Saturday, January 31, 2015

GREAT SQUAT VARIATIONS

Want to master the king of leg exercises? Start with the goblet and landmine squats and you'll experience royal gains in strength, size, and form faster than you can get under the bar.



TAKE A VACATION FROM BACK SQUATTING AND DIAL IN YOUR SQUATTING PATTERN WITH THESE TWO RELATIVELY FOOLPROOF VARIATIONS.
Squats are often touted as the king of lifts—not just for legs, but all lifts. 
But for most people who step under the bar, the only thing that's royal is the pain in their lower back the next day. 
You may think I'm just talking about newbs who pit themselves against a barbell way out of their league—and I wish I was.
The fact is, however, that most people in the weight room are atrocious squatters. 
Don't believe me? Just walk into virtually any commercial gym in the country and have a look around. Your eyes might start bleeding.
As good as well-executed squats may be for strength and leg development, poorly executed squats are not only ineffective for leg development, but also downright dangerous. 
Many lower backs and knees have been pretty much ruined from poor squatting.
The answer isn't to stop squatting; it's to squat better. So do yourself a favor: 
Take a vacation from back squatting and dial in your squatting pattern with these two relatively foolproof variations. It could be the best decision you make in the gym this year.

SQUAT 1 THE GOBLET SQUAT

Goblet squats with a dumbbell or kettlebell—popularized by well-known strength coach Dan John—are all many folks need to clean up their squat pattern. 

The anterior loading helps engage the core in a way that allows most lifers to achieve better depth than they ever could when back squatting. 
It also reminds them to keep an upright torso, because if they lean forward they'll drop the weight.
The technique is simple. Lil' John actually unknowingly nailed the coaching cues in one of his recent smash hits when he shouted, "Make ya knees touch ya elbows." 
Seriously, that's it. Just don't bounce to it! Pause at the bottom like I do here.

HOW TO: GOBLET SQUAT 

WATCH THE VIDEO


 Of course, the problem with goblet squats is that once you want to hold on to heavier weights, you'll find yourself limited by your upper-body strength. Since you're squatting for your legs, that's not ideal.

When that happens, try this unique goblet squat dropset. Start off your set with goblet squats for a predetermined number of reps. Then drop the weight down as if you were going to perform swings, and continue squatting for the same number of reps that you did for goblet squats. This allows you to reap the benefits of goblet squats and work your anterior core while also allowing your legs to get more of a training effect.
Here's what it looks like in action:

GOBLET SQUAT "DROP SET" 
WATCH THE VIDEO - 01:17




This isn't a dropset in the traditional sense, where you incrementally decrease the load as you fatigue. It's what's known as a "mechanical dropset," where you switch to an easier variation as you fatigue. Whatever you call it, it's a simple yet very effective way to get in lots of quality reps.

SQUAT 2 THE LANDMINE SQUAT

While goblet squats are great, they're not totally foolproof. If you're still struggling to stay upright while holding dumbbells and kettlebells, you may have better luck with landmine squats. Landmine squats are very similar to goblet squats in that they are anteriorly loaded, but in a landmine squat the bar travels in an arc. This helps reinforce the necessity of maintaining an upright torso, because if you come forward, the bar jams into your sternum.
I particularly like landmine squats for taller lifters, because taller lifters tend to have the hardest time squatting with good technique. The landmine usually cleans up the pattern quickly and easily. Here's what landmine squats look like in action as demonstrated by my client Ryan, who is 6-foot-3.

LANDMINE SQUATS
WATCH THE VIDEO - 00:48



You'll notice in the video that Ryan is able to achieve great depth while maintaining a very upright torso, and without a lot of forward knee travel like you'll often see in a traditional squat. This variation is fantastic for working the quads, but also for getting a good strength-training effect without much stress on the lower back and knees.
It can also be useful to perform landmine squats to a box or low bench to help serve as a depth gauge so you don't start cutting your squats high. This addition also serves as a reminder to sit back into the squat rather than letting the hips come forward.
Here's a video of UFC athlete Brendan Schaub crushing some heavy weight with good technique at 6-foot-4.

BRENDAN SCHAUB LANDMINE BOX SQUATS 
WATCH THE VIDEO - 00:48



If you were surprised to see that much weight on the bar in a landmine squat, don't be. Heavy landmine squats are a solid squat alternative for people with injuries, or who are looking for a higher-frequency squatting program but can't perform heavy barbell squats day in and day out. So load it up!

