Can Justice Finally Overtake Trump, 

Its Most Defiant Fugitive?

by

Ralph Nader

President Donald Trump speaks to reporters during a Cabinet meeting

 at the White House on October 21, 2019 in Washington, D.C.

 (Photo: Ricky Carioti/The Washington Post via Getty Images)

Despite the many crimes Donald Trump regularly committed over four years, it took his blatant incitement of the mob that stormed the U.S. Capitol on January 6, 2021, to put him on the road to prison. (See: Letter to vice President Mike Pence Re: Invocation of Amendment 25). What transpired on Wednesday in the shadows of the Washington Monument was a pure violent street crime that resulted in five fatalities, property smashed and damaged, and many assaults by hundreds of rioters who broke into or were allowed into the Capitol.

The current prosecutor is Acting United States Attorney for the District of Columbia, Michael R. Sherwin. USA TODAY reported that Mr. Sherwin said: “‘We’re looking at all actors here and anyone that had a role and, if the evidence fits the elements of the crime, they’re going to be charged,’ Sherwin said these words after he was asked by a reporter if investigators are looking at the role the president played.”

From Day One in 2017, several people foresaw the signs of an emerging sociopath, using violent rhetoric to encourage illegal behavior. It wasn’t only professional psychologists who declared Trump to be severely unstable. Each day he created and disseminated dangerous fantasies. This egomaniacal wannabee monarch could not stop lying in a dangerous manner, making false accusations or delusionally bragging.

Reporters, commentators, litigants, and elected representatives who were documenting Trump’s trail of political and public insanity were overwhelmed by his doubling down on his flailing and wrongdoing in plain sight. But they mostly declined to draw the enforcement conclusions arising from their convictions, further enabling Trump’s use of the power of the bully pulpit to intimidate or threaten his critics.

Remember, Trump, said, “I have an Article II, where I have the right to do whatever I want as president.” He recklessly kept doing just that. The Republicans supported him and covered for him, while the Democrats huffed and puffed in place. The Democrats refused to file eleven well-documented articles of impeachment and instead only went with the Ukraine matter. (See: December 18, 2019, Congressional Record, H-12197)

Meanwhile, in dozens of ways, Trump emboldened the most extreme of his supporters. Recall his outcry “liberate Wisconsin.” Trump’s support for the armed invasion of the Michigan state capitol with impunity, and his many signals, and inactions showed the white supremacists in the streets that the President and William Barr’s Justice Department would overlook hateful racist mischief and mayhem. He even encouraged one of these groups by repeating their militant mantra verbatim.

Published warnings about Trump’s interest in insurrection were largely unheeded by the mass media and even by the independent progressive media. They were too satisfied with reporting on his outrageous behavior and tweets, and too pleased with how easy a subject Trump was for derision. We and others would invoke specific criminal statutes he violated frequently, such as the Hatch Act (using federal property and personnel for political campaign objectives) or the Anti-Deficiency Acts (spending much money strictly not appropriated by Congress) and other grave flouting of statutory and regulatory, mandates, scores of congressional subpoenas and major constitutional provisions. The news media did not regard Trump’s deep lawlessness as worthy of much reporting or editorializing. The excuse was “Trump is just being Trump.” Both the media and members of Congress, without paying attention to legal penalties, allowed Trump to keep pushing the envelope on lawbreaking until his invasion of the very Congress that let him get away with so much. It took lawmakers scrambling for their lives through Congressional tunnels to wake them up beyond their rhetoric or perfidy. There are severe consequences for ignoring the law’s non-enforcement and when the media and elected officials become too jaded to challenge a president who doesn’t respect the rule of law or constitutional restraints.

This assault may not be Trump’s last act before January 20th. For sure he will increase the presidential pardons for his friends, family, and quite possibly the rioters and himself. Nobody knows what this “Mad Dog” Trump will try to do on his way out. However, it is reassuring that neither the courts nor the military have met his expectations of supporting and shielding him from his adversaries. These two institutions affirmatively refused to sanction dictatorial rule.

The mounting calls for Trump’s resignation, or prosecution, or removal by impeachment conviction or the exercise of the 25th Amendment are coming from all sides – Democrats, Republicans, bi-partisan declarations of retired military and civilian officials from past Administrations, and even business groups such as the National Association of Manufacturers. Their immediate urging would be to stop further mayhem and upheavals by a cornered, rampaging commander-in-chief who knows that, in one of his favorite phrases, “this is our last chance.”

Maybe merely advancing these acts of enforcement and evictions, rooted in our constitution and law, will be a deterrence and persuade Trump to quietly go right away to Mar-a-Largo, as suggested today on NPR by Jeh Johnson, former Secretary of Homeland Security.

That kind of finale has not been his MO, whether as a failed gambling czar, choosing corporate bankruptcy as an exit strategy, or as a president who doesn’t show remorse, admit mistakes, or that he ever “did anything wrong.”

