease in the size of their tumours when subsequently treated with platinum-based chemotherapy, a frequently-used treatment in ovarian cancer. The results show that a significant proportion of women with ovarian cancer could live longer if they received both treatments.PARP inhibitors have the advantage of causing fewer and less toxic side-effects than traditional chemotherapy. They are being developed in clinical trials worldwide as a potential ‘personalised’ treatment for women with BRCA gene mutations, although some have also shown some benefit in patients with non-BRCA tumours.The researchers also used high-tech new sequencing techniques to probe the precise genetic mechanisms responsible for drug resistance in ovarian tumours. Previously, tumours were thought to evolve resistance to both PARP inhibitors and platinum chemotherapy by acquiring new, secondary mutations to BRCA genes — transforming BRCA proteins from mutated, non-functioning forms back into working proteins.However, in a small subset of six cases, the study found no sign of secondary BRCA mutations, suggesting that at least in these cases, cancer was developing resistance to PARP inhibitors and platinum-based chemotherapy in different ways.Study leader Professor Stan Kaye, Cancer Research UK Professor of Medical Oncology at The Institute of Cancer Research, and Consultant at the Royal Marsden, said:”Our study finds that for many women with ovarian cancer, it is not a case of either/or chemotherapy or PARP inhibitors — there is a good chance that they may respond to both. Although some scientists were concerned that using PARP inhibitors would prevent chemotherapy from being effective, we’ve resolved that concern by showing that both drug types can work in the same patients.”Ovarian cancer is a difficult disease to treat and our research does underline the complexity of cancer, and the many different routes it can use to become resistant to treatment. But it also presents us with an opportunity, by showing us that two different types of drug treatment given in sequence could potentially extend lives.”

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Recycled sewage water is safe for crop irrigation, study suggests

Sep. 9, 2013 — The first study under realistic field conditions has found reassuringly low levels of pharmaceuticals and personal care products (PPCPs) in crops irrigated with recycled sewage water, scientists reported in Indianapolis today at the 246th National Meeting & Exposition of the American Chemical Society (ACS).”The levels of pharmaceuticals and personal care products that we found in food crops growing under real-world conditions were quite low and most likely do not pose any health concern,” said Jay Gan, Ph.D., who led the study. “I think this is good news. These substances do not tend to accumulate in vegetables, including tomatoes and lettuce that people often eat raw. We can use that information to promote the use of this treated wastewater for irrigation.”Gan and colleagues at the University of California-Riverside launched the study because drought and water shortages in the American southwest and in other arid parts of the world are using water recycled from municipal sewage treatment plants to irrigate food crops as the only option.Water from toilets and sinks enters those facilities from homes and offices, and undergoes processing to kill disease-causing microbes and remove other material. Processing leaves that water, or “effluent,” from most sewage treatment plants clean enough to drink. Traditionally, however, sewage treatment plants simply discharge the water into rivers or streams. The effluent still may contain traces of impurities, including the remains of ingredients in prescription drugs, anti-bacterial soaps, cosmetics, shampoos and other PPCPs that are flushed down toilets and drains.Gan explained that concerns have arisen about the health and environmental effects of those residual PPCPs, especially over whether they might accumulate to dangerous levels in food crops. Previous studies on PPCPs in food crops were small in scale and conducted in laboratories or greenhouses. Gan said his team was the first to focus on 20 PPCPs in multiple crops under realistic field conditions.They chose eight vegetables that people often eat raw — carrots, bell peppers, tomatoes, cucumbers, lettuce, spinach, celery and cabbage. …

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Important mechanism underlying Alzheimer’s disease discovered

