Circumcision

Customs of Central Asians. Circumcision. Photograph shows a group of men seated on the ground near a small boy who is being circumcised. Album print. Illus. in: Turkestanskii al’bom, chast’ etnograficheskaia, 1871-1872, part 2, vol. 1, pl. 71. Batga [sic] buri translated from Persian as circumcision. Photo credit: Unknown – Library of Congress, Public Domain, Wikipedia Commons

 

There is a huge amount of information regarding the history of circumcision, dates which are way before the Bible was written; the Bible has many references to circumcision. Vast historical references include religious and social customs as well as superstitions and taboos, in addition to medical evidence. There is only room here for just a glimpse of the medical point of view.

 

Sir John Hutchinson MD – Photo credit: Unknown; Wikipedia Commons

 

 

Jonathan Hutchinson (1828-1913), an eminent English physician was the first prominent medical advocate for circumcision. Hutchinson’s activity in the cause of scientific surgery and in advancing the study of the natural sciences was unwearying. He published more than 1,200 medical articles and also produced the quarterly Archives of Surgery from 1890 to 1900, being its only contributor. His lectures on neuropathogenesis, gout, leprosy, diseases of the tongue, etc., were full of original observation; but his principal work was connected with the study of syphilis, on which he became the first living authority. He was the first to describe his triad of medical signs for congenital syphilis: notched incisor teeth, labyrinthine deafness and interstitial keratitis, which was very useful for providing a firm diagnosis long before the Treponema pallidum or the Wassermann test were discovered. Hutchinson was the founder of the Medical Graduates’ College and Polyclinic; and both in his native town of Selby and at Haslemere, Surrey, he started educational museums for popular instruction in natural history. He published several volumes on his own subjects and was given an Hon. LL.D degree by both the University of Glasgow and University of Cambridge. He received a knighthood in 1908.

 

In 1855, Hutchinson published a study in which he compared the rate of contraction of venereal disease amongst the gentile and Jewish population of London. His study appeared to demonstrate that circumcised men were significantly less vulnerable to venereal diseases. In fact, a 2006 systematic review concluded that the evidence strongly indicates that circumcised men are at lower risk of chancroid and syphilis. Clearly, Dr. Hutchinson was ahead of his time. Hutchinson also became a notable leader in the campaign for medical circumcision for the next fifty years, publishing A Plea for Circumcision. in the British Medical Journal (1890). In that article, he contended that,“the foreskin constitutes a harbor for filth, and is a constant source of irritation. It conduces to [self eroticism], and adds to the difficulties of continence. It increases the risk of syphilis in early life, and of cancer in the aged. In an 1893 article, On circumcision as a preventive of self-eroticism, he wrote: I am inclined to believe that circumcision may often accomplish much, both in breaking the habit as an immediate result, and in diminishing the temptation to it subsequently.“

 

Nathaniel Heckford, a pediatrician at the East London Hospital for Children, wrote Circumcision as a Remedial Measure in Certain Cases of Epilepsy, Chorea, etc. (1865), in which he argued that circumcision acted as an effective remedial measure in the prevention of certain cases of epilepsy and chorea. These increasingly common medical beliefs were even applied to females. The controversial obstetrical surgeon Isaac Baker Brown founded the London Surgical Home for Women in 1858, where he worked on advancing surgical procedures. In 1866, Baker Brown described the use of clitoridectomy, as a cure for several conditions, including epilepsy, catalepsy and mania, which he attributed to self-stimulation. In On the Curability of Certain Forms of Insanity, Epilepsy, Catalepsy, and Hysteria in Females, he gave a 70% success rate using this treatment. However, during 1866, Baker Brown began to receive negative feedback from within the medical profession from doctors who questioned the validity of Baker Brown’s claims of success. An article appeared in The London Times, which was favorable towards Baker Brown’s work but suggested that Baker Brown had treated women of unsound mind. He was also accused of performing procedures without the consent or knowledge of his patients or their families. In 1867 he was expelled from the Obstetrical Society of London for carrying out the operations without consent. Baker Brown’s ideas were more accepted in the United States, where, from the 1860s, the operation was being used to cure hysteria, and in young girls what was called rebellion or unfeminine aggression“.

 

Lewis Sayre, New York orthopedic surgeon, became a prominent advocate for circumcision in America. In 1870, he examined a five-year-old boy who was unable to straighten his legs, and whose condition had so far defied treatment. Upon noting that the boy’s genitals were inflamed, Sayre hypothesized that chronic irritation of the boy’s foreskin had paralyzed his knees via reflex neurosis. Sayre circumcised the boy, and within a few weeks, he recovered from his paralysis. After several additional incidents in which circumcision also appeared effective in treating paralyzed joints, Sayre began to promote circumcision as a powerful orthopedic remedy. Sayre’s prominence within the medical profession allowed him to reach a wide audience. As more practitioners tried circumcision as a treatment for otherwise intractable medical conditions, sometimes achieving positive results, the list of ailments reputed to be treatable through circumcision grew. By the 1890s, hernia, bladder infections, kidney stones, insomnia, chronic indigestion, rheumatism, epilepsy, asthma, bedwetting, Bright’s disease, erectile dysfunction, syphilis, insanity, and skin cancer had all been linked to the foreskin, and many physicians advocated universal circumcision as a preventive health measure.

