Boston University

9 Devices That Are Changing Medicine

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Introduction

In 1922, a diabetic teenager in a Toronto hospital became the first person to be injected with insulin. Nearly a century later, patients with diabetes are on the verge of being able to set their insulin doses using their smartphones. The progress in tech-based treatment in recent years is staggering, with wireless and implantable technologies emerging that just a few years ago might have seemed like science fiction.

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An Artificial Pancreas

People with type 1 diabetes may soon be able to set their insulin doses by smartphone. Researchers from Massachusetts General Hospital and Boston University are testing a “bionic pancreas,” a pump that goes under your skin that when paired with an app and a small chip tracks blood sugar levels and adjusts amounts of insulin and glucagon on its own. In a small study[1]published in the New England Journal of Medicine, among 20 adults and 32 adolescents who were told that they could eat as they wish, the system maintained glucose levels in the acceptable range 79% and 75% of the time, respectively, vs 58% and 65% of the time when participants used their regular monitoring systems. A follow-up study is planned followed by a submission for US Food and Drug Administration (FDA) approval in 2017.

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Smart Pills

No more missed doses: Researchers in the United States and the United Kingdom are testing a silicon tablet called Helius (Proteus Digital Health; Redwood City, California) that helps monitor medication adherence. The once-daily “pill” has a sensor resembling a grain of sand; the sensor is covered in magnesium and copper, which generate power by reacting with stomach acid, sending a signal indicating the time of pill ingestion (other pills, that is) to a wearable patch. The patch in turn forwards this information to a patient’s smartphone using Bluetooth. Current studies include patients with heart failure or hypertension; however, the Helius manufacturers plan to study the technology in other chronic health conditions soon.

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Cuff That Curbs Heart Failure

An experimental treatment called C-Pulse® (Sunshine Heart; Eden Prairie, Minnesota) has the potential to slow down and possibly even reverse heart failure. The device is implanted through a small incision in the chest; it wraps around the aorta and consists of a cuff that inflates and deflates in rhythm with a patient’s heartbeat, improving blood flow. An external battery powers the C-Pulse.

 

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Dime-Sized Heart Monitor

A tiny device approved last year by the FDA alerts physicians when their patient’s heart failure symptoms are worsening. The CardioMEMS™ HF System (St Jude Medical; St Paul, Minnesota) is inserted through a catheter into the pulmonary artery; it wirelessly measures and monitors pulmonary arterial pressure and uploads the data to a website. Treatment response can also be monitored in real time.

 

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A Disc to Ease Inflammation

Data are mounting supporting a connection between our immune and nervous systems. An investigational iPad®-driven neuromodulation device (SetPoint Medical; Valencia, California) reportedly reduces systemic inflammation by stimulating the vagus nerve via an implantable pulse generator. A small study[2] presented at the 2012 American College of Rheumatology Annual Meeting reported positive results in patients with rheumatoid arthritis; a study in patients with Crohn disease is also planned.

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Annual Implants to Treat Diabetes

This matchstick-size pump—currently called the ITCA 650 (Intarcia Therapeutics; Boston, Massachusetts)—could replace pills and injections for type 2 diabetes. It’s implanted under the skin of the abdomen and releases doses of the glucagon-like peptide-1 agonist exenatide (Bydureon®, Byetta®) to help control blood glucose. It must be replaced yearly. Clinical trials are nearing completion, and the maker hopes to bring the device to market in 2016.

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A New Option in Sleep Apnea

Many patients with sleep apnea aren’t so keen on cumbersome, often uncomfortable continuous positive airway pressure (CPAP) machines. As an alternative, last year the FDA approved a device called Inspire® (Inspire Medical Systems, Maple Grove, Minnesota) that improves upper airway patency during sleep. Here’s how it works: A respiration sensor in the chest delivers a signal to an implanted generator, which in turn stimulates the hypoglossal nerve in between the end of expiration and the beginning of the next expiratory phase.

