SOURCE:  California Healthline/Pauline Bartolone     Nov 8, 2017

Dr. Mary Meengs remembers the days, a couple of decades ago, when pharmaceutical salespeople would drop into her family practice in Chicago, eager to catch a moment between patients so they could pitch her a new drug.

Now living in Humboldt County, Calif., Meengs is taking a page from the pharmaceutical industry’s playbook with an opposite goal in mind: to reduce the use of prescription painkillers.

Meengs, medical director at the Humboldt Independent Practice Association, is one of 10 California doctors and pharmacists funded by Obama-era federal grants to persuade medical colleagues in Northern California to help curb opioid addiction by altering their prescribing habits.

She committed this past summer to a two-year project consisting of occasional visits to medical providers in California’s most rural areas, where opioid deaths and prescribing rates are high.

“I view it as peer education,” Meengs said. “They don’t have to attend a lecture half an hour away. I’m doing it at [their] convenience.”

This one-on-one, personalized medical education is called “academic detailing” — lifted from the term “pharmaceutical detailing” used by industry salespeople.

Detailing is “like fighting fire with fire,” said Dr. Jerry Avorn, a Harvard Medical School professor who helped develop the concept 38 years ago. “There is some poetic justice in the fact that these programs are using the same kind of marketing approach to disseminate helpful evidence-based information as some [drug] companies were using … to disseminate less helpful and occasionally distorted information.”

Recent lawsuits have alleged that drug companies pushed painkillers too aggressively, laying the groundwork for widespread opioid addiction.

Avorn noted that detailing has also been used to persuade doctors to cut back on unnecessary antibiotics and to discourage the use of expensive Alzheimer’s disease medications that have side effects.

Kaiser Permanente, a large medical system that operates in California, as well as seven other states and Washington, D.C., has used the approach to change the opioid-prescribing methods of its doctors since at least 2013. (Kaiser Health News is not affiliated with Kaiser Permanente.)

In California, detailing is just one of the ways in which state health officials are attempting to curtail opioid addiction. The state is also expanding access to medication-assisted addiction treatment under a different, $90 million grantthrough the federal 21^st Century Cures Act.

The total budget for the detailing project in California is less than $2 million. The state’s Department of Public Health oversees it, but the money comes from the federal Centers for Disease Control and Prevention through a program called “Prevention for States,” which provides funding for 29 states to help combat prescription drug overdoses.

The California doctors and pharmacists who conduct the detailing conversations are focusing on their peers in the three counties hardest hit by opioid addiction: Lake, Shasta and Humboldt.

They arrive armed with binders full of facts and figures from the CDC to help inform their fellow providers about easing patients off prescription painkillers, treating addiction with medication and writing more prescriptions for naloxone, a drug that reverses the toxic effects of an overdose.

“Academic detailing is a sales pitch, an evidence-based … sales pitch,” said Dr. Phillip Coffin, director of substance-use research at San Francisco’s Department of Public Health — the agency hired by the state to train the detailers.

In an earlier effort, Coffin said, his department conducted detailing sessions with 40 San Francisco doctors, who have since increased their prescriptions of naloxone elevenfold.

“One-on-one time with the providers, even if it was just three or four minutes, was hugely beneficial,” Coffin said. He noted that the discussions usually focused on specific patients, which is “way more helpful” than talking generally about prescription practices.

Meengs and her fellow detailers hope to make a dent in the magnitude of addiction in sparsely populated Humboldt County, where the opioid death rate was the second-highest in California last year — almost five times the statewide average. Thirty-three people died of opioid overdoses in Humboldt last year.

One recent afternoon, Meengs paid a visit during the lunch hour to Fortuna Family Medical Group in Fortuna, a town of about 12,000 people in Humboldt County.

“Anybody here ever known somebody, a patient, who passed away from an overdose?” Meengs asked the group — a physician, two nurses and a physician’s assistant — who gathered around her in the waiting room, which they had temporarily closed to patients.

“I think we all do,” replied the physician, Dr. Ruben Brinckhaus.

Brinckhaus said about half the patients at the practice have a prescription for an opioid, anti-anxiety drug or other controlled substance. Some of them had been introduced to the drugs years ago by other prescribers.

Meengs’ main goal was to discuss ways in which the Fortuna group could wean its patients off opioids. But she was not there to scold or lecture them. She asked the providers what their challenges were, so she could help them overcome them.

Meengs will keep making office calls until August 2019 in the hope that changes in the prescribing behavior of doctors will eventually help tame the addiction crisis.

“It’s a big ship to turn around,” said Meengs. “It takes time.”

“Our study is the first to show that nanosized plastic particles can accumulate in fish brains”, says Tommy Cedervall, a chemistry researcher at Lund University.

