Culture

CORVALLIS, Ore. - Broader monitoring of patients is needed to reduce the number of people who develop a urinary tract infection after being discharged from the hospital, new research by Oregon State University suggests.

Findings were published in the journal Infection Control & Hospital Epidemiology. The exploratory study of more than 3,000 at-risk patients showed that infection was nearly three times as likely to begin after they went home compared to when they were in the hospital.

"Every healthcare-associated infection represents an undesirable patient outcome," said Jessina McGregor, associate professor in the OSU College of Pharmacy and the study's corresponding author. "If people are still at risk for those types of infections after they leave the hospital, then healthcare-associated infection research should focus more broadly than the current definitions of surveillance definitions. We need more data to stimulate innovation for better informing patient care and preventing these types of infections."

Urinary tract infections, or UTIs, are the most common type of healthcare-associated infection, according to the National Institutes of Health. Seventy-five percent of UTIs acquired in a hospital trace to the use of a urinary catheter, a tube inserted into the bladder through the urethra to drain urine. About 20% of hospitalized patients need a catheter.

"UTI surveillance has largely focused on catheter-associated infections, and also has not focused very much on infections that onset post-discharge from the hospital," McGregor said. "But recently discharged patients are still at risk for hospital-associated UTIs, and as hospitals continue to encourage shorter hospital stays, symptoms of these infections may be more likely to show up after the patient goes home. However, data to describe the incidence of these infections is lacking, which is a barrier to better identifying which patients are most at risk."

In the group studied by Oregon State researchers, 10.6 patients per 1,000 developed a UTI while in the hospital; 29.8 per 1,000 did so within 30 days of going home. In addition to catheterization, other risk factors for healthcare-associated "community onset" UTIs - those that develop outside a hospital setting - are quadriplegia and paraplegia, prior use of certain antibiotics, and whether a patient has private insurance; those with private insurance are less likely to become infected.

"Patients who got sick after discharge had similar pathogens and antibiotic sensitivities to those who got sick while still in the hospital, which suggests that patients developing a UTI following discharge may need different treatment strategies than patients who develop UTIs that aren't associated with hospital stays," McGregor said.

The results don't say with certainty that the post-discharge infections were acquired in the hospital, but the evidence is strong enough to warrant further study, she added.

ANAHEIM, CA (Embargoed until 10:30 a.m. PDT, Tuesday, June 25, 2019) - Research presented at the 2019 Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging (SNM MI) shows preliminary evidence that tobacco smokers may have reduced neuroimmune function compared with nonsmokers.

Tobacco, a leading cause of preventable death, has complex effects on immune signaling. While nicotine suppresses the immune system, other compounds in tobacco smoke cause inflammation. Since impaired neuroimmune signaling may contribute to compulsive drug use, this study compared neuroimmune responses in tobacco smokers and nonsmokers using a new [11C]PBR28 positron emission tomography (PET) brain imaging paradigm.

"This work has important implications for tobacco smokers," explains Ansel T. Hillmer, PhD, assistant professor of radiology and biomedical imaging and of psychiatry at Yale University in New Haven, Connecticut. "There is broad interest in targeting neuroimmune mechanisms with therapeutics for substance use disorders, but most of the interest is in suppressing the brain's immune system. Our preliminary work suggests that restoring the immune system may benefit tobacco smokers. Immune dysfunction is linked to cognitive dysfunction, which is also a typical complaint in smokers trying to quit."

For the study, baseline scans were acquired in 16 smokers and 19 nonsmokers. A subset of eight smokers and nine nonsmokers also participated in a second scan three hours after administration of the pro-inflammatory stimulus lipopolysaccharide (LPS).

No significant differences in baseline scans were observed between smokers and nonsmokers. However, the response to LPS was significantly lower in smokers vs. nonsmokers in certain regions of the brain, including the striatum and cortex. The preliminary results of this ongoing study provide initial evidence for impaired neuroimmune function in tobacco smokers compared to nonsmokers.

Hillmer points out, "This is the first demonstration of group differences with this imaging paradigm. Our findings indicate an important new role for molecular imaging in clinical research studying the brain's immune system." He adds, "We hope to explore in future research how restoration of the immune system may help smokers quit by improving cognitive function."

The Affordable Care Act (ACA) expanded health insurance coverage, including eligibility for Medicaid, the public insurance program for low-income Americans. Under the ACA, states can decide whether to expand eligibility for Medicaid coverage. As of earlier this year, 36 states and the District of Columbia had adopted Medicaid expansion, and other states are still debating whether to do so.

Against this background, a new study sought to determine how the nature of visits to emergency departments (EDs) changed for previously uninsured patients who gained Medicaid insurance expansion under the ACA in 2014 and who went to the ED at least once before and once after expansion. The study found that compared with patients who remained uninsured in states where Medicaid was not expanded, these patients shifted their use of the ED toward conditions that required subsequent hospitalization and predominantly for illnesses that were not easily avoided by robust outpatient care.

