AI Can Help Apple Watch Predict High Blood Pressure, Sleep Apnea

The world’s most valuable company crammed a lot into the tablespoon-sized volume of an Apple Watch. There’s GPS, a heart-rate sensor, cellular connectivity, and computing resources that not long ago would have filled a desk-dwelling beige box. The wonder gadget doesn’t have a sphygmomanometer for measuring blood pressure or polysomnographic equipment found in a sleep lab—but thanks to machine learning, it might be able to help with their work.

Research presented at the American Heart Association meeting in Anaheim Monday claims that, when paired with the right machine-learning algorithms, the Apple Watch’s heart-rate sensor and step counter can make a fair prediction of whether a person has high blood pressure or sleep apnea, in which breathing stops and starts repeatedly through the night. Both are common—and commonly undiagnosed—conditions associated with life-threatening problems, including stroke and heart attack.

The new study adds to evidence that the right algorithms might transform the Apple Watch from personal trainer to personal physician. Apple said in September that it is working on a study with Stanford that will test whether the gadget can detect atrial fibrillation, or irregular heartbeat, which can lead to stroke or heart failure. A study independent of Apple presented in May has already suggested the answer is yes. And health insurer Aetna said last week that it is partnering with Apple to give Apple Watches to members to try to reduce health costs.

The Apple Watch’s potential to predict high blood pressure and sleep apnea was revealed by a collaboration between University of California San Francisco and a startup called Cardiogram. The company offers an app for organizing heart-rate data from an Apple Watch, and other devices with heart-rate sensors. UCSF provided data from more than 6,000 Apple Watch users enrolled in a study on mobile health. Cardiogram’s founders drew on their previous experience as Google employees, working on speech recognition for Android phones and the Google Assistant.

Cardiogram’s engineers took the kind of artificial neural networks that Google and others use to turn our speech into text and adapted them to interpret heart-rate and step count data. (Like speech, they are signals that vary over time.) The system, dubbed DeepHeart, is given strings of heart-rate and step data from multiple people, and information about their health conditions. In May, the company and UCSF released results showing that DeepHeart could figure out how to predict atrial fibrillation from a person's Apple Watch data. The study presented Monday shows that with one week of data on a wearer, the algorithms can predict hypertension with roughly 80 percent accuracy, and sleep apnea with about 90 percent accuracy.

Doctors don’t—and probably couldn’t—diagnose high blood pressure or sleep apnea just by eyeballing a week’s worth of data from your smartwatch. They diagnose hypertension by putting that familiar cuff on your arm. Sleep apnea requires a visit to a sleep clinic, or use of home monitoring equipment. So how do Cardiogram’s algorithms make good guesses without directly measuring a person's blood pressure or breathing? We only sort of know.

Breathing, heart rate, and blood pressure are all connected to our autonomic nervous system, which regulates the unconscious bodily functions that keep us alive. Past research has shown how hypertension and sleep apnea alter the dynamics of heart rate. For example, heart rate variability is lower in people with sleep apnea. But Brandon Ballinger, a Cardiogram cofounder, admits that he doesn’t know all the patterns in a person's heart rate that his algorithms use to make predictions. “They’re kind of a foreign form of intelligence,” says Ballinger.

Ballinger says that, with the right testing, that doesn't prevent his alien intelligence from having business potential. Cardiogram’s app for Apple Watch and other devices is free today. But the startup’s business plan is to one day add features that advise a user to be checked for atrial fibrillation, high blood pressure, or sleep apnea. To stay on the right side of the FDA, the app would have to advise a person to get tested, and not suggest the person has a particular condition. Cardiogram would make money by offering to ship the necessary equipment for a home test, and billing a person's health insurer. The app could also provide advice after a diagnosis, or link people to medical practitioners or health coaches, Ballinger says. He predicts some of these features will appear within months.

That plan is plausible, but needs to be proved out. Leslie Saxon, a cardiologist and executive director of the Center for Body Computing at the University of Southern California, says the idea of inferring conditions indirectly from heart rate and step counts needs more testing. “The study is seeing a correlation and that’s important to know, but the value is still unproven for medicine,” she says. Saxon also notes that the Apple Watch's heart data varies in accuracy depending on how a person wears the device. Cardiogram says it has more research underway, and expects accuracy to improve. There are now about 30,000 people enrolled in Cardiogram's study with UCSF.

That’s big for a medical study—and perhaps a reflection of people’s readiness for wearables like the Apple Watch to act as medical advisers. Saxon says studies at USC have shown that patients eagerly engage with apps capable of medical-grade measurements. If people are properly educated about what they can do alone, their health care is better managed as a result, she says. Her center's projects include testing a mobile heart sensor that pairs with a phone or watch made by startup AliveCor. “Patients would much rather self-manage than deal with you, the physician,” says Saxon. “And they’re already on their phone 200 times a day.” If Cardiogram and Saxon are right, medical-grade notifications may soon nestle among those for our Snaps, likes, and texts.

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Newly discovered nearby planet could support life

(CNN)You may want to get used to the name Ross 128 b. The newly discovered exoplanet is the second-closest found to our solar system, only 11 light-years away. And it could support life.

