Culture

Scientists have found that countries with mandatory Bacillus Calmette-Guérin (BCG) vaccination until at least the year 2000 tended to exhibit slower infection and death rates during the first 30 days of the outbreak of COVID-19 in their country. By applying a statistical model based on their findings, the researchers further estimated that only 468 people would likely have died from COVID-19 in the U.S. as of March 29, 2020 - which is 19% of the actual figure of 2,467 deaths by that date - if the U.S. had instituted mandatory BCG vaccination several decades ago. They established this correlation via statistical analyses that controlled for several potential biases, including differences in the availability of tests, how cases were reported, and the timing of outbreak onset across countries. Their findings suggest that national policies for universal BCG vaccination can be effective in the fight against COVID-19 - an association that merits clinical investigation, the authors say. Available evidence demonstrates that BCG vaccination, typically given at birth or during childhood to prevent tuberculosis, can also help strengthen immunity against various other infectious diseases - perhaps including COVID-19. However, investigating a potential relationship between universal BCG vaccination and spread of the SARS-CoV-2 virus requires accounting for the effects of several biases and variables across countries, which previous studies have not done, the authors say. For example, some past efforts focused on the total number of infections and deaths, which have varied considerably among countries based on when the disease took hold.

Martha Berg and colleagues instead focused on changes in the growth rates of COVID-19 cases and deaths, while controlling for variables including diagnostic test availability, median age, per capita GDP, population size and density, net migration rate, and various cultural differences such as individualism. They analyzed the day-by-day rate of increase of confirmed cases in 135 countries and deaths in 134 countries in the first 30-day period of each country's outbreak. Mandatory BCG vaccination correlated with a flattening of the curve in the spread of COVID-19, the analysis showed. However, the authors caution that their results do not portray BCG as a "magic bullet." They found substantial variation in COVID-19 growth rates even among BCG-mandated countries, suggesting that additional societal variables likely have an effect on mandatory BCG vaccination's effect on the spread of COVID-19. The authors note that this variation must be addressed in future work.

Metabarcoding allows scientists to extract DNA from the environment (known as environmental DNA or eDNA), for example, river water or, as in the case of the study by the team from the University of Duisburg-Essen (Essen, Germany) within the German Barcode of Life project (GBOL II): Vera Zizka, Dr Martina Weiss and Prof Florian Leese, from individuals in bulk samples. Thus, they are able to detect what species inhabit a particular habitat.

However, while the method has already been known to be of great use in getting an approximate picture of local fauna, hence facilitating conservation prioritisation, few studies have looked into its applicability to infer responses below species level. That is, how the populations of a particular species fare in the environment of interest, also referred to as intraspecific diversity. Meanwhile, the latter could actually be a lot more efficient in ecosystem monitoring and, consequently, biodiversity loss mitigation.

The potential of the method is confirmed in a new study, published in the peer-reviewed scholarly journal Metabarcoding & Metagenomics. To do so, the researchers surveyed the populations of macroinvertebrate species (macrozoobenthos) in three German rivers: Emscher, Ennepe and Sieg, where each is subject to a different level of ecological disturbance. They were looking specifically at species reported at all of the survey sites by studying the number of different haplotypes (a set of DNA variations usually inherited together from the maternal parent) in each sample. The researchers point out that macrozoobenthos play a key role in freshwater ecosystem functionality and include a wide range of taxonomic groups with often narrow and specific demands with respect to habitat conditions.

"As the most basal level of biodiversity, genetic diversity within species is typically the first to decrease, and the last to regenerate, after stressor's impact. It consequently provides a proxy for environmental impacts on communities long before, or even if never visible on species diversity level," explain the scientists.

Emscher is an urban stream in the Ruhr Metropolitan Area that has been used as an open sewage channel for the past hundred years, and is considered to be a very disturbed environment. Ennepe - regarded as moderately stressed - runs through both rural and urban sites, including ones with sewage treatment plant inflow. Meanwhile, Sieg is considered as a stable, near-natural river system with a good ecological and chemical status.

As a result, despite their original assumption that Sieg would support the most prominent diversity within populations of species sensitive to organic pollution, such as mayflies, stoneflies and caddisflies, the scientists reported no significant difference to the medium stressed river Ennepe. This was also true for overall biodiversity. On the other hand, the team discovered higher intraspecific diversity for species resilient to ecological disturbance like small worms and specialised crustaceans in the heavily disturbed Emscher. The latter phenomenon may be explained with low competition pressure for these species, their ability to use organic compounds as resources and, consequently, increased population growth.