The study, by researchers at Carnegie Mellon University and US Acute Care Solutions, appears in Medical Care Research and Review.

"This is the first study to follow individual patients across multiple states who gained Medicaid insurance under the expansion of the ACA, and we found that they shifted their ED use toward visits for more severe conditions," explains Rahul Ladhania, a recent Ph. D. graduate from Carnegie Mellon University's Heinz College, who led the study. "The findings suggest that newly insured patients may have greater access to outpatient care for less severe conditions that had previously been addressed by visits to the ED."

The researchers sought to identify the average effect of enrollment in Medicaid after the ACA expansion went into effect on the nature of subsequent ED use by patients who had previously been uninsured and who visited EDs at least once before and once after expansion. To do so, they looked at data on patient visits from 30 EDs in seven states (Illinois, Nevada, North Carolina, Ohio, Oklahoma, Rhode Island, and West Virginia) from April 2013 through September 2015. Of these seven states, 19 EDs were in five states (Illinois, Nevada, Ohio, Rhode Island, West Virginia) that expanded Medicaid in January 2014, and 11 were in two states (North Carolina and Oklahoma) that did not expand Medicaid before the end of 2015. ED visits in the facilities the researchers examined are comparable to ED visits nationally.

Specifically, the researchers examined changes in use of EDs by previously uninsured 18- to 64-year-old patients who were identified as repeat ED users in states that expanded Medicaid eligibility and were subsequently Medicaid-insured in the period after expansion. The authors compared these patients' change in ED use with that of patients who were similar in their use of EDs but remained uninsured because they lived in states that did not expand Medicaid. The study linked individual patients' ED visits to the same facility over time, which allowed researchers to track changes in individual patients' behavior as they went from being uninsured to having Medicaid or as they remained uninsured, depending on the state.

The study found that visits to the ED were nearly 29% more likely to result in hospital admission for the newly insured patients in expansion states, compared with those visiting the ED who remained uninsured in non-expansion states. Additionally, they found a similar (31%) increase for conditions for which hospital admissions may not be avoided by robust treatment in an outpatient setting. The authors point to these findings as important for the patients studied because using the ED for less severe conditions is of particular concern.

"We find that Medicaid expansion led the newly insured to use EDs for more severe, acute conditions than they did when they were uninsured. This suggests that ending Medicaid expansion may increase the use of hospital EDs for less severe cases, reducing the efficiency of EDs in taking care of critically ill and injured patients - exactly what policymakers and clinicians wish to avoid," says Amelia Haviland, associate professor of statistics and health policy at Carnegie Mellon University, who co-authored the study.

The researchers acknowledge that the group targeted in their work--patients who use the EDs at least twice in a two-and-a-half-year period --is a selective cohort. This is a group of particular interest to policymakers.

CLEVELAND -- Common antidepressants interact with the opioid pain medication tramadol to make it less effective for pain relief, according to a study from University Hospitals (UH). These findings have important implications for the opioid epidemic, suggesting that some patients suspected of drug-seeking may in fact be under-medicated and just are seeking more effective pain relief. They also could help explain why some people exceed the prescribed dose of tramadol, increasing their risk of addiction.

The study was published in the journal Pharmacotherapy.

Researchers reviewed the medication records of 152 patients at UH Cleveland Medical Center and UH Geauga Medical Center who received scheduled tramadol for at least 24 hours. All participants in the study were admitted as inpatients or observation status. Those patients who also were taking the antidepressants Prozac (fluoxetine), Paxil (paroxetine) or Wellbutrin (bupropion) required three times more pain medication per day to control "breakthrough" pain throughout the day, when compared with patients not taking those antidepressants.

"As we looked at in secondary analysis, it ended up being four times as much over their entire hospital stay," said Derek Frost, a pharmacist at UH and lead author of the study.

Previous studies with healthy volunteers have shown effects on blood levels when combining tramadol with these particular antidepressants. However, this is the first study to document the effects of this interaction in a real-world setting with patients.

"We knew that there was a theoretical problem, but we didn't know what it meant as far as what's happening to pain control for patients," Frost said.

What explains the interaction between tramadol and these antidepressants?

"Tramadol relies on activation of the CYP2D6 enzyme to give you that pain control," Frost said. "This enzyme can be inhibited by medications that are strong CYP2D6 inhibitors, such as fluoxetine, paroxetine and bupropion."

According to Frost, it's likely that millions of Americans may be suffering the ill effects of this drug-to-drug interaction.

"These drugs are super-common," he said. "They're all in the top 200 prescription drugs. In addition, chronic pain and depression and anxiety go hand in hand. Many chronic pain patients are taking antidepressants, mainly selective serotonin reuptake inhibitors (SSRIs), which many of these CYP2D6 inhibitors fit into. There are a lot of patients who experience both, unfortunately. The likelihood that somebody on one of these offending agents and tramadol is relatively high."

Fortunately, Frost said, this problem has a relatively easy fix.