Announcements about exoplanets, those found outside our solar system, seem almost commonplace in this golden age of discovery for astronomers. So why is Ross 128 b unique — apart from its rather human-sounding name?
The planet is about the same size as Earth, and it may have a similar surface temperature, making it a temperate world that could support life.
    Every 9.9 days, it completes an orbit around its host star, Ross 128, which is what’s known as a red dwarf star: They’re the coolest, faintest and most common stars found in the universe.
    Because of their plentiful nature and the fact that other exoplanets have been found around these types of stars, red dwarfs are being studied and observed with increasing frequency in the hopes of finding more exoplanets.
    Astronomers found Ross 128 and its planet using the European Southern Observatory’s planet-hunting instrument, called HARPS. The High Accuracy Radial velocity Planet Searcher is based at La Silla Observatory in Chile. The astronomers detail their discovery in a new study, published Wednesday in the journal Astronomy and Astrophysics.
    “To be involved in such a discovery is very rewarding, and it helps to realize that so much effort is worth it,” Nicola Astudillo-Defru, one of the study’s co-authors at the University of Geneva’s observatory, wrote in an email. “The special properties of this system means that we are contributing our bit on the search of a Earth 2.0.”
    Other notable discoveries of Earth-size exoplanets in recent years, like the TRAPPIST planets and Proxima b, were also found around these types of stars. They are also considered to be among the best hopes for supporting life on planets outside our solar system because they exist within the “habitable zones” of their stars, where liquid water could pool on the surface of the planet and potentially support life as we know it.
    The astronomers don’t yet know whether Ross 128 b is in the habitable zone of its star, but it’s likely, given what they understand about red dwarfs and the planets that orbit them.
    Ross 128 b is 20 times closer to its star than Earth is to the sun, but because the star is small, dim and cool, the planet would still be at a potentially comfortable temperature. The nature of the star is also why the planet is subjected to only 1.38 times the radiation that Earth receives from the sun, even though the planet and star are close together.
    But the reason astronomers are excited about Ross 128 b is because the star is “quiet.” Other red dwarfs, like Proxima Centauri — the star that Proxima b orbits — have a tendency to lash out at their planets with deadly flares of ultraviolet and X-ray radiation.
    But Ross 128 doesn’t seem to be doing this, so it’s considered “quieter,” which means the planet is a more comfortable place for life to form without being subjected to such violent episodes from time to time.
    Proxima b is currently the closest exoplanet to our solar system ever discovered, at a distance of 4.2 light-years. Ross 128 b could change this, because the planet and its star are moving toward us.
    “A detailed study investigated the movement of our stellar neighbor by combining data from the Hipparcos satellite and ground-bases velocimeters,” Astudillo-Defru said. “They list all the close encounters with other stars, and because of the relative movements of stars and the Sun, it results that Ross 128 will be our closest star.”
    Astronomers estimate that in 79,000 years, Ross 128 b will be our exoplanet neighbor, even closer than Proxima b. That may sound like a long time, but in a universe that is billions of years old, it’s merely a cosmic moment.
    The astronomers believe that Ross 128 b is a good candidate for further study when the European Southern Observatory’s Extremely Large Telescope can begin searching the atmospheres of exoplanets for biomarkers in 2025.
    “I plan to continue searching for new worlds, specially around Ross 128 because it is likely that there are more planets,” Astudillo-Defru said.

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    Bill Gates’ newest mission: Curing Alzheimer’s

    (CNN)It’s one of the holy grails of science: a cure for Alzheimer’s. Currently, there is no treatment to stop the disease, let alone slow its progression. And billionaire Bill Gates thinks he will change that.

    “I believe there is a solution,” he told me without hesitation.
    “Any type of treatment would be a huge advance from where we are today,” he said, but “the long-term goal has got to be cure.”
      I had the chance to sit down with Gates recently to talk about his newest initiative. He sat in front of our cameras exclusively to tell me how he hopes to find a cure to a disease that now steals the memories and other cognitive functions of 47 million people around the world.
      For Gates, the fight is personal. He is investing $50 million of his own money into the Dementia Discovery Fund, a private-public research partnership focused on some of the more novel ideas about what drives the brain disease, such as looking at a brain cell’s immune system. It’s the first time Gates has made a commitment to a noncommunicable disease. The work done through his foundation has focused primarily on infectious diseases such as HIV, malaria and polio.
      I have interviewed Gates many times over the years, in countries around the world. He was more engaged on this topic of Alzheimer’s than I’ve ever seen before.
      Today, Alzheimer’s disease is the most common form of dementia and the sixth leading cause of death in the United States, where a new case is diagnosed every 66 seconds. More than 5 million Americans live with the disease, at a cost of $259 billion a year. Without any treatment, those numbers are projected to explode to 16 million Americans with the disease, at a cost of over $1 trillion a year, by 2050.
      “The growing burden is pretty unbelievable,” the tech guru-turned-philanthropist told me. It’s something he knows personally. “Several of the men in my family have this disease. And so, you know, I’ve seen how tough it is. That’s not my sole motivation, but it certainly drew me in.”
      When he said, “I’m a huge believer in that science and innovation are going to solve most of the tough problems over time,” I could feel his optimism.
      He told me he has spent the past year investigating and talking to scientists, trying to determine how best to help move the needle toward treatment of the disease itself rather than just the symptoms.

      A disease turns 100

      It has been more than a century since the disease was identified by German physician Dr. Alois Alzheimer. He first wrote about it in 1906, describing the case of a woman named “Auguste D.” Alzheimer called it “a peculiar disease,” marked by significant memory loss, severe paranoia and other psychological changes.
      But it wasn’t until Alzheimer performed an autopsy on her brain that the case became even more striking. He found that her brain had shrunk significantly, and there were unusual deposits in and around the nerve cells.
      It would take another 80 years for scientists to identify what those deposits were: plaques and tangles of proteins called amyloid and tau. They have become hallmarks of the disease.
      Both amyloid and tau are naturally occurring proteins that can be found in healthy brain cells. But in a brain with Alzheimer’s, something goes haywire, causing parts of amyloid proteins to clump together and block the cell’s messaging pathways. Eventually, tau proteins begin to tangle up inside the neurons.
      All of this contributes to a breakdown of the neural highway that helps our brain cells communicate. These changes in the brain can begin years before anyone starts actually exhibiting any symptoms of memory loss or personality changes.
      Until recently, it’s been a challenge to understand the disease, let alone identify who has it. The only way to definitively diagnose Alzheimer’s is still after someone has died and their brain can be examined under the microscope, looking for the telltale amyloid plaques and tau tangles.

