Urine Biomarkers Reveal Mitochondrial Dysfunction in Diabetic Kidney Disease

Newswise — Researchers at the University of California, San Diego School of Medicine have identified 13 metabolites – small molecules produced by cellular metabolism – that are significantly different in patients with diabetes and chronic kidney disease compared to healthy controls.

Twelve of the 13 metabolites are linked to mitochondrial function, suggesting that suppression of mitochondria – the powerhouses of cells – is a fundamental characteristic of diabetic kidney disease. The findings are published in the November edition of the Journal of the American Society of Nephology.

“This work provides strong evidence that reduced mitochondrial function is a dominant feature of human diabetic kidney disease,” said first author Kumar Sharma, MD, professor of medicine and director of the Center for Renal Translational Medicine at UC San Diego. “We found that a specific cellular pathway, AMPK-PGC1a, likely plays a key role to reduce mitochondrial function and content, which means that new therapeutic approaches that restore and increase mitochondrial function and content could ameliorate or perhaps even arrest chronic kidney disease.”

Diabetic kidney disease is the leading cause of end-stage kidney disease, which is the eighth leading cause of death in the United States and a major risk factor for cardiovascular disease, the nation’s leading killer. An estimated 26 million American adults have chronic kidney disease (CKD), with millions more at increased risk. These patients often require dialysis or an organ transplant.

The primary causes of CKD are high blood pressure and diabetes. Rates of both CKD and diabetes have risen dramatically in the last decade, particularly among people aged 65 and older. According to the National Kidney and Urologic Diseases Information Clearinghouse, the annual mortality rate for end-stage renal disease rose from 10,478 in 1980 to 90,118 in 2009, though it has declined somewhat in recent years.

After analyzing a total of 193 urine samples from patients with diabetes and CKD, diabetes but no CKD and healthy controls with neither condition, Sharma and colleagues quantified 94 metabolites in the samples. Thirteen metabolites were significantly different between patients with diabetes and CKD versus controls. Twelve remained significant when compared to patients with diabetes but not CKD. Twelve metabolites play a role in mitochondrial metabolism and were present in lower levels in patients with diabetes and CKD, suggesting that this major diabetic complication is at least partly the consequence of suppressed mitochondrial activity.

Sharma said measuring urine metabolites to detect and assess diabetic kidney disease is a major diagnostic step forward. “The urine metabolites can indicate the underlying function of the kidney at a biochemical and intracellular level,” he said, “and are well-conserved compared to many cell-based and protein measurements. Urine metabolomics also offers an opportunity to gauge effects of new treatments which will be an advantage to guide precision medicine.”

Co-authors include Bethany Karl and Maggie Diamond-Stanic, UCSD Institute of Metabolic Medicine, UCSD Center for Renal Translational Medicine and Division of Nephology-Hypertension, VA San Diego Healthcare System; Anna V. Mathew, UCSD Center for Renal Translational Medicine and Division of Nephology-Hypertension, VA San Diego Healthcare System, now at the University of Michigan; Jon A. Gangoiti, Bruce Barshop, William Nyhan, Biochemical Genetics Program and Institute of Metabolomic Medicine, UCSD; Christina L. Wassel and Minya Pu, Department of Family and Preventive Medicine, UCSD; Rintaro Saito, UCSD Institute of Metabolic Medicine, UCSD Center for Renal Translational Medicine and Division of Medical Genetics, UCSD; Shoba Sharma and Young You, UCSD Center for Renal Translational Medicine; Lin Wang, Mitochondrial and Metabolic Disease Center, UCSD; Maja T. Lindenmeyer and Clemens D. Cohen Division of Nephology, University Hospital Zurich, Switzerland; Carol Forsblom, Folkhalsan Institute of Genetics, Helsinki Finland; Wei Wu and Sanjay K. Nigam, Departments of Pediatrics and Cell and Molecular Medicine, UCSD; Joachim H. Ix, Division of Nephology-Hypertension, VA San Diego Healthcare System, UCSD Center for Renal Translational Medicine; Trey Ideker, Division of Medical Genetics, UCSD; Jeffrey B. Koop, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health; Per-Henrik Groop, Folkhalsan Institute of Genetics, Helsinki, Finland and IDI Baker Heart and Diabetes Institute, Melbourne, Australia; Loki Natarajan, UCSD Institute of Metabolomic Medicine and Department of Family and Preventive Medicine, UCSD; and Robert K. Naviaux, Mitochondrial and Metabolic Disease Center, UCSD, UCSD Institute of Metabolomic Medicine, Division of Medical Genetics, UCSD, Biochemical Genetics Program, UCSD.

