Day: July 28, 2024

Washington — New blood tests could help doctors diagnose Alzheimer’s disease faster and more accurately, researchers reported Sunday – but some appear to work far better than others.

It’s tricky to tell if memory problems are caused by Alzheimer’s. That requires confirming one of the disease’s hallmark signs — buildup of a sticky protein called beta-amyloid — with a hard-to-get brain scan or uncomfortable spinal tap. Many patients instead are diagnosed based on symptoms and cognitive exams.

Labs have begun offering a variety of tests that can detect certain signs of Alzheimer’s in blood. Scientists are excited by their potential, but the tests aren’t widely used yet because there’s little data to guide doctors about which kind to order and when. The U.S. Food and Drug Administration hasn’t formally approved any of them and there’s little insurance coverage.

“What tests can we trust?” asked Dr. Suzanne Schindler, a neurologist at Washington University in St. Louis who’s part of a research project examining that. While some are very accurate, “other tests are not much better than a flip of a coin.”

Demand for earlier Alzheimer’s diagnosis is increasing

More than 6 million people in the United States and millions more around the world  

have Alzheimer’s, the most common form of dementia. Its telltale “biomarkers” are brain-clogging amyloid plaques and abnormal tau protein that leads to neuron-killing tangles.

New drugs, Leqembi and Kisunla, can modestly slow worsening symptoms by removing gunky amyloid from the brain. But they only work in the earliest stages of Alzheimer’s and proving patients qualify in time can be difficult. Measuring amyloid in spinal fluid is invasive. A special PET scan to spot plaques is costly and getting an appointment can take months.

Even specialists can struggle to tell if Alzheimer’s or something else is to blame for a patient’s symptoms.

“I have patients not infrequently who I am convinced have Alzheimer’s disease and I do testing and it’s negative,” Schindler said.

New study suggests blood tests for Alzheimer’s can be simpler, faster

Blood tests so far have been used mostly in carefully controlled research settings. But a new study of about 1,200 patients in Sweden shows they also can work in the real-world bustle of doctors’ offices — especially primary care doctors who see far more people with memory problems than specialists but have fewer tools to evaluate them.

In the study, patients who visited either a primary care doctor or a specialist for memory complaints got an initial diagnosis using traditional exams, gave blood for testing and were sent for a confirmatory spinal tap or brain scan.

Blood testing was far more accurate, Lund University researchers reported Sunday at the Alzheimer’s Association International Conference in Philadelphia. The primary care doctors’ initial diagnosis was 61% accurate and the specialists’ 73% — but the blood test was 91% accurate, according to the findings, which also were published in the Journal of the American Medical Association.

Which blood tests for Alzheimer’s work best?

There’s almost “a wild West” in the variety being offered, said Dr. John Hsiao of the National Institute on Aging. They measure different biomarkers, in different ways.

Doctors and researchers should only use blood tests proven to have a greater than 90% accuracy rate, said Alzheimer’s Association chief science officer Maria Carrillo.

Today’s tests most likely to meet that benchmark measure what’s called p-tau217, Carrillo and Hsiao agreed. Schindler helped lead an unusual direct comparison of several kinds of blood tests, funded by the Foundation for the National Institutes of Health, that came to the same conclusion.

That type of test measures a form of tau that correlates with how much plaque buildup someone has, Schindler explained. A high level signals a strong likelihood the person has Alzheimer’s while a low level indicates that’s probably not the cause of memory loss.

Several companies are developing p-tau217 tests including ALZpath Inc., Roche, Eli Lilly and C2N Diagnostics, which supplied the version used in the Swedish study.

Who should use blood tests for Alzheimer’s?

Only doctors can order them from labs. The Alzheimer’s Association is working on guidelines and several companies plan to seek FDA approval, which would clarify proper use.

For now, Carrillo said doctors should use blood testing only in people with memory problems, after checking the accuracy of the type they order.

Especially for primary care physicians, “it really has great potential to help them in sorting out who to give a reassuring message and who to send on to memory specialists,” said Dr. Sebastian Palmqvist of Lund University, who led the Swedish study with Lund’s Dr. Oskar Hansson.

The tests aren’t yet for people who don’t have symptoms but worry about Alzheimer’s in the family — unless it’s part of enrollment in research studies, Schindler stressed.

That’s partly because amyloid buildup can begin two decades before the first sign of memory problems, and so far, there are no preventive steps other than basic advice to eat healthy, exercise and get enough sleep. But there are studies underway testing possible therapies for people at high risk of Alzheimer’s, and some include blood testing.
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LOS ANGELES — Billions of dollars have been spent on efforts to get homeless people off the streets in California, but outdated computer systems with error-filled data are all too often unable to provide even basic information like where a shelter bed is open on any given night, inefficiencies that can lead to dire consequences.

The problem is especially acute in Los Angeles, where more than 45,000 people — many suffering from serious mental illness, substance addictions or both — live in litter-strewn encampments that have spread into virtually every neighborhood, and where rows of rusting RVs line entire blocks.

