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NASA-NOAA's Suomi NPP satellite kept an eye on Hurricane Genevieve overnight and provided infrared imagery to forecasters who were monitoring the storm's strength, structure and size. Because Genevieve is close to the coast of western Mexico, warnings and watches were still in effect.

NASA's Night-Time View of Genevieve

The Visible Infrared Imaging Radiometer Suite (VIIRS) instrument aboard Suomi NPP provided a nighttime image of Hurricane Genevieve on Aug. 18 at 8 p.m. EDT (Aug. 19 at 0000 UTC).The hurricane's eye was still visible and well defined. It was surrounded by powerful thunderstorms, although deep convection is generally lacking over the southwestern portion of the circulation.  The image was created using the NASA Worldview application.

Warnings and Watches on Aug. 19

NOAA's National Hurricane Center issued a Hurricane Warning for the southern Baja California peninsula from Los Barriles to Todos Santos, Mexico. A Tropical Storm Warning is in effect for the west coast of the Baja California peninsula from north of Todos Santos to Cabo San Lazaro, and a Tropical Storm Watch is in effect for the east coast of the Baja California peninsula from Los Barriles to La Paz.

Hurricane Genevieve's Status on Aug. 19

At 11 a.m. EDT (1500 UTC), the center of Hurricane Genevieve was located near latitude 20.9 degrees north and longitude 109.7 degrees west. That puts the eye about 140 miles (225 km) south of the southern tip of Baja California, Mexico. The estimated minimum central pressure is 959 millibars. Genevieve was moving toward the north-northwest near 9 mph (15 kph).

Maximum sustained winds are near 115 mph (185 km/h) with higher gusts.  Genevieve is a category 3 hurricane on the Saffir-Simpson Hurricane Wind Scale.

The NHC Forecast for Genevieve

NOAA's NHC forecast noted, "Gradual weakening is forecast over the next couple of days, but Genevieve is expected to remain a strong hurricane while it passes west of the southern Baja California peninsula. A turn toward the northwest is expected this afternoon or tonight, with this motion continuing through Friday night.  On the forecast track, the center of Genevieve is expected to move near but just southwest of the southern portion of the Baja California peninsula tonight and Thursday, and move away from the peninsula on Friday."

About NASA's EOSDIS Worldview

NASA's Earth Observing System Data and Information System (EOSDIS) Worldview application provides the capability to interactively browse over 700 global, full-resolution satellite imagery layers and then download the underlying data. Many of the available imagery layers are updated within three hours of observation, essentially showing the entire Earth as it looks "right now."

NASA Researches Earth from Space

For more than five decades, NASA has used the vantage point of space to understand and explore our home planet, improve lives and safeguard our future. NASA brings together technology, science, and unique global Earth observations to provide societal benefits and strengthen our nation. Advancing knowledge of our home planet contributes directly to America's leadership in space and scientific exploration.

For updated forecasts, visit: http://www.nhc.noaa.gov

By Rob Gutro 
NASA's Goddard Space Flight Center

Young gay men who are uncomfortable discussing sexual issues with their primary care providers and experience health care discrimination are less likely to seek coordinated care, leading to missed opportunities for early diagnosis of chronic and mental health issues, according to Rutgers researchers.

The study, published in the Journal of Gay and Lesbian Social Services, examined the types of health care facilities that young gay men use, their preference for coordinated health care and their satisfaction with the care provided.

Researchers found that dissatisfaction with health care - due to discrimination based on race, ethnicity, economic status or sexual orientation - greatly impacted how and where people seek medical care.

"Oftentimes, once gay patients disclose their sexual orientation, providers do not know how to respond in a sensitive way and many patients leave the encounter less likely to disclose this information in future visits," said Marybec Griffin, assistant professor at the Rutgers School of Public Health. "Even if the disclosure conversation is successful, many providers lack the knowledge of gay men's health issues, which translates to inappropriate screening and prevention service, including the low levels of HPV vaccination and site-specific STI [sexually transmitted infection] testing."

The Center for Health, Identity, Behavior and Prevention Studies researchers surveyed 800 young gay men in New York City between the ages of 18 and 29 who reported their health care usage and satisfaction across three factors: facility type, coordination of health care and satisfaction with care provided. They found that the health care system does not fully address the health care needs of gay men.

Participants who had prior experiences of discrimination in health care settings were less likely to seek care from a single provider and were more likely to be dissatisfied with health care as a result.

Those who had disclosed their sexual orientation and were comfortable discussing sexual activity with their health care provider were more likely to agree that their health care needs were being adequately addressed. Creating safe spaces that encourage disclosure of sexual orientation builds trust between patients and providers and allows for relevant screening and preventive services that young gay men need, researchers found.

The study also found that health care cost and convenience play an important role in accessing care. Participants who had a primary care provider were less likely to use walk-in models of health care, such as emergency rooms and urgent care facilities, indicating that once satisfactory care is established, patients will not doctor-shop or use more convenient types of care, allowing an ease of access and more anonymity for STI testing and treatment.

"As the use of non-traditional health care facilities like urgent care centers increases, it is important that providers in these settings are aware of the health care needs of gay men," said Perry N. Halkitis, dean of the Rutgers School of Public Health. "Providers in these settings should be trained on proper screening protocols for gay men, including sensitivity around soliciting information on sexual orientation and behaviors."

