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1 Rassegna Stampa Internazionale del 09 Gennaio 2017 UNIVERSITY OF BASEL 06/01/2017 Autoimmunity and Infections When the Body Fights Itself Basel-based doctors are on the trail of a possible connection between autoimmune diseases and infections: errors can occur when immune cells absorb certain proteins from pathogen cells. These findings were reported in the journal PNAS by researchers from the Department of Biomedicine at the University of Basel and University Hospital Basel, as well as colleagues in the USA. It is already known that there is a connection between infections and autoimmunity the inability of an organism to recognize parts of its own body as "self". As a result, increasing hygiene is leading to a higher incidence of autoimmune diseases in the population. It is also apparent that some autoimmune diseases are triggered by infections. However, the mechanism behind these connections is still not fully understood. One possible explanation is that the immune system confuses protein structures from pathogens with the body's own proteins because they look structurally alike. Errors in protein uptake Together with colleagues from the Whitehead Institute in Cambridge (USA), the Basel-based team of researchers tested out a new hypothesis in experiments to investigate the special ability of immune cells to identify specific proteins on the surface of neighboring cells and capture them from the cell membrane. In certain cases, errors can occur in the uptake of these proteins, as the group led by Professor Tobias Derfuss has now demonstrated. Their assumption is that certain immune cells, so-called B cells, capture not only the protein of an influenza virus for which they were specialized but also small quantities of other neighboring membrane proteins. One example of this is a protein known as an autoantigen that originates from the cell membrane layer in the central nervous system. An immune response to this membrane protein results in an autoimmune inflammation in the brain in the animal model and may well also contribute to inflammation of this kind in humans. Harmful immune cells B cells cultivated with cells that had incorporated both the influenza virus protein and the membrane protein were not only able to activate other immune cells, specifically certain T cells, in order to combat the virus; they also activated T cells that had recognized the body's own membrane protein which can trigger autoimmune inflammation in the brain. Consequently, a viral infection could lead to the activation of autoaggressive T cells through an error in the protein uptake of B cells. The researchers discovered this mechanism after conducting experiments using cells from genetically modified mice. "The next step would now be to examine whether similar errors occur in protein uptake by human B cells. We also want to clarify whether a viral infection in an animal can, under certain circumstances, lead to autoimmune inflammation in the brain," says Derfuss. Corresponding follow-up projects are planned. Original source Nicholas S.R. Sanderson, Maria Zimmermann, Luca Eilinger, Ce'line Osswald, Nicole Schaeren-Wiemers, Raija L.P. Lindberg, Stephanie K. Dougan, Hidde Ploegh, Ludwig Kappos, and Tobias Derfuss Cocapture of cognate and bystander antigens can activate autoreactive B cells PNAS (2017), doi: /pnas

2 INSERM FR 04/01/2017 Les LED pas si inoffensives que a... Les ampoules LED que nous utilisons quotidiennement pourraient-elles tre dangereuses pour la qualite' de notre vision? La question me'rite d' tre pose'e car, chez le rat, certaines de leurs longueurs d'onde s'av rent toxiques pour la re'tine. Un me'canisme qui pourrait favoriser la d g n rescence maculaire lie'e a' l' ge. On sait que la re'tine peut tre endommage'e par la lumi re du soleil, mais on manque de donn es sur les le'sions que la lumi re artificielle peut lui porter. C'est notamment le cas concernant la lumi re e'mise par les ampoules LED qui ont de'sormais remplac les ampoules a' incandescence. Pour combler ce de'ficit, une quipe Inserm* s'est inte'ress e a' l'impact phototoxique des rayons mis par ces dispositifs. Les chercheurs ont proce'de' en trois temps : Ils ont d'abord montre' que, quel que soit le type d'ampoules utilise', l'exposition a' une forte intensit lumineuse (6000 lux) durant 24 heures alt re la re'tine de rats dont la pupille a e't dilat e. L'analyse biologique montre dans tous les cas un e'tat inflammatoire qui favorise la mort cellulaire (apoptose) des photore'cepteurs impliqu s dans la vision. En revanche, en exposant durant 24 heures ces m mes animaux a' une intensite' lumineuse similaire a' celle habituellement utilise'e dans les habitations (500 lux), seules les LED sont apparues ne'fastes : avec ces ampoules, la re'tine des animaux montre des signes d'alte'ration moindres mais similaires a' ceux observe's sous forte exposition. Ceci n'est pas observe' avec les autres types d'ampoules. Alicia Torriglia, qui a encadre' ces travaux avec le Professeur Behar-Cohen, pre'cise : "Le recours a' des rats dont la pupille a e't dilat e permet d'amplifier les cons quences potentielles de la lumi re, puisque la contraction de la pupille est un me'canisme physiologique de protection de l' il contre l'agression lumineuse". Il n'en reste pas moins qu'en l'absence de dilatation de la pupille, des rats albinos expose's a' long terme a' la lumi re des LED (en continu durant une semaine ou un mois) montrent aussi une de'ge'ne'rescence re'tinienne. Et m me les rats non albinos, re'put s pour tre prot g s de la de'g n rescence photo-induite, pr sentent des signes de stress oxydant au niveau de leurs re'tines. Les cellules r tiniennes meurent en endommageant leurs voisines Derri re la phototoxicite' des ampoules LED, une coupable : la lumi re bleue. "La lumi re blanche, qu'elle soit naturelle ou artificielle, combine en re'alite' des rayons de diffe'rentes couleurs, chacune correspondant a' une longueur d'onde spe'cifique" explique la chercheuse. Chaque source de lumi re - LED, tubes a' fluorescence ou ampoules fluocompactes - combine diffe'rentes couleurs dans des proportions variables. Et la potentielle toxicite' de chacune d'entre elles sur la re'tine de'pend a' la fois de l'intensit de la lumi re et des longueurs d'onde qui la compose. "En 2005, la Commission europe'enne a impose' l'abandon des ampoules a' incandescence, e'nergivores, et leur remplacement par des ampoules LED, plus e'conomes". Ces derni res cr ent de la lumi re blanche en combinant des lumi res bleue et jaune. Or, les rayons correspondant a' la lumi re bleue sont plus e'nerge'tiques que les autres. Ils sont aussi connus pour tre plus de'l t res pour des dure'es d'exposition et des intensit s lumineuses e'quivalentes. "Gr ce a' nos observations, nous avons montr que

3 la lumi re e'mise par les LED engendre deux ph nom nes toxiques parall les : l'apoptose, mais e'galement une seconde forme de mort cellulaire, la ne'crose. Or en se n crosant, une cellule endommage ses voisines. Ceci explique pourquoi la toxicite' de la lumi re bleue est plus e'lev e que celle des autres longueurs d'onde". La question du risque sanitaire lie' a' ces ampoules se pose donc. En 2005, l'agence nationale de se'curit sanitaire de l'alimentation, de l'environnement et du travail (Anses) a recommande' l'e'tude approfondie des risques potentiels li s a' ces nouveaux dispositifs. Elle a publie', en 2010, un premier rapport sur le sujet. M me s'il est probable que les observations faites chez le rat ne sont pas transposables telles qu'elles chez l'homme, les donne'es de cette e'tude interrogent. "Nos cellules poss dent des me'canismes de re'paration qui permettent sans doute de corriger en partie les le'sions induites par les LED. Mais nous avons un capital lumie're, comme notre peau poss de un capital soleil. On peut se demander si nos ampoules domestiques ne favorisent pas son e'puisement pre'coce, et ainsi l' volution vers la de'g n rescence maculaire li e a' l' ge (DMLA)". Par principe de pre'caution, ces donn es appellent a' une prochaine ge'n ration d'ampoules domestiques, dans laquelle la proportion de lumi re bleue serait re'duite U.S. FDA 05/01/2017 Mammography Record Retention: What Should I Keep, and For How Long? The Mammography Quality Standards Act (MQSA) includes provisions related to record retention and transfer. Under MQSA, original mammograms and their reports are considered medical records. A facility must "maintain mammography films and reports in a permanent medical record of the patient for a period of not less than 5 years, or not less than 10 years if no additional mammograms of the patient are performed at the facility, or a longer period if mandated by State or local law" (900.12(c)(4)(i)). This requirement to retain prior exams facilitates the comparison of a patient's more recent exams to her earlier exams, since assessing for stability or change over time can be a very important aspect of mammographic interpretation. Some facilities have expressed confusion concerning the different retention requirements of 5 years and 10 years. Under MQSA, the length of time that a particular mammogram must be retained depends on both the date of that exam and the date (if any) when the patient last returned to the facility. At a minimum, each mammogram must be retained for at least 5 years. If a patient has returned to the facility within those 5 years for one or more subsequent mammograms, only the most recent 5 years' worth of exams must be retained. If a patient has not returned for another mammogram at the facility within 5 years of her most recent exam performed there, the facility cannot know when she might return for another exam (or might request her exams), so her mammograms must be retained for up to 5 additional years (10 years in total) in case she returns or makes such a request. However, remember that States may impose more stringent requirements for medical record retention, and facilities must also comply with any applicable State or local requirements. Also, the MQSA record retention requirement is a baseline standard. For continuity of care, if a patient is returning regularly for subsequent exams, many facilities opt to retain all of that patient's mammograms, not only those exams which are less than 5 years old. It is important to note that there is no

