Delicious side dish for your Thanksgiving Table – ©Joyce Hays, Target Health Inc.
Pumpkin Part of Risotto
3 large eggs
1/2 cup granulated Splenda
1/3 cup brown Splenda or other brown sugar substitute
1.5 cans (23-24-oz) pumpkin puree or 2.5 cups fresh pumpkin puree
3/4 cup evaporated milk
2 teaspoon vanilla extract
2 teaspoons ground cinnamon
1 teaspoon ground ginger
1/2 teaspoon ground cloves
1/2 teaspoon kosher salt
Directions for Pumpkin Ingredients
Make Pumpkin Part of the Risotto First:
In a mixing bowl, whisk eggs and both sugars together until smooth. Add the can of pumpkin puree, evaporated milk, vanilla, cinnamon, ginger, cloves and the salt. Stir until well blended. Set aside
Ingredients for the rest of the risotto
6 cups chicken or turkey stock or broth, more as needed
2 Tablespoons butter
2 Tablespoons olive oil
1 large onion, chopped
3 large cloves garlic, minced
1 and 1/2 cups arborio rice
1/4 teaspoon freshly grated nutmeg
1/3 cup dry white wine
Pumpkin mixture, divided (ingredients above)
Pinches, Salt and pepper
1 teaspoon turmeric
1 cup water chestnuts, chopped
1 cup toasted pine nuts
Grated Parmigiano-Reggiano, to taste
Directions for the entire recipe
- Toast the pine nuts and set aside
- In a medium saucepan, bring the chicken stock or vegetable broth to a simmer over medium heat.
- Meanwhile, in a large heavy-bottomed pot or Dutch oven, melt the butter and olive oil over medium heat. Stir in the onion and garlic, and cook, stirring frequently, until the onion is translucent and just begins to color, 8 to 10 minutes.
Stirring in the rice – ©Joyce Hays, Target Health Inc.
- Stir in the rice and nutmeg and cook, stirring frequently and coating the rice with the fat, until the rice just begins to toast, about 3 minutes.
- Add the wine and continue to stir, cooking until the wine is mostly absorbed.
- Add a ladleful of broth and cook, stirring constantly, until the broth is almost completely absorbed. Continue adding an additional ladle of broth as each is absorbed by the rice.
- After 10 minutes of cooking the rice, stir in half of the pumpkin mixture, with another ladle of broth. Season with one-half teaspoon salt and a pinch of pepper.
- Continue cooking the rice, stirring in additional broth as needed, until the rice is slightly al dente, about another 10 minutes.
Stirring in the remaining pumpkin mixture – ©Joyce Hays, Target Health Inc.
- Stir in the remaining pumpkin mixture, the toasted pine nuts and 2 Tablespoons walnut oil, the turmeric, chopped water chestnuts, cayenne. Stir in additional broth as desired for a creamy consistency.
- Serve each portion with a light drizzle of walnut oil and a sprinkling of freshly grated cheese (optional – I didn’t, I simply sprinkled a few pine nuts on top)
This is the fourth incarnation of my pumpkin risotto. I just couldn’t seem to get the right balance of sweet and savory. Either it was too bland, or when I added candied chestnuts, it was too sweet. I was trying to create a dish to serve on Thanksgiving and afterwards with leftovers, like the turkey croquettes recipe from last week. I think I finally got the right amounts of ingredients; Jules says, he gives it a 4.5 to 5 out of 5 stars, but you be the final judge.
We started this meal with red and white wine, a salad: beautiful ripe tomatoes, shredded endive, avocados cut into cubes, green olives and thinly sliced cucumbers (the kind with thin skin, you don’t want/have to remove). The dressing was a simple olive oil and fresh lemon juice. The entre was left-over turkey slices with stuffing and the pumpkin risotto. Just happened to have pomegranate arils on hand so we sprinkled some of those over the turkey. This was a scrumptious meal!
We’re drinking a new red, Pinot Noir, from Paul Hobbs vineyards in CA, in addition to Santa Margherita, Pinot Grigio
This past week, we saw Magic Flute at the MetOpera, one of our favorite operas at the Met. Needless to say, Mozart’s music was sublime from start to finish. This has got to be the perfect opera! Voices were top notch, the brilliant Julie Taymor production could not be improved upon. Our experience of this opera was of the highest level. Days later, my mind is still swirling with the arias of Tamino, Papageno, Sarastro, Queen of the Night, Pamina and Papagena. I’ve been obsessed with Mozart. It’s no wonder that I had to do the History of Medicine on this especially rare genius. We also watched the film, Amadeus, which we saw years ago, but loved it again as if for the first time.
Hope you enjoy some of the musical links provided in this week’s newsletter.
From Our Table to Yours!
Reporting in the Nov. 14 issue of the journal Science, University of California, Berkeley, climate scientist David Romps and his colleagues look at predictions of precipitation and cloud buoyancy in 11 different climate models and conclude that their combined effect will generate more frequent electrical discharges to the ground.
“With warming, thunderstorms become more explosive,” said Romps, an assistant professor of earth and planetary science and a faculty scientist at Lawrence Berkeley National Laboratory. “This has to do with water vapor, which is the fuel for explosive deep convection in the atmosphere. Warming causes there to be more water vapor in the atmosphere, and if you have more fuel lying around, when you get ignition, it can go big time.”
More lightning strikes mean more human injuries; estimates of people struck each year range from the hundreds to nearly a thousand, with scores of deaths. But another significant impact of increased lightning strikes would be more wildfires, since half of all fires — and often the hardest to fight — are ignited by lightning, Romps said. More lightning also would likely generate more nitrogen oxides in the atmosphere, which exert a strong control on atmospheric chemistry.
While some studies have shown changes in lightning associated with seasonal or year-to-year variations in temperature, there have been no reliable analyses to indicate what the future may hold. Romps and graduate student Jacob Seeley hypothesized that two atmospheric properties — precipitation and cloud buoyancy — together might be a predictor of lightning, and looked at observations during 2011 to see if there was a correlation.
“Lightning is caused by charge separation within clouds, and to maximize charge separation, you have to loft more water vapor and heavy ice particles into the atmosphere,” he said. “We already know that the faster the updrafts, the more lightning, and the more precipitation, the more lightning.”
Precipitation — the total amount of water hitting the ground in the form of rain, snow, hail or other forms — is basically a measure of how convective the atmosphere is, he said, and convection generates lightning. The ascent speeds of those convective clouds are determined by a factor called CAPE — convective available potential energy — which is measured by balloon-borne instruments, called radiosondes, released around the U.S. twice a day.
“CAPE is a measure of how potentially explosive the atmosphere is, that is, how buoyant a parcel of air would be if you got it convecting, if you got it to punch through overlying air into the free troposphere,” Romps said. “We hypothesized that the product of precipitation and CAPE would predict lightning.”
