Category Archives: Health

This Cannabis Dispensary Directory Is Blowing Up

Recently, as the public interest in cannabis has grown so much and four new states legalized marijuana, we discovered a great new website tracking cannabis dispensaries around the country called Dispensary Genie. Here is what we learned when we interviewed them about their project.

As the legalization of cannabis continues to spread across the United States, picking up some should be easier than ever – right? Consumers with all levels of cannabis experience are discovering that finding a place to purchase cannabis legally using other dispensary listing sites can be almost as frustrating as waiting for ‘their dude’ was in the days of prohibition. That is because these sites are often jam-packed with advertisements, fake reviews and lack the perspective visitors are looking for.

Fortunately, we are offering a better way to learn more about dispensaries in your area. Dispensary Genie’s commitment to providing cannabis consumers with an easy to use comprehensive way to learn more about your favorite local dispensaries in a concise and clean format is reflected in our slogan ‘unlimited wishes’. Here you can find essential info like hours and customer requirements (ex: age, recreational, medical card), phone numbers and addresses, as well as the story behind your favorite dispensary. Our fast-loading, easy-to-use site design allows you to conveniently make a call to the dispensary of your choice or get directions with one touch.

Dispensary Genie has more than just the basics. We let you know what to expect when you visit a particular dispensary. You can explore the interior of each cannabis business as well as their underlying philosophy. Some dispensaries are ideal for a quick stop to pick up familiar products while others are best for browsing the variety of products and absorbing the customer experience they have to offer.

In your searches for dispensaries online, you’ve likely noticed they can be inundated with spammy reviews. The volume of these irrelevant messages can make it difficult to get an accurate feel for the establishment. Every review left on Dispensary Genie is from an actual customer – not the business itself, a bot or other malicious actors.

Even if you already have a go-to dispensary, you can use Dispensary Genie to keep your finger on the latest industry news. When CBD products started to become mainstream, we compiled a CBD Gummy Gift Guide, CBD Drops and Tinctures Gift Guide and recently, the best CBD cigarettes of 2021. For those new to cannabis, introduction topics are also covered in a lot of other posts such such as vaping vs smoking, buying from your friend vs buying from a dispensary, your first time trying edibles, and knowing the difference between marijuana and hemp among other topics.

While the directory is rather new, it’s already gaining traction because of the shear wealth of information on marijuana dispensaries that it provides, as well as its presence as an informational resource on the cannabis industry in general. If you haven’t yet heard about it, we suggest you check them out right away and bookmark them as they are sure to become a leading source of cannabis.

Smoking CBD Hemp May Ease Your Arthritis Pain

Arthritis is one of the many “silent” ailments affecting the nation. While you don’t hear as much about arthritis as you do other headline-grabbing conditions, the truth is that over 20 million people suffer with severe, debilitating arthritis pain every single day. Luckily, CBD hemp may be the answer.

Arthritis is also a condition that is not well understood by most people. Arthritis can be much more than simply “joint pain.” There are actually over 100 different types of arthritis, and while some may cause local discomfort in the fingers, others can also cause a number of other serious symptoms: sensitivity and pain throughout the entire body, sciatica that makes normal activity difficult, even depression and low energy.

Moreover, there is no “cure” for most forms of arthritis. Nor are all forms fully understood. Those diagnosed with the condition must therefore, instead, consider ways to manage the pain and maintain an acceptable quality of life.

CBD hemp might provide an answer.

What is CBD Hemp and How Does it Treat Arthritis Pain?

CBD is a cannabinoid that comes from the hemp plant. While it can be extracted from cannabis, it is NOT psychoactive like THC and will not cause a person to get “high”.

What CBD can do however, is to treat both inflammation AND pain. It does this by binding to a network of cell receptors called the endocannabinoid system. These cells are responsible for controlling such things as mood, memory, immune function, appetite, sleep, and pain.

Seeing as many forms of arthritis are autoimmune conditions – meaning that the body is attacking itself (thus leading to inflammation/swelling) – CBD appears to be beneficial in reducing that swelling. What’s more, is that CBD can help to improve the mood AND reduce the experience of the pain.

For these reasons, more and more people are now using CBD-based products to manage arthritis symptoms – with extremely promising results.

Why Smoke CBD?

While CBD hemp can be taken in many forms, oral use (using a pill) is not the most effective for treating your arthritis. This is because orally ingested CBD has low “bioavailability.” This means that while you might have consumed a certain amount of CBD, only a small portion of that will be usable by your body.

In other words, are you actually benefiting from the CBD that you’re taking? That’s a pretty significant question. If you’re swallowing a pill and only getting 10% of the dose effectively, then you’re throwing money down the drain. Most importantly, you’re not getting the effects, which you may need to function more normally.

Sublingual actually means beneath the tongue and this is one way that you can use any orally ingested psychoactive compound. By placing the pill beneath your tongue, it will actually dissolve more quickly and enter the blood stream. But while sublingual administration is preferable to simply swallowing, the fact still remains that pills won’t be as potent as vaping or smoking.

Another issue with using any pill form of drug is that you are introducing more chemicals and ingredients into your system. Pills need binding agents and coatings and in some rare cases, these can cause allergic reactions. And while marijuana use is now legal in California, it’s still possible that you might have acquired the substance from a less well-regulated source (shall we say…) – meaning that there’s a high chance it may have been contaminated or even cut with other things. Apart from anything else, smoking CBD hemp cigarettes and vaping CBD hemp are definitely more hygienic!

New York Restaurants Closed By 2021 Says Study

  • Most New York restaurants will be closed by 2021 due to coronavirus restrictions
  • No new economic relief coming for restaurant owners

It is now September and indoor dining is still prohibited in New York State, drastically reducing the workforce and sales in the restaurant industry. New York restaurants closed due to air circulation having a detrimental effect of spreading the virus fast in other countries.

