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Feed for "Health + Behavior" newsUCLA RESEARCH ALERTFINDINGS

Forty-four percent of people who held jobs before contracting a condition called acute respiratory distress syndrome were jobless one year after they were discharged from the hospital, costing them an average of about $27,000 in earnings. After one year, fewer of them had private health insurance (30 percent, down from 44 percent) and more of them were enrolled in Medicare and Medicaid (49 percent versus 33 percent). There was little change in the number of jobless survivors who were uninsured.

The study found that the people who experienced the longest delays in returning to work tended to be older and non-white, and those who had been hospitalized for longer periods of time. Men and women experienced similar delays before they could return to work, and the severity of people’s illness did not affect how long they were out of work.

BACKGROUND

Acute respiratory distress syndrome affects about 200,000 Americans each year. Often caused by severe infection or trauma, it is characterized by a buildup of fluid in the lungs’ air sacs, which leads to a substantial decrease in oxygen in the bloodstream and rapidly developing difficulty breathing. People with the condition are usually hospitalized and placed on life-supporting ventilators. The syndrome often causes long-lasting cognitive dysfunction, mental health issues and physical impairments, all of which can affect people’s ability to hold jobs.

Several studies have suggested that joblessness is common in survivors of the condition. But the researchers believe this new study was the first to track those who returned to work or subsequently lost their jobs, perform an in-depth analysis of risk factors for joblessness and evaluate the impact of joblessness on lost earnings and health care coverage.

METHOD

The study was conducted as part of the ARDS Network Long-Term Outcome Study, or ALTOS, a national multicenter prospective study of people who survived acute respiratory distress syndrome from 2006 to 2014, encompassing patients from 43 U.S. hospitals.

The investigators interviewed 922 survivors by telephone six months and 12 months after the onset of their condition. Each person was asked about employment status, the number of hours they worked per week, the length of time before they returned to work after they were discharged from the hospital, their perceived effectiveness at work and any major changes in their occupation.

IMPACT

The study showed that 25 percent of survivors who do return to work end up losing their jobs. Survivors who experience joblessness lose approximately two-thirds of their annual earnings.

Based on these findings, the authors suggest that ARDS patients who are at risk for joblessness may benefit from early interventions, even while still in the intensive care unit, to help them successfully return to work after their recovery.

AUTHORS

The study’s first author is Dr. Biren Kamdar, assistant professor of medicine in the division of pulmonary and critical care medicine at the David Geffen School of Medicine at UCLA; the senior author is Dr. Dale Needham of the Johns Hopkins University School of Medicine. Other authors are Minxuan Huang, Victor Dinglas and Elizabeth Colantuoni of Johns Hopkins; Till von Wachter of UCLA; and Ramona Hopkins of Intermountain Medical Center in Utah.

JOURNAL

The research was published April 28 in the American Journal of Respiratory and Critical Care Medicine.

FUNDING

Funding was provided by the National Heart, Lung and Blood Institute (N01HR56170, R01HL091760 and 3R01HL091760-02S1), the ARDS Network trials (contracts HHSN268200536165C to HHSN268200536176C and HHSN268200536179C) and the UCLA Clinical and Translational Science Institute (NIH–National Center for Advancing Translational Science UCLA UL1TR000124 and UL1TR001881).

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Kamdar.jpgBiren KamdarDr. Biren Kamdar

Dr. Biren Kamdar

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Kamdar.jpgBiren Kamdar

Dr. Biren Kamdar

AmyAlbin310-267-7095aalbin@mednet.ucla.eduNearly half of adults who had been employed before experiencing and surviving acute respiratory distress syndrome were jobless one year after hospital discharge.Amy Albinhttp://newsroom.ucla.edu/releases/survivors-of-acute-respiratory-distress-syndrome-often-experience-delays-in-returning-to-workFri, 28 Apr 2017 21:23:00 GMTUCLA report finds that big cuts to health care benefits would hurt the disabled, children and elderly Americans

The Trump administration’s intent to reform Medicaid includes financing changes that would save hundreds of billions in federal dollars over time, but at the expense of cutting significant health care benefits to tens of millions of the program’s most vulnerable recipients — the disabled, children and elderly Americans, according to a new report from the UCLA Center for Health Policy Research.

None of three “capped” financing systems — block grants, capped allotments and per capita caps — discussed in previous health proposals guarantees benefits for those who qualify for the low-income health program. All of them shrink real funding over time because the proposed growth formulas set the growth to a lower rate than what would be expected under current law. In contrast, the current Medicaid system guarantees benefits to all eligible enrollees and grows in response to increases in enrollment and health care costs.

As a result of capping, states would have to choose whether to bear an increasingly larger share of Medicaid costs, cut patient benefits, create waiting lists, or institute other strict requirements to limit enrollment, according to the study’s authors.

“These are great plans for federal accountants. It’s a terrible plan for everyone else,” said center Director Gerald Kominski, co-author of the policy brief. “The decrease in funding will profoundly damage the ability of California — and other states — to cover beneficiaries as time goes on.”

Disabled and elderly account for a disproportionately high level of care

The Medicaid program is jointly financed by the federal and state governments. The federal government currently pays about 63 percent of the cost, and states the remaining 37 percent, although the proportion varies by state, according to the study. As a provision of the Patient Protection and Affordable Care Act, Medicaid eligibility was expanded to include poor single, childless, low-income adults, which vastly expanded the number of people gaining health insurance. In 2015, Medicaid covered 62.4 million Americans at a cost of $552 billion, according to the report.

Benefits vary widely by population group, with the disabled and those 65 years and older making up about 25 percent of enrollees in 2011, but accounting for 64 percent of Medicaid spending.

“It obviously costs more to provide care for certain populations, such as the severely disabled,” said Haleigh Mager-Mardeusz, a graduate student at the UCLA Fielding School of Public Health and co-author of the report. “Capped funding will force states to make hard choices about who ‘deserves’ health care coverage.”

How three capped funding systems would change benefits

Each proposed capped financing system would change — and decrease — Medicaid funding to states as well as fundamentally alter the structure of the Medicaid program from an entitlement program, in which any person who qualifies can receive health benefits:

Block grant: Changes Medicaid to a fixed-grant program that stays constant over time, regardless of whether an economic downturn leaves more people uninsured or a population spike increases demand for enrollment. The report’s authors say funding for block grant programs are often targeted during federal budget cuts.

In California, spending per enrollee in one proposed version of a block grant would drop from $4,500 a year currently to $3,200 a year within the first year of a block grant conversion, according to the study.

Capped allotment: Requires the state to spend money in order to receive matching federal funds, up to a limit. A state that spends less than anticipated would have its federal match reduced. Funding under this system is expected to be lower than current funding.

Per capita caps: Limits how much can be spent on health care per enrollee. The state would be responsible for any amount that exceeds the limit, which would be a problem with sicker, older patients, who require more care, or in the event of a natural or man-made disaster. Geographic variation in health costs could be a problem for many states, if the federal government uses a uniform cost measure. Per capita caps were the proposed funding system in the American Health Care Act.

In California, estimated benefits would drop significantly in the first year under one proposed version of a per capita cap system for almost all population groups except adults, from $21,775 to $15,100 for a disabled beneficiary; from $12,725 to $5,580 for an elderly individual; and from $2,500 to $1,820 for a child. Adult beneficiaries are an exception: Their benefits would increase from $1,715 to $2,271 under a per capita cap funding system.

According to the report, proponents of capped funding systems say those systems will encourage states to become more efficient and innovative and to find ways to provide health services for less money. However, the authors note that state Medicaid programs are already very efficient and most states would end up bearing increased costs as the real value of federal funding diminishes over time.

“Under these caps, many Medicaid patients will see retraction of their health care,” said Cosima Lenz, a graduate student at the UCLA Fielding School of Public Health and co-author of the report. “It’s the opposite of what we saw with Medicaid expansion under the Affordable Care Act.”

Read the policy brief, “A ‘cap’ on Medicaid: how block grants, per capita caps and capped allotments might fundamentally change the safety-net.”

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/MedicaidPB_iStock-502573906.jpgPeople cutouts-Medicaid

People cutouts-Medicaid

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/MedicaidPB_iStock-502573906.jpgPeople cutouts-Medicaid

People cutouts-Medicaid

GwendolynDriscoll310-794-0930gdriscoll@ucla.eduA UCLA report finds that big cuts to health care benefits would hurt the disabled, children and elderly Americans. Venetia Laihttp://newsroom.ucla.edu/releases/federal-budget-would-win-but-the-most-vulnerable-and-poor-would-lose-under-capped-medicaid-funding-scenariosWed, 26 Apr 2017 09:15:00 GMTHe developed wearable biosensor that can be used to diagnose disease UCLA Sam Emaminejad has been working on a wearable sensor that can extract sweat by applying an electrical current to the skin and then analyzing its molecular components, such as chloride ions and glucose, to detect certain diseases.

Sam Emaminejad, assistant professor of electrical engineering at UCLA, has demonstrated that a wearable biosensor can be used in the diagnosis of cystic fibrosis, diabetes and other diseases by measuring molecules present in an individual's sweat.

He developed the biosensor with colleagues while he was a joint postdoctoral researcher at Stanford Medicine and UC Berkeley. Currently, he is completing his first year on the UCLA engineering faculty and is continuing this line of research in his lab.

The key to the biosensor is it “activates” your sweat while you wear it and you don’t have to run up stairs or stay on a treadmill to the point where you break out in sweat. The research demonstrated for the first time that a wearable, non-invasive sensor can extract sweat at the skin’s surface and monitor in real time important biomarkers for patients.

Emaminejad spoke recently to UCLA Engineering writer Matthew Chin about his research and teaching goals.

 What can sweat tell about what’s going on inside us? And why hasn’t sweat been used much for patient monitoring and tracking?

Sweat is a rich source of physiological information and contains many biomarkers such as metabolites, electrolytes  and proteins that can inform us of our health status.

Sweat-based monitoring has a huge potential to facilitate non-invasive and continuous monitoring of individuals in a wearable format, such as a smartwatch. For robust analysis we need a few droplets of sweat on demand, which is not really accessible unless we exercise or lock ourselves in sauna!

In the work that just came out, we demonstrated a platform that can stimulate sweat glands to produce sweat with the aid of an electrical current.

In other words, [patients] don’t have to work up a sweat, or feel discomfort to get at this valuable source of physiological information. This is an unprecedented opportunity, because now a previously inaccessible source of information has been made available for real-time monitoring.

What is the long-term vision for your research? 

The Interconnected and Integrated Bioelectronics Lab was established [at UCLA] to bridge the gap between the two worlds of Internet of Things and personalized medicine, through the development of an ecosystem of integrated and interconnected mobile, wearable and in-vivo health monitoring platforms.

These platforms facilitate the analysis of biomarker content in various human biofluids such as blood, sweat, saliva and urine, in combination with continuous measurement of physiological signals to provide a comprehensive and dynamic view of our health states.

Realizing this vision requires resolving major bottlenecks from various fronts, and we work closely with experts in biology, medicine and data science to optimize our efforts toward high impact applications. In that regard, UCLA is the perfect place for leading this collaborative research program, given the excellent synergy between the engineering and medical schools.

Courtesy of Sam Emaminejad A wearable sweat sensor can be used for diagnosing and monitoring diseases in real time.

You’re teaching a class this spring quarter of your own design (EE 279 AS Micro- and Nanoscale Biosensing for Molecular Diagnostics) based on one that you co-developed and taught while a graduate student and post-doc. What does it cover, and what do you hope students get out of it?

I believe to exponentially amplify our efforts toward achieving our research vision, it is crucial to also focus on raising the next generation of researchers who ... can take the lead in resolving the challenges ahead.

The goal of this course is for students to appreciate the interface of biology and engineering and to be equipped with the critical thinking and problem-solving skills necessary to evaluate and propose solutions for today’s most pressing biosensing problems.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Emaminejad+0799_crop.jpgSam EmaminejadSam Emaminejad has been working on a wearable sensor that can extract sweat by applying an electrical current to the skin and then analyzing its molecular components, such as chloride ions and glucose, to detect certain diseases.

