When President Donald Trump took a mental test as part of his physical in January, the results called attention to far more than his fitness for office. (He passed with a perfect score, according to his physician.) It put a test commonly used to catch early signs of dementia in the spotlight. That publicity could lead to missed diagnoses, researchers warn July 16 in JAMA Neurology.

Google searches of the Montreal Cognitive Assessment, a 10-minute screening test consisting of 30 questions, spiked in the week after news coverage of Trump’s physical. Of 190 news articles about his performance identified by the researchers, 53.7 percent included some or all of the test’s questions and answers. And 17 percent encouraged readers to see how their mental abilities stacked up against the president’s.

That might make it more difficult for clinicians to screen patients for early signs of dementia. Taking the test once increases your score the next time you take it, a phenomenon called a learning effect. The study didn’t track how many readers took the memory test. But for those who did, researchers say, the learning effect could artificially inflate some patients’ scores and make it harder for doctors to pick up on the memory symptoms linked to Alzheimer’s and other neurodegenerative diseases.

Most of the news articles quoted questions from one specific version of the test, so the researchers suggest that doctors should administer alternate versions to prevent skewed results.

The northwestern United States has become an air pollution hot spot — literally.

Air quality in states from Nevada to Montana is worse than it was 30 years ago on the days with the most extreme air pollution. Bigger and more frequent wildfires that spew plumes of fine particulate matter into the sky are largely to blame, researchers report July 16 in Proceedings of the National Academy of Sciences.

By contrast, the rest of the country has seen decreasing trends in similar smog and haze over the last three decades. Legislation such as the Clean Air Act, which mandates air quality standards and the regulation of vehicle and factory emissions of particulate matter, is making a difference, says study coauthor Daniel Jaffe, an atmospheric scientist at the University of Washington in Bothell.
But the increase in lung-clogging particulate matter from wildfires shows how the effects of climate change — which is, in part, driving the worsening fires — can counteract those gains, Jaffe says.

Wildfire smoke is filled with fine particulates, minuscule solids or droplets that can be inhaled into the lungs, exacerbating breathing problems. Children, the elderly and people with asthma are most at risk, but communities near wildfires can temporarily experience levels of pollutants so high that it’s unsafe for anyone to be outside for very long. “When we start to think about people’s health, episodic events matter a lot,” says Gannet Hallar, an atmospheric scientist at the University of Utah in Salt Lake City, who wasn’t part of the study.

Regular exposure to elevated levels of these fine airborne pollutants (less than 2.5 micrometers wide, or about 3 percent of the width of a human hair) has also been linked to an increased risk of chronic health conditions such as heart disease and diabetes (SN: 9/30/17, p. 18).
Tracking the broader influence of wildfires on air pollution can be tricky because the fires are intermittent and patchy, says Jaffe, who carried out the study with Crystal McClure, also an atmospheric scientist at the University of Washington in Bothell. “Most of the year, wildfires aren’t impacting air quality, but on some of the worst days they are.” And the blazes can hit one community hard, but leave neighboring towns relatively unaffected.

Jaffe and McClure looked at daily measurements of fine particulate matter at more than 100 rural monitoring sites around the country, from 1988 to 2016. In most parts of the country, the data showed a success story of cleaner air over time — but not in the northwest, an area that gets hit hard by wildfires every summer.
The team made similar calculations for levels of a few specific pollutants — particulate carbon, a hallmark of fire emissions, and sulfate, a by-product of burning fossil fuels. Particulate carbon levels had increased over time in the northwest, but sulfate levels didn’t, supporting the conclusion that wildfires are mainly driving the air pollution trend in the western United States, rather than industrial activity.

Wildfires weren’t making air pollution on an average day worse in the northwest, the team found. Most of the time, air quality is fine — wildfires might only affect a given community for a few days or weeks out of a year. But the air quality on the bad days, when air pollutants are especially high, is getting worse over time, the analysis shows. Those particularly bad days tended to be in the summer, when wildfires are at their peak. In the northwest, levels of fine particulates on the handful of days with the worst air quality each year have increased at an average rate of 0.21 micrograms per cubic meter per year, though there’s substantial local variability in that number.

As the overall air quality picture in the country has improved, we now have harder work to do, says Jenny Hand, an atmospheric scientist at Colorado State University in Fort Collins who wasn’t part of the study. Those challenges include figuring out how to prevent and mitigate these more uncontrollable sources of air pollution that can’t be regulated like emissions from human sources can, she says.

Mouth wounds heal faster than injuries to other parts of the skin, and now scientists are learning how the mouth performs its speedy repairs.

