Health24.com | Eating out – a recipe for poor nutrition, study finds

Whether you’re stopping at a casual fast-food place or sitting down to eat in a full-service restaurant, eating out is an easy way to fill up when you’re hungry. But those meals may not deliver much nutritional value, a new study suggests.

The researchers found that 70% of fast-food meals consumed in the US were of poor nutritional value. For full-service restaurants, around half of the meals were of poor nutritional value.

Less than 0.1% of the restaurant meals analysed during the entire study period – 2003 to 2016 – were considered to be of ideal nutritional quality.

“On any given day, nearly one-third of American adults eat at a full-service restaurant, and nearly half at a fast-food restaurant. The nutritional quality of most of these meals is poor and almost none are ideal, and this is true for both quick-serve and full-service restaurants,” said senior study author Dariush Mozaffarian. He’s dean of the Friedman School of Nutrition Science and Policy at Tufts University in Boston.

“Today, more American adults are sick than are healthy, and much of this is due to diet-related illness. Looking for healthier restaurant options should be a priority for all Americans,” he added.

The shift from homemade

Over the past 30 years, American meals have largely shifted away from meals prepared at home to restaurant meals, the study authors said. Today, the typical American gets one out of every five calories they eat from a restaurant.

Other studies have found a link between restaurant foods and a higher risk of poor health outcomes, like type 2 diabetes, the researchers said. But there was little research on the nutritional quality of individual meals from restaurants.

The latest study included information from a nationally representative sample of more than 35 000 American adults. They all provided dietary information for a 24-hour period.

Counting calories

The researchers graded the nutritional value of the foods using an American Heart Association diet score.

Fast-food meals accounted for 12% of all the calories eaten. Full-service restaurant meals made up 9% of all calories consumed. During the study period, fast-food breakfasts went from around 4% of calories eaten to 8%.

The study found some disparities when it came to nutrition in restaurant meals. The quality of fast-food meals for whites and Mexican-Americans improved during the study period. But there was no similar change in the quality of fast-food meals eaten by black Americans.

For people with college degrees, poor-quality meals from fast-food restaurants dropped from 74% to 60% during the study. For people without a high school diploma, 76% of fast-food meals were of poor nutritional value.

Promoting unhealthy options

“Restaurants aggressively develop and promote unhealthier options to lower-income and marginalised communities, and restaurant choices in these communities tend to be less healthy. It’s a vicious cycle, and one that needs to be broken,” Mozaffarian said.

Restaurants need to add more whole grains, nuts, legumes, fish, vegetables and fruits to their meals to boost the nutritional value, the researchers said. The amount of salt in the food should also be reduced, they noted.

Mozaffarian said to choose seltzer or unsweetened tea instead of soda, and to minimize the amount of processed meats you eat.

He said people don’t necessarily need to eat out less frequently, but when they do dine out (even if it’s fast food), they could choose healthier options from the menu.

Find healthier options

Dietician Audrey Koltun, from Cohen Children’s Medical Center in Lake Success, N.Y., said, “Most restaurants – but not all – do have healthy, or at least somewhat better options if one chooses. There have been trends focusing on healthier kids meals, whole grains and vegetarian options, but people want to eat what they want when eating out or getting take-out.”

She said even people who are mindful of nutrition when they’re preparing food at home may view eating out as a “cheat” day, so they don’t pay attention to the nutritional quality of their meal.

Koltun noted that cost is a big factor in food choices. Many fast-food places have a cheaper menu, and she noted, those foods are likely to be lower in quality and nutritional value.

The study was published in The Journal of Nutrition.

Image credit: Dan Gold/Unsplash

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Could resetting our internal clocks help control diabetes?

The circadian clock system allows the organisms to adjust to periodical changes of geophysical time. Today, increasing evidence show that disturbances in our internal clocks stemming from frequent time zone changes, irregular working schedules or ageing, have a significant impact on the development of metabolic diseases including type-2 diabetes. Using a molecule extracted from lemon peel, researchers have succeeded in ‘repairing’ the disrupted cellular clocks.