Sam Emaminejad is an assistant professor of electrical engineering in the UCLA School of Engineering and Applied Sciences.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Emaminejad+0799_crop.jpgSam Emaminejad

Sam Emaminejad is an assistant professor of electrical engineering in the UCLA School of Engineering and Applied Sciences.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Sweat_Band_1-copy.jpgSweat band sensor

A wearable sweat sensor can be used for diagnosing and monitoring diseases in real time.

Sam Emaminejad, assistant professor of electrical engineering at UCLA, has demonstrated that a wearable biosensor can be used in the diagnosis of cystic fibrosis, diabetes and other diseases.Matthew Chinhttp://newsroom.ucla.edu/stories/engineer-puts-sweat-tech-to-the-testMon, 24 Apr 2017 15:57:00 GMTUCLA researchers focused on low-income individuals younger than 65, those most affected by ACA’s Medicaid expansion

One of the indirect societal benefits of the Affordable Care Act has been increased levels of volunteerism, especially among lower-income populations, a study from UCLA’s California Center for Population Research suggests.

Researchers found that instances of self-reported volunteerism increased markedly among people in low-income groups who lived in states that enacted the Affordable Care Act’s Medicaid expansion.

The study, published in Socius: Sociological Research for a Dynamic World, focused on low-income individuals younger than 65. This is the group most affected by the Medicaid expansion, which provided public health insurance for approximately 13 million uninsured Americans.

UCLA postdoctoral researcher Heeju Sohn analyzed data from the volunteering supplement of the annual Current Population Survey conducted by the U.S. Census Bureau, comparing the pre-ACA years of 2010–2013 to information collected in 2014 and 2015. The study was co-authored by UCLA sociology professor Stefan Timmermans.

“Our thought was to see if we would find any changes in volunteer rates between states that opted to expand Medicaid and states that did not expand,” Sohn said. “And we did. Not only did we see it, but we saw it in a very robust manner.”

Research has shown that obtaining health insurance provides individuals greater emotional and financial stability. Other research has shown that when people are financially stable, they are more likely to volunteer. Given that the ACA’s Medicaid expansions were responsible for the largest gains in public insurance coverage since its inception in 1965, researchers suspected there might be a strong correlation between even a perceived access to health care and the sense of personal stability that often accompanies volunteerism.

“We also were surprised that the associations between the ACA and volunteering were noteworthy even in advance of measurable changes in the literal health of the respondents,” Sohn said.

Low-income adults under 65 living in Medicaid-expansion states were about 50 percent more likely to report they had formally volunteered with an organization than those who lived in a state that did not expand Medicaid, the study showed.

When respondents were asked whether they had participated in informal “helping,” like assisting a neighbor, or working on a neighborhood improvement project, a similar pattern emerged. People living in Medicaid-expansion states were about 20 percent more likely to help.

States that did not expand Medicaid did not show increases in reported volunteerism or informal helping, the study found.

Higher-income groups in Medicaid-expansion states also did not show an increase in volunteering, nor did low-income groups in the older-than-65 age group. This is compatible with what researchers suspected, given that the senior age group has enjoyed more consistent access to health coverage through Medicare, Sohn said.

The study also found that volunteer work in Medicaid-expansion states increased among minority groups. Prior to the ACA, minority groups, especially Latinos, were the least likely to have participated in formal volunteering.

Post-ACA in Medicaid expansion states, Latinos reported volunteering at almost the same rate as whites. According to the study, in the years after the ACA Medicaid expansion Latino respondents in participating states were 75 percent more likely to report they had participated in formal volunteerism and 40 percent more likely to say they had been involved in informal helping than in the years prior.

There’s a positive domino effect at play. This analysis seems to suggest that communities-at-large can benefit from greater populations of residents enjoying the stability provided by health insurance coverage.

“People who are not necessarily affected by Medicaid expansion may still benefit from a spillover effect of having neighbors who suddenly gain insurance and become more actively engaged in the community,” Sohn said. “If we were to improve upon this study we would want to go back and more-literally track people who gained and used Medicaid and look at their individual volunteerism levels from before and after the ACA went into effect.”

One thing that did not seem to be affected in populations where Medicaid was newly available, was the pervasive gender divide in volunteerism. Women, in every age and economic bracket, are more likely to volunteer than men, according to the study.

Further investigation into indirect benefits of health insurance such as volunteerism and well-being could be affected by the current cloud of uncertainty around the fate of the ACA and Medicaid, Sohn said.

“But it’s clear that there are larger societal benefits to be considered as policymakers pursue changes to individual healthcare,” she said.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Volunteering.jpgVolunteeringThe UCLA study found that volunteer work increased among minority groups in states that expanded Medicaid.

Stock art of volunteers at a food bank.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Volunteering.jpgVolunteering

Stock art of volunteers at a food bank.

JessicaWolf310-825-1046jwolf@support.ucla.eduUCLA researchers found that volunteerism surged among people in low-income groups who lived in states that enacted the ACA’s Medicaid expansion.Jessica Wolfhttp://newsroom.ucla.edu/releases/when-more-people-have-health-insurance-volunteering-increases-ucFri, 21 Apr 2017 19:50:00 GMTUCLA study indicates a need to improve detection and treatment in primary health settings

People who are addicted to opioids and receiving their medical care in a general health care setting were more than 10 times as likely to die during a four-year period than people without substance abuse problems, UCLA researchers have found. The new study, published in the Journal of Addiction Medicine, suggests that health care systems should have better infrastructure and training for primary care physicians to diagnose and treat opioid use disorder, a condition that includes addiction to both prescription and illicit opioids.

UCLA Yih-Ing Hser

The study, led by Yih-Ing Hser, professor of psychiatry and behavioral sciences at the David Geffen School of Medicine at UCLA, is the first to look at the mortality rate of people with opioid use disorder in a general health care system rather than those treated at specialty addiction clinics. The mortality rate among patients in this setting, which includes primary care offices and large research hospitals, was more than two times higher than what previous studies had found in specialty clinics.

“The high rates of death among patients with opioid use disorder in a general health care system reported in this study suggest we need strategies to improve detection and treatment of this disorder in primary care settings,” Hser said.

Opioids often are prescribed to treat acute and chronic pain, and include prescription medications such as oxycodone (or OxyContin), hydrocodone (or Vicodin), codeine, morphine and fentanyl, as well as illicit substances such as heroin. The number of opioid overdoses in the United States has quadrupled since 1999, leading some physicians and policymakers to declare the opioid problem a national crisis. The 21st Century Cures Act, legislation signed in December by former President Barack Obama, included $1 billion in funding to help states address opioid abuse.

As rates of opioid addiction have risen, patients with opioid abuse problems increasingly are being treated by generalists, such as internists and primary care physicians, in doctors’ offices. Until now, researchers had not gauged the impact of this influx of patients with opioid abuse and addiction in primary care settings.  

Hser and colleagues studied electronic health records, and an associated death index system, for 2,576 patients, ages 18 to 64, diagnosed with opioid use disorder from 2006 to 2014. The individuals received health care at a major university hospital system. While all of those studied had diagnoses of opioid use disorder, not all were receiving treatment for it.

By the end of the study period, 465 people (18.1 percent of the study population) had died. Based on how long each person had participated in the study — an average of about four years for each individual — the researchers calculated a crude mortality rate of 48.6 deaths per 1,000 person-years, more than two times higher than the 20.9 deaths per 1,000 reported in previous studies done in specialty addiction clinics. The rate was also more than 10 times higher than the expected death rate for people of the same age and sex in the general U.S. population.

Overall, the patients in the new study were older at diagnosis and had a higher rate of other diseases and disorders compared to patients included in previous studies that took place at specialty clinics. Hser’s team noted higher rates of both simultaneously occurring health complications — including hepatitis C, liver disease, cardiovascular disease, cancer and diabetes — as well as other substance abuse disorders involving  tobacco, alcohol, cannabis and cocaine — among the patients who died.

“The findings were surprising because one would potentially expect better health care outcomes for patients being served by a large health care system,” Hser said. “Late identification of opioid use disorder and lack of addiction treatment could contribute to these high rates of serious health conditions and death.”

Black or uninsured individuals were also more likely to die during the study period, the researchers said, a finding they noted highlights the need for additional research on disparities in addiction care.

Additional research will be needed, they concluded, to determine how to best curb the mortality rates among all individuals with opioid use disorder and better integrate substance abuse disorder screening and treatment into primary care.

The study’s other authors are UCLA psychiatrists Larissa Mooney and Karen Miotto; UCLA professor of medicine Douglas Bell; UCLA graduate students Yuhui Zhu and Di Liang; David Huang, the senior statistician at the UCLA Integrated Substance Abuse Programs; and Andrew Saxon of the Veterans Affairs Puget Sound Health Care System.

The research was funded by the National Institute on Drug Abuse’s Clinical Trials Network.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20165/Pills+in+bottle.jpgPills in bottle

Stock image for story on a new study by UCLA School of Law and the Dartmouth Institute of Health Policy and Clinical Practice that found that state laws that attempt to curb opioid abuse have no measurable effect on opioid use by a large segment of disabled Medicare beneficiaries.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20165/Pills+in+bottle.jpgPills in bottle

Stock image for story on a new study by UCLA School of Law and the Dartmouth Institute of Health Policy and Clinical Practice that found that state laws that attempt to curb opioid abuse have no measurable effect on opioid use by a large segment of disabled Medicare beneficiaries.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Hser+headshot.JPGHser headshotLeighHopper310-267-7149 LHopper@mednet.ucla.eduUCLA study indicates a need to improve detection and treatment in primary health settings.Sarah C.P. Williamshttp://newsroom.ucla.edu/releases/opioid-addiction-raises-mortality-rateFri, 21 Apr 2017 14:10:00 GMTUCLA dietitian Dana Hunnes gives her expert opinion on this tricky question

Anyone who's ever walked into a grocery store has seen the various health claims on food items calling certain products "healthy." But what exactly does “healthy” mean — and can you rely on it?

The Food and Drug Administration is trying to find out. The federal agency recently began a public process to redefine how the word "healthy" can be used on food products. It's an issue that would change how companies can label foods and how consumers perceive them. 

To help unravel the meaning of the term "healthy," UCLA Health writer Ryan Hatoum spoke with Dana Hunnes, senior dietitian at Ronald Reagan UCLA Medical Center and adjunct assistant professor at UCLA's Fielding School of Public Health, to get an expert's take.

What would you consider a healthy food?

I would consider healthy foods ones that are as close to nature as possible. That would mean foods that aren't highly processed or adulterated.

UCLA Dana Hunnes

Generally speaking, foods with fewer ingredients as well as ingredients that are recognizable are healthy. A list of ingredients that are easily recognizable as a food, such as walnuts and artichokes, can indicate a healthy food. Manufactured ingredients — with unrecognizable names like methyl paraben, maltodextrin, artificial color yellow 5 and the like — can indicate a food isn’t so healthy. 

Single-ingredient foods, like green beans, edamame and avocado, are clearly healthy, but a frozen dinner made up of quinoa, bell peppers and tofu can be healthy too — as long as it doesn't have too many additives.

I'd also say a food can be considered healthy if it isn't associated with the development of chronic illness. Trans fats found in processed foods, added sugars, sodium and saturated fats found in animal proteins are some of the biggest contributors to heart disease, diabetes, stroke and cancers. We also know that red meats are possible carcinogens, and processed meats are definite carcinogens, as defined by the World Health Organization.

How do you think words like “healthy” should be used on food packaging?

The term "healthy" should be used in a way that points the consumer to those food products that are, more or less, unadulterated and unprocessed and contain ingredients they can identify. A long list of unrecognizable ingredients should be cause for concern.  

For example, I think it would be perfectly acceptable to call popcorn kernels a "healthy" food item, but not microwavable popcorn with trans fats and salt added. You could call trail mix that contains a mixture of dried fruits and nuts a healthy food, but not trail mix that is primarily chocolate with a smattering of nuts in it.