Using U.S. Weather Service data on precipitation, radiosonde measurements of CAPE and lightning- strike counts from the National Lightning Detection Network at the University of Albany, State University of New York (UAlbany), they concluded that 77 percent of the variations in lightning strikes could be predicted from knowing just these two parameters.
“We were blown away by how incredibly well that worked to predict lightning strikes,” he said.
They then looked at 11 different climate models that predict precipitation and CAPE through this century and are archived in the most recent Coupled Model Intercomparison Project (CMIP5). CMIP was established as a resource for climate modelers, providing a standard protocol for studying the output of coupled atmosphere-ocean general circulation models so that these models can be compared and validated.
“With CMIP5, we now have for the first time the CAPE and precipitation data to calculate these time series,” Romps said.
On average, the models predicted an 11 percent increase in CAPE in the U.S. per degree Celsius rise in global average temperature by the end of the 21st century. Because the models predict little average precipitation increase nationwide over this period, the product of CAPE and precipitation gives about a 12 percent rise in cloud-to-ground lightning strikes per degree in the contiguous U.S., or a roughly 50 percent increase by 2100 if Earth sees the expected 4-degree Celsius increase (7 degrees Fahrenheit) in temperature. This assumes carbon dioxide emissions keep rising consistent with business as usual.
Exactly why CAPE increases as the climate warms is still an area of active research, Romps said, though it is clear that it has to do with the fundamental physics of water. Warm air typically contains more water vapor than cold air; in fact, the amount of water vapor that air can “hold” increases exponentially with temperature. Since water vapor is the fuel for thunderstorms, lightning rates can depend very sensitively on temperature.
In the future, Romps plans to look at the distribution of lightning-strike increases around the U.S. and also explore what lightning data can tell climatologists about atmospheric convection.
Romps’ co-authors are Jacob Seeley, also of the Department of Earth and Planetary Science at UC Berkeley, and David Vollaro and John Molinari of the Department of Atmospheric and Environmental Sciences at UAlbany.
The work was supported by the U.S. Department of Energy’s Office of Advanced Scientific Computing Research and Office of Biological and Environmental Research, and the National Science Foundation.
- D. M. Romps, J. T. Seeley, D. Vollaro, J. Molinari. Projected increase in lightning strikes in the United States due to global warming. Science, 2014; 346 (6211): 851 DOI: 10.1126/science.1259100
University of California – Berkeley. “Lightning expected to increase by 50 percent with global warming.” ScienceDaily. ScienceDaily, 13 November 2014. <www.sciencedaily.com/releases/2014/11/141113142112.htm>.
After a tense wait during the seven-hour descent to the surface of Comet 67P/Churyumov-Gerasimenko, the signal confirming the successful touchdown arrived on Earth at 16:03 GMT (17:03 CET).
The confirmation was relayed via the Rosetta orbiter to Earth and picked up simultaneously by ESA’s ground station in Malargüe, Argentina and NASA’s station in Madrid, Spain. The signal was immediately confirmed at ESA’s Space Operations Centre, ESOC, in Darmstadt, and DLR’s Lander Control Centre in Cologne, both in Germany.
The first data from the lander’s instruments were transmitted to the Philae Science, Operations and Navigation Centre at France’s CNES space agency in Toulouse.
“Our ambitious Rosetta mission has secured a place in the history books: not only is it the first to rendezvous with and orbit a comet, but it is now also the first to deliver a lander to a comet’s surface,” noted Jean-Jacques Dordain, ESA’s Director General.
“With Rosetta we are opening a door to the origin of planet Earth and fostering a better understanding of our future. ESA and its Rosetta mission partners have achieved something extraordinary today.”
“After more than 10 years travelling through space, we’re now making the best ever scientific analysis of one of the oldest remnants of our Solar System,” said Alvaro Giménez, ESA’s Director of Science and Robotic Exploration.
“Decades of preparation have paved the way for today’s success, ensuring that Rosetta continues to be a game-changer in cometary science and space exploration.”
“We are extremely relieved to be safely on the surface of the comet, especially given the extra challenges that we faced with the health of the lander,” said Stephan Ulamec, Philae Lander Manager at the DLR German Aerospace Center.
“In the next hours we’ll learn exactly where and how we’ve landed, and we’ll start getting as much science as we can from the surface of this fascinating world.”
Rosetta was launched on 2 March 2004 and travelled 6.4 billion kilometres through the Solar System before arriving at the comet on 6 August 2014.
“Rosetta’s journey has been a continuous operational challenge, requiring an innovative approach, precision and long experience,” said Thomas Reiter, ESA Director of Human Spaceflight and Operations.
“This success is testimony to the outstanding teamwork and the unique knowhow in operating spacecraft acquired at the European Space Agency over the decades.”
The landing site, named Agilkia and located on the head of the bizarre double-lobed object, was chosen just six weeks after arrival based on images and data collected at distances of 30-100 km from the comet. Those first images soon revealed the comet as a world littered with boulders, towering cliffs and daunting precipices and pits, with jets of gas and dust streaming from the surface.
Following a period spent at 10 km to allow further close-up study of the chosen landing site, Rosetta moved onto a more distant trajectory to prepare for Philae’s deployment.
Five critical go/no-go decisions were made last night and early this morning, confirming different stages of readiness ahead of separation, along with a final preseparation manoeuvre by the orbiter.
Deployment was confirmed at 09:03 GMT (10:03 CET) at a distance of 22.5km from the centre of the comet. During the seven-hour descent, which was made without propulsion or guidance, Philae took images and recorded information about the comet’s environment.
“One of the greatest uncertainties associated with the delivery of the lander was the position of Rosetta at the time of deployment, which was influenced by the activity of the comet at that specific moment, and which in turn could also have affected the lander’s descent trajectory,” said Sylvain Lodiot, ESA Rosetta Spacecraft Operations Manager.
“Furthermore, we’re performing these operations in an environment that we’ve only just started learning about, 510 million kilometres from Earth.”
Touchdown was planned to take place at a speed of around 1 m/s, with the three-legged landing gear absorbing the impact to prevent rebound, and an ice screw in each foot driving into the surface.
At the same time, two harpoons fired and locked the probe onto the surface.
But during the final health checks of the lander before separation, a problem was detected with the small thruster on top that was designed to counteract the recoil of the harpoons to push the lander down onto the surface. The conditions of landing — including whether or not the thruster performed — along with the exact location of Philae on the comet are being analysed.
The first images from the surface are being downlinked to Earth and should be available within a few hours of touchdown.
Over the next 2.5 days, the lander will conduct its primary science mission, assuming that its main battery remains in good health. An extended science phase using the rechargeable secondary battery may be possible, assuming Sun illumination conditions allow and dust settling on the solar panels does not prevent it. This extended phase could last until March 2015, after which conditions inside the lander are expected to be too hot for it to continue operating.
Science highlights from the primary phase will include a full panoramic view of the landing site, including a section in 3D, high-resolution images of the surface immediately underneath the lander, on-the-spot analysis of the composition of the comet’s surface materials, and a drill that will take samples from a depth of 23 cm and feed them to an onboard laboratory for analysis.