"We have a lot of other antidepressants available that are in the same class of medication that don't inhibit this particular enzyme, such as Zoloft (sertraline), (Celexa) citalopram and Lexapro (escitalopram)," he said. "You also have other options for pain control - non-opioid medications such as NSAIDs. If we need to use opioids, a scheduled morphine or a scheduled oxycodone would avoid this interaction."

"For patients who have the combination of chronic pain and depression or anxiety, keep in mind that this interaction does exist," Frost said. "And for health care providers, if you have a patient approaching you saying this medication isn't working for me, is there an interaction at play?"

CORVALLIS, Ore. - Private prisons play a political role in immigration and incarceration issues in the United States and the industry may face obstacles as well as opportunities in the current political landscape, a new paper from an Oregon State University researcher suggests.

"The big picture view of this industry shows that companies operating private prisons are political actors who shape politics and policies but also are affected by ongoing political battles," said the paper's author, Brett Burkhardt, an associate professor of sociology in the School of Public Policy at OSU. "That leaves them in a somewhat precarious position moving forward."

The findings were published recently in a special issue of the journal Criminology & Public Policy that focuses on private prisons.

The modern private prison system in the United States has been around since the 1980s. Today, the industry is a multi-faceted, multi-billion dollar market. Private prisons hold more than 120,000 inmates, about 8% of all prisoners, for 29 states and the federal government. The two largest private prison companies also operate more than 13,000 beds for immigrant detention.

Burkhardt's paper reviews existing research on private prisons and the politics of the industry in an effort to identify broad themes. He found that privatizing corrections is not uniformly accepted by politicians and the public.

"There is no evidence to suggest that private prisons are any better, or worse, than public correctional facilities, which raises questions about what their role is," Burkhardt said. "Private prisons tend to take on different responsibilities, generally working with lower risk offenders."

He also found that private prisons face both challenges and opportunities in the current climate. Among the obstacles facing the industry is the volatility around immigration detention, which provides a growing market but also may present moral or ethical challenges for investors and the public.

While the current U.S. government administration has adopted tough immigration policies that have led to increased detention, some private companies are refusing to participate in activities related to detention of migrant children, or publicly distancing themselves from government policies around child detention, Burkhardt found.

The private prison industry also faces declining incarceration rates nationally - in part due to political decisions around criminal justice reform and decriminalization of drugs like marijuana in many places.

But as the corrections industry changes in the U.S. private prison companies also could explore new opportunities that emerge, such as overseeing drug testing and treatment programs or community supervision programs.

"The issues the private corrections industry are facing are not going away anytime soon. That presents a dilemma for the industry," Burkhardt said. "Political decisions will help determine how the industry develops from here."

A recent study conducted at The Westmead Institute for Medical Research has shed light on the role of vitamin D in muscle cells. The study looked at the role of vitamin D in muscles in mice, and showed that vitamin D signaling (how cells communicate with one another) is needed for normal muscle size and strength.

Researchers found that mice missing the vitamin D receptor only in myocytes (muscle cells) had smaller muscles, and they were less strong. They also had significantly decreased running speed and didn't run as far as mice with normal vitamin D action.

Lead researcher, Professor Jenny Gunton says, "For a long time, we have known that vitamin D deficiency is associated with muscle weakness and greater risk of falls and fractures. However, whether vitamin D played a direct role in muscle wasn't known.

"We show that vitamin D receptor is present in low levels in normal muscle, and our study found that deleting muscle cell vitamin D receptors had important effects on muscle function."

Professor Gunton says that, compared to a previous study she conducted that looked at mice missing vitamin D receptors across their whole body, this new study has highlighted some important differences.

"We found that mice missing muscle cell vitamin D receptors had normal body size but less muscle mass and more fat mass.

"In terms of choosing to run on a wheel in their cage, the mice had shorter running distance and slower speed. These might contribute to the lower muscle mass and increase in fat.

In terms of muscle strength, these mice also had a significantly decreased grip strength from a very early age."

While more research is needed, Professor Gunton says that these results suggest that maintaining normal vitamin D signaling in muscle is important for preserving muscle bulk and function.

"These findings also have the potential to open up avenues to pursue new therapies that target muscle cell vitamin D receptors. These therapies could help to address or prevent age-related sarcopenia (degenerative loss of skeletal muscle mass) and other disorders related to muscle function."

The research paper was published in the Journal of Cachexia, Sarcopenia and Muscle.

Researchers at the University of Washington in Seattle, Washington, are developing a user-friendly (worn at home) vest with technology that collects data to tailor personalized therapy for patients with metastatic, somatostatin-receptor-2 positive neuroendocrine tumors (NETs). The study was presented at the 2019 Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging (SNMMI).

Targeted therapy using lutetium-177 (177Lu)-DOTATATE greatly increases progression-free survival for NETs patients. While approved by the United States Food and Drug Administration (FDA), the FDA package instructions call for patients to receive a standardized protocol, regardless of size or weight. Traditionally, targeted radionuclide therapies are personalized based on dose to the main organs at risk (OAR, e.g., kidneys, liver, spleen).