Alzheimer's disease is one of the most common causes of dementia, and while most people might know someone who is affected by it, the genetic factors behind the disease are less known. A new study by investigators from Brigham and Women's Hospital uncovered a group of closely related genes that may capture molecular links between Alzheimer's disease and Limbic-predominant Age-related TDP-43 Encephalopathy, or LATE, a recently recognized common brain disorder that can mimic Alzheimer's symptoms. LATE is often combined with Alzheimer's disease to cause a more rapid cognitive decline. The study's results are published in Neuron.

"Genetic variants that regulate other genes' expressions are thought to play an important role in human disease, but genome-wide discovery of these variants has been difficult given the large numbers of genes and genetic variants that have to be tested," said Philip De Jager, MD, PhD, formerly of the Brigham. De Jager is now the chief of the Division of Neuroimmunology at Columbia University and senior author of the study. "We decided to leverage a previously developed data-driven approach to group closely correlated genes together into gene modules so that we can focus on the expression of 47 gene modules, rather than targeting more than 13,000 individual brain-expressed genes."
Gene expression is the process in which the information encoded in a gene is used to assemble a protein. The investigators conducted a genome-wide screen of genetic variants that regulate gene expression using 494 autopsied brain samples from the Religious Orders Study (ROS) and the Rush Memory and Aging Project (MAP), community-based clinical-pathologic studies of aging and Alzheimer's disease. They observed that two genes, named TMEM106B and RBFOX1, regulate gene expression in the aging brain. The research team replicated their finding in an independent dataset from the Mayo RNAseq study, and analyzed clinical, autopsy, and genetic data to connect their findings with brain diseases that cause dementia.

The authors note that the study mainly analyzed people whose average age was close to 90 at their time of death and brain donation. Therefore, the study results should be interpreted cautiously outside of this context, and further studies are required to investigate whether their findings could be extended to other TDP-43 related conditions that affect younger patients, such as frontotemporal dementia and amyotrophic lateral sclerosis.
The research team also found that amyloid-β accumulation, a hallmark of Alzheimer's disease, and the TMEM106B risk variant both increased the expression of the same set of genes that are important in the function of lysosome, a cell compartment specializing in cellular waste removal. In turn, the increased expression of lysosomal genes correlated with LATE neuropathological change in human brain.
"It is becoming increasingly apparent that the frequent coexistence of Alzheimer's disease and LATE is not a coincidence," said Hyun-Sik Yang, MD, of the Division of Cognitive and Behavioral Neurology at the Brigham, who is the first author of the study. "We should further investigate the shared molecular links between Alzheimer's and LATE, so that one day we can treat and even prevent two of the most common causes of dementia in our rapidly aging population."

Researchers from Skoltech, INRIA and the RIKEN Advanced Intelligence Project have considered several state-of-the-art machine learning algorithms for the challenging tasks of determining the mental workload and affective states of a human brain. Their software can help design smarter brain-computer interfaces for applications in medicine and beyond. The paper was published in the IEEE Systems, Man, and Cybernetics Magazine.

A brain-computer interface, or BCI, is a link between a human brain and a machine that can allow users to control various devices, such as robot arms or a wheelchair, by brain activity only (these are called active BCIs) or can monitor the mental state or emotions of a user and categorize them (these are passive BCIs). Brain signals in a BCI are usually measured by electroencephalography, a typically noninvasive method of recording electrical activity of the brain.

But there is quite a long way from raw continuous EEG signals to digitally processed signals or patterns that would have the ability to correctly identify a user's mental workload or affective states, something that passive BCIs need to be functional. Existing experiments have shown that the accuracy of these measurements, even for simple tasks of, say, discriminating low from high workload, is insufficient for reliable practical applications.

"The low accuracy is due to extremely high complexity of a human brain. The brain is like a huge orchestra with thousands of musical instruments from which we wish to extract specific sounds of each individual instrument using a limited number of microphones or other sensors," Andrzej Cichocki, professor at the Skoltech Center for Computational and Data-Intensive Science and Engineering (CDISE) and a coauthor of the paper, notes.

Thus, more robust and accurate EEG classification and recognition of various brain patterns algorithms are badly needed. Cichocki and his colleagues looked at two groups of machine learning algorithms, Riemannian geometry based classifiers (RGC) and convolutional neural networks (CNN), which have been doing quite well on the active side of BCIs. The researchers wondered whether these algorithms can work not just with so-called motor imaginary tasks, where a subject imagines some movements of limbs without any real movement, but for workload and affective states estimation.

They ran a competition of sorts among seven algorithms, two of which the scientists designed themselves by further improving well-performing Riemannian methods. The algorithms were tested in two studies, one with a typical arrangement for BCIs where algorithms were trained on data from a specific subject and later tested on that same subject, and one that was subject-independent -- a much more challenging setup, since our brain waves could be quite different. Real EEG data was taken from earlier experiments done by Fabien Lotte, a coauthor of the paper, and his colleagues, as well as from DEAP, an existing database for emotion analysis.