      A new hope

      “It’s gone slower than we all would have hoped. A lot of failed drug trials,” Gates told me. And he’s right. Since 2002, there have been more than 400 Alzheimer drug trials run and yet no treatments. There are some drugs prescribed to help with cognitive symptoms such as memory loss or confusion but nothing that actually targets Alzheimer’s.
      In the past five years, advanced imaging technology has allowed us to see tau and amyloid in living people.
      Dr. James Hendrix, who heads up the Alzheimer Association’s Global Science Innovation team, believes that this development is a game-changer. “You need good tools to find the right therapeutics,” he said.
      By identifying these biomarkers earlier, Hendrix told me, scientists can work on finding ways to prevent the brain from deteriorating.
      “If we can catch the earliest signs of Alzheimer’s, then we’re treating a mostly healthy brain, and keeping it mostly healthy. … It’s very difficult to repair the damage once it’s done,” he explained.
      Dr. Rudy Tanzi agrees that imaging has been essential in understanding the pathology of Alzheimer’s and potential treatments. Tanzi, a professor of neurology at Harvard, has been at the helm of Alzheimer’s research, discovering several of the genes associated with the disease.
      He points out that one of the greatest faults with some of the trials has not been in the treatment itself but in the application: too late in the disease’s progression, when symptoms are already occurring. “It’s like trying to give someone Lipitor when they have a heart attack,” he explained. “You had to do it earlier.”
      Tanzi said we need to think about Alzheimer’s like cancer or heart disease. “That’s how we’re going to beat the disease: early detection and early intervention.”

      Think different

      Most of the focus in Alzheimer’s research has been on tau and amyloid, what Gates likes to call “the mainstream.” With his donation, Gates hopes to spur research into more novel ideas about the disease, like investigating the role of the glial cells that activate the immune system of the brain or how the energy lifespan of a cell may contribute to the disease.
      “There’s a sense that this decade will be the one that we make a lot of progress,” Gates told me.
      Gates believes that it will be a combination of mainstream and out-of-the-box thinking that will lead to potential treatments in the near future.
      “Ideally, some of these mainstream drugs that report out in the next two or three years will start us down the path of reducing the problem. But I do think these newer approaches will eventually be part of that drug regimen that people take,” he said.

      See the latest news and share your comments with CNN Health on Facebook and Twitter.

      Has looking into Alzheimer’s research caused Gates to worry about his own health?
      “Anything where my mind would deteriorate” is, he said, one of his greatest fears. He’s seen the hardship it has caused in his own family. “I hope I can live a long time without those limitations.”
      So Gates is now focused on prevention, by exercising and staying mentally engaged. “My job’s perfect, because I’m always trying to learn new things and meeting with people who are explaining things to me. You know, I have the most fun job in the world,” he said with a smile.

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      Alzheimer’s is a young(er) person’s disease — so get to work

      (CNN)While he couldn’t possibly have known, Sandy Halperin was likely around 35 years old when his brain began slowly accumulating the plaques and tangles of Alzheimer’s disease.

      Thanks to recent advances that allow us to see disease in the living brain, we now know there is evidence of Alzheimer’s in neural tissue 20 to 30 years before one first starts noticing lapses in memory. By age 60, when Sandy first started losing words and forgetting his intentions, the disease was already advanced, even if Sandy and his family were noticing symptoms for the first time.
      “There is no pain,” Sandy told me. I had asked about this because of recent papers showing inflammation in the brain being a primary enemy at the time Alzheimer’s disease starts to show itself.

          Dr. Sanjay Gupta: Introducing ‘Sandy’s Story’

        According to Harvard’s Rudy Tanzi, when brain cells, known as glia, sense the death of other brain cells from plaques and tangles, they assume one thing: infection. In an attempt to fight these “foreign invaders” the brain becomes flooded with inflammatory free radicals that begin a vicious war inside the brain. But the infection doesn’t actually exist; the brain is fighting a ghost.
        No, not pain, Sandy reiterated, pausing and searching hard for the right words. He told me it actually feels like cotton stuffed deeply into the base of his frontal lobes. He eloquently described this with the precision of a Harvard assistant dental professor, which he once was. But then he completely forgot what we were discussing and looked at me sheepishly. “Frontal lobes,” I gently prompt him. “Right,” he remembered. And for just a few minutes Sandy is lucid once again.

          Preserve memories despite Alzheimer’s: Sandy’s Story

        Over the last three years, we have frequently visited with Sandy as he slowly descends into dementia. There aren’t many happy endings with stories about Alzheimer’s disease, but Sandy’s story is different somehow.
        He wants to open up his life and his brain to us, and to science. He wants to be a part of the transformative advances taking place in Alzheimer’s, even if he is not around to benefit from them. Unwilling to be relegated to the sidelines, Sandy has thrown himself head-on into the battles for increased funding and decreased stigma. Neither has been easy, but his progress has been deeply inspirational.

        Only leading cause of death not currently preventable

        By 2040, it’s estimated that Alzheimer’s will consume almost 25% of Medicare’s budget. But while dementia is about to become the biggest caregiving challenge of our generation, funding to battle the disease has not kept pace. Alzheimer’s research was promised a mere $580 million in funding from the NIH this year, while cancer is slated for more than $5 billion, AIDS is getting $3 billion and cardiovascular disease nearly $2 billion.
        While it is futile to compare one medical condition to another, Alzheimer’s disease remains the only leading cause of death that is not currently preventable, let alone curable. Most existing treatments revolve around keeping certain neurotransmitters, such as acetylcholine, around in the brain longer after Alzheimer’s has already taken hold. But that is like bringing a knife to a gun fight.

          Sandy’s Story: a family’s end of life struggles

        Still, there is remarkable enthusiasm today from scientists toiling away in laboratories around the world. Tanzi’s group has created an “Alzheimer’s-in-a-dish” model. It is essentially mini brains created with human nerve cells grown in a petri dish.
        This allows Alzheimer’s disease to be studied like never before. From this and other models we have learned, for example, that it is the beta-amyloid plaques that come first — and early. The tangles caused by tau only occur much later, closer to the beginning of symptoms. So if we can reduce early plaque formation with a sort of vaccine, the word “cure” starts getting tossed around by normally reserved scientists.
        “This is an exciting time,” the Alzheimer’s Association’s Dean Hartley told me as he looks to the future. “If most people start symptoms at 65, then we might extrapolate and say we need to be treating at 45. So you’d go in at say, age 40 or 45 and get a beta-amyloid checkup to see if you need some type of treatment or intervention.”
        “Giving drugs to mildly or asymptomatic people is new,” agreed clinical neurologist David Knopman at the Mayo Clinic.
        Researchers are exploring some fringe areas as well. Most intriguing to me was the reason why some people form the plaques in the first place. After all, it’s just too easy to chalk it up to bad luck. As it turns out, the plaques may not be all bad. Just recently, we have learned that some people with Alzheimer’s have higher levels of yeast, bacteria and viruses in their brains as compared to people of similar age without the disease.
        Scientists now wonder if plaques occur as part of the body’s natural defense system to protect the brain from pathogens. As a result, preventing Alzheimer’s might have some parallels with preventing infectious diseases. And, that simply getting rid of all the plaque could be disastrous. Instead, plaque in the brain may need to be reduced, but not eliminated — similar to cholesterol in the blood.