Support for this research includes funding from the Juvenile Diabetes Research Foundation, the National Institute of Diabetes and Digestive and Kidney Disease, the Folkhalsan Research Foundation, the Wilhelm and Else Stockmann Foundation, the Liv och Halsa Foundation, the UCSD Christini Fund, the Wright Family Foundation, the Lennox Foundation, the Else Kroner-Fresnius Foundation, the Swiss National Center of Competence in Research and National Institutes of Health grants P41 GM103505 and P50 GM085764.

 

NYU sponsors Committee headed by Gordon Brown to update the Universal Declaration of human rights

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Newswise — Does the Universal Declaration on Human Rights, crafted in the aftermath of World War II, continue to serve well in a world in which political and religious extremism, climate change, globalization and other trans-national issues have come to dominate the international agenda?

That is the key question that will be taken up by a Global Citizenship Commission of leading public figures, human rights leaders, and public intellectuals led by The Right Honourable Gordon Brown, MP, former UK Prime Minister and a Distinguished Global Leader in Residence at NYU, which is sponsoring the Commission’s work. The Commission will reexamine the 1948 Universal Declaration on Human Rights and, taking into account the myriad global developments since its passing over 60 years ago, formulate a report that will suggest revisions or ways of updating this fundamental document.

The Commission’s inaugural meeting will take place on Oct. 18, 2013 at the University of Edinburgh. Speaking at the event will be education and women’s’ rights campaigner Malala Yousafzai, whose activism on universal education and women’s rights brought her into direct conflict with the Taliban, which attempted to assassinate her in October 2012.

Mr. Brown, who serves as the UN Secretary-General’s Special Envoy for Global Education, developed the idea for the Commission after convening a series of high-level dialogues at NYU over 2010-11 that explored the moral and ethical underpinnings for the creation of a global civil society.

Mr. Brown said: “The debate around ethics and the protection of human rights is as important today as it was in 1948, when the Universal Declaration was signed.

“This Commission brings together global leaders in the field of ethics and citizenship, and crucially allows members of the public to join the debate. After all, it is their rights of global citizens that this historic document enshrines.

"Global citizenship is at the heart of the UN Secretary-General's Education First initiative which he launched last year, and I look forward to relaying our discussions to him before the end of 2015."

“NYU is proud to provide the support necessary to convene this talented and experienced group of Commissioners from across the world, and is especially excited to be working closely with such an outstanding and learned leader as Gordon Brown. In an era in which discussion of the great challenges of our times often bog down in partisanship, universities – with their tradition of free inquiry – serve a difficult-to-replicate role as a forum for thoughtful discussion. We think NYU -- with its unequalled global presence, its network of academic sites, and its diverse group of students and faculty – is especially well suited to support the Commission’s activities,” NYU President John Sexton said.