If there is anything Trump dislikes more than being a loser (the election), it is being a two-time loser. Perhaps he will back down, play the victim again, and with the help of a stable of defense attorneys, hope that he can wear a pin-striped suit instead of an orange jumpsuit while wistfully watching Fox News behind bars.

(See our new book, Wrecking America: How Trump’s Lawbreaking and Lies Betray All)

Ralph Nader is a consumer advocate and the author of "The Seventeen Solutions: Bold Ideas for Our American Future" (2012). His new book is, "Wrecking America: How Trump’s Lies and Lawbreaking Betray All" (2020, co-authored with Mark Green).

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'History Will Not Look Kindly on Us'

If Trump Not Impeached, 

Says Rep. Ilhan Omar

The Minnesota Democrat said she will formally introduce two articles of impeachment Monday.

by

Andrea Germanos, staff writer

Rep. Ilhan Omar (D-Minn.) removes her mask to speak during a press conference

 on August 5, 2020 in St. Paul, Minnesota. (Photo: Stephen Maturen/Getty Images)

Rep. Ilhan Omar said Sunday that she plans on introducing two articles of impeachment against President Donald Trump on Monday and warned that history would "not look kindly" upon lawmakers if they fail to ensure Trump faces consequences for his role in inciting the extremist mob that attacked the U.S. Capitol last week.

Omar (D-Minn.), a frequent target of Trump's racist rhetoric, released the articles of impeachment Thursday. One article targets Trump's attempt to overturn the results of the November election, which he decisively lost to President-elect Joe Biden, and the second article addresses Trump's abuse of "the powers of the presidency to incite violence and orchestrate an attempted coup against our country"—a reference to the Wednesday siege.

Asked by host Esme Murphy of Minneapolis' "This Morning" on WCCO about any certainty of Democratic leadership scheduling the start of impeachment proceedings, Omar said, "That is our hope."

"Right now we are still in the process of pushing our colleagues to... realize that the actions are deserving of consequences, that if we do not take a decisive, expedient decision on how to deal with these actions, we risk further damage to our democracy, to our republic."

"We are constitutionally mandated to protect and preserve our democracy and our republic," she said, "and this man is clearly exhibiting dangers to it."

As to whether it was worth it to pursue impeachment given that the Republican-controlled Senate is not set to resume its regular session until January 19, the day before President-elect Joe Biden's inauguration, Omar said that "there is a greater risk not having consequences for this president and his actions and those in the House and in the Senate that have enabled this insurrection and attempted coup to take place."

"If we do not take action," she continued, "then we are sending a message to the country and to the world that ours is one where democracy can come under siege, our nation's Capitol can be threatened, and we look the other way."

"If we do not do that, then history will not look kindly on us," said Omar.

"There [have] to be actions that are taken in order to avoid this from happening again," Omar added, issuing the same message fellow "squad" member Rep. Alexandria Ocasio-Cortez (D-N.Y.) also gave Sunday morning.

Other lawmakers have called for invoking the 25th Amendment of the Constitution to remove Trump, an option Vice President Mike Pence has reportedly not fully ruled out.

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Failure to Hold Trump Accountable for Capitol Siege Means 'It Will Happen Again,' Says Rep. Ocasio-Cortez

"If another head of state came in and ordered an attack on the United States Congress, would we say that that should not be prosecuted?" the New York Democrat said Sunday.

by

Andrea Germanos, staff writer

Rep. Alexandria Ocasio-Cortez (D-N.Y.) is seen during a hearing before the House Oversight and Reform Committee on August 24, 2020 on Capitol Hill in Washington, D.C. (Photo: Tom Williams-Pool/Getty Images)

Rep. Alexandria Ocasio-Cortez on Sunday stressed a need for President Donald Trump's removal from office, saying that failing to hold him accountable for Wednesday's violent attack on the Capitol could ensure "it will happen again."

Speaking with George Stephanopoulos on ABC's "This Week," the New York Democrat said that ensuring Trump's ouster was a "top priority" and that House leadership must schedule impeachment.

The president poses "a clear and present danger not just to the United States Congress but frankly to the country," said Ocasio-Cortez. In addition to removing Trump from the Oval Office, lawmakers must ensure he can neither run for office again nor issue a self-pardon, she said.

Asked her response to a letter sent Saturday to President-elect Joe Biden from a group of seven House Republicans urging him help stop impeachment, calling it "as unnecessary as it is inflammatory," Ocasio-Cortez was clear she views the situation quite differently.

"What happened on Wednesday was insurrection against the United States," she said. Referencing Republicans' framing of the letter as being "in the spirit of healing," Ocasio-Cortez said that "the process of healing... requires accountability."

"So if we allow insurrection against the United States with impunity, with no accountability, we are inviting it to happen again," she said. Ocasio-Cortez emphasized that lives were at risk during the armed siege, telling Stephanopoulos, "We came close to half of the House nearly dying on Wednesday."

"If another head of state came in and ordered an attack on the United States Congress, would we say that that should not be prosecuted? Would we say there should be absolutely no response to that? No," she said.

"It is an act of insurrection. It's an act of hostility," she continued. "And we must have accountability, because without it it will happen again."