        What will make a difference: your taxes and your time

        As we start to understand more than ever about Alzheimer’s disease, we are able to also better understand what will be needed to finally make a significant dent in this disease. It’s no surprise we need more money. After all, that’s what it took to make a dent in cancer, heart disease and HIV/AIDS.
        The Alzheimer’s Association’s researchers did the math and announced that Uncle Sam needs to spend $2 billion a year — instead of today’s $580 million — to get a treatment in 2025 that would delay the onset of Alzheimer’s by five years. The good news? That would reduce the number of people with Alzheimer’s by 42% in 2025 and save $220 billion within the first five years alone.

          Toll of Alzheimer’s Caregiving: Sandy’s Story

        That sounds like a good investment to me. One of the critical areas not contingent on more money is recruiting enough volunteers for clinical trials. That doesn’t cost anything but your time.
        “Other than research funding, recruiting and retaining trial participants is the greatest obstacle to developing new treatments that can slow, stop or prevent Alzheimer’s disease,” Hartley told me. He said the Alzheimer’s Association needs at least 50,000 people to meet current enrollment demands.
        “There is a HUGE need for people to join, with the most pressing need for those with a family history,” agreed Weill Cornell’s Richard Isaacson. His study needs volunteers and he says the A4 Alzheimer’s prevention study needs to screen at least 5,000 people with currently normal cognitive abilities.

        Preventing your own decline

        Isaacson runs one of the few Alzheimer’s prevention clinics in the country, and he also stresses the need to look at the disease holistically. “We now have research that shows very specific types of exercise, brain stimulation, taking control of diabetes, even in the pre-diabetes phase, can all make a difference.”
        Tanzi agrees, and even lists his recommendations in order of priority: exercise, at least seven to eight hours of sleep, which helps the brain clear debris, an anti-inflammatory Mediterranean style diet, adding good quality Omega 3 oils (he likes krill), intellectual stimulation and social engagement.
        Sandy has known this all along. He swims, sings, eats well and is also constantly engaging his brain by lobbying for change. His time on Capitol Hill and speaking to thousands of like-minded advocates and scientists has had the added benefit of keeping his brain animated and slowing down the progression of his disease.
        For now, that is all he has. But he wants more for his daughters and granddaughters, and for the millions who will soon be diagnosed with Alzheimer’s.

          A dream comes true despite Alzheimer’s: Sandy’s Story

        “Help!” he told our cameras on one of our visits. “CNN World — you’re listening to me right now…Help! What are you going to do if you’re a legislator, physician, plumber, educator…it’s not about me, Sandy Halperin, it’s about the Alzheimer’s effort!”
        And as his disease progresses, and his ability to function is reduced, he — and I — have a challenge for you: Get in the game. Give money if you can, but more than that, volunteer. Participate in a clinical trial. And allow Sandy’s story to change the way you look at Alzheimer’s disease forever.
        On our last day together, Sandy took me aside. We said goodbye, and gave one another a long hug. He then grabbed me by the shoulders and said in a moment of profound clarity: “Here’s the ball, grab it. I love you, thank you for taking the ball. Run with the ball and play the game because we all need to do something for our nation.”
        For you Sandy, I will keep trying. CNN World, will you join me?

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        UK disappointed as Robert Mugabe becomes WHO goodwill ambassador

        UN body appoints Zimbabwean despot to help tackle non-communicable diseases, despite dire health crisis under his rule

        The UK government has criticised the World Health Organizations decision to appoint Robert Mugabe as a goodwill ambassador, calling the move surprising and disappointing.

        A Downing Street spokesman said British diplomats had raised serious concerns with the WHO director general, Tedros Adhanom Ghebreyesus, over the decision to offer the high-profile role to the Zimbabwean president.

        The UN body asked the 93-year-old, who has been in power since 1980, to help tackle non-communicable diseases such as heart attacks, strokes and asthma across Africa.

        However, the move has been condemned by human rights groups and international bodies, which say Zimbabwes healthcare system has collapsed under Mugabes authoritarian regime. Most hospitals lack essential medicines and supplies, and nurses and doctors regularly go unpaid.

        A UK government spokesman said the WHO decision was at odds with US and EU sanctions against Mugabe. Although Mugabe will not have an executive role, his appointment risks overshadowing the work undertaken globally by the WHO on non-communicable diseases, he said.

        Mugabe was in Uruguay for the announcement by Tedros, the former Ethiopian health minister who was elected as the WHOs first director general from Africa this year after defeating the British candidate, David Nabarro, in three close rounds of voting.

        Tedros said he was honoured to announce that Mugabe had agreed to serve as a goodwill ambassador on non-communicable diseases for Africa. He hailed Zimbabwe as a country that places universal health coverage and health promotion at the centre of its policies to provide healthcare to all.

        The choice of Mugabe for the role has also angered opposition parties in Zimbabwe and human rights campaigners who accuse the leader of violent repression, election rigging and presiding over the countrys economic ruin.

        Iain Levine, a programme director at Human Rights Watch, tweeted:

        Iain Levine (@iainlevine)

        Given Mugabe’s appalling human rights record, calling him a Goodwill Ambassador for anything embarrasses @WHO and @DrTedros

        October 20, 2017

        The main opposition party in Zimbabwe, MDC, described the appointment as laughable. The Zimbabwe health delivery system is in a shambolic state. It is an insult, the spokesman Obert Gutu said.

        Mugabe trashed our health delivery system. He and his family go outside of the country for treatment in Singapore after he allowed our public hospitals to collapse.

        Mugabe is in increasingly fragile health and makes regular trips abroad for medical treatment.

        Zimbabwes state-run Herald newspaper reported the appointment under the headline New feather in Presidents cap. It said Mugabe had told the WHO conference in Montevideo on Wednesday that Zimbabwe had developed a national policy on non-communicable diseases, and that he had called for more funds for developing nations.