BONUS SQUAT VARIATION LANDMINE SQUAT-TO-PRESS

If seeing those landmine squats made you think about all the other things you can do with this underappreciated tool, this one's for you. After you've knocked out your squats with perfect form, you can add in a press at the end of the squat, as demonstrated here by trainer Kevin Anderson at the start of this brutal landmine complex.

BRUTAL LANDMINE COMPLEX 
WATCH THE VIDEO - 03:19



Adding in the press can work well if you're looking to achieve a full-body training effect, and it can also work well for individuals who struggle to bring their hips through at the top of the squat. You'll find that you must come all the way through with your hips in order to perform the press.
Spend awhile with these variations, and watch your squat strength soar to new heights while your body feels a whole lot better—a win-win.

What are the health benefits of zinc?

Zinc is an important mineral required for countless reactions and functions in the body, including proper growth and immune function, DNA synthesis, cell division and cellular metabolism. The highest concentrations of zinc in the body are found in the liver, pancreas, kidney, bone, muscles and eyes.
The World Health Organization (WHO) has identified zinc deficiency as one of the top factors contributing to disease in underdeveloped countries.
This article provides an in-depth look at recommended intake of zinc, its possible health benefits, foods high in zinc and any potential health risks of consuming zinc.

Recommended intake

The Recommended Daily Allowance (RDA) for zinc is 8 milligrams per day for adult females and 11 milligrams per day for adult males.
zinc periodic table
Zinc is required for countless reactions and functions in the body, including proper growth and immune function, DNA synthesis, cell division and cellular metabolism.
Adequate zinc intake is especially important for children because even mild zinc deficiency can impede growth, increase risk of infection and increase risk of diarrhea and respiratory disease.
The recommended intake for children 1-8 years old ranges from 3-5 milligrams, increasing as the child gets older.
Males 9-13 years old require 8 milligrams of zinc per day. After the age of 14, the requirement increases to the 11 milligrams per day that is required for all adult males.
For females over the age of 8, the requirement stays stable at 8 milligrams per day, except for ages 14-18, where the recommendation increases to 9 milligrams per day.
Pregnant and lactating women have an increased need for zinc at 11-13 milligrams per day, depending on age.
Along with growth retardation, zinc deficiency can cause delayed wound healing, decreased taste perception, skin lesions, night blindness and hair loss. Zinc deficiency has also been linked with neuronal plasticity defects and impact behavior in children with ADHD.5
Zinc supplements are available, but it is best to obtain any vitamin or mineral through food. It is not the individual vitamin or mineral alone that make certain foods an important part of our diet, but the synergy of nutrients in that food working together.
It has been proven time and again that isolating certain nutrients in supplement form will not provide the same health benefits as consuming the nutrient from a whole food. First focus on obtaining your daily zinc requirement from foods, then use supplements as a backup if necessary.

Possible health benefits of consuming zinc


Common cold

Although zinc deficiency is known to depress immune function, the widely used zinc gluconate lozenges and chews often used to prevent or treat the common cold have not yet been found to be an effective treatment in studies and trials in those with normal zinc status.

Proper growth

Zinc deficiency was first discovered in adolescent boys suffering from mild anemia, short stature and delayed sexual maturation. Their diets were high in unrefined cereals and unleavened breads, both high in phytate, which competes with zinc for absorption.
Once zinc deficiencies were corrected, the boys grew as much as 5 inches per year. Infant and children's foods such as ready to eat cereals are now fortified with zinc.

Decreased risk of age-related chronic disease

A study from researchers at Oregon State University have found that improving zinc status through diet and supplementation may reduce the risk of inflammatory diseases.
Using cell cultures, and a mouse model, researchers were able to show that age-related reductions in zinc status may lead to impaired immune system function and systemic inflammation, both contributing factors to chronic diseases.
Adults 60 years of age and older from food-insufficient households have a significantly higher risk of zinc deficiency, reporting an intake of less than 50% of the Recommended Daily Intake for zinc compared with adults from food-sufficient households.2

Fighting age-related macular degeneration (AMD):

AMD is an age-related disease that gradually deteriorates the part of the eye responsible for clear central vision, significantly decreasing reading ability and facial recognition. Zinc supplementation has been shown to the decrease risk of developing more advanced AMD by 25% and lower risk of central vision loss by 19%.