Watch the full interview below:

The interview came after a day after House Speaker Nancy Pelosi told her Democratic colleagues that it was "absolutely essential that those who perpetrated the assault on our democracy be held accountable. There must be a recognition that this desecration was instigated by the president."

The dear colleague letter, released late Saturday, does not specifically mention impeachment, but references "parliamentary and constitutional options available to us" she's discussed with lawyers. "I urge you to be prepared to return to Washington this week," Pelosi added.

Rep. Ted Lieu (D-Calif.) said Sunday that an impeachment resolution he drafted along with Reps. David Cicilline (D-R.I.) and Jamie Raskin (D-Md.) has 195 co-sponsors. It will be introduced in the House Monday at a pro-forma session, he said.

With a mere 11 days left in his term, the prospect of Trump's removal through impeachment is dim, as Politico noted Saturday. "The Senate likely wouldn't even begin Trump's impeachment trial until after Biden’s inauguration on Jan. 20," the outlet reported. "Even then, it's not clear if any Senate Republicans would join with Democrats to convict Trump."

Timing and intensity of oral sex may affect risk of oropharyngeal cancer

WILEY

NEWS RELEASE 11-JAN-2021

Research News

 

Human papillomavirus (HPV) can infect the mouth and throat to cause cancers of the oropharynx. A new study published early online in CANCER, a peer-reviewed journal of the American Cancer Society, has found that having more than 10 prior oral sex partners was associated with a 4.3-times greater likelihood of having HPV-related oropharyngeal cancer. The study also shows that having oral sex at a younger age and more partners in a shorter time period (oral sex intensity) were associated with higher likelihoods of having HPV-related cancer of the mouth and throat.

Previous studies have shown that performing oral sex is a strong risk factor for HPV-related oropharyngeal cancer. To examine how behavior related to oral sex may affect risk, Virginia Drake, MD, of Johns Hopkins University, and her colleagues asked 163 individuals with and 345 without HPV-related oropharyngeal cancer to complete a behavioral survey.

In addition to timing and intensity of oral sex, individuals who had older sexual partners when they were young, and those with partners who had extramarital sex were more likely to have HPV-related oropharyngeal cancer.

"Our study builds on previous research to demonstrate that it is not only the number of oral sexual partners, but also other factors not previously appreciated that contribute to the risk of exposure to HPV orally and subsequent HPV-related oropharyngeal cancer," said Dr. Drake. "As the incidence of HPV-related oropharyngeal cancer continues to rise in the United States, our study offers a contemporary evaluation of risk factors for this disease. We have uncovered additional nuances of how and why some people may develop this cancer, which may help identify those at greater risk."

###

Additional Information

NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. A free abstract of this article will be available via the Cancer News Room upon online publication. For more information or to obtain a PDF of any study, please contact: Dawn Peters +1 781-388-8408 (US) newsroom@wiley.com Follow us on Twitter @WileyNews

Full Citation: "Timing, number, and type of sexual partners associated with risk of oropharyngeal cancer." Virginia E. Drake, Carole Fakhry, Melina J. Windon, C. Matthew Stewart, Lee Akst, Alexander Hillel, Wade Chien, Patrick Ha, Brett Miles, Christine G. Gourin, Rajarsi Mandal, Wojciech K. Mydlarz, Lisa Rooper, Tanya Troy, Siddhartha Yavvari, Tim Waterboer Nicole Brenner, David W. Eisele, and Gypsyamber D'Souza. CANCER; Published Online: January 11, 2021 (DOI: 10.1002/cncr.33346).

URL Upon Publication: http://doi.wiley.com/10.1002/cncr.33346

Author Contact: Amy Mone (amone@jhmi.edu) or Valerie Mehl (mehlva@jhmi.edu).

About the Journal

CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology, course, and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online.

Follow us on Twitter @JournalCancer

About Wiley

Wiley drives the world forward with research and education. Through publishing, platforms and services, we help students, researchers, universities, and corporations to achieve their goals in an ever-changing world. For more than 200 years, we have delivered consistent performance to all of our stakeholders. The Company's website can be accessed at http://www.wiley.com.

Marijuana use typically drops at the beginning of the year, then climbs in summer and fall

Seasonal variation may be explained by new year's resolutions

NEW YORK UNIVERSITY

Research News

NEWS RELEASE 11-JAN-2021

IMAGE: MARIJUANA USE INCREASES THROUGHOUT THE CALENDAR YEAR, WITH USE UP 13 PERCENT ON AVERAGE AT THE END OF EACH YEAR COMPARED TO THE BEGINNING, ACCORDING TO A NEW NYU STUDY. view more

CREDIT: IMAGE BY LOULIANA VOELKER FOR NYU; ICONS BY GUILHERME FURTADO AND MADE (NOUN PROJECT) LICENSED AS CREATIVE COMMONS CCBY.

Marijuana use increases throughout the calendar year, with use up 13 percent on average at the end of each year (2015-2019) compared to the beginning, according to a new study published in the journal Drug and Alcohol Dependence.

