Employees who decline genetic testing could face penalties under proposed bill – Washington Post

Employers could impose hefty penalties on employees who decline to participate in genetic testing as part of workplace wellness programs if a bill approved by a U.S. House committee this week becomes law.

In general, employersdon't have that power under existing federal laws, which protect genetic privacy and nondiscrimination. But a bill passed Wednesday by theHouse Committee on Education and the Workforce would allow employers to get around thoseobstacles if the information is collected as part of a workplace wellness program.

Suchprograms which offer workers a variety ofcarrots and sticksto monitor and improve their health, such as lowering cholesterol have become increasingly popularwith companies.Some offer discounts on health insurance to employees who complete health-risk assessments. Others might charge people more for smoking.Under the Affordable Care Act, employers are allowed to discount health insurance premiums by up to 30 percent and in some cases 50 percent for employees who voluntarily participate in a wellness program.

[Obamacare revision clears two House committees as Trump, others tried to tamp down backlash]

The bill is under review by other House committees and still must be considered by the Senate. But it has already faced strong criticism from a broad array of groups, as well as House Democrats. In a letter sent to the committee earlier this week, nearly 70 organizations representing consumer, health and medical advocacy groups, including the American Academy of Pediatrics, AARP, March of Dimes and the National Women's Law Center said the legislation, if enacted, would undermine basic privacy provisions of the Americans With Disabilities Act and the 2008 Genetic Information Nondiscrimination Act(GINA).

Congress passed GINA to prohibit discrimination by health insurers and employers based on the information that people carry in their genes. There is an exception that allows for employees to provide that information as part of voluntary wellness programs. But the law states that employee participation must be entirely voluntary, with no incentives for providing the dataor penalties for not providing it.

But theHouse legislation would allow employers to impose penalties of up to 30 percent of the total cost of the employee's health insurance on those who choose to keep such information private.

[Rich Americans seem to have found a way to avoid paying a key Obamacare tax]

It's a terrible Hobson's choice between affordable health insurance and protecting one's genetic privacy, said Derek Scholes, director of science policy at the American Society of Human Genetics, which represents human genetics specialists. The organization sent aletter to the committee opposing the bill.

The average annual premium for employer-sponsored family health coverage in 2016 was $18,142, according to the Kaiser Family Foundation. Under the plan proposed in the bill, a wellness program could charge employees an extra $5,443 in annual premiums if they choose not to share their genetic and health information.

The bill, Preserving Employee Wellness Programs Act, HR 1313, was introduced by Rep. Virginia Foxx, (R-N.C.), who chairs the Committee on Education and the Workforce. A committee statement said the bill provides employers the legal certainty they need to offer employee wellness plans, helping to promote a healthy workforce and lower health care costs.

The bills supporters in the business community have argued that competing regulations in federal laws make it too difficult for companies to offer these wellness programs. In congressional testimony this month, the American Benefits Council, which represents major employers, said the burdensome rules jeopardize wellness programs that improve employee health, can increase productivity and reduce health care spending.

A House committee spokeswoman told CNBC that those opposed to the bill are spreading false informationin a desperate attempt to deny employees the choice to participate in a voluntary program that can reduce health insurance costs and encourage healthy lifestyle choices.

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Employees who decline genetic testing could face penalties under proposed bill - Washington Post

Better Buy: Myriad Genetics, Inc. vs. Opko Health, Inc. – Motley Fool

It's been a rough 12 months for Myriad Genetics (NASDAQ:MYGN) and Opko Health (NASDAQ:OPK). Myriad lost nearly half of its market cap during the period, while Opko stock is down around 20%.

Could better days be ahead for these two stocks? And which is the better pick for long-term investors? Here's how Myriad Genetics and Opko Health stack up against each other.

Image source: Getty Images.

There are three primary arguments in favor of buying Myriad Genetics stock. The company is a leader in the U.S. hereditary cancer screening market and is poised to expand its lead. Myriad is quickly growing its non-hereditary cancer business. The company also has significant opportunities in international markets.

How does Myriad plan to grow its U.S. hereditary cancer business? The greatest potential lies in expanding testing beyond breast cancer patients. A key to achieving this objective is with Myriad's myRisk, a single comprehensive DNA test that screens for breast cancer, ovarian cancer, colon cancer, uterine cancer, melanoma, pancreatic cancer, prostate cancer, and gastric cancer.

In Myriad Genetics' fiscal year 2013, only 1% of total testing volume stemmed from non-hereditary cancer screening. The company expects to report that figure is roughly 67% for fiscal year 2017. One primary product making this growth possible is GeneSight, a genomic test used to help physicians prescribe the correct psychiatric medications for patients. Myriad picked up GeneSight with its acquisition last year of Assurex Health.

As for international growth, Myriad is looking over the short term to expand primarily in the Canadian and major European markets. Over the longer term, though, the company plans to grow significantly in Japan, China, and Brazil.

Myriad's management team thinks the company can grow revenue at an average annual rate of more than 10% with an operating margin of at least 30%. The stock is up so far in 2017, thanks to a string of good news for the company -- including positive coverage decisions for Myriad's EndoPredict breast cancer test by multiple Blue Cross Blue Shield plans.

