In fact, when patients who are on a commonly prescribed blood thinner stop taking aspirin, their risk of bleeding complications drops significantly, a Michigan Medicine study finds.

Researchers analyzed over 6,700 people treated at anticoagulation clinics across Michigan for venous thromboembolism, or blood clots, as well as atrial fibrillation, an irregular heart rhythm that can cause stroke. Patients were treated with the common blood thinner warfarin but also took aspirin despite not having history of heart disease.

"We know that aspirin is not a panacea drug as it was once thought to be and can in fact lead to more bleeding events in some of these patients, so we worked with the clinics to reduce aspirin use among patients for whom it might not be necessary," said Geoffrey Barnes, M.D., senior author of the study and a cardiologist at the University of Michigan Health Frankel Cardiovascular Center.

Over the course of the study intervention, aspirin use among patients decreased by 46.6%. With aspirin used less commonly, the risk of a bleeding complication dropped by 32.3% -- amounting to one major bleeding event prevented per every 1,000 patients who stop taking aspirin. Results are published in JAMA Network Open.

"When we started this study, there was already an effort by doctors to reduce aspirin use, and our findings show that accelerating that reduction prevents serious bleeding complications which, in turn, can be lifesaving for patients," said Barnes, who is also an associate professor of internal medicine at U-M Medical School. "It's really important for physicians and health systems to be more cognizant about when patients on a blood thinner should and should not be using aspirin."

This de-escalation of aspirin use is based off several studies that found concerning links between concurrent use of aspirin and different blood thinners.

One study reported that patients taking warfarin and aspirin for atrial fibrillation and VTE experienced more major bleeding events and had more ER visits for bleeding than those taking warfarin alone. Similar results occurred for patients taking aspirin and direct oral anticoagulants -- who were found more likely to have a bleeding event but not less likely to have a blood clot.

"While aspirin is an incredibly important medicine, it has a less widely used role than it did a decade ago," Barnes said. "But with each study, we are seeing that there are far fewer cases in which patients who are already on an anticoagulant are seeing benefit by adding aspirin on top of that treatment. The blood thinner they are taking is already providing some protection from clots forming."

For some people, aspirin can be lifesaving. Many patients who have a history of ischemic stroke, heart attack or a stent placed in the heart to improve blood flow -- as well as those with a history of cardiovascular disease -- benefit from the medication.

The challenge comes when some people take aspirin without a history of cardiovascular disease and are also prescribed an anticoagulant, said first author Jordan Schaefer, M.D., a hematologist at U-M Health and clinical associate professor of internal medicine at U-M Medical School.

"Many of these people were likely taking aspirin for primary prevention of heart attack or stroke, which we now know is less effective than once believed, and no one took them off of it when they started warfarin," Schaefer said. "These findings show how important it is to only take aspirin under the direction of your doctor and not to start taking over-the-counter medicines like aspirin until you review with your care team if the expected benefit outweighs the risk."

Additional authors include Josh Errickson, Ph.D., Xiaokui Gu, M.D., M.A., Tina Alexandris-Souphis, R.N., Brian Haymart, R.N., M.S., Eva Kline-Rogers, M.S., R.N., N.P., Suman L. Sood, M.D., MSCE, James B. Froehlich, M.D., M.P.H., all of University of Michigan, Mona A. Ali, Pharm.D., Department of Heart and Vascular Services at Beaumont Hospital, Scott Katz, D.O., Division of Hospital Medicine at Henry Ford Hospital, Jay H. Kozlowski, M.D., Huron Valley Sinai Hospital, Gregory D. Krol, M.D.,Vinay Shah, M.D., both of Department of Internal Medicine at Henry Ford Hospital.

New research from Edith Cowan University (ECU) has shown one type of muscle contraction is most effective at increasing muscle strength and muscle size -- and rather than lifting weights, the emphasis should be on lowering them.

The team, which also included researchers from Niigata University and Nishi Kyushu University in Japan and Brazil's Londrina State University, had groups of people perform three different types of dumbbell curl exercise and measured the results.

It found those who only lowered a weight saw the same improvements as those who raised and lowered weights -- despite only performing half the number of repetitions.

