Cincinnati’s homeless camp


Staff & Wire Reports



Residents and supporters of a homeless encampment along Third St. remove their belongings before Cincinnati officials arrive to clean the area., Friday, Aug. 3, 2018, in Cincinnati. A federal judge refused to block the city cleanup after the advocates sued to stop it. They called an order to vacate "a bullying tactic" that violates constitutional rights of the homeless. (AP Photo/John Minchillo)

Residents and supporters of a homeless encampment along Third St. remove their belongings before Cincinnati officials arrive to clean the area., Friday, Aug. 3, 2018, in Cincinnati. A federal judge refused to block the city cleanup after the advocates sued to stop it. They called an order to vacate "a bullying tactic" that violates constitutional rights of the homeless. (AP Photo/John Minchillo)


Residents and supporters of a homeless encampment along Third St. remove their belongings before Cincinnati officials arrive to clean the area., Friday, Aug. 3, 2018, in Cincinnati. A federal judge refused to block the city cleanup after the advocates sued to stop it. They called an order to vacate "a bullying tactic" that violates constitutional rights of the homeless. (AP Photo/John Minchillo)


Residents and supporters of a homeless encampment along Third St. remove their belongings before Cincinnati officials arrive to clean the area., Friday, Aug. 3, 2018, in Cincinnati. A federal judge refused to block the city cleanup after the advocates sued to stop it. They called an order to vacate "a bullying tactic" that violates constitutional rights of the homeless. (AP Photo/John Minchillo)


Homeless forced to leave Cincinnati camp but vow to return

By ANGIE WANG

Associated Press

Friday, August 3

CINCINNATI (AP) — Homeless people living along a busy downtown Cincinnati street left minutes before the city’s deadline Friday afternoon when crews tasked with sanitizing the area arrived in white, full-body suits and neon vests.

But they didn’t go far.

Most took tents and other belongings and relocated just around the corner. Some went even closer to the city’s entertainment district that includes stadiums and an arena that host pro sports and big-name concerts.

Advocates for the homeless said displaced individuals plan to return as soon as city crews leave area. Police said they had no immediate plans to keep them away.

A federal judge refused to block the city’s cleanup after homeless advocates filed a lawsuit Friday morning trying to stop it, saying constitutional rights were being violated.

City officials cited health and safety reasons when they began to issue notices to vacate downtown homeless encampments about two weeks ago. Cincinnati Mayor John Cranley has called the encampments an “unacceptable” public health hazard.

Police and public officials are sweeping homeless camps across the nation in response to pressure from residents and business owners who want to avoid visible poverty, said Megan Hustings, executive director of the National Coalition for the Homeless. Hustings said complaints about cleanliness are valid, but removing individuals from public streets isn’t the answer.

“If dirtiness is the issue, focus on that,” she said. “Provide trash collection and portable restrooms.”

Those who sleep on the streets have begun to set up tents and take shelter in more visible spaces over the last few years because they think they’re safer in more open, trafficked locations, said Kevin Finn, president of Strategies to End Homelessness.

Billy Watson grills chicken wings on the sidewalk in front of his bar and restaurant Kitty’s, less than a block from the first encampment city officials shut down last week. He said he’s glad they’re doing something about it, because some customers told him they wouldn’t return until the tent city was dealt with.

Watson said he would be fine moving the encampment away from downtown tourist stops.

Homeless advocate Josh Spring said the homeless individuals have a right to be seen by both locals and tourists, and have a First Amendment right to protest — not with signs, but with their tents.

“Until we get serious about permanent solutions, we must not punish people for trying to live,” said Spring, of the Greater Cincinnati Homeless Coalition.

Joseph Phillips, the homeless man named in the lawsuit against the city, said he decided to live on downtown sidewalks because the area is safe and well-lit. He added it’s close to food kitchens and shelters, and the location makes it easy for people to drop off donations.

Acting City Manager Patrick Duhaney said he plans to next target a camp that formed near a luxury riverfront apartment complex around the same time the first encampment was shut down.

Cities such as Seattle and San Diego have experimented with sanctioned encampments in designated areas.

The vast majority of the Cincinnati area’s homeless population lives in shelters, Finn said. But others prefer living on the streets. Some shy away from shelters because of paranoia or anxiety, or because of substance dependencies. Some couples without children who can’t stay together in shelters don’t want to be apart.

Over the last few weeks, homeless individuals weaved brown plastic bags into the metal fencing along a Cincinnati freeway overpass, spelling “Home is where the heart is.”

Follow Angie Wang at http://www.twitter.com/byangiewang

ICYMI: Rob Richardson Outraises Republican Opponent 4:1

COLUMBUS, OH – Democratic nominee for Ohio Treasurer Rob Richardson announced another strong fundraising filing. Richardson raised $468,222.09, more than four times as much as his Republican opponent, State Rep. Robert Sprague. Richardson also continued to surpass Sprague in overall individual contributions, leading him 1,853 to 717.

