Massive U.S. children’s study needs major tweaks, report finds

first_imgA controversial plan to study the health of 100,000 U.S. babies to age 21 has some strong points—but also a host of weaknesses that could further delay its launch, an outside review has concluded. The critique from an Institute of Medicine (IOM) and National Research Council (NRC) panel raises questions about whether the National Children’s Study (NCS) can sustain the political support needed to assure funding for the ambitious effort, which has already cost $1 billion and could require billions more in coming years.NCS “offers enormous potential, but it also presents a large number of … challenges,” states the 16 June IOM/NRC report. To overcome them, IOM/NRC recommends that the study’s leader, the National Institute of Child Health and Human Development (NICHD), undertake some major changes, including fine-tuning the study’s guiding hypotheses and bolstering scientific input and oversight. And it should drop an existing plan to enroll nearly half of the children at birth, and instead enroll all of them earlier, during the mother’s pregnancy.“It’s not like [NICHD needs] to start at square zero again,” because much of the groundwork for NCS has already been laid, says panel chair Greg Duncan, an economist at the University of California, Irvine. But the needed changes would likely delay initial recruitment, now planned for 2015.Sign up for our daily newsletterGet more great content like this delivered right to you!Country *AfghanistanAland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia, Plurinational State ofBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic of theCook IslandsCosta RicaCote D’IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and Mcdonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People’s Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People’s Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, The Former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMartiniqueMauritaniaMauritiusMayotteMexicoMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorwayOmanPakistanPalestinianPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussian FederationRWANDASaint Barthélemy Saint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuela, Bolivarian Republic ofVietnamVirgin Islands, BritishWallis and FutunaWestern SaharaYemenZambiaZimbabweI also wish to receive emails from AAAS/Science and Science advertisers, including information on products, services and special offers which may include but are not limited to news, careers information & upcoming events.Required fields are included by an asterisk(*)NCS grew out of a request from Congress, made 14 years ago, that the National Institutes of Health (NIH) follow a large group of children from birth to adulthood in a bid to understand how environmental factors, including social settings and chemical pollutants, influence health. Planners decided to recruit 100,000 women and their unborn babies by knocking on household doors in a random sample of about 100 U.S. counties. But this approach proved too expensive, so NICHD turned to other designs. Members of Congress expressed concern in 2012, after NICHD, having spent $1 billion, decided to pull the plug on 40 NCS sites run by academic investigators and turn over to large contractors the job of tracking the 4000 families it had already enrolled in a pilot study. In March 2013, Congress called for IOM to review the study and suggest improvements.In general, the IOM/NRC panel endorses the NCS concept. Similar studies are under way in Europe and Japan, it notes, but the U.S. version would be more comprehensive in part because researchers would collect extensive data on environmental exposures. The panel also agreed with NICHD’s decision to design the study as a “data collection platform” that will start out focused on testing just a few hypotheses—such as that exposure to kitchen dust exacerbates respiratory problems—and add more later. But these “exemplar hypotheses” need to be more scientifically robust, IOM/NRC found.The panel found fault, however, with how NCS planned to enroll subjects. Instead of enrolling 45,000 babies at birth and the same number before birth, the panel calculated the study could enroll 95,000 mothers during pregnancy for the same cost—if it dropped plans for separate studies of 10,000 women. Those smaller studies were to focus on particular questions such as preconception exposures and the effects of natural disasters. Enrolling siblings, as is planned, could also provide useful data on preconception exposures, the panel noted.  Such changes would enable NICHD to enroll participants for about $1.5 billion over 7 years, the panel estimates, with annual costs peaking at just over $300 million. (NIH is now allocating $165 million per year for the study.) The IOM/NRC total appears to put NCS on a lower cost path than earlier NIH estimates, which predicted the study could cost $3 billion. But the IOM/NRC estimate does not include costs such as archiving data and storing biological samples, the report notes. If NIH must further trim costs, the panels says it would be better to enroll fewer families than cut back on exposure measurements.The panel could not determine whether NICHD’s plan to enroll pregnant women through a sample of U.S. hospitals would yield a group as representative of the population as recruiting women through prenatal providers within the original 100 NCS counties. The problem is that “no such list [of all hospitals] exists,” Duncan says.  Scientific leadership of NCS is a major deficiency, the report finds. Although the study has various advisory committees, “the processes by which study decisions are made and vetted are opaque,” it says. NCS needs more expertise within its program office, the panel concludes, as well as a new outside scientific advisory group that has the authority to approve the study’s design.Such conclusions are vindication for some NCS critics, including academic scientists who were pushed out of the study 2 years ago. “From my point of view, this is an excellent report,” says pediatrician and epidemiologist Nigel Paneth of Michigan State University in East Lansing, who led a former NCS site in Detroit. “Its conclusions are essentially the same as mine. They’re just putting it more nicely.”Now that IOM/NRC has had its say, the question is whether NIH will embrace its recommendations—and whether Congress will be willing to keep funding the study.*Correction, 16 June, 4:35 p.m.: The report is from the National Research Council as well as the Institute of Medicine, both part of the National Academies.*Update, 16 June, 4:35 p.m.: NIH Director Francis Collins issued a statement in response to the report saying that it “raises significant concerns.” He is putting the main study on hold. A team of experts will meet in the coming weeks to advise Collins on whether the study is “actually feasible” given current budget constraints and if so, how to implement the recommendations. If not, the panel will look at “new methods to answer key research questions that are most important to pediatric health today.”last_img read more