ECU's Professor Ken Nosaka said the results reinforced previous research indicating a focus on "eccentric" muscle contractions -- in which activated muscles are lengthened -- is more important to increasing strength and size of muscles, rather than the volume.

"We already know only one eccentric muscle contraction a day can increase muscle strength if it is performed five days a week -- even if it's only three seconds a day -- but concentric (lifting a weight) or isometric muscle contraction (holding a weight) does not provide such an effect," Professor Nosaka said.

"This latest study shows we can be far more efficient in the time we spend exercising and still see significant results by focusing on eccentric muscle contractions.

"In the case of a dumbbell curl, many people may believe the lifting action provides the most benefit, or at least some benefit, but we found concentric muscle contractions contributed little to the training effects."

Crunching the numbers

The study consisted of three groups who performed dumbbell curls twice a week for five weeks, plus a control group who did nothing.

Of the training groups, one performed eccentric-only muscle contractions (lowering weight), another concentric-only muscle contractions (lifting weight) and another performed both concentric and eccentric muscle contractions (lifting and lowering weight alternatively).

All three saw improvements in concentric strength, but this was the only improvement for the concentric-only group.

The eccentric-only and concentric-eccentric groups also saw significant improvements in isometric (static) strength and eccentric strength.

Most interestingly, despite the eccentric-only group doing half as many reps as those lifting and lowering weights, the gains in strength were very similar and the eccentric-only group also saw a greater improvement in muscle thickness, an indicator of muscle hypertrophy: 7.2 per cent compared to the concentric-eccentric group's 5.4 per cent.

"Understanding the benefits of eccentric-focused training can allow people to spend their time exercising more efficiently," Professor Nosaka said.

"With the small amount of daily exercise needed to see results, people don't necessarily even have to go to the gym -- they can incorporate eccentric exercise into their everyday routine."

Putting it into practice

So how can we put this knowledge to use in the gym?

Using a dumbbell, Professor Nosaka recommends using two hands to help with the concentric (lifting weight) phase, before using one arm for the eccentric phase (lowering weight), when performing:

• Bicep curls
• Overhead extension
• Front raise
• Shoulder press

Using leg weight machines, Professor Nosaka recommends using the same concentric/eccentric technique when performing:

• Knee extensions
• Leg curls
• Calf raises

Looking after home bodies

Happily, Professor Nosaka says you don't need gym weights to apply the same principles to a workout and has come up with several simple exercises one can do at home.

In the exercises, feel that the contracting muscles are gradually stretched from the start to the end of the range of motion.

After each eccentric muscle contraction, minimise the effort to go back to the starting position (i.e., concentric muscle contraction).

Repeat 10 times for each exercise.

Chair sit: From a half-squatting position, sit down slowly on a chair in three seconds, (narrower and wider stances will create different effects). If this is easy, try to sit down with one leg.

Chair recline: Sit on the front of a chair to make a space between your back and the backrest, recline back slowly in three seconds (arms can be crossed at the chest or hold at the back of a head).

Uneven squat: Stand behind a chair, lean to one side to put more weight on one leg, then squat down in three seconds.

Heel down: Still behind a chair, lean forward and raise your heels. Then, lift one leg off the ground and lower the heel of the other leg in three seconds.

Wall kiss: Lean against a wall with both arms fully extended. Bend the elbow joint slowly over three seconds until your face gets close to the wall.

Front lunge: Place one leg in front of the other and bend the knees deeper over three seconds.

'Comparison between concentric-only, eccentric-only and concentric-eccentric resistance training of the elbow flexors for their effects on muscle strength and hypertrophy' was published in the European Journal of Applied Physiology.

Corporal punishment can be simply defined as the "intentional infliction of physical pain by any means for the purpose of punishment, correction, discipline, instruction, or any other reason." This violence, particularly when inflicted by a parent, evokes a complex emotional experience. The researchers, led by Kreshnik Burani, MS, and working with Greg Hajcak, PhD, at Florida State University, wanted to understand the neural underpinnings of that experience and its downstream consequences.