Some master regulators of gene activity work overtime in the mouth to heal wounds without scarring, researchers report July 25 in Science Translational Medicine. Those regulators — proteins known as SOX2, PITX1, PITX2 and PAX9 — are active in skin cells called keratinocytes in the mouth, but not in skin cells from the arm. The regulators hold down inflammation that can lead to scarring and turn on molecular programs involved in cell movement and wound closure, say the researchers, from the University of California, San Diego and the National Institutes of Health in Bethesda, Md.
Knowing how the mouth performs its speed healing may eventually lead to therapies that fix skin sores without forming scars. Because the regulators are involved in many biological processes, including guiding an organism’s development, scientists need to discover which of these processes is important for wound healing, says Luis Garza, a skin researcher and dermatologist at Johns Hopkins School of Medicine. The study may provide some clues.

Researchers made small wounds in both the mouths and the inner upper arms of 30 volunteers. The mouth wounds healed about three times as fast as the wounds made in the arm skin — on average at a rate of about 0.3 millimeters a day in the mouth compared with less than 0.1 millimeter a day on the arm. Reducing amounts of PITX1 and SOX2 in mouth keratinocytes grown in lab dishes altered the activity of genes involved cell movement. Boosting SOX2 levels in the skin of mice shortened healing time — from about nine days to about three.Knowing how the mouth performs its speed healing may eventually lead to therapies that fix skin sores without forming scars. Because the regulators are involved in many biological processes, including guiding an organism’s development, scientists need to discover which of these processes is important for wound healing, says Luis Garza, a skin researcher and dermatologist at Johns Hopkins School of Medicine. The study may provide some clues.

Researchers made small wounds in both the mouths and the inner upper arms of 30 volunteers. The mouth wounds healed about three times as fast as the wounds made in the arm skin — on average at a rate of about 0.3 millimeters a day in the mouth compared with less than 0.1 millimeter a day on the arm. Reducing amounts of PITX1 and SOX2 in mouth keratinocytes grown in lab dishes altered the activity of genes involved cell movement. Boosting SOX2 levels in the skin of mice shortened healing time — from about nine days to about three.
Perhaps it shouldn’t be a surprise that the lining of the mouth and other mucus membranes heal quickly. It may be a product of vertebrates evolving in the ocean, Garza says. “We spent most of our time learning how to repair wounds underwater. So it makes sense that we repair wounds really well on our moist mucosa.”

A single star, careening around the monster black hole in the center of the Milky Way, has provided astronomers with new proof that Albert Einstein was right about gravity.

More than 100 years ago, Einstein’s general theory of relativity revealed that gravity is the result of matter curving the fabric of spacetime (SN: 10/17/15, p. 16). Now, in a paper published July 26 in Astronomy & Astrophysics, a team of researchers reports the observation of a hallmark of general relativity known as gravitational redshift. The measurement is the first time general relativity has been confirmed in the region near a supermassive black hole.
As light escapes a region with a strong gravitational field, its waves get stretched out, making the light redder, in a process known as gravitational redshift. The scientists, a team known as the GRAVITY collaboration, used the Very Large Telescope array, located in the Atacama Desert of Chile, to demonstrate that light from the star was redshifted by just the amount predicted by general relativity.

Scientists have observed gravitational redshift before. In fact, GPS satellites would fail to function properly if gravitational redshift weren’t taken into account. But such effects have never been seen in the vicinity of a black hole. “That’s completely new, and I think that’s what makes it exciting — doing these same experiments not on Earth or in the solar system, but near a black hole,” says physicist Clifford Will of the University of Florida in Gainesville, who was not involved with the new study.

At the Milky Way’s heart there lurks a hulking supermassive black hole, with a mass about 4 million times that of the sun. Many stars swirl around this black hole (SN Online: 1/12/18). The researchers zeroed in on one star, known as S2, which completes an elliptical orbit around the black hole every 16 years.
In May 2018, the star made its closest approach to the black hole, zipping by at 3 percent of the speed of light — extremely fast for a star. At that point, the star was just 20 billion kilometers from the black hole. That may sound far away, but it’s only about four times the distance between the sun and Neptune.
Measuring the effects of general relativity in the black hole’s neighborhood is challenging because the region is jam-packed with stars, says astrophysicist Tuan Do of UCLA, who studies S2, but was not involved with this work. If attempting to observe this region with a run-of-the-mill telescope, “you’ll just see this big blur.”