Sep. 6, 2013 — Alzheimer’s disease affects more than 26 million people worldwide. It is predicted to skyrocket as boomers age — nearly 106 million people are projected to have the disease by 2050. Fortunately, scientists are making progress towards therapies. A collaboration among several research entities, including the Salk Institute and the Sanford-Burnham Medical Research Institute, has defined a key mechanism behind the disease’s progress, giving hope that a newly modified Alzheimer’s drug will be effective.In a previous study in 2009, Stephen F. Heinemann, a professor in Salk’s Molecular Neurobiology Laboratory, found that a nicotinic receptor called Alpha7 may help trigger Alzheimer’s disease. “Previous studies exposed a possible interaction between Alpha-7 nicotinic receptors (α7Rs) with amyloid beta, the toxic protein found in the disease’s hallmark plaques,” says Gustavo Dziewczapolski, a staff researcher in Heinemann’s lab. “We showed for the first time, in vivo, that the binding of this two proteins, α7Rs and amyloid beta, provoke detrimental effects in mice similar to the symptoms observed in Alzheimer’s disease .”Their experiments, published in The Journal of Neuroscience, with Dziewczapolski as first author, consisted in testing Alzheimer’s disease-induced mice with and without the gene for α7Rs. They found that while both types of mice developed plaques, only the ones with α7Rs showed the impairments associated with Alzheimer’s.But that still left a key question: Why was the pairing deleterious?In a recent paper in the Proceedings of the National Academy of Sciences, Heinemann and Dziewczapolski here at Salk with Juan Piña-Crespo, Sara Sanz-Blasco, Stuart A. Lipton of the Sanford-Burnham Medical Research Institute and their collaborators announced they had found the answer in unexpected interactions among neurons and other brain cells.Neurons communicate by sending electrical and chemical signals to each other across gaps called synapses. …

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Divers willingness to pay for biodiversity could help conservation efforts

Aug. 20, 2013 — Now teeming with life, a new study using the “Tamar Reef” shows that divers assign economic importance to aspects of reef biodiversity. These findings could help underwater conservation efforts.According to the study published in the ICES Journal of Marine Science, divers were willing to pay to improve the reef’s attributes and were able to differentiate and rank their preferences of biodiversity, numbers of fish and corals, coral species richness, fish species richness, coral size, coral abundance, and fish abundance.Respondents ranked biodiversity as the most desirable value, while fish abundance was the least important.”This result was exiting to us, since it shows that the general public as well as scientists place a high value on biodiversity and that visitors understand the fundamentals that constitute a coral reef community,” says Dr. Nadav Shashar of BGU’s Marine Biology and Biotechnology Program in Eilat, Israel.”This may help direct conservation efforts undertaken in designing future marine reserves and pre-planned artificial reefs.”Dr. Shashar and his team surveyed 295 divers to evaluate their willingness to pay for improving various elements of a coral reef. They were shown a series of photographs of the BGU-created Tamar Reef with varied densities and compositions of fish and coral species.The researchers focused on the overall aesthetic value of each component, but also how divers’ aesthetic preferences compare with scientific biodiversity attributes that might be of interest for conservation purposes.The artificial reef project is a collaboration between Israelis and Jordanians to restore the local Gulf reef culture. The Tamar Reef was the first of four reefs installed in the Red Sea. Students and faculty from both countries work together in studying the artificial reef and how it affects the marine ecology in the area.Special coral nurseries were developed to augment coral diversity. Small fragments developed into large corals and were planted on the artificial reefs.”One of the nurseries developed into an entirely new ecosystem of a floating coral reef with all types of fish; we even filmed a turtle stopping by to feed,” Shashar explains.”We are not just studying biodiversity but helping to reestablish fish and marine life that has been depleted in the Gulf.”The study was partly supported by the US-AID MERC program under grant number TA-MOU-05-M25-069 and by the Halperin and the Schechter foundations.

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Archaeologists find massive fortifications from the Iron Age in present-day Israel

Aug. 19, 2013 — Researchers from Tel Aviv University have unearthed the remains of massive ancient fortifications built around an Iron-Age Assyrian harbor in present-day Israel.At the heart of the well-preserved fortifications is a mud-brick wall up to more than 12 feet wide and 15 feet high. The wall is covered in layers of mud and sand that stretch for hundreds of feet on either side. When they were built in the eighth century B.C.E., the fortifications formed a daunting crescent-shaped defense for an inland area covering more than 17 acres.The finding comes at the end of the first excavation season at the Ashdod-Yam archaeological dig in the contemporary Israeli coastal city of Ashdod, just south of Tel Aviv. Dr. Alexander Fantalkin of TAU’s Department of Archaeology and Ancient Near Eastern Cultures is leading the project on behalf of the Sonia and Marco Nadler Institute of Archaeology.”The fortifications appear to protect an artificial harbor,” says Fantalkin. “If so, this would be a discovery of international significance, the first known harbor of this kind in our corner of the Levant.”Building up and putting downWhen the fortifications were built, the Assyrians ruled the southeastern part of the Mediterranean basin, including parts of Africa and the Middle East. Assyrian inscriptions reveal that at the end of the century, Yamani, the rebel king of Ashdod, led a rebellion against Sargon II, the king of the Assyrian Empire. The Kingdom of Judah, under King Hezekiah, rejected Yamani’s call to join the insurrection.The Assyrians responded harshly to the rebellion, eventually destroying Philistine Ashdod. As a result, power shifted to the nearby area of Ashdod-Yam, where the TAU excavations are taking place. …