The circadian clock system (from Latin “circa diem,” about a day) allows the organisms to anticipate periodical changes of geophysical time, and to adjust to these changes. Nearly all the cells in our body comprise molecular clocks that regulate and synchronize metabolic functions to a 24-hour cycle of day-night changes. Today, increasing evidence show that disturbances in our internal clocks stemming from frequent time zone changes, irregular working schedules or ageing, have a significant impact on the development of metabolic diseases in human beings, including type-2 diabetes. Such disturbances seem to prevent the proper functioning of the cells in the pancreatic islet that secrete insulin and glucagon, the hormones that regulate blood sugar levels. By comparing the pancreatic cells of type 2 diabetic human donors with those of healthy people, researchers at the University of Geneva (UNIGE) and at the University Hospitals of Geneva (HUG), Switzerland, were able to demonstrate, for the first time, that the pancreatic islet cells derived from the Type 2 Diabetic human donors bear compromised circadian oscillators. The disruption of the circadian clocks was concomitant with the perturbation of hormone secretion. Moreover, using clock modulator molecule dubbed Nobiletin, extracted from lemon peel, the researchers succeeded in “repairing” the disrupted cellular clocks and in partial restoring of the islet cell function. These results, published in the Proceedings of the National Academy of Sciences of the United States, provide a first insight into innovative approach for diabetes care.

Two years ago, the team led by Charna Dibner, Principle Investigator in the Departments of Medicine and of Cell Physiology and Metabolism, and Diabetes Centre at UNIGE Faculty of Medicine, and at HUG, has already shown that in rodents the perturbation of pancreatic cellular clocks led to disrupted insulin and glucagon secretion, thus promoting the onset of diabetes. But what is the situation in human beings? “We had also previously observed that if the clocks of human pancreatic cells were artificially disrupted in the cellular culture in vitro, secretion of the key islet hormones — insulin and glucagon — was compromised,” says Volodymyr Petrenko, a researcher in Dr. Dibner’s lab and the first author of these publications. Hence our next step, that we report here, was to unravel whether the circadian rhythms were perturbed in human pancreatic islets in type 2 diabetes, and, if so, how would this perturbation affect the islet function.”

Using combined bioluminescence-fluorescence time-lapse microscopy, a technology that allows tracking the molecular clock activity in living cells very precisely over time, the scientists compared the behaviour of pancreatic cell of type-2 diabetic donors and those of healthy subjects throughout the day. “The verdict is indisputable,” says Charna Dibner. The biological rhythms of the islet cells in type-2 diabetes exhibit both reduced amplitudes of circadian oscillations and poor synchronization capacity. “As a result, hormone secretion is no longer coordinated. Moreover, the defects in temporal coordination of insulin and glucagon secretion observed in patients with type-2 diabetes were comparable to those measured in healthy islet cells with artificially-disrupted circadian clock.”

It’s all in the timing!

Circadian clocks represent the daily cycles governing the various cellular functions. There are several interlocking levels of synchronization of these clocks, the main one being light, which in particular regulates the central clock located in the cerebral hypothalamus. Like a conductor in the orchestra, it regulates peripheral clocks present in organs and cells. The latter are therefore partly centrally regulated, but function differently in each organ, and even in each cell, depending on their functions. “Pancreatic cells are also subject to the rhythm of fasting and food intake, and to a tight hormonal regulation,” says Charna Dibner. “Coordinating all levels of regulation therefore allows the optimization of metabolic functions. Clocks deregulation in pancreatic islet leads to a compromised function: they are not anymore anticipating food-derived signals. Indeed, if you eat the same food but at night rather than during the day, you may gain weight much faster, due to a suboptimal response of your metabolism.”

Setting the right time again

Step two of their research: the Geneva scientists used Nobiletin, a small clock modulator molecule — a natural ingredient of lemon peel whose impact on circadian clocks has been recently discovered — in order to resynchronize the clocks. “By acting on one of the core-clock components, it resets efficiently the amplitude of the oscillations in the human islets” says Volodymyr Petrenko. “And as soon as we got the clocks back in sync, we also observed an improvement in insulin secretion.”

“This is the first proof of principle that repairing compromised circadian clocks may help improving the function of the pancreatic islet hormone secretion,” says Charna Dibner. “We will continue by exploring this repair mechanism in vivo, first in animal models. Our society experiences epidemic growth in metabolic diseases, concomitant with shifted working and eating schedules, and lack of sleep. By re-synchronizing the perturbed molecular clocks, either by personalized eating and exercise schedules or with the help of clock modulator molecules, we hope to ultimately be able to provide an innovative solution to an epidemical metabolic problem affecting an ever-increasing proportion of the world’s population. .”

