Source:http://www.frontiersin.org/ Reviewed by Alina Shrourou, B.Sc. (Editor)Jan 11 2019In a trial of one of the main class of prescription sleeping pills, half the participants slept through a fire alarm as loud as someone vacuuming next to their bed. But a newer alternative preserves the ability to wake in response to danger signals, according to a new research.Published this week in Frontiers in Behavioral Neuroscience, the study showed that mice given the experimental hypnotic drug DORA-22 wake as quickly when threatened as drug-free sleepers – and then fall back asleep as quickly as ones given standard sleeping pills, once the threat is gone.Common sleeping pills muffle your sleeping brain’s ‘intruder alert’Even during sleep the brain continuously processes sensory information, waking us if it detects a threat. But the most widely prescribed class of sleeping pills, known as benzodiazepines, makes us less likely to rouse in response to sensory input.”Benzodiazepines stimulate the widespread brain receptor GABA-A, which makes us sleepy but also suppresses off-target brain areas – including the ‘gatekeeper’ that decides which sensory inputs to process,” explains study senior author Professor Tomoyuki Kuwaki of Kagoshima University, Japan.Over the last decade, researchers have been developing a new class of hypnotic drugs called dual orexin receptor antagonists (DORAs). DORAs more selectively target the brain’s sleep/wake pathways, which gives them safety advantages over benzodiazepines. These include a reduced ‘hangover effect’, with DORAs less likely to affect driving ability the day after use.Kuwaki and colleagues hypothesized that the selectivity of DORAs could make them a safer alternative during sleep as well – by allowing the brain’s sensory gatekeeper to stay vigilant to threats.DORA-22 allows mice to wake to a threat, but still helps them sleepThe group tested their theory in mice.The mice were dosed and tested after dark, when they are normally most active. One group was administered DORA-22, another a benzodiazepine called triazolam – and a third group was given placebo as a control.”DORA-22 and triazolam had similar sleep promoting effects, extending the duration of deep sleep by 30-40% compared to placebo,” reports Kuwaki.Related StoriesSleep disorders in patients with low back pain linked to increased healthcare visits, costsSleep makes synapses ready for new learningSleep quality could be indicator for later Alzheimer’s disease finds studyOne to four hours after dosing, the deep-sleeping mice were presented with a threatening stimulus: the smell of a fox, a high-pitched noise like a dog whistle, or trembling of their cage. The trembling frequency was designed to match that of an earthquake – a serious threat in Kuwaki’s native Japan and many other parts of the word.”As expected, arousal in response to these threatening stimuli was delayed significantly in the triazolam treatment, but not in the DORA-22 treatment, compared to placebo.Even more promising, the sleep-promoting effect of DORA-22 remained after the rude awakening.”Even though the DORA-22-treated mice were quickly woken by a threat, they subsequently fell back asleep as quickly as with triazolam, and significantly faster than with placebo.”To help demonstrate that the delay in waking to a threat during triazolam treatment was due specifically to inhibition of sensory gating in the brain, the researchers also tested the sleeping mice with a non-sensory stimulus.”The three groups woke equally quickly when we suddenly reduced the amount of oxygen in their cage. This suggests that the delay in rousing to threatening stimuli caused by triazolam was not caused by a general inhibition of waking systems in the brain.”Human studies are needed to confirm DORA safety and efficacy”Although it remains to be seen whether DORAs have the same properties when used in humans, our study provides important and promising insight into the safety of these hypnotics.”Since 2014, another DORA called surovexant has gained regulatory approval in Japan, the USA and Australia. So far, the high cost and limited clinical testing of surovexant have limited its use, amid concerns that doses high enough to significantly improve sleep lead to drowsiness the following day. New DORAs currently in development could overcome this hangover effect if they are cleared more quickly from the body than suvorexant, so that their effects are less likely to last beyond bedtime. Keep your eyes peeled.