4 difference in the required length of time for retention of digital mammograms compared to screen-film mammograms. Screen-film mammograms should be retained in their original form, neither as copy films nor digitized. The Policy Guidance Help System advises that if a mammogram was originally produced in digital form, such as full-field digital mammography (FFDM) or digital breast tomosynthesis (DBT), it should be retained in a fully retrievable form, either as an uncompressed digital image, or using only lossless (not lossy) data compression, or it may be retained as a hard-copy image of final interpretation quality. (This latter option may not be practical for DBT exams.) Another provision of MQSA addresses the transfer of mammograms. Mammograms may be needed for diagnosis or treatment somewhere other than the facility where the mammograms were performed. Therefore, protecting a patient's access to her mammograms is important to the continuity of patient care. In the era of screen-film mammography, it was especially important to transfer the original mammograms, rather than copies which might be of lesser quality. Therefore, under MQSA regulations, written when screen-film mammography was the mammographic modality in clinical use, a facility must "upon request by, or on behalf of, the patient, permanently or temporarily transfer the original mammograms and copies of the patient's reports to a medical institution, or to a physician or healthcare provider of the patient or to the patient directly" (900.12(c)(4)(ii)). In the current era of digital mammography (FFDM and DBT), the actual transfer of the original digital mammogram is rare. Instead, digital copies of mammograms are usually released, while the facility retains the originals. Since this is a release of copies, the transfer provision of MQSA does not apply. Off-site storage of medical records is permitted under MQSA. There is no requirement that the storage of retained records be within the facility itself, and mammograms and reports do not necessarily need to be stored together at the same location. Whether records are stored on-site or off-site, however, it is important to make contingency plans to prevent the loss of records due to disaster or equipment failure (such as the failure of a Picture Archiving and Communication System or PACS). As discussed in a previous MQSA Insights article, if your PACS fails and images are lost due to preventable reasons, the FDA may take one or more actions against your facility. Remember, there may also be applicable requirements for contingency planning for record retention under the Health Insurance Portability and Accountability Act (HIPAA) and/or State or local laws, and facilities must comply with all applicable requirements. Finally, there are MQSA recommendations for the disposition of medical records (mammograms and reports) if a facility closes or ceases performing mammography. The facility should (a) inform its accreditation body that it will no longer be performing mammography; (b) notify its State radiation control program; (c) arrange transfer of each patient's medical records to the facility where the patient will receive future care, to the patient's referring provider or other provider designated by the patient, or to the patient or her representative; and (d) inform the patient of the arrangements made. Facilities should also check with State or local agencies to determine whether other requirements apply. If transfer of all records is not feasible, facilities may store the remaining records in a hospital, other healthcare facility, or a warehouse, but should assure that there is a mechanism to release records to an appropriate entity when requested, and should make patients aware of that mechanism. Facilities that remain open but have permanently ceased performing mammography may choose to keep patient medical records rather than transfer them to another facility (unless a patient requests such a transfer). Because some facilities have not followed these recommendations, patients have contacted FDA with concerns about where and how to request their records. Therefore, we also request that a closing facility notify us (or its State certifying agency, if applicable) of how it intends to fulfill its obligations with respect to medical records. Access to mammography records is extremely important for

5 patient care, and we hope that this article helps facilities recognize and carry out their responsibilities with respect to mammography medical records. BRITISH FERTILITY SOCIETY 06/01/2017 World leader in reproductive medicine calls for a more holistic view of IVF treatment IVF treatment needs a more holistic and individualised approach, a world leader in fertility and reproductive health will say today at the Fertility 2017 conference in Edinburgh. Fertility 2017 is the 10th joint conference of the UK Fertility Societies: the Association of Clinical Embryologists, the British Fertility Society and the Society for Reproduction & Fertility. Professor Bart Fauser, Professor of Reproductive Medicine, from the University of Utrecht, The Netherlands and Fellow ad eundem of the Royal College of Obstetricians and Gynaecologists (RCOG) will give an overview of ovarian stimulation for infertility treatment over the years and looking to the future. He will say that there are several forms of ovarian stimulation, mainly treatment of infertility due to abnormal ovarian function. IVF success rates have improved over the years with improvements in laboratory performance and techniques used, however, Professor Fauser questions the complex and costly ovarian stimulation regimens requiring many hospital visits and the effects on patients. Professor Fauser will say: "We need to look at IVF more from a holistic perspective. At the end of the day, the outcome most relevant for the couple, is what are the chances for a healthy child per treatment, which may include multiple