“Today’s filing clearly shows that Rob’s message of holding the powerful accountable is resonating across Ohio,” Richardson’s Campaign Manager Chris Myers said. “People are tired of powerful special interests like drug companies, private prisons, and for-profit charter schools putting profits before people. We don’t need another failed legislator, who’s received thousands of dollars in contributions from these industries, in office. We need strong new leadership that will ensure Ohio’s tax dollars are used to expand opportunities for all Ohioans.”

Rob Richardson is a former chairman of the University of Cincinnati Board of Trustees, where he established the U.C. Scholars Academy for students in the Cincinnati Public School District. He also founded the first Next Lives Here Innovation Summit and led the development of the 1819 Innovation Hub where students, faculty, and staff collaborate with entrepreneurs, startups, and others in the private sector.

Richardson has been a longtime advocate for workers as a marketing construction representative. He also serves “of counsel” with the law firm Branstetter, Stranch & Jennings, where he practices in securities litigation.

LINK

Boston brothers who said Trump inspired them to beat homeless man for being an ‘illegal immigrant’ plead guilty

http://www.nydailynews.com/news/crime/boston-brothers-beat-homeless-man-plead-guilty-felonies-article-1.2639087

OP-ED: Common ground needed

Ashtabula, Ohio Star Beacon

Aug 5, 2018

The Ashtabula County Developmental Disabilities Board has a messaging problem. The Educational Service Center, whom they are currently locked in heated negotiations with, knows it; the county commissioners, who are trying to broker a deal between the sides, knows it; and the DD Board itself knows it. If the public relations battle doesn’t turn around, the most vulnerable population in the county — both adults and children — will be at risk of serious harm. And while we have often been critical of the DD Board’s actions throughout the process of Happy Heart’s closure, we do not want to see the DD Board fail in its mission to serve this population.

The biggest issue is one the DD Board itself identified in a meeting late last month with the Star Beacon editorial board — it is inexorably linked to Happy Hearts and AshCraft. Except, because of changes to state and federal regulations over the years, that is not a state mandate or even a service the DD Board should be responsible for — though no one, including the DD Board, wanted to recognize it until forced.

Instead, by 2019, the DD Board will run neither the school nor the sheltered workshop, but it will still have an important role in the lives of more than 500 individuals who receive DD services — outside of those who work at AshCraft and the 70 students enrolled in Happy Hearts. In order to continue operating, the DD Board has to divest itself of services it is not state-mandated to offer. In fairness, educating the DD population has always been the school districts responsibility, but they have always had Happy Hearts — and the public support of it — to take the pressure off.

Going forward, the biggest responsibility the DD Board has is providing services — and funding — for those individuals with disabilities to be able to live and work and function within the community outside of residential care facilities. The bulk of the expenses comes from a 40-percent local match to Medicaid waivers for those who qualify and are living at home rather than those in an institution, where Medicaid covers the full cost — an expense that can range greatly and change at any given time. It’s an important service, and a state-mandated one, but a much harder sell to the community when asking for a levy than children smiling at school or adults hard at work in the sheltered workshop.

Getting the community to see and understand the value of the services it does provide, while at the same time letting go of its desire to control and keep the Happy Hearts brand, is a big challenge facing the DD Board. While negotiations about the future of Happy Hearts have been rocky — and the DD Board is coming from a good place because they want to do right for the children and the adults — in order to face the hurdles the state mandates they clear they will have to let the ESC move along, offering whatever help they can without strings. And the ESC should take that help graciously and with thanks.

We urge both the DD Board and the ESC to find common ground, and we expect the commissioners to step up their role as peace brokers to try to facilitate a deal. But neither side has made it easy. Though we have criticized the DD Board in the past for not offering more in negotiations — an assessment the DD Board disagrees with strongly — there is a clear personality conflict between ESC Superintendent John Rubesich and DD Board Superintendent Anne Zeitler that has added unneeded drama and difficulty to the negotiations. If it has not completely poisoned the well, feelings have been hurt among pointed criticisms on both sides.

For the good of the children that needs to end.

Yesterday.

The adults in the room need to get over it. Everyone wants to provide services to these children, but what those services look like, and who pays and how much, remain unsettled. Both the DD Board and the ESC’s newly formed taxing district will have levies on the November ballot, and while the DD Board’s is a renewal as opposed to new money, it will still be tough sledding for both given the climate. It would go a long way if the two sides could bury the hatchet before voters go to the polls in November. Or, at the very least, put an end to open hostilities so negative attitudes don’t doom our most vulnerable population — who should be put first, before any organization.