The lander will also measure the electrical and mechanical characteristics of the surface. In addition, low-frequency radio signals will be beamed between Philae and the orbiter through the nucleus to probe the internal structure.
The detailed surface measurements that Philae makes at its landing site will complement and calibrate the extensive remote observations made by the orbiter covering the whole comet.
“Rosetta is trying to answer the very big questions about the history of our Solar System. What were the conditions like at its infancy and how did it evolve? What role did comets play in this evolution? How do comets work?” said Matt Taylor, ESA Rosetta project scientist.
“Today’s successful landing is undoubtedly the cherry on the icing of a 4 km-wide cake, but we’re also looking further ahead and onto the next stage of this ground-breaking mission, as we continue to follow the comet around the Sun for 13 months, watching as its activity changes and its surface evolves.”
While Philae begins its close-up study of the comet, Rosetta must manoeuvre from its post-separation path back into an orbit around the comet, eventually returning to a 20 km orbit on 6 December.
Next year, as the comet grows more active, Rosetta will need to step further back and fly unbound ‘orbits’, but dipping in briefly with daring flybys, some of which will bring it within just 8 km of the comet centre.
The comet will reach its closest distance to the Sun on 13 August 2015 at about 185 million km, roughly between the orbits of Earth and Mars. Rosetta will follow it throughout the remainder of 2015, as they head away from the Sun and activity begins to subside.
“It’s been an extremely long and hard journey to reach today’s once-in-a-lifetime event, but it was absolutely worthwhile. We look forward to the continued success of the great scientific endeavour that is the Rosetta mission as it promises to revolutionise our understanding of comets,” said Fred Jansen, ESA Rosetta mission manager.
More about Rosetta
Rosetta is an ESA mission with contributions from its Member States and NASA. Rosetta’s Philae lander is provided by a consortium led by DLR, MPS, CNES and ASI. Rosetta is the first mission in history to rendezvous with a comet. It is escorting the comet as they orbit the Sun together, and has deployed a lander to its surface.Comets are time capsules containing primitive material left over from the epoch when the Sun and its planets formed. By studying the gas, dust and structure of the nucleus and organic materials associated with the comet, via both remote and in situ observations, the Rosetta mission should become the key to unlocking the history and evolution of our Solar System.
European Space Agency. “Touchdown! Rosetta’s Philae probe lands on comet.” ScienceDaily. ScienceDaily, 12 November 2014. <www.sciencedaily.com/releases/2014/11/141112124834.htm>.
“For the first time, we have been able to tap into human brainwaves, transfer them wirelessly to a gene network and regulate the expression of a gene depending on the type of thought. Being able to control gene expression via the power of thought is a dream that we’ve been chasing for over a decade,” says Fussenegger.
A source of inspiration for the new thought-controlled gene regulation system was the game Mindflex, where the player wears a special headset with a sensor on the forehead that records brainwaves. The registered electroencephalogram (EEG) is then transferred into the playing environment. The EEG controls a fan that enables a small ball to be thought-guided through an obstacle course.
Wireless Transmission to Implant
The system, which the Basel-based bioengineers recently presented in the journalNature Communications, also makes use of an EEG headset. The recorded brainwaves are analysed and wirelessly transmitted via Bluetooth to a controller, which in turn controls a field generator that generates an electromagnetic field; this supplies an implant with an induction current.
A light then literally goes on in the implant: an integrated LED lamp that emits light in the near-infrared range turns on and illuminates a culture chamber containing genetically modified cells. When the near-infrared light illuminates the cells, they start to produce the desired protein.
Thoughts Control Protein Quantity
The implant was initially tested in cell cultures and mice, and controlled by the thoughts of various test subjects. The researchers used SEAP for the tests, an easy-to-detect human model protein which diffuses from the culture chamber of the implant into the mouse’s bloodstream.
To regulate the quantity of released protein, the test subjects were categorised according to three states of mind: bio-feedback, meditation and concentration. Test subjects who played Minecraft on the computer, i.e. who were concentrating, induced average SEAP values in the bloodstream of the mice. When completely relaxed (meditation), the researchers recorded very high SEAP values in the test animals. For bio-feedback, the test subjects observed the LED light of the implant in the body of the mouse and were able to consciously switch the LED light on or off via the visual feedback. This in turn was reflected by the varying amounts of SEAP in the bloodstream of the mice.
New Light-sensitive Gene Construct
“Controlling genes in this way is completely new and is unique in its simplicity,” explains Fussenegger. The light-sensitive optogenetic module that reacts to near-infrared light is a particular advancement. The light shines on a modified light-sensitive protein within the gene-modified cells and triggers an artificial signal cascade, resulting in the production of SEAP. Near-infrared light was used because it is generally not harmful to human cells, can penetrate deep into the tissue and enables the function of the implant to be visually tracked.
The system functions efficiently and effectively in the human-cell culture and human-mouse system. Fussenegger hopes that a thought-controlled implant could one day help to combat neurological diseases, such as chronic headaches, back pain and epilepsy, by detecting specific brainwaves at an early stage and triggering and controlling the creation of certain agents in the implant at exactly the right time.
- Marc Folcher, Sabine Oesterle, Katharina Zwicky, Thushara Thekkottil, Julie Heymoz, Muriel Hohmann, Matthias Christen, Marie Daoud El-Baba, Peter Buchmann, Martin Fussenegger. Mind-controlled transgene expression by a wireless-powered optogenetic designer cell implant. Nature Communications, 2014; 5: 5392 DOI: 10.1038/ncomms6392
ETH Zurich. “Controlling genes with your thoughts.” ScienceDaily. ScienceDaily, 11 November 2014. <www.sciencedaily.com/releases/2014/11/141111111317.htm>.
How is all this information processed at once? The provisional answer, for decades, has centered on specialization. Biologists have assumed that neurons are specialized for specific behaviors, and that they fall into distinct classes based upon kind of signals they interpret. But findings in rats made by a team at Cold Spring Harbor Laboratory (CSHL) now call the universality of that concept into question. The team, led by CSHL Associate Professor Anne Churchland, has found a population of neurons in the rat cortex that process information in a way that supports multiple behaviors at once. The neurons they studied in this population, the scientists say, cannot be individually classified according to specialization.
Much previous neuroscience research has measured how neurons respond to a single, specialized activity. This research has uncovered distinct neuronal classes in specific brain areas. “The visual cortex is an excellent example,” explains Churchland. “We know that those neurons are highly specialized. For example, specific neurons are specialized to respond to stimuli located in particular parts of space, way up high, or way off to the left, for instance.”
Churchland wondered if the same rules apply in other parts of the brain where complex processing tasks are taking place. Her team studied the posterior parietal cortex (PPC). This area of higher brain function has been has been associated with numerous behaviors, such as decision-making, value judgments, attention, and planning. Are there specialized groups of neurons in the PPC for each function? Or do individual neurons respond to multiple stimuli, in unique ways?