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Diabulimia: ‘Diabetes and eating disorder almost killed me’

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Gwyneth Paltrow’s Goop series on Netflix slammed by NHS chief

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Coronavirus declared global health emergency by WHO

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Call, Raise, or Fold

Let me share one of my favorite techniques for simplifying complicated decisions.

There’s a popular form of poker called Texas Hold’em, and in this game (as well as in many other poker variants), you just really just have three possible decisions on each turn: call, raise, or fold.

So you can call – or match – the current bet. You can raise – or increase – the current bet. Or you can fold by quitting the hand.

Note that I’m simplifying this a bit more by considering checking to be a form of calling because when you check you’re keeping a zero bet at zero. And I’m also considering making an opening bet to be a form of raising since you’re going from a zero bet to a positive bet. And furthermore, let’s assume for the sake of simplicity that we’re playing what’s called limit poker, so the bet size is fixed. In a spread limit or no limit game, you’d also have to decide the size of your bets when you raise. So I’m deliberately constraining this analogy because it’s meant to be a simple tool, not a crazy complicated one.

Now if you’re a poker nerd, it’s easy to get caught up in thinking that there are more decisions to be made, like figuring out whether to bluff or trying to assess how strong an opponent’s hand may be. But to an outside observer watching you play, all that any player actually does in terms of what’s actionable and involves an outcome-based choice is to call a bet, raise a bet, or fold. In any situation there are really just those three options.

I often like to think in terms of these three options when I have a big decision to make.

I can call. I can maintain the status quo and keep my energy investment the same as before. I can raise. I can escalate the situation and put more energy into it. Or I can fold by exiting the situation.

Suppose you’re at a career crossroads. You can call by maintaining your current path as-is. You can raise by seeking to bet even bigger on your current path, such as by going for a promotion. Or you can fold by exiting that career and doing something else for a change.

In tricky relationship situations, you have the same three basic options. Invest the same. Invest more. Or invest less.

Reducing any decision to three options is an oversimplification of course, so don’t consider this tool to be your one ring to rule them all, but in some situations it works really well because it gets you to the core of the decision quickly, so you aren’t drowning in noncritical details and spinning yourself in circles.

In fact, we can usually apply this tool in an even simpler way.

Maybe you’ve heard the expression Go big or go home. To go big is to raise. And to go home is to fold or to give up. There is a third option though – calling – which is basically akin to staying put.

However, in many tricky poker situations, professional players will advise that calling is rarely the right choice. Most of the time you should be thinking: raise or fold. This is because when a choice seems difficult, it’s usually because the best option is to raise or fold, and you’re not sure which is best.

So if you find yourself at a crossroads, consider that you may really have just two viable options: raise or fold. Go big or go home.

And here’s a way we can compress the options even further. If you’re able to rule out calling, and you’re convinced that you’re in a situation where raise or fold are your two best options, then if you can rule out either one of those options as clearly being an incorrect choice, then in a pseudo-Sherlock Holmesian style, we can know that the other option is your best bet.

For instance, if maintaining your current path just isn’t working for you, then you’re down to a classic raise or fold situation. Now if it’s also pretty obvious to you that there’s no way in hell you’d want to raise by betting even bigger on that path and investing even more energy into it, then your decision is clear: it’s time to fold.

Or consider a tricky relationship situation where maintaining the current level of investment and engagement isn’t making you and your partner happy. You know it’s never going to improve if you both keep calling the way you’ve been doing. That’s another classic raise or fold situation. Now suppose that in this case, you just couldn’t see you and your partner ever breaking up. Deep down you still believe that you’re kindred spirits and that you’re meant to be together, and you have compelling reasons for believing that. You couldn’t stomach the possibility of folding; it just doesn’t make sense. Your choice is clear then: it’s time to raise. It’s time to recommit to the relationship in a much bigger way. It’s time to heal what needs healing and fix what isn’t working. It’s time to raise the level of truth, love, and power in the relationship to a whole new level. Get some deeply honest communication flowing again. Express your appreciation for each other, and do more of what makes you feel in love. Have more sexy time. Find new ways to empower, encourage, and uplift each other. You may know that it’s going to be hard, but you’ve got to do it. It’s time.

Folding or raising in real life is more complicated than pushing your chips a few inches forward or tossing your cards into the muck. The consequences will likely be trickier to deal with… unless maybe you’re playing a hand with a lot of money in the pot.