"Organ specific dosimetry for the 177Lu-DOTATATE (Lutathera) is the norm at many medical centers outside of the United States," explains Robert Miyaoka at the University of Washington. "Longitudinal imaging studies are conducted after each therapy treatment to determine the cumulative dose to the OAR for each patient. The standardized 177Lu-DOTATATE treatment protocol in the United States consists of four 200 mCi doses spaced two months apart. Although this is safe for a vast majority of patients, it is less than optimal for most. Studies out of Europe are revealing that tailoring the number of treatment doses based upon the dose-limiting toxicity to the patient's OAR can more than double the progression-free and overall survival for NET patients undergoing 177Lu-DOTATATE therapy."

Another factor the researchers sought to address is the fact that traditional imaging-based methods for organ dosimetry estimation for 177Lu require three-to-four longitudinal imaging sessions spread over seven days. This is expensive, uses a lot of clinic resources and is burdensome to the patient.

"We propose to create a lightweight, low-cost, wearable, patient-specific technology that will allow organ-specific measurement recordings to be made within the comfort of the patient's home," Miyaoka says. "The garment [called a multi-detector personalized home dosimetry (MD PHD) vest] will house 15-20 small radiation detectors, strategically placed within the vest based upon the patient's own anatomy. In addition to the radiation detectors the vest will be coupled to a compact electronics pack that will acquire the data and send it via WiFi or cellular services to a secure website where medical personnel/software can check the data for quality control in near real-time."

He further explains, "The patient will be asked to wear the vest for a two-minute data acquisition once a day for seven (and up to 21) days. Based upon these at-home measurements and a single SPECT/CT image taken 24 hours after the therapy administration, organ specific dosimetry will be determined for all of the patient's OAR." With the information collected via the vest, physicians would be able to tailor the number of treatments based upon personalized organ dosimetry information.

Miyaoka reports, "Preliminary vest results from simulations are showing that at-home vest measurements made over 7-21 days can provide organ-specific washout rates with precision as good or better than the current accepted gold standard of three-four quantitative SPECT/CT images acquired over seven days. The initial goal of this technology is to enable personalized 177Lu-DOTATATE therapies in the United States and to lower the cost for treatment personalization throughout the world."

A new technology discovered by a team including UConn School of Dental Medicine researchers records cellular communication in real time – providing a closer look into the dynamics of cell secretion and a greater understanding of how cells repair tissue.

Kshitiz, an assistant professor (who goes by just his first name), and Yasir Suhail, a postdoctoral fellow, in the Dental School’s Department of Biomedical Engineering, along with Andre Levchenko and Onur Kilic, Yale University; David D. Ellison and Laura Woo, The Johns Hopkins School of Medicine; Junaid Afzal, University of California, San Francisco; and Jeffrey Spees, University of Vermont, collaborated on the study, which is published online in the Proceedings of the National Academy of Sciences.

Now for the first time, scientists can record cells communicating in real time, opening the floodgates for new developments in cell therapy and other areas within cell biology.

Cells - like humans - are in constant communication with each other. Whereas humans exchange words, cells deliver and receive messages through secreting proteins and changing their behavior accordingly. When we listen to humans speak to each other, we can understand how words are placed into sentences and how the conversation moves back and forth. When it comes to recording communication between cells, however, the key characteristics of the conversation have been largely unknown until now.

Communication between cells is necessary to maintain most functions in the body and can also help the body properly respond to an external cue - such as an ailment or injury. Current technology only allows broad snapshots of these protein secretions.

"This is akin to detecting what words were spoken in a sentence, but not really knowing their placement, the inflection, and tone of the message," says Kshitiz. Prior to the current findings, he adds, understanding of the language of communication between cells has been very limited, and did not capture the complexity of messaging involved.

Using a combination of microfluidics and computer modeling, researchers created a platform to record cell messages in depth, uncovering the precise ways in which the words and messages are arranged in these intercellular conversations.

In the study, which was funded by the American Heart Association and the National Cancer Institute, Kshitiz and fellow researchers Suhail at UConn and Levchenko at Yale looked at stem cells from bone marrow that can be used to treat myocardial infarction, commonly known as a heart attack. Using the platform, the researchers recorded the proteins that were secreted by these stem cells, and how these secretions changed with time.

The information was used to create a protein cocktail that led to a second discovery - the possibility of aiding an injury without the use of stem cells. Since the researchers recorded in depth the conversations between the stem cells, they were able to copy the stem cells' exact behavior.

Stem cells - the researchers witnessed - are flexible enough to change their behavior depending on the injury present. These cells only act as "Good Samaritans," the researchers discovered, when they see injured tissue.

This information created a way to make a "cell-less" therapy by copying what stem cells do when they see a tissue injury and creating a new protein cocktail that aided in repairing cardiac tissue. The discovery of cell-less therapy can potentially reduce many complications associated with stem cell transplantation in the future.