cycles. And what is the burden of treatment and cost for the families and society." He will also talk about mild ovarian stimulation for IVF and multiple studies confirm its effectiveness, in the context of reduced drug cost and burden of treatment. Moreover he will discuss how individual variability can be observed in ovarian response to stimulation and in recent years biomarkers have been developed predicting this. "This concept should be developed further, but initial observations suggest that such markers can be used to individualise dosing of ovarian stimulation, representing an important step towards improved, patient tailored care in IVF," he will say. Professor Adam Balen, Chair of the British Fertility Society, adds: "Professor Bart Fauser has had a profound influence on modern clinical practice, training and inspiring a generation of researchers and new leaders in the field of reproductive medicine. It is our duty to individualise our management to specifically suit a patient's needs and use the lowest effective dose to stimulate the ovaries during fertility treatments." NATIONAL INSTITUTES OF HEALTH 06/01/2017 Biomarker in blood may help predict recovery time for sports concussions Researchers at the National Institutes of Health found that the blood protein tau could be an important new clinical biomarker to

6 better identify athletes who need more recovery time before safely returning to play after a sports-related concussion. The study, supported by the National Institute of Nursing Research (NINR) with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), published online in the Jan. 6, 2017 issue of Neurology (link is external), the medical journal of the American Academy of Neurology. Despite the millions of sports-related concussions that occur annually in the United States, there is no reliable blood-based test to predict recovery and an athlete's readiness to return to play. The new study shows that measuring tau levels could potentially be an unbiased tool to help prevent athletes from returning to action too soon and risking further neurological injury. "Keeping athletes safer from long-term consequences of concussions is important to players, coaches, parents and fans. In the future, this research may help to develop a reliable and fast clinical lab test that can identify athletes at higher risk for chronic post-concussion symptoms," said NINR Director Patricia A. Grady Ph.D., R.N. Athletes who return to play before full recovery are at high risk for long-term symptoms like headaches, dizziness, and cognitive deficits with subsequent concussions. About half of college athletes see their post-concussive symptoms resolve within 10 days, but in others, the symptoms become chronic. Tau is also connected to development of Alzheimer's and Parkinson's diseases, and is a marker of neuronal injury following severe traumatic brain injuries. In the study, led by Dr. Jessica Gill, NIH Lasker Clinical Research Scholar and chief of the NINR Division of Intramural Research's Brain Injury Unit, researchers evaluated changes in tau following a sports-related concussion in male and female collegiate athletes to determine if higher levels of tau relate to longer recovery durations. "Incorporating objective biomarkers like tau into return-to-play decisions could ultimately reduce the neurological risks related to multiple concussions in athletes," said Gill. To measure tau levels, a group of 632 soccer, football, basketball, hockey, and lacrosse athletes from the University of Rochester first underwent pre-season blood plasma sampling and cognitive testing to establish a baseline. They were then followed during the season for any diagnosis of a concussion, with 43 of them developing concussions during the study. For comparison, a control group of 37 teammate athletes without concussions was also included in the study, as well as a group of 21 healthy non-athletes. Following a sports-related concussion, blood was sampled from both the concussed and control athletes at six hours, 24 hours, 72 hours, and seven days post-concussion. Concussed athletes who needed a longer amount of recovery time before returning to play, (more than 10 days post-concussion) had higher tau concentrations overall at six, 24, and 72-hours post-concussion compared to athletes who were able to return to play in 10 days or less. These observed changes in tau levels occurred in both male and female athletes, as well as across the various sports studied. Together, these findings indicate that changes in tau measured in as short a time as within six hours of a sports-related concussion may provide objective clinical information to better inform athletes, trainers, and team physicians' decision-making about predicted recovery times and safe return to play. E-CANCER NEWS 06/01/2017 Comprehensive study of oesophageal cancer reveals molecular subtypes