In the meantime, it is up to the DD Board to help the community understand its state-mandated mission and responsibility so voters can see beyond the “Happy Hearts and AshCraft” brand. One other thing we hope voters keep in mind is that the state has put these difficult choices on the local entities trying to provide services. In other states, funding flows primarily from the states to DD Boards, rather than flowing from local taxpayers directly creating a situation where a single failed levy can create a spiraling crisis. Those candidates who promise “less government” also mean either less services or a greater local tax burden — and an increase in the hard choices we’re seeing today.

Stalling runoff order short-sighted

Marietta Times

Aug 6, 2018

The Ohio Soil and Water Conservation Commission is supposed to look out for all Ohioans by making sure Ohio’s precious natural resources aren’t squandered. Those resources include, prominently, Lake Erie, a state jewel.

Instead, by hastily shelving Gov. John Kasich’s recent executive order aimed at reducing the farm runoff feeding the lake’s destructive toxic algal blooms, the commission has shown itself beholden to farm interests at the expense of its own mandate and the state’s future.

The commission, which is not scheduled to meet again until Nov. 1, must reverse its short-sighted July 19 stall, supposedly done to study Kasich’s July 11 executive order, and it must do so soon, if necessary, via an emergency meeting.

Kasich’s order also gives the Agriculture Department the power to implement any crackdown, assuring a careful review by an agency tasked generally with keeping Ohio’s multi-billion-dollar agricultural sector thriving and happy.

The commission should move forward, too. It needs to convene soon to confirm Kasich’s distressed watersheds designation.

Hocking College to offer the first medical cannabis tech degree in the nation

Nelsonville, OH – Aug. 8, 2018 – The Ohio Department of Higher Education (ODHE) has approved Hocking College’s request to offer a cannabis laboratory technician major as part of their new Laboratory Sciences Program.

The cannabis laboratory technician is one component of the College’s new Associates Degree in Laboratory Science. The other two components are medical lab technician and chemical lab technician.

The program is the only one in the nation that provides hands-on technical training for those seeking to work in medical cannabis quality assurance labs.

The cannabis laboratory major was established for workforce development, preparing students with sufficient depth and hands-on experience to allow them to become skilled technicians in this emerging area.

Hocking College recently received a provisional license from the State of Ohio to operate a medical cannabis testing lab. According to the program director, Dr. Jonathan Cachat, the lab will provide hands on training for students choosing the medical cannabis laboratory tract.

“What’s really most exciting to me is the new avenue for workforce development,” said Cachet. “This new program will benefit students who have a strong interest in the cannabis industry, but may not have considered themselves eligible for advanced analytical biomedical career paths.

“Hocking College’s unique hands-out, day-in-day-out practical experience with these advanced analytical instruments will certainly set them apart from the more theoretical knowledge programs found in larger four-year institutions,” said Cachet.

The Cannabis Lab technician major is a two-year associates degree program.

The first year covers general education requirements found in the Associates of Science degree program. After successful completion of this first year, students will then be exposed to more technical aspects of operating a cannabis analytic lab, as well as its role without the broader medical cannabis industry. While the intended career path for this workforce development program is specifically toward Cannabis Laboratory Technician positions, but more broadly this program will prepare students for a position in almost any aspect of the newly emerging legal cannabis industry.

The cannabis lab technician program is still awaiting approval from the Higher Learning Commission.

Updates will be posted to the Hocking College website at http://www.hocking.edu/.

About Hocking College

With more than 50 associate degree programs to choose from, Hocking College now serves more than 3,000 students. Set in the scenic town of Nelsonville, Ohio, the 2,300-acre institution is rich in history, nature, art and culture. Hocking College also has the Perry Campus located in New Lexington, Ohio and the Logan Campus. In addition to the school’s on-campus residents, who attend Hocking from throughout the United States and around the world, local students commute from all over Southeastern Ohio. As a not-for-profit corporation, Hocking College Foundation is committed to the best practices in governance, accountability, and transparency in all that we do.

News from the City of Westerville

City of Westerville

Introducing Internet Purchase Exchange Zones

Buying, trading and selling items on social media sites has become a popular way for residents to exchange goods.

To maximize the safety of buyers and sellers, the Westerville Division of Police (WPD) has introduced an “Internet Purchase Exchange Zone” program, designating sites for parties agreeing to exchange items.

Approved sites are marked with signage and offer enhanced safety features that may not be available at other public sites, including a staff presence and surveillance (where and when available). WPD officers will not oversee exchanges unless requested due to safety concerns or conflict.

Mosquito Treatment Scheduled for North Area

Spraying to reduce adult mosquito populations in the northern portion of the City will begin at 9 p.m. tonight. All work is weather permitting.

Did you know that there are more than 60 different species of mosquitoes active in Ohio? Learn more from FCPH.

The City joins Franklin County Public Health (FCPH) in encouraging residents to guard against these pesky insects.

