Sassafras Tea: Using a Traditional Method of Preparation to Reduce the Carcinogenic Compound Safrole

The purpose of this research is to quantify the carcinogenic compound safrole in the traditional preparation method of making sassafras tea from the root of Sassafras albidum. The traditional method investigated was typical of preparation by members of the Eastern Band of Cherokee Indians and other Appalachian peoples. Sassafras is a tree common to the eastern coast of the United States, especially in the mountainous regions. Historically and continuing until today, roots of the tree are used to prepare fragrant teas and syrups. These traditional uses can be found across cultures throughout its range. Products made from sassafras are banned from the market by the US Food and Drug Administration (FDA) due to a carcinogenic compound, safrole, found in the unprocessed root. Low levels of safrole are permitted in Europe due to the small concentration found in common spices, including nutmeg and cinnamon. However, in sufficient doses, safrole causes genotoxicity and cell toxicity, oxidative stress, and liver cancer in laboratory rats after ingestion. In this study, traditionally prepared tea and the FDA method of eliminating safrole were analyzed using high-performance liquid chromatography. These two methods were compared for effectiveness of eliminating or reducing safrole levels. The FDA method resulted in little to no safrole content. A smaller amount of safrole was present in the traditionally prepared tea compared to agitate samples, used to gauge a baseline concentration of safrole present in the root. Collaborations with the Center for Cherokee Plants within the Cherokee community will help us to return the results of the research and contribute resources emphasizing the cultural and historical importance of Sassafras albidum

Globalization of Alzheimer's disease clinical trials

Alzheimer's disease (AD) therapies are increasingly being tested in global clinical trials. A search of ClincalTrials.gov revealed that of 269 currently active trials, 28% are currently being conducted in the United States; the majority of trials and the majority of trial sites are ex-US. The US has the largest number of trial sites of any single country; cumulatively, nearly half of all sites are outside the US. The US conducts more trials in all phases of drug development but has a greater proportion of phase 3 trials. The increasing importance of global participants in clinical trials emphasizes the importance of considering the ethnic and international factors that may influence trial outcome. The International Conference on Harmonization guidelines divide ethnic factors that may affect drug development into intrinsic and extrinsic influences. These include language, cultural factors, educational levels, the general level of health and standard of care, as well as nutrition and diet. Ethnic influences on pharmacokinetics are known for some metabolic pathways. The biology of AD may also differ among the world's populations. The frequency of the apolipoprotein e4 allele, a major risk factor for AD, differs internationally. Genetic variations might also affect inflammatory, excitotoxic, and oxidative components of AD. Diagnostic standards and experience vary from country to country. Levels of practitioner training and experience, diagnostic approaches to AD, and attitudes regarding aging and AD may differ. Experience and sophistication with regard to clinical trial conduct also vary within and between countries. Experience with conducting the necessary examinations, as well as the linguistic and cultural validity of instrument translations, may affect trial outcomes. Operational and regulatory aspects of clinical trials vary and provide important barriers to seamless conduct of multiregional clinical trials. Collection and testing of biological samples, continuous provision of drug substance, and protection of the integrity of supply lines may be difficult in some international circumstances. Attention to these potential influences on clinical trials will determine the success of global drug development programs and the utility of global trials for developing new AD therapeutics

Planning for sustainable tourism development in Wales: an analysis of destination management plans

Tourism is a vital component of the Welsh economy and the need to incorporate sustainability principles into new and more responsible forms of tourism development is now widely accepted. Sustainability in a tourism context is multi-faceted, involving consideration of the economic, sociocultural and environmental impacts of tourism on all of the people and places impacted by it, including tourism and non-tourism businesses, residents and guests. Planning for sustainable tourism is therefore complex, requiring integration with other relevant planning processes; wide-ranging stakeholder participation; and, an integrative, iterative and strategic approach. This study assessed the extent to which Wales’ regional tourism entities have to date incorporated a stakeholder-driven, sustainability-focused mindset into their planning activities. Evaluation of 22 recent destination management plans revealed that there are many opportunities for improvement in the extent to which the desires of the industry, visitors and residents, and the conditions of the local economy, society and environment, are given equal consideration in tourism planning efforts. The need to refocus is especially important in light of Visit Wales’ recently articulated new ambition for tourism and the broader aspirations of the Well-being of Future Generations Act

Measuring Spatial Dependence for Infectious Disease Epidemiology.