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Meds via Microchip

New investigational technology from MicroCHIPS (Lexington, Massachusetts) may make long-term, wireless drug delivery possible. The microchip-based implant is placed under the skin and contains 200 microreservoirs that can each store 1 mg of medication. Clinicians can remotely control medication release wirelessly; it can also be outfitted with sensors that release drugs in response to physiologic measures. The first human study[3] of the chip system reported that women receiving teriparitide for osteoporosis absorbed the same therapeutic drug levels as those receiving daily injections. The device also resulted in more dose-to-dose consistency.

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An Injectable for Back and Leg Pain

A new treatment for chronic back and leg pain is about the size of a staple. The Stimwave Freedom Spinal Cord Stimulation System (Stimwave; Miami Beach, Florida) is injected and powered by an external battery; the tiny stimulator delivers pulsed electric current to nerve fibers near the dorsal aspect of the spinal column to lessen pain sensation. The FDA approved the device in 2014.

‘Determination’ can be induced by electrical brain stimulation.

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Applying an electric current to a particular part of the brain makes people feel a sense of determination, say researchers

The men were having a routine procedure to locate regions in their brains that caused epileptic seizures when they felt their heart rates rise, a sense of foreboding, and an overwhelming desire to persevere against a looming hardship.

The remarkable findings could help researchers develop treatments fordepression and other disorders where people are debilitated by a lack of motivation.

One patient said the feeling was like driving a car into a raging storm. When his brain was stimulated, he sensed a shaking in his chest and a surge in his pulse. In six trials, he felt the same sensations time and again.

Comparing the feelings to a frantic drive towards a storm, the patient said: “You’re only halfway there and you have no other way to turn around and go back, you have to keep going forward.”

When asked by doctors to elaborate on whether the feeling was good or bad, he said: “It was more of a positive thing, like push harder, push harder, push harder to try and get through this.”

A second patient had similar feelings when his brain was stimulated in the same region, called the anterior midcingulate cortex (aMCC). He felt worried that something terrible was about to happen, but knew he had to fight and not give up, according to a case study in the journal Neuron.

Both men were having an exploratory procedure to find the focal point in their brains that caused them to suffer epileptic fits. In the procedure, doctors sink fine electrodes deep into different parts of the brain and stimulate them with tiny electrical currents until the patient senses the “aura” that precedes a seizure. Often, seizures can be treated by removing tissue from this part of the brain.

“In the very first patient this was something very unexpected, and we didn’t report it,” said Josef Parvizi at Stanford University in California. But then I was doing functional mapping on the second patient and he suddenly experienced a very similar thing.”

“Its extraordinary that two individuals with very different past experiences respond in a similar way to one or two seconds of very low intensity electricity delivered to the same area of their brain. These patients are normal individuals, they have their IQ, they have their jobs. We are not reporting these findings in sick brains,” Parvizi said.

The men were stimulated with between two and eight milliamps of electrical current, but in tests the doctors administered sham stimulation too. In the sham tests, they told the patients they were about to stimulate the brain, but had switched off the electical supply. In these cases, the men reported no changes to their feelings. The sensation was only induced in a small area of the brain, and vanished when doctors implanted electrodes just five millimetres away.

Parvizi said a crucial follow-up experiment will be to test whether stimulation of the brain region really makes people more determined, or simply creates the sensation of perseverance. If future studies replicate the findings, stimulation of the brain region – perhaps without the need for brain-penetrating electrodes – could be used to help people with severe depression.

The anterior midcingulate cortex seems to be important in helping us select responses and make decisions in light of the feedback we get. Brent Vogt, a neurobiologist at Boston University, said patients with chronic pain and obsessive-compulsive disorder have already been treated by destroying part of the aMCC. “Why not stimulate it? If this would enhance relieving depression, for example, let’s go,” he said.

Deaf Student, Denied Interpreter by Medical School, Draws Focus of Advocates.

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Speaking with the parents of a sick infant, Michael Argenyi, a medical student, could not understand why the child was hospitalized. During another clinical training session, he missed most of what a patient with a broken jaw was trying to convey about his condition.

His incomprehension, Mr. Argenyi explained, was not because of a deficiency in academic understanding. Rather, he simply could not hear.