The Commission will bring together distinguished leaders from across many sectors—politics, the academy, international public interest organizations, business, religious institutions, law, and philanthropy. The commissioners have been selected from among the highest levels of their professions that will each bring unique perspective to the relevant areas of the Commission’s work. In addition to Mr. Brown, the members of the Commission include:
• K. Anthony Appiah, Laurance S. Rockefeller University Professor of Philosophy, Princeton University;
• Aung San Suu Kyi, Chairperson and General Secretary of the National League for Democracy in Burma; Member of the Burmese House of Representatives;
• Zaniab Hawa Bangura, United Nations Special Representative on Sexual Violence in Conflict;
• Laurel Bellows, Principal, The Bellows Law Group, P.C. & Immediate Past President, American Bar Association;
• Nicolas Beggruen, Chairman, Berggruen Holdings;
• Paul Boghossian, Silver Professor of Philosophy, New York University;
• Derek Bok, 300th Anniversary University Professor; Professor of Law; President Emeritus, Harvard University;
• Sissela Bok, Senior Visiting Fellow, Harvard Center for Population and Development Studies, Harvard University;
• Mohamed El Baradei, Former Director General, International Atomic Energy Agency;
• Craig Calhoun, Director, London School of Economics and Political Science;
• Andrew Forrest, Philanthropist; Non-executive Chairman, Fortescue Metals Group;
• Ronald George, 27th Chief Justice of California (retired);
• His Excellency John Kufuor, Former President of Ghana; Graça Machel, Former First Lady of South Africa and Mozambique;
• Graça Machel, Former First Lady of South Africa and Mozambique
• Kate O’Regan, Chairperson, International Justice Council of the United Nations; Phumzile Mlambo-Ngcuka, Executive Director, UN Women;
• Emma Rothschild; Jeremy and Jane Knowles Professor of History; Director, Center for History and Economics, Harvard University;
• Robert Rubin, Co-Chairman, Council on Foreign Relations; Former United States Secretary of the Treasury;
• Jonathan Sacks, Chief Rabbi, United Kingdom;
• Michael Sandel, Anne T. and Robert M. Bass Professor of Government, Harvard University;
• Klaus Schwab, Founder and Executive Chairman, World Economic Forum;
• Amartya Sen, Thomas W. Lamont University Professor; Professor of Economics and Philosophy, Harvard University;
• John Sexton, president, NYU;
• Robert Shrum, Senior Fellow, Robert F. Wagner Graduate School of Public Service, New York University;
• Jeremy Waldron, University Professor, New York University School of Law; Chichele Professor of Social & Political Theory, All Souls College, Oxford University;
• Joseph Weiler, President, European University Institute;
• The Most Reverend Rowan Williams, former Archbishop of Canterbury.

The intellectual underpinnings of the Commission’s work will be framed by the efforts of a Philosophers’ Committee, established under the auspices of and funded by NYU’s Global Institute for Advanced Study; the Philosophers’ Committee will be led by NYU/Oxford University Professor Jeremy Waldron.. Diane C. Yu, Deputy President of NYU, will serve as the Commission’s Executive Director.

The inaugural meeting of the Global Commission will be held on 18 October 2013 at the University of Edinburgh, in Scotland. The Commission will hold public meetings beginning on 19 October 2013 that will allow members of the public—including from the civic, academic, and at-large communities—to enter their comments related to the work of the Commission into its formal record. This event will be held in the University of Edinburgh’s historic McEwan Hall and will be open to the public, though advance tickets and RSVPs are required.

University of Edinburgh Principal Timothy O’Shea said: “The University is delighted to welcome this important Commission to Edinburgh. How we understand and promote human rights is a matter of global significance and it is a privilege to host the first public hearing of the Commission.”

The inaugural meeting of the Commission has been made possible through the generous support and encouragement of the Carnegie UK Trust, based in nearby Dunfermline, the birthplace of Andrew Carnegie, which is celebrating its centennial this year with a number of special events.

Martyn Evans, Chief Executive of Carnegie UK Trust, the key supporter of the public event, said: “The theme of wellbeing lies at the heart of the work of our Trust, and it motivated our founder, Andrew Carnegie, to leave his fortune to improve the welfare of society one hundred years ago.

“We are delighted to be supporting such an ambitious and timely event. It will bring together global leaders in ethics and citizenship to review and revitalize the relevance of human rights around the world.”