"The findings solve a fundamental problem afflicting systems biology: measuring how cells communicate with each other," says Suhail. "The platform technology will open new lines of inquiry into research, by providing a unique way to detect how cells talk to each other at a deeper level than what is possible today."

BINGHAMTON, N.Y. - The Woodstock Music Festival celebrates its 50th anniversary this summer, and new archaeological research from Binghamton University, State University of New York shows that the iconic event took on a life of its own.

Binghamton University's Public Archaeology Facility have worked closely with The Museum at Bethel Woods and Bethel Woods Center for the Arts to dig at the site of the original Woodstock Music and Art Fair. In 2018 they determined the exact location of the stage. More recently, they worked to locate and identify cultural features to help the museum construct a trail system based on plans from the Woodstock archives. By analyzing the rocks and vegetation surrounding the area, the team successfully identified 24 vendor booths and 13 other potential cultural features in an area known as the Bindy Bazaar.

Maria O'Donovan, project director, said the Bindy Bazaar is an important cultural landmark that reflects the spirit of the festival.

"The Bindy Bazaar was a meeting place where transactions -- which included trading and bartering, in addition to selling -- and cultural interactions took place," said O'Donovan. "It exemplifies the informal, free-wheeling spirit of the counterculture."

An original map and photos of the Bindy Bazaar indicate that there were about 25 vendor booths in the area that appear to have been ad hoc arrangements of natural rock, trees, wood and other materials. However, the mapped-out booths were not in the same spatial configuration as those defined by the current archaeological research.

O'Donovan said this discovery reveals the exciting spontaneity of Woodstock.

"Our research demonstrated that the reality of what occurred at Woodstock was not captured by the preliminary plans," she said. "Archaeologists located 24 potential vendor booths concentrated on one side of the Bindy Bazaar area and not distributed as on the 1969 plans. This is more evidence that the festival took on a life of its own that organizers could not control. We also identified more recent usage of the area, which could be related to later anniversary events or causal use of the site before it was acquired and preserved by Bethel Woods."

Based on photos, the Bindy Bazaar seemed to be located between two campgrounds, with trails that funneled foot traffic between venues. At first glance, the location appears to be unchanged over the last 50 years, but new trees and vegetation produced debris that reduced the area's visibility. Despite these challenges, archaeologists determined that potential vendor booths could be distinguished through well-defined examples of stacked stone and other features that clearly indicated human intervention. Other elements were labeled as cultural features if they had no clear function and if the arrangements seemed unnatural.

The results from this research will help The Museum at Bethel Woods develop a cultural interpretation program that includes interpretive walking routes for the concert's 50th anniversary this summer. O'Donovan said the Museum at Bethel Woods aims to use this research to preserve and honor the Bindy Bazaar and surrounding area.

"The Museum at Bethel Woods has long-term preservation and interpretive goals for the site," she said. "Their immediate concerns were to prevent further impact to the area and to open the Bindy Bazaar to visitors with a reconstructed trail network and with interpretive signage. The Museum at Bethel Woods is considering special displays in the Bindy Bazaar for the 50th anniversary and I am sure the anniversary influenced the timing of our research."

The trails opened to the public on May 4 in a ribbon cutting ceremony, Assistant Curator at Bethel Woods Center for the Arts Julia Fell welcomed guests in saying "...[Bindy Bazaar] was a whimsical place where all manner of vendors and other attendees bartered for goods, met up with lost friends, made new friends, and attempted to stay out of the rain. With all this in mind, The Museum at Bethel Woods set out to bring the Bindy Bazaar back into its former glory."

If a man is handy with the vacuum cleaner, isn't averse to rustling up a lush family meal most nights after he's put on the washing machine having popped into the supermarket on his way home then it's more than likely his partner will have her own bank account.

A new study by Lancaster University reveals the way in which couples manage their money tells 'a tale of two marriages' in the UK today.

The research shows the management of household finances and control of financial decisions are linked to the time spent by women and men on routine housework such as cooking, cleaning, laundry and grocery shopping.

'What about money? Earnings, household financial organization, and housework' conducted by Lancaster Lecturer in Sociology, Dr Yang Hu, is published today in the Journal of Marriage and Family.

The study analysed data from more than 6,000 heterosexual couples, aged 20 to 59, from the UK Household Longitudinal Survey (Understanding Society).

This is the first study to examine how the organisation of household finances intervenes between couples getting their pay packets and housework at home. It takes previous studies on housework a step further.

"Housework provides a window into the 'checks and balances' of power and gender in couple relationships," said Dr Hu.

To negotiate their housework participation, men either hand over their income to their partners, who manage the money, so they use money to 'exchange' their way out of housework, or they hold on to their income to 'bargain' their way out of housework.

"Men get away with not doing housework through both channels," explains Dr Hu. "It puts women in a very compromising position as they are left to do the lion's share of housework."

Given wage penalties and a glass ceiling in the labour market, women are unlikely to win the 'war' over housework by 'exchanging' and 'bargaining' with men.

They are seen to negotiate in a different way. Going 'solo', some working women are seen to opt out of housework by taking control of their own earnings and developing a sense of autonomy.