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Mr. Argenyi, 26, is legally deaf. Despite his repeated requests to use an interpreter during clinical training, administrators at the Creighton University School of Medicine in Omaha, Neb., have refused to allow it. They have contended that Mr. Argenyi, who is able to speak, communicated well enough without one and that patients could be more hesitant to share information when someone else was present. They added that doctors needed to focus on the patient (not a third party) to rely on visual clues to make a proper diagnosis.

Mr. Argenyi took a leave of absence at the end of his second year, in 2011, after suing Creighton for the right to finish his medical training with an interpreter. The case, scheduled to go to trial on Tuesday in Federal District Court in Omaha, is attracting the attention of the federal government and advocates who are concerned that it could deal a setback to continuing efforts to achieve equality for people with disabilities.

“I couldn’t understand so much of the communication in the clinic,” Mr. Argenyi wrote in an e-mail. “It was humiliating to present only half of a history because I had missed so much of what was communicated. I was embarrassed every time I would miss medicine names that I knew from classes but couldn’t understand when the patient or a colleague spoke them.”

Despite making tremendous strides over the past four decades with the passage of theRehabilitation Act and the Americans with Disabilities Act, those with disabilities remain underrepresented in higher education and in the work force. In the medical field, people who are deaf or hard of hearing remain less likely to hold high-skilled positions than those without impairments.

Universities tend to provide requested accommodations after admitting a student who they know has a disability, proponents for the deaf say. And most arrangements for the deaf are settled long before any issues reach a courtroom, said Curtis Decker, the executive director of the National Disability Rights Network, a federally financed association of legal services programs.

But, he said of Mr. Argenyi’s lawsuit, “It’s a very important case because, I think, if it’s successful it will send a very powerful message to the university community that the law does cover them and the law is clear about the accommodations that they need to provide.”

Creighton officials maintain that they have provided Mr. Argenyi with the necessary tools for him to succeed in medical school.

“Michael Argenyi is a very bright, capable young man who Creighton believes will make a good doctor,” said Scott Parrish Moore, the lead counsel for Creighton.

After being accepted to Creighton four years ago, Mr. Argenyi asked the university to provide a real-time captioning system for lectures and a cued speech interpreter. (Mr. Argenyi, who does not know sign language, can read lips. An interpreter helps by mouthing words while using hand signals to clarify sounds.) These were the same accommodations that Mr. Argenyi, who had a diagnosis of profound deafness when he was 8 months old, received for much of his schooling, from grade school through undergraduate studies at Seattle University.

Creighton provided Mr. Argenyi with just one of the aides that his audiologist had recommended — an FM system, which amplifies the sounds he hears in cochlear implants. The university also provided note takers for lectures, priority seating and audio podcasts.

Soon after classes began, Mr. Argenyi told school officials that the accommodations were inadequate and that he was missing information. He sued in federal court in Omaha in September 2009, arguing that the university was legally required to pay for and provide necessary aides.

Mr. Argenyi said he hired his own interpreter and transcription service, which cost him more than $100,000 during his two years in medical school. The breaking point, he said, came during his clinical work in his second year when Creighton refused to allow him to use an interpreter, even if he paid for it himself. The university did allow Mr. Argenyi to use interpreters during a couple of clinics while the Justice Department was trying to broker a settlement, but stopped when a deal could not be reached.

Mr. Argenyi is pursuing degrees in public health and social work at Boston University, which is providing his requested transcription services, while the lawsuit is pending.

 

Source: http://www.nytimes.com

Some Antihypertensives Linked to Breast Cancer Risk.

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 The first observational study of long-term antihypertensive use and breast cancer risk has found that calcium-channel blockers are associated with a more than 2-fold increased risk and that angiotensin-converting-enzyme (ACE) inhibitors are associated with a reduced risk.

These findings come from a study published online August 5 inJAMA Internal Medicine.

Women who had taken calcium-channel blockers for 10 years or more had more than double the usual risk for invasive ductal breast carcinoma (IDC) (odds ratio [OR], 2.4) and for invasive lobular breast carcinoma (ILC) (OR, 2.6). The researchers also observed a possible association between the long-term use of ACE inhibitors and reduced risks for both IDC (OR, 0.7) and ILC (OR, 0.6), although the risk estimate for IDC was within the limits of chance.