 

Specific medical arguments aside, several hypotheses have been raised in explaining the public’s acceptance of infant circumcision as preventive medicine. The success of the germ theory of disease had not only enabled physicians to combat many of the postoperative complications of surgery, but had made the wider public deeply suspicious of dirt and bodily secretions. Accordingly, the smegma that collects under the foreskin was viewed as unhealthy, and circumcision readily accepted as good hygiene. In this Victorian climate, circumcision could be employed as a means of discouraging self-stimulation. All About the Baby, a popular parenting book of the 1890s, recommended infant circumcision for precisely this purpose. As hospitals proliferated in urban areas, childbirth, at least among the upper and middle classes, was increasingly under the care of physicians in hospitals rather than with midwives in the home. It has been suggested that once a critical mass of infants were being circumcised in the hospital, circumcision became a class marker of those wealthy enough to afford a hospital birth.

 

During the same time period, circumcision was becoming easier to perform. William Stewart Halsted’s 1885 discovery of hypodermic cocaine as a local anesthetic made it easier for doctors without expertise in the use of chloroform and other general anesthetics to perform minor surgeries. Also, several mechanically aided circumcision techniques, forerunners of modern clamp-based circumcision methods, were first published in the medical literature of the 1890s, allowing surgeons to perform circumcisions more safely and successfully. By the 1920s, advances in the understanding of disease had undermined much of the original medical basis for preventive circumcision. Doctors continued to promote it, however, as good penile hygiene and as a preventive for a handful of conditions such as: balanitis, phimosis, and cancer.

 

By 2014 the American Academy of Pediatrics found that the health benefits of newborn male circumcision outweigh the risks

 

Circumcision in English-speaking countries arose in a climate of antiquated, negative attitudes towards relationships. In her 1978 article The Ritual of Circumcision, Karen Erickson Paige writes: The current medical rationale for circumcision developed after the operation was in wide practice. The original reason for the surgical removal of the foreskin, or prepuce, was to control ‘insanity’ – the range of mental disorders that people believed were caused by the polluting’ practice of self-abuse.“

 

Editor’s note: Page is pointing out, how hard it is to believe that anyone could have such outrageous ideas, completely lacking in any scientific evidence and so harshly punitive.

 

Self-abuse was a term commonly used to describe self-stimulation in the 19th century. According to Paige, treatments ranged from diet, moral exhortations, hydrotherapy, and marriage, to such drastic measures as surgery, physical restraints, frights, and punishment. Some doctors recommended using plaster of Paris, leather, or rubber; cauterization; making boys wear chastity belts or spiked rings; and in extreme cases, castration. Paige details how circumcision became popular as a remedy:

 

In the 1890s, it became a popular technique to prevent, or cure, insanity. In 1891 the president of the Royal College of Surgeons of England published On Circumcision as a Preventive, and two years later another British doctor wrote Circumcision: Its Advantages and How to Perform It, which listed the reasons for removing the vestigial prepuce. Evidently the foreskin could cause nocturnal incontinence, hysteria, epilepsy, and irritation that might give rise to erotic stimulation. Another physician, P.C. Remondino, added that circumcision is like a substantial and well-secured life annuity as it insures better health, greater capacity for labor, longer life, less nervousness, sickness, loss of time, and less doctor bills. No wonder it became a popular remedy.

 

One of the leading advocates of circumcision was John Harvey Kellogg. He advocated the consumption of Kellogg’s corn flakes as a remedy, and he believed that circumcision would be an effective way to eliminate stimulation in males.

 

Editor’s note: Talk about plain old Puritanical meanness can hardly believe some of this, but it’s true. Eighteenth and Nineteenth Century solutions: Covering the organs with a cage had been practiced with entire success. A remedy which is almost always successful in small boys is circumcision, especially when there is any degree of phimosis. The operation should be performed by a surgeon without administering an anesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. The soreness which continues for several weeks interrupts the practice, and if it had not previously become too firmly fixed, it may be forgotten and not resumed. If any attempt is made to watch the child, he should be so carefully surrounded by vigilance that he cannot possibly transgress without detection. If he is only partially watched, he soon learns to elude observation, and thus the effect is only to make him cunning in his vice.

 

Robert Darby (2003), writing in the Medical Journal of Australia, noted that some 19th-century circumcision advocates – and their opponents – believed that the foreskin was highly erotic and sensitive:

 

In the 19th century the role of the foreskin in erotic sensation was well understood by physicians who wanted to cut it off precisely because they considered it the major factor leading boys to self-stimulation. The Victorian physician and venerealologist William Acton (1814-1875) damned it as a source of serious mischief, and most of his contemporaries concurred. Both opponents and supporters of circumcision agreed that the significant role the foreskin played in responses was the main reason why it should be either left in place or removed. William Hammond, a Professor of Mind in New York in the late 19th century, commented that circumcision, when performed in early life, generally lessens the voluptuous sensations of intimacy, and both he and Acton considered the foreskin necessary for optimal reproductive function, especially in old age. Jonathan Hutchinson, English surgeon and pathologist (1828-1913), and many others, thought this was the main reason why it should be excised.