Feb 14 2019Introducing physician-assisted suicide would fundamentally change the doctor-patient relationship, finds a major new poll for Care Not Killing.The survey of over 2,000 members of the public found high levels of concern about vulnerable people feeling pressure to end their lives with four in 10 saying changing the law risks normalizing suicide.The ComRes poll asked GB adults about their views on assisted suicide, the model used in Oregon, and how this would affect trust in doctors.Asked “If GPs are given the power to help patients commit suicide it will fundamentally change the relationship between a doctor and patient, since GPs are currently under a duty to protect and preserve lives,” more than twice as many said it would (48 per cent to 23 per cent), while nearly 3 in ten (29 per cent) were not sure.Dr Gordon MacDonald, a spokesman for Care Not Killing commented: The survey asked if legalizing assisted dying risks normalizing suicide and leading to an increase in deaths among the general population. The public were evenly split but almost four in ten (37 per cent) agreed, exactly the same proportion who disagreed – while a quarter were not sure. It concludes by asking if “as a society we ought to try to do everything we reasonably can to reduce the rate of suicides, especially among men who are three times as likely as women to take their own lives”. Eight in 10 agreed (78%), while perhaps surprisingly 6% disagree.Dr MacDonald, concluded: The poll found that most (51 per cent) of those surveyed were concerned that some people might feel pressured into accepting help to take their own life “so as not to be a burden on others”, while half that proportion (25 per cent) disagreed. These figures reflect what is happening in the US states of Oregon and Washington where a majority of those ending their lives in 2017 said that not wanting to be a burden was a motivation for their decision. This compared to just one in five (21 per cent) in those states who were concerned about the possibility of inadequate pain control, or were experiencing discomfort.The survey was commissioned in the wake of the decision by the Royal College of Physicians to survey their members about “assisted dying” and in a highly unusual move require a super-majority of 60 per cent to prevent the doctors group adopting a neutral position. Asked if cases such as Dr Harold Shipman and the Gosport Hospital scandal made people more concerned that changing the law to allow doctors to prescribe lethal doses of a substance to kill terminally ill patients would fundamentally change the relationship between doctors and patients, more than four in 10 (42 per cent) agreed, 28 per cent disagreed and three in 10 (30 per cent) did not know.Related StoriesHow to get a cheaper prescription before leaving the doctor’s officeEven when HIV prevention drug is covered, other costs block treatmentAre physical examinations by family doctors still needed?The poll found high levels of concern about whether overstretched doctors have the time or clinical ability to accurately assess a patient’s mental capacity if they requested help to end their life. Alarmingly, more than a quarter of adults (27 per cent), equivalent to 13.5 million patients, said that if assisted suicide were legal, “they would not trust their own GP enough for them to make a decision about their mental capacity to decide whether or not to accept help to take their own life.Dr MacDonald, continued: It is clear that ripping up the longstanding agreement between doctors and society that their job is to save life not to end it would have a seriously damaging effect on how the profession is viewed. In places like Oregon and Washington there have been reports of the sick being denied the life-saving and life-extending drugs they need but offered the poison to end their life. While in Belgium one study found more than 1,000 assisted deaths were without the explicit request of the patient.” This poll shows a greater level of understanding of the difficulties with assisted suicide than most so-called experts think possible. Usually the public are only asked a simple rights based question that is heavily framed, but these questions reveal significant unease around the removing universal protections to allow doctors to kill their patients.” This poll puts a sword to the lie that changing the law on assisted suicide enjoys unremitting support. Abandoning universal protections and expecting doctors to dispense lethal drugs with the express purpose of killing their patients causes alarm. It would undermine the doctor-patient relationship and, as large numbers of the public recognize, risks normalizing suicide.” Source: https://www.carenotkilling.org.uk/
We intended to associate practices of peritoneal dialysis use of hypertonic exchanges, use of automated peritoneal dialysis vs. continuous ambulatory peritoneal dialysis, use of icodextrin, and use of diuretics with technique failure. Our main finding is that the association between technique failure and fluid overload is dependent upon center size and thus presumably experience within the treating center.”Wim Van Biesen, MD, PhD, University Hospital Ghent, Belgium Reviewed by James Ives, M.Psych. (Editor)May 24 2019A new study published in CJASN found substantial volume overload, or too much fluid in the body, in patients with kidney failure who initiated peritoneal dialysis. Volume overload tended to improve over time after starting dialysis, but was at all times was higher in males vs. females and in patients with diabetes vs. those without. The study also revealed variations in practice of care across different geographic regions. This variation was associated with differences in degree of volume overload.Individuals with kidney failure who are undergoing hemodialysis or peritoneal dialysis often experience fluid overload. To examine the implications of this condition, Wim Van Biesen, MD, PhD (University Hospital Ghent, in Belgium) and his colleagues designed a study to assess patients’ health and fluid volume over time after initiating peritoneal dialysis. It’s thought that actively managing volume overload may reduce the risk of technique failure (transfer from peritoneal dialysis to hemodialysis) and prolong patient