No Changes in Clinical Practice Recommended Yet

“We don’t think this should change clinical practice in any way. It was the first study of long-term antihypertensive use. It was an observational study, not a clinical trial. We can suggest an association, but we cannot infer any causal relation at this point,” lead author Christopher Li, MD, PhD, from the Fred Hutchinson Cancer Research Center in Seattle, told Medscape Medical News.

Dr. Li and colleagues interviewed women 55 to 74 years of age from the Puget Sound region — 880 with IDC, 1027 with ILC, and 856 without cancer (control group). Participants were interviewed in person to establish detailed histories of hypertension and heart disease and risk factors for cancer, including family history, obesity, smoking, and alcohol use. The researchers gathered data on the use of antihypertensive drugs, including beginning and end dates of use, drug names, dose, route of administration, pattern of use, and indication.

The antihypertensives included ACE inhibitors, angiotensin-receptor blockers, beta blockers, calcium-channel blockers, diuretics, and combination antihypertensive preparations, regardless of indication.

Calcium-channel blockers are among the most frequently prescribed medications in the United States; they accounted for nearly 98 million of the more than 678 million prescriptions filled in 2010.

Subjects who had used antihypertensives for 6 months or longer and were still using them were classified as current users, subjects who had used them for 6 months but were no longer using them were classified as former users, and subjects who had used them for less than 6 months were classified as short-term users.

In the regression analyses, potential confounders included age, county of residence, other commonly used medications, comorbid conditions (cardiovascular disease, diabetes, hyperlipidemia, depression), alcohol use, and estrogen-receptor status.

Increased Risk After 10 Years

“In examining duration effects for current users, we found an increased risk only in relation to the use of calcium-channel blockers for 10 years or longer, and an increased risk was observed for both IDC (OR, 2.4; 95% confidence interval [CI], 1.2 – 4.9; P = .04 for trend) and ILC (OR, 2.6; 95% CI, 1.3 – 5.3; P = .01 for trend). This association with 10 years or longer of current calcium-channel blocker use did not vary appreciably when results were further stratified by estrogen-receptor status,” the researchers report.

Dr. Li told Medscape Medical News that they were surprised by the magnitude of the risk associated with calcium-channel blockers and by the decrease associated with ACE inhibitors.

“We expected that we might see some increase in breast cancer risk with calcium-channel blockers, but not a more than doubling of the risk,” Dr. Li said. “The suggestion of an association between ACE inhibitors and reduction in breast cancer risk was a very unexpected finding and is worthy of follow-up.”

The mechanism behind the apparent calcium-channel blocker effect is not known, Dr. Li explained, but some researchers suspect that these drugs might increase cancer risk by inhibiting apoptosis.

“First-Rate Study,” But Confirmation Needed

“The data are persuasive because this was a first-rate study: it was population-based, large (1900 case patients and 856 controls), identified cases from the Seattle-area SEER surveillance system, had a high (80%) case response rate, and used best practices in ascertaining medication use from study participants,” Patricia F. Coogan, ScD, from the Slone Epidemiology Center at Boston University, writes in a related commentary.

“Given these results, should the use of calcium-channel blockers be discontinued once a patient has taken them for 9.9 years? The answer is no, because these data are from an observational study, which cannot prove causality and by itself cannot make a case for change in clinical practice,” Dr. Coogan explains.

“If the 2- to 3-fold increase in risk found in this study is confirmed, long-term calcium-channel blocker use would take its place as one of the major modifiable risk factors for breast cancer. Thus it is important that efforts be made to replicate the findings,” Dr. Coogan notes.

“We are cautious and don’t want to read too much into this, since this was the first study to look at long-term use of these medications. We need to see confirmation of the study before making any clinical recommendations,” Dr. Li emphasized.

Source: Medscape.com

“Corkscrew” Light Could Turbocharge the Internet

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Twisty beams of light could boost the traffic-carrying capacity of the Internet, effectively adding new levels to the information superhighway, suggests research published today in Science.