The Commission plans to engage in its work over the course of the next two years, with meetings and public hearings set to take place in cities across the world. The tentative plan for future meetings and hearings is as follows:

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Weight Loss Apps Lack Key Ingredients for Success

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Stephanie Stephens, HBNS Contributing Writer
American Journal of Preventive Medicine

Key Points:
* Mobile applications for weight loss typically include features for setting weight and diet goals, and tracking calories.

* Current weight loss apps lack proven behavioral strategies, such as stress reduction, advice about managing social cues, dealing with negative thinking and time management.

Newswise — Weight loss mobile applications may work well as basic tracking devices, but need to do more to help dieters improve motivation, reduce stress and solve problems, according to a new report in the American Journal of Preventive Medicine.

Many of the country’s 285 million mobile phone subscribers want to lose weight, but neither consumers nor doctors really understand current apps, said lead study author Sherry Pagoto, Ph.D., an associate professor in the division of preventive and behavioral medicine at the University of Massachusetts Medical School.

“Apps are generally good but we need more science behind this effort,” she said. “Busy healthcare providers hesitate to recommend apps because they don’t really know what they’re telling patients to use. Patients also worry about receiving incorrect information or offensive advertising when they open an app.”

“But because of their ‘advanced technical features,’ some apps accomplish what we can’t with weight loss behavioral counseling alone,” said Pagoto.

The researchers looked for weight loss apps that included behavioral strategies currently used in evidence-based weight loss programs. Out of nearly 900 apps available in “health and fitness” categories, 30 apps designed for both iPhone and Android platforms were reviewed in depth. Basic features of the apps studied included the capacity to track weight, diet and physical activity.

Common behavioral strategies included setting weight loss goals, dietary goal-setting and balancing calories. However, seven evidence-based behavioral strategies for weight loss were completely missing, such as stress reduction, relapse prevention, social cues, negative thinking, developing regular patterns of eating, time management, and instructions on reading nutrition labels.

“We think apps can grow into more sophisticated and impactful tools if they include strategies to help with diet motivation and adherence, which are super important for weight loss,” Pagoto noted.

“The ability for real-time information, monitoring and support may help individuals change their diets and exercise in ways that have previously required time-intensive and/or face-to-face intervention, “ said Wendy Nilsen, Ph.D., a health scientist administrator at the NIH Office of Behavioral and Social Sciences Research (OBSSR). “The authors’ findings, similar to work in smoking cessation, highlight the lack of integrated behavioral science in app development.”

There’s more to do, Nilsen added. “For apps to be able to effect maximal behavior change, developers are missing important opportunities to improve their applications by overlooking a well established literature in the behavioral sciences and to incorporate existing knowledge into new technologies. Further, this work can help determine when a well-designed app alone is most likely to help someone to reach their health goals and when more intensive intervention, such as the use of a coach, is needed. With technology and science paired, the optimal app strategies can be developed in a way that helps people live healthier lives.”

TERMS OF USE: This story is protected by copyright. When reproducing any material, including interview excerpts, attribution to the Health Behavior News Service, part of the Center for Advancing Health, is required. While the information provided in this news story is from the latest peer-reviewed research, it is not intended to provide medical advice or treatment recommendations. For medical questions or concerns, please consult a health care provider.

American Journal of Preventive Medicine: Contact the editorial office at (858) 534-9340 or eAJPM@ucsd.edu.

Sherry Pagoto, PhD, Kristin Schneider, PhD, Mirjana Jojic, MD, Michele DeBiasse, MS, RD,
CNSD, Devin Mann, MD, MS. (2013) Evidence-Based Strategies in Weight Loss Mobile Apps. American Journal of Preventive Medicine.

Tips to Celebrate Halloween Safely From The Scariest Place of All - The Emergency Department

Each year, 9.2 million babies, children, and teens are injured severely enough to need treatment in emergency departments all across America, reports the Centers for Disease Control and Prevention. "Nothing is scarier than a trip to the emergency room," said Mark Cichon, DO, chair, Department of Emergency Medicine, Loyola University Health System. "In a season devoted to frights, it is our goal to keep everyone safe."