Let me gently remind you here to be careful not to confuse the truth and power aspects of a tough decision. We can overcomplicate such decisions by weaving in all kinds of extraneous details to keep ourselves stuck in analysis paralysis on the truth side, when the actual decision may be a no-brainer if we cut to the core of it – like of course you need to fold, or of course you need to raise. But damn… now there’s a lot of crap to deal with either way once the decision is made.

When you’ve decided that it’s time to fold, you may have a tendency to keep asking yourself, But if I fold this hand, then what will I have left? If I fold my job, how will I pay my bills? If I fold my relationship, then who will love me again?

And the answer is simple. Just get back into the game, and you’ll be dealt a fresh hand. A fresh hand brings fresh hope. A weak hand doesn’t.

You may need to step away from the table to regain your composure sometimes, and that’s totally fine. Now and then you’re going to get rivered by that nutter who hit their improbable inside straight draw. Bad beats are part of life. You take your licks, and you get back in the game when you’re ready.

Try not to worry so much about the next hand when you know it’s time to fold your current hand. Go ahead and grieve the loss as your cracked aces going down in flames, and then let that hand go and release that energy. It’s fine to think about the future, but the game is played one hand at a time. Have you finished playing your current hand yet? If not, then finish that hand before you worry about the next one. Otherwise you’ll split your energy between past, present, and future, and that’s only going to weaken you. Focus your energy on the present challenge, the present situation, the present decision.

Call, raise, or fold – it’s a simple tool, but it’s really good for freeing up stuck energy and getting back into the flow again. In 2004 when I felt out of alignment with my computer games business, and I’d been calling for years, I finally decided to fold. And I decided to bet big (or to raise) on blogging and speaking that same year. In 2009 I folded one relationship, and a few months later I raised on a new one. And then some years after that, I re-raised by getting married again. With each transition came a burst of fresh energy and this delightful feeling of flow.

When we get stuck, it’s often because we’re calling too much when we should be raising or folding more. Calling is the choice to maintain the status quo. That may seem okay for a while, but life will eventually destabilize the status quo if we don’t consciously do it ourselves.

The big transitions in life are usually raise or fold decisions. Put more energy in, or withdraw your energy so you can invest it elsewhere. We only have so much energy to invest, so it’s wise to make sure that our investments are continuing to create good value for ourselves and others and that we aren’t wasting energy chasing our losses. We have to make decisions based on how the energy is flowing right now, not on where it’s been. It’s the same with poker. We have to look at the current pot odds of each bet anew.

When you’re not in the flow, raising and folding can help you grow beyond the stuckness. Calling? Not so much. Calling makes sense when you’re in the flow.

So what’s a tricky decision you’re facing right now? And what happens if you view that decision through the simple lens of call, raise, or fold?

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If it takes a hike, riders won’t go for bike sharing

Even a relatively short walk to find the nearest bicycle is enough to deter many potential users of bike sharing systems, new Cornell research suggests.

“If a docking station is more than two or three blocks away, they just won’t go there,” said Karan Girotra, professor of operations, technology and innovation at Cornell Tech and the Cornell SC Johnson College of Business. “And if they encounter a station without bikes, it’s very unlikely they will go to the next station.”

Girotra co-authored “Bike-Share Systems: Accessibility and Availability,” published in November by Management Science, with Elena Belavina, associate professor at the School of Hotel Administration in the SC Johnson College, and Ashish Kabra, assistant professor at the University of Maryland’s Robert H. Smith School of Business.

Their findings imply that, outside of a few big stations at major transit hubs, cities and bike-share operators should strive to create denser networks with many smaller stations, Girotra and Belavina said, and keep them stocked.

“It’s no surprise that people want stations close to them, but it’s much closer than most planners and bike-share systems thought they needed,” Belavina said. “Most systems are nowhere close to their optimal density.”

Bike sharing systems hold the potential to reduce traffic and pollution in dense, flat cities such as London, New York, Paris and Shanghai, the researchers noted. They encourage and enhance public transit use by providing “last mile” connections to bus and train stations.

But “their promise of urban transformation is far from being fully realized,” according to the paper. Many systems were established quickly, sometimes through public-private partnerships, and with less rigorous planning than higher-cost transit systems, Girotra said.

“There was perhaps an opportunity to put a little more thought into how a bike-share system can be introduced in a city,” he said.