I don't think foods with added sugar, trans fats, saturated fats, white flour or low fiber should have "healthy" written on the packaging.

How do we get to an acceptable definition of the term “healthy food”?

We should look at the supporting research. We need to look at the science behind which nutrients and foods help prevent the chronic diseases I mentioned earlier.

Our team of dietitians often jokes that the only constants among healthy diets are fruits and vegetables. We're finding that the diets linked to the lowest risk for those chronic diseases are primarily plant-based diets, which are full of whole grains, nuts, seeds, legumes and occasional, small doses of lean animal proteins.

How can consumers make informed decisions about the health claims on packaged foods?

One reason why packaged foods can be challenging is because of the FDA labeling laws that allow food and supplement manufacturers to make claims about the structure and function of a particular ingredient. 

For example, a company can designate on packaging that a cereal containing calcium is "good for you" and thus promotes bone health even if that cereal is laden with added sugars. Claims about particular ingredients can be misleading in understanding the nutritional value of the entire food.

Our first order of business should be to create a rubric of what will be accepted as "healthy." Then we can set about revising current food-labeling regulations. At the end of the day, the clearer food labels are, the likelier consumers are to make healthier choices. 

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/SuperStock_1598R-156516.jpgReading a nutritional label

A stock image of someone reading a nutritional label.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/SuperStock_1598R-156516.jpgReading a nutritional label

A stock image of someone reading a nutritional label.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/dana+hunnes+2a.jpgDana Hunnes

Dana Hunnes is a senior dietitian at Ronald Reagan UCLA Medical Center and adjunct assistant professor at UCLA's Fielding School of Public Health,

RyanHatoum310-267-8304rhatoum@mednet.ucla.eduWhat exactly does “healthy” mean — and can you rely on it? The Food and Drug Administration is trying to find out.Ryan Hatoumhttp://newsroom.ucla.edu/stories/what-exactly-does-healthy-mean-when-it-comes-to-foodThu, 20 Apr 2017 21:00:00 GMTUCLA RESEARCH ALERTFINDINGS

New research by scientists at the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research at UCLA overturns a long-standing paradigm about how axons — thread-like projections that connect cells in the nervous system — grow during embryonic development. The findings of the study, led by Samantha Butler, associate professor of neurobiology, could help scientists replicate or control the way axons grow, which may be applicable for diseases that affect the nervous system, such as diabetes, as well as injuries that sever nerves.

BACKGROUND

As an embryo grows, neurons — the cells in the nervous system — extend axons into the developing spinal cord. Axons are then guided to reach other areas of the body, such as the brain, to establish a functioning nervous system. It has been generally understood that various guidance cues, which are cellular molecules such as proteins, either attract or repel axon growth as the axons reach out from neurons to find their destination in the nervous system.

Previous research suggested that a particular guidance cue, called netrin1, functions over a long distance to attract and organize axon growth, similar to how a lighthouse sends out a signal to orient a ship from afar. However, previous research also shows that netrin1 is produced in many places in the embryonic spinal cord, raising questions about whether it really acts over a long distance. Most notably, netrin1 is produced by tissue-specific stem cells, called neural progenitors, which can create any cell type in the nervous system. Yet, it was not understood how the netrin1 produced by neural progenitors influences axon growth.

METHOD

Butler and her research team removed netrin1 from neural progenitors in different areas in mouse embryonic spinal cords. This manipulation resulted in highly disorganized and abnormal axon growth, giving the researchers a very detailed view of how netrin1 produced by neural progenitors influences axons in the developing nervous system.

They found that neural progenitors organize axon growth by producing a pathway of netrin1 that directs axons only in their local environment and not over long distances. This pathway of netrin1 acts as a sticky surface that encourages axon growth in the directions that form a normal, functioning nervous system.

IMPACT

Butler’s study is a significant reinterpretation of the role of netrin1 in nervous system formation. The results further scientists’ understanding of the contribution neural progenitors make to neural circuit formation. Determining how netrin1 specifically influences axon growth could help scientists use netrin1 to regenerate axons more effectively in patients whose nerves have been damaged.

For example, because nerves grow in channels, there is much interest in trying to restore nerve channels after an injury that results in severed nerves, which is seen often in patients who have experienced an accident or in veterans with injuries to their arms or legs. One promising approach is to implant artificial nerve channels into a person with a nerve injury to give regenerating axons a conduit to grow through. Butler believes that coating such nerve channels with netrin1 could further encourage axon regrowth. Her continued research will focus on uncovering more details about how netrin1 functions and how it could be used clinically.

AUTHORS

Butler is the senior author of the study. The first author is Supraja Varadarajan, a graduate student in Butler’s lab.

JOURNAL

The study is published today in the journal Neuron.

FUNDING

The study was funded by grants from the National Institutes of Health (DK097075, HL098294, HL114457, DK082509 HL109233, DK109574, HL119837, NS072804, NS089817, NS063999, NS085097 and HL133900), the Canadian Institutes of Health Research (MOP-97758 and MOP-77556), Brain Canada, the Natural Sciences and Engineering Research Council of Canada, Canada Foundation for Innovation, the W. Garfield Weston Foundation, the March of Dimes Foundation (6-FY10-296 and 1-FY07-458) and the UCLA Broad Stem Cell Research Center.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Netrin1+and+axon+growth.jpgNetrin1 and axon growthLeft: axons (green, pink, blue) form organized patterns in the normal developing mouse spinal cord. Right: removing netrin1 results in highly disorganized axon growth.

Left: axons (green, pink, blue) form organized patterns in the normal developing mouse spinal cord. Right: removing netrin1 results in highly disorganized axon growth.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Netrin1+and+axon+growth.jpgNetrin1 and axon growth

Left: axons (green, pink, blue) form organized patterns in the normal developing mouse spinal cord. Right: removing netrin1 results in highly disorganized axon growth.

MirabaiVogt-James310-983-1163mvogt@mednet.ucla.eduThe findings by UCLA researchers could help scientists replicate or control the way axons grow, which could be applicable for diseases that affect the nervous system.Mirabai Vogt-Jameshttp://newsroom.ucla.edu/releases/study-overturns-seminal-research-about-the-developing-nervous-systemThu, 20 Apr 2017 18:02:00 GMTUCLA study focuses on results for low-income women

Doctors who care for low-income women who have survived breast cancer are more likely to implement recommended follow-up care if the patients receive counseling and a care plan that is tailored for them, according to a UCLA-led study.

“The results are very exciting as they clearly demonstrate that the combination of a survivorship care plan with counseling can empower low-income women as they transition from breast cancer patient to breast cancer survivor,” said Dr. Patricia Ganz, director of Prevention and Control Research at the UCLA Jonsson Comprehensive Cancer Center and a co-author of the study.

The customized treatment plans are particularly important for lower-income women, who tend to have less access to high-quality health care.

Dr. Rose C. Maly, a member of the Jonsson Cancer Center, is the lead author of the study, which was published online in the Journal of Clinical Oncology. The research was supported by the National Institutes of Health and National Cancer Institute.

Read the full news release.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Ganz+Patricia.jpgDr. Patricia GanzDr. Patricia Ganz

Dr. Patricia Ganz

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Ganz+Patricia.jpgDr. Patricia Ganz

Dr. Patricia Ganz

Peter Bracke310-206-4430pbracke@mednet.ucla.eduCustomized treatment plans are particularly important for lower-income women, who tend to have less access to high-quality health care. Peter M. Brackehttp://newsroom.ucla.edu/releases/breast-cancer-survivors-who-are-provided-a-tailored-care-plan-are-more-likely-to-receive-recommended-care-ucla-study-findsWed, 19 Apr 2017 21:26:00 GMTUCLA-led study suggests people often don’t recall memories that threaten the way they want to see themselves

“What’s too painful to remember/ We simply choose to forget.”
– Barbra Streisand, “The Way We Were”

UCLA-led research has found that students in a college mathematics course experienced a phenomenon similar to repression, the psychological process in which people forget emotional or traumatic events to protect themselves.

In a study published online by the Journal of Educational Psychology, the researchers found that the students who forgot the most content from the class were those who reported a high level of stress during the course. But, paradoxically, the study also found that the strong relationship between stress level and the tendency to forget course material was most prevalent among the students who are most confident in their own mathematical abilities.

The phenomenon, which the authors call “motivated forgetting,” may occur because students are subconsciously protecting their own self-image as excellent mathematicians, said Gerardo Ramirez, a UCLA assistant professor of psychology and the study’s lead author.

For the study, researchers analyzed 117 undergraduates in an advanced calculus course at UCLA. The students generally consider themselves to be strong in mathematics and plan to pursue careers that rely on high-level mathematical skills, so the logical assumption would be that they would be likely to remember most of the material from the course.

Researchers asked students a series of questions at the start of the course, including having them assess to what extent they see themselves as “math people.” Each week throughout the course, students were asked to gauge how stressful they thought the course was. Then, the study’s authors examined students’ performance on the course’s final exam and on another similar test two weeks later. On average, students’ grades were 21 percent lower on the follow-up.

Among students who strongly considered themselves to be “math people,” those who experienced a lot of stress performed measurably worse on the follow-up exam than those whose stress levels were lower.

The results were striking because, in the cases of the students whose stress levels were highest, test scores dropped by as much as a full letter grade — from an A-minus to a B-minus, for example. But, according to Ramirez, the findings make sense from a psychological perspective.

“Students who found the course very stressful and difficult might have given in to the motivation to forget as a way to protect their identity as being good at math,” he said. “We tend to forget unpleasant experiences and memories that threaten our self-image as a way to preserve our psychological well-being. And ‘math people’ whose identity is threatened by their previous stressful course experience may actively work to forget what they learned.”

The idea that people are motivated to forget unpleasant experiences — activating a sort of “psychological immune system” — goes back to Sigmund and Anna Freud, the pioneers of psychoanalysis, Ramirez said.

The students who think of themselves as excellent at math and felt high levels of stress were also more likely to report they avoided thinking about the course after it ended more than other students did.

Previous studies by other researchers seem to support the concept of motivated forgetting. For example, a 2011 Harvard University study found that when people were asked to memorize an “honor code” and then pay themselves for solving a series of problems, those who cheated and overpaid themselves remembered less of the honor code at the end of the experiment than those who did not cheat.

“Motivated forgetting, or giving in to the desire to forget what we find threatening, is a defense mechanism people use against threats to the way they like to depict themselves,” Ramirez said. “The students are highly motivated to do well and can’t escape during the course, but as soon as they take their final exam, they can give in to their desire to forget and try to suppress the information.”

Ramirez said there are steps teachers can take to help students retain information. Some of them:

  • Emphasize the material’s real-world applications. This will give students incentives to remember information and review it later on. “I think we often do a poor job of showing students why the content is relevant to their lives and future job skills,” Ramirez said.
  • Cover the entire course in final exams. And not just the most recent material. “Non-cumulative exams tell students they can forget what they have already been tested on,” he said.
  • Guard against learning-by-photo. Specifically, Ramirez advises students not to try to capture course notes by taking photos with their smartphones — it might subtly create an impression that they don’t need to actually learn the information.
  • Embrace the challenges. When his students struggle, Ramirez tells them the challenge they’re facing will lead to deeper learning. “I try to change what ‘struggle’ means for them so that they don’t feel threatened when they are stressed out about the material,” he said.

The study’s co-authors are Ian McDonough of the University of Alabama, and Ling Jin, a former UCLA graduate student.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Gerardo+Ramirez+math+image+2017.jpgRemembering mathAmong students who most considered themselves “math people,” those who experienced a lot of stress performed measurably worse on a follow-up exam than those with lower stress levels.

Among students who strongly considered themselves to be “math people,” those who experienced a lot of stress performed measurably worse on the follow-up exam than those whose stress levels were lower.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Gerardo+Ramirez+math+image+2017.jpgRemembering math

Among students who strongly considered themselves to be “math people,” those who experienced a lot of stress performed measurably worse on the follow-up exam than those whose stress levels were lower.