The scientists found, for instance, that an artificial deep neural network outperformed all its competitors quite significantly in the workload estimation task but did poorly in emotion classification. And the two modified Riemannian algorithms did quite well in both tasks. Overall, as the paper concludes, using passive BCIs for affective state classification is much harder than for workload estimation, and subject-independent calibration leads, at least for now, to much lower accuracies.

"In the next steps, we plan to use more sophisticated artificial intelligence (AI) methods, especially deep learning, which allow us to detect very tiny changes in brain signals or brain patterns. Deep neural networks can be trained on the basis of a large set of data for many subjects in different scenarios and under different conditions. AI is a real revolution and is also potentially useful for BCI and recognition of human emotions," Cichocki said.

Below please find a summary and link(s) of new coronavirus-related content published today in Annals of Internal Medicine. The summary below is not intended to substitute for the full article as a source of information. A collection of coronavirus-related content is free to the public at http://go.annals.org/coronavirus.

"Remote misses" may create a false sense of invulnerability to COVID-19

It has been theorized that population-wide traumatic experiences can result in emotional and behavioral changes through a mechanism known as "passive adaptation to danger," in which near misses result in more cautious behavior. However, in the case of COVID-19, many in the public may have more remote misses, causing them to develop a false sense of security. Dr. Ahmad Mourad from Duke University School of Medicine explores this phenomenon and provides historical examples of population-wide responses to other large-scale, traumatic events. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-4984.

Media contacts: A PDF for this article is not yet available. Please click the link to read full text. The lead author, Ahmad Mourad, MD, can be reached directly at ahmad.mourad@duke.edu.

As the novel coronavirus continues to spread around the world, so do the concerns of breastfeeding mothers. Although there have been no documented cases to date of an infant contracting COVID-19 as a result of consuming infected breast milk, the critical question of whether there is potential for this form of transmission remains. In a recent study, researchers from University of California San Diego School of Medicine and University of California Los Angeles collaborated to find the answer.

The study, published August 19, 2020 in the online edition of JAMA, examined 64 samples of breast milk collected by the Mommy's Milk Human Milk Research Biorepository from 18 women across the United States infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although one sample tested positive for viral RNA, subsequent tests found that the virus was unable to replicate, and thus unable to cause infection in the breastfed infant.

"Detection of viral RNA does not equate to infection. It has to grow and multiply in order to be infectious and we did not find that in any of our samples," said Christina Chambers, PhD, MPH, co-principal investigator of the study, professor of pediatrics at UC San Diego School of Medicine, director of Mommy's Milk Human Milk Research Biorepository and co-director of the UC San Diego Center for Better Beginnings. "Our findings suggest breast milk itself is not likely a source of infection for the infant."

The current recommendations to prevent transmission while breastfeeding are hand hygiene and sterilizing pumping equipment after each use.

"In the absence of data, some women infected with SARS-CoV-2 have chosen to just not breastfeed at all," said Grace Aldrovandi, MD, co-principal investigator of the study, chief of the Division of Infectious Diseases at UCLA Mattel Children's Hospital and a professor of pediatrics in the David Geffen School of Medicine at UC Los Angeles. "We hope our results and future studies will give women the reassurance needed for them to breastfeed. Human milk provides invaluable benefits to mom and baby."

Early breastfeeding is associated with a reduced risk of sudden infant death syndrome and obesity in children, as well as improved immune health and performance on intelligence tests. In mothers, breastfeeding has been associated with lower risks for breast and ovarian cancer, cardiovascular disease and type 2 diabetes.

The researchers also mimicked conditions of the Holder pasteurization process commonly used in human donor milk banks by adding SARS-CoV-2 to breast milk samples from two different donors who were not infected. The samples were heated to 62.5°C for 30 minutes and then cooled to 4°C. Following pasteurization, infectious virus was not detected in either sample.

"This is a very positive finding for donor milk, which so many infants, especially those born premature, rely on," said Chambers. "Our findings fill in some important gaps, but more studies are needed with larger sample sizes to confirm these findings."

Chambers said future work will not only look at whether breast milk is free of the virus, but also whether it contains active antiviral components. For example, antibodies to SARS-CoV-2 that women may produce after exposure to the virus and then transfer to their infants through breast milk, protecting them from COVID-19.

Plastic waste in the ocean is an increasing problem for wildlife, including seabirds who frequently mistake it for food. However, ingested plastic does not just pose physical risks for such birds. A new study in open-access journal Frontiers in Environmental Science is the first to show that plastic waste can release chemicals into the stomach oil of seabirds over time, potentially posing a threat to their health. The findings highlight the importance of reducing plastic pollution in our oceans and dealing with our waste responsibly.

With ever increasing levels of plastic polluting the ocean and beaches, this waste is a growing threat to marine wildlife. Many seabirds confuse plastic with food, and it can pose physical risks such as intestinal blockages. However, ingested plastic can stay in birds' intestines for long periods, and scientists are concerned that such plastic could release harmful chemicals.

"I've been working on northern fulmars for almost 10 years," said Susanne Kühn of Wageningen Marine Research in the Netherlands. "As these seabirds ingest plastics regularly, and 93% of the fulmars from the North Sea have some plastic in their stomachs, it is important to understand the potential harm this could cause."

