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Wednesday, January 22, 2020

How stress causes gray hair

When Marie Antoinette was captured during the French Revolution, her hair reportedly turned white overnight. In more recent history, John McCain experienced severe injuries as a prisoner of war during the Vietnam War—and lost color in his hair.
For a long time, anecdotes have connected stressful experiences with the phenomenon of  graying. Now, for the first time, Harvard University scientists have discovered exactly how the process plays out:  activates nerves that are part of the fight-or-flight response, which in turn cause  to pigment-regenerating stem  in hair follicles.
The study, published in Nature, advances scientists’ knowledge of how stress can impact the body.
“Everyone has an anecdote to share about how stress affects their body, particularly in their skin and hair—the only tissues we can see from the outside,” said senior author Ya-Chieh Hsu, the Alvin and Esta Star Associate Professor of Stem Cell and Regenerative Biology at Harvard. “We wanted to understand if this connection is true, and if so, how stress leads to changes in diverse tissues. Hair pigmentation is such an accessible and tractable system to start with—and besides, we were genuinely curious to see if stress indeed leads to hair graying. ”
Narrowing down the culprit
Because stress affects the whole body, researchers first had to narrow down which body system was responsible for connecting stress to hair color. The team first hypothesized that stress causes an immune attack on pigment-producing cells. However, when mice lacking  still showed hair graying, researchers turned to the hormone cortisol. But once more, it was a dead end.
“Stress always elevates levels of the hormone cortisol in the body, so we thought that cortisol might play a role,” Hsu said. “But surprisingly, when we removed the  from the mice so that they couldn’t produce cortisol-like hormones, their hair still turned gray under stress.”
After systematically eliminating different possibilities, researchers honed in on the sympathetic nerve system, which is responsible for the body’s fight-or-flight response.
Sympathetic nerves branch out into each  on the skin. The researchers found that stress causes these nerves to release the chemical norepinephrine, which gets taken up by nearby pigment-regenerating stem cells.
Scientific evidence found for role of stress in hair whitening
Image comparing mice submitted to pain-inducing experiment, which resulted in loss of pigmentation [bottom], to dark-colored mice in the control group. Credit: William A. Gonçalves
Permanent damage
In the hair follicle, certain stem cells act as a reservoir of pigment-producing cells. When hair regenerates, some of the stem cells convert into pigment-producing cells that color the hair.
Researchers found that the norepinephrine from sympathetic nerves causes the stem cells to activate excessively. The stem cells all convert into pigment-producing cells, prematurely depleting the reservoir.
“When we started to study this, I expected that stress was bad for the body—but the detrimental impact of stress that we discovered was beyond what I imagined,” Hsu said. “After just a few days, all of the pigment-regenerating stem cells were lost. Once they’re gone, you can’t regenerate pigment anymore. The damage is permanent.”
The finding underscores the  of an otherwise protective evolutionary response, the researchers said.
“Acute stress, particularly the fight-or-flight response, has been traditionally viewed to be beneficial for an animal’s survival. But in this case, acute stress causes permanent depletion of stem cells,” said postdoctoral fellow Bing Zhang, the lead author of the study.
Answering a fundamental question
To connect stress with hair graying, the researchers started with a whole-body response and progressively zoomed into individual organ systems, cell-to-cell interaction and, eventually, all the way down to molecular dynamics. The process required a variety of research tools along the way, including methods to manipulate organs, nerves, and cell receptors.
“To go from the highest level to the smallest detail, we collaborated with many scientists across a wide range of disciplines, using a combination of different approaches to solve a very fundamental biological question,” Zhang said.
The collaborators included Isaac Chiu, assistant professor of immunology at Harvard Medical School who studies the interplay between nervous and immune systems.
“We know that peripheral neurons powerfully regulate organ function, blood vessels, and immunity, but less is known about how they regulate stem cells,” Chiu said.
“With this study, we now know that neurons can control stem cells and their function, and can explain how they interact at the cellular and molecular level to link stress with hair graying.”
The findings can help illuminate the broader effects of stress on various organs and tissues. This understanding will pave the way for new studies that seek to modify or block the damaging effects of stress.
“By understanding precisely how stress affects  that regenerate pigment, we’ve laid the groundwork for understanding how stress affects other tissues and organs in the body,” Hsu said. “Understanding how our tissues change under stress is the first critical step towards eventual treatment that can halt or revert the detrimental impact of stress. We still have a lot to learn in this area.”