Internet traffic is growing exponentially and researchers have sought ways to squeeze ever more information into the fiber-optic cables that carry it. One successful method used over the last 20 years essentially added more traffic lanes, using different colors, or wavelengths, for different signals. But to compensate for the added lanes, each one had to be made narrower. So, just as in a real highway, the spacing could get only so tight before the streams of data began to jumble together.

In the last few years, different groups of researchers have tried to encode information in the shape of light beams to ease congestion, using a property of light called orbital angular momentum. Currently, a straight beam of light is used to transmit Internet signals, but certain filters can twist it so that it corkscrews around with varying degrees of curliness as it travels.

Previous experiments using this effect have found that differently shaped light beams tend to jumble together after less than a meter.

Now, a team of researchers from Boston University in Massachusetts and the University of Southern California in Los Angeles has found a way to keep the different light beam shapes separated for a record 1.1 kilometers.

The researchers designed and built a 1.1-kilometer-long glass cable, the cross section of which had a varying index of refraction — a measure that describes how fast light can travel in a particular medium. They then sent both twisty and straight beams of light down the cable.

The team found that the light output matched the input — light beams of each shape were not getting muddled together. The varying index of refraction apparently affected each light shape uniquely, so that different shapes moved at different speeds down the cable. “That meant that I could keep them separated,” says Siddharth Ramachandran, an electrical engineer and leader of the Boston University team.

Improving infrastructure
The work published today used clockwise and anticlockwise versions of twisted light with a specific curliness, but Ramachandran says that the team has since done other research that suggests that about ten different beam shapes can be used to convey information.

That is exciting because each shape could potentially act as an entirely new level of traffic on the information superhighway. On each level, streams of data could be further divided into narrow lanes of color, maximizing flow. “We showed a new degree of freedom in which we could transmit information,” says Ramachandran.

Translating the work from the lab to the real world will take time, however, in part because current Internet cables carry only straight beams of light. A more immediate goal, says Ramachandran, might be to install cables that are capable of carrying twisty light on the short distances between servers on giant ‘server farms’, used by large Web companies such as Facebook.

Miles Padgett, an optical physicist at the University of Glasgow, UK, is impressed with the work and is optimistic about its potential. “One day, more bandwidth will mean we can all Skype at the same time,” he says.

Source: http://www.scientificamerican.com

 

0pt;ba� on�&� X1� ertical-align:baseline’>I was irrationally attached to the thought of dying while diving! Perhaps a little melodramatic, but I had terrible childhood memories of badly run swimming lessons and almost drowning as a toddler from falling in a pool. This created an instinctive fight for survival whenever my head went under water. However, the deeper part of me knew that the “I might die” excuse was nonsense, because people dive every day around the world, and with an instructor by my side I would be very safe.

 

4. Do I believe I have the strength and courage to do it?

It was all too easy pretending that I wasn’t brave enough, that I wouldn’t be able to physically control myself and decisions in the water because of fear. The hilarious thing was that I was strutting around in every other area of my life with self-belief and incredible determination. Yet, here I was playing weak and meek regarding diving. I realised that “not being brave enough” was a lame excuse.

5. Do I think mastering this would help me in other areas of my life?

I had always convinced myself that you should stay away from what you fear, and stick to what you know and trust. However, when I got really honest with myself, I realised that my life was a safe little box that I was staying very comfortably within. Unless I started to do things differently, I wouldn’t grow as a person and I wouldn’t know what more I was capable of. I realised that when fear roars at you, it’s time to step up and face it, because that is the exact spot where life begins… at the end of your comfort zone.

Ditching Excuses to Start Living

Having challenged all of my own excuses and seeing how hollow they were, I finally did it! It took all my courage and will power to complete the diving certification and while it was the most fear striking experience of my entire life, it was also the most exhilarating and freeing. I believe there is nothing in this life now that I cannot achieve, having faced my biggest fear. I no longer allow excuses to cover up opportunities for growth. If I did it in the face of a fear this big, you can too.

Source: Purpose Fairy

 

For Spiders, It’s Cruel to Be Kind.