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King David’s palace uncovered in Judean Shephelah

July 21, 2013 — King David’s Palace was Uncovered in the Judean Shephelah. Royal storerooms were also revealed in the joint archaeological excavation of the Hebrew University and the Israel Antiquities Authority at Khirbet Qeiyafa. These are the two largest buildings known to have existed in the tenth century BCE in the Kingdom of Judah.Two royal public buildings, the likes of which have not previously been found in the Kingdom of Judah of the tenth century BCE, were uncovered this past year by researchers of the Hebrew University and the Israel Antiquities Authority at Khirbet Qeiyafa — a fortified city in Judah dating to the time of King David and identified with the biblical city of Shaarayim.One of the buildings is identified by the researchers, Professor Yossi Garfinkel of the Hebrew University and Saar Ganor of the Israel Antiquities Authority, as David’s palace, and the other structure served as an enormous royal storeroom.On Thursday July 18 the excavation, which was conducted over the past seven years, is drawing to a close. According to Professor Yossi Garfinkel and Sa’ar Ganor, “Khirbet Qeiyafa is the best example exposed to date of a fortified city from the time of King David. The southern part of a large palace that extended across an area of c. 1,000 sq m was revealed at the top of the city. The wall enclosing the palace is c. 30 m long and an impressive entrance is fixed it through which one descended to the southern gate of the city, opposite the Valley of Elah. Around the palace’s perimeter were rooms in which various installations were found — evidence of a metal industry, special pottery vessels and fragments of alabaster vessels that were imported from Egypt.The palace is located in the center of the site and controls all of the houses lower than it in the city. From here one has an excellent vantage looking out into the distance, from as far as the Mediterranean Sea in the west to the Hebron Mountains and Jerusalem in the east. …

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Innovative study estimates extent to which air pollution in China shortens human lives

July 8, 2013 — A high level of air pollution, in the form of particulates produced by burning coal, significantly shortens the lives of people exposed to it, according to a unique new study of China co-authored by an MIT economist.The research is based on long-term data compiled for the first time, and projects that the 500 million Chinese who live north of the Huai River are set to lose an aggregate 2.5 billion years of life expectancy due to the extensive use of coal to power boilers for heating throughout the region. Using a quasi-experimental method, the researchers found very different life-expectancy figures for an otherwise similar population south of the Huai River, where government policies were less supportive of coal-powered heating.”We can now say with more confidence that long-run exposure to pollution, especially particulates, has dramatic consequences for life expectancy,” says Michael Greenstone, the 3M Professor of Environmental Economics at MIT, who conducted the research with colleagues in China and Israel.The paper, published today in the Proceedings of the National Academy of Sciences, also contains a generalized metric that can apply to any country’s environment: Every additional 100 micrograms of particulate matter per cubic meter in the atmosphere lowers life expectancy at birth by three years.In China, particulate-matter levels were more than 400 micrograms per cubic meter between 1981 and 2001, according to Chinese government agencies; state media have reported even higher levels recently, with cities including Beijing recording levels of more than 700 micrograms per cubic meter in January. (By comparison, total suspended particulates in the United States were about 45 micrograms per cubic meter in the 1990s.)Air pollution has become an increasingly charged political issue in China, spurring public protests; last month, China’s government announced its intent to adopt a series of measures to limit air pollution.”Everyone understands it’s unpleasant to be in a polluted place,” Greenstone says. “But to be able to say with some precision what the health costs are, and what the loss of life expectancy is, puts a finer point on the importance of finding policies that balance growth with environmental quality.”A river runs through itThe research stems from a policy China implemented during its era of central planning, prior to 1980. The Chinese government provided free coal for fuel boilers for all people living north of the Huai River, which has long been used as a rough dividing line between north and south in China.The free-coal policy means people in the north stay warm in winter — but at the cost of notably worse environmental conditions. Using data covering an unusually long timespan — from 1981 through 2000 — the researchers found that air pollution, as measured by total suspended particulates, was about 55 percent higher north of the river than south of it, for a difference of around 184 micrograms of particulate matter per cubic meter.Linking the Chinese pollution data to mortality statistics from 1991 to 2000, the researchers found a sharp difference in mortality rates on either side of the border formed by the Huai River. They also found the variation to be attributable to cardiorespiratory illness, and not to other causes of death.”It’s not that the Chinese government set out to cause this,” Greenstone says. “This was the unintended consequence of a policy that must have appeared quite sensible.” He notes that China has not generally required installation of equipment to abate air pollution from coal use in homes.Nonetheless, he observes, by seizing on the policy’s arbitrary use of the Huai River as a boundary, the researchers could approximate a scientific experiment.”We will never, thank goodness, have a randomized controlled trial where we expose some people to more pollution and other people to less pollution over the course of their lifetimes,” Greenstone says. For that reason, conducting a “quasi-experiment” using existing data is the most precise way to assess such issues.In their paper, the researchers address some other potential caveats. For instance, extensive mobility in a population might make it hard to draw cause-and-effect conclusions about the health effects of regional pollution. …