The study appears in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, published by Elsevier.

The researchers conducted a longitudinal study on 149 boys and girls ages 11 to 14 from the Tallahassee, FL, area. Participants performed a video game-like task and a monetary guessing game while undergoing continuously recorded electroencephalography, or EEG -- a noninvasive technique to measure brain-wave activity from the scalp. From the EEG data, the researchers determined two scores for each participant -- one reflecting their neural response to error and the other reflecting their neural response to reward.

Two years later, participants and their parents completed a series of questionnaires to screen for anxiety and depression and to assess parenting style. As expected, kids who had experienced corporal punishment were more likely to develop anxiety and depression.

"Our paper first replicates the well-known negative effect that corporal punishment has on a child's wellbeing: we found that corporal punishment is associated with increased anxiety and depressive symptoms in adolescence. However, our study goes further to demonstrate that corporal punishment might impact brain activity and neurodevelopment," said Burani.

That was reflected by larger neural response to error and a blunted response to reward in the adolescents who received physical punishments.

"Specifically," Burani added, "our paper links corporal punishment to increased neural sensitivity to making errors and decreased neural sensitivity to receiving rewards in adolescence. In previous and ongoing work with Dr. Hajcak, we see that increased neural response to errors is associated with anxiety and risk for anxiety, whereas decreased neural response to rewards is related to depression and risk for depression. Corporal punishment, therefore, might alter specific neurodevelopmental pathways that increase risk for anxiety and depression by making children hypersensitive to their own mistakes and less reactive to rewards and other positive events in their environment."

Cameron Carter, MD, Editor of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, said of the findings, "Using EEG, this study provides new insights into the mechanisms that may underlie the adverse effects of corporal punishment on mental health in children as well as the neural systems that may be affected."

The work provides new clues as to the neural underpinnings of depression and anxiety and could help guide interventions for at-risk youth.

The study was led by a team of researchers: Dr. Irit Zohar, a researcher at TAU's Steinhardt Museum of Natural History and curator of the Beit Margolin Biological Collections at Oranim Academic College, and HU Professor Naama Goren-Inbar, director of the excavation site. The research team also included Dr. Marion Prevost at HU's Institute of Archaeology; Prof. Nira Alperson-Afil at BIU's Department for Israel Studies and Archaeology; Dr. Jens Najorka of the Natural History Museum in London; Dr. Guy Sisma-Ventura of the Israel Oceanographic and Limnological Research Institute; Prof. Thomas Tütken of the Johannes Gutenberg University in Mainz and Prof. Israel Hershkovitz at TAU's Faculty of Medicine.

Dr. Zohar and Dr. Prevost: "This study demonstrates the huge importance of fish in the life of prehistoric humans, for their diet and economic stability. Further, by studying the fish remains found at Gesher Benot Ya'aqob we were able to reconstruct, for the first time, the fish population of the ancient Hula Lake and to show that the lake held fish species that became extinct over time. These species included giant barbs (carp like fish) that reached up to 2 meters in length. The large quantity of fish remains found at the site proves their frequent consumption by early humans, who developed special cooking techniques. These new findings demonstrate not only the importance of freshwater habitats and the fish they contained for the sustenance of prehistoric man, but also illustrate prehistoric humans' ability to control fire in order to cook food, and their understanding the benefits of cooking fish before eating it."

In the study, the researchers focused on pharyngeal teeth (used to grind up hard food such as shells) belonging to fish from the carp family. These teeth were found in large quantities at different archaeological strata at the site. By studying the structure of the crystals that form the teeth enamel (whose size increases through exposure to heat), the researchers were able to prove that the fish caught at the ancient Hula Lake, adjacent to the site, were exposed to temperatures suitable for cooking, and were not simply burned by a spontaneous fire.

Until now, evidence of the use of fire for cooking had been limited to sites that came into use much later than the GBY site -- by some 600,000 years, and ones most are associated with the emergence of our own species, homo sapiens.