Be aware of and drain areas of standing water that form after heavy rains, like those we experienced this morning. It is in these pools that mosquitoes like to lay eggs.

Read more tips on the City’s website.

Smothers Road Closes At Red Bank, Schott Roads

The Franklin County Engineer’s Office (FCEO) will close Smothers Road at Red Bank and Schott Roads for 60 days beginning Monday, Aug. 13 for road reconstruction and the installation of a single-lane roundabout.

During peak hours, expect increased traffic along Sunbury Road where it intersects with Central College Road and County Line Road. Detour information is available on the GoWesterville Interactive map (under “Projects Around Westerville”).

The City will adjust traffic signals near construction to help ease the flow of vehicles in the area.

This is not a City project. Please direct questions to FCEO.

Updates about Westerville construction and infrastructure projects in one place.

Construction Updates

County Line Road Improvements

Striping will take place along County Line Road, between State Street and Sunbury Road this week. All work is weather permitting. This plane and overlay treatment is being completed as part of the City’s annual Street Maintenance program.

Find more information about this program on the GoWesterville interactive map, just visit www.westerville.org/construction and select the “Street Maintenance Program” tab.

FALL COMMUNITY

RECREATION GUIDE

The Fall Westerville Community Recreation Guide will be mailed to residents next week. The publication includes updates about big initiatives, like the Westerville Community Center Expansion, and, of course, all of the fun fall class offerings.

Now Playing on Westerville TV

Many Westerville families are soaking up the last weeks of summer along the 44 miles of recreational trails that run through City parks, wooded areas, fields, over rivers and roads, as well as along streets and through neighborhoods. The City shows you how to safely navigate the recreational path system on Westerville TV.

Want more? Get behind-the-scenes looks of your favorite City programs and services at www.westerville.org/tv.

AUG. 8, 2018 CHIPOTLE UPDATE

This week, Health District staff identified 624 people who consumed food from the Chipotle on Sawmill Parkway between Thursday July 26 – Monday July 30, 2018 and self-reported gastrointestinal symptoms.

Initial stool testing by the Ohio Department of Health came back negative last week for Salmonella, Shigella, E.coli and Norovirus. Food sample test results are still pending.

The Ohio Department of Health sent stool samples for further testing to the Centers for Disease Control and Prevention.

New information will be released when it becomes available on both the Delaware General Health District Facebook page and Twitter account (@DelawareHealth).

The Conversation

Designed to deceive: How gambling distorts reality and hooks your brain

August 13, 2018

The longer they keep you plugged in to a game, the better it is for the house.

Author

Mike Robinson

Assistant Professor of Psychology, Wesleyan University

Disclosure statement

Mike Robinson has previously received funding from the National Center for Responsible Gaming (NCRG).

Partners

Wesleyan University

Wesleyan University provides funding as a member of The Conversation US.

To call gambling a “game of chance” evokes fun, random luck and a sense of collective engagement. These playful connotations may be part of why almost 80 percent of American adults gamble at some point in their lifetime. When I ask my psychology students why they think people gamble, the most frequent suggestions are for pleasure, money or the thrill.

While these might be reasons why people gamble initially, psychologists don’t definitely know why, for some, gambling stops being an enjoyable diversion and becomes compulsive. What keeps people playing even when it stops being fun? Why stick with games people know are designed for them to lose? Are some people just more unlucky than the rest of us, or simply worse at calculating the odds?

As an addiction researcher for the past 15 years, I look to the brain to understand the hooks that make gambling so compelling. I’ve found that many are intentionally hidden in how the games are designed. And these hooks work on casual casino-goers just as well as they do on problem gamblers.

Uncertainty as its own reward in the brain

One of the hallmarks of gambling is its uncertainty – whether it’s the size of a jackpot or the probability of winning at all. And reward uncertainty plays a crucial role in gambling’s attraction.

Dopamine, the neurotransmitter the brain releases during enjoyable activities such as eating, sex and drugs, is also released during situations where the reward is uncertain. In fact dopamine release increases particularly during the moments leading up to a potential reward. This anticipation effect might explain why dopamine release parallels an individual’s levels of gambling “high” and the severity of his or her gambling addiction. It likely also plays a role in reinforcing the risk-taking behavior seen in gambling.

Studies have shown that the release of dopamine during gambling occurs in brain areas similar to those activated by taking drugs of abuse. In fact, similar to drugs, repeated exposure to gambling and uncertainty produces lasting changes in the human brain. These reward pathways, similar to those seen in individuals suffering from drug addiction, become hypersensitive. Animal studies suggest that these brain changes due to uncertainty can even enhance gamblers’ cravings and desire for addictive drugs.

Repeated exposure to gambling and uncertainty can even change how you respond to losing. Counterintuitively, in individuals with a gambling problem, losing money comes to trigger the rewarding release of dopamine almost to the same degree that winning does. As a result, in problem gamblers, losing sets off the urge to keep playing, rather than the disappointment that might prompt you to walk away, a phenomenon known as chasing losses.