To that end, the research team built a model to produce the first estimates of how station proximity and bike availability influence bike-share operations.

The structural demand model analyzed data from Paris’ Vélib’ system — the largest outside China with roughly 17,000 bikes and 950 stations — during four months of 2013, a period that included nearly 4.4 million trips. The data provided snapshots of system usage every two minutes, showing how stations changed throughout each day.

The researchers blended that information with data about population density in different city districts, metro ridership, attendance at top tourist destinations and weather conditions. The team also logged the locations of thousands of points of interest such as transit stations, parks, libraries, hotels, grocery stores, restaurants and cafes.

“Put together,” Belavina said, “that gave us some ability to disentangle what guides people’s decisions in choosing bike sharing and different bike-share stations.”

The model determined that someone roughly 300 meters (nearly 1,000 feet) from a docking station is 60% less likely to use the service than someone very near the station. The odds decrease slightly with every additional meter, such that someone 500 meters away — about one-third of a mile — is “highly unlikely to use the system.”

But a 10% increase in bike availability — the likelihood of finding a bicycle at a station — would grow ridership by roughly 12%, the study found, thanks to fewer lost sales at out-of-stock stations and improved expectations of the system.

Among the various points of interest, placing stations near grocery stores provides the most benefit, the model showed.

Generating the study’s findings required methodological advances to adapt demand modeling to a bike-share context, the researchers said.

Models have long predicted shifts in usage patterns when considering new locations for transit stations, retail outlets or bank ATMs. But bike-share demand in a major city, with hundreds of stations changing inventory throughout each day, involved studying a more dynamic system with much finer resolution, Girotra said.

The team’s huge volume of data might have required completing more than a quadrillion calculations to generate the best estimates, likely taking over a year, according to the paper. Instead, the researchers developed new computational techniques, Belavina said, to condense some data and make the process more manageable.

The resulting model, according to the co-authors, can be applied not only to bike-share systems but other micro-mobility services: scooters, powered bikes, local food delivery and ride-sharing. The researchers plan to look more broadly at micro-mobility in a future study partnering with London’s transit agency.

Regarding bike sharing, the study’s advice was clear: “Make bikes and stations more available,” Girotra said. “People don’t like walking to access a bike-share system.”

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The first roadmap for ovarian aging

Due to the modern tendency to postpone childbirth until later in life, a growing number of women are experiencing issues with infertility. Infertility likely stems from age-related decline of the ovaries, but the molecular mechanisms that lead to this decline have been unclear. Now, scientists from the U.S. and China have discovered, in unprecedented detail, how ovaries age in non-human primates. The findings, published in Cell on January 30, 2020, reveal several genes that could be used as biomarkers and point to therapeutic targets for diagnosing and treating female infertility and age-associated ovarian diseases, such as ovarian cancer, in humans.

“This is the first in-depth analysis of ovarian aging at a single-cell resolution in a non-human primate model,” says Juan Carlos Izpisua Belmonte, one of the co-corresponding authors, professor in Salk’s Gene Expression Laboratory and holder of the Roger Guillemin Chair. “We found that oxidative stress, the cellular stress that damages cells, is a key player in ovarian aging. This discovery provides valuable insight into the mechanisms by which ovaries age and eventually become infertile.”

The ovary is a complex reproductive organ in which an ovarian cell, called an oocyte, undergoes meiosis to become an egg. Current research suggests that women are born with a set number of oocytes that start to become less functional once women turn 35, leading to infertility. A better understanding of the ovarian environment as well as the mechanisms of healthy aging could inform new therapies for women with fertility issues.

“Our goal was to analyze each ovarian cell type along with patterns in gene expression in order to better understand exactly how ovaries age,” says Jing Qu, co-corresponding author, professor at the Chinese Academy of Sciences and former Salk research associate. “This systematic approach provides a better understanding of the mechanisms of healthy ovarian aging.”

The scientists compared 2,601 ovarian cells from young and old non-human primates, and identified gene activity patterns for every type of primate ovarian cell including ooctyes and granulosa cells, which surround the oocytes as they develop. Similar to previous studies in rodents, the scientists observed changes in gene function related to cellular stress and cell division across the non-human primates. As the oocytes and granulosa cells aged, some of the genes that fight cellular stress became less active which led to damage and impairment in function.