There are two key things to look at with Opko Health: the company's current products and services and its pipeline prospects. Opko currently gets over 80% of its revenue from services provided by Bio-Reference Labs, which it acquired in 2015. Bio-Reference generates solid cash flow and helps Opko market its 4Kscore prostate cancer DNA test.

Opko also has two drugs on the market. Varubi, which is used to treat chemotherapy-induced nausea and vomiting (NINV), is licensed to Tesaro. Rayaldee won U.S. regulatory approval in June 2016 for thetreatment of secondary hyperparathyroidism (SHPT) in adults with stage 3 or 4 chronic kidney disease (CKD). Although it's still relatively early in the commercial launch of Rayaldee, the potential for the drug appears to be quite promising. CKD is the ninth leading cause of death, with most CKD patients dying from cardiovascular disease precipitated by SHPT. There aren't any great options for treating SHPT other than Rayaldee.

Opko has several pipeline candidates. The most eagerly anticipated product is human growth hormone hGH-CTP that Opko is developing in partnership withPfizer. Opko reported disappointing results from a late-stage study of hGH-CTP.However, the company saw some outliers in the clinical data that gave hope that the hormone could potentially still win regulatory approval. Opko and Pfizer are working to advance to a regulatory filing based on an additional statistical analysis of the data.

Unlike Myriad Genetics, Opko isn't turning a profit right now. The company reported a net loss in 2016 of $25 million. However, its bottom line has improved and should get a big boost if Rayaldee picks up steam.

Quite frankly, both of these stocks are risky. Myriad Genetics faces intense competition in the DNA screening business. It's also at the mercy of payers' reimbursement decisions. Opko Health could be derailed if its hGH-CTP doesn't win approval or if Rayaldee sales don't meet expectations.

Personally, my risk tolerance isn't enough for me to buy either of these stocks. However, I thinkOpko gets the nod as the better choice between the two. The basis of my decision was on the opportunity that Opko has if things go its way. Granted, that might not happen. But if the company enjoys some good luck, the stock could soar.

Keith Speights owns shares of Pfizer. The Motley Fool has no position in any of the stocks mentioned. The Motley Fool has a disclosure policy.

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Canada’s new genetic privacy law is causing huge headaches for Justin Trudeau – Science Magazine

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By Wayne KondroMar. 10, 2017 , 6:00 PM

A vote in Canadas Parliament to approve a genetic privacy bill is creating a self-inflicted political headache for Prime Minister Justin Trudeaus Liberal governmentand could result in a relatively rare and unusual court case.

The Genetic Non-Discrimination Act, originally introduced in 2013 by now-retired Liberal Senator James Cowan, is aimed at preventing the use of information generated by genetic tests to deny health insurance, employment, and housing, or to influence child custody and adoption decisions. It calls for fines of up to $740,000 and prison terms of up to 5 years for anyone who requires any Canadian to undergo a genetic test, or to disclose test results, in order to obtain insurance or enter into legal or business relationships. The bill bars discrimination on the grounds of genetics, and the sharing of genetic test results without written consent (with exemptions for researchers and doctors).

Supporters said the law is needed to encourage Canadians to make greater use of genetic testing. Currently, they claimed, many Canadians refuse genetic tests in the course of care or clinical trials because they fear insurers or others could use the results against them. But opponents of the bill, including health and life insurers, argued a ban would increase treatment and insurance costs. Instead, insurers support a voluntary code regulating the use of genetic tests in underwriting life insurance policies; it would allow insurers to require tests only for policies worth more than $185,500. Trudeaus Liberal Party cabinet also formally opposed the measure, with Justice Minister Jody Wilson-Raybould arguing that the bill is unconstitutional because it intrudes on powers given to Canadas 13 provincial and territorial governmentsto regulate insurance.

Those arguments, however, failed to sway lawmakers. On 9 March, members of Parliament voted 22260 to approve the measure. More than 100 Liberal members voted for the bill, taking advantage of a so-called free vote, which allows members to vote their conscience rather follow the party line.

The vote was applauded by Bev Heim-Myers, chair of the Canadian Coalition for Genetic Fairness in Kitchener, which represents 18 disease-based organizations. Finally, the voices of Canadians, and the voices of science and medicine, were heard, she says.

The result has prompted Trudeaus government to consider extraordinary measures to block the legislation. Normally, the bill would become law once it is approved by Canadas governor-general (and in this case, after Canadas Senate approves a minor amendment requested by the House of Commons). The governor-general, who represents the queen of England, is a holdover from Canadas past as a British colony, and typically rubber stamps legislation passed by Parliament.

To delay and potentially kill the legislation, Trudeaus government is considering not sending the bill to the governor-general (a tactic that doesnt appear to have been used since the 1920s), and instead asking Canadas Supreme Court to rule on the bills constitutionality. That process could take up to 2 years.

Cowan, the bills original sponsor, says he cant fathom the rationale behind the governments stance. Is it really up to the government of Canada to defend provincial jurisdiction, or the insurance industry? he asks.