To obtain precise measurements and pinpoint individual stars in the crowd, the scientists used a technique called adaptive optics (SN Online: 7/18/18), which can counteract the distortions caused by the Earth’s atmosphere, and combined information from four telescopes in the Very Large Telescope’s array. “You can bring the light together from these four telescopes and thereby generate a super telescope … and that does the trick,” says study coauthor Reinhard Genzel, an astrophysicist at the Max Planck Institute for Extraterrestrial Physics in Garching, Germany. Genzel and colleagues have been observing this star for decades, since before its previous swing by the black hole 16 years ago.

In future work, the scientists hope to test other aspects of general relativity, including the theory’s prediction that S2’s orbit should rotate over time. A similar rotation was previously seen in Mercury’s orbit around the sun, which puzzled astronomers until Einstein’s theory explained the effect (SN Online: 4/11/18).

The GRAVITY researchers might find other stars that orbit even closer to the black hole, allowing them to better understand the black hole and further scrutinize general relativity. If that happens, Will says, “they’ll really start to explore this black hole up close and personal, and it’ll be a very cool new set of tests of Einstein’s theory.”

Hobbits took a separate evolutionary path to becoming small than did short, modern-day humans living on the same Indonesian island, a new DNA analysis suggests.

Rampasasa pygmies residing near a cave on Flores that previously yielded small-bodied hobbit fossils inherited DNA from Neandertals and Denisovans but not from any other now-extinct hominid, an international team of researchers reports in the Aug. 3 Science. The finding provides genetic backup for a fossil-based argument portraying these controversial Stone Age hominids as a separate species, Homo floresiensis, not small-bodied Homo sapiens that could have represented ancestors of Rampasasa people.
Diminutive hobbits, standing roughly a meter tall, lived on Flores from at least 100,000 to 60,000 years ago, with possible ancestors on the island dating to about 700,000 years ago (SN: 7/9/16, p. 6). Some scientists contend that hobbits were actually short humans, not an ancient hominid species (SN: 11/18/06, p. 330). So far, researchers have been unable to extract DNA from hobbit fossils. Comparing hobbit and present-day human DNA would go a long way toward clarifying the evolutionary ID of the half-size Flores hominids.
In the new study, evolutionary geneticist Serena Tucci of Princeton University and colleagues compared DNA from 32 Rampasasa individuals with that of Neandertals, Denisovans and present-day humans around the world. The Flores pygmies got smaller due in part to alterations to genes linked to height and the breakdown of fatty acids in foods, the researchers found.

Still, without hobbit DNA, it’s impossible to say with certainty that Rampasasa pygmies — on average more than 30 centimeters taller than hobbits — inherited no genes from H. floresiensis, says evolutionary geneticist and coauthor Richard Green of the University of California, Santa Cruz. “But we looked hard for [H.] floresiensis ancestry in Rampasasa people and could not find it.”

The question of how many died in the aftermath of Hurricane Maria has yet another answer.

Using vital statistics records from hard-hit Puerto Rico, researchers estimate that 1,139 more people died than expected from September 20, 2017 — the day the Category 5 hurricane made landfall — through that December.

Alexis Santos-Lozada of Penn State and Jeffrey Howard of the University of Texas at San Antonio tallied monthly death counts from January 2010 through December 2017 to determine the expected number of deaths and the variability in these numbers over time. Excess deaths spiked in September, the month the hurricane hit, and peaked in October 2017, with 564 more deaths than expected that month, the pair report online August 2 in JAMA. However, the vital statistics data don’t pinpoint individual causes of death.
The official death toll from the Puerto Rican government is 64, based on death certificates that document if a death was directly due to the hurricane. But this method doesn’t factor in deaths indirectly related to the storm, such as those from infectious-disease outbreaks or because of disruptions in electricity or medical care.
Last May, another study in the New England Journal of Medicine based on surveys of 3,299 randomly selected households across the island estimated at least 4,645 deaths from the hurricane (SN Online: 5/29/18). Survey participants were asked about deaths, delays in medical care, and electricity, water and cell phone interruptions to capture deaths indirectly related to the disaster.

Getting a good estimate on deaths after natural disasters is crucial for guiding rescue and recovery efforts, Santos-Lozada and Howard say.

Of these methods, “using excess death counts from dependable vital statistics data is probably a more solid approach,” says James Shultz, director of the Center for Disaster & Extreme Event Preparedness at the University of Miami Miller School of Medicine. But he finds it interesting that the excess deaths in the new study are concentrated in September and October, while the previous survey-based research assumes excess deaths continued past this time.

“Hopefully, future calculations will extend the analysis into the first half of 2018, when many areas of Puerto Rico still lacked power and health care services were only partially restored,” Shultz says.