According to a recent study by the New York State Restaurant Association, over half the remaining restaurants will be closed, estimated at a whopping 66% permanent closures.

Upwards of 66% of the state’s cafés, bars and restaurants could be gone for all time by the end of this year on the very likely chance that they don’t get considerable government help, as per the study. The review surveyed 1,042 of the state’s 50,000+ eateries and discovered that 63.6 percent of restaurateurs were “likely” or “fairly likely” to close their doors completely in the following four months ahead. The greater part of those who responded said they would be compelled to close their entryways before November in the event that they don’t get some type of monetary alleviation.

Numerous cafés got advances through the widely popular Paycheck Protection Program (PPP) when the pandemic first hit and a stimulus was created through congress, yet more and more establishments have been shutting down as that cash runs out and further monetary alleviation is withheld from the bargaining table in the state congress.

Reviews like those from the NYSRA are simply expectations, but on the other hand they’re probably the best proportions of the pandemic’s cost for the New York restaurant industry at the present time, given that there’s no state or government organization reporting eatery terminations progressively.

Recently, the NYSRA anticipated that upwards of 11 percent of the state’s eateries and bars — amounting to roughly about 5,500 organizations — would shudder their doors by May 2020 due to COVID-19. In all reality, however, specialists state that number is likely a lot higher and will just keep on ascending without an unmistakable guide for indoor eating or considerable government mediation, including the $120 billion bill to help free eateries from the perils of this unprecedented economic downturn.

Beyond just promise, CRISPR is delivering in the lab today

Ian Haydon, University of Washington

There’s a revolution happening in biology, and its name is CRISPR. The Conversation

CRISPR (pronounced “crisper”) is a powerful technique for editing DNA. It has received an enormous amount of attention in the scientific and popular press, largely based on the promise of what this powerful gene editing technology will someday do.

CRISPR was Science magazine’s 2015 Breakthrough of the Year; it’s been featured prominently in the New Yorker more than once; and The Hollywood Reporter revealed that Jennifer Lopez will be the executive producer on an upcoming CRISPR-themed NBC bio-crime drama. Not bad for a molecular biology laboratory technique.

Two of the CRISPR co-inventors, Emmanuelle Charpentier (middle-left) and Jennifer Doudna (middle-right), rubbing elbows with celebs after receiving the 2015 Breakthrough Prize in Life Sciences.
Breakthrough Prize Foundation, CC BY-ND

CRISPR is not the first molecular tool designed to edit DNA, but it gained its fame because it solves some longstanding problems in the field. First, it is highly specific. When properly set up, the molecular scissors that make up the CRISPR system will snip target DNA only where you want them to. It is also incredibly cheap. Unlike previous gene editing systems which could cost thousands of dollars, a relative novice can purchase a CRISPR toolkit for less than US$50.

Research labs around the world are in the process of turning the hype surrounding the CRISPR technique into real results. Addgene, a nonprofit supplier of scientific reagents, has shipped tens of thousands of CRISPR toolkits to researchers in more than 80 countries, and the scientific literature is now packed with thousands of CRISPR-related publications.

When you give scientists access to powerful tools, they can produce some pretty amazing results.

The CRISPR revolution in medicine

The most promising (and obvious) applications of gene editing are in medicine. As we learn more about the molecular underpinnings of various diseases, stunning progress has been made in correcting genetic diseases in the laboratory just over the past few years.

Take, for example, muscular dystrophy – a complex and devastating family of diseases characterized by the breakdown of a molecular component of muscle called dystrophin. For some types of muscular dystrophy, the cause of the breakdown is understood at the DNA level.

In 2014, researchers at the University of Texas showed that CRISPR could correct mutations associated with muscular dystrophy in isolated fertilized mouse eggs which, after being reimplanted, then grew into healthy mice. By February of this year, a team here at the University of Washington published results of a CRISPR-based gene replacement therapy which largely repaired the effects of Duchenne muscular dystrophy in adult mice. These mice showed significantly improved muscle strength – approaching normal levels – four months after receiving treatment.

Using CRISPR to correct disease-causing genetic mutations is certainly not a panacea. For starters, many diseases have causes outside the letters of our DNA. And even for diseases that are genetically encoded, making sense of the six billion DNA letters that comprise the human genome is no small task. But here CRISPR is again advancing science; by adding or removing new mutations – or even turning whole genes on or off – scientists are beginning to probe the basic code of life like never before.

CRISPR is already showing health applications beyond editing the DNA in our cells. A large team out of Harvard and MIT just debuted a CRISPR-based technology that enables precise detection of pathogens like Zika and dengue virus at extremely low cost – an estimated $0.61 per sample.

Using their system, the molecular components of CRISPR are dried up and smeared onto a strip of paper. Samples of bodily fluid (blood serum, urine or saliva) can be applied to these strips in the field and, because they linked CRISPR components to fluorescent particles, the amount of a specific virus in the sample can be quantified based on a visual readout. A sample that glows bright green could indicate a life-threatening dengue virus infection, for instance. The technology can also distinguish between bacterial species (useful for diagnosing infection) and could even determine mutations specific to an individual patient’s cancer (useful for personalized medicine).

Feng Zhang, another co-inventor of CRISPR technology, discussing its safety and ethical ramifications.
AP Photo/Susan Walsh

Almost all of CRISPR’s advances in improving human health remain in an early, experimental phase. We may not have to wait long to see this technology make its way into actual, living people though; the CEO of the biotech company Editas has announced plans to file paperwork with the Food and Drug Administration for an investigational new drug (a necessary legal step before beginning clinical trials) later this year. The company intends to use CRISPR to correct mutations in a gene associated with the most common cause of inherited childhood blindness.