Here are Dr. Cichon's top tips to avoid going bump in the night and for a healthy, happy Halloween:
Invest in a pumpkin carving kit and avoid knives. "Manipulating a sharp knife in a rigid pumpkin rind without injury is almost impossible for an adult or child," said Dr. Cichon. "Proper tools make sure you carve the jack o' lantern and not yourself or a loved one."

Supervise anything that is burning, from scented candles to carved pumpkins to firepits. "Fires can happen in a flash and get quickly out of control," said Dr. Cichon. "The colder temperatures invite the warm glow of candles to the excitement of an end-of-season bonfire. Watch out for burning leaf piles."

Use extra precaution when climbing ladders to hang decorations inside and outside. "Falls from ladders are one of the top reasons adults come to the emergency room and they are largely avoidable," said Dr. Cichon. "Use the right-sized ladder, and one that is safe, and work with a partner to do the job right."

Make sure Halloween costumes offer visibility and ease of movement. "Masks, hats, wigs, glasses, hoods -- costumes often include headgear that can obstruct vision and lead to trips and falls," said Dr. Cichon. "And make sure it is easy to walk in the costume without tripping or catching on things."

Dress for the weather. "It is easy to get overheated or too cold in the Midwest at this time of year, without the addition of wearing a costume," said Dr. Cichon. "Check skin temperature and watch for signs such as shivering or lethargy. Don't forget to wear waterproof footgear that has treads for sure footing."

Have one adult in the trick-or-treating group wear a reflective safety vest and give each child a glow stick or flashlight to increase visibility. "You want to be able to see where you are going and also for others to see you, especially around moving vehicles," said Dr. Cichon. Stay in a group and put kids on the buddy system.

Avoid alcohol use when supervising children. "Don't drink and accompany your kids as they trick-or-treat," said Dr. Cichon. "If you choose, enjoy a beer or cocktail at the end of the night after kids are safely indoors, or better yet, in bed."

Avoid over-tiring children. "Fatigue can lower resistance, leading to illness and injury," said Dr. Cichon. Make sure a good night's sleep starts Halloween day and rest up before the night's activities. Eat healthy meals and drink plenty of water to stay hydrated. Maintain regular bedtimes.

Inspect treats when you get home. "Make sure candy and goodies are age-appropriate; avoid smaller pieces for younger children that could be a choking hazard," said Dr. Cichon.

Balance candy consumption with healthy foods. "When my four children were younger my wife and I would hide their candy and allow them each to choose two pieces after dinner to limit over-consumption," said Dr. Cichon.

Be aware of the potential for loud and scary noises. "Playful scaring antics by enthusiastic celebrants and even barking dogs can frighten children and cause them to react suddenly," said Dr. Cichon. "Falling down porch stairs, tripping over curbs and even colliding with others can result in harm."

Drive vehicles slowly and cautiously on Halloween, especially on sidestreets. "Watch for trick-or-treaters but also be aware of any flying eggs or other debris that could impede vision," said Dr. Cichon.

Since 1995, annual patient volumes in Loyola's emergency division have increased from 29,000 to 53,000 patients. The Loyola emergency medicine division is classified as a Level 1 Trauma Center, providing the highest level of surgical care to trauma patients. The division also has been recognized by groups such as The Joint Commission, the Commission on Accreditation of Medical Transport Systems, the American College of Surgeons for Trauma and the Illinois Department of Public Health for Trauma, Burns, Pediatric and Emergency departments.

Cell Growth Discovery by UCSF Team Has Implications for Targeting Cancer

 to support growth, to repair damaged tissues, or simply to maintain our healthy adult functioning — is controlled in previously unsuspected ways UC San Francisco researchers have discovered. The findings, they said, may lead to new ways to fight cancer.