The scientists then compared the primate data with granulosa cells from healthy women ranging in age from 21 to 46 years. They observed age-associated damage from cellular stress as well as cell death in the women’s cells. Two key antioxidant genes (IDH1 and NDUFB10) showed decreased function, as seen in the non-human primate cells. To better understand the connection between ovarian aging and the antioxidant genes, the scientists tested what happened to the human cells when the antioxidant genes were made non-functional. They found that without IDH1 or NDUFB10, the cells appeared old and similar to the old non-human primate cells.

The results suggest that IDH1 and NDUFB10 play a critical role in protecting both human and non-human primate ovarian cells from cellular stress during aging. These genes represent promising biomarkers or therapeutic targets for the diagnosis and treatment of age-related decline of the ovaries.

“This study provides a comprehensive understanding of the specific mechanisms of primate ovarian aging at single-cell resolution,” says Guang-Hui Liu, co-corresponding author, professor at the Chinese Academy of Sciences and former Salk research associate. “Our results will hopefully lead to the development of new tools to aid in the rejuvenation of aged ovarian cells.”

“Our research is enabling the identification of new biomarkers for the diagnosis and treatment of female infertility as well as aging-associated human ovarian disorders,” says Concepcion Rodriguez Esteban, an author on the paper and senior staff researcher in the Izpisua Belmonte lab. “These genes could possibly be targeted for the development of therapies to assist with fertility preservation.”

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Nanotechnology: Putting a nanomachine to work

A team of chemists at Ludwig-Maximilians-Universitaet (LMU) in Munich has successfully coupled the directed motion of a light-activated molecular motor to a different chemical unit — thus taking an important step toward the realization of synthetic nanomachines.

Molecular motors are chemical compounds that convert energy into directed motions. For example, it is possible to cause a substituent attached to a specific chemical bond to rotate unidirectionally when exposed to light of a certain wavelength. Molecules of this sort are therefore of great interest as driving units for nanomachines. However, in order to perform useful work, these motors must be integrated into larger assemblies in such a way that their mechanical motions can be effectively coupled to other molecular units. So far, this goal has remained out of reach. LMU chemist Dr. Henry Dube is a noted specialist in the field of molecular motors. Now he and his team have taken an important step towards achievement of this aim. As they report in the journal Angewandte Chemie, they have succeeded in coupling the unidirectional motion of a chemical motor to a receiver unit, and demonstrated that motor can not only cause the receiver to rotate in the same direction but at the same time significantly accelerate its rotation.

The molecular motor in Dube’s setup is based on the molecule hemithioindigo, which contains a mobile carbon double bond (-C=C-). When the compound is exposed to light of a specific wavelength, this bond rotates unidirectionally. “In a paper published in 2018, we were able to show that this directional double bond rotation could be transmitted by means of a molecular ‘cable’ to the single carbon bond rotation of a secondary molecular unit.” says Dube. “This single bond itself rotates randomly under the influence of temperature fluctuations. But, thanks to the physical coupling between them, the unidirectional motion of the light-driven motor is transmitted to the single bond, which is forced to rotate in the same direction.”

To verify that the ‘motorized’ bond was actively driving the motion of the single bond, and not simply biasing its direction of rotation, Dube and colleagues added a brake to the system that reduced the thermal motion of the single bond. The modification ensured that the motor would have to expend energy to overcome the effect of the brake in order to cause the single bond to rotate. “This experiment enabled us to confirm that the motor really does determine the rate of rotation of the single bond — and in fact increases it by several orders of magnitude,” Dube explains.

Taken together, these results provide unprecedentedly detailed insights into the mode of operation of an integrated molecular machine. In addition, the experimental setup allowed the authors to quantify the potential energy available to drive useful work, thus yielding the first indication of how much work can effectively be done by a single molecular motor under realistic conditions. “Our next challenge will be to demonstrate that the energy transmitted in this system can indeed be used to perform useful work on the molecular scale,” says Dube.

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Health24.com | Rare disease put this young mom in a coma for 7 months

Kertisha Brabson’s mom rushed to the hospital after being told her adult daughter was acting out of her mind.

“She was talking out of her head, dancing like she was at a concert,” recalls Kertease Williams. “She was trying to get out of the room. They had to have a nurse in her room around the clock because she would try to leave.”

Neither woman could know it, but this incident in September 2018 was the start of an ordeal that would leave Brabson in a coma for seven months. Doctors thought she was brain-dead.