Indeed, women's income only reduces their housework time when they can access their own earnings and have a say in household financial decisions. But the study finds that in the UK, less than 12% of working-age women kept separate purses, another 23% managed household finances, and only around 15% controlled financial decisions.

"Our research provides further evidence to show that despite women's participation in education and the labour market, this still has not yet translated into gender equality in housework at home," said Dr Hu.

"If men still monopolise the management of household finances and financial decisions, then things are unlikely to change," said Dr Hu. "It's therefore important for everyone to be able to access their own earnings.

"Educating and employing more women and settling the gender pay gap with gender equality flowing neatly into place at home as a result is certainly not the story this analysis is revealing."

Selecting the best possible embryo to implant in a woman undergoing in vitro fertilization (IVF) is a complicated task. As success rates for IVF have improved, many clinics now implant a single embryo during an IVF cycle -- with the goal of avoiding a multiple pregnancy -- and the responsibility of selecting the embryo falls to the embryologist. To determine the quality and viability of an embryo, embryologists typically examine specific features of the embryos using a light microscope. In addition, specialists can use data from preimplantation genetic testing for aneuploidy (PGT-A), a test of whether cells from the embryo at the blastocyst stage have a normal or abnormal number of chromosomes. However, this crucial test carries the risk of false positives (which could lead to discarding a normal embryo) and false negatives (which could lead to transferring an embryo with a chromosomal abnormality). A team of researchers from Brigham and Women's Hospital, in collaboration with colleagues at Peking University and Yikon Genomics in China, have evaluated a new way to conduct preimplantation genetic testing and present results showing that this new method may improve the reliability of the test. Their findings are published in Proceedings of the National Academy of Sciences.

"This technique holds the promise of a more precise test than the current method," said co-corresponding author Catherine Racowsky, PhD, director of the IVF laboratory at the Brigham, and professor in the Department of Obstetrics and Gynecology at Harvard Medical School. "It represents a new way to evaluate embryos with less risk of discarding a viable embryo."

Current PGT-A testing uses a trophectoderm (TE) biopsy. If the blastocyst was a tennis ball, then its fluffy, green outer covering would be its TE cells. Inside the blastocyst is the inner cell mass (ICM) -- cells that will give rise to the fetus. Since current PGT-A testing involves biopsy of a few TE cells, they sometimes fail to reflect the genomic profile of the ICM cells within, especially if the blastocyst contains both normal and abnormal cells -- a phenomenon known as mosaicism.

The new technique, originally developed by co-corresponding author Xiaoliang Sunney Xie, PhD, of Peking University, is known as noninvasive preimplantation genetic testing for aneuploidy (niPGT-A). Instead of extracting TE cells, niPGT-A analyzes DNA leaked from human blastocysts into the culture medium in which they are growing. The technique has several potential advantages. Since it is non-invasive, it does not interfere directly with the embryo. In addition, the technique has the potential to resolve the issue of mosaicism and is more likely to capture the genomic profile of cells from within the inner cell mass.

The team tested the accuracy of niPGT-A using 52 blastocysts donated for research by patients undergoing infertility treatment. Each blastocyst had previously undergone TE biopsy testing by an outside laboratory. The investigators compared the sequencing results of DNA from both the surrounding culture medium and TE biopsy samples with the true results obtained by sequencing the whole embryo.

The team found that the new technique of niPGT-A outperformed the current PGT-A with the TE biopsy method. The niPGT-A technique had a false positive rate of 20 percent, reporting that 3 of 15 embryos tested as abnormal when they were not; the TE method had a false positive rate of 50 percent, reporting that 9 of 18 embryos testing as abnormal were, indeed, normal.

The team notes that the sample size they used was small and that a higher percentage of the embryos were abnormal than would be traditionally seen from women of comparable age in an IVF clinic. The embryos had also been previously biopsied, frozen and then thawed, potentially increasing the amount of DNA leakage from the inner cell mass into the medium. The team is already at work on follow-up experiments to validate that DNA can be detected in the medium, even in embryos that have not been previously biopsied.

"Our ongoing work will help us to determine whether niPGT-A will translate into a paradigm shift for PGT-A in clinical IVF," said Racowsky.

If you made any plans for next week, congratulations! You've demonstrated a key feature of being human: being able to think beyond the here and now - or, think abstractly. But when babies learn different kinds of abstract thought, and how, is still hotly debated by psychologists. Now new research published in the Proceedings of the National Academy of Sciences suggests that cultural environment may play a role.

The paper, titled "Context Shapes Early Diversity in Abstract Thought," details three experiments involving nearly 400 children in the United States and China, aged 18 to 48 months old.

The children were tested on their "relational reasoning" skills. Specifically, they were tested on their ability to infer the abstract concepts "same" and "different" from pairs of blocks that either matched each other or did not.

The youngest children in the U.S. and China appear to have similar success. By age 3, however, Chinese children are outperforming their U.S. counterparts, the research shows.