Prominent legal scholars are skeptical of the governments claim that the law is unconstitutional. Canadas Supreme Court has previously held that federal criminal law can apply to regulating food, drugs, guns, and other areas in which the goal is to mitigate so-called social evils, they note. And the claim that the bill infringes on provincial power to regulate insurance may not hold up, because the law applies equally to all commercial sectors.

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Genetics and cancer: why testing can aid prevention – WRVO Public Media

No one wants to talk about cancer. A disease that has taken the lives of so many, even the word itself has an ominous connotation. But as much as we dont want to talk about it, new genetic technology suggests that starting the conversation about your familys cancer history might be in everyones best interest.

In her new book, "A Cancer in the Family: Take Control of your Genetic Inheritance," Dr. Theodora Ross addresses how our familys medical history plays a role in our health. To shed some light on the genetics of cancer, as well as genetic counseling, Ross spoke with Take Care to explain the importance of knowing your family history. Ross, a cancer geneticist, is director of University of Texas Southwestern Medical Centers cancer genetics program.

First and foremost, Ross says that while you may feel theres nothing you can do about an impending cancer diagnosis, knowing is always better than not knowing. Ross herself was hesitant to find out about her own genetics, even though she's a cancer expert and has a family history of the disease, including a sister with breast cancer. But when she developed a melanoma in 2004, she decided it was time to talk to a geneticist and a genetic counselor.

Ross attributes her hesitation to truthiness, which occurs when we want something to be true. Often when it comes to health, we ignore or deny potential problems. We dont go to doctors when were healthy, we dont want to believe there could be a problem, and so we dont look.

But Ross says knowing the family history of a patient is an important step in prevention, and helps not only the patient, but researchers too. Genetic counselors can go to physicians and obtain medical records, which gives researchers more data to work with, and gives patients an accurate understanding of their family history.

According to Ross, the most common genetically inherited cancer syndrome is Lynch syndrome, which occurs when there is a mutation in mismatched repaired genes. This mutation will lead to a predisposition to colon, endometrial, ovarian, pancreatic, and other cancers. The kicker? Only 5 percent of people with this syndrome actually know they have it, and its common. About one in 300 have it, says Ross. And if they knew, they could carry out preventative measures such as frequent colonoscopies and check-ups.

Comprehensive genetic testing is becoming cheap enough, according to Ross, for people to seek out this information at a reasonable cost. Genetic counselors, she says, have an incredible ability to connect with their patients while providing them with the information they need to make the most of their genetic history. Talking about cancer in the family can be a scary conversation, but its crucial, says Ross, to aid in our efforts towards prevention.

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Tennessee Bird Flu Shares Name, Not Genetics, Of Feared China Strain – Huffington Post

The strain of bird flu that infected a chicken farm in Tennessee in recent days shares the same name as a form of the virus that has killed humans in China, but is genetically distinct from it, U.S. authorities said on Tuesday.

The U.S. Department of Agriculture identified the strain in Tennessee as H7N9, following a full genome sequencing of samples from the farm. It said all eight gene segments of the virus had North American wild bird lineage.

On Sunday, the USDA confirmed the farm in Tennessee was infected with highly pathogenic bird flu, making it the first case in a commercial U.S. operation in more than a year.

In China, at least 112 people have died from H7N9 bird flu this winter, Xinhua news agency said on Friday.

However, that virus has Eurasian lineage, U.S. flu experts said.

Even though the numbers and the letters are the same, if you look at the genetic fingerprint of that virus, it is different, said Dan Jernigan, director of the influenza division at the National Center for Immunization and Respiratory Diseases at U.S. Centers for Disease Control and Prevention.

Jernigan said the risk to humans from the virus found in Tennessee is low. Genome sequencing shows the H7N9 virus did not have genetic features present in the virus in China that make it easier for humans to become infected, he said.

The virus found in Tennessee likely mutated to become highly pathogenic from a less dangerous, low pathogenic form, he said.

Disease experts fear a deadly strain of bird flu could mutate into a form that could be passed easily between people and become a pandemic.

Multiple outbreaks of the virus have been reported in poultry farms and wild flocks across Europe, Africa and Asia in the past six months. Most involved strains that were low risks for human health, but the sheer number of different types, and their simultaneous presence in so many parts of the world, has increased the risk of viruses mixing and mutating - and possibly jumping to people, according to disease experts.

Chinas Center for Disease Control and Prevention has said the majority of people infected by H7N9 in China reported exposure to poultry, especially at live markets.

Identifying the viruses in Tennessee and China both as H7N9 is similar to having two cars from different states with the same license plate number, said Carol Cardona, avian flu expert at the University of Minnesota.

The strain in Tennessee is NOT the same as the China H7N9 virus that has impacted poultry and infected humans in Asia, the USDA emphasized in a statement.

While the subtype is the same as the China H7N9 lineage that emerged in 2013, this is a different virus and is genetically distinct from the China H7N9 lineage, the USDA added.