The steps leading a quiet cell to make and divvy up new parts to form daughter cells rely on some of the cell’s most complex molecular machines. Different machines play key roles at different stages of this cell cycle. Each of these cellular machines consists of many proteins assembled into a functioning whole. They carry out such tasks as repairing DNA in the newly replicated gene-bearing chromosomes, for instance, or helping pull the chromosomes apart so that they can be allocated to daughter cells. 

In a study published online on October 10, 2013 in the journal Molecular Cell, UCSF researchers led by molecular biologist Davide Ruggero, PhD, associate professor of urology, and computational biologist Barry Taylor, PhD, assistant professor of epidemiology and biostatistics, found that the production of entire sets of proteins that work together to perform such crucial tasks is ramped up together, all at once — not due to the transcription of genes into messenger RNA, a phenomenon scientists often study to sort out cellular controls — but at a later stage of gene expression that occurs within the cell’s protein-making factories, called ribosomes.

“We have found that these proteins are regulated specifically and exquisitely during the cell cycle,” Ruggero said. When this regulation falters, it wreaks havoc in the cell, he added. “Cell-cycle control is a process that is most often misregulated in human disease,” he said. 

More specifically, the researchers found that this coordinated timing of protein production during the cell cycle is largely governed at the tail end of gene expression, within the ribosome, where cellular machinery acts on messenger RNA to churn out the chains of amino acids that eventually fold into functional form as proteins.

In 2010 Ruggero reported key evidence suggesting that this stage of protein production, called “translation,” might be an often-neglected process in many tumors, ranging from lymphomas, multiple myeloma and prostate cancer.

In the new study, the researchers examined translation of messenger RNA into protein at the classic phases of the cell cycle, before the cell actually divides. These are the G1 phase, when cells grow and make lots of proteins before replicating their DNA; the S phase, when cells replicate their DNA; and the G2 phase, when cells make internal components known as organelles, which they divvy up along with the chromosomes when the cell actually divides during mitosis.

The scientists used a technique know as ribosome profiling, originally developed for yeast cells in the lab of Jonathan Weismann, PhD, Howard Hughes Investigator at UCSF and professor of cellular and molecular pharmacology, to figure out which messenger RNA was being translated into protein by the ribosome during human cell division. They then used computational techniques developed by Taylor’s lab team along with the lab team of Adam Olshen, PhD, professor of epidemiology and biostatistics, to better quantify which genes had been translated into proteins.

By conducting a genome-wide investigation of translation and interrogating the data with sophisticated computer algorithms, the researchers discovered that different groups of protein were made in abundance at a particular phase, only to be quieted during another phase of the cell cycle. Previous studies of translation of messenger RNA into protein focused on only one or just a few genes at a time, according to Ruggero and Taylor.

“We hope these methods will be helpful to others who study gene regulation at the translational stage in various diseases, and those who want to identify specific targets for drug development based on discoveries of aberrant translation,” Taylor said.

Ruggero has been a pioneer in probing the ability of tumor cells to make extraordinary amounts of protein to sustain their rapid growth and immortality. He also is exploring ways to therapeutically target this excess protein production in cancer.

One striking finding from this new UCSF study is the discovery that production of a protein called RICTOR is boosted due to increased translation during the S phase of the cell cycle. RICTOR serves as a signal to help the cell cycle run like finely tuned clockwork, but several studies suggest that RICTOR often is constitutively turned on in cancer, Ruggero said.

The biochemical signaling cascade within the cell that RICTOR is a part of is under extensive investigation for experimental cancer therapies, and these new findings may point to novel strategies for drug development Ruggero said. Ruggero and Craig Stumpf, PhD, a postdoctoral fellow with his lab and the first author of the Molecular Cell paper, now are tracking down the upstream trigger that coordinates timing of many of the other suites of proteins that are produced simultaneously during the different cell-cycle phases.

UCSF technician Melissa Moreno also worked on the study. The research was funded by grants from the National Institutes of Health.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy, a graduate division with nationally renowned programs in basic biomedical, translational and population sciences, as well as a preeminent biomedical research enterprise and two top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital.