To distinguish between the two possibilities, Churchland and her team exploited a research setup that has been used to study decision-making. “We trained rats to associate a rapid pulse of flashing light or sound with a particular door, and slower stimuli with another door.” The team then measured how individual neurons in the rat PPC respond to both light and sound, and correlated these with the decisions the animals ultimately made in each trial.
“We were surprised to find that there were no specialized populations among neurons in the PPC that we studied,” says Churchland. Instead, the team found that PPC neurons were multitasking, each one responding to more than one stimulus. No distinct classes emerged among the more than 300 neurons they measured. “Each neuron had its own signature for how it responded — no two were alike — which means that we couldn’t lump them together into categories.”
Churchland proposes that neurons such as these, which are able to multitask, may offer the brain a flexible way to combine responses. “This changes the way our team thinks about how neurons are used and work together,” she says. Based on these results, Churchland says, researchers may want to question the often used method of averaging the responses of different neurons to describe their collective behavior, under the assumption that anatomically distinct groups of neurons will respond to stimuli in the same way. More broadly, the research suggests a new way of thinking about how neurons behave. In this view, “it is no longer single neurons making sense of a behavior, but the whole group, integrating multiple signals,” says Churchland.
The work has important implications as scientists try to understand cognition more broadly. “In order to have a coherent view of the world, we must be able to make sense of hundreds, maybe even thousand of inputs at once,” says Churchland. And that ability is something that often goes awry in mental disorders, like autism.
- David Raposo, Matthew T Kaufman, Anne K Churchland. A category-free neural population supports evolving demands during decision-making. Nature Neuroscience, 2014; DOI: 10.1038/nn.3865
Cold Spring Harbor Laboratory. “Some neurons can multitask, raising questions about importance of specialization.” ScienceDaily. ScienceDaily, 10 November 2014. <www.sciencedaily.com/releases/2014/11/141110124225.htm>.
Target Health Inc. on YouTube
Last week, Dr. Mitchel, President of Target Health was asked to be a keynote speaker at a breakfast at NY Medical College, which included a ribbon cutting ceremony for a new incubator. The slide presentation was titled Working With FDA – How Creative One Can Be When Working with the FDA to Optimize the Drug and Device Development Process. The presentation addressed the innovative processes going on at FDA and how FDA, in part, is ahead of the industry in suggesting alternative approaches on how to get products to the market sooner. The presentation is also available on YouTube and the slides are on our website.
Laurence Gottlieb (Pres. & CEO HVEDC), Jules Mitchel (Target Health); Robert W. Amler, MD (VP & Dean) NY Medical College)
ON TARGET is the newsletter of Target Health Inc., a NYC-based, full-service, contract research organization (eCRO), providing strategic planning, regulatory affairs, clinical research, data management, biostatistics, medical writing and software services to the pharmaceutical and device industries, including the paperless clinical trial.
For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 104). For additional information about software tools for paperless clinical trials, please also feel free to contact Dr. Jules T. Mitchel or Ms. Joyce Hays. The Target Health software tools are designed to partner with both CROs and Sponsors. Please visit the Target HealthWebsite.
Joyce Hays, Founder and Editor in Chief of On Target
Jules Mitchel, Editor
Size Matters: Baby’s Size at Birth May Predict Risk for Disease Later in Life
A new research report published in the November 2014 issue of The FASEB Journal suggests that being overweight might be better in the long term than being 1) ___. Before you reach for that box of Twinkies, however, it’s important to note that this discovery only applies to the weight of newborn babies in relation to risk of future disease. These findings support the hypothesis that common long-term variation in the activity of genes established in the womb may underpin links between size at birth and risk for adult 2) ___, said Claire R. Quilter, Ph.D., study author from the Mammalian Molecular Genetics Group, Department of Pathology at the University of Cambridge in the United Kingdom. If confirmed these could be important markers of optimal fetal growth and may be the first step along a path to very early disease prevention in the womb. Quilter and colleagues set out to determine whether or not there was any truth to the prevailing hypothesis that conditions in the womb that lead to a high birth weight or low birth weight could affect expression of genes in the baby, which in turn, leads to effects that persist into 3) ___ life. To do this, they looked at DNA derived from the cord blood of newborn babies from mothers with raised glucose levels during late pregnancy and in those babies born following relatively slow growth in the womb that later caught up after birth. These DNA methylation patterns (chemical modifications of DNA) are known to affect changes in 4) ___ activity. Results showed differences in these methylation changes which were specific to boys and girls and to each of the two groups. However, changes were also identified that were common to both groups of babies. Similar overlapping signals were seen in two other groups of babies studied.
In the age of epigenetics, prenatal care is moving beyond infant survival and into optimizing the health of the baby for his or her entire life, said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. Understanding the epigenetic factors that play a role in a baby’s birthweight will eventually help doctors give the best care and advice to their pregnant patients. Experts at the American Academy of Pediatrics (AAP) say parents should ask their child’s health care provider to keep tabs on children’s weight from birth on up. But they shouldn’t obsess about the weight of a child younger than 2 years. Members of the AAP Nutrition Committee say there are no data to support the belief that children in this age group who are overweight are more prone to be 5) ___ later.
Journal Reference: C. R. Quilter, W. N. Cooper, K. M. Cliffe, B. M. Skinner, P. M. Prentice, L. Nelson, J. Bauer, K. K. Ong, M. Constancia, W. L. Lowe, N. A. Affara, D. B. Dunger. Impact on offspring methylation patterns of maternal gestational diabetes mellitus and intrauterine growth restraint suggest common genes and pathways linked to subsequent type 2 diabetes risk. The FASEB Journal, 2014; DOI: 10.1096/fj.14-255240
Over 60? Drink Up as Alcohol Use is Associated with Better Memory
Once, during Prohibition, I was forced to live for days on nothing but food and water. (W.C. Fields)
Candy is dandy but liquor is quicker. (Ogden Nash, Reflection on Ice-Breaking)
Researchers from the University of Texas Medical Branch at Galveston, University of Kentucky, and University of Maryland found that for people 60 and older who do not have dementia, light 6) ___ consumption during late life is associated with higher episodic memory — the ability to recall memories of events. Moderate alcohol consumption was also linked with a larger volume in the hippocampus, a brain region critical for episodic 7) ___. The relationship between light alcohol consumption and episodic memory goes away if hippocampal volume is factored in, providing new evidence that hippocampal functioning is the critical factor in these improvements. These findings were detailed in the October 2014, American Journal of Alzheimer’s Disease and Other Dementias.