The under-3 set do comparably well at recognizing the relationships between pairs of blocks - whether they're the same or different - and then figuring out whether these blocks' sameness or difference is responsible for activating a musical toy. But then the skills diverge in the two cultures for a while. Also, when given a choice between favoring an object-based solution (concrete thinking) and a relation-based solution (abstract), U.S. 3-year-olds favor the former while Chinese 3-year-olds, on the other hand, go for the latter.

Why? Why does the development curve for American kids looks like a "U," with relational reasoning skills dipping around age 3 until they pick up later - while Chinese children show no such dip in the middle, and their development seems to follow a linear trajectory?

The root reasons could be linguistic, the paper's authors suggest, or they could be cultural, environmental or some combination of these. In any case, what seems to be at work is a "learned bias," with children in the U.S. learning, for a while, to focus on objects to the detriment of relations.

The paper's first author is Alexandra Carstensen, now a postdoctoral researcher at Stanford University and a visiting scholar at the University of California San Diego. The paper's senior author is Caren Walker, assistant professor of psychology at UC San Diego and director of the university's Early Learning and Cognition Lab.

Carstensen and Walker started working on the idea when both were graduate students at UC Berkeley. Walker had shown earlier that children begin to reason abstractly much younger than had been previously believed (as well as that, in the U.S., they lose the ability for a while). That work inspired Carstensen to wonder about the possible role of language.

Both Carstensen and Walker are doing follow-up work to extend the research.

Carstensen and Walker are trying to figure out, with graduate and undergraduate students in Hungary, Germany, Italy, the United Kingdom and Pakistan, what cultural features might be most relevant to relational reasoning and the learned bias against it.

Walker and her lab, meanwhile, are also doing a series of projects to examine ways to get preschoolers in the U.S. to think more abstractly.

"It doesn't have to be something as grand as language or cultural context that makes a profound difference," Walker said. "It could be as small as changing a few features of the learning environment - or just changing a handful of simple learning cues."

Smoking increases both men's and women's risk of a major heart attack at all ages, but women smokers have a significantly higher increased risk compared to men, especially women under 50 years old, according to a study in the Journal of the American College of Cardiology. Despite the increased risk, smokers can reduce their risk to that of a never smoker in as little as a month after quitting.

Heart disease is the No. 1 cause of death for women and men worldwide, and acute ST segment elevation myocardial infarction (STEMI) is among the most life-threatening forms of heart disease. STEMI is sometimes called a major heart attack and is caused by a complete blockage of one of the main coronary arteries.

Smoking is a risk factor for heart disease and researchers have previously identified smoking as the cause of STEMI in nearly 50 percent of all cases. However, none have quantified and compared the incidence of STEMI associated with smoking between genders and within different age groups.

In research led by Sheffield Teaching Hospitals NHS Foundation Trust in partnership with the University of Sheffield, the authors sought to assess smoking as an independent risk factor for STEMI and determine the differences in risk between age groups and genders. They used a retrospective ecological cohort study to compile data for all patients in the South Yorkshire region of the U.K. who presented with acute STEMI between January 2009 and July 2014, which included 3,343 STEMIs. The percentage who were current smokers was similar between genders, with 46.8 percent of female patients and 47.6 percent of male patients.

They found that smoking increases STEMI risk in all patients, regardless of age or gender; however, the risk is higher in females compared to males at all ages. The largest relative risk difference between men and women smokers was in the 50-64 years old group, but the highest risk increase in both genders was in the 18-49 years group--the youngest group. Female smokers in this age group had a greater than 13 times higher risk of STEMI compared to their non-smoking female contemporaries. Young male smokers had an 8.6 times increased risk.

The authors of the study proposed several possible reasons why smoking leads to such a greater risk of STEMI for females, including that smoking may lower levels of serum estrogen. Estrogens, which have long been known to have protective effects against atherosclerosis, which is a buildup of fats, cholesterol and other substances within artery walls that can restrict blood flow, are inhibited in female smokers. Also, men have been found to have larger coronary arteries than women, meaning that chronic inflammation from smoking may lead to a greater degree of arterial narrowing in women than men since their arteries are narrower to begin with. Several other vascular conditions are more prevalent in female STEMI patients, including vasospasm, vasculitis and spontaneous coronary artery dissection. The researchers said it is highly likely that smoking perpetuates some of these events and imposes a greater increase in STEMI risk for women.

However, researchers also found it is possible to substantially reverse the risk by quitting smoking.

"Our study found that smoking cessation, regardless of age or gender, reduces STEMI risk to that of a never smoker, possibly within a month," said Ever Grech, MD, senior author of the study and consultant interventional cardiologist and TAVI lead at South Yorkshire Cardiothoracic Centre in Sheffield, U.K. "Patients who smoke merit encouragement to give up their habit, and this study adds quantitative evidence to the massive benefits of doing so."

Researchers also speculated that since a previous study had shown that physicians perceived coronary artery disease in males as being more important than in females, professional advice on smoking cessation may differ between genders if smoking is considered to be less of a cardiac risk for females.