U.S. officials are working to determine how the Tennessee farm, which was a supplier to Tyson Foods Inc, became infected. All 73,500 birds there were killed by the disease or suffocated with foam to prevent its spread.

Tyson, the worlds biggest chicken company, is hopeful this is an isolated incident, spokesman Worth Sparkman said.

Authorities have not identified the name of the farm or the town in Lincoln County, Tennessee, where it is located.

(Editing by Matthew Lewis and Bernard Orr)

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How Global Warming Is Threatening Genetic Diversity | JSTOR Daily – JSTOR Daily

The meltwater stonefly has adapted to a very specific and extreme niche the cold, clear water that pours off of the melting ice and snow from the glaciers in Glacier National Park in Montana. This bug is on the leading edge of climate change because its frigid mountain habitat is rapidly disappearing. Since 1850, 85 percent of the ice in Glacier has disappeared, and all of it is forecast to vanish completely by 2020.

In a study published in 2016, researchers found the cold-loving insect in trouble. Their physiology requires really, really cold water, and they cant survive once the water gets above an average of 9 degrees Centigrade during August, said Joe Giersch, a biologist with the U.S. Geological Survey (USGS), who has studied this and a similar insect, the western glacier stonefly.

Meltwater stoneflies and western glacier stoneflies move upstream to find cold water as things warm, and because of steeper mountain topography, populations become separated. This has interrupted gene flow, causing some genetics to disappear. As genes dwindle, the species is losing genetic variation and likely adaptive capacity the genetics that give species the ability to evolve needed traits as habitat conditions change. Its a big part of why the meltwater stonefly (Lednia tumana) is being considered for listing as threatened under the federal Endangered Species Act.

And many of its fellow high-altitude insects are in trouble too. This stonefly, Giersch and his co-authors wrote, likely represents a guild of species facing similar threats in alpine headwaters worldwide.

There is a huge unknown when it comes to protecting the meltwater stonefly and other species. Biologists are missing a huge piece of the puzzle knowing which genetics will give species the evolutionary lift that allows them to adapt successfully to a warmer world. This hidden DNA and the possibly important traits it represents are known as cryptic diversity, and much of it is being lost, experts say, as the range of species contracts, fragments, and otherwise changes. Yet this DNA is vital because it contains information on different lineages and on species that are emerging, the cutting edge of evolution. Losing it will greatly complicate the task of assessing how climate change will affect biodiversity and what to protect.

Genetic diversity in foundational plant species alpine flowers, cottonwoods, or tall grass prairie drive hundreds if not thousands of other species.

What disappears before we know it could have far-reaching consequences. A long-term research project on the genetic variations in cottonwood trees, called the Cottonwood Ecology Group, found that the genotype of a tree affects the communities of some 700 insect species that depend on it, as well as chemical emissions, microbes, bacteria, lichens, beavers, and birds that feed on the insects. Should important genotypes disappear, whole ecological communities could change in unpredictable ways. Genetic diversity in foundational plant species alpine flowers, cottonwoods, or tall grass prairie drive hundreds if not thousands of other species, said Thomas Whitham who heads the project at Northern Arizona University. Thats why climate change is an evolutionary event.

Often where the climate is changing fastest is where species are affected most. The bull trout, a threatened species that depends on very cold water in the Pacific Northwest, is also being impacted by warming. What we found is that genetic diversity is lowest in those locations that are going to experience the greatest climate change and the most stressful environmental conditions, said Ryan Kovach, a USGS fisheries biologist in Glacier National Park who has published papers on the subject of bull trout and climate. In other words they dont have genetic diversity where they are most likely to need it. Thats because there are fewer fish in these habitats because of already stressful conditions.

These kinds of genetic studies are a race against climate warming that is happening far faster than predicted. Although genetic diversity is literally the fundamental building block for all life, it is almost completely ignored in the context of climate change, said Kovach.

Carsten Nowak, a conservation biologist at the Senckenberg Research Institute and Natural History Museum in Gelnhausen, Germany, has also studied the genetics of climate change response in alpine insects, as well as in wolves and other species.

In 2011 Nowak and his colleagues conducted research in high-country Europe that looked at seven species of caddis fly and one species each of mayfly and stonefly, which like the stoneflies in Glacier National Park are cold-loving bugs. The scientists examined the species genetics and divided them into a finer scale, populations within the species that are genetically distinct from each other, something known as Evolutionary Significant Units (ESUs).

If the climate scenario doesnt change, according to their work, 79 percent of the ESUs will go extinct by 2080, decimating hidden genetic diversity. If greenhouse gas emissions are reduced by the amount needed to cap global warming at 2 degrees Celsius, as the Intergovernmental Panel on Climate Change has urged, then 59 percent of the ESUs are projected to disappear.

Nowaks study predicted that the loss of genetic diversity in Europe would be most marked in the Mediterranean region of southern Europe, which is also the area of the continent with the greatest genetic diversity. Even if populations disappear, no one knows what the loss represents. We need to know if there are ten populations and nine disappear does that matter? Nowak said.