Even in the state that is home to Silicon Valley, technology has not kept up with the long-running crisis. In an age when anyone can book a hotel room or rent a car with a few strokes on a mobile phone, no system exists that provides a comprehensive listing of available shelter beds in Los Angeles County, home to more than 1 in 5 unhoused people in the U.S.

Mark Goldin, chief technology officer for Better Angels United, a nonprofit group, described L.A.’s technology as “systems that don’t talk to one another, lack of accurate data, nobody on the same page about what’s real and isn’t real.”

The systems can’t answer “exactly how many people are out there at any given time. Where are they?” he said.

The ramifications for people living on the streets could mean whether someone sleeps another night outside or not, a distinction that can be life-threatening.

“They are not getting the services to the people at the time that those people either need the service, or are mentally ready to accept the services,” said Adam Miller, a tech entrepreneur and CEO of Better Angels.

The problems were evident at a filthy encampment in the city’s Silver Lake neighborhood, where Sara Reyes, executive director of SELAH Neighborhood Homeless Coalition, led volunteers distributing water, socks and food to homeless people, including one who appeared unconscious.

She gave out postcards with the address of a nearby church where the coalition provides hot food and services. A small dog bolted out of a tent, frantically barking, while a disheveled man wearing a jacket on a blistering hot day shuffled by a stained mattress.

At the end of the visit Reyes began typing notes into her mobile phone, which would later be retyped into a coalition spreadsheet and eventually copied again into a federal database.

“Anytime you move it from one medium to another, you can have data loss. We know we are not always getting the full picture,” Reyes said. The “victims are the people the system is supposed to serve.”

The technology has sputtered while the homeless population has soared. Some ask how can you combat a problem without reliable data to know what the scope is? An annual tally of homeless people in the city recently found a slight decline in the population, but some experts question the accuracy of the data, and tents and encampments can be seen just about everywhere.

Los Angeles Mayor Karen Bass has pinpointed shortcomings with technology as among the obstacles she faces in homelessness programs and has described the city’s efforts to slow the crisis as “building the plane while flying it.”

She said earlier this year that three to five homeless people die every day on the streets of L.A.

On Thursday, Gov. Gavin Newsom ordered state agencies to start removing homeless encampments on state land in his boldest action yet following a Supreme Court ruling allowing cities to enforce bans on sleeping outside in public spaces.

There is currently no uniform practice for caseworkers to collect and enter information into databases on the homeless people they interview, including notes taken on paper. The result: Information can be lost or recorded incorrectly, and it becomes quickly outdated with the lag time between interviews and when it’s entered into a database. 

The main federal data system, known as the Homeless Management Information System, or HMIS, was designed as a desktop application, making it difficult to operate on a mobile phone.

“One of the reasons the data is so bad is because what the case managers do by necessity is they take notes, either on their phones or on scrap pieces of paper or they just try to remember it, and they don’t typically input it until they get back to their desk” hours, days, a week or even longer afterward, Miller said.

Every organization that coordinates services for homeless people uses an HMIS program to comply with data collection and reporting standards mandated by the U.S. Department of Housing and Urban Development. But the systems are not all compatible.

Sam Matonik, associate director of data at L.A.-based People Assisting the Homeless, a major service provider, said his organization is among those that must reenter data because Los Angeles County uses a proprietary data system that does not talk to the HMIS system.  

“Once you’re manually double-entering things, it opens the door for all sorts of errors,” Matonik said. “Small numerical errors are the difference between somebody having shelter and not.”

Bevin Kuhn, acting deputy chief of analytics for the Los Angeles Homeless Services Authority, the agency that coordinates homeless housing and services in Los Angeles County, said work is underway to create a database of 23,000 beds by the end of the year as part of technology upgrades.

For case managers, “just seeing … the general bed availability is challenging,” Kuhn said.

Among other changes is a reboot of the HMIS system to make it more compatible with mobile apps and developing a way to measure if timely data is being entered by case workers, Kuhn said.

It’s not uncommon for a field worker to encounter a homeless person in crisis who needs immediate attention, which can create delays in collecting data. Los Angeles Homeless Services Authority aims for data to be entered in the system within 72 hours, but that benchmark is not always met.

In hopes of filling the void, Better Angels assembled a team experienced in building large-scale software applications. They are constructing a mobile-friendly prototype for outreach workers — to be donated to participating groups in Los Angeles County — that will be followed by systems for shelter operators and a comprehensive shelter bed database.

Since homeless people are transient and difficult to locate for follow-up services, one feature would create a map of places where an individual had been encountered, allowing case managers to narrow the search.

Services are often available, but the problem is linking them with a homeless person in real time. So, a data profile would show services the individual received in the past, medical issues and make it easy to contact health workers, if needed.

As a secondary benefit — if enough agencies and providers agree to participate — the software could produce analytical information and data visualizations, spotlighting where homeless people are moving around the county, or concentrations of where homeless people have gathered.

One key goal for the prototypes: ease of use even for workers with scant digital literacy. Information entered into the app would be immediately unloaded to the database, eliminating the need for redundant reentries while keeping information up to date.