"We found that marijuana use is consistently higher among those surveyed later in the year, peaking during late fall or early winter before dropping at the beginning of the following year. We think this may be due, in part, to a 'Dry January' in which some people stop drinking alcohol or even stop using marijuana as part of a New Year's resolution," said Joseph Palamar, PhD, MPH, an associate professor of population health at NYU Grossman School of Medicine, an affiliated researcher with the Center for Drug Use and HIV/HCV Research (CDUHR) at NYU School of Global Public Health, and the study's lead author. "We're now in the time of year when people are the least likely to use marijuana."

Prior research shows that alcohol and drug use vary by time of year, with drug use often increasing during summer months, possibly due, in part, to social events. These seasonal variations can inform interventions--for instance, studies show that programs to reduce heavy drinking among college students should begin during the summer.

To better understand seasonal trends in marijuana use, Palamar and his colleagues analyzed data from 282,768 adolescents and adults who responded to the National Survey on Drug Use and Health from 2015 to 2019. The survey asked participants about their past-month use of marijuana and other substances, and the researchers estimated their use within each calendar quarter: January through March, April through June, July through September, and October through December.

Each year, as the calendar year progressed, marijuana use grew, increasing in summer and fall months before dropping as each new year began. While 8.9 percent reported using marijuana in January through March, 10.1 percent reported using in October through December, a 13-percent relative increase.

These seasonal trends occurred independently of annual growth in marijuana use and were seen across nearly all groups surveyed, regardless of sex, race/ethnicity, and education level. Teens were one exception; their marijuana use grew in the summer but declined in the fall months back to winter and spring levels.

Recreational use may be driving the growth throughout the year, as similar small increases occurred among those living in states with and without legal medical marijuana, and among those without a prescription for medical marijuana. Seasonal marijuana use also increased among those who reported using other substances, including alcohol, nicotine, and especially LSD.

The researchers note that the consistent dip in marijuana use during winter months could be a result of a variety of factors: a lower supply this time of year from cannabis harvests, colder weather keeping people inside who usually smoke outdoors, or people quitting marijuana as a New Year's resolution.

"Ultimately, we hope that these findings can be utilized by researchers and clinicians alike," said study coauthor Austin Le, DDS, a research associate at NYU Langone Health and orthodontic resident at NYU College of Dentistry. "Researchers studying marijuana use should consider seasonal variation, as surveys administered at the end of the year may yield different results than at the beginning of the year. And for those who wish to reduce marijuana use, it appears the best time for such targeting may be later in the year--when use is highest."

In addition to Palamar and Le, Benjamin Han of the University of California, San Diego's Department of Medicine, Division of Geriatrics co-authored the study. The research was supported by the National Institute on Drug Abuse, part of the National Institutes of Health (grants R01DA044207 and K23DA043651).

About CDUHR The mission of the Center for Drug Use and HIV/HCV Research (CDUHR) is to end the HIV and HCV epidemics in drug using populations and their communities by conducting transdisciplinary research and disseminating its findings to inform programmatic, policy, and grass roots initiatives at the local, state, national, and global levels. CDUHR is a Core Center of Excellence funded by the National Institute on Drug Abuse (Grant #P30 DA011041). It is the first center for the socio-behavioral study of substance use and HIV in the United States and is located at the NYU School of Global Public Health. For more information, visit http://www.cduhr.org.

About NYU Langone Health NYU Langone Health is a world-class, patient-centered, integrated academic medical center, known for its excellence in clinical care, research, and education. Included in the 260+ locations throughout the New York area are six inpatient locations: Tisch Hospital, its flagship acute-care facility in Manhattan; Rusk Rehabilitation, ranked as one of the top 10 rehabilitation programs in the country; NYU Langone Orthopedic Hospital, a dedicated inpatient orthopedic hospital in Manhattan with all musculoskeletal specialties ranked top 10 in the country; Hassenfeld Children's Hospital at NYU Langone, a comprehensive pediatric hospital, also in Manhattan, supporting a full array of children's health services; NYU Langone Hospital--Brooklyn, a full-service teaching hospital and level 1 trauma center located in Sunset Park, Brooklyn; and NYU Langone Hospital--Long Island, a full-service teaching hospital and level 1 trauma center located in Nassau County on Long Island. Also part of NYU Langone Health is the Laura and Isaac Perlmutter Cancer Center, a National Cancer Institute-designated comprehensive cancer center; NYU Grossman School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history; and NYU Long Island School of Medicine. For more information, go to nyulangone.org, and interact with us on Facebook, Twitter, YouTube, and Instagram.