Kühn and colleagues set out to investigate whether plastic waste could release chemicals after being eaten by fulmars. They aimed to replicate the conditions found in the fulmar stomach, and the plastic debris that fulmars ingest. The researchers obtained a nutrient-rich liquid found in the fulmar stomach, known as stomach oil, from hunters in the Faroe Islands who traditionally catch and eat these birds.

"Previous studies have typically used uniform plastic pellets, sometimes artificially contaminated, which is not representative of plastic found in the sea," explained Kühn. "Instead, we went beach combing and found a variety of plastic types and shapes to create a marine plastic sample that a fulmar might realistically ingest."

The researchers incubated the plastic samples in stomach oil and mimicked the conditions found in the fulmar stomach in terms of temperature and agitation. They performed chemical analysis on the oil at different time points to see whether chemicals had leached out of the plastic over time.

Concerningly, the study revealed that the plastic released a variety of chemicals in the stomach oil over time, in some cases for over three months. These were chemicals added by plastic manufacturers during the production process, including plasticizers, flame retardants and stabilizers.

Strikingly, the stomach oil, which came from fulmar chicks, already had some plastic-derived chemicals in it before the experiments, as the chicks' parents may have been feeding them plastic. The long-term health implications for the birds are unclear, but previous studies have reported that several of the leached chemicals can disrupt hormone release and reproduction and may have genetic effects in birds.

You may be familiar with distressing images of birds caught in plastic packaging or fishing line, but this study reveals that discarded plastic could also have long-term toxic effects on seabirds. "I hope that these results will increase awareness of the various negative effects of plastic debris in the oceans," said Kühn. "We urgently need to reduce the amount of plastic in the marine environment."

Shipwrecks act as artificial reefs and provide a substrate and nutrients for a great diversity of microorganisms, which can contribute to either the deterioration or preservation of the ship. Precisely how diverse such communities are, and how they are organized, is still unknown. Here, researchers from East Carolina University in Greenville, North Carolina, identify the bacteria associated with a shipwreck from the 1960s. They find a highly diverse community on the wreck, consisting of at least 4,800 OTUs (Operational Taxonomic Units, roughly corresponding to species) from 28 bacterial phyla, including nitrogen-, carbon-, sulfur-, and iron-cycling species. Microbial community composition strongly differed between locations within the site, suggesting niche partitioning, in the same way that fungal species specialize in particular microhabitats within a forest, based on the local abiotic and biotic environment. The results are published in the open-access journal Frontiers in Microbiology.

The 50-m-long wreck, called the Pappy Lane, represents the remains of the steel-hulled USS LCS(L)(3)-123, built in 1944 as a WWII warship and abandoned after running aground in the 1960s in the shallows of the Pamlico Sound lagoon, North Carolina, after a second career a barge. DNA sequencing of 14 samples from across the site - visibly corroded and visibly preserved shipwreck debris, drilled shipcores, nearby sediment, and surrounding seawater - revealed notable differences in composition and metabolic capacities of the local microbial communities living on and around the shipwreck, as well as the microbial communities living on different parts of the ship. The authors explain this diversity as evidence of niche partitioning, driven by small-scale variability in the abiotic environment, for example iron content, exposure to oxygen, and traces of hydrocarbons from a former fueltank.

Present across the shipwreck and abundant where corrosion was observed, were iron-oxidizing ("iron-eating") Proteobacteria, which may contribute to biocorrosion. These included a new strain of the marine iron-oxidizing Zetaproteobacteria, with the apt name Mariprofundus ferrooxydans O1. Genomic analysis showed that the metabolic capacities of this strain include iron oxidation, carbon fixation in both oxygen-rich and -poor environments, and nitrogen fixation, indicating that it contributes to the cycling of metals and nutrients in the shipwreck environment.

This research also has wider implications for future resource management and the development of conservation strategies for shallow water shipwrecks across all coastlines.

"We have learned that iron-oxidizing bacteria that produce rust are widespread on these shipwrecks, causing corrosion and deterioration of the wreck-site. These microbes are more abundant in areas where we see corrosion occurring, which makes them likely indicators of where further deterioration may occur. In order to prevent this damage, we can design strategies for early detection, stopping their growth and limit further biocorrosion by other microbes," says corresponding author Dr Erin Field, Assistant Professor in the Department of Biology at East Carolina University.

The results of this study point towards the need to adapt future conservation efforts to the unique situation of each shipwreck, taking into account original construction materials, environmental factors and time spent in water.

"Historically, shipwreck sites were treated as a single environment, but our research goes deeper, showing that there are different microbial communities within single wreck-sites and associated with the wreck itself. As such, we need to tailor conservation efforts to each shipwreck in order to more effectively mitigate biocorrosion and deterioration," explains Dr Field.

This study highlights the importance of increasing the understanding of the role of biocorrosion in the deterioration of shipwrecks and the need for more research into the microbial ecosystem of shipwrecks.

"While there is well-developed literature on the impact of galvanic corrosion on shipwrecks and historic ships, the role certain microbes play in corrosion is less well-understood. It is hoped that this article helps decipher the mechanisms of biocorrosion that could one day also lead to the development of protective measures and conservation strategies," concludes Dr Nathan Richards, Professor and Director of Maritime Studies in the Department of History at East Carolina University and co-author of the study.

August 19, 2020 - Sorghum, a common food item in regions of Africa and Asia, has one missing puzzle piece. The missing piece? Protein digestibility, which researchers in the Department of Agronomy at Kansas State University are trying to find.