Wound healing

Zinc plays a role in maintaining skin integrity and structure. Patients experiencing chronic wound or ulcers often have deficient zinc metabolism and lower serum zinc levels. Those with low levels should be treated with increased zinc. However, research has not consistently shown that use of zinc sulfate in patients with chronic wounds or ulcers is effective at improving healing rate.

Fertility

Several studies and trials have linked poor zinc status with low sperm quality. For example, one study in the Netherlands found that subjects had a higher sperm count after zinc sulfate and folic acid supplementation.3
In another study, researchers concluded that poor zinc intake may be a risk factor for low quality of sperm and male infertility.

Foods sources of zinc

The best sources of zinc are beans, animal meats, nuts, fish and other seafood, whole grain cereals and dairy products. Zinc is also added to some breakfast cereals and other fortified foods.
The typical western diet allows for adequate zinc intake, at an average range of between 10-15 milligrams per day.
Several dietary factors can decrease zinc absorption. Phytates (found in whole-grain breads, cereals and legumes), copper, calcium and folic acid may all reduce zinc absorption. Zinc absorption is increased when consumed with red wine, glucose, lactose or soy protein.
Vegetarians may require up to 50% more than the recommended intake of zinc because of low bioavailability of zinc from plant-based foods.
pacific oysters
Raw oysters are a valuable source of zinc, containing 14.1 mg per 3 oz.
  • Raw oysters (Pacific), 3 oz: 14.1 mg
  • Beef, lean chuck roast, braised, 3 oz: 7.0 mg
  • Baked beans, canned, ½ cup: 6.9 mg
  • Crab, King Alaskan, cooked, 3 oz: 6.5 mg
  • Ground beef, lean, 3 oz: 5.3 mg
  • Lobster, cooked, 3 oz: 3.4 mg
  • Pork loin, lean, cooked, 3 oz: 2.9 mg
  • Wild rice, cooked, ½ cup: 2.2 mg
  • Peas, green, cooked, 1 cup: 1.2 mg
  • Yogurt, plain, 8 oz: 1.3 mg
  • Pecans, 1 oz: 1.3 mg
  • Peanuts, dry roasted, 1 oz: 0.9 mg.

Potential health risks of consuming zinc

The upper limit for zinc in adults is 40 milligrams per day. Ingestion of toxic amounts of zinc is rare, but can cause GI irritation and vomiting.1 High levels of zinc supplementation are known to cause copper deficiency and impair iron absorption.
It is the total diet or overall eating pattern that is most important in disease prevention and achieving good health. It is better to eat a diet with a variety than to concentrate on individual nutrients as the key to good health.
References:
1.        Mahan, L. Kathleen and Escott-Stump, Sylvia. Krause’s Food & Nutrition Therapy, 12th edition, Saunders Elsevier, St. Louis, MS, Copyright 2008.
2.        Zinc and inflammation — age-related zinc deficiency may contribute to chronic disease risk, Marie Spano, MS, RD, CSCS, CSSD, Today’s Dietitian, Vol. 15 No. 1 P. 52, accessed 21 January 2015.
3.        Improving male fertility — research suggests a nutrient-dense diet may play an integral role, Sharon Palmer, RD, Today’s Dietitian, Vol. 15 No. 6 P. 40, accessed 21 January 2015.
4.        Age-related macular degeneration, Megan Tempest, RD, Today’s Dietitian, Vol. 15 No. 10 P. 50, accessed 21 January 2015.
5.        Research shows combination of key nutrients reduces stress, emotional problems in ADHD, Today’s Dietitian, accessed 21 January 2015.

Mold in the home: how big a health problem is it?


For many people, January is a cold and damp month. During the winter, activities at home can lead to increased humidity and moisture indoors and, unfortunately, this can lead to the growth of mold.

Large patch of black mold next to window.
Indoor mold growth is a common problem and is most likely to occur during the fall and winter months.
Walls, clothes, books, toys and even CDs - nothing is sacred when it comes to mold growth. Its seemingly insidious growth can turn prized possessions into musty, moist sadness that only look fit for the garbage.
But for all its corrupting menace, to what extent should we be worried about mold when it invades our homes? If these are the effects that it can have on our possessions, what effects can it have on our bodies?
In this spotlight feature, we take a look at precisely what mold is, what causes it to grow, whether it is bad for our health and, if so, what can be done to stop it.