Explore further

More information: Hyperactivation of sympathetic nerves drives depletion of melanocyte stem cells, Nature (2020). DOI: 10.1038/s41586-020-1935-3 , https://nature.com/articles/s41586-020-1935-3

La. ends Medicaid contracts for Humana, UnitedHealth, others on bid process issue

Louisiana rescinded Medicaid managed care contracts to UnitedHealthcare, Humana and two other insurers because of problems with the bidding process.
The decision by Louisiana’s state procurement officer announced Friday likely will mean a new round of bidding for Louisiana’s Medicaid managed care program unless the decision is appealed and overturned.
Centene’s Louisiana Healthcare Connections and Aetna Better Health Louisiana protested the state’s award of Medicaid contracts to Healthy Blue, Humana Health Benefit Plan of Louisiana, AmeriHealth Caritas and UnitedHealthcare Community Plan last year.
Centene and Aetna charged in their appeal last August that Humana gave inaccurate information and that the scoring method used by the bidding process was “tainted with multiple conflicts of interest within the evaluation committee.”
Louisiana’s procurement officer didn’t find any bias against Aetna or Centene among the evaluators nor any conflicts of interest.
However, the procurement officer did find the evaluation process to be riddled with problems. For instance, the state changed its evaluation tool for bids multiple times after the review process had started, tainting the evaluation.
The original request for proposals also required the insurers to give a provider network listing. However, “unbeknownst to proposers and contrary to the language of the RFP” the evaluation committee did not examine the provider network listing.

The committee also didn’t properly amend the RFP to tell insurers they were not going to review the listing.
Humana said that it was “disappointed” in the ruling.
“We will be appealing the decision and await the state’s final determination in the coming weeks,” the insurer said in a statement. “We continue to focus on preparing for the start of the new Medicaid program.”
AmeriHealth added that it was reviewing the decision, and UnitedHealthcare said it will continue to serve the state’s Medicaid beneficiaries but did not mention an appeal.
Louisiana paid out $7.6 billion to five managed care plans in the 2018 fiscal year, the state’s department of health said.