"[T]his pioneer study shows that the extraction of intraspecific genetic variation, so-called 'haplotypes' from DNA metabarcoding datasets is a promising source of information to assess intraspecific diversity changes in response to environmental impacts for a whole metacommunity simultaneously," conclude the scientists.

However, the researchers also note limitations of their study, including the exclusion of specialist species that only occured at single sites. They prompt future studies to also carefully control for the individual number of specimens per species to quantify genetic diversity change specifically.

According to recent Gallup polls, socialism is now more popular than capitalism among Democrats and young people, and support for "some form of socialism" among all Americans is at 43% (compared to 25% in 1942). Policies that went unmentioned or were declared out-of-bounds in elections four years ago--a federal jobs guarantee, single-payer health care, free college, massive tax hikes on the rich, and the Green New Deal--are commonplace in Democrats' 2020 campaigns.

However, in "Freedom Now," a new paper published by Alex Gourevitch and Corey Robin in Polity's May Symposium on the Challenges Facing Democrats, there is still no clear, unifying idea behind this political shift. "One has not heard anything on the order of Franklin Roosevelt's Commonwealth Club speech or Reagan's story of the free market," the authors write. If these policies are to have a chance of breaking through, they will need a grounding principle, or ideology name the enemy, organize the policies, orient the actions, state the destination, and provide the fuel for the movement.

Gourevitch and Robin propose that that idea is freedom. "While the left once understood freedom as emancipation from the economy, the right spent the twentieth century neutralizing and appropriating the idea of freedom by reinventing the economy as the true site of freedom."

To reclaim freedom as a value of the left, the authors believe the first place to start is the unfreedom of the workplace. "In nearly every capitalist country, one of the leading elements of the legal definition of employment is subordination to the will of a superior." That can mean that employees must urinate--or are forbidden to urinate. It can mean that they should be sexually appealing--or must not be sexually appealing. They may be told how to speak, what to say, whom to say it to, where to be, where to go, how to dress, when to eat, and what to read--all in the name of the job. "But isn't the worker free to leave a bad boss? Formally speaking, yes," the authors write. "But even if they are free to exit this workplace, they are not free to exit the workplace."

Reclaiming "freedom" names the problem that an increasing number of people face today: systemic unfreedom in the neoliberal economy. By confronting that unfreedom, the left can do more than identify, in a coherent and cohesive way, the myriad problems that individuals are currently facing. The authors find the seeds of that idea in Bernie Sanders's rhetoric about being "organizer in chief," and in proposals from the Warren and Sanders camps that would strengthen workers' right to strike and organize.

However, they note, "A real politics of freedom posits a belief in the capacity of people to revise the terms of their existence and a commitment to the institutions that make these collective revisions possible." In other words, freedom is best realized not through tending our own gardens but through disciplined commitment and collective struggle, in activities like mass strikes and party politics. "These democratic struggles are not simply expressions and experiences of freedom, though they are that. They are also the means to the freedoms people deserve."

The recent rise of authoritarian nationalist movements has reinforced the tendency of many on the left, and some on the right, to reject all forms of nationalism, writes Rogers M. Smith in "Toward Progressive Narratives of American Identity," published in Polity's May Symposium on the Challenges Facing Democrats.

Nationalism, Smith argues, is seen by some as prone to the repression of minorities and other vulnerable groups within states, and as hostile to the concerns of all outsiders, as well as to free movement of goods and people. "Liberals and progressives in America and elsewhere have failed to counter with politically resonant narratives of national identity that champion greater and more egalitarian inclusiveness."

Some argue chauvinistic forms of nationalism must be opposed by developing better forms, not by rejecting nationalism outright. "In light of the recent surge of virulent nationalisms, better rather than worse national stories are part of what liberal parties like the Democrats need now," Smith says.

The paper offers three criteria for devising such narratives: resonance, respectfulness, and reticulation, which Smith defines as recognizing the reality that public policies in every society treat persons and citizens in ways that are enormously variegated. "When a society's variegated rights and duties form a logically explicable and practically useful (and always evolving) network of statuses, they are suitably 'reticulated." While "separate but equal" policies are to be avoided, it is necessary to accept that in politics we must seek to create not absolute uniformity, but appropriately egalitarian reticulated civic statuses.

