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Acuna: 'I'd like to stay in the leadoff spot'

When the Braves re-signed Nick Markakis in January, they began leaning toward putting Ender Inciarte in the leadoff spot and moving Ronald Acuna Jr. to the cleanup role. But manager Brian Snitker said Acuna may still get his wish to stay at the top of the lineup.




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Markakis enjoys reaping rewards of dedication

Braves manager Brian Snitker joked that he could almost detect a smile as he shared a phone conversation with Nick Markakis after the stoic outfielder re-signed with the club in January. Snitker and others actually saw that smile on Tuesday morning, when Markakis reported to Spring Training to begin his fifth season with the Braves and attempt to push the club past the rebuild he positively enriched through his leadership.




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Uniform patch to mark 150 years of pro baseball

All 30 Major League teams will wear special "MLB 150" patches on their uniforms for the entire 2019 season in honor of the 150th anniversary of the 1869 Cincinnati Red Stockings, the first openly all-salaried professional baseball team.




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30 low-key acquisitions who could pay off big

Fans and analysts spend the entire offseason speculating where the top free agents could go, but sometimes an under-the-radar pickup can end up making a world of difference. As positional competitions begin to heat up at Spring Training camps this month, MLB.com's beat writers were asked to identify one potentially overlooked acquisition for each of the 30 clubs. Here's who they came up with.




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Wilkerson is Orioles' man of many gloves

Steve Wilkerson enters Orioles camp competing for a super-utility role after a brief big league cameo last year. He isn't traveling light, as Wilkerson has 10 gloves on display.




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Inhibition of Mitochondrial Calcium Overload by SIRT3 Prevents Obesity- or Age-Related Whitening of Brown Adipose Tissue

The whitening and loss of brown adipose tissue (BAT) during obesity and aging promote metabolic disorders and related diseases. The imbalance of Ca2+ homeostasis accounts for the dysfunction and clearance of mitochondria during BAT whitening. Capsaicin, a dietary factor activating TRPV1, can inhibit obesity induced by high-fat diet (HFD), but whether capsaicin inhibits BAT loss and the underlying mechanism remain unclear. In this study, we determined that the inhibitory effects of capsaicin on HFD-induced obesity and BAT whitening were dependent on the participation of SIRT3, a critical mitochondrial deacetylase. SIRT3 also mediated all of the beneficial effects of capsaicin on alleviating reactive oxygen species generation, elevating mitochondrial activity, and restricting mitochondrial calcium overload induced by HFD. Mechanistically, SIRT3 inhibits mitochondrial calcium uniporter (MCU)-mediated mitochondrial calcium overload by reducing the H3K27ac level on the MCU promoter in an AMPK-dependent manner. In addition, HFD also inhibits AMPK activity to reduce SIRT3 expression, which could be reversed by capsaicin. Capsaicin intervention also inhibited aging-induced BAT whitening through this mechanism. In conclusion, this study emphasizes a critical role of the AMPK/SIRT3 pathway in the maintenance of BAT morphology and function and suggests that intervention in this pathway may be an effective target for preventing obesity- or age-related metabolic diseases.




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Brantley's bat has Astros buzzing ahead of '19

The signing of veteran outfielder Michael Brantley by the Astros came a week after the Winter Meetings and only a few days before Christmas, meaning it didn't exactly garner much attention on national, or even local, news cycles. For the Astros, Brantley was exactly the player they needed at exactly the right price -- two years and $32 million -- and the kind of addition that should fire up the fanbase.




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30 low-key acquisitions who could pay off big

Fans and analysts spend the entire offseason speculating where the top free agents could go, but sometimes an under-the-radar pickup can end up making a world of difference. As positional competitions begin to heat up at Spring Training camps this month, MLB.com's beat writers were asked to identify one potentially overlooked acquisition for each of the 30 clubs. Here's who they came up with.




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Uniform patch to mark 150 years of pro baseball

All 30 Major League teams will wear special "MLB 150" patches on their uniforms for the entire 2019 season in honor of the 150th anniversary of the 1869 Cincinnati Red Stockings, the first openly all-salaried professional baseball team.




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Astros can still win the offseason

We're reluctant to finalize our list of offseason winners because, as you may have heard, there are some prominent unsigned free agents. Not just Bryce Harper and Manny Machado, either.