About NYU School of Global Public Health At the NYU School of Global Public Health (NYU GPH), we are preparing the next generation of public health pioneers with the critical thinking skills, acumen, and entrepreneurial approaches necessary to reinvent the public health paradigm. Devoted to employing a nontraditional, interdisciplinary model, NYU GPH aims to improve health worldwide through a unique blend of global public health studies, research, and practice. The School is located in the heart of New York City and extends to NYU's global network on six continents. Innovation is at the core of our ambitious approach, thinking and teaching. For more, visit: http://publichealth.nyu.edu/

Canada must dismantle anti-Black racism in medicine

CANADIAN MEDICAL ASSOCIATION JOURNAL

Research News

 

Canada must dismantle anti-Black racism in health care to address its harmful effects on people's health, argue authors of a commentary in CMAJ (Canadian Medical Association Journal)
http://www.cmaj.ca/lookup/doi/10.1503/cmaj.201579

Racism has significant negative effects on the physical and mental health of Black people and people of nondominant racial groups. For example, there have been significantly higher death rates from COVID-19 among Black people in North America and the United Kingdom. Anti-Black racism also exists in the medical system, with stereotyping and bias by health care providers and an underrepresentation of Black physicians.

"First, we who work in health care must acknowledge the existence of anti-Black racism in our systems and commit to meaningful, sustained change. We can do this by listening to the voices of Black Canadians, patients and health care professionals who have been grappling with anti-Black racism for generations, and by engaging with the many communities that have made recommendations for meaningful change to address the problem," write Drs. OmiSoore Dryden, Dalhousie University, Halifax, Nova Scotia, and Onye Nnorom, University of Toronto, Toronto, Ontario, co-leads of Canada's Black Health Education Collaborative.

They recommend anti-racism training for health care providers, collecting race-based data in partnership with specific communities, addressing anti-Black racism in medical schools and the health system, and increasing accessibility and admission for Black students.

"The field of medicine can no longer deny or overlook the existence of systemic anti-Black racism in Canada and how it affects the health of Black people and communities. It is time to acknowledge and commit to dismantling systemic racism within our institutions of care and education," they argue.

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U.S. mental health system needs broad changes to improve access and quality

Comprehensive analysis finds transforming mental health system is possible

RAND CORPORATION

 NEWS RELEASE 11-JAN-2021

Research News

 

Conditions are ripe for transforming the U.S. mental health care system, with scientific advances, the growth of Medicaid and political consensus on the importance of improving mental health creating the possibility that goals once thought out of reach may be possible, according to a new RAND Corporation study.

Broad changes will be needed to improve how Americans receive mental health care, such as integrating behavioral health care into general health care settings, providing supportive housing to the homeless and promoting comprehensive mental health education.

Federal mental health parity legislation is one recent promising development that aims to put coverage for mental health treatment and general health care on equal footing, but researchers say that more effort is needed to enforce the law.

Other efforts urged by the report include increasing the use of evidence-based mental health treatments, expanding scholarships and loan repayments to stimulate growth of the mental health workforce, and improving access to digital and telehealth services for mental health.

The RAND recommendations come from an extensive project that reviewed published research about the nation's mental health system and consulted with consumers, mental health advocates, researchers, clinicians, health system representatives, policymakers and payers.

"For decades, the nation's mental health system has faced challenges such as the underdevelopment of community-based supports, high levels of unmet need, and inequities in both access to care and the quality of care," said Ryan McBain, the study's lead author and a policy researcher at RAND, a nonprofit research organization. "Our report outlines the fundamental building blocks that policymakers should consider to bring about transformative change to the U.S. mental health system."

The RAND evaluation examined the mental health system broadly, encompassing the organization of people, institutions and resources that support delivery of mental health services, as well as adjacent sectors such as housing and education.

Researchers received stakeholder input from a broad-based advisory panel that met twice over the course of the project to discuss the conceptual model and policy options for achieving goals of health system transformation. The RAND team also conducted one-on-one interviews with more than 20 additional mental health policy experts.

Despite a wide need for services, just 45% of people in the U.S. with a mental illness received any mental health treatment during 2019. The shortcomings are even greater for members of racial and ethnic minority groups, who are about half as likely to receive mental health care as non-Hispanic White people.

Prisons and jails are now recognized as the largest institutional providers of housing for people with serious mental illness. There also are striking geographic variations in availability of mental health specialty care, with rural areas particularly underserved.

There has been a resurgence of innovation and bipartisan advocacy for people experiencing mental illness in recent years, with significant changes in how mental health care is financed and the emergence of a stronger evidence base for treatment and policy. Parity laws aim to improve access, and states have endorsed an expanded role of Medicaid in providing coverage for individuals with serious mental illness.

"There is reason to believe that the time is right for major changes to the nation's mental health shortcomings," McBain said. "Our recommendations are rooted in evidence and are patient-centered -- mapping directly to the patient journey traversed by those affected by mental illness."

This RAND report aims to lay out how policy changes at all levels of government -- federal, state and local -- can build on recent developments and effect broad transformational change to improve the lives of the 60 million Americans living with mental illness.

The report's 15 recommendations are structured around three overarching goals for improving the nation's mental health landscape: promoting pathways to care, improving access to mental health care and establishing an evidence-based continuum of care.

RAND researchers say that for people to get the mental health care they need, communities should be sensitized to the importance of mental health, ideally beginning in school systems where children and adolescents can be provided with consistent information about the importance of mental health.