Microsoft, Amazon and IBM access millions of US hospital records

  • The tech giants are each working with medical centers in Washington, Massachusetts and Minnesota, The Wall Street Journal reports
  • Each deal means information from millions of records could be handed over 
  • Hospitals are allowed to share patient data as long as they follow privacy laws
  • It has already been revealed how Google has teamed up with Ascension, a leading healthcare services company, to access health data 
  • Certain laws allow for people’s medical data to be shared without them knowing
Hospitals across the United States are said to have granted Microsoft, Amazon and IBM access to sensitive identifiable medical records.
The tech giants are each working with medical centers in Washington, Massachusetts and Minnesota, The Wall Street Journal reports.
But the breadth of access was not made immediately clear as the contracts were signed, according to the paper, although there is no suggestion of legal wrongdoing.
And it means information from millions of identifiable records could be handed over available as part of the deals to crunch the data.
Microsoft is said to be building cancer algorithms with the help of data from Providence Health & Services, which is based Renton, Washington
Microsoft is said to be building cancer algorithms with the help of data from Providence Health & Services, which is based Renton, Washington
In Boston a deal between IBM and Brigham and Women¿s Hospital allows the medical center to share data for particular requests, although they are yet to do so
In Boston a deal between IBM and Brigham and Women’s Hospital allows the medical center to share data for particular requests, although they are yet to do so
Federal privacy laws do allow hospitals to share patient data. Consultant Lisa Bari said: ‘Hospitals are massive containers of patient data. The data belongs to whoever has it.’
Microsoft is said to be building cancer algorithms with the help of data from Providence Health & Services, which is based Renton, Washington.
The doctor’s notes they are using are said to still contain information which can identify patients.
In Boston a deal between IBM and Brigham and Women’s Hospital allows the medical center to share data for particular requests, although they are yet to do so.
And in Seattle Amazon Web Services have access to individual patient information at the Fred Hutchinson Cancer Research Center.
DailyMail.com has contacted each of the health services and tech giants connected.
Microsoft executive Peter Lee said in December the data is still in Providence’s control. A spokesman for Providence said their actions were ‘not intended to mislead’.
IBM said: ‘Responsible data stewardship is core to our mission.’ Brigham and Women’s Hospital have not commented publicly on the tech giant’s ability to look at identifiable information.
Amazon Web Services say that any data protected under federal privacy laws is not used.
The US has seen a rise in the percentage of hospitals using electronic health records
The US has seen a rise in the percentage of hospitals using electronic health records
It comes in the wake of Google’s Project Nightingale, alongside leading healthcare company Ascension, to gather millions of Americans’ health data without them knowing it.
The two companies announced the collaboration in a press release where they revealed that Ascension’s data will move onto Google’s Cloud platform.
Google will now have access to patients’ test results, diagnoses and hospitalizations to give them a full digital health history. Neither doctors nor the patients in the 21 states where it will be used had been told about it.
The practice is legal under the Health Insurance Portability and Accountability Act of 1996 which allows hospitals to share patients’ medical data with business partners on the condition that it is used to ‘help the entity carry out its healthcare functions.’
But a whistleblower said that the lack of transparency made many members of the team working on the project uneasy and could put the healthcare data of millions at risk
‘Two simple questions kept hounding me: did patients know about the transfer of their data to the tech giant? Should they be informed and given a chance to opt in or out?’ the whistleblower wrote.
‘The answer to the first question quickly became apparent: no. The answer to the second I became increasingly convinced about: yes. Put the two together, and how could I say nothing?’ the person continued.
The person said that about 150 Google employees and 100 Ascension staff collaborated on Project Nightingale, transferring the personal data of more than 50 million Americans to Google.
‘I’d like to hope that the result of my raising the lid on this issue will be open debate leading to concrete change,’ the person wrote. ‘Transfers of healthcare data to big tech companies need to be shared with the public and made fully transparent, with monitoring by an independent watchdog.’
The whistleblower also insisted: ‘Patients must have the right to opt in or out.’
A spokesman for Providence said their actions were 'not intended to mislead'
A spokesman for Providence said their actions were ‘not intended to mislead’
Google is also said to have a deal with the Mayo clinic in Rochester, Minnesota
Google is also said to have a deal with the Mayo clinic in Rochester, Minnesota
Google is also said to have a deal with the Mayo clinic in Rochester, Minnesota. Mayo spokesman said: ‘It was not our intention to mislead the public.’ Data-team member Lois Krahn said: ‘We are a tremendously cautious and conservative organization.’
Head of Google Health Dr. David Feinberg said: ‘We didn’t hide it.’
The Health Insurance Portability and Accountability Act does not leave patients with ‘much control’, one ethics professor has said. Hospitals do not have to warn users of deals if it can be argued the records are needed for treatment, payment or surgery.

Researchers trace coronavirus outbreak in China to snakes

Emerging viral infections—from bird flu to Ebola to Zika infections—pose major threats to global public health, and understanding their origins can help investigators design defensive strategies against future outbreaks. A new study provides important insights on the potential origins of the most recent outbreak of viral pneumonia in China, which started in the middle of December and now is spreading to Hong Kong, Singapore, Thailand, and Japan. The findings are published early online in the Journal of Medical Virology.
The study notes that patients who became infected with the virus—which is a type of virus called a coronavirus and was named 2019-nCoV by the World Health Organization—were exposed to wildlife animals at a wholesale market, where seafood, poultry, snake, bats, and  were sold.
By conducting a detailed genetic analysis of the virus and comparing it with available genetic information on different viruses from various geographic locations and , the investigators concluded that the 2019-nCoV appears to be a virus that formed from a combination of a coronavirus found in bats and another coronavirus of unknown origin. The resulting virus developed a mix or “recombination” of a viral protein that recognizes and binds to receptors on host cells. Such recognition is key to allowing viruses to enter host cells, which can lead to infection and disease.
Finally, the team uncovered evidence that the 2019-nCoV likely resided in snakes before being transmitted to humans. Recombination within the viral receptor-binding protein may have allowed for cross-species transmission from snake to humans.
“Results derived from our evolutionary analysis suggest for the first time that snake is the most probable wildlife animal reservoir for the 2019-nCoV,” the authors wrote. “New information obtained from our evolutionary analysis is highly significant for effective control of the outbreak caused by the 2019-nCoV-induced pneumonia.”
An accompanying editorial notes that although the ultimate control of emerging  requires the discovery and development of effective vaccines and/or antiviral drugs, currently licensed antiviral drugs should be tested against the 2019-nCoV.