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Indian troops kill seven civilians three militants in disputed Kashmir

first_imgLondon best pest control Indian troops laid a siege around a village in Pulwama area on a tip that militants were hiding there. As the soldiers began searching for the militants, gunfire erupted, leaving three rebels and a soldier dead.Hundreds of people marched near the site in solidarity with the rebels while chanting pro-militant slogans and seeking an end of Indian rule over the Himalayan region.Indian police and paramilitary forces fired bullets, shotgun pellets and tear gas at the stone-throwing protesters, killing seven civilians and wounding over three dozen protesters, the Kashmir Press reported.The killings sparked more protests and clashes at several places in the area.Residents accused troops of directly spraying gunfire into the crowds.“They (Indian troops) fired at us as if they were practicing their guns,” said Shabir Ahmed, a local resident who accompanied some wounded taken to a hospital in Srinagar, the region’s main city.Pro-Independence groups called for strikes and protest march to one of region’s largest army cantonments hosting thousands of Indian soldiers.Kashmir’s popular resistance leader Mirwaiz Umar Farooq called for a march towards Srinagar’s city’s Badami Bagh army cantonment on Monday “to ask GOI [Government of India] to kill all of us at one time rather than killing us daily.” Bloodbath in #Pulwama.7 civilains shot dead by Indian armed forces along with 3 militants. Reports coming in say 50 people injured while a few are critical.People chat slogans of Azadi after a civilian Abid Ahmad’s dead body is escorted out of the hospital.#Kashmir 71 people are talking about this 477:15 AM – Dec 15, 2018 Support for rebels’ causeIndia and Pakistan each claim the divided territory of Kashmir in its entirety.Most Kashmiris support the rebel cause that the territory be united either under Pakistani rule or as an independent country while also participating in civilian street protests against Indian control.India, which has deployed over 500,000 troops in the tiny Muslim-majority region, accuses Pakistan of arming and training the rebels, a charge Pakistan denies.Nearly 100,000 people have been killed in the uprising and the ensuing Indian military crackdown.Source: TRTWorld and agencies Mirwaiz Umar Farooq@MirwaizKashmir 1,4118:06 AM – Dec 15, 2018 · Anantnag, Jammu And KashmirTwitter Ads info and privacy 979 people are talking about this Twitter Ads info and privacy At least seven civilians were killed and nearly three dozens wounded as Indian troops fired at anti-India protesters in India-administered Kashmir after a gun battle left three rebels and a soldier dead. Indian soldiers carry a box containing bulletproof shields near the site of a gun battle with suspected rebels in Srinagar on February 12, 2018. (Reuters) #PulwamaMassacre,Bullets and pellets rain!As Govt of India has decided to kill Kashmiri’s through its #ArmedForces who control us,JRL and people will march towards Badami Bagh Army cantonment on Monday 17 Dec to ask GOI to kill all of us at one time rather than killing us daily.. A demonstrator wearing a Guy Fawkes mask throws a stone towards the Indian police (not pictured) during a protest in India-administered Kashmir, Friday, December 14, 2018. (Reuters)At least seven civilians were killed and nearly three dozens wounded when government forces fired at anti-India protesters in disputed Kashmir following a gun battle that left three militants dead on Saturday, police and local media said. Two police officials, speaking on condition of anonymity because they were not authorised to talk to the media, said the two civilians were killed in the anti-India protests.However, resident Ubaid Ahmed said that soldiers in an armoured vehicle fired at a small group of civilians away from the site of the battle, and as the vehicle jammed on a roadside, the troops fatally shot one of them.At least 238 militants, 150 members of Indian soliders and police, and 147 civilians have died in the armed conflict so far this year, the deadliest since 2009. Irfan Mehraj@IrfanMeraj Twitter Ads info and privacylast_img read more