"We must have stories of peoplehood that not only permit but valorize efforts to protect and expand opportunities for all by recognizing and accommodating, not ignoring or suppressing, many human differences," Smith says, to enact policies that resonate desirably with the different values and identities of the multiple groups in all modern societies; that display respect for as many of those values and identities as possible; that militate against harsh treatment of ethnocultural minorities and outsiders, and against reinforcement of the advantages of dominant groups.

The paper also contends that America's democratic traditions, its constitutional traditions aimed at achieving a more perfect union without effacing legitimate diversity, and its quest to realize the goals of the Declaration of Independence over time all provide rich resources for stories of American peoplehood that can meet these criteria and, perhaps, defeat narrower nationalist visions. Smith says it is hard to see Trump's America First agenda as genuinely respectful toward all Americans, much less all persons. "Yet the political potency of Trump's nationalism cannot be gainsaid." Smith suggests it is wise to explore whether there are better stories of American peoplehood that might check these features of Trump's vision, while also responding to legitimate concerns to which he has spoken powerfully. "But rather than insisting one narrative is 'the' American story, the quest must be to identify a variety of inclusive, egalitarian stories of American peoplehood that can serve to build progressive coalitions among those with overlapping yet distinguishable values and identities."

Smith posits perhaps the best story of American peoplehood today is one first advanced by anti-slavery constitutionalists, including Lysander Spooner and Frederick Douglass, and then made prominent in modified form by Abraham Lincoln and the new Republican Party of the 1850s. "All these figures presented the story of America as a collective historical endeavor to fulfill the principles of the Declaration of Independence--to secure basic rights, including the rights to life, liberty, and the pursuit of happiness, for, in Lincoln's words, 'all people, of all colors, everywhere.'"

Telling the story of American peoplehood as a quest to realize more fully the goals and values defined in the Declaration of Independence is the best way to elaborate a resonant, respectful -- and suitably reticulated conception of American nationality today, Smith says. It defines a sense of purpose that is more demanding, but also more elevating than "America First." "Toxic forms of nationalism represent the world's worst political poisons. They must be countered by nationalist antitoxins that can serve as balms for the festering wounds visible in all too many bodies politic today."

Among the many things rodents have taught neuroscientists is that in a region called the hippocampus, the brain creates a new map for every unique spatial context - for instance, a different room or maze. But scientists have so far struggled to learn how animals decides when a context is novel enough to merit creating, or at least revising, these mental maps. In a study in eLife, MIT and Harvard researchers propose a new understanding: The process of "remapping" can be mathematically modeled as a feat of probabilistic reasoning by the rodents.

The approach offers scientists a new way to interpret many experiments that depend on measuring remapping to investigate learning and memory. Remapping is integral to that pursuit, because animals (and people) associate learning closely with context, and hippocampal maps indicate which context an animal believes itself to be in.

"People have previously asked 'What changes in the environment cause the hippocampus to create a new map?' but there haven't been any clear answers," said lead author Honi Sanders. "It depends on all sorts of factors, which means that how the animals define context has been shrouded in mystery."

Sanders is a postdoc in the lab of co-author Matthew Wilson, Sherman Fairchild Professor in The Picower Institute for Learning and Memory and the departments of Biology and Brain and Cognitive Sciences at MIT. He is also a member of the Center for Brains, Minds and Machines. The pair collaborated with Samuel Gershman, a professor of psychology at Harvard on the study.

Fundamentally a problem with remapping that has frequently led labs to report conflicting, confusing, or surprising results, is that scientists cannot simply assure their rats that they have moved from experimental Context A to Context B, or that they are still in Context A, even if some ambient condition, like temperature or odor, has inadvertently changed. It is up to the rat to explore and infer that conditions like the maze shape, or smell, or lighting, or the position of obstacles, and rewards, or the task they must perform, have or have not changed enough to trigger a full or partial remapping.

So rather than trying to understand remapping measurements based on what the experimental design is supposed to induce, Sanders, Wilson and Gershman argue that scientists should predict remapping by mathematically accounting for the rat's reasoning using Bayesian statistics, which quantify the process of starting with an uncertain assumption and then updating it as new information emerges.

"You never experience exactly the same situation twice. The second time is always slightly different," Sanders said. "You need to answer the question: 'Is this difference just the result of normal variation in this context or is this difference actually a different context?' The first time you experience the difference you can't be sure, but after you've experienced the context many times and get a sense of what variation is normal and what variation is not, you can pick up immediately when something is out of line."

The trio call their approach "hidden state inference" because to the animal, the possible change of context is a hidden state that must be inferred.