The Lund University researchers studied how nanoplastics may be transported through different organisms in the aquatic ecosystem, i.e. via algae and animal plankton to larger fish. Tiny plastic particles in the water are eaten by animal plankton, which in turn are eaten by fish.

According to Cedervall, the study includes several interesting results on how plastic of different sizes affects aquatic organisms. Most importantly, it provides evidence that nanoplastic particles can indeed cross the blood-brain barrier in fish and thus accumulate inside fish’s brain tissue.

In addition, the researchers involved in the present study have demonstrated the occurrence of behavioural disorders in fish that are affected by nanoplastics. They eat slower and explore their surroundings less. The researchers believe that these behavioural changes may be linked to brain damage caused by the presence of nanoplastics in the brain.

Another result of the study is that animal plankton die when exposed to nanosized plastic particles, while larger plastic particles do not affect them. Overall, these different effects of nanoplastics may have an impact on the ecosystem as a whole.

“It is important to study how plastics affect ecosystems and that nanoplastic particles likely have a more dangerous impact on aquatic ecosystems than larger pieces of plastics”, says Tommy Cedervall.

However, he does not dare to draw the conclusion that plastic nanoparticles could accumulate in other tissues in fish and thus potentially be transmitted to humans through consumption.

“No, we are not aware of any such studies and are therefore very cautious about commenting on it”, says Tommy Cedervall.

The present study was conducted in collaboration between the divisions of Biochemistry and structural biology, Aquatic ecology and Center for environmental and climate research at Lund University.

Explore further: Plastic nanoparticles also harm freshwater organisms

More information: Karin Mattsson et al, Brain damage and behavioural disorders in fish induced by plastic nanoparticles delivered through the food chain, Scientific Reports (2017). DOI: 10.1038/s41598-017-10813-0

Read more at: https://phys.org/news/2017-09-brain-fish-affected-plastic-nanoparticles.html#jCp

SOURCE:  USA Today/Mary Bowerman  Sept 14, 2017

A California-based nature photographer, nominated for wildlife photographer of year, wishes the photo he’s nominated for “didn’t exist.”

Justin Hofman’s photo of a tiny seahorse clinging to a pink plastic cotton swab highlights how plastic pollution has left virtually no corner of our world untouched.

“I wish we didn’t have to see this beautiful wildlife mixed in with all of our waste,” he told USA TODAY. “I travel all over the world, and I can’t think of a single place where people haven’t impacted the environment.”

More than 8 million tons of plastic end up in the ocean each year, and some estimates show that by 2050 there will be more plastic than fish. Hofman, who is nominated forLondon’s Natural History Museum’s Wildlife Photographer of the Year, snapped the photo while snorkeling near Subawa Island, Indonesia last year.

He said his friend pointed out the sea horse, which was holding onto a piece of seaweed and drifting with the current.

“When the tide came in, the debris came in with it, and the seahorse hopped from the seaweed to a little piece of plastic and then a Q-tip,” he said.

Hofman said his “blood was boiling,” but he continued to snap pictures.

“I took the photo in Indonesia, but this is happening everywhere in the world,” he said.

He said that many people in Indonesia are horrified by the pollution, but do not have the resources to recycle. He points out that it’s hard to tell where the plastic came from because of the oceans currents.

The competition’s winners will be announced on October 17.

Hofman said he hopes his photo will prompt people to think about making more environmentally friendly decisions.

“At night when I am laying in bed, I don’t feel very optimistic, but I have to be, or otherwise there would be no reason to keep doing what I do,” he said.

SOURCE:  Pew Charitable Trusts/Polita Glynn  April 27, 2017

While many people view climate change as an intangible and overwhelming problem, they can address its impacts on the oceans, chiefly through continued investment in innovative strategies for managing the seas and the life within them.

That is one conclusion of a new paper titled “Avoiding a Crisis of Motivation for Ocean Management Under Global Environmental Change” from a group of Pew marine fellows and other researchers.

Led by Peter Mumby from the University of Queensland and Jane Lubchenco from Oregon State University, the group reviewed evidence that climate change poses such a crisis because of how people typically respond to long-term, incremental change. Humans are wired to learn from personal experience, and thus many individuals avoid acting on what they perceive as long-range, diffuse, anticipated threats, such as climate change. This crisis can lead to reduced investment in resource management, monitoring, and enforcement.

Insights from case studies

Counteracting that trend requires a more flexible approach to finding solutions and responding to the inevitable surprises that ongoing research will reveal.

Through a series of case studies on climate change’s impact on marine ecosystems, the paper explores which variables might encourage or discourage further investments, and considers the possible consequences of those decisions. For instance, the worldwide decline of coral reefs is often perceived as management failure, even if climate change is one of the primary drivers of that deterioration. Yet science shows that human management of reef ecosystems can improve them.