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Breakthrough could lead to ‘artificial skin’ that senses touch, humidity and temperature

July 8, 2013 — Using tiny gold particles and a kind of resin, a team of scientists at the Technion-Israel Institute of Technology has discovered how to make a new kind of flexible sensor that one day could be integrated into electronic skin, or e-skin. If scientists learn how to attach e-skin to prosthetic limbs, people with amputations might once again be able to feel changes in their environments.The findings appear in the June issue of ACS Applied Materials & Interfaces.The secret lies in the sensor’s ability to detect three kinds of data simultaneously. While current kinds of e-skin detect only touch, the Technion team’s invention “can simultaneously sense touch, humidity, and temperature, as real skin can do,” says research team leader Professor Hossam Haick. Additionally, the new system “is at least 10 times more sensitive in touch than the currently existing touch-based e-skin systems.”Researchers have long been interested in flexible sensors, but have had trouble adapting them for real-world use. To make its way into mainstream society, a flexible sensor would have to run on low voltage (so it would be compatible with the batteries in today’s portable devices), measure a wide range of pressures, and make more than one measurement at a time, including humidity, temperature, pressure, and the presence of chemicals. In addition, these sensors would also have to be able to be made quickly, easily, and cheaply.The Technion team’s sensor has all of these qualities. The secret is the use of monolayer-capped nanoparticles that are only 5-8 nanometers in diameter. They are made of gold and surrounded by connector molecules called ligands. In fact, “monolayer-capped nanoparticles can be thought of as flowers, where the center of the flower is the gold or metal nanoparticle and the petals are the monolayer of organic ligands that generally protect it,” says Haick.The team discovered that when these nanoparticles are laid on top of a substrate — in this case, made of PET (flexible polyethylene terephthalate), the same plastic found in soda bottles — the resulting compound conducted electricity differently depending on how the substrate was bent. (The bending motion brings some particles closer to others, increasing how quickly electrons can pass between them.) This electrical property means that the sensor can detect a large range of pressures, from tens of milligrams to tens of grams. …

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Earliest evidence of using flower beds for burial found in Raqefet Cave in Mt. Carmel

July 4, 2013 — The earliest evidence of using flower beds for burial, dating back to 13,700 years ago, was discovered in Raqefet Cave in Mt. Carmel (northern Israel), during excavations led by the University of Haifa. In four different graves from the Natufian period, dating back to 13,700-11,700 years ago, dozens of impressions of Salvia plants and other species of sedges and mints (the Lamiaceae family), were found under human skeletons.”This is another evidence that as far back as 13,700 years ago, our ancestors, the Natufians, had burial rituals similar to ours, nowadays,” said Prof. Dani Nadel, from the University of Haifa, who led the excavations.The Natufians, who lived some 15,000-11,500 years ago, were of the first in the world to abandon nomadic life and settle in permanent settlements, setting up structures with stone foundations. They were also among the first to establish cemeteries — confined areas in which they buried their community members for generations. The cemeteries were usually located at the first chambers of caves or on terraces located below the caves. In contrast, earlier cultures used to bury their dead (if at all) randomly. Mt. Carmel was one of the most important and densely populated areas in the Natufian settlement system. Its sites have been explored by University of Haifa archeologists for dozens of years.A Natufian cemetery containing 29 skeletons of babies, children and adults was discovered at Raqefet cave. …