In the study the authors describe several cases in which hidden state inference can help explain the remapping, or the lack of it, observed in prior studies.

For instance, in many studies it's been difficult to predict how changing some of cues that a rodent navigates by in a maze (e.g. a light or a buzzer) will influence whether it makes a completely new map or partially remaps the current one and by how much. Mostly the data has showed there isn't an obvious "one-to-one" relationship of cue change and remapping. But the new model predicts how as more cues change, a rodent can transition from becoming uncertain about whether an environment is novel (and therefore partially remapping) to becoming sure enough of that to fully remap.

In another, the model offers a new prediction to resolve a remapping ambiguity that has arisen when scientists have incrementally "morphed" the shape of rodent enclosures. Multiple labs, for instance, found different results when they familiarized rats with square and round environments and then tried to measure how and whether they remap when placed in intermediate shapes, such as an octagon. Some labs saw complete remapping while others observed only partial remapping. The new model predicts how that could be true: rats exposed to the intermediate environment after longer training would be more likely to fully remap than those exposed to the intermediate shape earlier in training, because with more experience they would be more sure of their original environments and therefore more certain that the intermediate one was a real change.

The math of the model even includes a variable that can account for differences between individual animals. Sanders is looking at whether rethinking old results in this way could allow researchers to understand why different rodents respond so variably to similar experiments.

Ultimately, Sanders said, he hopes the study will help fellow remapping researchers adopt a new way of thinking about surprising results - by considering the challenge their experiments pose to their subjects.

"Animals are not given direct access to context identities, but have to infer them," he said. "Probabilistic approaches capture the way that uncertainty plays a role when inference occurs. If we correctly characterize the problem the animal is facing, we can make sense of differing results in different situations because the differences should stem from a common cause: the way that hidden state inference works."

This research defines the new mini-invasive technique for the treatment of osteoid osteomas, which are benign but painful bone-forming tumors that usually involve long bones, with 10-20% of the cases having localization at the spine.

The most common symptom in osteoid osteomas is back pain which is generally responding to nonsteroidal anti-inflammatory drugs, but in some cases, also radicular pain can be present. The best treatment, for years, has been known to be surgical excision for cases with unresponsive pain. It has been practiced with much success but it also has a high rate of fusion with instrumentation.

In the recent years, percutaneous radiofrequency ablation has been suggested as a new mini-invasive technique for the treatment of osteoid osteomas.

LOWELL, Mass. - More durable prosthetics and medical devices for patients and stronger parts for airplanes and automobiles are just some of the products that could be created through a new 3D printing technology invented by a UMass Lowell researcher.

Substances such as plastics, metals and wax are used in 3D printers to make products and parts for larger items, as the practice has disrupted the prototyping and manufacturing fields. Products created through the 3D printing of plastics include everything from toys to drones. While the global market for 3D plastics printers is estimated at $4 billion and growing, challenges remain in ensuring the printers create objects that are produced quickly, retain their strength and accurately reflect the shape desired, according to UMass Lowell's David Kazmer, a plastics engineering professor who led the research project.

Called injection printing, the technology Kazmer pioneered is featured in the academic journal Additive Manufacturing posted online last week.

The invention combines elements of 3D printing and injection molding, a technique through which objects are created by filling mold cavities with molten materials. The marriage of the two processes increases the production rate of 3D printing, while enhancing the strength and properties of the resulting products. The innovation typically produces objects about three times faster than conventional 3D printing, which means jobs that once took about nine hours now only take three, according to Kazmer, who lives in Georgetown.

"The invention greatly improves the quality of the parts produced, making them fully dense with few cracks or voids, so they are much stronger. For technical applications, this is game-changing. The new process is also cost-effective because it can be used in existing 3D printers, with only new software to program the machine needed," Kazmer said.

The process took about 18 months to develop. Austin Colon of Plymouth, a UMass Lowell Ph.D. candidate in plastics engineering, helped validate the technology alongside Kazmer, who teaches courses in product design, prototyping and process control, among other topics. He has filed for a patent on the new technology.

Pupils' achievements at school are often shaped by the way that they 'act out' specific gender roles, according to a new study which warns against over-generalising the gender gap in education.

The study, by researchers at the University of Cambridge, suggests that young people's attainment is linked to their ideas about what it means to be male or female. Those who defy traditional gender stereotypes appear to do better in the classroom.