 

Born in the United Kingdom during the late-nineteenth century, John Maynard Keynes and his brother Geoffrey, were both circumcised in boyhood due to parents’ concern about their habits. Mainstream pediatric manuals continued to recommend circumcision as a deterrent until the 1950s.

 

Wikipedia; http://www.nytimes.com/1997/04/02/us/study-is-adding-to-doubts-about-circumcision.html

 

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Residual Echo of Ancient Humans In Scans May Hold Clues to Mental Disorders

 

During their primordial migration out of Africa, ancestors of present-day humans are thought to have interbred with Neanderthals, whose brain characteristics can be inferred from their fossilized skulls. For example, these indicate that Neanderthals had more prominent visual systems than modern humans.

 

According to an article published in Scientific Reports (24 July 2017), scientists from the National Institute of Mental Health (NIMH) have produced the first direct evidence that parts of our brains implicated in mental disorders may be shaped by a “residual echo “ from our ancient past. What was demonstrated was that the more a person’s genome carries genetic vestiges of Neanderthals, the more certain parts of his or her brain and skull resemble those of humans’ evolutionary cousins that went extinct 40,000 years ago. In particular, the parts of our brains that enable us to use tools and visualize and locate objects owe some of their lineage to Neanderthal-derived gene variants that are part of our genomes and affect the shape of those structures – to the extent that an individual harbors the ancient variants. But this may involve trade-offs with our social brain. It has been proposed that Neanderthals depended on visual-spatial abilities and toolmaking, for survival, more so than on the social affiliation and group activities that typify the success of modern humans – and that Neanderthal brains evolved to preferentially support these visuospatial functions. According to the authors, the evidence from MRI scans suggests that such Neanderthal-derived genetic variation may affect the way our brains work today – and may hold clues to understanding deficits seen in schizophrenia and autism-related disorders.

 

Might some of us, more than others, harbor Neanderthal-derived gene variants that may bias our brains toward trading sociability for visuospatial prowess – or vice versa? The current study adds support to this possibility by showing how these gene variants influence the structure of brain regions underlying those abilities. To test this possibility, the authors measured the impact of Neanderthal variants on MRI measures of brain structure in a sample of 221 participants of European ancestry, drawn from the NIMH Genetic Study of Schizophrenia. Results showed that the new MRI evidence points to a gene variant shared by modern-day humans and Neanderthals that is likely involved in development of the brain’s visual system. Similarly, Neanderthal variants impacting development of a particular suspect brain area may help to inform cognitive disability seen in certain brain disorders .

 

For example, in 2012, the authors reported on how genetic variation shapes the structure and function of a brain area called the Insula in the autism-related disorder, Williams Syndrome. People with this rare genetic disorder are overly sociable and visuo-spatially impaired – conspicuously opposite to the hypothesized Neanderthal propensities and more typical cases on the autism spectrum. For example, mice in which a gene affected by Williams syndrome is experimentally deleted, show increased separation anxiety. And just last week, it was reported that the same genetic variability also appears to explain why dogs are friendlier than wolves.

 

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Waterlogged Brain Region Helps to Gauge Damage Caused by Parkinson’s Disease

 

According to a study published in the journal Brain (26 July 2017), a new method was discovered to observe the brain changes caused by Parkinson’s disease (PD). In PD, the dopamine-producing cells in the substantia nigra are destroyed. The new method suggests that fluid changes in a specific brain area could provide a way to track that damage. The study showed that a greater free water increase in the substantia nigra was associated with a decrease in dopamine neuron activity in one of these nearby regions, supporting the idea that free water changes are related to disease progression.

 

For the study, a form of MRI was used that differentiates between water contained in brain cells and “free “ water outside of the cells. The study focused on the substantia nigra, a brain structure where PD kills neurons that use the chemical dopamine to communicate with other cells. The results showed that the amount of free water in that brain area stayed the same over the course of a year in healthy individuals, but increased in early-stage PD patients during that period and increased further over the next three years. This confirmed and expanded on a prior study by the same group that measured free water over just one year. The new findings also revealed the increase in free water was linked to worsening symptoms. The authors used a scale to evaluate patient’s movement problems, with Stage One on the scale being the least severe and Stage Five being the most advanced. Results showed that patients who moved up a stage on the scale during the four years of the study, had a greater free water increase than patients who remained at the same stage, suggesting the change reflected PD’s-related damage to neurons.

 

The study’s results suggest that the MRI-based free water measurement could be used in PD clinical trials as a surrogate marker, in that if a treatment slows or stops the increase in free water, it might be evidence that the drug is slowing the progressive loss of dopamine neurons. The study used data from the Parkinson’s Progression Markers Initiative (PPMI), a large study sponsored by the Michael J. Fox Foundation that has been collecting information on recently diagnosed PD patients from over 30 different U.S. and international sites. The fact that the authors found similar patterns in patients at every location boosted their confidence in the results because, like the PPMI, clinical trials must collect data from many sites using numerous different MRI machines.