StuartWolpert310-206-0511swolpert@support.ucla.eduParadoxically, the strong relationship between stress level and the tendency to forget course material was most prevalent among students who are most confident in their own mathematical abilities.Stuart Wolperthttp://newsroom.ucla.edu/releases/students-may-forget-relevant-information-in-order-to-protect-their-own-psychesWed, 19 Apr 2017 16:33:00 GMTUCLA RESEARCH ALERTFINDINGS

UCLA researchers found that offering an eye exam for people with diabetes in a primary care setting in addition to eye clinics — where the exam is usually performed — dramatically reduced the length of time people had to wait for the exam and increased the number of people who underwent screenings.

The exam, teleretinal diabetic retinopathy screening, identifies people at risk for a disorder called diabetic retinopathy, which affects more than 5.3 million people in the U.S. and can cause blindness if untreated. Among those who were screened, wait times for the exam decreased to 17 days from 158 before the program began, and screening rates increased to 56.9 percent, from 40.6 percent. Of 21,222 patients, 68.8 percent did not require referral to an eye care provider, 19.6 percent were referred for treatment or monitoring of diabetic retinopathy, and 11.6 percent were referred for other ophthalmologic conditions.

BACKGROUND

Although early detection and treatment can prevent the disease from causing blindness, diabetic retinopathy is the leading cause of blindness among working-age adults. In Los Angeles County, Latinos are the majority users of health clinics that serve lower-income, uninsured people and Medicaid recipient — and among Los Angeles Latinos who have diabetes, approximately 50 percent have diabetic retinopathy. But the wait for screenings at eye clinics is often eight months or more thanks in part to limited specialty care resources. Only 60 percent of Americans with diabetes receive recommended annual eye examinations, and in at-risk populations, screening rates have been as low as 25 percent or less.

The screening has traditionally been performed by dilating patients’ eyes at ophthalmologists’ offices. But the screening can also be done using retinal photography at primary care clinics.

METHOD

The UCLA researchers implemented teleretinal diabetic retinopathy screening programs in 15 of the largest primary care clinics operated by the Los Angeles County Department of Health Services and evaluated results at five of the clinics. The screenings took place between September 2013 and December 2015.

IMPACT

Teleretinal diabetic retinopathy screening programs could help maximize access to much-needed eye exams for largely underserved segments of the population. 

AUTHORS

The paper’s senior author is Carol Mangione, who holds UCLA’s Barbara A. Levey and Gerald S. Levey Endowed Chair in Medicine. Lauren Daskivich of the Los Angeles County Department of Health Services is the lead author. Other authors are Carolina Vasquez and Chi-hong Tseng of UCLA, and Carlos Martinez Jr. of Charles R. Drew University of Medicine and Science.

JOURNAL

The study was published in JAMA Internal Medicine.

FUNDING

The research was supported by the UCLA Robert Wood Johnson Foundation Clinical Scholars Program, the UCLA Resource Center for Minority Aging, the National Institutes of Health/National Institute on Aging (grant P30AG021684), the NIH National Center for Advancing Translational Science UCLA CTSI (grant UL1TR001881).

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Retinopathy+test.jpgRetinopathy testTeleretinal diabetic retinopathy screenings identify people at risk for a disorder called diabetic retinopathy, which affects more than 5.3 million Americans.

Teleretinal diabetic retinopathy screening identifies people at risk for a disorder called diabetic retinopathy, which affects more than 5.3 million people in the U.S. and can cause blindness if untreated.

Here, a Los Angeles County Department of Health Services coordinator provides instruction to a clinic photographer.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Retinopathy+test.jpgRetinopathy test

Teleretinal diabetic retinopathy screening identifies people at risk for a disorder called diabetic retinopathy, which affects more than 5.3 million people in the U.S. and can cause blindness if untreated.

Here, a Los Angeles County Department of Health Services coordinator provides instruction to a clinic photographer.

EnriqueRivero310-267-7120erivero@mednet.ucla.eduOffering an eye exam for people with diabetes in a primary care setting in addition to eye clinics dramatically reduced the length of time people had to wait for the test.Enrique Riverohttp://newsroom.ucla.edu/releases/large-scale-diabetic-retinopathy-screenings-boost-exam-rates-reduce-wait-timesMon, 17 Apr 2017 23:11:00 GMTIn recent years, a lively debate over the pros and cons of the annual physical exam for boomers and others have appeared in major medical journals. Opinions have been mixed.UCLA's Dr. Kodi Azari uses novel approach to prepare man for complex surgery

In October 2016, Jonathan Koch, a 51-year-old entertainment executive from Los Angeles, underwent a 17-hour procedure to replace the hand he lost to a mysterious, life-threatening illness. Six months after surgery by the UCLA hand transplant team and countless hours of physical therapy, Koch continues to make remarkable strides in his recovery.

Already, he has used his new hand to hold a jump rope, dribble a basketball, unscrew a bottle top and swing a tennis racquet.

His remarkable story about the illness that nearly took his life and the rare transplant procedure that helped him recover is chronicled by writer Amy Wallace in the April issue of Los Angeles Magazine.

Koch’s story opens with the description, “In just 30 hours, a super fit Hollywood executive went from the top of his game to the precipice of death. What happened next would teach him everything about grace, resolve and the power of love.”

Koch’s road to transplantation began back in 2015 after a sudden illness led to the destruction of tissue in his feet and hands. Following treatment at two out-of-state hospitals and knowing that his left hand would have to be amputated, he sought a transplant.  

After Koch was accepted for the experimental transplant program at UCLA, Dr. Kodi Azari, surgical director of the UCLA Hand Transplant program and a professor of orthopaedic surgery and plastic surgery, used a novel approach to prepare Koch’s hand for the possibility of a future transplantation. He amputated the hand closer to the wrist than the elbow, keeping all of the nerves and tendons long and extended, and then attached them to the patient's bone.

To help prepare for and perform the grueling surgery, Azari assembled a team that included transplant medicine physicians as well as top surgeons recruited from hospitals around greater Los Angeles, most of whom trained at UCLA. This was crucial to Azari's plan because “hand transplants can throw you curveballs. They’re never as you expect,” he said in the article.

As with any organ transplant, Koch must now take immunosuppressant medications to help prevent his body from rejecting the new hand. One of the world’s experts in transplant medicine, Dr. Sue McDiarmid, medical director of the UCLA Hand Transplantation Program, is overseeing his care.

 “It’s a delicate balance of finding the right combination of drugs that minimize the side effects, but are still effective in preventing rejection,” said McDiarmid, who is also a professor of pediatrics and surgery, and director of the Dumont–UCLA Pediatric Liver Transplant Program. “Jonathan has been a great patient during this process, and we are very happy with his progress.”

Koch’s story, as described by Wallace, is one of inspiring drive and determination. Before transplant surgery, Koch hired a personal trainer so he could be in top physical shape to give himself the best possible chance of a successful recovery. After the surgery, he will spend about a year with occupational therapists at UCLA working with his hand. Of course, his journey could not have been possible without the priceless gift of the donor’s hand and the family members who agreed to donate it for transplanation.

Koch's compelling story reads like a movie script, except it is real life, like the many unscripted reality shows the Hollywood executive has brought to television.

This Los Angeles Magazine video contains some graphic imagery:

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20172/Dr.+Azari+and+Jonathan+grip+hands.jpgDr. Kodi Azari and Jonathan KochDr. Kodi Azari, director of the UCLA Hand Transplant program, gets a good grip on Jonathan Koch's transplanted hand. Azari led the surgical teams that amputated Koch's hand and later transplanted a donor hand.

Dr. Kodi Azari is surgical director of the UCLA Hand Transplant program. He led a team of surgeons that performed a 17-hour hand transplant surgery on Jonathan Koch, a entertainment executive from Los Angeles.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20172/Dr.+Azari+and+Jonathan+grip+hands.jpgDr. Kodi Azari and Jonathan Koch

Dr. Kodi Azari is surgical director of the UCLA Hand Transplant program. He led a team of surgeons that performed a 17-hour hand transplant surgery on Jonathan Koch, a entertainment executive from Los Angeles.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20172/Jonathan+with+hand+outstretched.jpgJonathan Koch and his transplanted hand

Jonathan Koch, 51, an entertainment executive, lost his hand after contracting a mysterious illness. He holds up his hand six weeks after having transplant surgery.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20172/Testing+grip.jpgTesting griphttp://cms.ipressroom.com.s3.amazonaws.com/173/files/20172/catching+a+ball.jpgJonathan Koch

Jonathan Koch gets ready to catch a ball with his transplanted hand.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20172/testing+touch.jpgJonathan Koch and Renee Portenier

Jonathan Koch and UCLA occupational therapist Renee Portenier work on his transplanted hand at the UCLA Outpatient Rehabilitation Clinic in Westwood.

AmyAlbin310-267-7095aalbin@mednet.ucla.eduIn October 2016, Jonathan Koch, a 51-year-old entertainment executive from Los Angeles, underwent a 17-hour procedure to replace the hand he lost to a mysterious, life-threatening illness. Amy Albinhttp://newsroom.ucla.edu/stories/patient-makes-dramatic-recovery-from-amputation-to-transplanted-handThu, 13 Apr 2017 16:00:00 GMTStudy indicates that a minimum-age standard is needed to protect California children from court prosecution

Although Laura Abrams and Dr. Elizabeth Barnert come from opposite ends of the UCLA campus, their work in their respective academic professions meets at the intersection of health and juvenile justice.

A recent University of California study led by Abrams, professor of social welfare in the UCLA Luskin School of Public Affairs, and Barnert, an assistant professor of pediatrics in the David Geffen School of Medicine at UCLA, offers a powerful rationale for shielding children 11 years old and younger from prosecution and incarceration in the state’s juvenile justice system.

“Children in the juvenile justice system literally meet the definition of children with special health care needs,” said Barnert, who worked with Abrams as members of a team affiliated with the University of California Criminal Justice and Health Consortium. Prior to their study, which was recently published in International Journal of Prisoner Health, the issue in California was not on anyone’s radar, they said.

“Kids in conflict with the law are kids that typically have unmet health needs. We see a lot of undiagnosed depression, ADHD and learning disabilities — or absentee parents who can’t support their children due to working three jobs, deportation, imprisonment or substance abuse,” Barnert said. “When we prosecute these children or lock them away, we’re putting them in a system that traumatizes them further and often makes their problems worse.”

The UCLA study brought together UC experts from social welfare, medicine, psychology and psychiatry, law and criminology, as well as community partners from organizations such as the Children’s Defense Fund-California and the National Center for Youth Law.

“Our findings provide a rationale for why California should have a minimum age for entering the juvenile justice system and why children 11 and younger should be excluded,” Barnert said. “The study recommendations are based on international human rights standards, guidelines from organizations like the American Academy of Pediatricians, and medical evidence that children’s brains do not fully mature until their mid-20s.”

Added Abrams: “The United Nations Convention on the Rights of the Child has established a standard on children in conflict with the law. The convention states that every country should have a minimum age of criminal responsibility, or what we refer to as a minimum age of juvenile justice jurisdiction. The United States does not have this type of law at the federal level, however, so it is up to the states to determine.”

Abrams pointed out that protections for minors already built into current state law are based on the capacity or the intent to commit a crime, as well as the competency to stand trial. California’s 58 counties, however, set many of their own juvenile probation standards. Therefore, “there’s no way to insure, without a minimum-age law, that state laws around capacity and competency are being implemented fairly and without geographic or racial disparities. There is no statewide oversight of these mechanisms for protecting children,” Abrams said.

Findings and recommendations from the UC study and related policy briefs prepared by the researchers include:

  • Children should be held less culpable under criminal law, given their expected developmental immaturity, as repeatedly recognized in recent U.S. Supreme Court decisions.
  • Children have a diminished capacity to make intentional decisions regarding participation in crimes or to understand that an act was morally wrong.
  • Children have less developed abilities to understand court proceedings and meaningfully participate, emotionally or cognitively, in working with attorneys to wage their own defense.     