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Whitley throws first bullpen session of spring

All eyes were on right-hander Forrest Whitley, MLB Pipeline's top pitching prospect, when he threw in the bullpen for the first time Friday in Major League camp. Astros manager AJ Hinch, assistant general manager Brandon Taubman and director of player development Pete Putila were all watching intently as Whitley threw 21 pitches -- fastballs, changeups and cutters.




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Winter ball: Snowy offseason ideal for Sneed

The question would come shortly after Cy Sneed would write his name on the chalkboard. A young hand would rise into the air, and Sneed would brace himself for the chuckles that were sure to soon fill the classroom. "Are you a lumberjack?"




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Hall of Famer Biggio visits camp, shares wisdom

The first Hall of Famer to join the Astros at Spring Training is Craig Biggio, who was in uniform for morning workouts on Tuesday and will remain with the team throughout the week.




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Uber to lay off 3,700 workers, CEO to waive salary

NEW YORK (AP) — Uber is cutting 3,700 full-time workers and its CEO will give up his base salary with the nation largely still in lockdown. The San Francisco company said Wednesday that the layoffs and related costs like severance will reach...




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Airbnb laying off 1,900 employees due to travel decline

Airbnb says it is laying off 25% of its workforce as it confronts a steep decline in global travel due to the new coronavirus pandemic. It’s a serious setback for the 12-year-old home-sharing company, which just a few months ago was...




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Colombian company creates bed that can double as coffin

BOGOTA, Colombia (AP) — A Colombian advertising company is pitching a novel, if morbid, solution to shortages of hospital beds and coffins during the coronavirus pandemic: combine them. ABC Displays has created a cardboard bed with metal...




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Germany offers hope to other Euro leagues

Germany’s decision that football can return this month provided encouragement for players and teams across Europe yesterday that the shutdown caused by the coronavirus pandemic could soon be coming to an end. With COVID-19 infections declining,...




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Management of cancer induced bone pain

Bone pain is the most common type of pain from cancer and is present in around one third of patients with bone metastases, currently, improvements in cancer treatments mean that many patients are living with metastatic cancer for several years. Christopher Kane, NIHR academic clinical fellow in palliative medicine at Leeds University School of...




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Has the balance of screening for AAA tipped towards harm?

Abdominal aortic aneurysms (AAA) are usually asymptomatic until they rupture, which is fatal in more than 80% of cases. Screening aims to detect the aneurysm before it ruptures, enabling preventive surgery and hence reducing morbidity and mortality. However, preventive surgery has a mortality of 3.9-4.5%. As the prevalence of risk factors, ie...




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Katherine Henderson A and E consultant - lack of ward beds is hitting A and E the hardest

Katherine Henderson is the clinical lead of the emergency department at St Thomas's hospital in London. She worries that lack of ward space is having a domino effect throughout A and E and is the cause of increased waiting time for both patients and ambulances. If you would like to contribute to this collection, please email a brief audio...




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QOF, what is it good for?

Martin McShane, medical director of long term conditions at NHS England, questions the validity of the Quality and Outcomes Framework and suggests how it should change in the future. Read the related article: http://www.bmj.com/content/350/bmj.h2540




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Diagnosis and treatment of hepatic encephalopathy

Hepatic encephalopathy constitutes a spectrum of neuropsychiatric abnormalities, beginning with subtle psychomotor changes and progressing to confusion with asterixis, somnolence, and then coma, arising in patients with impaired liver function. In this podcast, Tim Cross, a consultant hepatologist from the Royal Liverpool University Hospital,...




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They drained 92L from me - diagnosis and management of pleural effusion

Pleural effusions are common, with an estimated 1-1.5 million new cases in the United States and 200 000-250 000 in the United Kingdom each year. Rahul Bhatnagar, academic clinical lecturer at the University of Bristol, describes how pleural effusions may be investigated and treated in the community and secondary care, with a particular focus on...




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Is place of death important to patients?

The current orthodoxy is that home is the best and preferred place of death for most people, but in this podcast, Kristian Pollock a sociologist from Nottingham University questions these assumptions and calls for greater attention to improving the experience of dying in hospital and elsewhere. Read the full...