        According to the WHO, non-communicable diseases are by far the worlds leading cause of death, killing more than 36 million people a year.

        UN agencies such as the WHO, UNHCR and Unesco all appoint goodwill ambassadors to highlight specific causes and often to draw publicity.

        Unicef ambassadors include the singer Katy Perry and the tennis player Serena Williams.

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        Radical new approach to schizophrenia treatment begins trial

        Exclusive: as evidence emerges that schizophrenia could be an immune system disease, two-year trial will use antibody drug currently used for MS

        British scientists have begun testing a radically new approach to treating schizophrenia based on emerging evidence that it could be a disease of the immune system.

        The first patient, a 33-year old man who developed schizophrenia after moving to London from Cameroon a decade ago, was treated at Kings College Hospital in London on Thursday, marking the start of one of the most ambitious trials to date on the biology of the illness and how to treat it.

        During the next two years, 30 patients will receive monthly infusions of an antibody drug currently used to treat multiple sclerosis (MS), which the team hopes will target the root causes of schizophrenia in a far more fundamental way than current therapies.

        The trial builds on more than a decades work by Oliver Howes, a professor of molecular psychiatry at the MRC London Institute of Medical Sciences and a consultant psychiatrist at the Maudsley Hospital in south London. Howess team is one of several worldwide to have uncovered evidence that abnormalities in immune activity in the brain may lie at the heart of the illness for some patients, at least.

        In the past, weve always thought of the mind and the body being separate, but its just not like that, said Howes. The mind and body interact constantly and the immune system is no different. Its about changing the way we think about mental illnesses.

        Recent work by Howes and colleagues found that in the earliest stages of schizophrenia, people experience a surge in the number and activity of immune cells in the brain. As well as fighting infection, these cells, called microglia, have a gardening role, pruning unwanted connections between neurons. But in schizophrenia patients, the pruning appears to become more aggressive, leading to vital connections being lost.

        We studied people in that [initial] phase of the illness and saw microglial changes, said Howes. It shows that its something [happening] very early on and seems to be driving the illness.

        The most extensive pruning appears to occur in the frontal cortex, the brains master control centre, and also the auditory regions, which could explain why patients often hear voices. The frontal cortex indirectly controls the brains levels of dopamine a surge in this brain chemical is thought to explain the delusions and paranoia experienced by those with schizophrenia.

        Nearly all existing medications work by blocking dopamine, which can bring psychotic symptoms under control, but fail to protect the brains basic architecture from damage.

        The current drugs are based on 1950s technology; they all still work in exactly the same way, said Howes. They are only able to target the delusion side of things. Its like getting a sledgehammer and squashing it down.

        Microglial cells, outlined in green stain, have thin processes that reach out around brain cells, stained in red. Photograph: Bloomfield et al

        There is a growing appreciation that other, perhaps less well-known, symptoms associated with schizophrenia memory and cognitive problems, and lack of motivation can have an equally profound impact on patients, and existing drugs do little to help this side of the disease. Its typically [these other] symptoms that are the most disabling, said Toby Pillinger, a psychiatrist and Kings College London researcher involved in the study.

        The latest trial, a collaboration between MRC scientists and Kings College London, involves treating patients with a monoclonal antibody drug, called Natalizumab, that is already licensed for MS. In MS, the brains immune cells go awry by attacking a different aspect of the brains wiring. And although the diseases manifest in very different ways, apparent parallels in the underlying biology raise the possibility that the MS drug might help schizophrenia patients.

        The drug works by targeting microglia and restricting their movement around the brain, which scientists hope could prevent the over-pruning of vital connections. In doing so, it could potentially address the diseases full spectrum of symptoms.

        The first participant, Leopold Fotso, 33, received his first dose of treatment on Thursday. Fotso, who lives in south London after moving from Cameroon in 2007, was diagnosed with schizophrenia four years ago. He has been admitted to hospital several times with psychotic episodes. His illness also forced him to abandon his studies in accountancy which he had moved to the UK to pursue and his part-time kitchen job.

        Leopold Fotso undergoes the first treatment of a new therapy for schizophrenia. Photograph: Teri Pengilley for the Guardian

        He currently has monthly injections of an antipsychotic drug, and his condition is now stable. He feels on the way to being himself again and is looking to slowly start working again. Its quite hard, he said.

        At some time during their life about 1 in 100 people will suffer an episode of schizophrenia. In the UK, about 220,000 people are being treated for the condition by the NHS at any one time.

        In total, in this first trial, 60 patients will be treated for three months, attending clinic once a month for hour-long infusions half will receive the antibody, half a placebo. The patients symptoms will be tracked and, along with 30 healthy volunteers, they will be given a series of brain scans, cognitive assessments and tests of immune activity. The hope is that, even if symptoms do not improve, the study should also answer fundamental questions about the role of the immune system in the illness.

        Belinda Lennox, senior clinical lecturer in psychiatry at the University of Oxford, whose work also focuses on the role of the immune system in schizophrenia, said the concept behind the latest study was exciting although at a very experimental stage. Theres a lot of emerging evidence that the immune system is going wrong [in schizophrenia], she said. If reducing inflammation acts to improve psychosis in this study it will open a new range of treatment possibilities, which is very exciting for the field, and desperately needed.

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        Acid reflux drug linked to more than doubled risk of stomach cancer study

        There are more than 50m prescriptions for proton pump inhibitors in the UK, though they have previously been linked to side-effects and increased risk of death

        A drug commonly used to treat acid reflux is linked to a more than doubled risk of developing stomach cancer, researchers have claimed.

        Proton pump inhibitors (PPIs) reduce the amount of acid made by the stomach and are used to treat acid reflux and stomach ulcers.

        A study published in the journal Gut identified an association between long-term use of the drug and a 2.4 times higher risk of developing stomach cancer. In the UK, there are more than 50m prescriptions for PPIs every year but they have been linked to side-effects and an increased risk of death.

        A link between PPIs and a higher stomach cancer risk has previously been identified by academics but never in a study that first eliminates a bacteria suspected of fuelling the illnesss development.

        Research by the University of Hong Kong and University College London found that after the Helicobacter pylori was removed, the risk of developing the disease still rose in line with the dose and duration of PPI treatment.