What is mold?

Molds are a form of fungus. There are many different molds and they can be found both indoors and outdoors. Molds spread through the production of spores, which are present in all indoor environments and cannot be removed from them - spores are capable of surviving in harsh conditions that otherwise prevent the normal mold growth.
Molds grow best in moist, warm and humid environments - easily created in the home during the winter. When mold spores land on a damp spot they can begin to grow, digesting the material they are growing on as they do so. Molds are capable of growing on a variety of different surfaces, including fabric, paper and wood.
Common indoor molds include:
  • Alternaria - found in damp places indoors, such as showers or under leaky sinks
  • Aspergillus - often found indoors growing on dust, powdery food items and building materials, such as drywall
  • Cladosporium - capable of growing in cool areas as well as warm ones. It is typically found on fabrics and wood surfaces
  • Penicillium - typically found on materials that have been damaged by water and often has a blue or green appearance.
Molds take a variety of forms and textures, appearing as white, black, yellow, blue or green and often looking like a discoloration or stain to a surface. They can also have a velvety, fuzzy or rough appearance, depending on the type of mold and where it is growing.

How does mold get into our houses?

Damp patch with mold in ceiling corner.
Large patches of damp, such as those caused by leaks, provide an ideal environment for mold growth.
Mold spores, invisible to the naked eye, can be found everywhere, both indoors and outdoors. Spores make their way into the home either through the air or after attaching to objects or people. 
Open windows, doorways and ventilation systems are all gateways through which spores can enter. Clothing, shoes and pets can all facilitate the arrival of mold within the home.
Mold will only grow if spores land somewhere that has the ideal conditions for growing - places with excessive moisture and a supply of suitable nutrients. If this does not happen, molds do not normally cause any problem at all.
Mold can often be found in areas where leakages and flooding have occurred and near windows where condensation builds up. Wet cellulose materials are most supportive of mold growth, including paper products, cardboard, ceiling tiles and wood products. Wallpaper, insulation materials and upholstery are other typical launchpads for mold growth.
Mold growth is usually noticeable - it is usually visible and often produces a musty odor.
The World Health Organization (WHO) report that 10-50% of indoor environments in Europe, North America, Australia, India and Japan are estimated to be affected by indoor dampness. This figure suggests that mold could be a highly prevalent issue in locations spread across the world.
In North America, the US Environmental Protection Agency (EPA) state that "if mold is a problem in your home, you should clean up the mold promptly and fix the water problem." But do the EPA recommend dealing with mold swiftly because of the damage it can do to property? Or because of the damage it could do to health?

Potential effects of mold on health

"Mold exposure does not always present a health problem indoors," state the Centers for Disease Control and Prevention (CDC). "However some people are sensitive to molds."
Meanwhile, the WHO say that a moldy environment is associated with and could worsen indoor air pollution - a risk factor for certain respiratory conditions:
"Excess moisture on almost all indoor materials leads to growth of microbes, such as mold, fungi and bacteria, which subsequently emit spores, cells, fragments and volatile organic compounds into indoor air. Moreover, dampness initiates chemical or biological degradation of materials, which also pollutes indoor air."
Molds can produce a number of substances that can be harmful. Allergens, irritants and mycotoxins - potentially toxic substances - can affect individuals who are particularly sensitive to them.
In particular, the EPA state that exposure to molds can irritate the eyes, lungs, nose, skin and throats of individuals, even if they do not have a mold allergy.
Mold allergies produce similar symptoms to other allergies to airborne substances affecting the upper respiratory tract, such as pollinosis. These include:
  • Blocked/runny nose
  • Itchy nose
  • Itchy throat
  • Sneezing
  • Watery eyes.
In addition, people with a mold allergy that also have asthma are at an increased risk of having their asthma symptoms triggered by a moldy environment, according to the CDC.
In fact, the presence of indoor mold can go further than simply exacerbating pre-existing conditions:
"Certain mold species can cause serious lung infections and scarring. For instance, in some asthmatics, inhaling the spores of a species of mold called aspergillus can lead to a condition called allergic bronchopulmonary aspergillosis, which can impact on the breathing."
Individuals whose immune and respiratory systems are already weakened by chronic conditions would appear to be more susceptible to adverse effects from indoor mold. 
In addition, among patients with certain blood disorders, inhaling mold could even lead to fatal complications.
Although more conclusive evidence is required, the CDC report that some research suggests there could be an association between indoor exposure to mold and the development of respiratory conditions in otherwise healthy people.
In 2004, the Institute of Medicine (IOM) reported that there was enough evidence to connect indoor mold with the development of upper respiratory tract problems in healthy people, and some evidence suggesting the same in healthy children.
More recently, the CDC state that exposure to mold early in a child's life could be associated with the development of asthma. However, this theory is opposed by the hygiene hypothesis.
The WHO's guidelines for indoor air quality explain the hygiene hypothesis - the theory that growing up in a hygienic environment can increase the risk of a person developing allergies. Several studies have found evidence supporting the hygiene hypothesis, but evidence so far has been mixed.
As a result, the WHO conclude that there is "sufficient evidence of an association between indoor dampness-related factors and a wide range of respiratory health effects," including asthma, respiratory infections, coughing, wheezing and dyspnea.
While heavy exposure to indoor mold could plausibly play a causal role in the development of these health conditions, the WHO state that such an association has yet to be established conclusively.