 

The authors speculated that the free water approach could make clinical trials less expensive by reducing the number of participants they would need to enroll. As a result, there is an ongoing clinical trial to validate the use of free water to gauge the effect of a potential PD treatment. At the same time, the authors are attempting to develop computer programs that will make free water analysis faster and easier. Clearly, future studies are needed to track changes in free water over longer time spans and in other brain regions and to determine what causes them.

 

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FDA Announces New Steps to Empower Consumers and Advance Digital Healthcare

 

The following was extracted from FDA Voice, by: Scott Gottlieb, M.D.

 

When people think about personalized medicine, they often think of genetic testing and sequencing of the human genome. But the concept of personalized medicine is much broader. It includes the re-imagination of healthcare delivery. It includes empowering consumers to take more control of their own healthcare information to make better informed decisions about their medical care and healthy living. This opportunity is enabled by a new technological paradigm of digital health tools, like apps, that enable consumers to have more active engagement and access to real-time information about their health and their activities. These tools allow consumers and providers to supersede the traditional, physical constraints of healthcare delivery and exploit the opportunities offered by mobile technology.

 

Historically, healthcare has been slow to implement disruptive technology tools that have transformed other areas of commerce and daily life. One factor that’s been cited, among many, is the regulation that accompanies medical products. But momentum toward a digital future in healthcare is advancing. Not all of these tools are subject to FDA regulation.

 

Last week, FDA announced, as part of our broader Medical Innovation Access Plan, a new component focused on digital health innovation – the formal launch of our Pre-Cert for Software Pilot Program. This new program embraces the principle that digital health technologies can have significant benefits to patients’ lives and to our healthcare system by facilitating prevention, treatment, and diagnosis; and by helping consumers manage chronic conditions outside of traditional healthcare settings. At the same time, FDA’s Center for Devices and Radiological Health (CDRH) is publishing its Digital Health Innovation Action Plan to provide details and timelines for an integrated approach to digital health technology and the implementation of the 21st Century Cures Act. By doing this, FDA is telling consumers and the digital health industry how FDA will establish clear and consistent expectations for the products FDA regulates. The challenge FDA faced in the past is determining how to best regulate these non-traditional medical tools with the traditional approach to medical product review. Now, FDA will envision and seek to develop through the Pre-Cert for Software Pilot a new and pragmatic approach to digital health technology. The method, of course, must recognize the unique characteristics of digital health products and the marketplace for these tools, so FDA can continue to promote innovation of high-quality, safe, and effective digital health devices.

 

FDA’s feels that its traditional approach to medical devices is not well suited to these products, and it needs to make sure its approach to innovative products with continual updates and upgrades is efficient and that it fosters, not impedes, innovation. Recognizing this, and understanding that the potential of digital health is nothing short of revolutionary, FDA is working toward establishing an appropriate approach that’s closely tailored to this new category of products. FDA needs a regulatory framework that accommodates the distinctive nature of digital health technology, its clinical promise, the unique user interface, and industry’s compressed commercial cycle of new product introductions.

 

This new, voluntary pilot program will enable FDA to develop a tailored approach toward this technology by looking first at the software developer or digital health technology developer, rather than primarily at the product (as FDA currently does for traditional medical products). This pilot will help FDA establish the most appropriate criteria for standing up a firm-based pre-certification program for these new tools. The goal of this new approach is for FDA to, after reviewing systems for software design, validation and maintenance, determine whether the company meets the necessary quality standards and pre-certify the company. Pre-certified companies could submit less information to us than is currently required before marketing a new digital health tool. In some cases, pre-certified companies could not submit a premarket submission at all. In those cases, the pre-certified company could launch a new product and immediately begin post-market data collection. Pre-certified digital health companies could take advantage of this approach for certain lower-risk devices by demonstrating that the underlying software and internal processes are sufficiently reliable. The post-market data could help FDA assure that the new product remains safe and effective as well as supports new uses.

 

FDA designed the new digital health pilot program to include up to nine software firms of various sizes. Initial participants in this new pilot will range from small startups to large companies that develop both high- and low-risk software products that are devices. FDA wants to include medical product manufacturers as well as non-traditional software developers. Given the amount of attention FDA is getting, and the ongoing innovation in this space, FDA is confident that there will be strong participation in the new pilot.

 

Digital health product developers will be selected for the program based on the following:

  • The company must be in the process of developing or planning to develop a software product that meets the definition of a medical device;
  • The company must have an existing track record in developing, testing, and maintaining software products and demonstrating a culture of quality and organizational excellence measures that are tracked by Key Performance Indicators (KPI) or other similar measures;
  • And during participation of the pilot, companies must agree to:
    • Provide access to measures for developing, testing and maintaining software products and demonstrating a culture of quality and organizational excellence measures by KPI;
    • Collect real-world post-market data and provide it to FDA;
    • Meet with FDA for real-time consultation;
    • Be available for site visits from FDA officials; and,
    • Provide information about the firm’s quality management system.

 

FDA has intentionally left the initial criteria broad because this pilot is purposely designed to be inclusive and flexible. FDA wants to be able to accommodate a broad range of participants and technologies. FDA also appreciates that the experience and capabilities of a small company will be different from that of a large company and recognize that we need a pre-certification program that accommodates both.