To identify population-level mental health needs, screening and treatment models linked to primary medical care should be broadly implemented in both public and private sectors.

For those with serious mental illness, the report says that needs pertaining to social determinants of health should be addressed. This includes connections to housing for the homeless and diversion strategies for those who are incarcerated or end up in hospital emergency departments with no other recourse for medical care.

Many recommendations aim to make the process of accessing services straightforward.

The report recommends strategies to create a robust and well-educated mental health workforce, as well as bringing services closer to patients by expanding access and use of telehealth. Improving enforcement of mental health parity and providing financial incentives to better reimburse providers should prompt more health systems to make mental health services available.

Because the journey to care can be unnecessarily convoluted and bureaucratic for patients, researchers recommend that communities consider using established guidelines to define a continuum of care that is appropriate for meeting individuals' level of need. For patients with both physical and mental health conditions, or who have diverse mental health needs, coordination among providers is essential.

While there is strong evidence demonstrating what works, the report says that a national effort is necessary to push out care coordination models at a larger scale.

The report includes a web-based tool that allows users to quickly scan the research literature that provides the basis for the report's recommendations.

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Support for the research was provided by Otsuka America, Inc., a pharmaceutical company that is a leader in the areas of mental, renal and cardiovascular health.

The study, "How to Transform the U.S. Mental Health System: Evidence-Based Recommendations," is available at http://www.rand.org. Other authors of the study are Nicole K. Eberhart, Joshua Breslau, Lori Frank, M. Audrey Burnam, Vishnupriya Kareddy and Molly M. Simmons.

RAND Health Care promotes healthier societies by improving health care systems in the United States and other countries.

Disclaimer: AAAS and EurekAlert! are not re

 MANDATORY MEGALODON STORY

Megalodons gave birth to large newborns that likely grew by eating unhatched eggs in womb

TAYLOR & FRANCIS GROUP

Research News

 

IMAGE: IDENTIFIED ANNUAL GROWTH BANDS IN A VERTEBRA OF THE EXTINCT MEGATOOTH SHARK OTODUS MEGALODON ALONG WITH HYPOTHETICAL SILHOUETTES OF THE SHARK AT BIRTH AND DEATH, EACH COMPARED WITH SIZE OF... view more 

CREDIT: DEPAUL UNIVERSITY/KENSHU SHIMADA

A new study shows that the gigantic Megalodon or megatooth shark, which lived nearly worldwide roughly 15-3.6 million years ago and reached at least 50 feet (15 meters) in length, gave birth to babies larger than most adult humans.

This latest research shedding light on the reproductive biology, growth and life expectancy of Megalodon (formally called Otodus megalodon) appears in the international journal Historical Biology.

Although Otodus megalodon is typically portrayed as a super-sized, monstrous shark in novels and films such as the 2018 sci-fi film "The Meg," scientific data support a more modest but still impressive estimate of about 50 feet (15 meters) for the presently known largest individuals. The study indicates that, from the moment of birth, Megalodon was already a big fish, noted Kenshu Shimada, a paleobiologist at DePaul University in Chicago and lead author of the study. Co-authors are Matthew Bonnan, Stockton University, New Jersey; and Martin Becker and Michael Griffiths, William Paterson University, New Jersey.

"As one of the largest carnivores that ever existed on Earth, deciphering such growth parameters of O. megalodon is critical to understand the role large carnivores play in the context of the evolution of marine ecosystems," said Shimada.

Otodus megalodon has a rich fossil record, but its biology remains poorly understood like most other extinct sharks because the cartilaginous fish is primarily known only from its teeth. Nevertheless, some remains of gigantic vertebrae are known, said Shimada.

Large size at birth

Researchers used a CT scanning technique to examine incremental 'growth bands' putatively recorded annually (analogous to tree rings) in Megalodon vertebral specimen housed in the Royal Belgian Institute of Natural Sciences in Brussels. Measuring up to about 6 inches (15 centimeters) in diameter, the vertebrae were previously estimated to have come from an individual about 30 feet (9 meters) in length based on comparisons with vertebrae of modern great white sharks, according to the researchers.

CT images reveal the vertebrae to have 46 growth bands, meaning that the 9-meter Megalodon fossil died at age 46. By back-calculating its body length when each band formed, the research suggests that the shark's size at birth was about 6.6 feet (2 meters) in length, a result that suggests Megalodon gave live birth to possibly the largest babies in the shark world. These data also suggest that, like all present-day lamniform sharks, embryonic Megalodon grew inside its mother by feeding on unhatched eggs in the womb -- a practice known as oophagy, a form of intrauterine cannibalism.

"Results from this work shed new light on the life history of Megalodon, not only how Megalodon grew, but also how its embryos developed, how it gave birth and how long it could have lived," said co-author Becker.

Interestingly, 'early-hatched embryos' in the shark group called Lamniformes will begin to eat surrounding unhatched eggs, and at least in the present day sandtiger shark, occasionally even feed on other hatched siblings for nourishment, the researchers noted. The outcome is that only a few embryos will survive and develop, but each of them can become considerably large at birth.