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It turns out nice guys do finish last, at least among arachnids. A 6-year study of a New World spider reveals that although colonies composed of docile individuals fare better in the short term, their passive behavior ultimately does them in. A species may need a mean personality to keep from going extinct, the results suggest.

Not all spiders earn their frightening reputations. Even within a single species, some individuals are much mellower than others. Take the social spider Anelosimus studiosus, a native of North and South American forests that builds collective webs that house 40 to 100 individuals. In 2005, ecologists discovered that not all A. studiosus had the same disposition. When two spiders shared a container overnight, docile animals remained beside each other the whole time, whereas aggressive ones attacked each other and then moved to opposite corners. Jonathan Pruitt, an ecologist at the University of Pittsburgh in Pennsylvania, wondered which personality was more successful in the wild.

To find out, Pruitt performed personality tests on dozens of A. studiosus spiders and then arranged them into 90 couples consisting of an aggressive pair, a docile pair, or an aggressive spider matched with a docile one. The arachnids’ personalities are heritable, so a docile pair produces almost exclusively docile offspring, aggressive mates mainly make aggressive offspring, and mixed pairs produce a combination of docile and aggressive babies. After 1 week in the lab, each of the pairs had created small webs, or nests, on chicken wire within separate containers.

Pruitt returned to the Tennessee woods where he originally collected the spiders and wired each of the 90 nests onto trees and shrubs. For the next 5 years, he removed other species of spiders from the territory surrounding half of the webs. These 45 webs served as a control to test the hypothesis that disposition matters when hungry, solitary spiders abound in nature. The colonies in these well-maintained territories faired roughly the same as one another between 2007 and 2012, no matter the personality of their founders.

In contrast, colonies in the areas that were open to invaders differed from one another over time as solitary spiders began to infest the webs. Colonies founded by aggressive spiders successfully fought the intruders off, but produced fewer offspring because of the continuous conflict. In contrast, the predominantly docile colonies ignored intruders and continued to reproduce. In 2009, the docile colonies were flourishing, and their offspring had begun three times as many new colonies on nearby trees and shrubs compared with offspring from aggressive communities. Yet by 2010, the docile spiders’ apparent advantage began to wane as invaders increasingly ate them and stole the insects snagged by the colonies’ webs. By 2012, not a thread remained from the webs established by docile pairs, and only a quarter of those started by mixed pairs were left. Meanwhile,three-quarters of the original 15 nests founded by aggressive pairs stood strong, the team reports today inEcology Letters.

In nature, A. studiosus colonies consist of a mix of docile and aggressive individuals. In short-term studies, Pruitt says, aggressive spiders appear to be troublemakers because they often brawl with members of their own group. However, this study showed their importance when it comes to defense. “Originally, I thought aggressive spiders exploited docile ones, but now I see that the aggressive ones catch most of the food and take care of the society,” he says. Without aggressive spiders to care for them, docile spiders would go extinct whenever other spiders abound. Pruitt speculates that docile behavior still exists because it is useful to the colony in small doses. Perhaps docile individuals provide better care to hatchlings, he says.

For these spiders, passivity represents an “evolutionary dead end” because it comes with quick payoffs but dooms the lineage over time, Pruitt says. Much of the evidence for dead-end strategies comes from mathematical models that predict extinction after a tipping point, but this study documents such a strategy in action and defines the conditions that lead to a lineage’s demise. “The tipping point occurs when invaders are abundant,” Pruitt says. “Without them, colonies founded by docile individuals would flourish, but with them, they succumb to extinction.” The results from this study suggest something about aggression in general, Pruitt adds. “Species without defense might be driven to extinction by enemies”.

“This is a great, robust study that takes the study of animal temperament—which is kind of narrow—and puts it into a broad evolutionary framework,” says James Traniello, a behavioral ecologist at Boston University. “The whole idea of evolutionary dead-end strategies is poorly understood,” he says. A number of studies, such as those on Darwin’s finches, document how species diversify in real time, Traniello says, “and here we have a study that shows what goes on at the opposite side, how lineages decline.”

Source: sciencemag.org