The study used data from more than 660 patients in the Framingham Heart Study Offspring Cohort. These patients completed surveys on their alcohol consumption and demographics, a battery of neuropsychological assessments, the presence or absence of the genetic Alzheimer’s disease risk factor APOE e4 and MRIs of their brains. The researchers found that light and moderate alcohol consumption in older people is associated with higher episodic memory and is linked with larger hippocampal 8) ___ volume. Amount of alcohol consumption had no impact on executive function or overall mental ability. Findings from animal studies also suggest that moderate alcohol consumption may contribute to preserved hippocampal volume by promoting generation of new nerve 9) ___ in the hippocampus. In addition, exposing the brain to moderate amounts of alcohol may increase the release of brain chemicals involved with cognitive, or information processing, functions. There were no significant differences in cognitive functioning and regional brain volumes during late life according to reported midlife alcohol consumption status, said lead author Brian Downer, UTMB Sealy Center on Aging postdoctoral fellow. This may be due to the fact that adults who are able to continue consuming alcohol into old 10) ___ are healthier, and therefore have higher cognition and larger regional brain volumes, than people who had to decrease their alcohol consumption due to unfavorable health outcomes.
Although the potential benefits of light to moderate alcohol consumption to cognitive learning and memory later in life have been consistently reported, extended periods of abusing alcohol, often defined as having five or more alcoholic beverages during a single drinking occasion is known to be harmful to the brain.
My grandmother is over eighty and still doesn’t need glasses. Drinks right out of the bottle. (Henny Youngman)
Journal Reference: B. Downer, Y. Jiang, F. Zanjani, D. Fardo. Effects of Alcohol Consumption on Cognition and Regional Brain Volumes Among Older Adults. American Journal of Alzheimer’s Disease and Other Dementias, 2014; DOI:10.1177/1533317514549411
ANSWERS: 1) underweight; 2) disease; 3) adult; 4) gene; 5) heavy; 6) alcohol; 7) memory; 8) brain; 9) cells; 10) age
Benjamin M. Spock MD, World’s Best Known Pediatrician
Benjamin M. Spock MD (1903-1998)
Benjamin McLane Spock (May 2, 1903 – March 15, 1998) was an American pediatrician whose book Baby and Child Care, published in 1946, is one of the best-sellers of all time. Throughout its first 52 years, Baby and Child Care was the second-best-selling book, next to the Bible. Its message to mothers is that you know more than you think you do. Spock was the first pediatrician to study psychoanalysis to try to understand children’s needs and family dynamics. His ideas about childcare influenced several generations of parents to be more flexible and affectionate with their children, and to treat them as individuals. In addition to his pediatric work, Spock was an activist in the New Left and anti Vietnam War movements during the 1960s and early 1970s. At the time his books were criticized by Vietnam War supporters for allegedly propagating permissiveness and an expectation of instant gratifications that led young people to join these movements, a charge Spock denied. Spock also won an Olympic gold medal in rowing in 1924 while attending Yale University. Spock had a 35-ft sailboat named Carapace, on which he lived in Tortola, British Virgin Islands. At age 84, Spock came in third out of a field of eight, rowing his dinghy across the Sir Frances Drake Channel between Tortola and Norman Island, a distance of four miles. It took him 2.5 hours. He credited his strength and good health to his life style and his love for life. Spock had a second sailboat named Turtle, which he lived aboard and sailed in Maine in the summers. They lived only on boats, with no house, for most of 20 years. At the very end of Spock’s life, he was advised to come ashore by his physician, Steve Pauker, of New England Medical Center, Boston.
Dr. Spock with granddaughter Susannah in 1968 (Wikimedia Commons / Library of Congress)
Dr. Benjamin Spock has been at the forefront of child care since he first made a splash more than 60 years ago. His advice has been religiously followed by some, dismissed as kooky by others; controversy has swirled around his ideas for decades. But despite the controversy, today new parents still follow his advice. They just might not realize they do. When Dr. Spock’s book Baby and Child Care was published in 1946, its simple core message was revolutionary: Don’t be afraid to trust your own common sense. Between that and his insistence that parents should show love and affection to their children rather than constant strict discipline, Dr. Spock challenged the conventional wisdom of early 20th-century childrearing like no one else. A spokesperson for Pocket Books, Spock’s main publisher, said that over 50 million copies have been sold around the world, and translated into 42 languages.
Today, the basic tenets of Dr. Spock’s child care philosophy might seem obvious to most parents. Hug your child. Tell her/him they’re special and loved and unique. Feed her/him when hungry. Discipline with words, not corporal punishment. But in 1946, this was new. Parents had long been encouraged not to shower their children with affection as this would make them weak and unprepared for the world. Feeding and naps were to be done on a strict schedule, regardless of the baby’s immediate needs. And a child who just got a mild spanking for an offense got off easy – physical punishment was the norm. Spock changed all that with his encouragement for parents to follow their instincts, be attentive to the baby’s needs, and be generous with affection.
Dr. Spock visits Karen Anderson, mother of quintuplets with their sibling, in October 1974. (AP Photo)
What caused the greatest controversy for Dr. Spock, was his advice on treating children with love and affection that made a generation of conservative parents question what he taught. The hand that rocks the cradle rules the world is a familiar and powerful adage. After all, perhaps no person exerts more power on a young person’s life than his or her mother. Yet in postwar Western society, no person has had more influence on mothers than Benjamin McLane Spock. Generations of children around the world have been reared on Spock’s fatherly advice, dispensed in a simple, straightforward and reassuring style. Indeed, Spock’s book became the modern bible of baby care, and he himself enjoyed near universal acclaim as America’s favorite doctor.
Benjamin McLane Spock was born May 2, 1903 to a prosperous family, in New Haven. He was the eldest of the six children — four girls and two boys — of Benjamin Ives Spock, a Yale graduate and railroad lawyer who was conservative in his politics, and Mildred Louise Stoughton Spock. The Spocks were descended from early Dutch settlers in the Hudson Valley; the family name was originally Spaak. After graduating from Phillips Academy in Andover, Mass., Dr. Spock entered Yale College, where he majored in English, minored in history and, as he recalled years later, gravitated toward medical school without any real decision.
Six feet 4 inches tall and broad-shouldered, he was, literally and figuratively, a big man on campus, a member of the Yale crew that won in the Paris Olympics in 1924. I had an awfully good time at college, he recalled years later. He also worked summers in a home for crippled children. I guess that’s why I became a baby doctor, thinking of those kids, he said later. My doctoring was always vaguely humanitarian. After earning a Yale College B.A. in 1925, he studied at the Yale Medical School from 1925 to 1927, and then transferred to Columbia University’s College of Physicians and Surgeons and earned his M.D. in 1929, after being at the head of his class at the end of the last two years. He interned at Presbyterian Hospital in New York and was a resident in pediatrics at the New York Nursery and Child’s Hospital. Sometime during the pediatric residency years (1931-1932) Dr. Spock wrote years later, I conceived the idea that someone going into pediatrics should have psychological training. And so he also spent 10 months as a resident in psychiatry at New York Hospital, and he went on to part-time training at the New York Psychoanalytic Institute from 1933 to 1938. Spock’s experience with children made him realize that half the questions parents asked related to psychological issues. He became convinced that pediatricians should have training in psychology, and that Sigmund Freud’s insights provided a better framework within which to encourage child development than the harsh, rigid and moralistic approach of his own parents.