CRISPR will soon affect what we eat

Physicians and medical researchers are not the only ones interested in making precise changes to DNA. In 2013, agricultural biotechnologists demonstrated that genes in rice and other crops could be modified using CRISPR – for instance, to silence a gene associated with susceptibility to bacterial blight. Less than a year later, a different group showed that CRISPR also worked in pigs. In this case, researchers sought to modify a gene related to blood coagulation, as leftover blood can promote bacterial growth in meat.

You won’t find CRISPR-modified food in your local grocery store just yet. As with medical applications, agricultural gene editing breakthroughs achieved in the laboratory take time to mature into commercially viable products, which must then be determined to be safe. Here again, though, CRISPR is changing things.

A common perception of what it means to genetically modify a crop involves swapping genes from one organism to another – putting a fish gene into a tomato, for example. While this type of genetic modification – known as transfection – has actually been used, there are other ways to change DNA. CRISPR has the advantage of being much more programmable than previous gene editing technologies, meaning very specific changes can be made in just a few DNA letters.

This precision led Yinong Yang – a plant biologist at Penn State – to write a letter to the USDA in 2015 seeking clarification on a current research project. He was in the process of modifying an edible white mushroom so it would brown less on the shelf. This could be accomplished, he discovered, by turning down the volume of just one gene.

White Agaricus bisporus mushrooms with no browning are more visually appealing.
Olha Afanasieva/

Yang was doing this work using CRISPR, and because his process did not introduce any foreign DNA into the mushrooms, he wanted to know if the product would be considered a “regulated article” by the Animal and Plant Health Inspection Service, a division of the U.S. Department of Agriculture tasked with regulating GMOs.

“APHIS does not consider CRISPR/Cas9-edited white button mushrooms as described in your October 30, 2015 letter to be regulated,” they replied.

Yang’s mushrooms were not the first genetically modified crop deemed exempt from current USDA regulation, but they were the first made using CRISPR. The heightened attention that CRISPR has brought to the gene editing field is forcing policymakers in the U.S. and abroad to update some of their thinking around what it means to genetically modify food.

New frontiers for CRISPR

One particularly controversial application of this powerful gene editing technology is the possibility of driving certain species to extinction – such as the most lethal animal on Earth, the malaria-causing Anopheles gambiae mosquito. This is, as far as scientists can tell, actually possible, and some serious players like the Bill and Melinda Gates Foundation are already investing in the project. (The BMGF funds The Conversation Africa.)

Most CRISPR applications are not nearly as ethically fraught. Here at the University of Washington, CRISPR is helping researchers understand how embryonic stem cells mature, how DNA can be spatially reorganized inside living cells and why some frogs can regrow their spinal cords (an ability we humans do not share).

It is safe to say CRISPR is more than just hype. Centuries ago we were writing on clay tablets – in this century we will write the stuff of life.

Ian Haydon, Doctoral Student in Biochemistry, University of Washington

Why Mexican immigrants are healthier than their US-born peers

Anna Waldstein, University of Kent

Supporters of Donald Trump’s wall might have us believe that Mexicans who enter the US illegally carry disease and take advantage of America’s healthcare system. But several large public health surveys suggest that most Mexican immigrants are healthier than the average American citizen. So what can Americans learn about health from their Mexican neighbours? The Conversation

The “Hispanic health paradox” was first identified in 1980, in the Hispanic health and nutrition examination survey. Results of the survey were compared with a second part of the survey, which looks at all Americans. Of all Hispanic groups, people from Mexico have some of the best health compared with the rest of Americans. For example, Mexicans have lower rates of high blood pressure, cardiovascular disease and most cancers than the general US population.

But, by the second or third generation, people of Mexican descent do not seem to have any health advantage over other Americans. This suggests that the paradox depends on cultural factors, such as physical activity, eating habits and family support.

I conducted research for my PhD thesis in “Los Duplex,” one of the first Mexican immigrant neighbourhoods in the city of Athens, in Georgia. I wanted to know if traditional medical practices migrated with people from Mexico to the US.

The World Health Organisation (WHO) defines traditional medicine as “the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness”. Traditional medicine is recognised and promoted by the WHO as an important healthcare resource.

At the time of my study, about 75% of the 131 homes in Los Duplex were occupied by Mexican tenants. Most were recent immigrants who worked in a nearby poultry processing plant. As part of my research, I collected family health histories and self-assessments of health, which were generally positive. I also found that Mexicans in Los Duplex approached health and healing by drawing on both traditional and mainstream medicine.

Living well in Los Duplex

Mexican immigrants in Los Duplex cared for and supported each other physically, emotionally and financially. Strong social networks help migrants cross the border and find jobs in the US. They also help spread knowledge of medical resources and traditional practices, which together form a holistic system of healthcare.

The Mexican families in my study had a relatively easy time accessing the mainstream medical system of Athens. But mainstream medicine was seen as a last resort. Immigrants reported that traditional Mexican health practices can often prevent or resolve problems before they require medical attention. Such practices promoted keeping calm, staying active and maintaining a positive attitude, to consuming traditional foods and herbal remedies.

Most Mexican women routinely cooked meals for their families made with beans and corn tortillas (the traditional Mexican staple foods), as well as meat and vegetables. Food was prepared fresh with a variety of seasonings, like onion, garlic, mint, chillies, cumin, and oregano. These add micronutrients and antioxidants, as well as flavour. Although children consumed sweets and fizzy drinks, which could be bought in the neighbourhood, meals were usually served with homemade drinks made from fresh fruit.