Global spatial clustering is the tendency of points, here cases of infectious disease, to occur closer together than expected by chance. The extent of global clustering can provide a window into the spatial scale of disease transmission, thereby providing insights into the mechanism of spread, and informing optimal surveillance and control. Here the authors present an interpretable measure of spatial clustering, τ, which can be understood as a measure of relative risk. When biological or temporal information can be used to identify sets of potentially linked and likely unlinked cases, this measure can be estimated without knowledge of the underlying population distribution. The greater our ability to distinguish closely related (i.e., separated by few generations of transmission) from more distantly related cases, the more closely τ will track the true scale of transmission. The authors illustrate this approach using examples from the analyses of HIV, dengue and measles, and provide an R package implementing the methods described. The statistic presented, and measures of global clustering in general, can be powerful tools for analysis of spatially resolved data on infectious diseases

Hazing and Movements of Canada Geese near Elmendorf Air Force Base in Anchorage, Alaska

Bird strikes to aircraft are a serious economic and safety problem in the United States, annually causing millions of dollars in damage to civilian and military aircraft and the occasional loss of human life. We observed movements of 1236 neckbanded lesser Canada geese (Branta canadensis parvipes) to determine efficacy of hazing as a means to reduce goose presence at Elmendorf Air Force Base (EAFB), Anchorage, Alaska from August to October 1997. Emphasis was on movements of geese onto EAFB with additional data collected at the other two major airports in the area, Anchorage International Airport (AIA) and Merrill Field Airport (MFA). Daily observations indicated the presence of 208 individual neckbanded geese on EAFB, and 20% returned more than once after being hazed from EAFB. We identified three staging areas, geese utilized prior to entering EAFB, and three post-hazing dispersal sites. Collared geese began moving onto EAFB 30-40 days post-molt with the largest proportions moving onto EAFB 70-90 days post-molt. We observed 75 neckbanded geese on AIA from seven molting sites, and 23% returned more than once after being hazed from AIA. We observed 141 neckbanded geese on MFA from 14 molting sites, and 21% returned more than once after being hazed from MFA. Our data indicated that as long as local goose populations increase, large numbers of Anchorage area geese are likely to enter one of the airports creating a variety of management problems. Hazed geese returning to airports multiple times present a special hazard to aircraft safety because they appear to have become habituated to non-lethal scare tactics. We recommend an integrated management approach to limit the Anchorage area goose population utilizing various control techniques which are acceptable to Anchorage residents while continuing the hazing program at area airports

Age-related biological features of germ cell tumors.

Germ cell tumors (GCTs) are rare but clinically and pathologically diverse tumors that occur in an extensive range of age groups, from children to older adults and which include both seminomatous and nonseminomatous tumors. Current clinical management for both male and female teenagers and young adults (TYAs) with GCTs remains inconsistent, alternating between pediatric and adult multidisciplinary oncology teams, based on locally defined age cutoffs. Therefore, we reviewed available literature to determine the biological similarities and differences between GCTs in young children (0-12 years), TYAs (13-24 years), and older adults (>24 years). GCTs arising in pediatric and adult populations in general showed marked molecular biological differences within identical histological subtypes, whereas there was a distinct paucity of available data for GCTs in the TYA population. These findings highlight that clinical management based simply on chronological age may be inappropriate for TYA and suggests that the optimal future management of GCTs should consider specific molecular biological factors in addition to clinical parameters in the context of patient-specific age group rather than medical specialty.This is the accepted manuscript. The final version is available at http://onlinelibrary.wiley.com/doi/10.1002/gcc.22131/abstract

Work of being an adult patient with chronic kidney disease: a systematic review of qualitative studies.

INTRODUCTION: Chronic kidney disease (CKD) requires patients and caregivers to invest in self-care and self-management of their disease. We aimed to describe the work for adult patients that follows from these investments and develop an understanding of burden of treatment (BoT). METHODS: Systematic review of qualitative primary studies that builds on EXPERTS1 Protocol, PROSPERO registration number: CRD42014014547. We included research published in English, Spanish and Portuguese, from 2000 to present, describing experience of illness and healthcare of people with CKD and caregivers. Searches were conducted in MEDLINE, Embase, CINAHL Plus, PsycINFO, Scopus, Scientific Electronic Library Online and Red de Revistas Científicas de América Latina y el Caribe, España y Portugal. Content was analysed with theoretical framework using middle-range theories. RESULTS: Searches resulted in 260 studies from 30 countries (5115 patients and 1071 carers). Socioeconomic status was central to the experience of CKD, especially in its advanced stages when renal replacement treatment is necessary. Unfunded healthcare was fragmented and of indeterminate duration, with patients often depending on emergency care. Treatment could lead to unemployment, and in turn, to uninsurance or underinsurance. Patients feared catastrophic events because of diminished financial capacity and made strenuous efforts to prevent them. Transportation to and from haemodialysis centre, with variable availability and cost, was a common problem, aggravated for patients in non-urban areas, or with young children, and low resources. Additional work for those uninsured or underinsured included fund-raising. Transplanted patients needed to manage finances and responsibilities in an uncertain context. Information on the disease, treatment options and immunosuppressants side effects was a widespread problem. CONCLUSIONS: Being a person with end-stage kidney disease always implied high burden, time-consuming, invasive and exhausting tasks, impacting on all aspects of patients' and caregivers' lives. Further research on BoT could inform healthcare professionals and policy makers about factors that shape patients' trajectories and contribute towards a better illness experience for those living with CKD. PROSPERO REGISTRATION NUMBER: CRD42014014547