        They compared the use of PPI against another drug which limits acid production known as H2 blockers in 63,397 adults. The participants selected had been treated with triple therapy, which combines PPI and antibiotics to kill off the H pylori bacteria over a week, between 2003 and 2012.

        Scientists then monitored them until they either developed stomach cancer, died or reached the end of the study at the end of 2015.

        During this period, 3,271 people took PPIs for an average of almost three years, while 21,729 participants took H2 blockers. A total of 153 people developed stomach cancer, none of whom tested positive for H plyori but all had long-standing problems with stomach inflammation, the study found.

        While H2 blockers were found to have no link to a higher risk of stomach cancer, PPIs was found connected to an increased risk of more than double.

        Daily use of PPIs was associated with a risk of developing the illness that was more than four times higher (4.55) than those who used it weekly. Similarly, when the drug was used for more than a year, the risk of developing stomach cancer rose five-fold, and as high as eight-fold after three or more years, the findings showed.

        The study concluded no firm cause and effect could be drawn, but doctors should exercise caution when prescribing long-term PPIs even after successful eradication of H plyori.

        Responding to the study, Stephen Evans, professor of pharmacoepidemiology at the London School of Hygiene and Tropical Medicine, said: Many observational studies have found adverse effects associated with PPIs.

        The most plausible explanation for the totality of evidence on this is that those who are given PPIs, and especially those who continue on them long-term, tend to be sicker in a variety of ways than those for whom they are not prescribed.

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        Bill Gates announces major donation to advance the fight against Alzheimer’s

        Bill Gates speaks speaks at the Goalkeepers 2017 event on Sept. 20, 2017, in New York City.
        Image: Jamie McCarthy / Getty Images for Bill & Melinda Gates Foundation

        Bill Gates just donated a piece of his fortune to advance the fight against Alzheimer’s disease.

        The philanthropist and Microsoft founder announced in a blog post Monday that he will give $50 million to the Dementia Discovery Fund, a public-private partnership that invests in innovative dementia research. Gates will also donate another $50 million in startups working in Alzheimer’s research.

        Through the Bill and Melinda Gates Foundation, Gates has a long track record of supporting research to eradicate diseases like malaria and polio. But Alzheimer’s disease, which is the most common form of dementia that progressively affects memory and other brain functions, is the first noncommunicable disease he’s fighting.

        The $100 million is his own investment, not his foundation’s. That’s, in part, because it’s personal. 

        “This is something I know a lot about, because men in my family have suffered from Alzheimer’s.”

        “It’s a terrible disease that devastates both those who have it and their loved ones,” Gates wrote in his blog post. “This is something I know a lot about, because men in my family have suffered from Alzheimer’s. I know how awful it is to watch people you love struggle as the disease robs them of their mental capacity, and there is nothing you can do about it. It feels a lot like you’re experiencing a gradual death of the person that you knew.”

        Alzheimer’s disease is the sixth-leading cause of death in the United States, according to the Alzheimer’s Association. An estimated 5.5 million Americans live with Alzheimer’s, and someone new develops the disease every 66 seconds. People of all ages are affected, but 1 in 3 seniors dies with Alzheimer’s or another form of dementia.

        Gates said he spent the last year learning everything he could about Alzheimer’s disease, speaking with researchers, academics, and other industry experts. Those conversations led him to focus on five areas: understanding how the disease unfolds, figuring out how to detect it earlier, funding more innovative and lesser-known drug trials, making it easier for people to enroll in clinical trials, and using data to inform better approaches.

        Gates’ investment in the Dementia Discovery Fund will help support startups as it explores “less mainstream approaches to treating dementia,” he explained.

        “The first Alzheimer’s treatments might not come to fruition for another decade or more, and they will be very expensive at first. Once that day comes, our foundation might look at how we can expand access in poor countries,” Gates wrote, explaining how he might look at the issue beyond his personal investment in the future.

        The announcement is timely, coinciding with National Alzheimer’s Disease Awareness Month in November. The goal of the month is to increase awareness and drive home the fact that as many as 16 million people could live with Alzheimer’s disease by the year 2050.

        “People should be able to enjoy their later years — and we need a breakthrough in Alzheimer’s to fulfill that,” Gates said. “I’m excited to join the fight and can’t wait to see what happens next.”

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        Columbine is no longer one of the 10 deadliest shootings in modern US history

        (CNN)After Columbine, it was hard to imagine things getting much worse.

        With 13 victims dead, it was also one of the deadliest shootings overall. But then came San Bernardino, Orlando, Las Vegas and Sutherland Springs.
        In the 18 years since Columbine rocked America to its core, the country has seen so many more mass shootings that the attack isn’t even among the 10 deadliest mass shootings in modern US history.
        Three of the five deadliest shootings have occurred in just the last year and a half.