In 1933 he opened his pediatric practice and after a couple of lean years it began to flourish. His success was partly the result of his charm, warmth and vitality. All the young mothers had a great crush on him, a former patient said years later. He was a gay and charming man. Another reason he did well was that, as the product of a large and happy family, he took great pleasure in being with his little patients. He once said, One of my faults as a pediatrician has always been that I whoop it up too much with children. His success was also the result in part of his concern for the feelings of his patients and their parents. He wore ordinary business suits, rather than white doctor’s coats, to make his visitors feel more relaxed. Describing Dr. Spock’s child-side manner, another writer on child care, Dr. Milton Levine, recalled later, I used to hear parents and even doctors talk about him as ?the man with the gentle face and eyes.’ In addition to his private practice, Dr. Spock served, early in his career, as an instructor in pediatrics at Cornell Medical College, an assistant attending pediatrician at New York Hospital and a consultant to the New York City Health Department. He also was the part-time school doctor at the Brearley School on East 83d Street, a private school for girls from kindergarten through the 12th grade. At the school, Lynn Z. Bloom wrote in her 1972 book, Dr. Spock: Biography of a Conservative Radical: He realized that the perceptive teachers could see each child in the context of the whole class and so understand her in a way the pediatrician never could. The perspective he gained at Brearley was to be drawn upon at length in his later writings for parents.
In 1943, ten years after the birth of his first son, Michael, Dr. Spock began three years of writing The Common Sense Book of Baby and Child Care. He spent countless evenings dictating it to his wife, the former Jane Davenport Cheney, who typed it up as he went along and assisted in many other ways. Dictating the book helped to give it the conversational tone that was one of its great attractions. By 1937 Spock became a board-certified pediatrician and was increasingly captivated with the goal of changing America’s child-rearing practices. By the early ?40s he was ready to commit his ideas to a book that would emphasize positive, commonsense, practical advice. It would embody the most up-to-date answers to all the problems that mothers might encounter during their children’s development from infancy through puberty. It would seek to correct the deficiencies of the overly strict parenting of the past, as revealed through psychoanalysis. He hoped it would revolutionize the way children were raised. Dr. Spock joined the Navy in 1944 and kept on writing in his spare time while working as a psychiatrist in military hospitals in New York and California. He left the Navy, with the rank of lieutenant commander, in 1946. Spock took enormous pains with the book and even worked on its original index during a slow troop-train journey from New York to California. To make things as convenient as possible for readers, he made sure the index included such common-sensical entries as Bedtime — keeping it happy. When the book appeared in 1946, Spock’s positive, can-do, deliberately non-authoritative tone took America’s mothers by storm. Spock insisted mothers could trust their own judgment. He succeeded in establishing a more sympathetic, child-centered approach, and in the process he became a national phenomenon. In a 1972 interview, Dr. Spock said he had undertaken the book as a departure from conventional wisdom. It wasn’t radical, though it struck out in new directions, he said. Taking a longer look backward, in the 1992 interview, Spock ascribed much of his professional success to his own psychoanalytic training in the 1930’s. In that period, he said, it was highly unusual for an American pediatrician to have that kind of training. For the first 10 years I was in practice, before I wrote the book, he said, I was trying desperately to reconcile Freudian concepts with what mothers told me about their babies. In the book, Dr. Spock wrote that it was unnecessary for a mother to stick to a rigid feeding schedule for her baby and that it hurt a mother emotionally to have to wait for a fixed feeding time while her baby wailed. But he also stipulated: This is not an argument against reasonable regularity. I do not think it is harmful for a baby or a mother to work toward a schedule. The mother has to run the rest of her household and when the baby is ready to fit in, it will help everybody.
On the question of how to cope with crying, Dr. Spock took a balanced view: I don’t think it’s good to let a baby cry miserably for long periods if there’s a way to comfort him, not because it will do him any physical harm but because of what it might do to his and his mother’s spirits. The child, he wrote, needs to feel that his mother and father, however agreeable, still have their own rights, know how to be firm, won’t let him be unreasonable or rude. And he added, The spoiled child is not a happy creature even in his own home.
From Book’s Success, A Frightened Author
In retrospect, it seemed almost inevitable that the book would become an enormous success, appearing as it did when the post-World War II baby boom was under way, and the winds of change were stirring in the baby and child care field. Even Dr. Spock’s flinty Yankee mother is said to have observed, after reading the book, Why Benny, it’s really quite sensible. But Spock said in the 1992 interview that he was frightened when 750,000 copies were sold in its first year. I was scared that the book would be misunderstood, he said, that somebody, thinking she was following my advice, would do something that would make a child worse, or even kill a child. In its first six years the book sold more than four million copies, and the languages it was eventually translated into included Urdu, Thai and Tamil. Duell, Sloan & Pearce published the original hard-cover edition. Pocket Books, which had persuaded Dr. Spock to write the book, brought it out in paperback with the title, The Pocket Book of Baby and Child Care, which later became simply Baby and Child Care and then Dr. Spock’s Baby and Child Care. That is the title of the hard-cover and paperback versions of the current, sixth edition, which came out in 1992. Dr. Spock’s earnings from the book were widely thought to have made him a millionaire but in the early 1990’s, they were about $150,000 a year. As time passed, Spock watched for new developments and insights that might require him to revise parts of his book. He recalled years later that when he returned briefly to his private pediatric practice in New York after the war, I began to see examples of a going-to-bed sleep problem in infants that I had never seen before: a baby would object to being put to bed in the evening, and his mother would keep picking him up. If she was a type who could be progressively intimidated, her baby could turn into a tyrant in six months. He could not only learn to stay awake until 10 or 11 o’clock at night but demand that his exhausted mother carry him around in her arms. Dr. Spock took that problem into account in 1954, when he began to prepare revisions. As he put it later, I wrote that more mothers got into difficulty from being afraid to give firm leadership than from being too rigid. And I put more emphasis on the rights of parents, on the need for firm parental leadership, and on my conviction that firmness makes for not only better-behaved children but for happier ones.
Changing of Guard in Child Authorities
After giving up his New York practice in 1947, Dr. Spock was affiliated with the Mayo Clinic in Rochester, Minn., and went on to serve as professor of child development at the University of Pittsburgh from 1951 to 1955 and at Case Western Reserve University in Cleveland from 1955 to 1967, when he retired from teaching. Over the next years, he kept active writing articles and books, keeping up with correspondence, going out on frequent speaking tours, he wrote in a 1989 volume of memoirs, Spock on Spock. He continued to make changes in his baby and child care book, and the fourth edition in 1976 was revised largely, as he said in a preface, to eliminate the gender biases of the sort that help to create and perpetuate discrimination against girls and women. One change was to refer to the baby and child as she as well as he. Another was in descriptions of the parents’ roles. I always assumed that the parent taking the greater share of young children (and of the home) would be the mother, whether or not she wanted an outside career, he said in the preface. Yet it’s this almost universal assumption that leads to women feeling a much greater compulsion than men to sacrifice a part of their careers in order that the children will be well cared for, he went on. Now I recognize that the father’s responsibility is as great as the mother’s.