All the bells and whistles work to keep you engaged and playing. Pavel L Photo and Video/Shutterstock.com

Lights and sounds egg you on

But gambling is more than just winning and losing. It can be a whole immersive environment with an array of flashing lights and sounds. This is particularly true in a busy casino, but even a game or gambling app on a smartphone includes plenty of audio and visual frills to capture your attention.

But are they just frills? Studies suggest that these lights and sounds become more attractive and capable of triggering urges to play when they are paired with reward uncertainty. In particular, win-associated cues – such as jingles that vary in length and size as a function of jackpot size – both increase excitement and lead gamblers to overestimate how often they are winning. Crucially, they can also keep you gambling longer and encourage you to play faster.

Feeling like a winner while you’re losing

Since games of chance are set up so the house always has an advantage, a gambler wins infrequently at best. You might only rarely experience the lights and sounds that come along with hitting a true jackpot. However, the gaming industry may have devised a way to overcome that issue.

Over the last few decades, casinos and game manufacturers significantly upgraded slot machines, retiring the old mechanical arms and reels in favor of electronic versions known as electronic gaming machines. These new computerized games and online slots come with more attractive colorful lights and a variety of sounds. They also possess more reels, ushering in a new era of multi-line video slot machines.

Rather than just hoping for three cherries to line up in a horizontal row, players can bet on lining up icons on multiple lines going in a variety of directions. AP Photo/Alex Brandon

Having multiple lines enables players to place a bunch of bets per spin, often up to 20 or more. Although each individual bet can be small, many players place the maximum number of bets on each spin. This strategy means a player can win on some lines while losing on others, netting less than the original wager. Even when you “win,” you don’t come out ahead, a phenomenon known as “losses disguised as wins.” Yet each win, even when it is a loss disguised as a win, comes with the lights and sounds of victory.

The result is that these multi-line slot machines produce more enjoyment and are highly preferred by players. Crucially, they tend to make gamblers overestimate how often they’re truly winning. The dramatic increase in the frequency of wins, whether real or fabricated, produces more arousal and activation of reward pathways in the brain, possibly accelerating the rate at which brain changes occur. Multi-line slots also seem to promote the development of “dark flow,” a trance-like state in which players get wholly absorbed in the game, sometimes for hours on end.

Almost: Near-miss effect and chasing your losses

The rise of electronic gambling machines also means that rather than being constrained by the physical arrangement of different possible outcomes on each reel, possible outcomes are programmed onto a set of virtual reels. Gaming designers can therefore stack the deck to make certain events occur more frequently than others.

This includes near-misses, where one of the reels stops just short of lining up for a jackpot. These near-miss almost-wins recruit areas of the brain that usually respond to wins, and increase one’s desire to play more, especially in problem gamblers.

The same hooks that work in casinos work in smartphone apps. Alexandru Nika/Shutterstock.com

This phenomenon is not confined to slot machines and casinos. Near-misses play an integral part in the addictive potential of smartphone games like the very popular “Candy Crush.”

Near-misses are more arousing than losses – despite being more frustrating and significantly less pleasant than missing by a longshot. But crucially, almost winning triggers a more substantial urge to play than even winning itself. Near-misses seem to be highly motivating and increase player commitment to a game, resulting in individuals playing longer than they intended. The size of the dopamine response to a near-miss in fact correlates with the severity of an individual’s gambling addiction.

Gambling and its games

When you engage in recreational gambling, you are not simply playing against the odds, but also battling an enemy trained in the art of deceit and subterfuge. Games of chance have a vested interest in hooking players for longer and letting them eventually walk away with the impression they did better than chance, fostering a false impression of skill.

For many people, these carefully designed outcomes enhance the satisfaction they get from gambling. It may remain easy for them to simply walk away when the chips run out.

Casinos aim to hook players – and sometimes their strategies work all too well. Alexander Kirch/Shutterstock.com

But gambling isn’t only a lighthearted promise of a good time and a possible jackpot. Up to 2 percent of the U.S. population are problem gamblers, suffering from what’s recently been reclassified as gambling disorder.

It stands out as one of the few addictions that doesn’t involve consumption of a substance, such as a drug. Like other forms of addiction, gambling disorder is a solitary and isolating experience. It’s tied to growing anxiety, and problem gamblers are at greater risk of suicide.

For these more susceptible individuals, the game designers’ hooks start to seem more sinister. A solution to life’s problems always feels just one spin away.

The Conversation US, Inc.