        Below is a list of the 10 deadliest single-day mass shootings in modern US history. If the shooter was killed or died by suicide during the incident, that death is not included in the total.
        (Here’s an explanation of why we say “modern history”).
        1. The Harvest Music Festival: 58 killed
        October 1, 2017 -A gunman, identified as 64-year-old Stephen Paddock, fires from the 32nd floor of the Mandalay Bay Resort and Casino on a crowd of more than 20,000 gathered on the Las Vegas Strip for the Route 91 Harvest Music Festival. He kills 58 people and injures more than 500. Police believe the gunman then kills himself. It is the deadliest mass shooting in modern US history.
        2. Pulse night club: 49 killed
        June 12, 2016 – Omar Saddiqui Mateen, 29, opens fire inside Pulse, a gay nightclub, in Orlando. At least 49 people are killed and more than 50 are injured. Police shoot and kill Mateen during an operation to free hostages officials say he was holding at the club.
        3. Virginia Tech: 32 killed
        April 16, 2007 – Student Seung-Hui Cho, 23, goes on a shooting spree, killing 32 people in two locations and wounding an undetermined number of others on the campus of Virginia Tech in Blacksburg. The shooter dies by suicide.
        4. Sandy Hook: 27 killed
        December 14, 2012 – Adam Lanza, 20, guns down 20 children, ages 6 and 7, and six adults at Sandy Hook Elementary School in Newtown, Connecticut, before turning the gun on himself. Investigators later find the shooter’s mother, Nancy Lanza, dead from a gunshot wound.
        5. First Baptist Church in Sutherland Springs: 26 killed
        November 5, 2017 – A manwalks into a small church in a rural Texas town and guns down 26 people. The shooter, identified by two law enforcement sources as Devin Patrick Kelley, is found dead after a brief chase, but it’s unclear if he is killed or takes his own life. It is the deadliest mass shooting in Texas history.
        6. Luby’s Cafeteria: 23 killed
        October 16, 1991 – In Killeen, Texas, 35-year-old George Hennard crashes his pickup truck through the wall of a Luby’s Cafeteria. After exiting the truck, Hennard shoots and kills 23 people. He then takes his own life.
        7. McDonald’s in San Ysidro: 21 killed
        July 18, 1984 – In San Ysidro, California, 41-year-old James Huberty, armed with a long-barreled Uzi, a pump-action shotgun and a handgun, shoots and kills 21 adults and children at a McDonald’s. A police sharpshooter kills Huberty one hour after the rampage begins.
        8. University of Texas: 18 killed
        August 1, 1966 – Charles Joseph Whitman, a former US Marine, kills 16 and wounds at least 30 while shooting from a tower at the University of Texas at Austin. Police officers Ramiro Martinez and Houston McCoy shoot and kill Whitman in the tower. Whitman had killed his mother and wife earlier in the day.
        9. San Bernardino: 14 killed
        December 2, 2015 – Married couple Syed Rizwan Farook and Tashfeen Malik open fire on an employee gathering taking place at Inland Regional Center in San Bernardino, killing 14 people. They are killed in a shootout with police later in the day.
        10. Edmond, Oklahoma: 14 killed
        August 20, 1986 -In Edmond, Oklahoma, part-time mail carrier Patrick Henry Sherrill, armed with three handguns, kills 14 postal workers in 10 minutes and then takes his own life with a bullet to the head.
        11: Columbine High School: 13 killed
        April 20, 1999 – Eric Harris, 18, and 17-year-old Dylan Klebold kill 12 fellow students and one teacher at their high school in Littleton, Colorado. The pair then committed suicide in the school library.

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        About 1 million Americans without running water. 3 million without power. This is life one month after Hurricane Maria.

        Puerto Rico (CNN)After Hurricane Maria toppled the bridge that connects him to the rest of civilization and ripped the roof and walls off his house here in the central mountains of Puerto Rico, Ramn Sostre raised a weathered American flag above the wreckage.

        It worked, if temporarily. Helicopters came. So did a tarp, food and bottled water.
        Yet little else has changed. His roof is still missing, as are some walls. He and his cat, Tipo, sleep in the kitchen. When the wind blows at night, rain soaks them. The power is out, as it is for roughly 3 million Puerto Ricans, or more than 80% of the island’s residents. More than a thirdof households in the US territory, including much of Sostre’s community, are without reliable drinking water at home. That’s roughly 1 million American citizens.
        One month after Hurricane Maria, these realities are starting to feel less like an emergency and more like the new way of life — a nightmarish loop that resets each day the sun rises.
        “You wake up and it’s this mess as far as the eye can see,” Sostre told me.

        Much of the island feels like it was hit by a storm yesterday

        The US government says it is committed to helping Puerto Rico but is confronted with challenging circumstances, including some roads that are narrow, muddied and impassable for large aid-delivery vehicles. There also are pre-existing problems with power and water systems. Puerto Rico is “an island sitting in the middle of an ocean … a very big ocean,” as President Donald Trump said on September 26, making Hurricane Maria more distant than two other recent storms that hit the US mainland, Hurricanes Harvey and Irma.
        After traveling the island for three days, however, and conducting interviews with residents and federal officials and experts, it’s clear the level of suffering is far outpacing relief.
          Much of the island feels as if it were hit by a storm yesterday, not one month ago. Mountains are covered in branchless trees, stuck in the dirt like the walking sticks of giants. Power lines are tangled about like spaghetti dropped from the sky. Sheet metal from roofs and fencing has been turned into floppy strips of chewing gum, scattered on the hills. Not only are people such as Sostre exposed to the elements, but supplies of clean drinking water are woefully inadequate and environmental health experts fear a public health emergency could be brewing.
          On Tuesday, the Federal Emergency Management Agency, or FEMA, said it had 1,700 personnel deployed in Puerto Rico and the US Virgin Islands, which also were hit by Hurricane Maria. Yet nearly 2,600 FEMA staff — about 900 more — remain deployed to Hurricane Harvey, nearly two months after that storm hit the Gulf Coast of the mainland United States.
          In their defense, FEMA officials point out also that 20,000 other federal staff and military have been deployed to respond to Hurricane Maria.
            “(P)lease understand that every disaster is different geographically and demographically and there is no point of comparison from one to the other. Numbers are a snapshot in time for any given day; it is like comparing apples to oranges,” FEMA said in an emailed statement. “Please note that numbers do not save or improve lives, missions and progress do; for example, (Texas) may need more people to support housing, while (Puerto Rico) may need more generators and poles to support the grid.”
            Others see it differently.
            “I thought we’d learned our lesson after (Hurricane) Katrina where the response was awful, both carelessly slow and incompetent,” said John Mutter, a professor at Columbia University and an expert in international disaster relief. “In Puerto Rico, it doesn’t look like we’ve learned anything at all — or we just don’t care.”