Spock began a nationwide TV show in 1955 and went on to write a monthly magazine column. In the early ?60s, as he approached the age of 60, Dr. Spock became an antiwar activist and opponent of the draft, nuclear armaments and the United States’ involvement in Vietnam. He was a co-chairman of the National Committee for a Sane Nuclear Policy, known as SANE, from 1962 to 1967. He became increasingly active in antiwar demonstrations, lending high-profile support to draft dodgers and various anti-establishment causes associated with the youth of that decade. Spock consistently urged greater political action by parents to force governments to adopt policies that, he believed, would better care for people’s needs.
Vice President Spiro T. Agnew, the tart-tongued political combatant who fired up the American electorate but then, in 1973, had to resign as Richard M. Nixon’s Vice President in the face of a kickback scandal, blamed the Dr. Spock for what Mr. Agnew called the undue permissiveness abroad in the land. What irony, that Agnew, accusing Spock of permissiveness, had to bargain as Vice President with prosecutors to avoid prison and finally pleaded no contest to tax evasion charges in a lucrative statehouse ward-heeling scheme that dated from his public service in Maryland politics but continued to reap payoffs even during his days as Vice President.
Spock, promoting peace not war, was arrested at various protest demonstrations. In 1968 a Boston court convicted him of conspiring to counsel evasion of the draft. He was sentenced to two years in prison and fined $5,000, but the conviction was reversed in 1969 by the United States Court of Appeals for the First Circuit on the ground of insufficient evidence. In 1972 Dr. Spock was the Presidential candidate of the People’s Party, a coalition of progressive organizations. His platform called for free medical care, the legalization of abortion and marijuana, a guaranteed minimum income for families and the immediate withdrawal of all American troops from foreign countries. In 1976 he was the party’s candidate for Vice President, and in the late 1970’s he was also prominent in anti-nuclear demonstrations. By the time he turned 80, in 1985, he had been arrested a dozen times for civil disobedience, but he did not stop. In 1987, he and others were arrested and charged with trespassing after demonstrating at Cape Canaveral Air Force Station against the test launching of a Trident 2 missile.
The Rev. Dr. Norman Vincent Peale, the author of The Power of Positive Thinking and a critic of Dr. Spock, saw it differently. He said the doctor had gone out in the streets with these babies raised according to his books, demonstrating with them for things they claim we should not deny them.
Dr. Peale said the doctor’s views amounted to: Feed ?em whenever they want, never let them cry, satisfy their every desire. Dr. Spock said that Dr. Peale, Mr. Agnew and other critics had distorted what he had written. I didn’t want to encourage permissiveness, but rather to relax rigidity, he once observed. Every once in a while, somebody would say to me, ?There’s a perfectly horrible child down the block whose mother tells everybody that he’s being brought up entirely by your book.’ But my own children were raised strictly, to be polite and considerate. I guess people read into the book what they wanted to. On another occasion, striking a different note, he said: Maybe my book helped a generation not to be intimidated by adulthood. When I was young, I was always made to assume that I was wrong. Now young people think they might be right and stand up to authority. Spock developed considerable visibility in politics; in 1972 he actually ran for U.S. president as a third-party candidate. But his political activism won him numerous detractors, who succeeded in branding him the father of permissiveness. And indeed, his child-centered approach was often misapplied or taken to extremes. In response to accusations that he taught a laissez-faire approach to child rearing, he stressed in later editions that children need standards, and that parents, too, have a right to respect. He called for parents to express their love for their children while providing clear, firm discipline, not instead of providing it. He suspected that he was being criticized for his liberal politics more than his childrearing philosophy.
Dr. Spock bounced back somewhat in the decades that followed the Vietnam war, although his advice continued to generate controversy. Spock had already broken with authority in his child-rearing handbook, which he saw as giving practical application to the ideas propounded by two early 20th-century sages, Sigmund Freud and John Dewey, the American philosopher and educator. John Dewey and Freud said that kids don’t have to be disciplined into adulthood but can direct themselves toward adulthood by following their own will, he observed in 1972. And so in the opening chapter of the book, first published in hardcover in 1946 with the title The Common Sense Book of Baby and Child Care, Dr. Spock counseled his readers not to take too seriously all that the neighbors say. Don’t be afraid to trust your own common sense, he wrote. What good mothers and fathers instinctively feel like doing for their babies is usually best. Such relaxed advice, given in the easy, practical, reassuring way that he had with parents, was light-years from the stern dictums of earlier standard works, like the 1928 book Psychological Care of Infant and Child by Dr. John B. Watson. Never, never kiss your child, Dr. Watson commanded. Never hold it in your lap. Never rock its carriage.
Dr. T. Berry Brazelton of the Harvard Medical School, noted pediatrician-author, once said of Dr. Spock: Before he came along, advice to parents was very didactic. He opened the whole area of empowered parenting. He gave parents choices and encouraged them to think things out for themselves. Altogether, Benjamin Spock was the author or a co-author of 13 books. He was also a prolific author of magazine columns for more than 30 years. He wrote columns about raising children for Redbook and Ladies Home Journal and, more recently, for Parenting magazine.
89 year old, Dr. Spock holds 3-month-old Ryan Michl at a Boston baby fair April 30, 1993. The birthday cake was presented to Dr. Spock to celebrate his 90th birthday, two days later. (AP Photo / Elise Amendola)
By early 1990, when Dr. Spock was 86, the 71-year-old Dr. T. Berry Brazelton, another psychoanalytically oriented pediatrician, who tirelessly addressed parents’ groups, had become the country’s most visible contemporary authority on raising babies and young children. And Dr. Penelope Leach, a British psychologist-author, had also joined the top echelon of experts to whom new parents were turning for advice. But Dr. Spock remained one of the most widely read authorities on child-rearing. In an interview in 1994, soon after Dr. Spock’s 91st birthday, he attributed his good health and longevity to his life style, which still included rowing. In those days he began each day with an hour’s meditation, 30 minutes of yoga, a shiatsu massage, a hot sesame oil massage and a macrobiotic breakfast of brown rice, miso soup and vegetables. Nonetheless, he said at the time, It surprised me very much to find I got to be 91. In 1994, Spock and his wife lived on a budget of roughly $100,000 a year, but their savings had been depleted by 24-hour nursing and by other kinds of care for the doctor, who came down with pneumonia six times the previous year and had been in declining health. Spock’s family was divided over whether the he should enter a nursing home, which would cost less. His home care in January, 1998 cost over $16,000 — which was largely not covered by Medicare and private insurance. In the end, the president of Pocket Books, his publisher, helped pay his medical bills and Spock remained at home. Toward the end of his life, Pocket Books published another edition of Spock’s great book, because he constantly sought to keep his material updated to be in line with the changing times – one of the reasons for his book’s enduring success.