 

The initiative will begin immediately. Starting on August 1, companies can submit a statement of interest that includes the qualities listed above, requesting participation in the pilot to FDAPre-CertPilot@fda.hhs.gov. Then, during the month of August, FDA’s Digital Health Team will evaluate submissions and select companies that reflect the broad range of software developers. A critical component is that FDA will include small and large companies, traditional and non-traditional MedTech companies, and products that range in risk. This approach will create opportunities for more dynamic entrepreneurship and competition and help continue to drive product innovation.

 

FDA expects that the first four months of the pilot will better inform FDA’s regulatory team as well as product developers. FDA will hold a public workshop in January 2018 to report on and review the initial findings. The goal is to inform product developers who are not participating in the pilot, so they can understand our process and findings, to help better inform development programs underway outside of the pilot.

 

As FDA launches its Digital Health Innovation Action Plan, FDA is aware that apps and app updates come to market every day. But the most powerful feature of this market may not be one revolutionary app but rather a combination of apps that provides consumers and providers with the information they need. This can help people better manage their chronic diseases, which could result in less trips to the doctor for checkups, or better awareness of illness, like prompts to a parent with a sick child on when they need to see a provider.

 

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Smoked Paprika Hummus with Warm Pita or Flatbread

Who wants to spend a lot of time in a warm kitchen, during the summer? We like to feast on small quick and easy dishes, like tapas; with a good bottle of wine.

 

 

Several years ago, our son, Alex, introduced us to one of Manhattan’s best gourmet vegan restaurants, Candle79. We all go for dinner there, each time he comes to Manhattan . We all love it, by the way. Our strategy at Candle79 (on East 79th Street), is to have 3 or 4 courses, each ordering something different – and sharing. This way, we all get to sample a wide variety of what this inventive restaurant offers. For the appetizer course, one of the dishes was “Smoked Paprika Hummus.“ This and a few other items on the menu, which we ordered, were so-o delicious, that I bought one of the restaurant’s cookbooks in order to try their recipes out at home. The recipes are not that difficult. We want to share with our readers, Candle79?s “Smoked Paprika Hummus“ recipe.

 

Ingredients

1 cup dried chickpeas, or 2 (15.5-ounce) cans chickpeas, drained and rinsed (I use the canned chickpeas)

2 large cloves garlic, minced

1 teaspoon freshly squeezed lemon juice

1/4 teaspoon cayenne pepper

2 teaspoons smoked paprika, plus more for garnish

1/2 teaspoon sea salt (I don’t use the salt)

1/2 teaspoon freshly ground pepper

2 Tablespoons finely chopped fresh flat-leaf parsley (I also like to use cilantro instead of parsley, for a change of pace)

1/3 cup extra-virgin olive oil, plus more for garnish

1/3 cup tahini

Optional garnishes: roasted red bell peppers, roasted garlic, lemon slices, olives, mint or parsley sprigs

 

Some of the ingredients – Serve with warm pita bread

 

Directions

If using dried chickpeas, put them in a saucepan or bowl and add cold water to cover by about 2 inches. Soak in the refrigerator for at least 6 hours or overnight. Drain and rinse.

 

Put the chickpeas in a saucepan and add cold water to cover by about 2 inches. Bring to a boil, decrease the heat, cover, and simmer until the chickpeas are tender, 50 to 60 minutes. Drain and let cool, reserving 1/4 to 1/2 cup of the cooking water.

 

Combine the chickpeas, garlic, lemon juice, cayenne, paprika, salt, pepper, parsley, olive oil, and tahini in a bowl and stir to mix well. Transfer the mixture to a food processor fitted with the metal blade and process until well mixed. Add 1/4 cup of the reserved cooking liquid (or water or vegetable stock if using canned chickpeas) and process until smooth and almost fluffy. Add more liquid if necessary. Scrape down the sides of the bowl once or twice. Transfer to a serving bowl and refrigerate for at least 1 hour. (The hummus can be made up to 3 days ahead and refrigerated. Return to room temperature before serving.)

 

In the food processor.

 

To serve, drizzle a bit of olive oil over the hummus and sprinkle a bit of paprika. Serve with desired garnishes.

 

Try stuffing chunks of cucumber with this paprika hummus, or mushrooms or deviled eggs.

 

On an informal summer Sunday night at home, we find that this hummus is so good, we heat up some pita bread, break out a bottle of our favorite white or rose wine, and just sit at our kitchen table, with raw carrot, celery, and cucumber sticks (and a few olives) and eat this delicious repast with total satisfaction. Sorta like a perfect summer picnic at home.

 

See below the wine we enjoyed with the paprika hummus and warm bread, this past weekend.

 

This is a light and lovely sparkling rose wine; perfect in the summer, with practically everything. ©Joyce Hays, Target Health Inc.

 

From Our Table to Yours

Bon Appetit!

 

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Date:
July 27, 2017

Source:
Yale University

Summary:
Scientists can now explore in a laboratory dish how the human brain develops by creating organoids — distinct, three-dimensional regions of the brain. Scientists coaxed early stage stem cells to create and fuse two types of organoids from different brain regions to show how the developing brain maintains proper balance of excitatory and inhibitory neurons.