Prof. Goren-Inbar added: "The fact that the cooking of fish is evident over such a long and unbroken period of settlement at the site indicates a continuous tradition of cooking food. This is another in a series of discoveries relating to the high cognitive capabilities of the Acheulian hunter-gatherers who were active in the ancient Hula Valley region. These groups were deeply familiar with their environment and the various resources it offered them. Further, it shows they had extensive knowledge of the life cycles of different plant and animal species. Gaining the skill required to cook food marks a significant evolutionary advance, as it provided an additional means for making optimal use of available food resources. It is even possible that cooking was not limited to fish, but also included various types of animals and plants."

Prof. Hershkovitz and Dr. Zohar note that the transition from eating raw food to eating cooked food had dramatic implications for human development and behavior. Eating cooked food reduces the bodily energy required to break down and digest food, allowing other physical systems to develop. It also leads to changes in the structure of the human jaw and skull. This change freed humans from the daily, intensive work of searching for and digesting raw food, providing them free time in which to develop new social and behavioral systems. Some scientists view eating fish as a milestone in the quantum leap in human cognitive evolution, providing a central catalyst for the development of the human brain. They claim that eating fish is what made us human. Even today, it is widely known that the contents of fish flesh, such as omega-3 fatty acids, zinc, iodine and more, contribute greatly to brain development.

The research team believe that the location of freshwater areas, some of them in areas that have long since dried up and become arid deserts, determined the route of the migration of early man from Africa to the Levant and beyond. Not only did these habitats provide drinking water and attracted animals to the area but catching fish in shallow water is a relatively simple and safe task with a very high nutritional reward.

The team posits that exploiting fish in freshwater habitats was the first step on prehistoric humans' route out of Africa. Early man began to eat fish around 2 million years ago but cooking fish -- as found in this study -- represented a real revolution in the Acheulian diet and is an important foundation for understanding the relationship between man, the environment, climate, and migration when attempting to reconstruct the history of early humans.

It should be noted that evidence of the use of fire at the site -- the oldest such evidence in Eurasia -- was identified first by BIU's Prof. Nira Alperson-Afil. "The use of fire is a behavior that characterizes the entire continuum of settlement at the site," she explained. "This affected the spatial organization of the site and the activity conducted there, which revolved around fireplaces." Alperson-Afil's research of fire at the site was revolutionary for its time and showed that the use of fire began hundreds of thousands of years before previously thought.

HU's Goren-Inbar added that the archaeological site of GBY documents a continuum of repeated settlement by groups of hunter-gatherers on the shores of the ancient Hula Lake which lasting tens of thousands of years. "These groups made use of the rich array of resources provided by the ancient Hula Valley and left behind a long settlement continuum with over 20 settlement strata," Goren-Inbar explained. The excavations at the site have uncovered the material culture of these ancient hominins, including flint, basalt, and limestone tools, as well as their food sources, which were characterized by a rich diversity of plant species from the lake and its shores (including fruit, nuts, and seeds) and by many species of land mammals, both medium-sized and large.

Dr. Jens Najorka of the Natural History Museum in London explained: "In this study, we used geochemical methods to identify changes in the size of the tooth enamel crystals, as a result of exposure to different cooking temperatures. When they are burnt by fire, it is easy to identify the dramatic change in the size of the enamel crystals, but it is more difficult to identify the changes caused by cooking at temperatures between 200 and 500 degrees Celsius. The experiments I conducted with Dr. Zohar allowed us to identify the changes caused by cooking at low temperatures. We do not know exactly how the fish were cooked but given the lack of evidence of exposure to high temperatures, it is clear that they were not cooked directly in fire, and were not thrown into a fire as waste or as material for burning."

Dr. Guy Sisma-Ventura of the Israel Oceanographic and Limnological Research Institute and Prof. Thomas Tütken of the Johannes Gutenberg University Mainz were also part of the research group, providing analysis of the isotope composition of oxygen and carbon in the enamel of the fishes' teeth. "This study of isotopes is a real breakthrough, as it allowed us to reconstruct the hydrological conditions in this ancient lake throughout the seasons, and thus to determine that the fish were not a seasonal economic resource but were caught and eaten all year round. Thus, fish provided a constant source of nutrition that reduced the need for seasonal migration."