Mexican migrants in Los Duplex also used a variety of medicinal plants, as well as other home remedies. They generally used these medicines for the health problems they experienced most frequently in Georgia: respiratory tract infections and digestive disorders. And there is some evidence for these traditional remedies. For example, the herb gordolobo (Gnaphalium spp.), which is used in Los Duplex for coughs and chest congestion, has been shown to have anti-inflammatory and antimicrobial properties that are useful in preventing and treating respiratory disease. And manzanilla (Matricaria recutita), which is used to relieve stomachache and menstrual cramps, has antimicrobial and antispasmodic properties.

Mexican immigrants use a variety of medicinal plants, but also eat well.

Mexican women described herbal remedies as inexpensive, natural and safe. But they were wary of most pharmaceuticals, even though they sometimes used them. Reasons for mistrusting pharmaceuticals related to their side effects. Drugs to counteract the side effects of other drugs were seen as especially problematic.

Too much, too little, just right

I asked people in Los Duplex why they thought Mexican immigrants were healthier than Americans. They attributed this to Americans’ overconsumption of fast foods, as well as the consumption of too many “pastillas” (pills). Most Americans do indeed rely heavily on pharmaceutical drugs, even for relatively minor conditions. Overmedication may in fact be undermining the health of many Americans.

Of course, under-medication is also a problem for uninsured Americans and other groups with limited access to medical care, including some Mexican migrants. For example, undocumented Mexican farm workers earn so little they can lack the means to see a doctor or pay for medicine. This is particularly problematic as these migrants often live in makeshift housing, with limited facilities for cooking or making herbal remedies. For these and other reasons (such as pesticide exposure), Mexican migrant farm workers have worse health than Americans.

My research on Mexican immigrants suggests that both too much and too little mainstream medicine is a potential threat to health. Because of their traditional medical knowledge, the Mexicans of Los Duplex were able to achieve the right balance between complementary and mainstream medicine. Their holistic approach to health and healing provides a valuable lesson for American citizens.

Anna Waldstein, Lecturer in Medical Anthropology, University of Kent

Why are we dragging our feet when more automation in health care will save lives?

Thomas Hooven, Columbia University Medical Center

As a neonatologist, I worry about patients with pulmonary hypertension. This unforgiving disease, sometimes seen after premature birth, can end with sudden death from constricting blood vessels in the lungs. One minute a baby in the neonatal ICU may be sleeping comfortably; moments later, doctors and nurses are giving chest compressions and rescue medications. The Conversation

A pulmonary hypertension crisis, as these frightening episodes are called, starts with a drop in the blood oxygen level. That drop triggers a monitor to beep. It’s up to the nurse to hear the sound, come to the bedside and take action.

The first and most effective step in stopping a pulmonary hypertension crisis is simple: Give oxygen. But a nurse caring for another patient might be delayed for 30 seconds, and the loss of that time can lead to brain injury or death.

In an age of self-driving cars and 400-ton airplanes that can land themselves in blinding fog, it makes no sense that hospitalized patients are surrounded by lifesaving machinery that can be activated only by a person pressing a button or turning a knob.

Modern transportation augments human judgment and reaction times with a computer’s superior ability to continuously respond to dozens of fluctuating variables. Yet in medicine, safety remains stubbornly reliant on human intervention.

FDA regulation impedes innovation

My patients with pulmonary hypertension are often attached to a respirator with adjustable oxygen settings. The respirator sits inches below the monitor that indicates how much oxygen is in the blood. But the two machines can’t communicate with each other. If they could, it would be possible to increase the flow of oxygen automatically the moment a crisis is detected.

In 2009, engineers developed just this kind of closed-loop respirator and introduced it in several hospitals as part of a feasibility study. It increased the time premature babies spent at a safe oxygen level by more than two hours per day. But no biotechnology company has marketed the idea.

There are other examples of automated systems with unrealized potential to save lives, and not just in the neonatal ICU. Software that scans an ECG for subtle heartbeat variability can identify patterns – undetectable to the human eye – that indicate an elevated risk of heart attack. Hospital beds that play audible feedback during an emergency promote more effective CPR. Yet patients are not benefiting because neither of these tools has been commercialized.

Why haven’t these innovations attracted the industry backing necessary to make them widely available?

One reason is that the process of getting FDA approval for new devices – particularly those deemed “life-sustaining” – is often even more complicated and expensive than getting approval for drugs. In the Journal of Public Economics, Harvard Business School professor Ariel Dora Stern recently described how FDA hurdles discourage companies from investing in innovation.

Often, the more profitable strategy is to wait for someone else to spend the time and money required to get approval for a new device, and then enter the market later with something similar that will face less scrutiny. Dr. Stern estimates that regulatory obstacles add an average of US$6.7 million to the cost of introducing a new medical device. For a company developing an ICU monitor, for instance, that will ultimately sell for less than $35,000 per unit, this up-front commitment can be prohibitive.

A consequence is that small biotechnology firms (with annual revenue less than $500 million) rarely gamble on getting new inventions approved. Dr. Stern’s paper notes that less than 17 percent of novel device applications to the FDA come from small companies. This is different from new drug applications, the majority of which originate at smaller firms.

What’s behind this discrepancy? Research has shown that while companies pay a steep price for pioneering new medical devices, the first firm to market a new type of drug often gets favorable treatment from the FDA. This raises the incentive for pharmaceutical startups to pursue innovation. In contrast, when it comes to medical devices, the current system discourages all but the biggest players from entering the arena.

And even when a new device has been approved, there is no strong impetus for hospitals and clinics to buy in. Even if they can afford upgrades, medical sites are free to use older equipment, with fewer safety mechanisms, long after improved versions become available.