 

Creation of organoids from stem cells allows scientists to study discrete areas of brain as it develops.
Credit: Courtesy of Yale University

 

 

Scientists can now explore in a laboratory dish how the human brain develops by creating organoids — distinct, three-dimensional regions of the brain. In research published in Cell Stem Cell, Yale scientists coaxed early stage stem cells to create and fuse two types of organoids from different brain regions to show how the developing brain maintains proper balance of excitatory and inhibitory neurons.

A failure to maintain this balance has been implicated in a host of neurodevelopmental disorders such as autism and schizophrenia.

“The inhibitory neurons migrate from specific areas of the embryonic brain to the region where excitatory neurons are being produced,” said senior author In-Hyun Park, associate professor of genetics and associate professor in the Child Study Center. “What we did is to fuse these two areas and watched the process unfold.”

The Yale team used human pluripotent stem cells to grow an organoid called the human medial ganglionic eminence, which produces inhibitory neurons and plays a crucial but brief role in early development of the cortex. By merging this structure with another that produces excitatory neurons they could track migration of the inhibitory cells, which provide a crucial check on excitatory neurons.

Understanding the process will not only help researchers understand how the human brain evolved, but shed light on how imbalances contribute to many neurodevelopmental disorders.

For instance, excess activity by excitatory neurons has been implicated in schizophrenia while too much inhibitory neuronal activity may contribute to depression, Park said. The imbalance has also been linked to development of autism spectrum disorders he said.


Story Source:

Materials provided by Yale University. Original written by Bill Hathaway. Note: Content may be edited for style and length.


Journal Reference:

  1. Yangfei Xiang, Yoshiaki Tanaka, Benjamin Patterson, Young-Jin Kang, Gubbi Govindaiah, Naomi Roselaar, Bilal Cakir, Kun-Yong Kim, Adam P. Lombroso, Sung-Min Hwang, Mei Zhong, Edouard G. Stanley, Andrew G. Elefanty, Janice R. Naegele, Sang-Hun Lee, Sherman M. Weissman, In-Hyun Park. Fusion of Regionally Specified hPSC-Derived Organoids Models Human Brain Development and Interneuron MigrationCell Stem Cell, 2017; DOI: 10.1016/j.stem.2017.07.007

 

Source: Yale University. “Lab-created mini-brains reveal how growing organ maintains neuronal balance.” ScienceDaily. ScienceDaily, 27 July 2017. <www.sciencedaily.com/releases/2017/07/170727141613.htm>.

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By analyzing people’s personal stories about their near-death-experiences, researchers look deeper into the chronology of different types of near-death-experiences

Date:
July 26, 2017

Source:
Frontiers

Summary:
New research examines how frequently and in what order different aspects of self-reported near-death-experiences occur. By analyzing written first-hand accounts of near-death-experiences, the researchers looked at whether specific aspects of these experiences tend to occur in the same order for different people. They found that even though some events are more common, and some are more likely to follow one another, near-death-experiences tend to be unique to the individual in terms of chronology.

 

In near-death-experiences many people report a sense of peacefulness and bright light.
Credit: © shaunwilkinson / Fotolia

 

 

No one really knows what happens when we die, but many people have stories to tell about what they experienced while being close to death. People who have had a near-death-experience usually report very rich and detailed memories of the event. Although such experiences can take many different shapes, some of the well-known phenomena include seeing a bright light, experiencing a feeling of peace, having an out-of-body experience and perceiving a tunnel. New research, published in Frontiers in Human Neuroscience, examines how frequently and in what order these different aspects of self-reported near-death-experiences occur.

While significant research efforts have gone into better understanding specific phenomenological features encountered during near-death-experiences, the scientific literature on the temporal structure of near-death-experiences is still quite limited. One less-explored area of research is whether there is any temporal regularity to near-death-experiences; in other words, do people tend to experience the different phenomena in a certain sequential order?

“To the best of our knowledge, no study has formally and rigorously investigated whether NDE features follow a fixed order or distribution,” says corresponding author Charlotte Martial (University of Liège and University Hospital of Liège, Belgium). “The aim of our study was to investigate the frequency distribution of these features, both globally and according to the position of features in narratives, as well as the most frequently reported temporality sequences of the different near-death-experience features.”

In order to examine the frequency distribution and chronology of different near-death experiences, the researchers collected and analyzed written accounts from 154 individuals who had gone through a near-death-experience. They took note of which specific near-death-experiences where present in each narrative and then examined the order of appearance of the different phenomena in each story. They found that on average, a person experiences about 4 different phenomena during a near-death-experience. The most frequently reported features were feeling of peacefulness (80% of participants), seeing a bright light (69%) and encountering with spirits/people (64%), whereas the two most uncommon experiences were speeding thoughts (5%) and precognitive visions (4%). In terms of chronology, they found that a third of the subjects (35%) experienced an out-of-body experience as the first feature of their near-death experience, and that the most frequent last feature was returning to the body (36%). “This suggests that near-death-experiences seem to be regularly triggered by a sense of detachment from the physical body and end when returning to one’s body,” says Charlotte Martial.

Overall, the most commonly shared experienced order of occurrences was: out-of-body experience, experiencing a tunnel, seeing a bright light, and finally feeling of peace. This sequence of events was reported by 6 (22%) of the participants. Although pairwise connections between different types of experiences were found in terms of how likely they were to follow each other chronologically, no universal sequence of events could be established in this sample of narratives, which suggests that each near-death-experience has a unique pattern of events.