Explore further

More information: Wei Ji et al, Homologous recombination within the spike glycoprotein of the newly identified coronavirus may boost cross‐species transmission from snake to human, Journal of Medical Virology (2020). DOI: 10.1002/jmv.25682Guangxiang (George) Luo et al. Global Health Concern Stirred by Emerging Viral Infections, Journal of Medical Virology (2020). DOI: 10.1002/jmv.25683

Ex-FDA Chief Brushes Off Some Coronavirus Concerns

Former FDA Commissioner Scott Gottlieb said Tuesday afternoon on CNBC the coronavirus “so far seems to be a mild illness.”
The total reported cases rose to 440 in China with nine confirmed fatalities, at time of publication Wednesday afternoon.

Gottlieb: Not That Serious

The current coronavirus has about a 70% overlap with SARS and the illness associated with the coronavirus isn’t as significant, Gottlieb said on Tuesday. As such, there are likely a lot of mild or moderate cases of infection which implies the 300 cases of infection which has been reported so far is not an accurate number.
However, the coronavirus appears to be spreading more rapidly and may have already achieved sustained human-to-human transmission. The U.S. government and relevant parties likely have the necessary tools to conduct an effective screening process.
All indications suggest the coronavirus outbreak “isn’t necessarily that serious” for people who aren’t young or old, he said. In fact, people get sick from some strain of a coronavirus “all the time.”

Sector Rotation Towards Med Stocks

If the coronavirus continues to spread investors may look to move away from hospitality and travel stocks and into companies who manufacture medical devices, Taurus Wealth Advisors’ Rainer Michael Preiss said Wednesday on CNBC’s “Street Signs Asia.” This trend started playing out over the past few days and could play out “longer than people think.”
The timing of the outbreak comes at a time of “peak optimism” in the markets and could not rebound until “peak pessimism” passes, he said.
“Anybody who thinks this will be a quick fix most probably needs to realize these things take time and also they are very complicated and deep issues,” he said.

Cramer: Buy Unrelated Stocks

So far the coronavirus looks to be less lethal than the SARS virus but will likely have a visible impact on companies with a strong presence in China, particularly travel, tourism and gaming companies, Jim Cramer said Tuesday on “Mad Money.” But if unrelated stocks start to sell off, investors should take advantage and buy high-quality stocks on any weakness.
“It’s collateral damage where there shouldn’t be damage,” Cramer said.

FDA: Study of Biohaven’s verdiperstat in ALS can proceed

Biohaven Pharmaceuticals (NYSE:BHVNannounces that the FDA has notified its collaborators at Boston’s Massachusetts General Hospital that they may proceed with a clinical trial of verdiperstat in patients with amyotrophic lateral sclerosis (ALS).
The study, HEALEY ALS, is a basket study that will evaluate multiple drugs in parallel.
Verdiperstat is also being evaluated for the treatment of multiple system atrophy.