A chance for Washington to improve health care

In contrast, a variety of government initiatives prod transportation companies to modernize. For example, the Federal Aviation Administration offers rebates to aircraft owners to offset the cost of advanced navigation technology that prevents midair collisions. The Federal Rail Administration is overseeing mandatory, nationwide installation of a GPS-based system to slow down speeding trains automatically.

There is an opportunity here – beyond the messy Obamacare debate – for the White House and congressional Republicans to stimulate economic growth in the biomedical sector while improving patient safety. Streamlining the approval process for new devices and offering financial incentives for early adopters would not threaten anti-regulatory groups, and would allow the new administration to claim progress in health care.

President Trump has expressed interest in expediting pharmaceutical approvals, something FDA commissioner nominee Scott Gottlieb also supports. But most drugs help only a small segment of the population.

Dr. Scott Gottlieb, nominee for FDA commissioner.
J. Scott Applewhite/AP

The president and Dr. Gottlieb should commit to advancing commonsense technology that makes health care better for all.

I’m not suggesting that machines should take over for health professionals. As in the manufacturing industry, the medical field is experiencing mounting anxiety about job displacement. There are many perceived threats, from artificial intelligence X-ray interpretation to robot nurses.

Those things might become commonplace, but they will never supplant the human relationships and insights at the core of medical practice. Neither will the kinds of safety innovations I’m recommending. With help from our leaders, physicians can take better care of patients by bringing more automation into our wards and offices.

Thomas Hooven, Neonatologist, Columbia University Medical Center

Increasing caesarean sections in Africa could save more mothers’ lives

Salome Maswime, University of the Witwatersrand and Gwinyai Masukume, University of the Witwatersrand

Caesarean sections have been lifesaving procedures for hundreds of thousands of women across the world who experience complications during labour. The Conversation

Globally, it’s estimated that just under 20% of births take place via caesarean section – a percentage that’s gone up over the last three decades. This has raised concerns, particularly in high-income countries where generally too many caesarean sections are performed.

But in many African countries women who are medically required to have caesarean sections are not able to access them. This is due to several reasons, the most prominent being weak health systems and a lack of resources.

This needs to be fixed as women in sub-Saharan African suffer from the highest maternal mortality ratio in the world. Close to 550 women die for every 100 000 children that are born. This amounts to 200 000 maternal deaths a year – or two thirds of all maternal deaths per year worldwide.

Some of these deaths could be prevented if skilled health personnel were able to perform caesarean sections safely. But this would require proper equipment and supplies including drugs and blood transfusions.

Research shows that low-income countries with the lowest caesarean section rates also have the highest maternal mortality rates.

Improving the access and availability of caesarean sections on the continent is therefore pivotal to reducing the number of maternal deaths and to achieve the sustainable development goal on maternal health of reducing maternal deaths to less than 70 per 100 000 live births by 2030.

Africa’s challenge

Between 1990 and 2015 maternal mortality dropped by about 44% across the world. And several countries in Africa have halved their levels of maternal mortality between 1990 and 2015. In Mali, for example, 1010 women died for every 100 000 children born in 1990. By 2015, this figure dropped to 587.

Despite this massive reduction, more than 800 women continue to die from preventable causes around childbirth every day, most in sub-Saharan Africa and South Asia. And millions more will suffer serious injuries, infections, complications or disabilities due to insufficient treatment.

The World Health Organisation has found that in countries where at least 10% of women have caesarean sections the number of maternal and newborn deaths decrease.

The organisation has not identified an ideal caesarean section rate, however there’s evidence that rates above 20% at country level might be to too high. But it encourages governments to make every effort to provide the procedure to women in need of it.

Africa has the lowest caesarean section rate in the world. In Europe about a quarter of births are conducted via caesarean section while Latin America and the Caribbean have caesarean section rates of about 40.5%.

In Africa only 7.3% of babies are born via this method. But it’s a very mixed picture across the continent. Some countries have very high rates such as Egypt (51.8%) and Mauritius (47%), the highest in Africa. And despite a 2.9% overall increase across the continent from 1990, there’s been a decline in some countries like Nigeria and Guinea which now stands at about 2%. Zimbabwe has maintained its caesarean section rates at 6%.

Caesarean section rate in selected African countries.

When caesars matter

Caesarean sections often happen at the end of a series of complex events. There can be both pre-existing and pregnancy related complications. The need for caesarean sections can be aggravated by a range of issues such as delays in accessing the appropriate level of care, transportation delays as well as a shortage of necessary technologies.

Complications require prompt access to quality obstetric services equipped with life-saving drugs, including antibiotics, and the ability to provide blood transfusions or other surgical interventions.

But there are several barriers to improving the caesarean section rates in a country. These include:

  • a shortage of midwives, obstetricians, anaesthetists, laboratory and other allied personnel,

  • limited access to health care, information and

  • a lack of equipment.

Cost is another significant barrier. It was estimated, almost a decade ago, that it would cost US$430 million to perform the almost 3 million additional caesarean sections needed.

Different playing fields

While reducing unnecessary caesarean sections may be a priority in high-income countries, access to it will save more lives, particularly in countries where deliveries in a health care facility are considered a luxury.

Many African countries are trying to increase the number of women delivering in a health care facility by a skilled birth attendant. In Africa, more than 40% of births are not attended by a skilled health provider.

Inequities in access to caesarean sections across different parts of sub-Saharan Africa and other low-income countries need to be addressed. And soon if the continent wants to reduce its unacceptably high maternal mortality rates.

Salome Maswime, Lecturer in Obstetrics and Gynaecology, University of the Witwatersrand and Gwinyai Masukume, Medical Doctor, Epidemiologist and Biostatistician: University College Cork, University of the Witwatersrand

This article was originally published on The Conversation. Read the original article.