Portuguese researchers forecasted in a paper published in February of 2016 that many lineages of amphibians and reptiles on the Iberian peninsula, which is expected to be hardest hit by warmer and drier weather, could disappear or contract within the next half century, causing a loss of cryptic diversity with implications to evolutionary processes.

These losses are important because a species, for example, that is exposed to a new disease, might not be able to evolve resistance to it because the genetics that govern immune response are gone. Or the genes that allow a fish or stonefly to regulate its temperature in warmer water might disappear.

The good news is that there has been a revolution in the ability to sequence DNA its now much faster and far cheaper than ever. The goal of many conservation scientists is to sequence the genomes of a species and then understand which section is responsible for adaptation, including such traits as migratory abilities, dispersal, and the ability to adapt to warmer temperature. Once thats done, it allows managers to allocate scarce resources to protect the populations most essential for adapting to changing conditions.

Can we use the Indian tiger to repopulate Siberia?

Nowak cited the example of the Siberian tiger, whose population has dwindled to a few hundred. Can we use the Indian tiger to repopulate Siberia? he asked rhetorically. If you have a lot of Evolutionary Significant Units and know what they represent, you might want some that are better at cold adaptation or fish catching, to repopulate Siberia. You cant just protect the species, you have to protect the populations, the small units of a species that might have the genes necessary for adaptation. Knowing what they represent is the hard part.

As ecologically important species come on line with their adaptation capacity mapped, it will give managers a powerful tool to triage species to protect the adaptation genetics. They might even affect gene rescues by focusing on the populations with the most vital genes. One of the options we have for the stonefly is translocation moving one population to a different location, said Giersch. Thats after we investigate the hidden adaptations within the DNA to figure out which ones have the ability to adapt to warmer temperatures. Thats a ways down the road.

Two species of trees have recently had their climate genes mapped and adaptive capacity located. A study published in September of 2016 found that two distantly related trees interior spruce and lodgepole pine use the same set of 47 genes to deal with temperature, precipitation and other climate variables. Knowing about these adaptations trees is important because they migrate slowly, over generations, and assisted migration efforts with trees are already underway. We have to understand climate adaptation in other conifers so we can address trees that are becoming mismatched to their environment, said Sally Aitken, a professor of forest and conservation science at the University of British Columbia. That will inform better management strategies, she said, and enable us to plant trees that are more likely to thrive and adapt more quickly to climate change.

By: C. Thompson, E. David, M. Freestone, and C.T. Robinson

Western North American Naturalist, Vol. 73, No. 2 (July 2013), pp. 137-147

Monte L. Bean Life Science Museum, Brigham Young University

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How Global Warming Is Threatening Genetic Diversity | JSTOR Daily - JSTOR Daily

Style anatomy: Rabbiya Abdullah – The Express Tribune

The owner and designer of Pakistans first loungewear label, Blood Orange, shares her personal style

The owner and designer of Pakistans first loungewear label, Blood Orange, shares her personal style. Find out what caused her style evolution and what she considers the biggest fashion mistake!

Understanding your body is the key to looking good and a trait found amongst all impeccably dressed fashionistas. While people shy away from talking about their bodies, these brave souls explain how they work their anatomies to their advantage

How would you describe your body type?

I would say I have an hourglass figure.

Has your body type changed over the last five years?

I used to be quite lean and thin naturally, but for the last few years its become hard to maintain my weight.

How has your style changed over the years?

My style has definitely become more laidback. It has also quite literally become a reflection of my personality.

In your opinion what is your most troublesome area?

My thighs!

How do you dress your body according to your body type?

I like monochromatic colours and simple cuts as they complement my body and easily hide my problem areas.

In your opinion what is the biggest mistake a person can make while dressing here?

Here people focus more on incorporating labels in their outfits, and dont think about what looks good or fits with their personality. Style isnt original or personal anymore. Also, I dont like cluttered looks. I always notice someone whose style and ensemble is well put together.

Which silhouettes suit your body the most?

I prefer flared cuts to fitted silhouettes.

What is the one piece of clothing that you shy away from wearing and why?

I usually avoid vibrant colours and exaggerated garments. I am a minimalist!

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Style anatomy: Rabbiya Abdullah - The Express Tribune

ACC 2017: CVD Outcomes for Evolocumab, Intermediate-Risk TAVR, Coronary Physiology Tests, and More – TCTMD

Returning to their own backyard again this year, the American College of Cardiology (ACC) 2017 Scientific Sessions kick off next Friday with high hopes of giving the world some headlines to compete with other news coming out of the nations capital. Among the hot-ticket items on this years roster are a large, cardiovascular outcomes trial for a market-approved PCSK9 inhibitor, a randomized comparison of a non-vitamin K antagonist oral anticoagulant (NOAC) against aspirin in acute coronary syndromes, and 2-year outcomes from ABSORB III, the pivotal randomized trial that led to US approval of the first bioresorbable scaffold in 2016.