Dr. Spock’s books continue to influence generations of parents – and the childcare experts of today and tomorrow. And even if a new parent in 2014 doesn’t read his Baby and Child Care, it’s likely that they’re still influenced by his advice. Any parents who hug and kiss their children, showing their love and encouraging their children to express their individuality, have Dr. Spock to thank. The life of Benjamin Spock is an amazing, dynamic and colorful story of success. It includes the story of how Freud’s humanistic philosophies were successfully introduced into the mainstream of American family life, by another wise physician. Spock lived to be 95 and toward the end he said, Our greatest hope is to bring up children inspired by their opportunities for being helpful and loving.
Spock died at his home in San Diego, CA on March 15, 1998. His ashes are buried in Rockport, Maine, formerly part ofCamden, Maine.
Editor’s note: I was one of those generations (later) of parents who knowing nothing, first hand, about child care, began reading the books of Dr. Spock, after becoming pregnant with my first child. When I gave birth I was anxious for a few hours. However, the second I began breast feeding, all fears disappeared and the words of Spock echoed forever, etched in my consciousness. Throughout the beginnings of my two children’s lives, Spock had passed on such a sense of confidence, that these early years of my children, were some of the best in my life. His books were, indeed, my Bibles. Such wisdom as Spock endowed is timeless. I recommend all of his books to all new parents. Spock is as relevant today as he has always been.
New Drug for Common Liver Disease Improves Liver Health
Nonalcoholic steatohepatitis (NASH) is a common, often silent liver disease. It resembles alcoholic liver disease, but occurs in people who drink little or no alcohol. The major feature in NASH is fat in the liver, along with inflammation and damage. Most people with NASH feel well and are not aware that they have a liver problem. Nevertheless, NASH can be severe and can lead to cirrhosis, in which the liver is permanently damaged and scarred and no longer able to work properly. NASH affects 2-5% of Americans and an additional 10 to 20% have fat in their liver, but no inflammation or liver damage, a condition called fatty liver. Although having fat in the liver is not normal, by itself it probably causes little harm or permanent damage. If fat is suspected based on blood test results or scans of the liver, this problem is called nonalcoholic fatty liver disease (NAFLD). If a liver biopsy is performed in this case, it will show that some people have NASH while others have simple fatty liver. Both NASH and NAFLD are becoming more common, possibly because of the greater number of Americans with obesity. In the past 10 years, the rate of obesity has doubled in adults and tripled in children. Obesity also contributes to diabetes and high blood cholesterol, which can further complicate the health of someone with NASH. Diabetes and high blood cholesterol are also becoming more common among Americans.
According to an article published online in The Lancet (6 November 2004), an experimental drug aimed at treating a common liver disease showed promising results and potential problems in a multicenter clinical trial funded by the National Institutes of Health. The Farnesoid X Receptor Ligand Obeticholic Acid in NASH Treatment Trial (FLINT) study found that compared with placebo, people with NASH who took obeticholic acid (OCA) had improved liver health, including decreased inflammation and fat in the liver and decreased body weight. OCA, however, was also associated with increases in itching and total cholesterol. FLINT enrolled 283 people at eight centers across the country. At the study’s start, participants were 18 and older and had been diagnosed with definite or borderline NASH. They were randomly assigned to one of two groups: one took 25 milligrams of OCA daily and one received a placebo that resembled the OCA pill. The study was double-blinded, so neither participants nor investigators knew which person was in which group.
Trial investigators intended for the groups to receive the drug or placebo for 72 weeks, with an additional 24 weeks of follow-up off treatment. However, planned interim analysis for safety and efficacy showed that OCA had significant beneficial effects on NASH-related liver health. The analysis also found unanticipated increases in total cholesterol in the OCA group. They had increased LDL cholesterol (bad cholesterol) and decreased HDL cholesterol (good cholesterol) — notable because NASH patients are already at higher risk for cardiovascular diseases. As cholesterol treatment was not standardized as part of the study, further research is needed to fully understand the potential effect of OCA on cholesterol. Because of both factors, and with the concurrence of the Data Safety and Monitoring Board, NIDDK decided to stop treatment but continue the study, move all patients into the follow-up phase, and perform no additional liver biopsies – which carry their own risks. Adverse cholesterol increases were not sustained after stopping OCA.
According to the authors, while the causes of NASH are not fully understood, and causes and treatments may be different among patients, the FLINT trial represents an important advance in the search for treatments of NASH. The authors added that they need to study the changes in cholesterol levels more to know if the increases caused by OCA also increase the risk of hardening of the arteries. Since the study found that the improvement in liver enzymes with OCA were not sustained after treatment was stopped, it appears that treatment would need to be indefinite, much like the medications for diabetes and hypertension.
Intercept Pharmaceuticals, Inc. provided partial funding and supplies.
The Effects of a Telehealth Coping Skills Intervention on Outcomes in Chronic Obstructive Pulmonary Disease
Since chronic obstructive pulmonary disease (COPD) is associated with increased morbidity and mortality and reduced quality of life (QoL), novel interventions are needed to improve outcomes in patients. As a result, a study published in Psychosomatic Medicine (2014;76: 581-592), assessed the effects of a telephone-based coping skills intervention on psychological and somatic QoL and on the combined medical end point of COPD-related hospitalizations and all-cause mortality.
The investigation was a dual-site, randomized clinical trial with assessments at baseline and after 16 weeks of treatment. The study population comprised 326 outpatients with COPD aged 38 to 81 years, randomized to coping skills training (CST), including sessions promoting physical activity, relaxation, cognitive restructuring, communication skills, and problem solving, or to COPD education (COPD-ED). Patients completed a battery of QoL instruments, pulmonary function tests, and functional measures and were followed up for up to 4.4 years to assess medical outcomes. Results showed that the CST group exhibited greater improvements in psychological QoL compared with controls (p = .001), including less depression and anxiety, and better overall mental health, emotional role functioning, vitality, and social functioning. A significant baseline psychological QoL by treatment group interaction revealed that CST with lower QoL at baseline achieved even greater improvements in psychological QoL compared with COPD-ED. CST participants also exhibited greater improvements in somatic QoL (p = .042), including greater improvements in pulmonary QoL, less fatigue, and less shortness of breath and greater improvement in distance walked on the Six-Minute Walk test. However, there was no significant difference in risk of time to COPD-related hospitalization or all-cause mortality between CST (34 events) and COPD-ED (32 events; p = 0.430).
According to the authors, a telehealth CST intervention produced clinically meaningful improvements in QoL and functional capacity, but no overall improvement in risk of COPD-related hospitalization and all-cause mortality.