Alzheimer\u27s Disease Drug Development Pipeline: 2019

Introduction Alzheimer\u27s disease (AD) has few available treatments, and there is a high rate of failure in AD drug development programs. Study of the AD drug development pipeline can provide insight into the evolution of drug development and how best to optimize development practices. Methods We reviewed clinicaltrials.gov and identified all pharmacologic AD trials of all agents currently being developed for treatment of AD. Results There are 132 agents in clinical trials for the treatment of AD. Twenty-eight agents are in 42 phase 3 trials; 74 agents are in 83 phase 2 trials; and 30 agents are in 31 phase 1 trials. There is an increase in the number of agents in each phase compared with that in the 2018 pipeline. Nineteen agents in trials target cognitive enhancement, and 14 are intended to treat neuropsychiatric and behavioral symptoms. There are 96 agents in disease modification trials; of these, 38 (40%) have amyloid as the primary target or as one of several effects. Eighteen of the antiamyloid agents are small molecules, and 20 are monoclonal antibodies or biological therapies. Seven small molecules and ten biologics have tau as a primary or combination target (18%). Amyloid is the most common specific target in phase 3 and phase 2 disease modification trials. Novel biomarkers (e.g., neurofilament light), new outcomes (e.g., AD Composite Score [ADCOMS]), enrollment of earlier populations, and innovative trial designs (e.g., Bayesian adaptive designs) are new features in recent clinical trials. Discussion Drug development continues robustly at all phases despite setbacks in several programs in the recent past. Continuing unmet needs require a commitment to growing and accelerating the pipeline

Beliefs about Appropriate Antibacterial Therapy, California

To our knowledge, previous population-based surveys have not assessed misconceptions about antibacterial drug use over time. We documented a 26.3% decline in a key misconception in California women in 2003 compared to 2000; declines varied significantly by education level. Educational campaigns specifically designed to influence important subpopulations are needed

Patients and informal caregivers' experiences of burden of treatment in lung cancer and chronic obstructive pulmonary disease (COPD): a systematic review and synthesis of qualitative research.

OBJECTIVE: To identify, characterise and explain common and specific features of the experience of treatment burden in relation to patients living with lung cancer or chronic obstructive pulmonary disease (COPD) and their informal caregivers. DESIGN: Systematic review and interpretative synthesis of primary qualitative studies. Papers were analysed using constant comparison and directed qualitative content analysis. DATA SOURCES: CINAHL, EMBASE, MEDLINE, PsychINFO, Scopus and Web of Science searched from January 2006 to December 2015. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Primary qualitative studies in English where participants were patients with lung cancer or COPD and/or their informal caregivers, aged >18 years that contain descriptions of experiences of interacting with health or social care in Europe, North America and Australia. RESULTS: We identified 127 articles with 1769 patients and 491 informal caregivers. Patients, informal caregivers and healthcare professionals (HCPs) acknowledged lung cancer's existential threat. Managing treatment workload was a priority in this condition, characterised by a short illness trajectory. Treatment workload was generally well supported by an immediacy of access to healthcare systems and a clear treatment pathway. Conversely, patients, informal caregivers and HCPs typically did not recognise or understand COPD. Treatment workload was balanced with the demands of everyday life throughout a characteristically long illness trajectory. Consequently, treatment workload was complicated by difficulties of access to, and navigation of, healthcare systems, and a fragmented treatment pathway. In both conditions, patients' capacity to manage workload was enhanced by the support of family and friends, peers and HCPs and diminished by illness/smoking-related stigma and social isolation. CONCLUSION: This interpretative synthesis has affirmed significant differences in treatment workload between lung cancer and COPD. It has demonstrated the importance of the capacity patients have to manage their workload in both conditions. This suggests a workload which exceeds capacity may be a primary driver of treatment burden. PROSPERO REGISTRATION NUMBER: CRD42016048191