The Conversation

Obesity and diabetes: 2 reasons why we should be worried about the plastics that surround us

August 13, 2018

Authors

Bruce Blumberg

Professor, Developmental & Cell Biology , University of California, Irvine

Raquel Chamorro-Garcia

Associate Specialist, University of California, Irvine

Disclosure statement

Bruce Blumberg receives funding from the United States National Institutes of Health and has previously received funding from the Swedish Environmental Agency FORMAS. He is the holder of US patents related to PPAR-gamma and other nuclear receptors which have been licensed to for-profit entities.

Raquel Chamorro-Garcia does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Partners

University of California

University of California provides funding as a founding partner of The Conversation US.

Email

Today, nearly 40 percent of U.S. adults and 21 percent of youth are obese. This trend is on the upswing and the worldwide population is becoming more obese – which is increasing the risk of other conditions like Type 2 diabetes and cardiovascular disease whose prevalence has doubled globally in the last 30 years. But you may be surprised to learn that it’s not just food that is making us fat.

Experiments using animal models have shown that exposure to chemicals used in industry and found in plastics, preservatives, pesticides and flame retardants, just to name a few, may be important contributors to the growing number of metabolic disorders – including obesity.

One of the research goals in my lab is to identify environmental chemicals that may contribute to these increased rates of metabolic diseases and to decipher the mechanisms through which they act. This line of work began with the unexpected discovery that a chemical (tributyltin, or TBT) we were studying for other reasons could activate a hormone receptor linked to the development of fat. We went on to show that TBT could make mice exposed during prenatal life fatter and that this trait could be transmitted to future generations.

Our recent study reveals that dibutyltin, a chemical used in the manufacture of a type of plastic called polyvinyl chloride, or PVC, alters glucose metabolism and increases fat storage in mice.

Obesity and Type 2 diabetes

In healthy individuals, the pancreas secretes a hormone called insulin into the bloodstream after a meal when the blood sugar levels rise. Insulin stimulates tissues, such as muscle, fat cells and the brain to absorb glucose from the blood and store it as fat. If the pancreas secretes insulin but tissues are not able to detect it, glucose levels remain unchanged leading to “insulin resistance.”

As an individual becomes overweight, there is an increase in free fatty acids in the blood stream which may contribute to reduced insulin sensitivity in the tissues, leading to increased glucose levels in blood. At early stages, when sugar levels are higher than normal, but not too high, the individual is considered prediabetic. At that stage, prediabetics can make lifestyle changes – lose weight and exercise more – to lower their glucose levels and reduce the risk to develop diabetes.

However, there is evidence in rodents showing that exposure to certain environmental chemicals hampers fat mobilization during periods of fasting and when animals are exposed to a low-fat diet, suggesting that losing weight may be tougher than curbing calories.

Chemicals in plastics associated with obesity

The most common explanation for obesity is overeating calorie-rich foods and sedentary lifestyle. However, in the last 10 years, a subset of endocrine-disrupting chemicals (EDCs) called obesogens has been shown to cause obesity in animals and were associated with more fat mass in humans. EDCs are chemicals from outside of the body that interfere with the action of natural hormones present in living organisms. Hormones are secreted by the endocrine glands, such as the pancreas and thyroid, which regulate critical biological functions in the body including reproduction and glucose metabolism. Therefore, altering hormone levels or action can contribute to disease.

Obesogens act by inappropriately stimulating fat storage in the organism by altering fat tissue biology, energy balance and/or the regulation of metabolic needs.

Dibutyltin (DBT) salts are used in the manufacture of PVC (vinyl) plastics that are extensively utilized in many applications including construction materials (e.g., window frames and vinyl flooring), and medical devices (e.g., tubing and packaging). DBT has been found in seafood and house dust, suggesting that DBT exposure may be widespread. However, there is little information available about DBT levels in humans.

Exposure to DBT in mice

We used cells in culture to show that DBT activated two proteins that promote fat cell precursors to become mature fat cells, leading to more fat cells and increased fat in each. Therefore, chemicals that activate these receptors promote the development of fat tissue, making them obesogens.

In our study, cells exposed to concentrations of DBT that are in the realm of what humans are predicted to be exposed to showed increased fat storage, as seen under the microscope, as well as increased activity of genes involved in fat tissue development.

Additionally, we gave DBT to pregnant mice via their drinking water and extended the exposure through lactation. Male offspring, which were exposed during development in the womb and through maternal breast milk, accumulated more fat when their diet was changed from a low-fat to a slightly higher fat diet than did unexposed animals. This indicates that DBT exposure during development and early in life predisposed these DBT exposed animals to become obese. Interestingly, we did not find this response to diet in females.

In these mice we noted that insulin production in the pancreas was altered.

Interestingly, they also had increased higher levels of leptin, a hormone secreted by the fat tissue involved in the regulation of appetite and blood glucose levels. Higher fasting glucose levels were found in both genders, but only males showed increased leptin levels and glucose intolerance. The results of our study indicate early exposure to obesogen DBT and increased dietary fat induces prediabetes in male mice.