survival.In the study of 1,054 patients from 28 countries who were examined every 3 months, volume overload before the start of dialysis amounted to an average of 1.9 L and decreased to 1.2 L during the first year. After 3 years of follow-up, the average relative volume overload in patients was lower than at the start in participants from all regions except those of Latin American, where it increased. The investigators concluded that volume overload is already present before the start of dialysis, and it tends to improve over the first 6 months and stabilize afterwards.At all time points, males and participants with diabetes were at a higher risk of experiencing volume overload. Also, volume overload was associated with a higher risk of premature death. The study revealed different treatment practices to address volume overload across dialysis centers and regions. Related StoriesResearchers identify trends in use of transcatheter dialysis conduit procedures over 15 yearsRapid fluid removal from patients with failing kidneys linked to increased risk of deathOne-fifth of U.S. surgeons still ‘overusing’ riskier method to create kidney dialysis access, study findsIn an accompanying Patient Voice editorial, Shari Gilford shared her experience of peritoneal dialysis, both ambulatory and automated, for 7 years. She also questioned why patients in Latin America had a different outcome than those from other regions.”If there are factors other than dialysate type, dialysate concentrate, or diet which make it more difficult for patients to control their volume overload, patients need to be made aware of this,” she wrote. “Based on my own experience [in hot vs. cold seasons], I wonder if the year-round hotter climate of Latin America, as opposed to most other regions in the study which have cold seasons, could have been a factor for fluid overload leading to increased mortality. Continued study of this variable might improve outcomes for peritoneal dialysis patients who live in warmer climes.”Source:American Society of NephrologyJournal reference:Biesen, W.V. et al. (2019) Evolution Over Time of Volume Status and PD-Related Practice Patterns in an Incident Peritoneal Dialysis Cohort. Clinical Journal of the American Society of Nephrology. doi.org/10.2215/CJN.11590918.
UK seeking warrant to access Cambridge Analytica servers (Update) © 2018 The Associated Press. All rights reserved. Citation: UK parliament asks Zuckerberg to testify in data misuse case (2018, March 20) retrieved 18 July 2019 from https://phys.org/news/2018-03-uk-parliament-zuckerberg-testify-misuse.html A British parliamentary committee on Tuesday summoned Facebook CEO Mark Zuckerberg to answer questions on fake news as authorities step up efforts to determine whether data has been improperly used to influence elections. Explore further The request comes amid reports that a U.K.-based company allegedly used Facebook data to help Donald Trump win the 2016 presidential election. The company, Cambridge Analytica, has been accused of improperly using information from more than 50 million Facebook accounts. It denies wrongdoing.The chairman of the U.K. parliamentary media committee, Damian Collins, said Tuesday that his group has repeatedly asked Facebook how it uses data and that Facebook officials “have been misleading to the committee.””It is now time to hear from a senior Facebook executive with the sufficient authority to give an accurate account of this catastrophic failure of process,” Collins wrote in a note addressed directly to Zuckerberg. “Given your commitment at the start of the New Year to ‘fixing’ Facebook, I hope that this representative will be you.”The request to appear comes as Britain’s information commissioner said she was using all her legal powers to investigate the social media giant and Cambridge Analytica over the alleged misuse of data.Commissioner Elizabeth Denham is pursuing a warrant to search Cambridge Analytica’s servers. She has also asked Facebook to cease in its efforts to pursue its own audit of Cambridge Analytica’s data use.”Our advice to Facebook is to back away and let us go in and do our work,” she said.Cambridge Analytica said it is committed to helping the U.K. investigation. However, Denham gave the firm a deadline to produce the information she requested—and it failed to meet it, her office said.Denham said the prime allegation against Cambridge Analytica is that it acquired personal data in an unauthorized way, adding that the data provisions act requires platforms like Facebook to have strong safeguards against misuse of data.Chris Wylie, who once worked for Cambridge Analytica, was quoted as saying the company used the data to build psychological profiles so voters could be targeted with ads and stories.The firm found itself in further allegations of wrongdoing. Britain’s Channel 4 used an undercover investigation to record Cambridge Analytica’s chief executive, Alexander Nix, saying that the company could use unorthodox methods to wage successful political campaigns for clients.He said the company could “send some girls” around to a rival candidate’s house, suggesting that girls from Ukraine are beautiful and effective in this role.He also said the company could “offer a large amount of money” to a rival candidate and have the whole exchange recorded so it could be posted on the internet to show that the candidate was corrupt.Nix says in a statement on the company’s website that he deeply regrets his role in the meeting and has apologized to staff.”I am aware how this looks, but it is simply not the case,” he said. “I must emphatically state that Cambridge Analytica does not condone or engage in entrapment, bribes or so-called ‘honeytraps’, and nor does it use untrue material for any purposes.”Nix told the BBC the Channel 4 sting was “intended to embarrass us”.”We see this as a co-ordinated attack by the media that’s been going on for very, very many months in order to damage the company that had some involvement with the election of Donald Trump,” he said.The data harvesting used by Cambridge Analytica has also triggered calls for further investigation from the European Union, as well as federal and state officials in the United States. This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.