Annual GCSE results in the UK, in common with many western countries, typically show that boys lag behind girls academically, but the research argues that this broad pattern masks a more nuanced picture. In particular, the researchers warn that a large sub-group of girls, who conform fairly rigidly to some traditional 'feminine' norms, could be academically at-risk. They point out that these girls are often 'invisible' in broad surveys of attainment by gender that show girls performing well as a group.

The researchers examined the English and Maths results of almost 600 GCSE candidates at four schools in England. On average, the girls did significantly better in English, while boys were slightly better at Maths. Girls outperformed boys overall.

But the study then went a step further, analysing sub-groups of boys and girls according to how they expressed their gender identity. This revealed that around half of the girls displayed 'maladaptive patterns of motivation, engagement and achievement'. By contrast, around two-thirds of boys were motivated, engaged and did well in exams. The pupils' academic performance corresponded closely to their sense of gender.

Dr Junlin Yu, a researcher at the Faculty of Education, University of Cambridge, said: "There has been a lot of justifiable concern about low attainment among boys, but we really need to move on from looking at averages, and ask which specific groups of boys and girls are falling behind. These findings suggest that part of the answer is linked to how pupils 'do' gender at school."

The study asked pupils to complete questionnaires which measured their motivation and engagement, and also examined how far they conformed to certain gender 'norms'.

These norms were drawn from two widely-used scales that identify the characteristics which people in western countries consider 'typically' masculine or feminine. The supposedly 'masculine' traits were emotional control, competitiveness, aggression, self-reliance, and risk-taking. The 'feminine' traits were thinness, an interest in appearance, concern with relationships, and an inclination towards domesticity.

In reality, most people exhibit a combination of masculine and feminine traits and the researchers found that pupils typically belonged to one of seven gender profiles that blended these characteristics. They classified these as:

'Resister boys' (69% of boys): typically resist traditional ideas about masculinity.

'Cool guys' (21%): competitive risk-takers, but concerned with appearance and romantic success.

'Tough guys' (10%): have an emotionally 'hard' image, self-reliant.

'Relational girls' (32% of girls): shun appearance norms, comfortable connecting with others emotionally.

'Modern girls' (49%): concerned with appearance, but also self-reliant and emotionally distant.

'Tomboys' (12%): uninterested in feminine qualities, often regarded as 'one of the lads.'

'Wild girls' (7%): embrace masculine behaviours, but also display an exaggeratedly 'feminine' appearance.

These profiles were then cross-referred with the pupils' GCSE results.

On average, the sample group performed as international trends predict. Girls had an average grade of 6.0 (out of 9) in English, compared with the boys' average of 5.3. In Maths boys averaged 5.9; slightly higher than the girls' 5.5.

But the researchers also found strong correlations between the specific gender profiles and patterns of engagement, motivation, and attainment. The two groups who resisted conventional gender norms - resister boys and relational girls - were found to be 'better academically adjusted' and typically did well in exams. The lowest overall performers were the 'cool guys' and 'tough guys'.

This significantly affected the average patterns of attainment by gender. In English, for example, relational girls far outperformed all other pupils in the cohort (averaging 6.3), almost single-handedly raising the girls' average.

The 'modern' and 'wild' girls typically had more mediocre GCSE results. More worryingly, these groups also displayed signs of low engagement and motivation: they gave up easily when faced with difficult tasks, and generally put less effort into their work. Collectively, these girls represented 56% of the total, but their underachievement was partially obscured by the high attainment average for girls.

The study suggests that one reason for the close correspondence between gender profile and academic achievement is that adolescents tend to express strong and inflexible ideas about gender, which influences their attitude towards school. For example, 'cool guys', who prize risk-taking and winning, consistently admitted to not trying hard at school - probably because doing so maintained the illusion that they would succeed if they put in more effort.

Attitudes towards gender probably also influence pupils' engagement with certain subjects. Previous studies have, for example, shown that Maths is often perceived as 'male'. Tellingly, within the sample, tomboys - girls who rejected 'feminine' traits - earned higher grades than the other girls in Maths.

The study's main recommendation is that efforts to close the gender gap in attainment need to focus less on 'girls versus boys' and more on these nuanced profiles. However, the researchers also suggest that schools could support pupils by encouraging them to think beyond traditional gender stereotypes.

"Among boys in particular, we found that those who resist gender norms were in the majority, but at school it often doesn't feel that way," Yu said. "Teachers and parents can help by encouraging pupils to feel that they won't be ridiculed or marginalised if they don't conform to traditional gender roles. Our findings certainly suggest that resistance to stereotypes is fast becoming less the exception, and more the rule."