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Long-term study reports deep brain stimulation effective for most common hereditary dystonia

June 19, 2013 — In what is believed to be the largest follow-up record of patients with the most common form of hereditary dystonia — a movement disorder that can cause crippling muscle contractions — experts in deep brain stimulation report good success rates and lasting benefits.Michele Tagliati, MD, neurologist, director of the Movement Disorders Program at Cedars-Sinai Medical Center’s Department of Neurology, and Ron L. Alterman, MD, chief of the Division of Neurosurgery at Beth Israel Deaconess Medical Center in Boston, published the study in the July issue of the journal Neurosurgery. The doctors worked together at two New York City hospitals for a decade, until Tagliati joined Cedars-Sinai in 2010.The study is focused on early-onset generalized dystonia, which in 1997 was found to be caused by a mutation of the DYT1 gene. Less than 1 percent of the overall population carries this mutation, but the frequency is believed to be three to five times higher among people of Ashkenazi Jewish heritage. Thirty percent of people who carry the defect develop dystonia.”Long-term follow-up of DYT1 patients who have undergone DBS treatment is scarce, with current medical literature including only about 50 patients followed for three or more years,” Tagliati said. This study reviewed medical records of 47 consecutive patients treated with DBS for at least one year over a span of 10 years, 2001 to 2011.”We found that, on average, symptom severity dropped to less than 20 percent of baseline within two years of device implantation. Sixty-one percent of patients were able to discontinue all their dystonia-related medications, and 91 percent were able to discontinue at least one class of drugs,” Tagliati said. “Although a few earlier studies found that stimulation’s effectiveness might wane after five years, our observations confirmed what other important DBS studies in dystonia are finding. Patients had statistically and clinically significant improvement that was maintained up to eight years.”Alterman, the article’s senior author and the neurosurgeon who performed the implant surgeries, said the study also confirmed the procedure’s safety. Complications, such as infection and device malfunction, were rare and manageable.Patient follow-up ranged from one year to eight years after surgery; 41 patients were seen for at least two years, and four completed eight years. …

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An ‘extinct’ frog makes a comeback in Israel

June 4, 2013 — The first amphibian to have been officially declared extinct by the International Union for Conservation of Nature (IUCN) has been rediscovered in the north of Israel after some 60 years and turns out to be a unique “living fossil,” without close relatives among other living frogs.The Hula painted frog was catalogued within the Discoglossus group when it was first discovered in the Hula Valley of Israel in the early 1940s. The frog was thought to have disappeared following the drying up of the Hula Lake at the end of the 1950s, and was declared extinct by the IUCN in 1996. As a result, the opportunity to discover more about this species’ history, biology and ecology was thought to have disappeared.However, a team of Israeli, German and French researchers now report in the scientific journal Nature Communications on an in-depth scientific analysis of this enigmatic amphibian.Based on new genetic analyses of rediscovered individuals and the morphologic analyses of extant and fossil bones, the conclusion is that the Hula frog differs strongly from its other living relatives, the painted frogs from northern and western Africa. Instead, the Hula frog is related to a genus of fossil frogs, Latonia, which were found over much of Europe dating back to prehistoric periods and has been considered extinct for about a million years,The results imply that the Hula painted frog is not merely another rare species of frog, but is actually the sole representative of an ancient clade of frogs (a group with a single common ancestor).Plans to reflood parts of the Hula Valley and restore the original swamp habitat are in place, which may allow expansion in population size and a secure future for the Hula painted frog.

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Stress management counseling in the primary care setting is rare

Nov. 19, 2012 — While stress may be a factor in 60 to 80 percent of all visits to primary care physicians, only three percent of patients actually receive stress management counseling, say researchers at Beth Israel Deaconess Medical Center.

The study appears online Nov. 19 in the Archives of Internal Medicine.

“Almost half of Americans report an increase in psychological stress over the past five years. Stress is the elephant in the room. Everyone knows it’s there, but physicians rarely talk to patients about it,” says lead author, Aditi Nerurkar, MD, MPH a primary care physician and the Assistant Medical Director of BIDMC’s Cheng & Tsui Center for Integrative Care. “In fact, stress management counseling is the least common type of physician counseling, falling behind counseling for nutrition, exercise, weight loss and smoking.”