"Sorghum is an important food crop grown in Africa," said Tesfaye Tesso. "It grows well in their climate because it requires less moisture and nutrients than other crops." Tesso is a researcher at Kansas State University.

The biggest flaw of sorghum is how difficult it is for people and animals to digest its protein. Once the problem is solved, sorghum will provide more nutrients to those who eat it. It will also increase the value of the crop for farmers.

With the goal of improving global hunger and food security, Tesso and his team began their research. While there are many aspects of the plant that may affect protein digestibility, the group narrowed their focus to the protein itself.

"Sorghum protein digestibility is affected by a lot of different pieces," said Tesso. "We focused on the characteristics of sorghum protein that may be associated with digestibility."

The research group selected 40 varieties of sorghum, including some with high digestibility and some with low digestibility. These varieties will help the team understand what genes are behind the difference in sorghum digestibility.

"Our goal was to look at the DNA that codes for all of the seed storage proteins, called kafirins," said Tesso. Then researchers identified differences in these codes, which could be a cause for digestibility differences.

"Three out of the four kafirins we identified were linked to high protein digestibility, while the other one had lower digestibility," said Tesso. "Identifying these factors is one important piece of a very complex puzzle."

Moving forward, this research may lay foundation for enhancing protein digestibility through breeding. By understanding the genes associated with protein digestibility, scientists can watch for these genetic variations in sorghum plants, which will then have the desired traits.

Since protein digestibility is complex and affected by multiple factors, there is still more work to be done, according to Tesso. With their new ability to easily identify digestibility, researchers now have the power to select sorghum with other desired traits.

Not only will identifying this missing puzzle piece be beneficial to people in third-world countries, but it will also help United States livestock producers.

"Sorghum can be a feed ingredient for pigs," said Tesso. "The low protein digestibility affects what the animal gets from their diet. By improving the protein digestibility, livestock farmers can save costs on protein supplementation, which enhances the competitiveness of both the livestock and sorghum industries."

In the United States, sorghum farmers will have a higher valued product and livestock owners will have a better feed ingredient. Internationally, countries with developing agriculture will be able to aid in the fight against hunger and malnutrition.

A study of 181 patients at 16 sites across the country who test negative for two antibodies long known to cause muscle-weakening myasthenia gravis, found that about 15% test positive for one of two newly discovered antibodies that also attack the point of communication between nerves and muscle.

About 13% tested positive for antibodies to both LRP4 and agrin, proteins critical to healthy nerve-muscle communication, investigators report in the journal Muscle & Nerve about the largest group of patients examined for the new antibodies.

Those who tested positive for antibodies to LRP4, agrin or both, tended to be sicker when diagnosed and have a more severe disease course, investigators at Case Western Reserve University School of Medicine and the Medical College of Georgia at Augusta University report.

The investigators hope that learning more about antibodies that cause the disease will lead to treatments that target specific antibodies, which should reduce side effects and further improve efficacy.

Patients in the new study had no evidence of long-established antibodies for the receptor for acetylcholine, a chemical released by neurons, which activates muscle cell receptors, or MuSK, an enzyme that supports the clustering of these receptors on the surface of muscle cells and is essential to maintain the function of acetylcholine receptors.

Rather patients recruited for the study had been termed "double negative." Now the investigators say the roughly 85% of study participants who also tested negative for LRP4 and agrin are more accurately termed "quad negative."

Despite increased disease severity, better than 80% of patients with LRP4 and agrin antibodies had their disease moderated by standard therapy that includes a drug that increases acetylcholine levels by decreasing its breakdown as well as immunosuppressive drugs that reduce the body's overall production of antibodies.

All four now-established antibodies that cause myasthenia gravis fit together in a puzzle with the neuromuscular junction as their target, says Dr. Michael H. Rivner, MCG neurologist specializing in neuromuscular disease. "They are all functionally related to the neuromuscular junction even though they do different things," says Rivner, who directs the Electrodiagnostic Medicine Laboratory at MCG's adult teaching hospital AU Medical Center.

He and Dr. Lin Mei, chair of the Department of Neurosciences and Allen C. Holmes Professor of Neurological Diseases at Case Western Reserve University School of Medicine, are long-time collaborators and co-corresponding authors of the new study.

Mei's lab discovered the newer targets, reporting LRP4 antibodies as a new cause of myasthenia gravis in 2013 and agrin antibodies as associated with the disease the next year. Those findings filled important knowledge gaps in how the brain and muscle connect during development and continue to interact lifelong.

For our muscles to contract, they have to get a message from our nerves at the neuromuscular junction, which becomes the target of antibodies in myasthenia gravis. During development, agrin is released by motor neurons to direct construction of the synapse where nerves and muscles connect, then binds to the LRP4 receptor to activate MuSK, an enzyme on the muscle cell surface, which enables a clustering of receptors that are then activated by acetylcholine. While agrin and MuSK work together, they don't directly communicate, which is where LRP4 comes in. Mei's lab found that agrin communicates with LRP4 on the muscle cell surface, then recruits MuSK to join the conversation. LRP4 and MuSK become major components of the receptor needed for the muscle cell to receive the message agrin is sending.