In The BMJ today, a panel of international experts make a weak recommendation for the use of remdesivir in patients with severe covid-19, and strongly support continued enrolment of patients into ongoing clinical trials of remdesivir.

Their advice is part of The BMJ's Rapid Recommendations initiative - to produce rapid and trustworthy guidelines for clinical practice based on new evidence to help doctors make better decisions with their patients.

The antiviral medication remdesivir has received worldwide attention as a potentially effective treatment for severe covid-19 and is already being used in clinical practice.

Today's recommendation is based on a new evidence review comparing the effects of several drug treatments for covid-19 up to 20 July 2020.

It shows that remdesivir may be effective in reducing recovery time in patients with severe covid-19, although the certainty of the evidence is low. But remdesivir probably has no important effect on the need for mechanical ventilation and may have little or no effect on length of hospital stay.

The authors stress that "the effectiveness of most interventions is uncertain because most of the randomised controlled trials so far have been small and have important study limitations."

After thoroughly reviewing this evidence, the expert panel says that most patients with severe covid-19 would likely choose treatment with remdesivir given the potential reduction in time to clinical improvement.

But given the low certainty evidence, and allowing for different patient perspectives, values, and preferences, they issued a weak recommendation with strong support for continued recruitment in trials.

They suggest that future research should focus on areas such as optimal dose and duration of therapy, and whether there are specific groups of patients most likely to benefit from remdesivir.

The authors also sound a note of caution about the potential opportunity cost of using remdesivir while the evidence base is still uncertain. As a relatively costly drug that is given intravenously, use of remdesivir may divert funds, time, attention, and workforce away from other potentially worthwhile treatments.

The study that today's recommendation is based on is called a living systematic review.

In a linked editorial, The BMJ editors explain that living systematic reviews are useful in fast moving research areas such as covid-19 because they allow authors to update previously vetted and peer reviewed evidence summaries as new information becomes available.

This is the second living systematic review published by The BMJ this year, and it will be updated to reflect emerging evidence. Several more are planned, including one on pregnancy outcomes among women infected with covid-19.

Experts have developed a risk score to predict cardiac arrest patient outcomes.

The study published today in European Heart Journal, by a team of researchers from King's College London and King's College Hospital, details a novel risk score for heart attack centres to predict brain damage in patients who have had an out of hospital cardiac arrest.

Out of hospital cardiac arrest is a major public health challenge and can lead to considerable morbidity and mortality. Patients have an extremely high risk of long-term brain damage after cardiac arrest, but this can be difficult to predict early on after admission.

The risk score, known as MIRACLE2, has been developed to help clinical decisions, improve selection of appropriate treatments and inform family discussion early after admission.

The study examined data on 400 patients who have had an out of hospital cardiac arrest and been treated at King's College Hospital and then identified characteristics of patients that developed brain injury. The team then performed prediction modelling to create a score that could be readily applied by clinicians on arrival to a heart attack centre.

The MIRACLE2 predicted brain injury with high accuracy and when validating the performance of the score in nearly 500 patients from two other heart attack centres from Europe, the score performed equally well.

The risk score will now be validated in a larger number of patients and potentially across different healthcare settings, for example by ambulance staff in the community. Once the performance of the score has been checked in these settings, it could be incorporated into future clinical trials and potentially into national guidance.

Nilesh Pareek from King's College Hospital said: "MIRACLE2 is the first practical score which can provide objective risk stratification to support clinicians in making critical decisions for patients with OOHCA. This could be a major step forward in understanding which OOHCA patients to select for invasive treatments, to guide the application of novel therapies and for standardising care across all healthcare settings."

Professor Ajay Shah, BHF Professor Cardiology at King's College London and Director of the King's BHF Centre of Research Excellence, said: "People who suffer a cardiac arrest in the community are among the most serious and complex emergency patients to manage, with a wide range of possible outcomes from complete recovery to possible long-term brain damage. The new risk score developed in our study should greatly aid ambulance teams and emergency heart doctors to make early decisions about the best treatment option for each patient."

New research has found that paying greater attention to internal bodily sensations can increase our appreciation of our own bodies.

The study, led by Jennifer Todd of Anglia Ruskin University (ARU) and published in the journal Body Image, focused on gastric interoception, which are the feelings of hunger or fullness that originate in the gut.

The researchers carried out an experiment involving 191 adults in the UK and Malaysia fasting and then consuming water.