Mobile Monitoring System vs Usual Care in Depression, Psychological Health

Early detection and monitoring of mental health symptoms are crucial, yet many patients and clinicians are unable to receive timely and reliable indicators of clinical progress. Mobile monitoring systems allow for passive tracking of vocal and behavioral indicators of symptoms and can provide infrastructure to securely store, analyze, and provide feedback to patients and clinicians.1 However, the evidence for the effectiveness of mobile monitoring systems in clinical settings is limited.2 We conducted a randomized clinical trial to assess whether patients using a mobile monitoring system with clinician access experienced improvements in depression symptoms and well-being.
Methods
Recruitment
Between February 2016 and June 2017, patients from 2 Brigham and Women’s Hospital Patient-Centered Medical Homes with colocated primary care and behavioral services were recruited through clinician referrals, online advertising, and within-clinic advertising. Exclusion criteria included the presence of a psychotic disorder, suicidal or homicidal risk, history of a cognitive disorder, or not owning an Android smartphone (Figure 1). Researchers obtained Partners Healthcare institutional review board approval and written informed consent from all participants. This study followed the Consolidated Standards of Reporting Trials (CONSORT) reporting guideline. The trial protocol appears in Supplement 1.
Mobile Monitoring System
Patients were randomized to receive usual care (control) or usual care plus the mobile monitoring system (intervention). Patients in the intervention group downloaded the mobile monitoring application to their smartphones. For the 6-month study duration, the application passively collected metadata on smartphone use, including short message service logs, call logs, and geolocation data. Metadata were analyzed against 3 previously modeled Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnostic criteria for depression and posttraumatic stress disorder, including fatigue, social isolation, and diminished interest.1 Patients could also leave short audio recordings through the application, which enabled voice feature analyses and provided an additional measure of depressed mood. Visual feedback on these 4 metrics were provided to patients via the mobile application (eFigure 1 in Supplement 2) and to clinicians via a desktop dashboard (eFigure 2 in Supplement 2). Clinicians were trained to review the dashboard as part of daily workflows, weekly team huddles, and routine clinical visits with patients in the intervention group.
Outcome Measures
At baseline and 6-month follow-up, patients completed the 2 following primary outcome measures: the Patient Health Questionnaire3 sum score for depression severity, ranging from no depressive symptoms (0-4) to severe major depression (>20), and the Schwartz Outcome Scale4 sum score, ranging from 0 to 60, with higher scores indicating better overall psychological health. A subset of patients in the intervention group completed questions at follow-up on their level of comfort with sharing data with clinicians and whether the application changed their patient-clinician communication. Patients were asked whether they believed this mobile monitoring system respected their privacy (range, 0-10, with 10 indicating very much so).
We used 2 mixed-design 1-within, 1-between analyses of variance with repeated measures on the assessment time factor for our 2 primary outcomes, ie, the Patient Health Questionnaire and the Schwartz Outcome Scale. Statistical significance was set at P < .05, and all tests were 2-tailed. Data were analyzed beginning in July 2018. Final data analysis was conducted in November 2019. All analyses were conducted using SPSS statistical software version 25 (IBM Corp). Additional detail appears in the eMethods in Supplement 2.
Results
Sixty-eight patients were randomized (33 to usual care and 35 to usual care plus the mobile monitoring system). Among them, 55 patients (40 [73%] women; 18 [33%] non-Hispanic white; 14 [25%] non-Hispanic black/African American; 11 [20%] Hispanic/Latinx; mean [SD] age, 36.8 [12.9 ] years) received usual care (27 [49%]) or usual care plus the mobile monitoring system (28 [51%]) as allocated. Overall, 53 patients (96%) completed follow-up surveys, and from the intervention group, 15 patients (54%) completed the user experience survey.
Analysis of variance revealed a significant treatment-by-time interaction effect, supporting decreased depressive symptoms (F1,51 = 4.36; P = .042; partial η2 = 0.08) and improved psychological health (F1,51 = 4.24; P = .045; partial η2 = 0.08) among patients receiving the mobile monitoring system compared with usual care (Figure 2). A total of 12 patients (80%) from the intervention group who completed the user experience survey reported that they would likely or definitely share mobile monitoring data with clinicians. Eight (53%) reported that the mobile monitoring application had at least somewhat improved their communication with clinicians, and 4 (27%) reported directly discussing scores with their clinicians. Patients felt the application respected their privacy (mean [SD] score, 8.80 [1.82]).
Discussion
In this randomized clinical trial, patients using a mobile monitoring system with clinician access showed significant improvement on depressive symptoms and psychological health compared with patients receiving usual care. This study has limitations, including its small sample size in 1 metropolitan area in the northeastern United States. These results provide initial empirical support for the effectiveness of mobile monitoring systems in outpatient clinical settings.5 Future research will test the intervention in additional clinical populations and examine potential mechanisms by which information on symptoms is associated with clinical decisions and behavioral health outcomes.
Article Information
Accepted for Publication: November 21, 2019.
Published: January 17, 2020. doi:10.1001/jamanetworkopen.2019.19403
Open Access: This is an open access article distributed under the terms of the CC-BY-NC-ND License. © 2020 Place S et al. JAMA Network Open.
Corresponding Author: Danielle Blanch-Hartigan, PhD, MPH, Department of Natural and Applied Sciences, Bentley University, 175 Forest St, Waltham, MA 02452 (danielleblanch@gmail.com).