Protection and prevention

Condensation on window creating mold.
Condensation on windows often leads to mold growth. Reducing humidity levels indoors or increasing ventilation can prevent it from occurring.
Despite the inconclusive nature of current research, the CDC and EPA recommend that any mold growth should be dealt with promptly.
Both organizations state that controlling moisture is most crucial to preventing mold from growing indoors. 
Acting quickly in the event of a leak or spillage is important, and drying areas within 48 hours of exposure to excess moisture should ensure that mold will not grow.
The level of humidity within the home is another important factor. Although it may not be immediately apparent, a high level of moisture in the air will promote mold growth. Condensation on windows is often a sign that humidity is high within a room.
Increasing ventilation by opening windows or using an extractor fan reduces the level of moisture in the air. Humidity can also be reduced in specific rooms by avoiding moisture-producing activities in them, such as drying clothes or using kerosene heaters.
When cleaning mold from hard surfaces, commercial products, soap and water or a heavily-diluted bleach solution can be used. Always dry surfaces that have been cleaned thoroughly to prevent mold from growing back.
Be wary of porous materials that have been affected by molds, such as fabric or wood. Mold can infiltrate these materials, may be impossible to remove completely and could potentially grow back if the conditions are right. In many cases, it may be best to get rid of items such as these that have been affected for a long period.
Patches of mold that are larger than 3 ft by 3 ft may be best tackled by professional mold cleaning experts.
If you are worried by any potential exposure to mold or you believe that you are having associated health problems, it is recommended that you contact a health service provider.

Tidy house, tidy mind

While evidence is inconclusive overall as to the extent that mold can affect health, there appears to be enough evidence available to suggest that people should be wary of it.
Even if it is the case that mold does not cause health problems, as some studies have suggested, the presence of mold indoors is indicative of a damp environment, which is known to be hazardous to health.
The impetus for getting rid of mold from the home is also much greater if the health of affected individuals is in any way compromised by chronic lung conditions or immune system impairment.
It may just be a case of reassurance, that having a home free of mold equals having a mind free of doubt and worry. 
Patches of odorous toxic-looking black mold can seem intimidating, and while it is possible that these might not be harmful to everyone, there is nothing like a clean, airy and dry room to instill confidence about one's health.
References:
1.     Adverse human health effects associated with molds in the indoor environment, BD Hardin, et al., J Occup Environ Med., published online May 2003, abstract.
2.     CDC, Facts about stachybotrys chartarum and other molds, accessed 27 January 2015.
3.     CDC, Mold - basic facts, accessed 26 January 2015.
4.     CDC, Protect yourself from mold, accessed 28 January 2015.
5.     Cleveland Clinic, Aspergillosis, accessed 27 January 2015.
6.     EPA, A brief guide to mold, moisture, and your home, accessed 26 January 2015.
7.     Everyday Health, Household molds and your health, accessed 27 January 2015.
8.     Mold-Advisor, Mold types found in homes, accessed 27 January 2015.
9.     WHO, WHO guidelines for indoor air quality - dampness and mould, accessed 27 January 2015.