In another case study, the authors consider management of fish stocks that are shifting their range in response to temperature changes. An economically rational response to such a shift is for people in a region that is losing fish to overexploit those declining stocks, while those in places where fish have increased might mistake migration for high productivity and overfish. But by treating the stock as a shared resource, both parties could help ensure a more sustainable outcome.

Other case studies in the paper explore expanded shipping through the Arctic due to the reduction of sea ice in the region as well as climate impacts on coastal habitats and those living in vulnerable areas.

Management challenges and options

The paper, which was published in the journal Global Change Biology, considers how management strategies can account for “climate surprises”—the gaps between expectations and actual events.

Technology, for example, can enable simulations that allow people to see what would happen under different environmental scenarios. Expanded monitoring and modeling can help provide early-warning signs of impending change and assist fisheries managers and others in preventing ecosystems from crossing critical thresholds. For example, by including additional variables in computer models, managers can better understand the benefits of various actions they could take under changing climates.

Reframing the problem

“Of the many surprises that we face with climate change, I hope that a proactive and strategic human response is among the greatest,” says Mumby. “Greater investment in ecosystem management does not mean more regulation, but smarter, more flexible approaches that better anticipate and respond to unexpected changes.”

Polita Glynn directs the Pew Fellows Program in Marine Conservation for The Pew Charitable Trusts.

SOURCE:  Stark County ESC  April 28, 2017

SOURCE:  West Hawaii Today/staff report  March 17, 2017

Her driving mission is to stop talking about death and destruction. Doom and gloom sells, she realizes, but it also creates pessimism, where it can be easy to throw up your hands and just wait for the forgone conclusion.

Instead, Gates, the director of the Hawaiian Institute of Marine Biology at the University of Hawaii, wants to talk about life. She wants to talk about creating it, about scientifically engineering it so that it’s as perfect as can be.

“We have lost 50 percent of the world’s coral reefs in the last three decades,” Ruth said, speaking about her research trying to crossbreed coral in an effort to save them at Hawaii Community College — Palamanui. “I’m going to let you absorb that.”

Yes, the hour-long President’s Series presentation led off with the alarming facts: Half are decimated and the remaining coral will be gone or heavily damaged by 2050 if things don’t turn around.

And turn around they must. Because human life without coral is limited. The structures are abundant food sources for aquatic life, provide oxygen and protect shores from erosion and the full force of storms. They’re also a backbone for tourism industries.

But what about the other half of those numbers?

“That means 50 percent didn’t die,” Gates said. “And the question is why? That’s a crucial question to understand.”

To figure that out, Ruth and her team of students are experimenting on crossbreeding different components of the surviving corals to see if they can create species that possess the attributes that make coral likely to resist rising sea temperatures — the primary cause of coral bleaching.

The science is daunting because corals are vast and complex. No two reefs anywhere in the world are the same.

And coral is different organisms living in perfect cohabitation. Coral colonies are made up of hundreds of genetically identical individual animals called polyps. These polyps partner with microalgae, tiny plant tissues that actually live inside the animal’s cells. Inside the cells, the plants use life energy to combine CO2 and water to produce oxygen.

Bleaching occurs when ocean temperatures rise enough to disturb the biochemical photosynthesis reaction. The animal, then, expels the nonfunctioning plant. Malnourished, the coral bleaches white from its normal healthy brown hue. Hawaii was an area greatly affected by the worldwide coral bleaching storm of 2014.

But with so many genotypes and partnerships among the surviving coral, the goal is to mix and match them to create breeds with traits proven to be resistant to bleaching.

“Why don’t we manipulate the system and develop corals that can survive the future?” Ruth said, adding that coral, like humans, are a product of who their parents were, who they partnered with and their environment and experiences. “Why don’t we selectively breed the strongest of the strong?”

That idea won her a $4 million grant to try and create it, which she and her team are doing.

They had a successful crossbreed last year and now they’re waiting to see if it grows, and the success continues. If it does, they can introduce the new populations to a reef where they can grow, which would create oxygen and lower the water temperatures to buy time to mitigate the bleaching problem.

But it would be just that, extra time while partnerships are formed and different groups and agencies join in an all out effort to save the coral.

“A full crush,” Gates called it.

Groups from all backgrounds should form. Biologists should partner with engineers and engineers with conservationists, philanthropists, and all of them with state and agency officials to come up with solutions.

Could an engineer create a system around a reef that would raise the temperature of the water by 2 degrees for 48 hours? If they could, the coral could pass along a trait to the next generation that enables them to survive a half-degree water temperature rise down the line.