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The diagnosis and treatment of post-traumatic stress disorder

PTSD may develop after exposure to exceptionally threatening or horrifying events. About 3% of the adult population has PTSD at any one time, and more than 50% in survivors of rape. In this podcast Jonathan Bisson, professor of psychiatry at the School of Medicine in Cardiff joins us to talk about the evidence for diagnosis and treatment, and...




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The big (research) book of British teeth

Despite what hollywood says, science has proven that British teeth are actually better than American. Richard Watt, head of the Research Department of Epidemiology and Public Health at UCL explains how they came to that conclusion. Read the full research: http://www.bmj.com/cgi/doi/10.1136/bmj.h6543




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The role of stenting in stable angina

Iqbal Malik, consultant cardiologist at Imperial College Healthcare NHS Trust in London, joins Mabel Chew to discuss the role of angioplasty and stenting in patients with stable angina. Read the full article online: http://www.bmj.com/content/352/bmj.i205




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"We're pulling the rug out from under the feet of [GPs]"

Gareth Iacobucci talks to Candace Imison, director of policy at The Nuffield Trust, about the problems facing GPs, and how primary care could be changed. "5 minutes with... Candace Imison": http://www.bmj.com/content/352/bmj.i1378




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"I thought I was the worst person with type I..." - Self management of diabetes

Nick Oliver, consultant diabetologist at Imperial Healthcare NHS Trust and Philippa Cooper, who has type I diabetes, join us to explain how structured education works for patients, and give tips on self management. Read the full review: http://www.bmj.com/content/352/bmj.i998




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The pattern of damage caused by Zika virus in the brains of 23 foetuses

In February World Health Organization (WHO) declared the microcephaly epidemic in South America an international public health emergency. Today, the US Centers for Disease Control and Prevention, the CDC, has confirmed that it’s is Zika virus which is causing that microcephaly.  The outbreak was originally spotted in Recife, in Brazil, and it’s...




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BMJ roundtable: How to fix out of hours care

The BMJ recently held a discussion between experts in the fields of general practice, emergency medicine, and paediatrics about the state of out of hours care in the UK, and crucially offered their vision for a better service. Are children a special case, can urgent care ‘hubs’ be a silver bullet, is NHS 111 up to the job of triaging patients,...




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Medical error—the third leading cause of death in the US

Medical error is not included on death certificates or in rankings of cause of death. Martin Makary, professor of surgery at Johns Hopkins University School of Medicine, joins us to explain why we don't measure medical error, and why it is so important that we start. Read the full analysis: http://www.bmj.com/content/353/bmj.i2139




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The science of improvement

Or, the one where Fiona Moss and Don Berwick tells us what they think quality improvement is. Fiona Moss is dean, Royal Society of Medicine, and Don Berwick is president emeritus and senior fellow, Institute for Healthcare Improvement. Don's talk and the interview with Fiona were both recorded at the International Forum on Quality and Safety in...




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Caring for patients with delirium at the end of their life

Delirium is common in the last weeks or days of life. It can be distressing for patients and those around them. A clinical update explains why successful management involves excluding reversible causes of delirium and balancing drugs that may provoke or maintain delirium while appreciating that most patients want to retain clear cognition at the...




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Not just our ethical credibility as a profession, but our shared humanity

"I say to all Australian doctors - young, old, the political and the apolitical - that on this depends not just our ethical credibility as a profession, but our shared humanity. " Following the leaked emails published in The Guardian newspaper, alleging abuse of asylum seekers detained by the Australian government on the Pacific island of Nauru,...




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Late effects of anticancer chemotherapy: It's hard to trust your body, after it's betrayed you

Lily was diagnosed at 14 years old with stage four Hodgkin's lymphoma and received six rounds of chemotherapy and two weeks of radiotherapy. She survived but now lives with the long term effects of that therapy - and joins us to discuss how it has impacted her quality of life. We're also joined by Saif Ahmad and Thankamma Ajithkumar, oncologists...




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Reprehensible, but the people carrying out atrocities have very low rates of mental disorders

Oversimplification and lack of evidence stigmatise people with mental illness and impede prevention efforts, says Simon Wessley, professor of psychiatry at King's College London, in an editorial published on thebmj.com. Read the full editorial: http://www.bmj.com/content/354/bmj.i4869




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How people die remains in the memory of those who live on - supporting the relatives of the dying

All doctors, irrespective of their specialty or the setting in which they work, will care for patients who die. Around half of all deaths occur in hospitals. Evidence suggests that the quality of communication around this process is poorer in hospitals than in other settings, according to responses from relatives who have experienced bereavement....