Since the sources of human exposure to obesogens are numerous, monitoring obesogen levels, including DBT, in human tissues will help understand and prevent the increasing rates of metabolic disorders such as obesity and T2D in human populations. Reducing the use of plastics that contain obesogens will not only improve our health but will be good for the environment as well, considering the huge plastic garbage patches in the world’s oceans.

The Conversation US, Inc.

How pharmacists can help solve medication errors

August 9, 2018

Patients are often overwhelmed by medications, especially when they leave the hospital.

Author

B. Joseph Guglielmo

Dean of the School of Pharmacy, University of California, San Francisco

Disclosure statement

B. Joseph Guglielmo does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

In today’s health care system, no one person – maybe not even you – knows exactly what drugs you’re taking. What’s more, no one health care provider knows how you, the patient, take your medications and at what doses. No single, up-to-date record consistently displays all of this important information.

The lack of an accurate medication list, and the associated lack of centralized and expert management of your full drug regimen, has serious consequences.

A 2016 study at the Johns Hopkins University School of Medicine suggested that medical errors are the third leading cause of death in the United States. Many of these deaths are directly related to errors associated with medications. The Centers for Disease Control and Prevention estimates 1 million visits to emergency rooms each year stem from adverse medication events.

In addition, thousands of people are harmed by suboptimal medication management, or because they don’t take their medications as directed. And millions of health care dollars are wasted each year in the form of duplicated or unneeded drugs and medication-related hospital readmissions.

As dean of the UCSF School of Pharmacy, a school defined by science, as well as a researcher who has strived to improve the effectiveness and safety of medications, I think the key to solving these problems is to expand the role of pharmacists. My position on this point is based on accumulating evidence.

Investigating the problem

In a 2015-2016 project, UCSF School of Pharmacy pharmacists compared the accuracy of the medication lists of 135 newly discharged patients with the medications the patients actually ended up taking. Not one of these lists completely reflected medication use at home, despite the fact that each patient had been recently discharged from a controlled hospital environment.

Common errors included:

Duplication of therapy (either getting two of the same medication or two drugs in the same class).

Omitted but necessary medications.

Unreported use of herbals or dietary supplements.

In a previous project in 2014, as part of a new transition of care program, patients received an automated phone call 48 hours after leaving the hospital. Any reported issues resulted in an immediate phone call by a nurse and pharmacists addressed any medication issues.

An unpublished study of these post-discharge phone calls by the School of Pharmacy revealed medication issues were common. Forty percent of the pharmacy calls during the study period involved access, such as insurance coverage or transportation to a pharmacy, while 60 percent involved clinical issues, including medication side effects, interactions or medication use instructions.

As a result of these findings, a voluntary program was offered to allow patients to receive their discharge medications at the bedside before going home in a meds-to-beds program. No meds-to-beds patients reported being without their discharge prescriptions at the 48-hour discharge phone call. The School of Pharmacy continues to study the outcomes associated with this program.

In 2016, the UCSF School of Pharmacy initiated another pilot project, teaming with the UCSF School of Dentistry in the Oral Medicine Clinical Center. This clinic manages the most serious mouth diseases, including soft tissue infections and cancers. Many drug treatments are associated with side effects, including bleeding, dry mouth and other systemic adverse events that affect oral health.

Our pharmacy faculty members and pharmacy students mentored and collaborated with their dental colleagues to complete a comprehensive medication review for patients prior to clinic visits. The team, in close collaboration with their patients, created an accurate medication list and placed the list in the patients’ electronic records on the day of the clinic visit.

When their providers took the time to discuss the importance of their medication lists, the patients routinely began bringing these lists to their clinic visits. Similarly, clinic health care providers began taking responsibility for updating patients’ electronic health records with new medications. The success of the experiment is underscored by the fact that the dental school has continued to fund this novel model of care.

The path forward

I am hopeful the results of our pilots suggest a way forward.

As the above examples suggest, pharmacists can increase the efficiency and impact of a whole health care team. Pharmacists have been doing this for years in hospitals, and it’s time for them to do it in the community as well. For patients, that means having a professional consistently reviewing the accuracy of their medication lists and ensuring all drugs are safe and effective.

Pharmacists know how drugs act and interact in the body. They are experts regarding medication choice and side effects. And they understand how to work with insurers on behalf of their patients. Their mission is to ensure the individual patient is receiving the right drugs at the right time, and that the drugs are safe, effective and affordable. They’re also generally adept at determining if the patient is willing and able to take the needed medication. Pharmacists have the credentials and training to perform all these critical tasks. They carry doctoral degrees and, of course, must be licensed to practice.

Some progress has been made in expanding the role of pharmacists to ensure patients are receiving safe, effective medication therapy.

California has started to implement a state bill, SB 493, that enables pharmacists to “furnish” – the law’s language for prescribing – certain medicines, like vaccinations and birth control, and to manage drug regimens for chronic diseases. Washington and other states have enacted similar legislation.