“Our findings suggest that near-death-experiences may not feature all elements, and elements do not seem to appear in a fixed order. While near-death-experiences may have a universal character so that they may exhibit enough common features to belong to the same phenomenon, we nevertheless observed a temporal variability within the distribution of reported features” says Charlotte Martial. “This raises significant questions about what specific aspects of near-death-experiences could be considered as universal -and what not. Further research is necessary to explore these differences and the precise extent of which content of those experiences reflects their expectations and cultural backgrounds, as well as the neurophysiological mechanisms underlying near-death-experiences.”

These findings suggest that the order in which different types of near-death-experiences occur can be very individual. However, Martial and her colleagues hope that exploring how the different phenomena relate to each other may lead to a more rigorous definition and better scientific understanding of near-death-experiences as a whole.


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Materials provided by FrontiersNote: Content may be edited for style and length.


Journal Reference:

  1. Charlotte Martial, Héléna Cassol, Georgios Antonopoulos, Thomas Charlier, Julien Heros, Anne-Françoise Donneau, Vanessa Charland-Verville, Steven Laureys. Temporality of Features in Near-Death Experience NarrativesFrontiers in Human Neuroscience, 2017; 11 DOI: 10.3389/fnhum.2017.00311

 

Source: Frontiers. “Do all people experience similar near-death-experiences? By analyzing people’s personal stories about their near-death-experiences, researchers look deeper into the chronology of different types of near-death-experiences.” ScienceDaily. ScienceDaily, 26 July 2017. <www.sciencedaily.com/releases/2017/07/170726102934.htm>.

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Date:
July 25, 2017

Source:
Society for Research in Child Development

Summary:
A new study compared children’s capacity to imitate behavior with the same capacity of humans’ closest living great ape relatives, the bonobos. The study found that bonobos do not copy actions as children do, which highlights the unique nature of human imitation.

 

From an early age, children are very skilled in imitating the actions of others and are so motivated to do so that they will even copy actions for no reason. (Stock image)
Credit: © bartsadowski / Fotolia

 

 

From an early age, children are very skilled in imitating the actions of others and are so motivated to do so that they will even copy actions for no reason. Imitation is part of what it means to be human, underlying our capacity to acquire and transmit culture, including social rituals, norms, and conventions. A new study compared children’s capacity to imitate behavior with the same capacity of humans’ closest living great ape relatives, the bonobos. The study found that bonobos do not copy actions as children do, which highlights the unique nature of human imitation. The study, by researchers at the University of Birmingham and Durham University in the United Kingdom, appears in the journal Child Development. “Our results show striking species differences in imitation,” explains Zanna Clay, assistant professor of psychology at Durham University (formerly at the University of Birmingham), the study’s lead author. “The young children were very willing to copy actions even though they served no obvious function, while the bonobos were not. Children’s tendency to imitate in this way likely represents a critical piece of the puzzle as to why human cultures differ so profoundly from those of great apes.”

In the study, researchers compared the imitative behavior of 77 typically developing 3- to 5-year-olds in the United Kingdom with that of 46 untrained bonobos living in naturalistic forest enclosures in Lola ya Bonobo Sanctuary in the Democratic Republic of Congo. Children were recruited from the Birmingham Science Museum, which resulted in an ethnically diverse sample from low- and middle-income families. Imitation was defined as faithfully copying others’ body movements. Bonobos are our closest living relatives (along with chimpanzees), but have been studied much less. Since imitation is inherently social, social learning may be better to study in bonobos because they outperform chimps on certain sociocognitive tasks, show enhanced social orientation, and have high levels of social tolerance, such as peacefully sharing food with one another.

In the study, the researchers showed children and bonobos a small wooden box with a reward inside. Before opening the box, an experimenter performed some nonsensical actions over the box, such as waving a hand or tracing an imaginary line over it. Each participant was then given a box without any instructions. Most of the children spontaneously imitated the actions; in contrast, none of the bonobos made any attempt to copy any of the actions.

“The fact that the bonobos failed to imitate demonstrates that even enhanced social orientation may not be enough to trigger human-like cultural learning behaviors,” notes Claudio Tennie, research group leader at the University of Tubingen, who coauthored the study when he was at the University of Birmingham. “Although some animals show some limited abilities to copy, copying actions that have no apparent purpose appears to be uniquely human.”


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Materials provided by Society for Research in Child DevelopmentNote: Content may be edited for style and length.


Journal Reference:

  1. Zanna Clay, Claudio Tennie. Is Overimitation a Uniquely Human Phenomenon? Insights From Human Children as Compared to BonobosChild Development, 2017; DOI: 10.1111/cdev.12857

 

Source: Society for Research in Child Development. “Humans imitate in unique ways: Comparing children and bonobos.” ScienceDaily. ScienceDaily, 25 July 2017. <www.sciencedaily.com/releases/2017/07/170725085916.htm>.