The study had several limitations, including that it did not provide information about intensity of smoking or duration of smoking cessation in ex-smokers who were defined as being abstinent for at least one month. It also only included patients presenting with STEMI as a candidate for PCI and did not include those who died in the community prior to admission.

Microdata from Swedish population registers provide new insights into cities' economic growth paths. The data reveal a surge in regional inequality, with more and more resources flowing to cities atop the urban hierarchy, which thus acquire an increasing share of national wealth.

A particular viewpoint has come to dominate the science of cities. Cities of different sizes are seen as scaled copies of one another, expected to go through similar lifecycles of socioeconomic growth - only in different historical epochs. In this perspective, cities follow parallel growth trajectories and, as an urban system grows in wealth and people, the relative inequality between cities remains stable.

"This idea has always puzzled me. It does not correspond to the increasing regional inequalities we observe in many countries around the world. The notion that cities grow completely in parallel appears empirically ill-founded as it is derived from datasets that only cover larger metropolitan areas. It misses out on small towns, many of which face a struggling economy and sustained out-migration of young and educated individuals", says Dr Marc Keuschnigg who is an Associate Professor at Linkoping University's Institute for Analytical Sociology.

The escalating urban-rural divide stands against the established interpretation of "urban scaling," as the dominant framework is known among academics. In his research article "Scaling trajectories of cities", published in the Proceedings of the National Academy of Sciences (PNAS), Keuschnigg puts the idea of self-similar urban growth to the test.

The new study also uses data on smaller cities, gathered from Swedish population registers that capture, for the first time, the city growth trajectories of an entire urban system - from the smallest town with 2,600 inhabitants to the capital city with 2.5 million inhabitants.

The results demonstrate that regional inequalities between smaller and larger cities increased substantially during 1990-2012, the period of observation. While big cities' economic growth trajectories are extremely robust over time, places with less than 75,000 inhabitants show little resilience to economic shocks and structural changes in society. The data reveal a firm grip of an urban hierarchy on cities' economic growth: Dominant positions in the urban system give an advantage to larger cities, helping their economies to thrive on specialized service industries and the sustained in-migration of talent from their hinterlands.

Because cities that rank lower in the urban hierarchy lack such relative advantages, path dependencies place bounds on the self-similarity of urban growth and, in relative terms, the pace of life in today's regional centers will never compare to a nation's core metropolitan areas back in time when they were of similar size.

These findings draw attention to the increasingly uneven economic geography observed in many countries, with growing levels of inequality between urban and rural areas.

"My research is of considerable policy relevance. It empirically identifies regional divides and measures the social inequalities associated with city growth and regional migration", says Dr Marc Keuschnigg.

Each year during the holiday season, soup kitchens and charities alike are flooded with offers to volunteer. But is a donation of your time most beneficial to the charity, or would a financial contribution provide more value?

Researchers from Portland State University and Texas A&M University wondered what drives volunteering -- especially when a monetary donation would have more impact. Their study, "Why Do People Volunteer? An Experimental Analysis of Preferences for Time Donations," was published in this spring in the journal Management Science.

PSU Assistant Professor of Economics J. Forrest Williams worked with Texas A&M economics professors Alexander Brown and Jonathan Meer to consider what drives volunteers. They found time and time again, people preferred to donate their time even when doing so is less efficient

Why do people make that choice? Williams said the "warm glow" effect appears to be responsible. Warm glow is described simply as the positive feeling associated with volunteering or donating to charity.

"If you have really high wages, why would you give up a few hundred dollars an hour, when you could just work an hour and donate that amount and then provide significantly more value than your time would be worth to the charity?" Williams said.

Past research assumes, he added, that when given the choice between donating $10 worth of someone's time and $10, the options are equivalent. Their research proves otherwise.

"The warm glow you get from volunteering appears to be significantly higher than that of giving money. And that went against what a lot of the field believed," Williams said.

Their findings should inform future economic studies and conversations considering gifts of time and money, he added.

"If we are only concerned about the impact of our donations, it makes no economic sense," Williams said of people's preferences to donate time. The warm glow effect is just that persuasive.

The study controlled for a variety of factors that may influence someone's choices: recognition, networking, reciprocity, happiness gained from working with others, etc.

Participants still chose to donate their time even when their choice essentially lost money for the charity and there was no personal benefit.

"If you make $100 an hour, then you go work in a soup kitchen and don't provide $100 worth of service in an hour, they would be better off if you just gave them $100," he said.

It's unclear how charities should respond to this finding. It's conceivable they could be better off insisting on donations and paying for labor to replace volunteers. But they may also lose a lot of potential donors who gain greater benefit from the volunteering experience. Those donors might end up volunteering at a competing charity. Further, volunteers might increase the visibility of the charity increasing future monetary donations, something this study could not address.

"Even if you are hyper-effective at what you do, it's just so unlikely that the value of your time there is greater than the value of the money you would give," Williams said.