According to the ACC 2017 program chairs, who spoke with media via a telebriefing last week, this years conference attracted over 2,600 abstracts, of which 114 were late-breaking clinical trial (LBCT) submissions. A full 23 of these were selected as late breakers, and an additional 17 submissions are grouped in the featured clinical research sessions. There are a total of five LBCT sessions and three featured clinical research sessions distributed throughout the 3-day congress, which runs from Friday, March 17, through Sunday, March 19.

Were incredibly excited about this upcoming meeting, Jeffrey Kuvin, MD (Dartmouth-Hitchcock Medical Center, Manchester, NH), enthused during the telebriefing. Were confident there will be numerous practice-changing science presentations.

Chief among those is shaping up to be FOURIER, the 27,500-patient cardiovascular outcomes trial testing the PCSK9 inhibitor evolocumab on top of statin therapy against statins alone for the prevention of cardiovascular death, nonfatal MI, nonfatal stroke, hospitalization for angina, or coronary revascularization. As previously reported by TCTMD, the company announced in February that the trial had met its primary and secondary endpoints, but full details on those will be released in the opening LBCT session at ACC.

This is undoubtedly going to be a widely noted study and has the potential to be truly game changing, Kuvin said

Fleshing out Fridays opening LBCT session are the SPIRE I and II results looking at cardiovascular outcomes with a second PCSK9 inhibitor, bococizumab. These trials were stopped early in late 2016 after trial monitors noticed an unanticipated attenuation of LDL cholesterol lowering over time combined with an increase in immunogenicity and injection-site reactions.

The third trial in what the ACC has dubbed its opening showcase is SURTAVI, the pivotal trial testing the CoreValve transcatheter valve (Medtronic) in intermediate-risk patients with severe symptomatic aortic stenosis. The trial, which was initially launched outside the United States and then extended to include US patients, is anticipated to pave the way for an expanded US Food and Drug Administration (FDA)-approved indication later this year.

Day two of ACC 2017 includes two LBCT sessions, the first of which is jointly hosted by the Journal of the American College of Cardiology and the Journal of the American Medical Association.

During the telebriefing, Kuvin highlighted EBBINGHAUS, a cognitive function substudy from FOURIER, as well as two NOAC studies in that session. The first of these, EINSTEIN CHOICE, is looking at rivaroxaban versus aspirin for extended treatment of venous thromboembolism, while the second, GEMINI-ACS-1, is comparing rivaroxaban and aspirin on top of P2Y12 inhibition for patients post-ACS.

ACC 2017 Vice Chair Andrew Kates, MD (Washington University in St. Louis, MO), also speaking on the media telebriefing, took over from Kuvin to list some of the highlights of the remaining two LBCT sessions. Topping Kates list was ABSORB III. When the primary results of the study were released in 2015, the Absorb BVS (Abbott Vascular) was noninferior to DES at 1 year, Kates noted, adding that severalbut not allstudies have pointed to an increased rate of scaffold thrombosis with the bioresorbable device after 1 year. What were excited about at ACC 17 is well be hearing the interval data between years 1 and 2 [as well as the] the 2-year data in this session, Kates said, adding, Certainly its going to be important data that were looking forward to hearing.

Kates highlighted a number of other key trials throughout the program. These included LEVO-CTS looking at the use of levosimendan in patients with LV systolic dysfunction undergoing cardiovascular surgery with cardiopulmonary bypass, part of Sundays LBCT IV session co-hosted by JACC and the New England Journal of Medicine. Also in LBCT IV, Kates noted, is a trial testing a cerebral protection device during cardiac surgery.

While using embolic protection devices is safe and does capture embolic material, Kates said, its really not clear whether these devices really do anything to prevent strokes, or if they may reduce cognitive decline after surgery. This is certainly a very important topic that we all care about.

Finally, from LBCT V, Kates highlighted two heart rhythm studies, RE-CIRCUIT and ARISTOTLE. The first is looking at a relatively new drug, dabigatran (Pradaxa, Boehringer Ingelheim), used without interruption during ablation for atrial fibrillation. The second is looking at an old drug, digoxin, in A-fib patients with and without heart failure.

For Interventionalists: TAVR and FFR/iFR

Interventionalists attending ACC 2017 will find plenty of other late breakers relevant to their subspecialty. Updates from transcatheter valve studies are dotted throughout the LBCT and featured clinical research sessions, including, in LBCT IV, an MRI analysis of microbleeds during TAVR and two studies looking at subclinical leaflet thrombosis in surgical and transcatheter valve prostheses. Saturdays featured clinical research session is focused on interventions and comparisons of SAVR and TAVR; transcatheter valve replacement for native versus failed surgical bioprostheses; and TAVR for bicuspid versus tricuspid valve disease. The same session also has a presentation addressing 1-year outcomes with the MitraClip (Abbott) in the US following FDA approval.

Coronary disease is also front and center, particularly in LBCT IV. This session includes a trial of culprit lesion versus complete revascularization in STEMI, plus two randomized trials of fractional flow reserve (FFR) versus instantaneous wave-free ratio (iFR): DEFINE-FLAIR and iFR-SWEDEHEART. These two large CV outcomes trials will determine how the physiologic information provided by iFR compares with the usefulness of FFR in guiding treatment.