Scientists now know how long it takes for a cell to tell itself it’s time to die.

Signals triggering a type of cell suicide called apoptosis move through a cell like a wave, traveling at a rate of 30 micrometers per minute, Stanford University systems biologists Xianrui Cheng and James Ferrell Jr. report in the Aug. 10 Science.

These findings resolve a debate over whether these death signals spread by diffusion, with signaling molecules working their own way across a cell, or as self-regenerating trigger waves, like toppling dominoes. The apoptosis process starts with damage that causes the release of death signal chemicals. One example is cytochrome c leaking from damaged mitochondria, the cell’s power plant. Once cytochrome c concentrations get high enough, the chemicals signal proteins called caspases to go to work. Caspases trigger other proteins to poke holes in neighboring mitochondria, releasing more cytochrome c and moving the death wave across the cell. That chain reaction happens more quickly than diffusion can, Ferrell says. In an African clawed frog egg, a trigger wave takes about a half-hour to spread across the 1.2 millimeter cell, whereas diffusion would take five hours, he says.

Like forest fires, trigger waves will keep going as long as there is fuel to feed them — in this case, the death signal chemicals and proteins, Ferrell says. He predicts that many other biological signals may move as trigger waves.

“We biologists are just waking to this idea that trigger waves are a recurring theme in biological communication,” Ferrell says.

Discovering that apoptosis travels as trigger waves in cells may give scientists clues about how to persuade cancer cells to kill themselves (SN: 1/21/17, p. 10). Or researchers may learn how to prevent cells from dying in conditions such as Alzheimer’s disease or muscular dystrophy.

Pregnant women aren’t immune to the escalating opioid epidemic.

Data on hospital deliveries in 28 U.S. states shows the rate of opioid use among pregnant women has quadrupled, from 1.5 per 1,000 women in 1999 to 6.5 per 1,000 women in 2014, the U.S. Centers for Disease Control and Prevention reports.

The highest increases in opioid use among pregnant women were in Maine, New Mexico, Vermont and West Virginia, according to the CDC study, published online August 9 in Morbidity and Mortality Weekly Report.
“This analysis is a stark reminder that the U.S. opioid crisis is taking a tremendous toll on families,” says coauthor Jean Ko, a CDC epidemiologist in Atlanta.

In this first look at opioid use during pregnancy by state, Washington, D.C. had the lowest rate in 2014, at 0.7 per 1,000 women, and Vermont had the highest, at 48.6 per 1,000. However, the data from the U.S. Health and Human Services Department represents only the 28 states that record opioid use at childbirth during the studied time frame.

“We knew the incidence was increasing” as the number of babies going through opioid withdrawal has also gone up, says Matthew Grossman, a pediatrician at Yale University. Overall, the number of U.S. deaths attributed to opioids has also been steadily rising (SN: 3/31/18, p. 18). In 2014, there were 14.7 opioid deaths per 100,000 people, up from 6.2 per 100,000 in 2000, according to the CDC.
Taking opioids during pregnancy, especially in the last trimester, increases the risk of preterm birth and stillbirth, as well as infant opioid withdrawal (SN: 6/10/17, p. 16). Pregnant women should tell their doctors if they are taking opioids, so complications can be addressed, says Alison Holmes, a pediatrician at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. Mothers may be prescribed methadone, a synthetic opioid which is safer for the fetus and protects it from going through withdrawal in the womb. “What’s not safe for the child is active opioid misuse,” she says.

Only eight U.S. states require that pregnant women be tested for opioids if substance abuse is suspected, the CDC says. In Cincinnati, all pregnant women are tested at delivery, but it would be even better to test women in the first trimester, says pediatrician Scott Wexelblatt at the Cincinnati Children’s Hospital. “If we could identify a mom at 12 weeks instead of 40 weeks, then we could get her into medicated assisted treatment.”

In one published swoop, an ancient fossil fruit bat has turned into a lemur. If that transformation holds, it suggests that lemur ancestors made two tricky sea crossings from Africa to Madagascar, not one as researchers have often assumed.

A new fossil analysis finds that the ancient species Propotto leakeyi, which lived in East Africa between 23 million and 16 million years ago, was not a bat, as scientists thought, but a primate closely related to modern aye-ayes. These strange-looking lemurs are found only on Madagascar along with another closely related lemur lineage.
What’s more, Propotto teeth and jaws display key similarities with fossils of a roughly 34-million-year-old primate, Plesiopithecus teras, previously found in Egypt, researchers say. Plesiopithecus, previously suspected to have been a primate, was an ancestor of Propotto and of modern aye-ayes, they conclude. Together, the findings, published August 21 in Nature Communications, may help rewrite lemurs’ evolutionary history.