Healthier Diets Possible in Low-Income, Rural Communities in America

children don’t eat enough fruits, vegetables and whole grains. Instead, their diets typically include excessive amounts of sugars and solid fats, counter to the 2010 Dietary Guidelines for Americans recommendations, increasing the risk of obesity and diabetes. A team of investigators implemented a two-year intervention study in low-income, rural areas where a disproportionately higher risk of overweight and obesity habits among children persists, leading to increased risk of diabetes and heart disease in adulthood. The children enrolled in the study consumed significantly more fruits and vegetables. The results are published in the Journal of the Academy of Nutrition and Dietetics.

To evaluate students’ diet quality at the beginning and after the study, researchers designed the CHANGE (Creating Healthy, Active and Nurturing Growing-up Environments) study, a two-year randomized, controlled, community- and school-based intervention to prevent unhealthy weight gain among rural school-aged children.

“Our primary objectives were to improve the diets, physical activity levels, and weight status of rural children based on the successful model developed by Tufts University researchers for the Shape Up Somerville study,” says lead investigator Christina Economos, PhD, Friedman School of Nutrition Science and Policy, Tufts University, Boston . “The objective of our analysis was to examine changes in fruit, vegetable, legume, whole-grain and low-fat dairy consumption among rural elementary students who were exposed to the CHANGE study intervention compared with students in control schools,” says lead author Juliana F. W. Cohen, ScM, ScD, Department of Nutrition, Harvard School of Public Health, Boston. The team wanted to test its hypothesis that students exposed to the study would improve their diet quality due to healthier food environments.

Eight communities in rural California, Kentucky, Mississippi, and South Carolina participated in the study between 2007 and 2009. Two communities in each state were randomly assigned to either an intervention or control group. Students in the intervention sample were given daily access to healthier school foods and weekly educational curriculum which incorporated the goals of the Shape Up Somerville model: at least five servings of fruits and vegetables; no more than two hours of television or other screen time; and at least one hour of physical activity. The mean age of the 1,230 participating students was 8.6 and about 85-95 percent were nonwhite.

A baseline analysis revealed that students in CHANGE schools:
• Ate similar amounts of fruits, vegetables, whole grains, dairy, potatoes/potato products, saturated fats, and sugars as students in control schools
• Consumed significantly more legumes

As a result of the intervention, food consumption of students in CHANGE schools was significantly different than students in the control schools with the following results:
• Eating 0.08 cups of vegetables per 1,000 kcal more per day
• Eating 0.22 cups combined fruits and vegetables per 1,000 kcal more per day
• Had a significantly lower glycemic index

There was a trend toward more fruit consumption in the CHANGE study intervention with 0.15 cups per 1,000 kcal per day.

Dr. Cohen concludes, “The outcomes of the CHANGE study provide evidence that a multi-component intervention targeting low-income children living in rural communities in America can improve their diet quality. Overall, students consumed significantly more vegetables and combined fruits and vegetables after exposure to the CHANGE study intervention compared with students in control schools and communities.”

Drs. Cohen and Economos and colleagues call for more research to examine ways to improve other aspects of children’s diets using this community-based model.

# # #

NOTES FOR EDITORS
“The CHANGE Study: A Healthy-Lifestyles Intervention to Improve Rural Children’s Diet Quality,” Juliana F.W. Cohen, ScM, ScD; Vivica I. Craak, MS; Silvina F. Choumenkovitch, PhD; Raymond R. Hyatt, PhD; and Christina D. Economos, PhD. Journal of the Academy of Nutrition and Dietetics, DOI: 10.1016/j.jand.2013.08.014, published by Elsevier.

Full text of this article is available to credentialed journalists upon request. Contact Eileen Leahy at 732-238-3628 or andjrnlmedia@elsevier.com to obtain copies. Journalists wishing to set up interviews with the authors should contact Andrea Grossman, Assistant Director, Public Relations, Tufts University Health Sciences Campus, at 617-636-3728 or Andrea.Grossman@tufts.edu.