7 A comprehensive analysis of 559 oesophagal and gastric cancer samples, collected from patients around the world, suggests the two main types of oesophagal cancer differ markedly in their molecular characteristics and should be considered separate diseases. The study, published today in Nature from The Cancer Genome Atlas (TCGA) Research Network, includes two key takeaways. First, upper oesophagal cancers more closely resemble cancers of the head and neck, while tumours further down in the oesophagus are virtually indistinguishable from a subtype of stomach cancer. Second, cancer clinical trials should group patients according to molecular subtype in general, grouping lower oesophagal tumours with stomach cancers, while evaluating upper oesophagal cancers separately. "These findings add several layers of depth and sophistication to our current understanding of oesophagal cancer genomics," said Adam Bass, M.D., co-leader of TCGA's oesophagal cancer study and physician-scientist at Dana-Farber Cancer Institute. "Our hope is this work settles several long-standing uncertainties in the oesophagal cancer field and will serve as the definitive reference manual for researchers and drug developers seeking more effective clinical trials and new treatment approaches." Physicians have known for decades that oesophagal cancers, when looked at under the microscope, fall into one of two categories adenocarcinomas, which resemble stomach or colorectal cancers, and squamous cell carcinomas, which are similar to some lung, skin, and head and neck cancers. What remained unknown was the extent to which adenocarcinomas and squamous oesophagal cancers differ molecularly and the relationship between oesophagal adenocarcinoma and stomach adenocarcinoma. "We have shown that these clinical subtypes differ profoundly at the molecular level, said Peter W. Laird, Ph.D., a principal investigator in the international TCGA Research Network and a professor at Van Andel Research Institute. "These findings suggest that whether the tumour originates in the oesophagus or the stomach is less relevant than the molecular characteristics of the individual tumours." Oesophagal cancer represents just 1 percent of new cancer diagnoses in the U.S. However, it kills 4-in-5 patients within five years of diagnosis, and current treatment approaches often fail to help. Additionally, cases of oesophagal adenocarcinoma have skyrocketed over the last four decades, increasing seven-fold since the mid-1970s. Within the field, there has been great uncertainty regarding the relationship between this growing burden of oesophagal adenocarcinoma and adenocarcinomas that occur in the stomach. Results from this new report argue against the need to continue to debate the demarcations of oesophagal and gastric adenocarcinoma and instead view gastroesophageal adenocarcinoma as a more singular entity, analogous to colorectal cancer. Specifically, this study revealed that oesophagal adenocarcinomas have striking molecular similarity to a class of stomach cancers called chromosomally unstable tumours, the hallmark of which are significant structural chromosomal aberrations. Oncologists say this nuanced view of the disease, including the detailed molecular taxonomy of oesophagal adenocarcinomas, will likely change their approach to studies and treatment. "It is clear from the TCGA data that oesophagal squamous and oesophagal adenocarcinomas are completely different diseases and should never be included in the same therapeutic trial," said Yelena Y. Janjigian, M.D., a gastrointestinal oncologist from Memorial Sloan Kettering Cancer Center who was not involved in the study. "In oesophagal adenocarcinoma, it is likely a combination of pathways and therapeutic strategies that will be successful. The therapeutic significance of these alterations will be explored in follow-up studies." Members of the TCGA Research Network team say these studies represent the work of dedicated collaborators, who seek to maximise results in search of new ways to battle cancer. "Studies from TCGA transcend the work of any one institution or individual," said Ilya Shmulevich, Ph.D., a principal investigator in the international TCGA Research Network and a professor at the Institute for Systems Biology. "These are massive undertakings that are possible only through contributions

8 from hundreds of specialists and scientists around the world people dedicate years of their lives to these projects in the hope of finding new treatments for people who are very sick." Source: Nature UNIVERSITY OF BRISTOL 06/01/2017 New research describes how bacteria resists last-resort antibiotic An international research team, led by the University of Bristol, has provided the first clues to understand how the mcr-1 gene protects bacteria from colistin a last resort' antibiotic used to treat life-threatening bacterial infections that do not respond to other treatment options. Last year, members of the team, led by Dr Jim Spencer from the School of Cellular and Molecular Medicine, in collaboration with colleagues from Oxford, Cardiff, Diamond Light Source, Thailand and China, identified mcr-1 as the first colistin-resistance gene that could be passed between bacteria, enabling resistance to spread rapidly within a bacterial population. Since then, the mcr-1 gene has been detected in common bacteria, such as E. coli, in China, the United States and across Europe first in farm animals and recently - worryingly - in human patients. The spread of mcr-1 has been linked to agricultural use of colistin, indicating that transmission between animals and humans may take place. In response to these findings the Chinese government has now banned use of colistin in animal feed. Colistin acts by binding to, and disrupting, the outer surface of bacteria. Bacteria carrying the mcr-1 gene make a protein that modifies the bacterial surface to reduce colistin binding, making the organism resistant. In their work the team used X-rays produced at Diamond's