How to eat chocolate without piling on the pounds this Easter

Trevor Simper, Sheffield Hallam University

Easter is once again upon us and for many people it is a time when a little more chocolate than usual is consumed. Chocolate gives many of us pleasure mainly because it has physiological effects that make it moreish – if not downright addictive. The Conversation

Some research studies even claim that certain types of chocolate are a “super food” – something that’s particularly good for us. After all, one of the ingredients of chocolate is cocoa, which is a good source of iron, magnesium, manganese, phosphorous and zinc. But is this really the case?

In dark chocolate – which has a high cocoa level – there is some evidence to show that small amounts may reduce the risk of heart disease. This is because of the presence of flavonoids – a type of plant chemical.

Flavonoids are said to be a powerful antioxidant with anti-inflammatory and immune system benefits. Health benefits include better blood sugar control and better insulin sensitivity – which are both indicators of protection from diabetes.

There are, of course, a lot of other foods that contain flavonoids – vegetables, for instance – but maybe they are not as marketable as a bar of dark chocolate.

Other ingredients

But despite this evidence, few neutral studies have been done, and work has only ever been done over the short term.

So before we can say for certain whether chocolate is actually a super food, there need to be far longer trials – that are not funded by chocolate manufacturers.

Easter egg bounty.

There is also the issue of the other ingredients apart from cocoa – given that your average Easter egg is likely to contain more sugar and saturated fat than plain cocoa.

There’s also the fact that there is little or no nutritional benefit to standard milk chocolate. So the only reason to eat it is because it gives us pleasure.

But whether its dark, milk or white, if you only binge on it once a year, the type of chocolate is not going to make much difference. What matters most is the rest of your lifestyle – what your diets like over the rest of the week, and how much you move around and exercise.

Healthy chocolate?

Maybe instead of worrying about the health benefits of chocolate, we should just see it for what it is – an indulgence or a treat – leaving us to get on with enjoying it occasionally.

With this in mind, we recently conducted an experiment that split people into three groups. The first group consumed a drink which contained calories from sugar only. The second group drank the same beverage but then did some gentle walking. And the third group drank a beverage with the same calories but from protein and a little fat, and not so much sugar.

The joys of spring.

When we traced everyone’s blood sugar levels over the next two hours, we found that the second and third groups had a much lower spike in blood sugar.

This is a good indicator that gentle exercise after eating or consuming foods which contain a mixture of protein and fat – rather than sugar alone – helps us to maintain steady blood sugar levels.

So maybe rather than worrying about chocolate as an occasional treat you should just enjoy it this Easter – and combine it with a nice spring walk.

Because at the end of the day, Easter is once a year, and your annual chocolate egg is unlikely to make a huge difference to your overall health or weight. So go ahead and enjoy – because that’s what Easter eggs are for. Just take advantage of the bank holiday to go for a walk as well.

Trevor Simper, Senior Lecturer/Researcher in nutrition and health, Sheffield Hallam University

This article was originally published on The Conversation. Read the original article.

Don’t believe everything you hear about pesticides on fruits and vegetables

Michael P. Holsapple, Michigan State University; Heather E. Dover, Michigan State University, and Keith Ayoob, Yeshiva University

Spring is just around the corner, and with it comes another growing season. Eating a diet rich in fruits and vegetables can help lower calorie intake; reduce risks for heart disease, obesity and Type 2 diabetes; and protect against certain cancers. The Conversation

With all these benefits, why do some consumers choose to avoid produce? Approximately three-quarters of people in the U.S. don’t eat enough fruits and vegetables, according to the 2015 Dietary Guidelines for Americans.

A lot of factors could explain the shortfall, including fear. Media stories about topics such as GMOs and pesticides may convince some consumers that it’s not safe to eat certain fruits and vegetables. There’s no question that negative news about produce can affect consumer choices. One survey found that, among 510 low-income shoppers, those who heard messages about pesticide residues on produce were less likely to purchase any type of fruits and vegetables.

One high-profile report intended to drive consumer choices is the Environmental Working Group (EWG) Dirty Dozen™ report, a listing of fruits and vegetables it claims have the highest levels of pesticide residues. The EWG is an American nonprofit environmental organization that specializes in research and advocacy in a number of areas, including toxic chemicals.

This year’s report, published on March 8, also came paired with the EWG’s 2017 Shopper’s Guide, which promises to “[help] protect your family from pesticides!” Both publications are based on an analysis of more than 36,000 samples of 48 popular fruits and vegetables, taken by the U.S. Department of Agriculture (USDA) in 2016.

But while a list like the Dirty Dozen may attract attention from concerned consumers, it doesn’t use the same rigorous methods for measuring risk that food scientists typically do. A report by the World Health Organization and United Nations found that the Dirty Dozen results in negative consumer perceptions about fruits and vegetables, which goes against dietary advice to eat more of them.

We are not challenging EWG’s right to publish this list, but its failure to provide proper context is a concern. Without that, an informed decision is impossible. As scientists interested in food safety, we believe the most appropriate context would be to compare that list to the actual USDA reports, which are developed under their Pesticide Data Program (PDP). The results suggest there is far less to fear from our produce than some would have you believe.

Looking at the list

To build the annual Dirty Dozen™ list, the EWG says it looks at six measures of pesticide contamination. For each metric, it ranks each food based on its individual USDA test results, then normalizes the scores on a 1 to 100 scale, with 100 being the highest. A food’s final score is the total of these six normalized scores from each metric.

This year, it lists strawberries at #1 (the “dirtiest” of the dirty), apples as #4, peaches as #5 and celery as #9. We did a comparison of the last 10 years of the Shopper’s Guide™ published by EWG. These four commodities were included on every list since 2007.