ABOUT THE AUTHORS
Juliana F.W. Cohen is a postdoctoral research fellow, Department of Nutrition, Harvard School of Public Health, Boston, MA.
Vivica I. Craak is a doctoral candidate, Deakin Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Burwood, Victoria, Australia.
Silvina F. Choumenkovitch is a research associate, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.
Raymond R. Hyatt is an associate professor, Department of Public Health and Community Medicine, Tufts University, Boston, MA.
Christina D. Economos is an associate professor, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.

ABOUT THE JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
The official journal of the Academy of Nutrition and Dietetics (www.eatright.org), the Journal of the Academy of Nutrition and Dietetics (www.andjrnl.org) is the premier source for the practice and science of food, nutrition and dietetics. The monthly, peer-reviewed journal presents original articles prepared by scholars and practitioners and is the most widely read professional publication in the field. The Journal focuses on advancing professional knowledge across the range of research and practice issues such as: nutritional science, medical nutrition therapy, public health nutrition, food science and biotechnology, food service systems, leadership and management and dietetics education.

The Journal has a current Impact Factor of 3.797 in the Nutrition and Dietetics category of the 2012 Journal Citation Reports®, published by Thomson Reuters. It was previously published as the Journal of the American Dietetic Association.

ABOUT THE ACADEMY OF NUTRITION AND DIETETICS
The Academy of Nutrition and Dietetics (www.eatright.org), formerly the American Dietetic Association, is the world’s largest organization of food and nutrition professionals. The Academy is committed to improving the nation’s health and advancing the profession of dietetics through research, education and advocacy.

American Epilepsy Society and the National Association of Epilepsy Centers Debuts Free Online Medical Education Series on Safety - www.EMUCaring.org

 The American Epilepsy Society (AES) and the National Association of Epilepsy Centers (NAEC) are pleased to announce a free online continuing medical education series “Safety in the Epilepsy Monitoring Unit.” This specially structured learning presentation is intended to educate healthcare providers on the best ways to create a culture of safety in the epilepsy unit. Meant for all members of the epilepsy team, including physicians, nurses, EEG technologists, pharmacists, social workers, and other staff in the unit, this program presents best practices as identified by a group of national experts in epilepsy.

“The relationship between how cohesively epilepsy monitoring units function and how effectively they can address the unique needs of their patients should not be understated,” says Patricia O. Shafer, R.N., M.N., Beth Israel Deaconess Medical Center and Content Chair for EMUCaring. “The finer attention that is paid to this relationship the greater probability of improved safety outcomes.”

The online program consists of seven modules addressing topics such as Seizure Observation, Environment and Activity, Managing Seizures and Comorbidities, and Preparing for Transition to Outpatient Care. For ease of learning, each module can be completed independently.

This tool can be used for continuing in-service education and as a training tool for new members of the team. At present, the program has been approved for physicians, nurses and EEG technologists to receive up to a maximum of 3.5 continuing education credits by the Accreditation Council for Continuing Medical Education (ACCME), EduPro Resources LLC (EDUPRO), and ASET – The Neurodiagnostic Society.

About the American Epilepsy Society
The American Epilepsy Society (AES) is the premier professional organization in the United States representing multi-specialty members including physicians, psychologists, nurses, social workers, and research scientists that provide care to people with epilepsy. The Society promotes research, interdisciplinary communication, and education for professionals dedicated to the prevention, optimal treatment, and cure of epilepsy.

About the National Association of Epilepsy Centers
With the goal of no seizures and no side effects, the National Association of Epilepsy Centers (NAEC) strives to make high quality healthcare available and affordable for epilepsy patients across the country. NAEC is a non-profit association with a membership of more than 190 specialized Level 3 and 4 epilepsy centers in the United States. Founded in 1987 by physician-leaders committed to setting a national agenda for quality epilepsy care, the NAEC connects people with epilepsy to specialized epilepsy care and supports epileptologists in the operation of their epilepsy centers.