California currently has no law that specifies a minimum age for prosecuting and imprisoning minors. But a new state senate bill, SB 439, which incorporates the research and recommendations in the UC study, would change that by amending sections 601 and 602 of the California Welfare and Institutions Code related to juvenile court jurisdiction. In particular, the bill would substitute current references to “any person under 18 years of age” with language specifying individuals “ages 12 to 18.”

In its first hearing on April 4, the senate’s committee on public safety passed the bill, which was then referred to the senate appropriations committee, the next step in the legislative process. The bill is part of a package of criminal justice reform bills put forth by the legislators in March.

Proposed amendments and revisions to SB 439 can be found online.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Juvenile+Justice+Project3+-+1.jpgDr. Elizabeth Barnert and Laura AbramsDr. Elizabeth Barnert, left, and Laura Abrams are lead authors of a paper that advocates establishing a minimum-age threshold for prosecution in California’s juvenile justice system.

Dr. lizabeth Barnert, left, and Laura Abrams are co-principal investigators and lead authors of a policy paper published recently by the International Journal of Prisoner Health.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Juvenile+Justice+Project3+-+1.jpgDr. Elizabeth Barnert and Laura Abrams

Dr. lizabeth Barnert, left, and Laura Abrams are co-principal investigators and lead authors of a policy paper published recently by the International Journal of Prisoner Health.

GeorgeFoulsham310-206-0159gfoulsham@luskin.ucla.eduChildren 11 and younger have less developed cognitive skills and should not be help to the same level of culpability.Stan Paulhttp://newsroom.ucla.edu/stories/ucla-researchers-seek-juvenile-justice-alternatives-for-children-under-12Tue, 11 Apr 2017 17:53:00 GMTBook for educators aims to help those with the disorder establish meaningful friendships and romantic relationships

A new book by a UCLA professor addresses a situation most of us have endured at some point in our lives — social awkwardness. Perhaps it was first-date angst, or a party where everybody seems to know everybody else, except you. Or a work conference you’ve come to late where everybody is already chatting away.

For most of us it’s a brief, uncomfortable moment that passes. For adults with autism, it’s an enduring part of their lives. That’s the group Elizabeth Laugeson, a UCLA assistant clinical professor of psychiatry, aims to help. Laugeson is the co-founder and developer of the UCLA PEERS Clinic, or Program for the Education and Enrichment of Relational Skills, the only research-supported treatment programs for improving social skills for preschoolers, adolescents and young adults with autism. Her book, “PEERS for Young Adults,” is based on the success of that program.

“Autism is generally associated with children, but the disorder doesn’t go away with age,” Laugeson said. “It’s a lifelong disorder.” She cites a recent CNN story about a woman diagnosed with autism at the age of 47, who in hindsight now recognizes how the disorder shaped her whole life.

Autism is characterized by challenges with social skills and communication, Laugeson said. “For a child, that makes it hard to fit in, to make friends and ‘belong,’” she said. “The same holds true for an adult with autism, although it’s not just making friends, but finding and keeping a job, dating and maintaining long-term romantic relationships.”

The book is geared for mental health professionals and educators to use in helping adults with autism, Laugeson said, and addresses a common complaint. “The social world lacks a ‘manual,’ and most of us learn through trial and error over time how to adapt to various social situations,” she said.

But the rules governing that world are complex, subtle and implicit, and are often missed by autistic adults. “PEERS for Young Adults” describes the steps necessary for autistic adults to make and keep friends and develop romantic relationships. Her book is a step-by-step manual for how to navigate through various social interactions. It contains 16 sessions, including homework assignments and practice/rehearsal tips. It also requires participation by a coach — a caregiver, friend, sibling or parent — who acts as a social coach in the real world.

“Having a coach reinforces what the book teaches,” Laugeson said.

The book gets down to specifics. How do you ask someone on a date? How do you let someone know you’re interested? How do you carefully plan a date — who will be there, what you plan to do, when, where and how you will make it happen.

For example, the book covers how to flirt with your eyes.

“People who have trouble with social communication misunderstand. They’ll be attracted to someone and instead of glancing at them and making brief eye contact, they’ll stare, hard, with a big grin on their face,” Laugeson said. “It’s unintentional, of course, but can be seen as creepy.”

The book teaches them, literally, the proper steps to take — a brief glance, initial eye contact, slight smile (no teeth!), look away, repeat.

Brief role-playing videos demonstrate the correct and incorrect ways to “flirt with the eyes”:

► Good example of flirting with the eyes.

► Bad example of flirting with the eyes.

The book is an outgrowth of the PEERS program, which teaches relational skills backed by peer-reviewed research. It uses the same concrete rules and steps as taught in the book. It is one of the few social skills interventions to be adopted by practitioners worldwide — it’s now taught in more than 25 countries, while the PEERS manual has been translated into more than a dozen languages.

The PEERS for Adolescents program is geared for teenagers with autism and other social challenges, and involves group classes, role-playing demonstrations, rehearsals to practice newly learned social skills and homework assignments to make sure the skills are working for adults.

“This book is intended as a practical, hands-on manual. We’ve shown through our research that social skills can be learned, in much the same way people can learn a foreign language,” Laugeson said. “PEERS for Young Adults” is published by academic publisher Routledge. 

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Elizabeth_Laugesen_2425_2.jpgElizabeth LaugesenAssistant Professor Elizabeth Laugeson says that although autism is usually associated with children, the disorder does not go away with age. “It’s a lifelong disorder.”

Elizabeth Laugeson is a UCLA assistant clinical professor of psychiatry and the co-founder and developer of the UCLA PEERS Clinic, or Program for the Education and Enrichment of Relational Skills, the only research-supported treatment programs for improving social skills for preschoolers, adolescents and young adults with autism. 

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Elizabeth_Laugesen_2425_2.jpgElizabeth Laugesen

Elizabeth Laugeson is a UCLA assistant clinical professor of psychiatry and the co-founder and developer of the UCLA PEERS Clinic, or Program for the Education and Enrichment of Relational Skills, the only research-supported treatment programs for improving social skills for preschoolers, adolescents and young adults with autism. 

MarkWheeler, UCLA Health310-267-7022mwheeler@mednet.ucla.eduA new book for educators aims to help those with the disorder establish meaningful friendships and romantic relationships. Mark Wheelerhttp://newsroom.ucla.edu/releases/for-adults-with-autism-learning-social-skills-and-finding-loveTue, 11 Apr 2017 16:39:00 GMTUCLA RESEARCH ALERTFINDINGS

UCLA scientists have found that conscious sedation — a type of anesthesia in which patients remain awake but are sleepy and pain-free — is a safe and viable option to general anesthesia for people undergoing a minimally invasive heart procedure called transcatheter aortic valve replacement.

In the study, patients who underwent conscious sedation had a similar rate of adverse events to those who underwent anesthesia, but those who were given conscious sedation had shorter stays in the intensive care unit (30 versus 96 hours for those with general anesthesia) and shorter hospital stays (4.9 days versus 10.4 days). The direct costs for their care were 28 percent lower, and almost all other medical costs were lower as well. In both groups, 1.5 percent of patients died during hospitalization.

BACKGROUND

Aortic stenosis is a common disease, particularly among people 75 and older, in which one of the valves of the heart narrows and impedes blood flow to the body. Previously, treating aortic stenosis required open heart surgery, which is particularly risky for elderly and frail patients.

In recent years, the use of transcatheter aortic valve replacement, or TAVR, has made the repair safer: Physicians place a new valve in the heart via a catheter inserted through the patient’s leg, which results in less injury and an easier recovery than open heart surgery. Most medical centers perform the procedure under general anesthesia but some, including UCLA, now offer their patients conscious sedation, which does not require a breathing tube.

METHOD

The study was the first to detail the cost differences and outcomes between conscious sedation and general anesthesia during transcatheter aortic valve replacement. Researchers analyzed records of 196 adult patients who underwent transcatheter aortic valve replacement at Ronald Reagan UCLA Medical Center between August 2012 and June 2016. The researchers write that a large-scale, controlled and randomized study should be conducted to validate their findings.

IMPACT

Based on the study, patients undergoing transcatheter aortic valve replacement should receive conscious sedation instead of general anesthesia whenever possible.

AUTHORS

The study was led by Dr. Richard Shemin, the Robert and Kelly Day Professor of Surgery and chief of cardiac surgery at the David Geffen School of Medicine at UCLA. Other authors are William Toppen, Daniel Johansen, Sohail Sareh, Josue Fernandez, Nancy Satou, Dr. Komal Patel, Dr. Murray Kwon, Dr. William Suh, Dr. Olcay Aksoy and Dr. Peyman Benharash, all of UCLA.

JOURNAL

The study was published online April 5 in the journal PLOS ONE. 

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Transcatheter+aortic+valve+replacement.jpgTranscatheter aortic valve replacementRendering of a heart valve inserted during transcatheter aortic valve replacement. A UCLA study found that keeping patients awake but sleepy during the procedure is preferable to general anesthesia.

Heart valve placed through transcatheter aortic valve replacement

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Transcatheter+aortic+valve+replacement.jpgTranscatheter aortic valve replacement

Heart valve placed through transcatheter aortic valve replacement

AmyAlbin310-267-7095aalbin@mednet.ucla.eduThe study evaluated both methods in people undergoing transcatheter aortic valve replacement, a procedure used to repair aortic stenosis.Amy Albin http://newsroom.ucla.edu/releases/conscious-sedation-shows-benefits-over-general-anesthesia-for-heart-valve-procedureMon, 10 Apr 2017 20:27:00 GMTFindings of UCLA–Harvard Medical School study suggest practices could reduce use of unneeded referrals

People with back pain, headaches and upper respiratory infections are more likely to receive tests and services of little diagnostic or therapeutic value — so-called low-value care — when they visit primary care clinics at hospitals rather than at community-based primary care clinics.

A national study led by researchers at the David Geffen School of Medicine at UCLA and Harvard Medical School found that the key factor driving the disparity appears to be the location of the clinic, rather than whether the clinic is owned by a hospital or a physician. In fact, aside from referring patients to specialists slightly more often, hospital-owned community clinics delivered care otherwise similar to physician-owned community clinics.

The research, published April 10 in JAMA Internal Medicine, found that providers at hospital-based clinics tend to refer too many patients to specialists, and order too many CT scans, MRIs and X-rays. The findings raise concerns about the value of care delivered in hospital-based primary care settings.

The paper suggests that physicians working in hospitals may be more likely to refer patients for those types of follow-up because they’re more immediately accessible and convenient, said Dr. John Mafi, the study’s lead author, an assistant professor of medicine at the Geffen School of Medicine and a primary care physician at Ronald Reagan UCLA Medical Center.

“An estimated one-third of health care spending in the United States stems from services that provide low-value care,” Mafi said. “Reducing the use of such services can not only help curb health care costs — and redirect such resources in more meaningful ways — but it can also protect patients from the potentially harmful effects associated with them.”

The subject is a serious concern because research has shown that up to one-third of medical care may be wasteful or unnecessary, which can be expensive for patients and drive up overall health care costs. Insights from the study could help hospital-based clinics develop strategies to limit unnecessary referrals and tests.

“Hospital-based practices need to be aware of their tendency to overuse certain tests and services of questionable therapeutic value for patients with uncomplicated conditions,” said Bruce Landon, the study’s senior author, a Harvard Medical School professor of health care policy and of medicine who practices general internal medicine at the Beth Israel Deaconess Medical Center. “That knowledge can help both frontline clinicians and hospital leadership find ways to eliminate, or at least reduce, such unnecessary services.”

The team compared records of 31,000 appointments over a 17-year period from two national databases, analyzing instances during which patients sought treatment for upper respiratory infections, back pain and headaches. To better identify people for whom the services were likely of low value, the researchers excluded those with more complex symptoms that suggested more serious disorders, and they accounted for people with different underlying disorders and chronic conditions.

Hospital-based and community-based clinics prescribed antibiotics at roughly the same rate. But people who visited hospital clinics were referred for MRIs and CT scans more often (8 percent) than those who went to community clinics (6 percent). They also were referred more often for X-rays (13 percent versus 9 percent) and far more often for an evaluation by a specialist (19 percent versus approximately 8 percent).