Research and Practice

Beyond the late breakers and featured research, this years ACC has11 learning pathways including one on special topics spanning everything from malpractice minefields to public reporting. There are also seven keynote lectures, including one by Janet S. Wright, MD, executive director of the joint Centers for Disease Control/Centers for Medicare & Medicaid Services Million Hearts initiative, now perilously close to its deadline of preventing 1 million heart attacks and strokes by the end of 2017. Another keynote will be delivered by NEJM Editor-in-Chief Jeffrey Drazen, MD, speaking on data sharing in clinical trials. Drazen famously penned a controversial editorial in the journal poking holes in the Open Data proposal set forth in draft form by the International Committee of Medical Journal Editors and referring to the risk of research parasites, a position he revised in a second editorial days later.

The entire TCTMD editorial teamCaitlin Cox, Yael Maxwell, Laura McKeown, Todd Neale, Michael ORiordan, and me, Shelley Wood, will be on the ground at ACC 2017. Follow us on Twitter for breaking news and find our in-depth stories on our conference coverage page.

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ACC 2017: CVD Outcomes for Evolocumab, Intermediate-Risk TAVR, Coronary Physiology Tests, and More - TCTMD

The Neuroscience of Seeing an Ex – Discover Magazine

When I arrived at the wine bar, there was only one open table dimly lit and intimate. The booze, music and candlelight felt like a callback to our first kiss 15 years before, almost to the day.

There was no sign of him, so I ordered a chardonnay and two small plates, and tried to focus on the novel I brought with me, ironically titled What She Knew. Instead, I found myself flashing back to the last time I saw him.

We had just returned from a trip to Napa to scout wedding venues. After a heated kiss, I drove to my apartment 95 miles away.

Days later, I learned hed been cheating on me, and I ended our six-year relationship the best of my life up to that point with a two-line email. He fired back with a litany of messages, which began with profanity and culminated in pleas.

PLEASE DONT LEAVE ME. . . YOU ARE MY EVERYTHING, he screamed through the screen.

He sent texts, letters, roses, and initiated countless hang-up calls.

I never responded. I never told him a mutual friend confirmed my suspicions. I never considered reconciling.

Over the years, we corresponded intermittently, but not about anything deep and never to revisit our history. But when work took me to his hometown of Santa Barbara, I reached out and asked if hed like to meet.

Im happily married with kids. Hes engaged. Whats the harm?

Apparently my urge to reconnect with an ex makes sense. The brain develops pathways based on learned patterns, says love expert Helen Fisher, a senior research fellow at the Kinsey Institute, Indiana University. So, if you laid down a powerful pattern that this person was your life partner, your brain can retain traces of that circuitry, even after youve bonded with someone new.

Nevertheless, I struggled to understand why, even though its certainly not the case for everyone especially those who have had toxic relationships I felt so comfortable sitting across the table from someone who pulled the rug out from under me. So down the rabbit hole I went to find out what happens in our brains when we reunite with an old love.

Laying Down a Template I met Ben (not his real name) when we were both 26. We had a sweet, albeit star-crossed romance. He was an irrepressible free spirit, a dreamer, a romantic. I was an ambitious type A who played it safe. Like peanut butter and jelly, we complemented each other.

He was the first to make me dinner, teach me to surf in ice-cold waters and unlock the seemingly impenetrable fortress of my body. Together, we formed our identities and defined what love meant. In the process, he ingrained himself into my psyche.

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The Neuroscience of Seeing an Ex - Discover Magazine

Q&A: Neuroscience major Alex Gogliettino ’17 explores ‘what makes us who we are’ – Bates News

As an English major, I can guarantee that I wont be called upon to inject a drug into a mouse brain. But for neuroscience honors candidate Alex Gogliettino 17 of Branford, Conn., thats a basic skill.

Already accepted into doctoral programs in neuroscience for next year, Gogliettino has spent hundreds of hours in a Bates lab using a mouse model to analyze and interpret a possible treatment for an exceptionally rare autism-spectrum disorder in humans.

In preparation for his honors thesis research, he spent the past two summers working at Yale University in the lab of Dr. Marc Potenza, receiving support from a Bates Summer Research Fellowship and the Kelsey Prize for Neuroscience Research, named for Professor Emeritus of Psychology John Kelsey.

This year, hes brought all his Bates training to bear on his thesis, DNA Methylomics: Targeting TET1 as a Treatment for Intellectual Disability, and as he explained it to me, this was my immediate thought: This is important, and I need to know more.

My adviser and I are basically knocking down a protein that is, blocking it from being made in the brain to try to enhance learning and memory in mice that have been genetically modified to have a certain intellectual disability.

The protein is the one in my thesis title: TET1, or Ten-eleven translocation methylcytosine dioxygenase 1.

We are also trying to better understand the molecular mechanisms that underpin learning and memory.

Thats one of the biggest challenges in science: Communicating to individuals who are not necessarily involved in science what exactly you are doing.