They measured both the quantity of water consumed in relation to stomach capacity, and the feelings and experiences of the adults during the task. This included completing questionnaires examining different aspects of body image, such as appreciation of the body and appreciation of the body's functionality.

Body image refers to appearance-related thoughts and feelings, and positive body image refers specifically to an active love, respect, and appreciation for one's body.

The study found that a greater change in the intensity of feelings in the gut after consuming water was associated with significantly higher levels of appreciation of the body and appreciation of the body's functionality for adults in both the UK and Malaysia.

Lead author Jennifer Todd, a Psychology PhD student at Anglia Ruskin University (ARU), said: "Our study shows a clear link between bodily awareness, in this case the feeling of fullness, and body image. In other words, people who are more in tune with their body's internal workings have a greater appreciation of their body in general. Interestingly, we found that this link exists in two very different countries.

"We think that greater sensitivity to gastric signals might increase awareness of the positive functions the body performs and improve the ability to respond to the body's needs, both of which promote positive body image.

"Individuals who are less in tune with internal stimuli, such as feeling full, could be more at risk of developing negative body image, due to an over-reliance on external, appearance-related characteristics such as shape and size.

"It is possible that body image can be promoted by encouraging people to be more aware of internal sensations, such as feeling full. Gut feelings can be good for you!"

As small and relatively simple as they may be, even viruses have strategies. Now, researchers in Japan report that they can evaluate two of these strategies through a combination of biology and math, providing a new tool for insight into viruses that could be used to develop better treatments.

Unable to reproduce on their own, viruses replicate by infecting a living organism's cells and getting the cells to make copies of them. Two main options exist for copies of a virus's genetic structure made in the cell: stay in the cell as a template for making even more copies or get packaged as a new virus and leave in an attempt to infect other cells.

Each option comes with trade-offs, so an individual virus's strategy of how much weight to place on each one should directly influence the progression of an infection and any health problems it may cause.

"While such strategies are expected to be in play, showing the existence of the strategy itself has been difficult," says Shingo Iwami, associate professor of the Faculty of Science at Kyushu University and associate investigator of the Institute for the Advanced Study of Human Biology (WPI-ASHBi) at Kyoto University.

However, as reported in the journal PLOS Biology, collaborative research led by Shoya Iwanami and Iwami at Kyushu University and Koichi Watashi at the National Institute of Infectious Diseases to mathematically model the behavior of two hepatitis C virus strains now provides a means to evaluate two such strategies.

While one of the studied virus strains causes severe and sudden symptoms, the other is a genetically modified version developed in the laboratory to increase virus production, which is important for creating stocks of viruses for the development of treatments and vaccines.

As an experimental base for the modeling, Watashi's group measured characteristics of each virus's behavior--such as number of infected cells and the amount of viral genetic code inside and outside of the cells--over several days for cells grown and infected in the lab.

Iwami and his group then developed a mathematical model with parameters to take into account key processes like the replication and release rates of the viral genetic information to explain the experimental data.

By finding the range of model parameters that reasonably reproduce the experimentally observed results, they could quantify differences in behavior between the two strains. In particular, they estimated that the fraction of replicated genetic code packaged by the lab-developed strain to make new viruses was three times that for the other strain, indicating the preference of a leave strategy for the former and a stay strategy for the latter.

"The stay strategy initially produces copies of the genetic code faster, while the leave strategy emphasizes newly infecting cells," explains Iwami. "Though other mathematical models exist, ours is the first to evaluate these opposing evolutionary strategies."

The current model does have some limitations, such as assuming some processes are constant and excluding some of the detailed biological processes, but for now, it provides a relatively simple way to gain an overall insight into two virus strategies.

"Such strategies may be common in other chronic virus infections, and understanding them could help us develop effective therapeutic methods to counter individual virus strategies," Iwami comments.