We compared these lists against the USDA’s actual annual reports from 2006 to 2015 and uncovered some interesting anomalies.

The USDA produces the most comprehensive pesticide residue database in the country. These data enable the EPA to assess dietary exposure, particularly among commodities popular with infants and children, and to provide guidance to governmental agencies.

Over the 20 years the USDA has tested residues, about 99 percent of crops and commodities have tested below – often significantly below – EPA tolerance levels. The USDA has consistently emphasized that “based on the PDP data, consumers can feel confident about eating a diet that is rich in fresh fruits and vegetables.”

Because the USDA doesn’t test every food every year, the EWG says that it generally uses the most recent sampling period for each food. However, using data that are as much as four years old to put together its annual lists seems more than a little arbitrary. It appears to us that some commodities have been mistakenly targeted over the last decade by the EWG as dangerous.

Importantly, the USDA actually analyzes the pesticide residues on fruits and vegetables. The EWG merely relies on the USDA data and scores risk simply by whether pesticide residues can be measured. By emphasizing fear over facts, it reinforces irrational perceptions.

What’s missing from the Dirty Dozen

The EWG says that their “goal is to show a range of different measures of pesticide contamination, to account for uncertainties in the science.” They claim their approach “best captures the uncertainties about the risks and consequences of pesticide exposure.”

However, the EWG errs by considering any and all pesticides as equally toxic, rather than relating detected pesticide residues to known safety standards.

All pesticides must be registered with the U.S. Environmental Protection Agency (EPA), which evaluates an extensive amount of scientific data.

The EPA assesses risks and benefits of a product’s use; provides label directions to control how products are used; and can suspend or cancel a product’s registration. The EPA also sets pesticide tolerances – that is, maximum permissible residue levels – for each and every pesticide used in or on food. The tolerance for an individual pesticide is tailored to reflect the specific scientific data, including toxicology studies, for that pesticide.

The EPA requires a large battery of studies to measure the effect and safety of a new pesticide. First, it determines the highest dosage at which there is no observable adverse effect. That dosage is then divided by uncertainty factors of up to 1,000 to calculate the allowable daily intake, and by an additional uncertainty factor of up to 10 to calculate the reference dose, or maximum acceptable dose.

One paper from 2011 looked at mean exposure to pesticides in each of that year’s Dirty Dozen. All pesticide levels were well below even a fraction of the reference dose. Indeed, the vast majority were less than 0.01 percent of the reference dose.

Finally, according to the Food Quality Protection Act, the EPA must determine that a pesticide poses “a reasonable certainty of no harm” before it can be registered for use on food or feed.

Since analytical instruments are able to pick up increasingly smaller concentrations, many crops have detectable residues yet no significant risk. The USDA reports its data on pesticide residues in parts per million, or ppm. To put that in context, one ppm is roughly equivalent to a single minute in two years.

In addition, the overwhelming understanding within the scientific community is that any risk assessment carries some level of uncertainty. The EWG twists this fact around to suggest that uncertainty equals harm. But its approach ignores the fact that uncertainties are a part of risk assessment. It effectively misrepresents the consequences of pesticide exposure.

Despite the claims made by the EWG, the mere presence of pesticide residues cannot constitute a risk. A “risk” is, by definition, dependent on the level of exposure, and the EPA has set specific tolerance levels for each and every pesticide. The challenge lies in accurately communicating risk and, by extension, safety, to consumers.

The real risk

While some groups, such as the EWG, promote organic produce over conventional produce, there are a far greater number of regulatory safeguards in place for use of conventional pesticides. As noted above, the EPA requires an extensive amount of scientific research to support an application for a new conventional pesticide. Organic pesticides are managed by the USDA National Organic Program (NOP). The NOP does not specifically list each allowable natural substance that can be used for organic farming. Rather, it sets the criteria for determining if a substance is natural. The reality is that data on pesticide use in organic farming are limited. Importantly, the NOP is managed by the 15 members of the National Organic Standards Board, of whom only one is listed as a scientist.

Finally, a huge body of peer-reviewed research shows the positive benefits of a diet rich in fruits and vegetables, including conventionally grown produce. Consumers should not avoid fruits and vegetables simply out of fear, or because they cannot afford the often higher cost of organic fruits and vegetables. No fruits or vegetables are nutritious until they’re eaten.

Hannah Rose Park at Michigan State University contributed to this article.

Michael P. Holsapple, Director and Endowed Chair of Center for Research on Ingredient Safety, Michigan State University; Heather E. Dover, Research Assistant, Michigan State University, and Keith Ayoob, Associate Clinical Professor of Pediatrics at Albert Einstein College of Medicine, Yeshiva University

This article was originally published on The Conversation. Read the original article.

Fishing for DNA: Free-floating eDNA identifies presence and abundance of ocean life

Mark Stoeckle, The Rockefeller University

Ocean life is largely hidden from view. Monitoring what lives where is costly – typically requiring big boats, big nets, skilled personnel and plenty of time. An emerging technology using what’s called environmental DNA gets around some of those limitations, providing a quick, affordable way to figure out what’s present beneath the water’s surface. The Conversation

Fish and other animals shed DNA into the water, in the form of cells, secretions or excreta. About 10 years ago, researchers in Europe first demonstrated that small volumes of pond water contained enough free-floating DNA to detect resident animals.

Researchers have subsequently looked for aquatic eDNA in multiple freshwater systems, and more recently in vastly larger and more complex marine environments. While the principle of aquatic eDNA is well-established, we’re just beginning to explore its potential for detecting fish and their abundance in particular marine settings. The technology promises many practical and scientific applications, from helping set sustainable fish quotas and evaluating protections for endangered species to assessing the impacts of offshore wind farms.