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The inadequacy of the UK's childhood obesity strategy

The UK government published its report Childhood Obesity: a Plan for Action, in August 2016. A new analysis article takes them to task for the inadequacy of that response to a growing problem. Neena Modi is a professor of neonatal medicine, at Imperial College London, and president of the Royal College of Paediatrics and Child Health, and joins...




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Emergency care plans at the end of life

When a person’s heart or breathing stops and the cause is reversible, immediate cardiopulmonary resuscitation (CPR) offers a chance of life. However, when a person is dying—for example, from organ failure, frailty, or advanced cancer—and his or her heart stops as a final part of a dying process, CPR will not prevent death and may do harm. But...




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Education round up - HIV testing, legal highs and care for relatives of the dying

The BMJ publishes a lot of educational articles, and in an attempt to help you with your CPD, we have put together this round-up. Our authors and editors will reflect on the key learning points in the articles we discuss, and explain how they may change their practice in light of that new understanding. In this week's round up we're...




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"We're kicking the can down the road" - how to get agreement on the future of the NHS

Our latest debate asks whether there should be a Royal Commission (a high level enquiry, with statutory powers) into the future of the NHS. A high level inquiry could detoxify the radical changes needed and command wide support, say Maurice Saatchi, conservative peer, and Paul Buchanan, The BMJ's patient editor; but Nigel Crisp, independent peer,...




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The evidence manifesto - better trials, better use of trial data

We're creating a manifesto for better evidence. The centre for Evidence Based Medicine at the University of Oxford, and the BMJ, are asking what are the problem with medical evidence, and how can we fix them? In this second discussion we went to Nottingham​ University, to find out what the people who create the bread and butter of EBM -...




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The magic of shared decision making

Adoption of shared decision making into routine practice has been remarkably slow, despite 40 years of research and considerable policy support. In 2010, the Health Foundation in the UK commissioned the MAGIC (Making Good Decisions in Collaboration) programme to design, test, and identify the best ways to embed shared decision making into...




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"The interest of diesel drivers over the interest of the public" - tackling air pollution

Air pollution is a truly damaging environmental insult to the human body. The numbers of premature deaths, in the UK alone, that can be attributed to it are calculated to be 40,000 a year. Yet despite this, action to tackle the problem - as with the other huge environmental issue of our time, climate change - is distinctly lacking. Robin...




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Childhood IQ and cause of death

Findings from a range of prospective cohort studies based around the world indicate that higher intelligence in children is related to a lower risk of all cause mortality in adulthood - and now a new study, published on bmj.com, is trying to dig into that association further, with a whole population cohort and data on cause specific...




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Preventing Overdiagnosis 2017 - Stacy Carter on the culture of overmedicalisation

In this interview from Preventing Overdiagnosis 2017 (preventingoverdiagnosis.net) Stacy Carter, associate professor at Sydney Health Ethics - and the author of a recently written BMJ essay the ethical aspects of overdiagnosis, joins us to talk about how the cultural context of medicine seeps into our decision making processes and affects how...




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Selling off NHS silver?

Should we welcome plans to sell off NHS land? The government seems likely to back the recommendations of Robert Naylor (national adviser on NHS property and estates) to raise capital by selling off inefficiently used assets, but Kailash Chand (GP) worries that services could be threatened and that public consultation is lacking. Read the Head...




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Early detection of eating disorders

Assessing young people with possible eating disorders can be complex for a variety of reasons. Building a therapeutic relationship with a young person with a possible eating disorder and their family is key to enabling a thorough assessment and ongoing management, but it introduces difficult issues regarding confidentiality and risk. In this...




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Taking the temperature of 37°C

Average body temperature is 37°C, right? That was the conclusion of Carl Wunderlich in his magnum opus, The Course of Temperature in Diseases - Wunderlich published that in 1868, following his extensive collection of body temperature readings - and 37°C stuck. But, it’s not as simple as that Philip Mackowiak, emeritus professor of medicine, and...