Because a characteristic of a surviving coral is that if they survived a stressed environment once before, they are more likely to survive another. The engineering system would mimic that stressed environment but under a controlled atmosphere, giving the coral the benefits of having adjusted to it.

“Let’s try,” Gates said. “Let’s not be affected by the naysayers.”

The broad thinking caught Alan Gemen by surprise. The engineer was one of about 100 people who listened to the Thursday evening outdoor lecture to learn about the state of coral, not expecting engineering ideas.

“I never thought about it before,” he said of building such a device. “But it’s something that’s possible, probably using solar.”

Time is of the essence, Gates said. Humans, when they put their minds to it, covered a hole in the ozone for the sake of humanity. Why not fix this?

While it’s too early to tell if Gates’ tests will work, she is posting her results in real time online rather than waiting for them to be published. She hopes that other scientists will pick up on the findings and study along, which is more important than a publisher and peer reviews.

“We’ve all been fortunate to be here to see science that’s alive, so full of life,” UH Palamanui Director Kenneth Fletcher said after the presentation.

SOURCE:  CBCNEWS/Brandie Weikle January 28, 2017

Tiny pieces of plastic are making their way into fish and shellfish found at the supermarket, a new study has shown.

The findings are part of a report prepared for the International Maritime Organization, the UN agency responsible for preventing marine pollution.

It’s not yet been established what effect these tiny particles of plastic will have on the humans who consume them, the report says.

Researchers do know, however, that microplastics get into aquatic habitats from many different sources, says Chelsea Rochman, an assistant professor of ecology and evolutionary biology at the University of Toronto and co-editor of the report.

These range from tiny fibres that come off the synthetic fabrics of our clothing, to bits of car tire that wear off on roads and make their way through storm drains into waterways, she says.

They also vary in size such that they can be consumed by marine animals both big and microscopic.

“It has infiltrated every level of the food chain in marine environments and likely fresh water, and so now we’re seeing it come back to us on our dinner plates,” says Rochman.

• Researchers sound alarm over millions of tonnes of plastic dumped into oceans
• Researchers tag 3,000 shellfish to study microplastics in B.C. waters

Gutting fish won’t rid them of the bits of plastic they consume.

“These materials enter marine organisms, not just their guts but also their tissues,” says Peter Wells, a senior research fellow with the International Ocean Institute at Dalhousie University.

A net designed to gather samples of microplastic particles is dragged through Lake Ontario on July 15, 2015. (Micki Cowan/CBC)

And it’s not just the plastic itself, but the stuff that comes along with it, that’s a concern, says Wells.

Microplastics absorb or carry organic contaminants, such as PCBs, pesticides, flame retardants and hormone-disrupting compounds of many kinds, he says.

Wells says that until recently, the world’s attention was on larger pieces of plastic in the ocean — the kind of garbage obviously visible to the naked eye.

Pictures of seabirds with plastic rings from six-packs of beer around their necks were shared with alarm, for example.

“Only when scientists started looking at plankton and water samples more carefully did they realize that a lot of the plastic was being broken down, not seen except under a microscope,” says Wells.

Not just microbeads

​Among all the microplastics in our lakes and oceans, microbeads — those little exfoliants from facial scrubs and hand soaps — are the best known by the public.

• Federal government set to ban sale of toiletries containing microbeads in 2018

“Microbeads are really what brought microplastics to the table in Canada as something that we would regulate and monitor,” says Rochman. A federal government ban on toiletries containing microbeads will come into effect in 2018.

However, these are not the main source of microplastics, she says.

Microbeads, like these from a sample of toothpaste seen under a microscope, are the best known among microplastics but not the most common source, says Chelsea Rochman, co-editor of the report. (Dr. Harold Weger)

“The biggest source is likely larger plastic items that we can see during beach cleanups that enter the water and over time break down with the sunlight into smaller and smaller pieces of microplastic.”

Think plastic bags, styrofoam takeout containers and plastic cutlery, says Rochman.

What does this mean for fish as food?

Kate Comeau, a registered dietitian and the spokeswoman for Dietitians of Canada, cautions consumers not to come to conclusions too quickly as a result of these findings.

“It’s an important conversation,” says Comeau, “but we don’t want people running away from eating healthy sources of food.”

Fish is an excellent source of protein, she says. “The fatty fish are also a great source of vitamin D, which we don’t have a lot of food sources of in our Canadian diet. Fish is also a great source of iron, and those omega-3 fats are really important in terms of our heart health.”

Rochman stresses that more research is required before anyone lets microplastics determine what’s for dinner.

“What we really need to do is a risk assessment … nobody has done that for microplastics.”

• Microplastics at ‘alarming levels’ in Canadian lakes and rivers

Researchers have found microplastics in molluscs like oysters both in field research and in retail outlets, says Rochman. (Cameron Spencer/Getty Images)