Who’s in the Hudson, when?

In our new study, my colleagues and I tested how well aquatic eDNA could detect fish in the Hudson River estuary surrounding New York City. Despite being the most heavily urbanized estuary in North America, water quality has improved dramatically over the past decades, and the estuary has partly recovered its role as essential habitat for many fish species. The improved health of local waters is highlighted by the now regular fall appearance of humpback whales feeding on large schools of Atlantic menhaden at the borders of New York harbor, within site of the Empire State Building.

Preparing to hurl the collecting bucket into the river.
Mark Stoeckle, CC BY-ND

Our study is the first recording of spring migration of ocean fish by conducting DNA tests on water samples. We collected one liter (about a quart) water samples weekly at two city sites from January to July 2016. Because the Manhattan shoreline is armored and elevated, we tossed a bucket on a rope into the water. Wintertime samples had little or no fish eDNA. Beginning in April there was a steady increase in fish detected, with about 10 to 15 species per sample by early summer. The eDNA findings largely matched our existing knowledge of fish movements, hard won from decades of traditional seining surveys.

Our results demonstrate the “Goldilocks” quality of aquatic eDNA – it seems to last just the right amount of time to be useful. If it disappeared too quickly, we wouldn’t be able to detect it. If it lasted for too long, we wouldn’t detect seasonal differences and would likely find DNAs of many freshwater and open ocean species as well as those of local estuary fish. Research suggests DNA decays over hours to days, depending on temperature, currents and so on.

Fish identified via eDNA in one day’s sample from New York City’s East River.
New York State Department of Environmental Conservation: alewife (herring species), striped bass, American eel, mummichog; Massachusetts Department of Fish and Game: black sea bass, bluefish, Atlantic silverside; New Jersey Scuba Diving Association: oyster toadfish; Diane Rome Peeples: Atlantic menhaden, Tautog, Bay anchovy; H. Gervais: conger eel., CC BY-ND

Altogether, we obtained eDNAs matching 42 local marine fish species, including most (80 percent) of the locally abundant or common species. In addition, of species that we detected, abundant or common species were more frequently observed than were locally uncommon ones. That the species eDNA detected matched traditional observations of locally common fish in terms of abundance is good news for the method – it supports eDNA as an index of fish numbers. We expect we’ll eventually be able to detect all local species – by collecting larger volumes, at additional sites in the estuary and at different depths.

In addition to local marine species, we also found locally rare or absent species in a few samples. Most were fish we eat – Nile tilapia, Atlantic salmon, European sea bass (“branzino”). We speculate these came from wastewater – even though the Hudson is cleaner, sewage contamination persists. If that is how the DNA got into the estuary in this case, then it might be possible to determine if a community is consuming protected species by testing its wastewater. The remaining exotics we found were freshwater species, surprisingly few given the large, daily freshwater inflows into the saltwater estuary from the Hudson watershed.

Filtering the estuary water back in the lab.
Mark Stoeckle, CC BY-ND

Analyzing the naked DNA

Our protocol uses methods and equipment standard in a molecular biology laboratory, and follows the same procedures used to analyze human microbiomes, for example.

eDNA and other debris left on the filter after the estuary water passed through.
Mark Stoeckle, CC BY-ND

After collection, we run water samples through a small pore size (0.45 micron) filter that traps suspended material, including cells and cell fragments. We extract DNA from the filter, and amplify it using polymerase chain reaction (PCR). PCR is like “xeroxing” a particular DNA sequence, producing enough copies so that it can easily be analyzed.

We targeted mitochondrial DNA – the genetic material within the mitochondria, the organelle that generates the cell’s energy. Mitochondrial DNA is present in much higher concentrations than nuclear DNA, and so easier to detect. It also has regions that are the same in all vertebrates, which makes it easier for us to amplify multiple species.

We tagged each amplified sample, pooled the samples and sent them for next-generation sequencing. Rockefeller University scientist and co-author Zachary Charlop-Powers created the bioinformatic pipeline that assesses sequence quality and generates a list of the unique sequences and “read numbers” in each sample. That’s how many times we detected each unique sequence.

To identify species, each unique sequence is compared to those in the public database GenBank. Our results are consistent with read number being proportional to fish numbers, but more work is needed on the precise relationship of eDNA and fish abundance. For example, some fish may shed more DNA than others. The effects of fish mortality, water temperature, eggs and larval fish versus adult forms could also be at play.

Just like in television crime shows, eDNA identification relies on a comprehensive and accurate database. In a pilot study, we identified local species that were missing from the GenBank database, or had incomplete or mismatched sequences. To improve identifications, we sequenced 31 specimens representing 18 species from scientific collections at Monmouth University, and from bait stores and fish markets. This work was largely done by student researcher and co-author Lyubov Soboleva, a senior at John Bowne High School in New York City. We deposited these new sequences in GenBank, boosting the database’s coverage to about 80 percent of our local species.

Study’s collection sites in Manhattan.
Mark Stoeckle, CC BY-ND

We focused on fish and other vertebrates. Other research groups have applied an aquatic eDNA approach to invertebrates. In principle, the technique could assess the diversity of all animal, plant and microbial life in a particular habitat. In addition to detecting aquatic animals, eDNA reflects terrestrial animals in nearby watersheds. In our study, the commonest wild animal detected in New York City waters was the brown rat, a common urban denizen.

Future studies might employ autonomous vehicles to routinely sample remote and deep sites, helping us to better understand and manage the diversity of ocean life.

Mark Stoeckle, Senior Research Associate in the Program for the Human Environment, The Rockefeller University

This article was originally published on The Conversation. Read the original article.