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Date:
July 24, 2017

Source:
Frontiers

Summary:
Researchers reported earlier this year in the journal Frontiers of Public Health that up to 76 percent of the world’s population may be overfat. Now these same researchers have focused their efforts on data from 30 of the top developed countries, with even more alarming findings that up to 90 percent of adult males and 50 percent of children may be overfat.

 

Rather than thinking of these disorders as separate, individual clinical problems, it might be best to consider the relationships between overfat, its various risks, and its associated downstream diseases as a spectrum or progression where the vicious cycle of overfat, insulin resistance and chronic inflammation lies at one end, (constituting the population with early measurable abnormality), while the presence of chronic conditions resides at the other end.
Credit: Maffetone, Rivera-Dominguez and Laursen; CC BY

 

 

Does your waist measure more than half your height?

If so, you may be part of the global overfat pandemic. A recent article, published in Frontiers in Public Health, suggests it to be even more prevalent in developed countries where up to 90 percent of adult males and 50 percent children may suffer from this condition. In the top overfat countries, 80 percent of women fall into this category.

The problem is particularly pervasive in the English-speaking countries of the United States and New Zealand, but also in Iceland and even Greece where people are generally thought to be healthy. This trend may be bad news for developing countries as well, since they have followed the trend of developed nations in the growing overfat pandemic.

The term overfat refers to the presence of excess body fat that can impair health, and may include even normal-weight non-obese individuals. Excess body fat, especially abdominal fat, is associated with increased risk of chronic diseases, increased morbidity and mortality, and reduced quality of life.

Researchers Philip Maffetone, Ivan Rivera-Dominguez and Paul B. Laursen reported earlier this year in the journal Frontiers of Public Health that up to 76 percent of the world’s population may be overfat. Now these same researchers have focused their efforts on data from 30 of the top developed countries, with even more alarming findings.

In addition, a recent rise in the incidence of abdominal adiposity, the unhealthiest form of excess body fat, has been observed in both adults and children, indicating a direct link to insulin-resistance, the body’s natural propensity to convert and store carbohydrate foods as fat.

The relationship between the overfat condition and poor health is a spectrum or progression in which the vicious cycle of excess body fat, insulin resistance and chronic inflammation lie at one end, causing abnormal blood fats (cholesterol and triglycerides) and glucose, and elevated blood pressure, which then produces a variety of common diseases at the other end.

Being overfat is linked to hypertension, dyslipidemia, coronary heart disease, stroke, cancer, Type 2 diabetes, gallbladder disease, osteoarthritis and gout, pulmonary diseases, sleep apnea and others.

Many physically active people, including professional athletes in various sports and active U.S. military personnel, also may fall into the overfat category.

Traditional means of assessment, such as stepping on a scale or calculating Body Mass Index (BMI), are ineffective at determining whether someone is overfat. Instead, researchers recommend taking a measure of the waistline (at the level of the belly button) and comparing it to height: The waist measure should be less than half a person’s


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Materials provided by FrontiersNote: Content may be edited for style and length.


Journal Reference:

  1. Philip B. Maffetone, Ivan Rivera-Dominguez, Paul B. Laursen. Overfat Adults and Children in Developed Countries: The Public Health Importance of Identifying Excess Body FatFrontiers in Public Health, 2017; 5 DOI: 10.3389/fpubh.2017.00190

 

Source: Frontiers. “Study finds 90 percent of American men overfat.” ScienceDaily. ScienceDaily, 24 July 2017. <www.sciencedaily.com/releases/2017/07/170724105111.htm>.

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Target e*Studio® (EDC Builder) Now Includes Target e*ICD™ (Informed Consent)

 

Target e*CRF® has been used in multiple clinical trials and multiple FDA, EMA, HC and global regulatory approvals, for drugs, biologics, devices and diagnostics (including companion diagnostics). Our patented direct data entry eSource solution has also revolutionized clinical trial operations where in most cases, 80-90% of data are entered in real time, and onsite monitoring has dropped by over 60%. You can do the math.

 

The whole clinical trial can now be managed at one website, including direct data entry capture (eSource), risk-based monitoring, randomization, drug supply management, SAE management, monitoring reports etc. We give you what is needed, no more, no less.

 

Based our approval record and regulatory inspection success, our software delivers virtually everything needed to run the daily requirements of a clinical trial. Already this year, our software was used in an approved NDA, as well as for an expansion of an indication of a de novo 510(k) device, to include all patients receiving chemotherapy who are at risk for hair loss.

 

Of course, there is always the need to grow and this past year we added Target e*ICD™ (Informed Consent Document) and successfully completed the study with 65% of subjects, in a dermatology indication, signing electronically.

 

Version Control

 

To make clinical trials even more efficient, we are building the next version of Target e*Studio in order to accommodate and facilitate the needs of academic studies, research fellows, smaller CROs, biotech startups, as well as big pharma and global CROs. What makes us different is our deep knowledge of the clinical trial space, as well as tangible successes over the last 18 years that Target e*CRF has been used for clinical trials.

 

For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 165). For additional information about software tools for paperless clinical trials, please also feel free to contact Dr. Jules T. Mitchel. The Target Health software tools are designed to partner with both CROs and Sponsors. Please visit the Target Health Website.

 

Joyce Hays, Founder and Editor in Chief of On Target

Jules Mitchel, Editor

 

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