The research challenges a long-standing view that all Madagascar lemurs, including aye-ayes, evolved from a single population of African ancestors that somehow reached the island at least 54 million years ago. That estimate rests largely on genetic studies of modern lemurs and other primates. Destruction of ancient lemurs’ African habitats by global cooling around 34 million years ago left their kind isolated on Madagascar, according to this scenario.

But the survival of aye-aye ancestors in Africa millions of years after that, as suggested in the new study, raises the possibility that Propotto reached Madagascar on its own — separate from the other lemur lineage found on the island — and gave rise to present-day aye-ayes. No Propotto fossils have been found on Madagascar.

“Our identification of both Propotto and Plesiopithecus as African relatives of the aye-aye implies that [these] lemurs weren’t present on Madagascar until 30 million years or more later than previously thought,” says study coauthor paleontologist Erik Seiffert of the University of Southern California in Los Angeles.
Ancestors of the modern lemurs other than aye-ayes traveled to Madagascar sometime between around 41 million and 20 million years ago, the researchers estimate. During that period, ancestors of the only other mammal groups now inhabiting Madagascar — rodents, Malagasy mongooses and insect-eating creatures called tenrecs — also reached the island from Africa. Previous computer simulations indicated that ocean currents at that time could have carried animals stranded on storm-uprooted trees and vegetation mats from East Africa to Madagascar.

The team, which included Duke University’s Gregg Gunnell (who died in 2017), created digital reconstructions of Plesiopithecus and Propotto fossils for comparison with fossil and living primates, including aye-ayes (Daubentonia), and to closely related mammals called colugos. Evolutionary trees based on tooth and jaw analyses and available DNA data pointed to a link between the two ancient species and aye-ayes.

Plesiopithecus and Propotto might have used enlarged teeth projecting from the front of their mouths to gouge holes in trees and expose grubs’ nests, as modern aye-ayes do. Aye-ayes also poke through tree holes with long, skinny middle fingers to extract grub. But no hand fossils from either ancient creature have been found, so it’s a mystery whether they shared aye-ayes’ taste for finger food.

The discoverer of three Propotto tooth-bearing lower jaws in Kenya originally reported in 1967 that the finds belonged to a new primate species, possibly an ancestor of primate relatives of lemurs called lorises. But within the next two years, the same scientist accepted another researcher’s proposal that Propotto’s jaws and teeth more closely resembled those of a fruit bat. A 1984 report describing several more Propotto teeth unearthed in Kenya also concluded that they came from a fruit bat.

The new identification of a line of ancient African lemurs that ran from Plesiopithecus through Propotto “is an interesting discovery,” says paleoanthropologist Marc Godinot of the National Museum of Natural History in Paris. “I have thought for years that Propotto was more likely a primate than a fruit bat.”

Godinot also argued in a 2006 study that the shape and positioning of teeth at the front of Plesiopithecus’ mouth pegged it as a relative of aye-ayes, consistent with a double colonization of Madagascar by lemur ancestors.

That possibility “merits serious consideration,” but a single African origin for lemurs on Madagascar remains the simplest, most likely scenario, says evolutionary biologist Anne Yoder of Duke University. Most African mammals couldn’t manage even one colonization of the island, so attributing two of these “highly improbable” events to lemur ancestors alone demands more evidence, Yoder says.

Still, it can’t be discounted that several ancient African lines of primates might have evolved in the aye-aye lineage but only one made it to Madagascar on a sea crossing that occurred independently of other African lemurs, Yoder says. Or, in line with her own view, Madagascar may have been colonized by one group of ancient lemurs that gave rise to multiple lines of creatures, one of which was a direct ancestor of modern aye-ayes. Only further fossil discoveries can resolve this mystery, Yoder says.

For cervical cancer screening, there’s a new option in town.

Women ages 30 to 65 can opt to have human papillomavirus, or HPV, testing alone every five years, according to new recommendations from the U.S. Preventive Services Task Force.

HPV testing alone joins two other alternatives that are still endorsed: an HPV test plus a Pap test every five years, or a Pap test alone every three years. The guidelines, published online August 21 in JAMA, are the first update to the group’s cervical cancer screening recommendations since 2012.

Recent research has shown that HPV testing, which checks for the presence of the sexually transmitted virus in a sample of cervical cells, is better at catching precancerous lesions early than the traditional Pap test, which looks for those lesions in a cervical cell sample.

Globally, cervical cancer is the fourth most common cancer among women. HPV causes nearly all cervical cancers.