LRP4 and agrin antibodies have been found in patients, and shown to produce myasthenia gravis in laboratory animals but there has been limited published data on their effect in humans.

Previously, about 10% of patients had no evidence of the two other antibodies already known to cause the disease. But they did have classic clinical symptoms such as general fatigue, blurred vision, drooping eyelids, generalized muscle weakness that gets worse with muscle use and, at its most aggressive, problems breathing, swallowing, even talking. When most patients first come to the doctor, it's because they are having problems with their droopy eyes and double vision, Rivner says, as the small muscle fibers and motor units that control them are ready targets for the antibodies.

In the newly published findings, about 70% of patients with the antibodies -- compared with nearly 43% without them -- had generalized symptoms of muscle weakness when they first sought medical care for those symptoms an average of 11 years ago.

Those with the antibodies also had a significantly higher severity of disease, including more eye problems, based on the Myasthenia Gravis Foundation of America's scale, with the state of disease classified as moderate to severe for 75% of the antibody positive patients compared with about 40% of the antibody negative individuals.

At their sickest, about half the patients with the antibodies had a mix of symptoms including difficulty with swallowing and speech, moving their arms and legs and breathing in additon to eye problems. "They started out sicker and became sicker," Rivner says. Twice as many patients in the antibody positive group needed mechanical ventilation support at some point, 11% versus 5% in the antibody negative group.

Regardless of their antibody status, patients were treated with standard therapies for myasthenia gravis including the drug pyridostigmine to improve muscle strength by blocking the breakdown of acetylcholine, plasma exchange to help clear circulating antibodies, and immunosuppressive drugs like prednisone. And most responded well to therapy, the investigators say.

The fact that patients respond to immunosuppressive drugs indicates they are making antibodies, Rivner says, which likely includes the "quad negative" patients. Immunotherapy helps diminish the immune system's attack on the neuromuscular junction, which can enable recovery of this communication point between nerves and muscle and help restore function to patients.

Next steps include analyzing five-year data on an even larger number of patients. They would also like to compare disease severity to patients with the longer-established antibodies.

About 80% of patients with myasthenia gravis have antibodies to the acetylcholine receptor and about 10% have antibodies to MuSK. The investigators chose to look at patients categorized as "double negative" to ensure that those antibodies were not a factor in their disease, Rivner says. However, he suspects many patients with those longer-established antibodies also have one or both of the newer ones.

It's not a surprise to anyone that numerous vertebrate species are being sold at different wildlife markets, but at the moment there is still no comprehensive understanding of how much people are involved in those actions in Laos (Lao PDR), nor what the impact on local wildlife populations really is.

The majority of Laotians live in rural areas and their income largely depends on wildlife. Since wildlife products are used as one of the major food sources, numerous species of terrestrial vertebrates are currently being offered at local markets.

Across the tropical regions, mammals and birds have been vanishing, with recent models estimating up to 83% decline by 2050. Furthermore, wild-caught reptiles have been reported from Southeast Asian wildlife markets for over 20 years, with Laos occupying the position of a very popular source.

Due to the large number of native endemic species, Lao PDR should assume the responsibility to introduce conservation measures to keep control over the predicted population declines. At the moment, the regulations on wildlife use and trade in Laos are mostly based on the Lao Wildlife and Aquatic Law, which, however, largely disregards international statuses of the species and other biological factors.

Stricter and reinforced legislation is needed in the fields related to wildlife trade and consumption, since such practices are not only causing biodiversity loss, but also suggested to pose a great threat of wildlife-associated emergence of zoonotic parasites and pathogens to humans. As an immediate example, the outbreak of the Coronavirus (COVID-19) is primarily considered to be a consequence of human consumption of wild animals.

An international group of students and scientists, led by Professor Dr. Thomas Ziegler at the University of Cologne and the Cologne Zoo (Germany), has conducted a number of extensive surveys on wildlife markets (66 observational surveys at 15 trade hubs) and households (63 households at 14 sites) in the Khammouane Province of Laos. The key question of the survey was: "Which species are traded and to what extent?" The results of the study are published in the open-access journal Nature Conservation.

The surveys showed overlaps between the most traded species at wildlife markets and those of highest conservation importance.

As for the households, approximately 90% of the surveyed respondents confirmed the use of wildlife. For the majority of the population, wildlife harvesting was found to be important for their livelihood and trapping activities were mostly aimed at self-consumption / subsistence. The reason for this could be explained by the prices of domesticated meat, which can be three times as higher as those of wildlife products.

The demand for the species on the wildlife market remained the same over time, according to the opinions of 84,1% of respondents, while the availability of wild meats was reported to have decreased, due to increasing price.

"We recommend local authorities to assess the markets within the province capital Thakhek in particular, as they showed the highest quantity of wild meats. The markets at Namdik and Ban Kok turned out to be very active trade hubs for wildlife as well, regardless of the vertebrate group. The loss of certain species may cause a cascade of unforeseeable effects in the ecosystems. Therefore, the biodiversity of tropical Southeast Asian countries like Lao PDR must be protected.", shares Dr. Thomas Ziegler.

To help the local population to avoid the crisis related to the change of activity and growing unemployment, scientists propose to introduce new activities in the region.