crystallography beamlines to generate detailed pictures of the portion of this protein responsible for this modification, and with this information identified key features that are necessary for it to function. They also constructed computer models of the chemical reaction that leads to resistance. This provides the first clues as to how mcr-1 acts within the bacterial cell, as well as information essential to efforts to identify ways of blocking MCR-1 function that could restore the activity of colistin against bacteria carrying mcr-1. This work was funded by the UK Medical Research (MRC), Biotechnology and Biological Sciences (BBSRC) and Engineering and Physical Sciences (EPSRC) Research Councils, the Royal Society of Chemistry and government agencies from China and Thailand. Essential to the study was the involvement of researchers from multiple disciplines, including medical and veterinary microbiologists and organic, inorganic and computational chemists. In particular BristolBridge, an EPSRC-funded research initiative at the University of Bristol that aims to engage researchers in the physical sciences and engineering with the problem of antimicrobial resistance, helped bring to the project expertise in inorganic and computational chemistry which proved invaluable in understanding the experimental results. Professor Adrian Mulholland, co-author of the study and Principal Investigator for the BristolBridge initiative, based in the School of Chemistry, said: "The importance of understanding colistin resistance can hardly be overstated: it is rapidly emerging threat to public health. "Our results illuminate the structural and (for the first time) mechanistic basis of transferable colistin resistance conferred by mcr-1, thanks to the combination of biological, chemical and computational expertise brought to bear on this project. "We are confident that our findings will drive efforts to understand

9 mcr-1-mediated resistance and ultimately help identify routes towards overcoming MCR-1 activity in harmful bacteria." DEPARTMENT OF HEALTH UK 07/01/2017 Children given sports prostheses to help them get active Children across England are being given specialised sports prostheses from the NHS to help them run, swim and play sport, and even become the next Paralympians. This follows the creation of a 1.5 million fund by the Department of Health, announced by Health Secretary Jeremy Hunt during last summer's Paralympic Games in Rio. The money has been split between funding for NHS limb centres to fund requests for prostheses and investment in a Child Prostheses Research Collaboration, bringing the latest technology into the NHS. It will also help more children to benefit from sports prostheses that are tailored to their needs and the sports they want to play. Health Secretary Jeremy Hunt said: Every child should be able to participate in sport. Team GB surpassed everyone's expectations at last year's Paralympics and this investment will ensure the next generation of children who have either been born without a limb or who have lost a limb will be able to lead an active life. It's wonderful that the first children are now receiving their blades and that they will be able to reach their sporting potential I hope some may even be selected in the future as members of Team GB. Ben, 13, from Brighton, has just been fitted for his new running blade and has enjoyed using his new blade to play football and run. Ben's mother, Kate Moore, said: We're really pleased Ben has been fitted with a new running blade. After watching the success of Team GB last year, this blade means Ben can develop his interest in sport and could become part of the next generation of Team GB. We hope more children and young people like Benjamin will be able to benefit too. Funding for the prostheses will be provided through NHS limb centres across the country. Limb centres are able to apply for funding to source the prosthetic limbs from suppliers and fit them. Kiera Roche, Chief Executive of LimbPower, the National Disability Sports Organisation for people with limb impairments, said: The children's prosthetic fund has been welcomed by the amputee community as a really positive step in supporting children to be more confident and socially engaged, providing them with the equipment to participate and immerse themselves fully in school PE and community activities." AMERICAN ACCADEMY OF PEDIATRICS 09/01/2016 Moderate to Vigorous Physical Activity at Ages 6 and 8 Linked to Fewer Symptoms of Depression Two Years Later A Norway study of children whose physical activity was measured at ages 6 and 8 found that those who displayed higher levels of moderate-to-vigorous activity showed fewer symptoms of major depressive disorder two years later. The study, "Physical Activity, Sedentary Behavior, and Symptoms of Major Depression in Middle Childhood," will be published in the February 2017 issue of Pediatrics (online Jan. 9). The study found that sedentary behavior did not predict depression, and, likewise, that

10 depression did not predict later physical activity or sedentary behavior. The researchers analyzed data from 799 children who wore a device around their waist for seven consecutive days that measured their activity. The authors concluded that, although the effect was small, the results suggested that increasing physical activity in children may prevent some symptoms of depression. VDA Net All Rights Reserved