Nerurkar and colleagues examined data from the 2006 to 2009 National Ambulatory Medical Care Survey involving more than 34,000 office visits and 1,263 physicians. They were looking for evidence of doctors who provided stress management help, which included counseling at the visit, providing “information intended to help patients reduces stress through exercise, biofeedback, yoga, etc.,” or referrals “to other health professionals for the purpose of coping with stress.”

What they found is that stress management counseling by physicians rarely happens in the primary care setting. Just three percent of physicians offer stress counseling, mostly for their more complex patients, particularly those coping with depression.

“Our research suggests that physicians are not providing stress management counseling as prevention, but rather, as a downstream intervention for their sickest patients,” says Nerurkar. “Considering what we know about stress and disease, this clearly points to missed opportunities.”

The researchers also found that stress management counseling was associated with longer office visits.

“We know that primary care physicians are overburdened. With the volume of patients they see, there simply may not be enough time to provide stress management counseling during the office visit,” says senior author, Gloria Yeh, MD, MPH, Director of the Integrative Medicine Fellowship Program at Harvard Medical School and BIDMC. “The fact that we found that so few physicians are counseling their patients about stress supports this, and highlights the need to rethink how primary care is being delivered.”

A key step towards incorporating stress management counseling into primary care may be restructuring primary care delivery and payment to support team-based care.

“New payment models designed to promote wellness will enable team-based primary care practices to add counseling and coaching staff to address stress, mental illness and behavioral change more effectively,” says co-author, Russell S. Phillips, MD, Director of the Harvard Medical School Center for Primary Care.

These changes could help shift counseling to earlier in the disease process.

“Our findings make us wonder whether stress management counseling, if offered earlier to more patients as prevention, could lead to better health outcomes,” says Nerurkar, “But more research is needed to establish the role that stress management might play clinically.”

In addition to Nerurkar, Yeh and Phillips, co-authors include Asaf Bitton, MD, MPH and Roger B. Davis, ScD of Beth Israel Deaconess Medical Center.

Nerurkar is supported by an Institutional National Research Service Award from the National Institutes of Health. Davis is supported in part by the Harvard Catalyst and the Harvard Clinical and Translational Science Center.

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Picking up a second language is predicted by ability to learn patterns

May 28, 2013 — Some people seem to pick up a second language with relative ease, while others have a much more difficult time. Now, a new study suggests that learning to understand and read a second language may be driven, at least in part, by our ability to pick up on statistical regularities.

The study is published in Psychological Science, a journal of the Association for Psychological Science.

Some research suggests that learning a second language draws on capacities that are language-specific, while other research suggests that it reflects a more general capacity for learning patterns. According to psychological scientist and lead researcher Ram Frost of Hebrew University, the data from the new study clearly point to the latter:

“These new results suggest that learning a second language is determined to a large extent by an individual ability that is not at all linguistic,” says Frost.

In the study, Frost and colleagues used three different tasks to measure how well American students in an overseas program picked up on the structure of words and sounds in Hebrew. The students were tested once in the first semester and again in the second semester.

The students also completed a task that measured their ability to pick up on statistical patterns in visual stimuli. The participants watched a stream of complex shapes that were presented one at a time. Unbeknownst to the participants, the 24 shapes were organized into 8 triplets — the order of the triplets was randomized, though the shapes within each triplet always appeared in the same sequence. After viewing the stream of shapes, the students were tested to see whether they implicitly picked up the statistical regularities of the shape sequences.

The data revealed a strong association between statistical learning and language learning: Students who were high performers on the shapes task tended to pick up the most Hebrew over the two semesters.

“It’s surprising that a short 15-minute test involving the perception of visual shapes could predict to such a large extent which of the students who came to study Hebrew would finish the year with a better grasp of the language,” says Frost.

According to the researchers, establishing a link between second language acquisition and a general capacity for statistical learning may have broad implications.

“This finding points to the possibility that a unified and universal principle of statistical learning can quantitatively explain a wide range of cognitive processes across domains, whether they are linguistic or nonlinguistic,” they conclude.

This research was supported by the Israel Science Foundation (159/10) and by the National Institute of Child Health and Human Development (RO1 HD 067364 and PO1HD 01994).

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