20 seizures a day

Brabson, now 31, had anti-NMDA receptor encephalitis. This is a rare disease in which the immune system attacks the brain and disrupts normal brain signaling. It first affected her ability to think clearly, but soon she was suffering from relentless seizures.

“She was having something like 20 seizures a day for six months, rapid seizures over and over and over” while comatose, Williams said.

The woman bounced from hospital to hospital as doctors tried to figure out what was wrong with her. Williams said her daughter was moved at least six times.

Brabson, herself a mother of two, emerged from her coma on April 7, 2019, after doctors at Ohio State University’s Wexner Medical Center were able to quiet her immune system and calm her seizures.

“She’s doing wonderfully,” said one of her physicians, neurologist Dr Shraddha Mainali. “She’s independent, and she’s looking forward to going back to working part time as a dental assistant.”

Tumour in an ovary

Brabson, who lives in Alliance, Ohio, hadn’t felt right for months. She was sleepless, lethargic, anxious and confused, struggling to put words together into sentences.

It got so bad that her sister took her to the hospital, and then called their mom when Brabson’s condition deteriorated further.

Williams rushed to Alliance from her home in Cleveland to help her stricken daughter, who soon fell into a coma.

“We just didn’t know what was taking over my daughter’s life and her body,” Williams said. “We didn’t know what was happening to her.”

Apparently, a tumour in one of her ovaries had caused Brabson to develop anti-NMDA receptor encephalitis, Mainali said.

“In her case, she had a tumour in her ovary that possibly had cells resembling brain cells,” Mainali said. “In the body’s attempt to attack that tumour, it started hurting brain cells.”

Anti-NMDA receptor encephalitis is a recently discovered disease, identified in 2007 by researchers at the University of Pennsylvania.

NMDA receptors are proteins in the brain that control the electrical impulses that form the basis of human thought. Any time you make a decision, observe something, interact with another person, or recall a memory, you’re relying on these receptors to make the necessary connections. Even automatic functions like breathing rely on these receptors.

Two-pronged treatment

The affected ovary was removed, but Brabson’s condition didn’t improve.

Eventually, Williams moved her daughter to Wexner Medical Center in Columbus, where doctors started a two-pronged approach to treatment.

Brabson’s brain imaging showed no signs of severe injury, Mainali said, so the doctors figured that if they treated her disease she should have a good chance of waking up and recuperating.

Brabson was put on intense immune suppression to stop her body from attacking her brain, Mainali said. They also put her on a cocktail of seizure medications at very high doses.

She arrived at Wexner in December, and around February she was seizure-free, Mainali said.

“Once we were confident the seizures were taken care of, we gradually started to lift one medication at a time,” Mainali said.

Brabson woke from her coma in April, gently eased back into the world by the steady withdrawal of her medications.

“I didn’t really know anything,” Brabson recalled. “When I woke up, I was confused. I didn’t know where I was at. I didn’t know what was going on.”

At first, she didn’t recognise her family, Williams said.

“She didn’t know who I was. I said, ‘I’m your mother.’ She said, ‘No, I’ve never seen you before,'” Williams recalled. “We left the room. When we came back an hour later, she said, ‘Hi Mom!'”

Doctors refused to give up

It took months of rehab for Brabson to be able to walk and care for herself, given the physical deterioration that had happened during her coma.

The illness was particularly hard on her 12-year-old daughter and five-year-old son, who stayed with family while their mom was in the hospital.

“They were scared, seeing me in a coma like that and waking up,” Brabson said. “They were scared and they were distant.”

Today, Brabson is mostly recovered, though she still has occasional problems with her short-term memory.

“When she first came home, she would ask me questions over and over,” Williams said. “Now she is so much better with her memory.”

Williams said she’s grateful to the doctors who refused to give up on her daughter, but said families in her situation should be ready to fight on behalf of the ailing.

“You have to advocate for your loved one, a lot of the time,” Williams said. “Always have a note pad, and everything they tell you, jot it down.”

Early on, one set of doctors told Williams that her daughter was brain-dead and she should consider pulling the plug. Instead of heeding that advice, Williams moved her to another hospital.

That was the right move in this case, but “not all comas are the same,” Mainali warned.

“I don’t want people to get misinformed and think if you keep trying, people wake up and miracles will happen,” Mainali said. In Brabson’s case, she had a treatable disease that although incredibly severe, hadn’t caused incapacitating damage to her brain.

Image credit: iStock

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