Although likely energetically costly for the mother to raise such large embryos, newborns have an advantage because their large size reduces chances of being eaten by other predators, said Shimada.

"The information presented in this new paper and our other recent work demonstrating just how large Megalodon was relative to other sharks have greatly increased the understanding of the Megalodon biology," said co-author Griffiths.

Added co-author Bonnan, "My students and I examine spiny dogfish shark anatomy in class and to think that a baby Megalodon was nearly twice as long as the largest adult sharks we examine is mind-boggling."

Relatively steady growth after birth

The study also shows that the shark grew without significant 'growth spurts' at an average rate of about 6.3 inches (16 centimeters) per year at least during the first 46 years of its life according to the data. This finding indicates that Megalodon was sufficiently large (6.6 feet) at birth to compete with other predators and to avoid being eaten. Further, a growth curve model based on the vertebrae appears to indicate its life expectance of at least 88-100 years, noted Shimada.

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COVID forced psychiatric care online. Many patients want it to stay there, study finds

Most opted for video, but the future of virtual mental health visits is less certain due to reimbursement

MICHIGAN MEDICINE - UNIVERSITY OF MICHIGAN

Research News

 

A year ago, trying to find patients who would agree to see their University of Michigan mental health provider through a video screen felt like pulling teeth.

Only 26 video visits with a few early-adopters had happened in nearly six months, compared with more than 30,000 in-person visits.

But Jennifer Severe, M.D., one of the three psychiatrists who helped launch a test of telehealth initiatives in the U-M's outpatient psychiatry clinic, wasn't about to give up.

She prepared to give a talk at the beginning of April of 2020, hoping to convince more of her colleagues to give telepsychiatry a try, now that a major insurance company was paying for it. She even had examples of how clinic staff had "rescued" the care of patients who had called at the last minute to cancel an appointment for their depression or bipolar disorder, but agreed to a video therapy session instead.

Severe never got to give that talk.

Instead, on March 23, all non-urgent health care across the state of Michigan shut down to prevent the spread of COVID-19. And video chats and phone calls became the only way for most patients to connect with their psychiatrists and psychologists from Michigan Medicine, U-M's academic medical center.

For nearly all of those patients, it has stayed that way for the past nine months.

Now, a new study led by Severe suggests that more than half of those patients will want to keep going with virtual mental health care even after the pandemic subsides.

According to the new findings published in JMIR Formative Research, the convenience of seeing a provider without leaving home, and avoiding potential exposure to the coronavirus especially for those with other underlying health concerns, factor heavily into this preference. So does a patient's initial experience with seeing a provider virtually.

Patient preferences

The data come from a summer 2020 phone survey of 244 patients or parents of patients who had had appointments scheduled with a U-M mental health provider in the first weeks of the pandemic-related shutdown. Nearly 83% decided to have their or their child's first pandemic-era appointment through a video chat instead.

But the study also suggests a need for special attention to the minority of patients who initially chose to continue psychiatric care through telephone calls.

Though this accounted for less than 14% of the study population, they were more likely to be over 45. By summer, they were much less likely to want to receive mental health care remotely in the future.

As health insurers and government agencies make decisions about whether and how to pay mental health providers for virtual care in the short- and long-term, the new data could help inform them, says Severe.

"We went from not getting much traction with telepsychiatry, and encountering a lot of reluctance among providers and patients, to having nearly all our care delivered virtually, and offering help to those who need it," she says. "These data suggest an opportunity to turn the experience of the pandemic into an opportunity to improve access to mental health care and improve the continuity of care. But policy and reimbursement decisions will be important."

More about the study

Nearly all the patients in the study group who had a virtual visit by summer said it went as well as they had expected, or better.

The study does not cover the period after Mary Carol Blazek, M.D., the study's senior author, led the development of a program called GET Access. It helps older adults prepare for video visits with a geriatric psychiatry specialist.

Michigan Medicine also now offers assistance for any patient with a scheduled appointment, to help them set up their online patient portal account and test the video visit technology within it.

Parents of children receiving mental health or behavioral health care from Department of Psychiatry providers especially noted that video visits were more engaging.

Phone-visit patients said it was important to have the option to talk when their internet connection was unstable or they had trouble with the video platform. One-third said they were just more comfortable talking by phone.

Impacts on access

Although the new paper does not examine clinic appointment cancellation and no-show rates, anecdotal evidence suggests that it has come down substantially from a one-in-four rate before the pandemic.

Whether it's the debilitating effect of their mental health condition, or their access to transportation, time off from work or child care, many factors can get in the way of a patient making it to an in-person appointment, Severe says. But virtual visits remove most of these barriers.

Cost poses another potential barrier for phone-based care. In the test-run months before COVID-19, insurers wouldn't typically cover phone calls, leaving the provider to absorb the cost or to ask patients to pay out of pocket to talk on the phone with their provider.