While the level of fine particulate air pollution has declined considerably over the last several decades, a new study finds that its distribution has remained largely unchanged. According to the results, the most and least polluted U.S. neighborhoods in 1981 remained the most and least polluted more than 30 years later, with disadvantaged communities far more likely to have higher levels of particulate pollution at any given time. The findings reveal persistent socioeconomic disparities in access to clean air and highlight the perpetual problem of environmental inequality. Overall, the concentration of fine particulate air pollution (PM2.5) - airborne particulate matter less than 2.5 microns in diameter - has decreased by roughly 70% since 1981 in the U.S., leading to improvements in air quality and, by extension, human health and economic well-being. But air pollution is not evenly distributed. Like other types of pollution and environmental hazards, increased levels of air pollution are often associated with disparities between different racial, ethnic and economic groups. However, little is known about how the spatial distribution of PM2.5 has evolved over time. Jonathan Colmer and colleagues combined measurements of PM2.5 spanning 1981-2016 with geographic, economic, and demographic data from 65,000 neighborhoods across the U.S. Colmer et al. found that the differences in PM2.5 between more and less polluted areas declined over time. However, the neighborhoods and subpopulations most exposed to pollution in 1981 remained the most exposed in 2016. In contrast, areas that were less polluted in 1981 were still less polluted in 2016. "Colmer et al.'s findings highlight outstanding issues relevant to implementing environmental justice in practice," writes Lala Ma in a related Perspective. "Further investigation to determine what caused the downward shift in the pollution distribution and the preservation of rankings over time could inform policies that avoid undesirable distributional consequences."

The ongoing COVID-19 pandemic has forced nations worldwide to implement unprecedented social measures to stem the rapid spread of the virus. In a Policy Forum, David Laborde and colleagues discuss how the economic fallout from these efforts and impacts on food supply chains worldwide puts global food security at risk. Laborde et al. argue that these new threats need to be acknowledged and addressed by governments worldwide to prevent the COVID-19 health crisis from becoming a global food crisis as well. According to the authors, COVID-19's most direct impacts on food security stem from the economic damage associated with the extreme measures designed to contain the virus, which has caused many around the world to lose their incomes and ability to buy food - particularly for the world's most poverty-stricken populations. What's more, disruptions to agricultural supply, production, and distribution of foods due to labor shortages, widespread industry closures, and restrictions on the movement of people and goods have placed further strain on the global food system. To address these emerging threats to global food security, Laborde et al. suggest that governments of both rich and poor nations should first focus on ways to provide income support to protect food access for their most vulnerable citizens. Novel strategies to enact safe social distancing in ways that facilitate food production and trade and allow for the movement of food-sector workers could also minimize disruptions to food systems and prevent looming food shortages as the COVID-19 pandemic progresses.

The alpine biome harbors distinctive communities adapted to stressful environmental conditions. For plants, the world's most species-rich temperate alpine biota occurs in the Qinghai-Tibet Plateau (QTP), Himalaya, and the Hengduan Mountains (THH).

Threatened by global warming, alpine species are vulnerable. To understand how alpine biotas formed in response to historical environmental change may improve our ability to predict and mitigate threats.

In a study published in Science, researchers from the Xishuangbanna Tropical Botanical Garden (XTBG) of the Chinese Academy of Sciences showed that the alpine flora of the Hengduan Mountains has continuously existed far longer than any other alpine flora on Earth. They also illustrated how modern biotas have been shaped by past geological and climatic events.

The researchers from XTBG and the Field Museum of the U.S. connected the dynamic tectonic and climatological history of the THH region to the biological processes that have driven the development of its alpine biota. The scientists especially focused on whether phylogenetic estimates of alpine ancestry are temporally and spatially consistent with geological evidence of alpine habitat availability.

By using a joint model of biome occupation, evolution of geographic range, and lineage diversification, they analyzed time-calibrated phylogenies of 18 groups of flowering plants.

"Our historical reconstructions indicate that an alpine flora had emerged in the THH region by the early Oligocene. This is much earlier than estimated origins of other extant alpine floras," said Prof. XING Yaowu from XTBG.

In addition, the researchers tested whether major tectonic events in the QTP, Himalaya, and Hengduan Mountains left discernible imprints on the tempo and mode of alpine biotic assembly.

They found that overall rates of in situ alpine speciation began to increase from the early Miocene and were jointly driven by the uplift of Himalaya and the Hengduan Mountains as well as intensification of the Asian monsoon.

"Our results, derived from analyses of time-scaled molecular phylogenies and not in situ fossil evidence of alpine ancestry, are nevertheless temporally consistent with the latest geological evidence that active orogeny associated with widespread crustal shortening and thickening established highlands from eastern Tibet to the Hengduan Mountains by the end of the Eocene," said DING Wenna, first author of the study.

"The rich alpine flora of the THH region has been shaped by a long and complex history of colonization, local recruitment and in situ diversification driven by mountain building and climate change. The Hengduan Mountains are not only the cradle of alpine plants. They are also the primary source of alpine lineages colonizing the Himalaya and QTP, which need urgent conservation in this temperate biodiversity hotspot," said Prof. XING.