The people who were most likely to receive unnecessary tests and services were those visiting hospital-based primary care clinics and seeing someone other than their usual physician. That indicates that patients may be more likely to be over-tested or over-treated when they bounce from physician to physician.

“Not seeing your regular primary care physician — what we call discontinuity of care — might be a weak spot where low-value care can creep in,” Landon said. “The more we know about what situations are most likely to lead to patients receiving low-value care, the more we can do to prevent it.”

The study’s co-authors are Christina Wee and Roger Davis, both of Harvard and Beth Israel Deaconess Medical Center. The research was supported by the National Institutes of Health (Midcareer Mentorship Award K24DK087932 and Harvard Catalyst National Institutes of Health Award UL1 TR001102). 

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Dr.+John+Mafi.jpgDr. John MafiDr. John Mafi

Dr. John Mafi

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Dr.+John+Mafi.jpgDr. John Mafi

Dr. John Mafi

EnriqueRivero310-267-7120erivero@mednet.ucla.eduPhysicians working in hospitals may be more likely to refer patients for certain types of follow-up care because they’re more immediately accessible and convenient, said UCLA’s Dr. John Mafi. Enrique Riverohttp://newsroom.ucla.edu/releases/patients-at-hospital-based-primary-clinics-are-more-likely-to-get-unnecessary-tests-and-servicesMon, 10 Apr 2017 16:27:00 GMTAs the number of Alzheimer’s patients grows, so does the need for skilled caregivers

More than 5 million Americans are living with Alzheimer’s disease, and according to the Alzheimer’s Association, that number is expected to nearly triple in the next three decades as the baby boomer generation ages. As the need for caregivers grows, younger family members are finding themselves in a role which they often are ill-prepared to handle. In fact, about one-quarter of caregivers are now under the age of 34, according to AARP and the National Alliance for Caregiving's 2015 caregiving report.

“Caregiving has become more diverse and will continue to be. In terms of gender, we have more male caregivers than ever before. Younger family members are also taking on the role as parents age, and oftentimes caregiving is shared across different generations,” said Dr. Zaldy Tan, medical director of the UCLA Alzheimer’s and Dementia Care Program and associate professor at the David Geffen School of Medicine at UCLA. “When a loved one is diagnosed, family members are suddenly thrust into this caregiving role, and unfortunately, a lot of them are ill-prepared.”

Experts at UCLA developed a “boot camp” to prepare caregivers of for the challenges of the progressive disease. Participants learn everything from how to prevent falls to how to calm a patient when they’re confused or agitated. The boot camp gives caregivers the best tools to manage their role, which can quickly become emotionally and physically taxing.

“Alzheimer’s caregiving is a full-time job because there are always risks present at any time of the day or night,” Tan said. “They have to be vigilant to prevent things like wandering or falling, while helping with everyday tasks like dressing a patient and preparing meals.”

Perhaps the biggest lesson taught at the boot camp is to also focus on your own well-being, which is why many family members approach the role of caregiver as a team, offering each other support.

“Taking care of the caregiver is just as important as taking care of the patient, so having someone that can provide a respite is extremely helpful,” Tan said. “The boot camp is an easy way for everyone involved in the caregiving process to gain the knowledge they’ll need when it’s their time to help.”

UCLA Health Dr. Zaldy Tan gives feedback to caregivers during a role-playing session at the Alzheimer’s Caregiver Boot Camp.  

That’s why Cyndi Ramirez, of Los Angeles, decided to attend the caregiver boot camp. Her father, Bucky Schmidt, took on the responsibility of caring for her mother when she was diagnosed with dementia in 2011. Ramirez recognized how difficult it was for him to keep up with the round-the-clock demands. She made time among her busy work schedule and taking care of her 5-year-old daughter to help.

“I wanted to help my dad manage all the things that go into taking care of my mom every day,” Ramirez said. “I’ve given her a shower, helped her dress, gotten her out of the house. I think it’s crucial for my dad to have a partner in caregiving so he can continue to be an effective caregiver as well.”

Her father had attended the boot camp and told Ramirez how much it helped him, prompting her to sign up and spend a Saturday learning how to better care for her mother.

“I was amazed at how much I learned at the boot camp that I hadn’t even thought about,” Ramirez said. “Even things that don’t apply to my situation now are so valuable because Alzheimer’s is a progressive disease, and I’m now prepared for whatever I might have to face in the future.”

Part of that preparation comes in the form of role playing with professional actors. During the boot camp, specially trained actors portray people with advanced dementia, and, after a full day of taking in new information, caregivers are able to test their knowledge and reinforce the skills they’ve learned. They simulate difficult scenarios like helping someone walk or de-escalating a combative conversation when someone with dementia becomes confused.

“The best way to allow all of the information to sink in is to practice what you’ve learned in a realistic situation. The actors are instructed to respond to intervention techniques just as an Alzheimer’s patient would,” Tan said.

After each caregiver interacts with the mock patient, Tan gives feedback on things he or she did well and ways they can improve. The group discusses each scenario to decide the best course of action for the challenge that was presented.

Tan said he hopes other institutions are inspired by UCLA’s caregiver program and establish their own to reach as many caregivers as possible. To participate in UCLA’s boot camp, the caregiver’s loved one must be a patient in the UCLA Alzheimer’s and Dementia Care Program. In the meantime, some of the information presented at the boot camp is available at dementia.uclahealth.org.

“A caregiver who comes in the morning unsure of themselves and really wanting to learn, leaves at the end of the day more knowledgeable and more confident,” Tan said. “We know that this caregiver will be much more effective, and that, ultimately, the patient will be safe and comfortable.”

Journalists: B-roll, sound bites, web elements, high-resolution still photos and high-definition video are available for free and unrestricted use by the news media here. For assistance downloading media assets email shannon@mediasourcetv.com or call: 614-932-9950

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Cyndi+Ramirez.jpgCyndi RamirezCyndi Ramirez, at right, who attended the Alzheimer’s Caregiver Boot Camp at UCLA Health, helps take care of her mother.

Cyndi Ramirez (right) and her daughter visit with their mother and grandmother, who has dementia. Cyndi helps take care of her mother and attended the Alzheimer’s Caregiver Boot Camp at UCLA Health to develop her skills as a caregiver.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Cyndi+Ramirez.jpgCyndi Ramirez

Cyndi Ramirez (right) and her daughter visit with their mother and grandmother, who has dementia. Cyndi helps take care of her mother and attended the Alzheimer’s Caregiver Boot Camp at UCLA Health to develop her skills as a caregiver.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Bucky+Schmidt.jpgBucky Schmidt

Bucky Schmidt helps his wife, Diane, take her medication at their home in Los Angeles. Schmidt recently attended the Alzheimer’s Caregiver Boot Camp at UCLA Health to learn how to handle the demands that come with taking care of someone with dementia.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Dr.+Zaldy+Tan.jpgDr. Zaldy Tan and caregivers boot camp

Dr. Zaldy Tan gives feedback to caregivers during a role-playing session at UCLA Health’s Alzheimer’s Caregiver Boot Camp. Professional actors are used to practice techniques for taking care of patients with dementia.

EnriqueRivero310-267-7120erivero@mednet.ucla.eduUCLA Health offers training to teach skills and techniques that help family members confidently care for a loved one who has dementia.UCLA Healthhttp://newsroom.ucla.edu/stories/younger-generations-forced-to-take-on-caregiving-role-turn-to-boot-camp-for-guidanceMon, 10 Apr 2017 04:01:00 GMTMaster teacher brought together scientists from different fields to study the human brain

Arnold “Arne” Scheibel, a renowned neuroanatomist whose passion for teaching and for understanding the workings of the human brain inspired generations of students and helped shape the neuroscience community at UCLA, died Monday, April 3, in Oakland, California. He was 94.

Scheibel, an emeritus distinguished professor of neurobiology and psychiatry and biobehavioral sciences, taught medical students, graduate students and undergraduates about the structure of the brain as a member of UCLA's Department of Neurobiology. “He was passionate about the nervous system, and he spent his life uncovering its mysteries and explaining them to thousands of students,” said Paul Micevych, professor and department chair of neurobiology. “If there was something Arne loved more than the structure and the function of the brain, it was teaching. He was a master at mesmerizing students both with the facts about the structure of the brain, but [also] with his ability to make it live in the students’ imagination.” 

 Scheibel led the UCLA Brain Research Institute (BRI) from 1987 to 1995 as acting director and later as its director. Under his leadership, working groups of scientists from across the campus were organized, a move that underscored a culture of multidisciplinary collaboration that helped the institute become well-known for its multidisciplinary and team-based neuroscience.

These affinity groups, which met regularly to discuss cross-cutting topics, led to the development of the Integrative Centers of Neuroscience Excellence at UCLA and helped bring in funding for several training programs and grants, including one that created the Alzheimer’s Disease Center.

"Under Dr. Scheibel’s leadership, the BRI flourished and became more integrated into the UCLA community,” said Christopher Evans, BRI director. “His contributions included advancing the BRI’s mission to pursue collaborative breakthroughs in understanding the brain and to communicate the excitement of neuroscience to UCLA students and children at local schools.”

Scheibel’s impact was felt throughout UCLA.

“When Arne wasn’t directing the institute, he was sharing his wisdom with others,” noted Dr. Kelsey Martin, dean of the David Geffen School of Medicine at UCLA, in announcing Scheibel’s passing to the UCLA Health campus. “He continued to consult with campus faculty on the BRI missions of research, teaching and outreach, and he generously bequeathed a BRI Term Chair to enrich the future research mission of the institute, from which new generations will benefit.”

In all, Scheibel dedicated 58 years of service to the university. He earned election to the American Academy of Arts and Sciences as well as UCLA’s highest teaching honor, the Distinguished Teaching Award, among other distinctions given him.

Former students who considered him a role model recalled that he never used PowerPoint slides, but preferred drawing diagrams in chalk, while also clearly communicating his love of neuroscience. “He was the greatest and most inspirational teacher I have ever had,” said Stephen Wilson, a neuroscientist and faculty member at Vanderbilt University. “He was passionate about the brain — understanding its structure and function — and he instilled in his students a deep and abiding respect for neuroanatomy. Even the most obscure brainstem nucleus would quickly take on a life of its own in Dr. Scheibel’s hands.”

Born in New York City in 1923, Scheibel did his undergraduate work at Columbia College and received his M.D. from Columbia College of Physicians and Surgeons in 1946. Initially interested in cardiology, he decided to study psychiatry instead when he became intrigued by the role emotions played in cardiac disease. After a year of psychiatric residency training at Washington University in St. Louis, he entered the Army as a medical officer and received further training while on active duty at Brooke General Hospital in San Antonio, Texas.

To learn about the brain structure and function, Scheibel joined the neurophysiology laboratory of Warren McCulloch at Illinois Neuropsychiatric Institute. After working briefly as a faculty member at the University of Tennessee and then spending 15 months at the universities of Pisa and Oslo on a Guggenheim Fellowship, Scheibel joined the faculty in the UCLA departments of anatomy and psychiatry in 1955.

His research was focused around psychiatry and the neural foundations of behavior. His laboratory studied the reticular core of the brain stem and thalamus, the organization of neural modules, and the structural correlation between aging and psychosis, among other topics.

Scheibel’s contribution to science extended far beyond campus boundaries. At the institute, he began a popular science outreach program, Project Brainstorm, which continues today. Each year, UCLA undergraduates, graduate students and faculty organize hands-on workshops and interactive demonstrations to introduce neuroscience in a fun way to thousands of LAUSD students, who are shown a human brain for the first time.

In 2016, as a memorial tribute to his parents, Scheibel established the Ethel Scheibel Endowed Chair in Neuroscience in the Department of Neurobiology at the David Geffen School of Medicine and the William Scheibel Endowed Chair in Neuroscience at the Brain Research Institute.