Insurers covered phone-based mental health care for much of 2020, but that appears to be ending soon. But Severe says that for certain patients with an established relationship with their mental health provider, phone and video appointments are equally effective and should receive similar reimbursement from insurers. Both modality offer opportunity for a blended care model bridging in-person session with virtual visits as deemed appropriate".

"For the first visit with a new patient, we try to avoid using phone as it limits the initiation of the provider-patient therapeutic alliance, reduce communication cues and limits the mental status exam that includes observing patient facial expressions, interactions, and movement," she says. "Depending on the complexity of the patient's situation, we may need to do a physical examination from time to time, to assess their balance and mobility, and check for medication side effects to name a few."

Going forward, Severe hopes to study more aspects of telepsychiatry in the COVID-19 era, including understanding how socioeconomic status, rural vs. urban residence, technology access and other factors play into access. She notes that the study team chose to conduct their study by phone, instead of reaching out via email or patient portal message, to ensure maximum access.

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In addition to Severe and Blazek, the new study was done by Ruiqi Tang, Faith Horbatch, Regina Onishchenko, and Vidisha Naini. Members of the Michigan Medicine Office of Patient Experience were instrumental in this endeavor and included Jen Sullivan, Caitlin Hanna, Darnysus Jackson and Rose Juhasz.

Including unhealthy foods may diminish positive effects of an otherwise healthy diet

Study by researchers at Rush University Medical Center finds adding more foods that are part of Western diet may reduce cognitive benefits of Mediterranean diet

RUSH UNIVERSITY MEDICAL CENTER

Research News
NEWS RELEASE 8-JAN-2021

Eating a healthy diet, such as the Mediterranean diet, has a positive impact on health, but little is known about the effects of including unhealthy foods in an otherwise healthy diet. Now researchers at Rush University Medical Center have reported diminished benefits of a Mediterranean diet among those with high frequency of eating unhealthy foods. The results of their study were published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association on Jan. 7.

"Eating a diet that emphasizes vegetables, fruit, fish and whole grains may positively affects a person's health," said Puja Agarwal, PhD, a nutritional epidemiologist and assistant professor in the Department of Internal Medicine at Rush Medical College. "But when it is combined with fried food, sweets, refined grains, red meat and processed meat, we observed that the benefits of eating the Mediterranean part of the diet seems to be diminished."

A Mediterranean diet is associated with slower rates of cognitive decline in older adults.

The observational study included 5,001 older adults living in Chicago who were part of the Chicago Health and Aging Project, an evaluation of cognitive health in adults over the age of 65 conducted from 1993 to 2012. Every three years, the study participants completed a cognitive assessment questionnaire that tested basic information processing skills and memory, and they filled out a questionnaire about the frequency with which they consumed 144 food items.

The researchers analyzed how closely each of the study participants adhered to a Mediterranean diet, which includes daily consumption of fruit, vegetables, legumes, olive oil, fish, potatoes and unrefined cereals, plus moderate wine consumption. They also assessed how much each participant followed a Western diet, which included fried foods, refined grains, sweets, red and processed meats, full-fat dairy products and pizza. They assigned scores of zero to five for each food item to compile a total Mediterranean diet score for each participant along a range from zero to 55.

The researchers then examined the association between Mediterranean diet scores and changes in participants' global cognitive function, episodic memory and perceptual speed. Participants with slower cognitive decline over the years of follow-up were those who adhered closest to the Mediterranean diet, along with limiting foods that are part of Western diet, whereas participants who ate more of the Western diet had no beneficial effect of healthy food components in slowing cognitive decline.

There was no significant interaction between age, sex, race or education and the association with cognitive decline in either high or low levels of Western diet foods. The study also included models for smoking status, body mass index and other potential variables such as cardiovascular conditions and findings remained the same.

"Western diets may adversely affect cognitive health," Agarwal said. "Individuals who had a high Mediterranean diet score compared to those who had the lowest score were equivalent to being 5.8 years younger in age cognitively."

Agarwal said that the results complement other studies showing that a Mediterranean diet reduces the risk of heart disease, certain cancers and diabetes and also support previous studies on Mediterranean diet and cognition. The study also notes that most of the dietary patterns that have shown improvement in cognitive function among older adults, including the Mediterranean, MIND, and DASH diets, have a unique scoring matrix based on the amount of servings consumed for each diet component.

"The more we can incorporate green leafy vegetables, other vegetables, berries, olive oil, and fish into our diets, the better it is for our aging brains and bodies. Other studies show that red and processed meat, fried food and low whole grains intake are associated with higher inflammation and faster cognitive decline in older ages," Agarwal said. "To benefit from diets such as the Mediterranean diet, or MIND diet, we would have to limit our consumption of processed foods and other unhealthy foods such as fried foods and sweets."

The study and its findings cannot be readily generalized. Future longitudinal studies on diet and cognition among the middle-aged population are needed to extend these findings.

Other researchers at Rush involved in the study at Rush were Klodian Dhana, PhD; Lisa Barnes, PhD; Thomas Holland, MD; Yanyu Zhang, MS; Denis Evans, MD; Martha Morris, ScD.

The study was supported by a grant from the National Institute on Aging.