Targeted biopsy 'better at detecting high-risk prostate cancers than standard biopsy'

If results of a prostate-specific antigen test or digital rectal exam are positive, the next port of call is normally a prostate biopsy to confirm whether cancer is present. 
In a new study published in JAMA, researchers claim a targeted biopsy method is much more accurate in detecting high-risk prostate cancers than the standard biopsy technique.
An illustration of the prostate
Targeted biopsy using a combination of MRI and ultrasound identified 30% more high-risk prostate cancers than standard biopsy, a study found.
The standard method of prostate biopsy, also referred to as a core needle biopsy, involves a doctor removing samples of tissue from the prostate using a thin, hollow needle. 
The samples are then sent to a pathologist who views them under a microscope and assesses them for cell abnormalities that indicate cancer.
But the research team, at the University of Maryland School of Medicine, says the technique used in their study involves a combination of ultrasound and magnetic resonance imaging (MRI), which they say can effectively differentiate high-risk prostate cancers from those that are low risk.
The researchers said that, there is a concern that we overdiagnose and overtreat low-risk cancers that are unlikely to be terminal, and this technology enables us to make a more reliable diagnosis than the current standard practice.
According to the background information of the study, the accuracy of prostate cancer detection with targeted biopsy alone compared with that of standard biopsy has been unclear, as has the accuracy of both methods combined.
The research team analyzed 1,003 men who had been referred for biopsy following either a positive prostate-specific antigen (PSA) test or a digital rectal examination (DRE). All men received a standard biopsy and a targeted ultrasound/MRI biopsy, and the researchers compared the prostate cancer detection accuracy of each method.
The results of the analysis revealed that 461 prostate cancer cases were diagnosed with standard biopsy and 469 were diagnosed with targeted biopsy. In 69% of cases, both methods revealed the same outcomes.
However, the research team found that the targeted biopsy identified 30% more high-risk cancers than the standard biopsy and 17% fewer low-risk cancers. A combination of both targeted and standard biopsy led to 22% more low-risk cancers being diagnosed.
In addition, the research team used each technique to assess biopsied tissue and tissue taken from the prostate of 170 men who underwent a prostatectomy - surgical removal of the prostate gland.
From this, they found that the targeted biopsy was better at identifying low- and intermediate-risk prostate cancers than the standard biopsy.

Targeted therapy may 'enhance ability to identify patients with high-risk prostate cancers'

Because current diagnostic techniques for prostate cancer are unable to determine between aggressive and nonaggressive types, most patients who test positive for the disease receive treatment for it, such as radiation therapy or a prostatectomy.
However, the majority of men diagnosed with prostate cancer have tumors that progress so slowly that they may never experience cancer-related complications, meaning they may receive unwarranted cancer treatment.
As such, these latest findings are important as they suggest potential for a more accurate diagnostic method for prostate cancer.
"This study demonstrates that targeted fusion-guided biopsy could significantly enhance our ability to identify patients with high-risk prostate cancers that need more aggressive treatment.
While these findings could translate into substantial benefit to patients, this study is preliminary with regard to clinical endpoints, such as recurrence of disease and prostate cancer-specific mortality."
The research team says further studies are warranted to assess how targeted biopsy affects the clinical outcomes of patients with prostate cancer.
In an editorial linked to the study, another team of clinicians at Columbia University College of Physicians and Surgeons in New York, NY, at the University of North Carolina and associate editor of JAMA, say any test that has the potential to improve diagnosis and reduce any unnecessary treatment is "appealing."
"Nonetheless," they add, "a new test should not be widely adopted in the absence of direct evidence showing benefits on quality of life, life expectancy, or ideally both. 
Therefore, the scientific community has the responsibility to ensure through clinical research that promising new technologies such as MR/ultrasound fusion imaging-guided biopsies bring value to patients."
References:
1.     Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer, Mohammad Minhaj Siddiqui, et al., JAMA, doi:10.1001/jama.2014.17942, published online 27 January 2015, abstract.

2.     MR/ultrasound fusion-guided biopsy in prostate cancer: what Is the evidentiary standard?, Lawrence H. Scwartz, Ethan Basch,JAMA, doi:10.1001/jama.2014.17943, published online 27 January 2015, editorial.

3.     JAMA news release, accessed 26 January 2015.

4.     University of Maryland news release, accessed 26 January 2015 via Newswise.