            ‘If I don’t drink water, I’m going to die’

            The situation is particularly bad when it comes to water.
            There are 3.4 million people in Puerto Rico, and about 35% of households were without access to safe drinking water as of Tuesday, according to government estimates. The World Health Organization says each person needs at least 2.5 liters per day for drinking alone, with a recommended daily allotment of up to 15 liters per dayincluding basic cooking and hygiene.
            Yet FEMA has provided 23.6 million liters — 6.2 million gallons — of bottled water and bulk water since the storm hit on September 20, said Justo Hernandez, FEMA’s deputy federal coordinating officer. That includes water delivered to hospitals and dialysis centers, he said.
            That’s only roughly 9% of the drinking water needs for the entire territory.
            It’s an even smaller fraction if you include basic cooking and hygiene needs.
              “The potential for cholera and diarrheal diseases is quite high” without bottled water, said Mutter, the disaster recovery expert at Columbia in New York, who recommended the WHO standard. “What you will get is contaminated wells and surface water. It’s a situation where you really should be drinking bottled water. If you can’t get bottled water … that’s trouble.”
              Volunteer groups and nonprofits also are helping with supplies. FEMA says it has distributed drinking-water purification tablets and deployed six mobile-filtration systems. And there are efforts to distribute water-purification tablets and to tell locals who can’t find bottled water either to boil the water or add bleach or water-purification tablets.
              But many residents remain desperate, week after week, for drinking water.
              Lines for water — potable or not — are long in many parts of the island. Rumors of contamination are rampant. Even as some taps turn back on, residents worry about drinking from faucets, which sputter and, in some locations, produce hazy liquid. Autoridad de Acueductos y Alcantarillados, the water utility in Puerto Rico, says on its website that residents should boil the water and add bleach even after service is restored.
                In Dorado, near the capital, San Juan, people are so desperate for water they’ve turned to a federal hazardous-waste site in search of something to drink. CNN has reported that people are breaking through a fence marked “danger” to pull water from a Superfund site in an area known to be contaminated with industrial chemicals linked to cancer. It’s unclear if the wells are unsafe for public health; the Environmental Protection Agency is conducting water tests on wells on the Superfund site.
                “If I don’t drink water, I’m going to die. So I might as well drink this water,” one resident said.

                ‘There is a public health crisis here’

                One afternoon, I met Wilfredo Santiago while he was collecting water from a spout along Highway 10. The area smelled something like a pet store, and Santiago told me there likely are dead squirrels, rats and horses in the hills.
                Santiago knows it may be unsafe, but his 9-year-old daughter bathed in the water stream while he filled up a number of plastic bottles with the liquid. A line of cars waited to do the same. He took the water home to an apartment complex in Utuado, an interior city. On the floor in the kitchen, there were 37 jugs of the stuff, bottled in containers meant for Sprite, Pepsi and cranberry juice. The family collects water from a gutter to flush the toilet. There’s no running water here, and bottled water is expensive and hard to come by, he told me. The grocery store in town had none. Deliveries to the area by government officials come infrequently, he said.
                Across the street is the municipal emergency management office, which helps distribute FEMA aid. Héctor Cruz Cruz, its director, told me everyone in that complex is fine — they all get bottled water delivered through the complex’s manager. He disputed the claims of Santiago and about a half-dozen of his neighbors who said they are short on water and often struggle to find it.
                “It’s dangerous,” Santiago told me, referring to drinking and bathing with water from the mountains, “but we have no choice.”
                All of this is concerning to public health experts.
                “Our biggest worry is that as people get desperate and sort of give up on safe water sources that they are going to rely on things like streams and pipes that just come out of a spring or a mountain,” said Erik Olson, head of the health program at the Natural Resources Defense Council, an environmental group. “It’s just really a desperate situation.”
                “There is a public health crisis here,” Catherine Kennedy, a vice president at National Nurses United, said from Puerto Rico. “They need water. And we haven’t seen much of FEMA.”

                ‘I step out of my bed and there’s water’

                Hernandez, the FEMA official, said this relief effort is “a marathon,” not a sprint.
                But President Donald Trump already is emphasizing the finite nature of federal attention.
                “We cannot keep FEMA, the Military & the First Responders, who have been amazing (under the most difficult circumstances) in P.R. forever!” Trump tweeted on October 12.
                Carmen Rivera Rodriguez, a 55-year-old resident of “P.R.,” didn’t see that tweet. She has heard next to nothing about Trump or the federal response to this storm. When we met outside a supermarket in Comerío, about 20 miles southeast of Sostre and his American flag, she told me she hasn’t even been able to reach her sonin the mainland United States because there’s virtually no cellular service here — 75% of antennas are down — and she doesn’t have a car.
                Rivera was wearing a cast on her left arm.
                She fell while trying to sweep rain out of her living room.
                That was October 11 — 21 days after the storm.
                Rivera invited me to her home, which is on a cleared and accessible road on the side of a mountain. When you step inside the house, your foot splashed in inch-deep water, sending ripples throughout the home across linoleum floors. This is what she was scraping with a squeegee when she slipped and fell. Her roof is gone, except for over the kitchen and a small garage, where she sleeps. And it rains most afternoons here, lately. “Just imagine. I step out of my bed and there’s water. I go to the bathroom and I have to bring an umbrella,” she said.
                The same week Trump visited Puerto Rico, throwing paper towels to hurricane victims on October 3, Rivera told me she heard a truck driving by her home with loudspeakers blaring what seemed like good news: US government workers would be in town tomorrow.
                The next morning, she said, she awoke at 4 and hitched a ride into the valley so she could apply for a tarp to stop it from raining indoors. Mold is growing on a baby picture of her now-grown son, which hangs on the plywood wall of her living room.
                Her right eye is pink and puffy, which she figures is a symptom of being damp for one month.
                She waited in line for hours and filled out a government form, she said.
                As of October 15, 25 days after the storm, the tarp hadn’t come.
                FEMA has distributed 38,000 tarps on the island, said Hernandez, the FEMA official.
                The need for roofing help is estimated at 60,000 homes, he said.

                ‘Soy americano’

                Puerto Rico is part of America and yet it isn’t.
                It’s a territory of the richest nation on Earth — a country founded in opposition to colonialism. It’s a place where the federal government oversees a financial crisis and controls certain aspects of commerce and shipping, but where Americans can’t cast ballots in presidential general elections, and where the island’s one representative in Congress can’t vote, either.
                Sostre, the man who was trapped on the other side of a broken bridge, was right to fly the Stars and Stripes above his home and to say, “Soy americano,” or “I’m an American.”
                Rivera, for her part, doesn’t think much about the politics.
                She only wants to stay safe and dry.
                Nights have been the hardest, she said as darkness fell over her neighborhood and the island’s coquí frogs began their electronic chorus. Rain splashed on the floor as she talked. The situation is so bad Rivera prays to God asking that if another storm comes, she won’t survive it.
                “I’m not ready to live through something like that again,” she said, crying.
                The truth is she’s still living it.

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