My actual thesis delves deeply into the molecular biology, but in the first few pages I discuss what this topic means to me personally and how it is addressing a societal issue and a pressing biomedical issue, intellectual disability. I explain why Im intrigued by it.

OK, this gets pretty philosophical. Humans have the capacity to recall just crazy amounts of detail from earlier parts of our lives. And that capacity really is what makes us who we are. We are what we can remember about our past. Thats just crazy, and its just a unique, really interesting puzzle.

And also, there are diseases of the brain, like Alzheimers and many others, where individuals cant do that. And in rare disorders like the one I am studying, Pitt-Hopkins Syndrome, they have impaired language and memory function.

Individuals with this disease are missing a functional copy of a single gene known as Transcription Factor 4.

Pitt Hopkins is an extremely rare disease. There are only about 500 people in the world that we know of. Individuals with Pitt Hopkins Syndrome often do not develop language spoken or sign.

My project is based on Pitt Hopkins research being done at Bates by my thesis adviser, Andrew Kennedy. We think one of the reasons is a disruption in their capacity for verbal memory.

Hes new, and I didnt really meet him until this year.

Last year, I was taking a neuroscience class, and my professor, Nancy Koven, was saying how Bates was hiring a new professor and we should go to the research talk that each candidate gives. I went and I thought that he was asking really interesting questions about learning and memory.

So I just emailed him, a cold email saying, I would love to work with you. He emailed me back and said, That would be cool. Here are the projects that you can work on.

Alex Gogliettinos thesis adviser is Assistant Professor of Chemistry Andrew Kennedy, shown teaching an organic chemistry lab on Feb. 9, 2017, in Dana Chemistry Hall. (Josh Kuckens/Bates College)

I really like working with him. Hes always available through email, phone, etc. Hes only 33 and has just finished his post-doc so he knows whats like to be an undergrad.

More important, he also went to a small college, Providence College, so he knows what the relationship between a small-college professor and a student is. He really cares and understands that this whole thing is a learning experience.

The most important part was to make sure I familiarized myself with the literature, so I started reading last May. Thats probably one of the hardest parts of a project like this: wrapping your head around what is actually happening in the field, where the barriers to new knowledge are, and what we know vs. what we dont know. That is a really important part of science.

Last semester, almost every morning from around 9 to 12, I would write. I would have the most energy in the morning, and writing is very taxing, thats the best time for me.

The spot where I wrote really didnt matter. I would just go somewhere I was comfortable and could work for three hours. It would depend. I would mix it up. First floor of the library sometimes. Then the third floor, then the second floor. And sometimes in my room at my desk.

When you start familiarizing yourself with the field, the first pieces of literature you are going to read are pretty intense. Honestly, reading a scientific paper in an unfamiliar field takes about five hours to go through. Youve got to just take your time and start as early as you possibly can.

I started out with reading review articles, which are not necessarily studies per se, but are reviewing the literature. They give you a scope of the field. They give you perspective, help you familiarize yourself with the jargon and, again, tell you whats known and whats not known about the field.

And once I started to get a feel for that, I started delving deep into the hard-core research papers. It was daunting, a little bit, but I would just take my time.

The most interesting part are the questions we are asking about our ability to recall thingsfrom the past, and how that fits into the bigger picture of understanding how the brain gives rise to consciousness. That is the coolest part.

I think the most difficult part is that this work is technically difficult and very time-consuming. Thats not negative, just challenging.

Working with animals requires a good amount of dexterity and injecting drugs into a mouse brain is pretty hard. In the grand scheme of cognitive neurobiology research, its pretty simple surgery, but at the undergraduate level it is probably one of the most challenging things that I would do.

Neuroscience major Alex Gogliettino 17 of Branford, Conn., poses in a Carnegie Science Hall laboratory on Feb. 28, 2017. The red light helps create a calm environment for the labs work with mice. Since mice cannot see red light, they behave as they would in their preferred, darkened environment. (Josh Kuckens/Bates College)

Also, another component of my thesis involves working with big data and doing computer-science work, so I had to teach myself a lot of computer science stuff, too. That was tough and challenging, but you grow and learn a lot from it.

Especially with lab theses, there is only a certain amount of control when you run the experiments. And there is a lot of stuff you cant control. That is just going to happen.

One of the most important parts of doing thesis, and being involved with science at all, is just understanding that nothing is ever going to be perfect. You are going to mess up and you are going to fail. But dont be discouraged or shy away from that. Just learn from your mistakes and move on. Be a little too optimistic at times because you need that positive energy to keep going, because there will be a lot of roadblocks to be found, but you can overcome them.

I hope to continue doing neuroscience research for the next five years, at least.

Ive been accepted to a couple neuroscience Ph.D. programs, at Washington University and Vanderbilt, and am heading to Stanford for interviews this week.

I have the potential opportunity to work with a professor who advised Professor Kennedy, doing the same sort of work at a research university that were doing here at Bates.

Interviews are just a great time to talk science with professors and be immersed in an environment where everyone is as passionate about studying neuroscience as you are.

Original post:
Q&A: Neuroscience major Alex Gogliettino '17 explores 'what makes us who we are' - Bates News