Time is often critical. Once a shelter bed is located, there is a 48-hour window for the spot to be claimed, which Reyes says happens only about half the time. The technology is so inadequate, the coalition sometimes doesn’t learn a spot is open until it has expired.

She has been impressed with the speed of the Better Angels app, which is in testing, and believes it would cut down on the number of people who miss the housing window, as well as create more reliability for people trying to obtain services.

“I’m hoping Better Angels helps us put the human back into this whole situation,” Reyes said.  
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KENITRA, Morocco — Golden fields of wheat no longer produce the bounty they once did in Morocco. A six-year drought has imperiled the country’s entire agriculture sector, including farmers who grow cereals and grains used to feed humans and livestock.

The North African nation projects this year’s harvest will be smaller than last year in both volume and acreage, putting farmers out of work and requiring more imports and government subsidies to prevent the price of staples like flour from rising for everyday consumers.

“In the past, we used to have a bounty — a lot of wheat. But during the last seven or eight years, the harvest has been very low because of the drought,” said Al Housni Belhoussni, a small-scale farmer who has long tilled fields outside of the city of Kenitra.

Belhoussni’s plight is familiar to grain farmers throughout the world confronting a hotter and drier future. Climate change is imperiling the food supply and, in regions like North Africa, shrinking the annual yields of cereals that dominate diets around the world — wheat, rice, maize and barley.

The region is one of the most vulnerable in the world to climate change. Delays to annual rains and inconsistent weather patterns have pushed the growing season later in the year and made planning difficult for farmers.

In Morocco, where cereals account for most of the farmed land and agriculture employs the majority of workers in rural regions, the drought is wreaking havoc and touching off major changes that will transform the makeup of the economy. It has forced some to leave their fields fallow. It has also made the areas they do elect to cultivate less productive, producing far fewer sacks of wheat to sell than they once did.

In response, the government has announced restrictions on water use in urban areas — including on public baths and car washes — and in rural ones, where water going to farms has been rationed.

“The late rains during the autumn season affected the agriculture campaign. This year, only the spring rains, especially during the month of March, managed to rescue the crops,” said Abdelkrim Naaman, the chairman of Nalsya. The organization has advised farmers on seeding, irrigation and drought mitigation as less rain falls and less water flows through Morocco’s rivers.

The Agriculture Ministry estimates that this year’s wheat harvest will yield roughly 3.1 billion kilograms, far less than last year’s 5.5 billion kilograms — a yield that was still considered low. The amount of land seeded has dramatically shrunk as well, from 36,700 square kilometers to 9,540 square miles 24,700 square kilometers.

Such a drop constitutes a crisis, said Driss Aissaoui, an analyst and former member of the Moroccan Ministry for Agriculture.

“When we say crisis, this means that you have to import more,” he said. “We are in a country where drought has become a structural issue.”

Leaning more on imports means the government will have to continue subsidizing prices to ensure households and livestock farmers can afford dietary staples for their families and flocks, said Rachid Benali, the chairman of the farming lobby COMADER.

The country imported nearly 2.5 million tons of common wheat between January and June. However, such a solution may have an expiration date, particularly because Morocco’s primary source of wheat, France, is facing shrinking harvests as well.

The United Nations’ Food and Agriculture Organization ranked Morocco as the world’s sixth-largest wheat importer this year, between Turkey and Bangladesh, which both have much bigger populations.

“Morocco has known droughts like this and in some cases known droughts that las longer than 10 years. But the problem, this time especially, is climate change,” Benali said.
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sydney, australia — The world’s largest platypus conservation center has welcomed its first residents as part of a project to protect the semi-aquatic mammal found only in Australia amid threats to its habitat from extreme weather and humans. 

The four platypuses — two females and two males — were released over the last two weeks into a custom-built research facility at Taronga Western Plains Zoo in Dubbo, about 400 kilometers (250 miles), northwest of Sydney.  

Featuring multi-tiered streams, waterfalls, pools and earth banks for burrowing, the facility will help researchers understand more about the species, Taronga Conservation Society Australia official Phoebe Meagher told Reuters. 

“This facility will allow us to not only save the species from the immediate threats of climate change, but also in the long term, be able to repopulate those populations,” she said. 

“We would love to see some puggles or baby platypus in the facility and understand what led to that reproductive success.” 

The facility was formed as a partnership between the Taronga Conservation Society Australia, San Diego Zoo Wildlife Alliance, the University of New South Wales, the New South Wales state government and wildlife rescue organization WIRES. 

Boasting the bill of a duck, webbed feet and a beaver-like tail, the platypus is unique to Australia. The nocturnal mammals lay eggs and live mostly across the eastern seaboard, from the far north of Queensland to the island state of Tasmania, close to rivers and streams whose beds and banks they forage for food. 

Platypus numbers may have more than halved over several decades, research models show, but figures are hard to pinpoint. Environment groups estimate the total population between 30,000 and 300,000. 

“Sadly, we’re not leaving many places left in the wild for platypus,” Meagher said. “So these platypus that we have here … will really fill those knowledge gaps and allow us to help save this species.”  
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