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Disaster medicine scientist may face death sentence in Iran

first_imgAhmadreza Djalali was arrested in April 2016 on still-unknown charges. Disaster medicine scientist may face death sentence in Iran Courtesy of VUB Email Sign up for our daily newsletter Get more great content like this delivered right to you! Country Colleagues are convinced of Djalali’s innocence. A petition set up by Hakan Altintas, a supporter in Turkey, asks the Iranian government to let Djalali come home; friends and colleagues are also raising awareness about his case on a Facebook page.”Ahmadreza is passionate about science,” says Ives Hubloue, the head of VUB’s Research Group on Emergency and Disaster Medicine. “He’s not interested in politics. We don’t believe he would do anything at all” to undermine the Iranian government.The petition says that Djalali, who has a wife and two children aged 14 and 5, has serious health issues after losing 18 kilograms during a hunger strike that he began on 26 December 2016.Djalali, 45, was arrested last April by the security forces of Iran’s Ministry of Information while en route from Tehran to the city of Karaj and was taken to Evin Prison in northwest Tehran, according to the petition. Worried that international publicity might make his situation worse, Djalali’s family initially told his colleagues that he was in a coma after a car accident, Hubloue says. VUB and CRIMEDIN didn’t learn that he had been imprisoned until October 2016, and even then, the family initially asked that his case not be publicized. Djalali studied medicine at the University of Tabriz in Iran and obtained a Ph.D. in disaster medicine, the study of health care management during large-scale emergencies, at the Karolinska Institute in Stockholm. He also earned a master’s degree from a program in disaster medicine jointly organized by CRIMEDIN and VUB. Now, he’s a professor in the same program and a scientist. His research focuses on how hospitals can best prepare for events with large numbers of casualties, including natural disasters and terrorist attacks, Hubloue says.Just what he has been accused of is unclear. “Ahmadreza has informed his family in Iran that he was forced to sign a confession, but the content is unknown,” says the petition. “His family has been informed that the investigation relates to an issue of ‘national security.’ They have no evidence against him, but they are continuing to keep him.”Hubloue says the charges are apparently related to Djalali’s international contacts. The joint masters program draws students and professors from countries around the world, he says, including the United States, Saudi Arabia, and Israel. “That could have something to do with it.” But any contacts with colleagues from countries that Iran might see as adversarial would have been solely about the science of saving lives, he says. “We don’t believe he did anything wrong,” Hubloue says. “Let him go. Let him do his work. We need him.”center_img *Correction, 7 February, 2:15 p.m.: This story previously said, based on information provided by the Free University of Brussels, that Djalali had been sentenced to death. On 7 February, we learned that information was erroneous. The story has been corrected accordingly.A researcher studying disaster medicine at two European institutes has been detained in Iran for 9 months, apparently for security-related offenses, and may face the death penalty. Iranian-born Ahmadreza Djalali, a scientist at the Research Center in Emergency and Disaster Medicine (CRIMEDIN) at the University of Eastern Piedmont in Novara, Italy, and the Free University of Brussels (VUB), was arrested in April 2016, and has spent much of the time since in solitary confinement and without access to a lawyer.According to Amnesty International, Djalali was taken before Branch 15 of the Revolutionary Court in Tehran on 31 January, without his lawyer present, and was told by the presiding judge that he was accused of “espionage” and could face the death penalty. 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