"Eco-tourism presents a great opportunity to combine conservation efforts and an alternative source of income. Former hunters with excellent knowledge of the forest and wildlife habitats can serve as professional wildlife tour guides or their involvement in the Village Forest Protection Group could help to protect natural resources in Laos", suggests Dr. Thomas Ziegler.

Researchers have designed a new X-ray classification system for adult idiopathic scoliosis that can more precisely define which parts of the spine need correction, an achievement that could enhance treatment, communication, and analysis of spinal deformities affecting older patients, according to a study published in Spine Deformity in August.

The team of researchers, led by James D. Lin, MD, MS, a spine surgeon at The Mount Sinai Hospital and Assistant Professor of Orthopedic Surgery at the Icahn School of Medicine at Mount Sinai, said their modern approach to the X-ray classification system could provide a more universal and standard assessment of adult scoliosis.

"This classification system provides a new language for clinicians and researchers, helping us reliably categorize and communicate the radiographic features of adult idiopathic scoliosis, in order to more effectively facilitate treatment and further analysis," said Dr. Lin. "This will help researchers and surgeons scrutinize past results from prior surgeries and refine future treatment."

Scoliosis is a sideways curvature of the spine, a condition that affects an estimated six million people in the United States. Many develop it in adolescence, but only a small percentage of adolescent cases require surgery. While adult scoliosis can be the natural progression of adolescent scoliosis, adults can also develop it for the first time; those cases are called adult degenerative scoliosis. The symptoms and surgical treatment can differ significantly for older patients; for example, adults often experience more pain from the condition.

The new method builds on the Lenke classification system for adolescent idiopathic scoliosis, which is widely used to define six curve types but is not applicable to adults. The new three-component method maintains the curve types from the Lenke classification and introduces assessments of the global alignment and lumbosacral curve, two features that more commonly deteriorate in older patients.

In the study, 12 spine surgeons used the new classification system to grade 30 cases twice, which resulted in near-perfect agreement in the assessment of the patients. This latest method to classify adult scoliosis could improve treatment options because it helps define the different areas of the spine that need to be corrected and fused, and there is currently no widely accepted X-ray classification system for the complex condition.

"The development of a new classification system, led by Dr. Lin, strengthens our efforts at the Spine Center at The Mount Sinai Hospital to provide innovative and customized treatment for patients with spinal disorders and injuries," said Andrew Hecht, MD, Chief of Spine Surgery for the Mount Sinai Health System and The Mount Sinai Hospital, and Director of the Spine Center at Mount Sinai. "The new method ensures that we have a more exhaustive, thorough, and rigorous benchmark in how we analyze and treat adults with spinal conditions throughout the Mount Sinai Health System, but also for our colleagues throughout the entire orthopedic community, helping us all to provide exceptional care."

Leading coma experts have created an ambitious plan to help doctors better care for comatose patients and answer that most awful question: "Will my loved one wake up?"

The three-part plan outlines key steps physicians and researchers should take in the coming years to improve patient care and deepen our understanding of coma and other conditions that reduce consciousness. The plan was developed by a blue-ribbon scientific advisory council as part of the Neurocritical Care Society's Curing Coma Campaign, a major effort launched in 2019.

"We now have the tools to understand comatose patients in a way we haven't in the past. This opens the door to ask the question, 'Can we improve consciousness in patients in a coma?'" said advisory council member and lead author J. Javier Provencio, MD, director of UVA Health's Nerancy Neuroscience Intensive Care Unit. "This research endeavor aims to help patients and families dealing with the consequences of brain damage gain clarity about the current chances for improvement and maintain hope that, in the future, there will be treatments to help recover consciousness."

The Coma Plan's Three Pillars

The plan's first recommendation is to better classify and understand different types of coma and their causes. Current treatments are limited in part because it is difficult for physicians to distinguish between different underlying mechanisms of impaired consciousness, the researchers say. This makes it challenging to predict whether patients will recover.

To improve this, they suggest several different classifications. For example, coma without underlying physical damage, such as those caused by drug overdoses or seizures, are often reversible using available treatments. Those must be treated differently than coma with causes such as brain injuries. Another category is particularly tricky - coma with hidden physical causes. Better categorization of common coma "endotypes" will help physicians with their diagnoses and treatment decisions, the council says.

The council also urges the development of better indicators of patient prognosis. These indicators, known as biomarkers, already play important roles in guiding treatment. But more sophisticated ones are needed to understand the complex interactions occurring inside the brain. This will help doctors guide patients to better outcomes and advise families on how well their loved one will recover.

Finally, the council urges clinical trials of new therapies to promote recovery of consciousness for intensive-care patients who are in comas or suffering from other forms of reduced consciousness.

"We envision that a principled, mechanistic approach to predicting and measuring responses to new therapies in the ICU could allow clinicians to provide targeted treatments that are personalized to each patient, ensuring that each patient is given the best possible chance to recover consciousness in the ICU and beyond," the council members write in a new paper outlining their recommendations.

"Coma is the most severe manifestation of brain injury," Provencio said. "With this initiative, we hope to be able to treat patients in a coma the way we treat patients with strokes and heart attacks. In the future, having impaired consciousness from brain injury won't be the lifelong medical condition it is now."