Another California state bill, AB 1535, enables pharmacists to furnish naloxone for opioid overdoses.

A critically important part of the change, the ability for pharmacists to get paid for these services, is still being worked out, first by Medicare and Medicaid reimbursement and then by third-party payors and pharmacies.

Two related national bills with bipartisan support, S. 109 and H.R. 592, could give provider status to pharmacists under Medicare, which would extend the role of pharmacists in primary care, including an associated model for reimbursement.

I believe this is good news for patients and another solution to our shortage of primary care providers, especially in rural areas.

However, the lack of an accurate medication list with expert oversight remains a serious – and sometimes deadly – gap in patient care.

Let pharmacists do their best work

Ensuring an accurate, managed medication list for each patient would require a radical change in the business of health care. The current community pharmacy business model is based upon the volume of drugs dispensed. In a new patient-centered model, pharmacists would be reimbursed for dispensing their advice to patients, just as they are for dispensing drugs. In this model, the pharmacist is a critical member of the patient’s health care team.

A tectonic shift in business models might seem like a lot to ask, but empowering pharmacists with the ability to fully apply their extensive medication knowledge is an obvious next step toward ensuring patients receive the safest, most effective drug therapy.

Couple the power of an accurate medication list with the medication expertise and management of the pharmacist, and I see patient health improving, adverse drug events falling and health care dollars being saved in the process.

For now, it’s your responsibility

For today, the solution is simple, but not ideal: You, the patient, not the health care provider, must take full responsibility for maintaining a personal, accurate list of all your medications, including all of your prescription and over-the-counter drugs, herbals and dietary supplements. And you must carry this list with you at all times and be responsible for sharing it with your provider at each health care visit.

For the future, a much better solution is possible: A medication expert will take full responsibility for reviewing your list with you. This expert will ensure that the medications you’re taking are safe, work for you and are affordable. This expert will consider your personal situation and all your health conditions in relation to the medications and will address any concerns with fellow providers on your health care team.

I believe the pharmacist is the medication expert that’s needed to implement the complete solution. And our evidence suggests that this approach is effective.

The Conversation US, Inc.

Residents and supporters of a homeless encampment along Third St. remove their belongings before Cincinnati officials arrive to clean the area., Friday, Aug. 3, 2018, in Cincinnati. A federal judge refused to block the city cleanup after the advocates sued to stop it. They called an order to vacate "a bullying tactic" that violates constitutional rights of the homeless. (AP Photo/John Minchillo)
https://www.sunburynews.com/wp-content/uploads/sites/48/2018/08/web1_121080810-af0a1efc341743d3a8acc2f93a8fb560.jpgResidents and supporters of a homeless encampment along Third St. remove their belongings before Cincinnati officials arrive to clean the area., Friday, Aug. 3, 2018, in Cincinnati. A federal judge refused to block the city cleanup after the advocates sued to stop it. They called an order to vacate "a bullying tactic" that violates constitutional rights of the homeless. (AP Photo/John Minchillo)

Residents and supporters of a homeless encampment along Third St. remove their belongings before Cincinnati officials arrive to clean the area., Friday, Aug. 3, 2018, in Cincinnati. A federal judge refused to block the city cleanup after the advocates sued to stop it. They called an order to vacate "a bullying tactic" that violates constitutional rights of the homeless. (AP Photo/John Minchillo)
https://www.sunburynews.com/wp-content/uploads/sites/48/2018/08/web1_121080810-fd7ad9801161424ab1370b2b3d1050c4.jpgResidents and supporters of a homeless encampment along Third St. remove their belongings before Cincinnati officials arrive to clean the area., Friday, Aug. 3, 2018, in Cincinnati. A federal judge refused to block the city cleanup after the advocates sued to stop it. They called an order to vacate "a bullying tactic" that violates constitutional rights of the homeless. (AP Photo/John Minchillo)

Residents and supporters of a homeless encampment along Third St. remove their belongings before Cincinnati officials arrive to clean the area., Friday, Aug. 3, 2018, in Cincinnati. A federal judge refused to block the city cleanup after the advocates sued to stop it. They called an order to vacate "a bullying tactic" that violates constitutional rights of the homeless. (AP Photo/John Minchillo)
https://www.sunburynews.com/wp-content/uploads/sites/48/2018/08/web1_121080810-b84f8287c6c04f87a73d39e9a4ed9702.jpgResidents and supporters of a homeless encampment along Third St. remove their belongings before Cincinnati officials arrive to clean the area., Friday, Aug. 3, 2018, in Cincinnati. A federal judge refused to block the city cleanup after the advocates sued to stop it. They called an order to vacate "a bullying tactic" that violates constitutional rights of the homeless. (AP Photo/John Minchillo)

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