“I hope that these two endowed chairs will help continue the tradition of bringing gifted and creative investigators to the neuroscience research and training programs at UCLA,” Scheibel said. “After all, the brain is the ultimate source of our humanity, the instrument of our culture and the key to our continued existence as a biological race.”  

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Arnold+Scheibel.jpgArnold ScheibelArnold "Arne" Scheibelhttp://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Arnold+Scheibel.jpgArnold ScheibelArnold “Arne” Scheibel, a renowned neuroanatomist whose passion for teaching and for understanding the workings of the human brain inspired generations of students and helped shape the neuroscience community at UCLA, died Monday, April 3, in Oakland. Cynthia Leehttp://newsroom.ucla.edu/dept/faculty/in-memoriam:-dr-arnold-scheibel-helped-shape-ucla-s-neuroscience-communityFri, 07 Apr 2017 20:19:00 GMTUCLA food policy expert says new labels should reduce food waste

Pop quiz: What’s the difference between “best by,” “sell by” or “expires on”?

If you’re not sure, you aren’t alone. Americans toss out $165 billion worth of food each year, often out of safety concerns fueled by confusion about the meaning of the more than 10 different date labels used on packages.

Grocery manufacturers and retailers are finally taking pity. Recently, the Food Marketing Institute and Grocery Manufacturers Association announced they would voluntarily streamline date labels and begin using two standard phrases: “best if used by” for quality and “use by” for highly perishable items like meat, fish and cheese that can be dangerous to eat if they are too old.

Food manufacturers will begin phasing in the change now, with widespread adoption expected by summer 2018.

Food policy experts from across the University of California praised the new guidelines, calling them a positive step that could help consumers and the environment.

“This is a great idea,” said Michael Roberts, executive director of the UCLA Resnick Program for Food Law and Policy and a UC Global Food Initiative subcommittee member. “Hopefully, it will not only eliminate confusion from consumers but also reduce food waste. Most consumers want to be safe and cautious. Too often, they’re throwing food away before it needs to be thrown away.”

Simplifying labels

About 40 percent of food in the United States goes uneaten — a staggering waste of money and sustenance, valued at roughly $165 billion per year.

The grocery industry initiative calls for replacing phrases like “best before,” “better if used by” or “enjoy by” with only two standard phrases to limit confusion.

The industry may have adopted the new guidelines to get ahead of legislators and regulators. Both state and federal legislation was introduced last year to address food date labels. In December, the U.S. Department of Agriculture issued guidance that encouraged food manufacturers and retailers to use a “best if used by” date label.

“For an industry, being regulated by 50 states in different ways is an incredible nuisance,” said Marsha Cohen, a law professor at UC Hastings College of the Law. “The fix that they’re proposing is quite simple. It’s a smart move by trade associations to be leaders for their companies.”

It would help if the industry also provided guidance on how long to keep food packages after opening them, Cohen said.

“It’s hard to know is this good or is this bad?” Cohen said.

Using common sense

“Best if used by” describes product quality, where the product may not taste as expected after that date but is safe to consume. The grocery industry recommends that “use by” products should be consumed by the date listed on the package and disposed of after that date.

“I think there still needs to be significant education,” said UC Davis food safety expert Linda Harris. “People don’t understand the difference in the labels between quality and safety.”

Use common sense, said Harris, a UC Cooperative Extension specialist in food safety. Is it safe to make jam with a package of pectin one day past its “best before” date? Yes. Should you consume a refrigerated product past its “use by” date? No.

When in doubt, if food is still good to eat after the “best before” date, look at it, Harris said. If it looks fine, you can smell it. If appropriate, feel the texture. If it passes those tests, go ahead and taste a little bit of it.

“Where you would draw the line on acceptable quality is not necessarily where I would draw the line,” Harris said. “With foods such as packaged nuts, some might not mind the rancid flavor that develops in some nuts after long storage times, while others might decide they don’t want to eat them.”

Planning food purchases

As an undergraduate, Harris and her roommate planned meals for each week, made a list and bought only those items at the grocery store. “Planning is important,” she said. “We had no food waste.”

If you’re not that precise, be practical. There are plenty of tools to help. If you have extra meat, freeze it. If there’s mold on soft cheese such as cottage cheese, discard it because the contamination is also likely far below the surface. If there’s mold on hard cheese such as cheddar, you can cut off an inch around and below the mold spot, and the rest should be OK to eat.

Once you open a food package, those “best before” dates are less meaningful because you can significantly shorten the shelf life, Harris said. The USDA’s FoodKeeper app can further help you understand food and beverage storage for open packages, she said.

“People need to take the time to understand what the dates mean, what spoilage is and how to properly handle food both before the package is opened and after,” Harris said.

Changing behaviors

UC Berkeley graduate student Becky Mackelprang, who helped organize a panel discussion last year on food waste, said consumers can make a difference by changing behaviors. She will eat bruised fruit and drink milk that’s just past its expiration date.

“I use my sense of smell and my tongue,” Mackelprang said. “If I think that milk is suspect, I will give it a little taste. Most of the time, it is fine. When it is bad, you spit it out and have five seconds of discomfort.”

People don’t realize how much food they waste, she said.

Taking additional steps

Except for infant formula, food product dating is not required by federal regulations. About 20 states have restrictions on food date labeling, such as “sell by” labeling laws on milk in Montana, said Roberts, the UCLA food policy expert.

“We’re living in an age where voluntary measures and local measures are done much more quickly than the FDA moves,” Roberts said. “I hope at some point that the FDA does more.”

To further reduce food waste, it would help to pass laws that make it easier to compost and donate food, said Roberts, who noted the current date labels are confusing even to food companies.

“There’s nothing really for them to lose by voluntarily complying with the association and institute’s guidelines,” Roberts said.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20172/food-labels-uc-feature.jpgA woman shopping for groceries

Stock image of a woman shopping for groceries

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20172/food-labels-uc-feature.jpgA woman shopping for groceries

Stock image of a woman shopping for groceries

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20172/Michael+Roberts.jpgMichael Roberts

Michael Roberts is executive director of the UCLA Resnick Program for Food Law and Policy and a UC Global Food Initiative subcommittee member.

Americans toss out $165 billion worth of food each year, often out of safety concerns fueled by confusion about the meaning of the multitude of date labels on packages.Alec Rosenberghttp://newsroom.ucla.edu/stories/confusing-food-labels-are-about-to-get-a-lot-simplerFri, 07 Apr 2017 19:42:00 GMTEvent sponsored by Semel and UCLA Brain Research Institute

UCLA is hosting its first-ever cannabis research symposium April 20, from 8 a.m. to 4 p.m., at the Neuroscience Research Building Auditorium.

With the recent passage of Proposition 64, the Adult Use of Marijuana Act, California became the largest U.S. market for legal marijuana. Moreover, 20% of the U.S population now has access to legal recreational cannabis, 60% has access to legal medical cannabis, and over 90% has access to some form of legal cannabis product. Despite this unprecedented access to legal cannabis, research about the risks and therapeutic potential of marijuana is lacking.

The symposium, sponsored by the UCLA Brain Research Institute and the Semel Institute, will feature visiting speakers and UCLA faculty on the science regarding cannabis, cannabinoids and the endocannnabinoid system. Topics will include cannabinoids for chronic pain and pediatric epilepsy, as well as psychiatric and pulmonary effects.

The event is free, but registration is required. You can find more information here.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Macro_cannabis_bud.jpgCannibis budA close-up of a cannabis bud

A close-up of a cannabis bud. 

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Macro_cannabis_bud.jpgCannibis bud

A close-up of a cannabis bud. 

LeighHopper310-267-7149 LHopper@mednet.ucla.eduThe symposium, sponsored by the UCLA Brain Research Institute and the Semel Institute, will feature visiting speakers and UCLA faculty on the science regarding cannabis, cannabinoids, and the endocannnabinoid system.Leigh Hopperhttp://newsroom.ucla.edu/dept/faculty/inaugural-ucla-cannibis-research-symposiumWed, 05 Apr 2017 23:00:00 GMTAutoantibodies, which attack people’s own proteins, cause some cases of hypertriglyceridemia

People with hypertriglyceridemia often are told to change their diet and lose weight. But a high-fat diet isn’t necessarily the cause for everyone with the condition.

UCLA researchers have discovered a subset of people with hypertriglyceridemia whose bodies produce autoantibodies — immune-response molecules that attack their own proteins — causing high levels of triglycerides in the blood.

Hypertriglyceridemia, which can increase risk of both cardiovascular disease and pancreatitis, is often caused by or exacerbated by uncontrolled diabetes or obesity. High plasma triglyceride levels can also be caused by mutations in a variety of genes that regulate triglyceride metabolism. However, despite decades of research and a growing understanding of triglyceride metabolism, most cases of hypertriglyceridemia are poorly understood.

This newly discovered syndrome, dubbed the “GPIHBP1 autoantibody syndrome,” represents an important advance in understanding hypertriglyceridemia, said Dr. Stephen Young, UCLA cardiologist and molecular biologist, who led the study along with his colleagues Anne Beigneux and Loren Fong. All three are professors of medicine at the David Geffen School of Medicine at UCLA. 

“It’s important to recognize this new syndrome because it is life threatening and potentially treatable,” Young said.

The study is published online today in the New England Journal of Medicine.

Triglycerides in the bloodstream are broken down by an enzyme called lipoprotein lipase, known as LPL, inside capillaries — the body’s smallest blood vessels. In 2010, Young, Beigneux and Fong discovered that another protein, GPIHBP1, binds to LPL and moves it into capillaries. Without GPIHBP1, LPL is stranded in the spaces between tissues, where it is useless for digesting the triglycerides in the bloodstream. The UCLA team went on to show that some people with hypertriglyceridemia have mutations in GPIHBP1 that keep it from binding to LPL, while others have mutations in LPL that keep it from binding to GPIHBP1. Both types of mutations prevent LPL from reaching the capillaries.

In their new research, Young, Beigneux, Fong and Katsuyuki Nakajima, a professor at Gunma University in Japan, found a group of people with hypertriglyceridemia whose GPIHBP1 can’t transport lipoprotein lipase into capillaries. But in these cases, they didn’t have genetic mutations; instead, they have autoantibodies against GPIHBP1 that prevent GPIHBP1 from binding LPL.

The scientists identified six people with autoantibodies against GPIHBP1. Four of the six had been diagnosed with an autoimmune disorder known to cause the body to develop autoantibodies against a variety of proteins. One of the six people with GPIHBP1 autoantibodies became pregnant. The autoantibodies against GPIHBP1 crossed the placenta and entered the baby’s circulation; consequently, the newborn infant had severe hypertriglyceridemia. Fortunately, the infant’s triglyceride levels gradually returned to normal with the disappearance of the mother’s autoantibodies.

More research will be needed to define the frequency of the GPIHBP1 autoantibody syndrome and how to treat it, but it seems likely that immunosuppressive drugs could help reduce autoantibodies and lowering plasma triglyceride levels, Young said.

“The researchers have not only discovered a new disease, but their findings have suggested that the disease is treatable,” said Dr. Michelle Olive, deputy chief, atherothrombosis and coronary artery disease branch of the National Heart, Lung and Blood Institute, funder of the study. “These findings are the result of years of NHLBI-funded studies of the molecular mechanisms of action of GPIHBP1 and are an excellent example of how basic science can lead to scientific advances with direct clinical implications.”

Added Young: “GPIHBP1 autoantibodies need to be considered in any new case of severe hypertriglyceridemia.”

Other authors from UCLA include Peter Tontonoz, Karen Reue, Maureen McMahon, Norma Sandoval, Xuchen Hu, Christopher Allan and Mikael Larsson.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Stephen+Young-Anne+Beigneux.jpgStephen Young and Anne BeigneuxDr. Stephen Young, UCLA cardiologist and molecular biologist and Anne Beigneux, UCLA professor of medicine.

Dr. Stephen Young, UCLA cardiologist and molecular biologist and Anne Beigneux, UCLA professor of medicine.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Stephen+Young-Anne+Beigneux.jpgStephen Young and Anne Beigneux

Dr. Stephen Young, UCLA cardiologist and molecular biologist and Anne Beigneux, UCLA professor of medicine.