Unconventional monetary policy does not lead to greater risk-taking by banks, according to new research. This will be welcome news for central banks and policymakers as they ramp up efforts to limit the economic fallout of the pandemic.

"Slashing interest rates is the usual response to a recession, but with rates now at 0.25% the Reserve Bank of Australia (RBA) can't cut any further, so it has now resorted to "unconventional" means to free up funds," says University of Technology Sydney finance researcher Dr Thomas Matthys.

"This means they are buying bonds to add cash to the balance sheets of Australian banks. The idea is that banks then channel this forward to the rest of the economy, providing loans at cheaper rates to individuals and firms, and allowing for extended mortgage holidays," he says.

While these unconventional policies should help to lift the economy, grow asset prices and stem panic on markets, there can also be negative impacts.

Savers will receive a lower deposit rate on their savings accounts, so self-funded retirees will find it harder to get by, and it will become more difficult for banks to get a return on their investments.

Previous research has suggested that when a central bank's policy interest rate goes lower (conventional monetary policy), banks start reaching for yield by investing in riskier loans. This can lead to bank failures and imperil the economy.

So researchers decided to examine whether unconventional monetary policy measures also lead to increased risk taking by the banking sector.

They looked at the syndicated loan market, which is the market for large corporate loans, and the impact of unconventional monetary policy in the US after the global financial crisis in 2008.

With a syndicated loan, two or more banks get together to grant a loan to one corporation - typically larger companies such as miners or retail chains.

What they found was that although, on average, loan interest rates go down following looser monetary policy, this was only the case for firms with sound financial performance.

The researchers found no additional interest rate reduction for riskier firms, which would have pointed to bank risk-taking behaviour.

These results, published in the Journal of International Money and Finance, confirm that, at least in the syndicated loan market, unconventional monetary policy doesn't necessarily lead to increased risk-taking, which is good news for the Reserve Bank and policy-makers.

"While unconventional monetary policy supports the financial system in a crisis, it needs to be complemented by other prudential policies that ensure bank asset quality.

"The Australian Prudential Regulation Authority (APRA) will strike the balance between supporting the economy and ensuring bank risk-taking is kept in check using such instruments as loan to value ratios and capital and liquidity ratios," says Dr Matthys.

Dr Matthys also notes that there are other lessons to be learned from the US and European responses to the 2008 global financial crisis.

"In Europe, unconventional monetary policy did not seem to help businesses as much as it did in the US. This may be because the US was very quick to clean up toxic assets on banks' balance sheets in the midst of the crisis through TARP - the Troubled Asset Relief Program," says Dr Matthys.

"Europe for a long time after the crisis had a legacy of high non-performing loans on bank balance sheets, which contributed to the ineffectiveness of unconventional monetary policy and very low rates. It leaves them with reduced firepower in the face of market instability," he says.

Many countries have a high debt burden, which means that if unemployment rises substantially, it will lead to home loan defaults, which negatively feed back to the stability of the financial system through lower bank income and additional write-offs.

"While the 2008 global financial crisis was a crisis of household debt burdens, companies today also on average have higher debt. This is where unconventional monetary policy may provide relief, as central banks supply liquidity," says Dr Matthys.

With the global COVID-19 pandemic shifting more and more of our work and school online, virtual communities are more important than ever -- but how do we know, without bias, that our online groups are actually successful in helping us with our goals? A team of researchers based in Italy think has proposed the first objective metric to assess the effectiveness of virtual groups. They published their results on IEEE/CAA Journal of Automatica Sinica.

"Group formation is a key issue in social communities due to the importance of establishing an effective organization in which users perform actions that could benefit from collaboration and mutual social interactions," said the author Giancarlo Fortino, professor of computer engineering in the DIMES Department of the University of Calabria. "Is it possible to form effective groups in virtual communities by exploiting trust information without significant overhead, similarly to real user communities?"

Facebook, for example, reached 2.4 billion active users in 2019, and, in the last five years, more than one billion groups have formed on the platform. In each group, individuals must trust that the group will provide some value to them, whether it is in the form of humor or parenting tips or product reviews. The group, in turn, must determine the value the individual will add to their group, as well as how important that value is, when admitting members.

"In general, the ability of the members of the same groups to have positive interactions will improve the social capital -- or, simply, the effectiveness -- of the community which represents the group itself," Fortino said. In the team's previous research, they proposed that individual members who trust each other and their contributions to a group enforces the cohesiveness of a group even as more members who are not directly connected join, such as friends of friends. "In this work, we address the general problem of forming effective groups."

The researchers examined interaction data from 34,541 individuals on two Italian-based social networks, EPINIONS and CIAO.

"EPINIONS and CIAO users review items and assign them numeric ratings," Fortino said. "Users can also build their own trust network by adding the people whose reviews they think are valuable."

Fortino and the researchers analyzed three classes of users, from most valued to least valued in their reviews. They found that when one user had limited or inadequate interactions with another user, they would turn to their network of friends to determine trustworthiness.

"It's similar to real communities," Fortino said. "We have implemented this strategy in our algorithm to form groups in virtual communities based on a weighted voting mechanism, whereby each vote is represented by a trust value obtained by a suitable combination of reliability and local reputation."

The strategy, when applied to the social network data, significantly improved the overall trust value of groups. The researchers are now studying the trust value metric in more complex configurations of the groups.