AmyAlbin310-267-7095aalbin@mednet.ucla.eduAutoantibodies cause some cases of hypertriglyceridemia, which can increase risk of cardiovascular disease and pancreatitis.Sarah C.P. Williamshttp://newsroom.ucla.edu/releases/ucla-researchers-discover-a-new-cause-of-high-plasma-triglyceridesWed, 05 Apr 2017 21:05:00 GMTDenice Lombard was 13 when her father donated a kidney to save her life

Denice Lombard and her father, Ted, made history in 1967 by becoming one of the first father-daughter duos to survive kidney transplant surgery in the United States.

Today, 50 years later, they both are thriving and are marking the anniversary of Denice’s transplant surgery at UCLA to urge more people to consider becoming organ donors.

“I am so very thankful to my dad for giving me the gift of life, not once, but twice,” said Denice, 62, who lives near Washington, D.C. “If you want living proof that kidney donors and their recipients can lead full, happy, healthy lives, just look at us.”

For the first time since that life-saving operation, the Lombard family reunited recently at UCLA, where doctors performed the surgery a half-century ago and helped to change the course of medicine.

“It was a big gamble,” said Dr. Albin Gritsch, surgical director of the kidney and pancreas transplant program at UCLA, who was not involved in Denice’s care at the time. “Denice’s transplant was very brave and pioneering, especially considering she was only 13 years old.”

While common today, kidney transplants were still considered experimental in the mid-1960s, Gritsch said, and were generally not performed on children.

“Only about half of the transplanted kidneys were viable after a year, meaning doctors were reluctant to approve the surgery for children,” he said.

The odds didn’t matter to Denice’s father, Ted, though. “I lost one daughter already,” Lombard said. “I wasn’t going to lose another.”

Since that groundbreaking procedure, UCLA has built one of the largest and most successful kidney transplant programs in the United States.

“It used to be that donating a kidney meant extensive, open-abdomen surgery, and recovery could take several months,” said Dr. Gabriel Danovitch, medical director of the kidney and pancreas transplant program. “Today, the surgery is done laparoscopically by creating two small incisions to remove the kidney. It’s minimally invasive, and people can get back to normal desk jobs in a couple of weeks.

According to UNOS, last year there were a record 357 kidney transplants performed at UCLA. “We’ve come a long way and owe a debt of gratitude to the Lombards, who were a part of this from the beginning,” Danovitch said.

Denice and her sister Diane were born in 1954, with a genetic disorder that slowly caused their kidneys to fail. Diane’s kidney deteriorated more rapidly. At age 7, Diane died, and her parents began a six-year crusade to save Denice.

“Because dialysis was still so new then, I was told by several doctors around Los Angeles that only males, heads of households who had jobs and who could return to work, would be allowed to be on dialysis,” said Anne Lombard, Denice’s mother.

“I tried everything I could think of and knocked on every door I could,” Anne recalled. Running out of options, the Lombards went to UCLA to propose a transplant. Doctors at UCLA decided to take the chance.

Recently, doctors, staff, donors and patients gathered for a reception to honor the Lombards.

“I want to take this opportunity to encourage more people to consider becoming living donors,” said Denice, while standing at a lectern during the reception. “My dad took a chance a half century ago volunteering to be a donor, and is still very active and incredibly healthy today. This year he will turn 88, and so will my kidney.”

Kidneys from living donors are also much more durable, lasting an average of 26.6 years, nearly twice as long as kidneys from deceased donors. However, only about a third of 19,061 kidneys (a record high) transplanted in 2016 came from living donors, according to United Network for Organ Sharing. That’s a statistic the Lombards hope will change.

Currently, there are about 100,000 people on a kidney donor waiting list, with a new patient added about every 14 minutes.

“The kidney is the only whole organ you can share as a living donor,” Denice said. “We are born with seven times the capacity we need with our kidneys, so you can donate one and never really miss it,” Denice said. “If my dad can do it and live a full, healthy and active life well into his 80s, I would challenge more people to consider it.”

To learn more about organ donation, go to www.organdonor.gov or visit the the UCLA kidney transplant center.

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http://cms.ipressroom.com.s3.amazonaws.com/173/files/20173/Lombards.jpgLombardsDenice Lombard with her mother, Anne, and father, Ted. Six years Denice’s twin sister, Diane, died of kidney failure at the age of seven, Ted donated a kidney to Denice.

Denice, Anne and Ted Lombard look through memorabilia at UCLA Medical Center. After Denice’s twin sister, Diane, died of kidney failure at the age of seven, Ted donated a kidney to Denice in 1967.

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Denice, Anne and Ted Lombard look through memorabilia at UCLA Medical Center. After Denice’s twin sister, Diane, died of kidney failure at the age of seven, Ted donated a kidney to Denice in 1967.

EnriqueRivero310-267-7120erivero@mednet.ucla.eduDenice Lombard and her father, Ted, made history in 1967 and now they’re urging others to become organ donors.UCLA Healthhttp://newsroom.ucla.edu/stories/daughter-father-celebrate-50-year-milestone-of-kidney-transplant-at-uclaTue, 04 Apr 2017 07:00:00 GMTResearchers from the Broad Stem Cell Research Center created a system to produce human T cells, the white blood cells that fight against disease-causing intruders in the body. UCLA Dentistry professor will partner with pathology department to make detection of non-small cell lung cancer more accurate and easier

In an effort to move the needle forward to improve cancer detection techniques, the National Cancer Institute awarded $2.5 million over a period of five years to principal investigator, Dr. David Wong, a professor of oral biology and associate dean for research at the UCLA School of Dentistry. The grant will support a clinical trial to validate the research team’s liquid biopsy test, a rapidly emerging technology, with the goal to have it become a certified service at UCLA and beyond.

For this project, the dental school is partnering with the UCLA Department of Pathology and Lab Medicine, led by Dr. Scott Binder, senior vice chair of pathology and laboratory medicine and director of pathology clinical services at UCLA Health.

Current clinical practice for diagnosing lung cancer involves an invasive bronchoscopy, followed by genotyping of the captured cells for key indicators and mutations of lung cancer. Genotyping is the process of determining the genetic make-up of an organism. However, this process comes with challenges. Tumor biopsies aren’t entirely accurate and could have sampling errors, or may not be feasible, depending on the health and age of the patient.

Liquid biopsy testing is a more effective, minimally invasive way to detect for key indicators in lung cancer. Current clinical liquid biopsy testing of blood and urine include utilizing digital droplet PCR or next generation sequencing, both of which provide roughly 80 percent concordance with tissue biopsy genotyping.

 “To our knowledge, this is the first grant of its kind from the National Cancer Institute that funds a liquid biopsy study for the detection of cancer mutations,” said Wong. “If our trial is successful, UCLA will be the only location in the country to offer this type of certified diagnostic testing of a patient’s blood or saliva.”

The trial will utilize the novel technology that Dr. Wong and his team developed two years ago. The test, called the electric field-induced release and measurement liquid biopsy, detects actionable mutations in lung cancer patients’ saliva for epidermal growth factor receptor gene mutations, a sign of lung cancer, which can be treated by medication such as thymidine kinase inhibitors. Up until now, this method of testing has remained in the research lab and isn't available at hospitals and diagnostics labs.

“This grant allows UCLA Health to partner with the UCLA School of Dentistry to introduce an exciting new technology into the clinical setting,” said Binder. “Liquid biopsy testing will not only save lives, but also make it much more convenient for patients to get very accurate monitoring of their cancer disease state.”

By the end of the trial, the goal is to have the test advance to a laboratory certified to develop the test and eventually become one of the diagnostic services offered at UCLA Health locations and UCLA dental clinics.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20172/David+Wong+photo+%28lab%29.jpgDr. David WongDr. David Wong

Dr. David Wong is a professor of oral biology and associate dean for research at the UCLA School of Dentistry.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20172/David+Wong+photo+%28lab%29.jpgDr. David Wong

Dr. David Wong is a professor of oral biology and associate dean for research at the UCLA School of Dentistry.

BriannaAldrich310-206-0835baldrich@dentistry.ucla.eduIn an effort to move the needle forward to improve cancer detection techniques, the National Cancer Institute awarded $2.5 million to principal investigator Dr. David Wong, associate dean for research at the UCLA School of Dentistry.Brianna Aldrichhttp://newsroom.ucla.edu/dept/faculty/ucla-dentistry-researcher-receives-a-2-5-million-grant-from-the-national-cancer-institute-to-clinically-validate-liquid-biopsy-testThu, 30 Mar 2017 23:17:00 GMTLimited two-dose completion among HIV-positive men puts them at particular risk

Despite a yearlong outbreak of invasive meningococcal disease in Southern California primarily affecting gay and bisexual men, less than 27 percent of men who have sex with men in Los Angeles County have been vaccinated for meningitis.

The findings released today by the California HIV/AIDS Policy Research Center in collaboration with the UCLA Luskin School of Public Affairs, the Los Angeles LGBT Center and APLA Health call for more education about the disease and more places offering immunization throughout Southern California at venues where gay and bisexual men socialize.

More than 500 men were interviewed about their knowledge of the meningitis outbreak by UCLA Luskin’s Ian Holloway, an assistant professor of social welfare, and teams of researchers who visited venues throughout Los Angeles County. Most of the canvassers were current UCLA students or recent graduates.

“Our rapid-response research suggests that coordinated efforts to standardize data collection about sexual practices in conjunction with immunization will enable better tracking of meningitis vaccination among gay and bisexual men,” said Holloway, who is also director of the UCLA Luskin-based Southern California HIV/AIDS Policy Research Center.

Meningococcal disease is often characterized with sudden onset of high fever, headache, nausea, vomiting, rash, stiff neck and confusion, which can lead to rapid septic shock and death if not treated quickly. Vaccination is highly effective and can prevent the disease. The current outbreak in Southern California is the second in the area in recent history. A 2014 meningitis outbreak led to the deaths of three gay men in their 20s.

Despite the outbreak and vaccination recommendations from the California Department of Public Health, the majority of respondents interviewed by the UCLA team were not protected against meningitis.

Holloway noted that HIV-positive people are at particular risk for developing serious health issues if infected with meningitis and are recommended to receive a two-dose primary series of meningitis vaccination. Few HIV-positive men surveyed by Holloway’s team had received two doses of the vaccination.

“Primary care doctors who treat gay and bisexual men and HIV-positive people should talk to their patients about the ongoing outbreak and make sure they receive the full recommended dosing,” said Phil Curtis, director of government affairs at AIDS Project Los Angeles Health.

The study praises the efforts of the Los Angeles County Department of Public Health Immunization Program, which distributed free vaccines, and of participating community-based organizations such as AIDS Healthcare Foundation and the Los Angeles LGBT Center, but researchers concluded that more needs to be done.

In addition to Holloway, study authors include Elizabeth Wu and Jennifer Gildner from the Southern California HIV/AIDS Policy Research Center, and Vincent Fenimore and Paula Frew from Emory University.

http://cms.ipressroom.com.s3.amazonaws.com/173/files/20172/Meningitis-Study2.jpgMeningitis StudyIan Holloway, left, assistant professor in the UCLA Luskin School of Public Affairs, discusses survey options with a team of student canvassers.

Ian Holloway, assistant professor in the UCLA Luskin School of Public Affairs, discusses survey options with a team of student canvassers outside a West Hollywood night spot in December 2016.

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Ian Holloway, assistant professor in the UCLA Luskin School of Public Affairs, discusses survey options with a team of student canvassers outside a West Hollywood night spot in December 2016.

GeorgeFoulsham310-206-0159gfoulsham@luskin.ucla.eduStudy from UCLA and other research partners suggests more data collections in conjunction with increasing access to immunizations.UCLA Newsroomhttp://newsroom.ucla.edu/releases/despite-ongoing-meningitis-outbreak-vaccination-among-gay-men-remains-low-new-study-showsThu, 30 Mar 2017 16:12:00 GMT
Updated: 20 hours 40 min ago