Culture

Primary care payment model, telemedicine use for Medicare Advantage during pandemic

What The Study Did: The association between primary care payment models and the use of telemedicine for Medicare Advantage enrollees during the COVID-19 pandemic was examined in this study.

Authors: Brian W. Powers, M.D., M.B.A., of Humana Inc. in Louisville, Kentucky, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamahealthforum.2021.1597)

Editor's Note: The article includes conflicts of interest disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Media advisory: The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jama-health-forum/fullarticle/10.1001/jamahealthforum.2021.1597?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=071621

About JAMA Heath Forum: JAMA Health Forum has transitioned from an information channel to an international, peer-reviewed, online, open access journal that addresses health policy and strategies affecting medicine, health and health care. The journal publishes original research, evidence-based reports and opinion about national and global health policy; innovative approaches to health care delivery; and health care economics, access, quality, safety, equity and reform. Its distribution will be solely digital and all content will be freely available for anyone to read.

Credit: 
JAMA Network

Outcomes of patients treated by female vs male physicians

What The Study Did: Researchers investigated whether death, other hospital outcomes and processes of care differed between patients cared for by female and male physicians at hospitals in Canada.

Authors: Fahad Razak, M.D., M.Sc., of the University of Toronto in Ontario, Canada, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/ 

(doi:10.1001/jamahealthforum.2021.1615)

Editor's Note: The article includes conflicts of interest disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Media advisory: The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jama-health-forum/fullarticle/10.1001/jamahealthforum.2021.1615?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=071621

About JAMA Heath Forum: JAMA Health Forum has transitioned from an information channel to an international, peer-reviewed, online, open access journal that addresses health policy and strategies affecting medicine, health and health care. The journal publishes original research, evidence-based reports and opinion about national and global health policy; innovative approaches to health care delivery; and health care economics, access, quality, safety, equity and reform. Its distribution will be solely digital and all content will be freely available for anyone to read.

Credit: 
JAMA Network

Exploring gap between excess mortality, COVID-19 deaths in 67 countries

What The Study Did: National health care systems have different capacities to correctly identify people who died of COVID-19. Researchers in this study analyzed the gap between excess mortality and  COVID-19 confirmed mortality in 67 countries to determine the extent to which official data on COVID-19 deaths might be considered reliable.

Authors: Davide Golinelli, M.D.,  Alma Mater Studiorum-University of Bologna in Italy, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamanetworkopen.2021.17359)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Media advisory: The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

Credit: 
JAMA Network

How micro-circuits in the brain regulate fear

image: Subdivision of the mouse amygdala. The cell types studied are located in the central amygdala (red).

Image: 
Rob Hurt / Wikicommons (CC BY-SA 4.0)

Fear is an important reaction that warns and protects us from danger. But when fear responses are out of control, this can lead to persistent fears and anxiety disorders. In Europe, about 15 percent of the population is affected by anxiety disorders. Existing therapies remain largely unspecific or are not generally effective, because the detailed neurobiological understanding of these disorders is lacking.

What was known so far is that distinct nerve cells interact together to regulate fear responses by promoting or suppressing them. Different circuits of nerve cells are involved in this process. A kind of "tug-of-war" takes place, with one brain circuit "winning" and overriding the other, depending on the context. If this system is disturbed, for example if fear reactions are no longer suppressed, this can lead to anxiety disorders.

Recent studies have shown that certain groups of neurons in the amygdala are crucial for the regulation of fear responses. The amygdala is a small almond-shaped brain structure in the center of the brain that receives information about fearful stimuli and transmits it to other brain regions to generate fear responses. This causes the body to release stress hormones, change heart rate or trigger fight, flight or freezing responses.

Now, a group led by Professors Stephane Ciocchi of the University of Bern and Andreas Luthi of the Friedrich Miescher Institute in Basel has discovered that the amygdala plays a much more active role in these processes than previously thought: Not only is the central amygdala a "hub" to generate fear responses, but it contains neuronal microcircuits that regulate the suppression of fear responses. In animal models, it has been shown that inhibition of these microcircuits leads to long-lasting fear behaviour. However, when they are activated, behaviour returns to normal despite previous fear responses. This shows that neurons in the central amygdala are highly adaptive and essential for suppressing fear. These results were published in the journal Nature Communications.

"Disturbed" suppression leads to long-lasting fear

The researchers led by Stephane Ciocchi and Andreas Luthi studied the activity of neurons of the central amygdala in mice during the suppression of fear responses. They were able to identify different cell types that influence the animals' behaviour. For their study, the researchers used several methods, including a technique called optogenetics with which they could precisely shut down - with pulses of light - the activity of an identified neuronal population within the central amygdala that produces a specific enzyme. This impaired the suppression of fear responses, whereupon animals became excessively fearful. "We were surprised how strongly our targeted intervention in specific cell types of the central amygdala affected fear responses," says Ciocchi, Assistant Professor at the Institute of Physiology, University of Bern. "The optogenetic silencing of these specific neurons completely abolished the suppression of fear and provoked a state of pathological fear."

Important for developing more effective therapies

In humans, dysfunction of this system, including deficient plasticity in the nerve cells of the central amygdala described here, could contribute to the impaired suppression of fear memories reported in patients with anxiety and trauma-related disorders. A better understanding of these processes will help develop more specific therapies for these disorders. "However, further studies are necessary to investigate whether discoveries obtained in simple animal models can be extrapolated to human anxiety disorders", Ciocchi adds.

This study was carried out in partnership with the University of Bern, the Friedrich Miescher Institute and international collaborators. It was funded by the University of Bern, the Swiss National Science Foundation and the European Research Council (ERC).

Systems Neuroscience Group, Institute of Physiology, University of Bern

Neuronal diversity is a hallmark of cortical networks. In the hippocampus, distinct neuronal cell-types interact together by selective synaptic contacts and neural activity patterns. We investigate how different forms of emotional and cognitive behaviours emerge within intricate neuronal circuits of the ventral CA1 hippocampus, a brain region instrumental for context-specific emotional memories, anxiety and goal-directed actions. We hypothesize that distinct behavioural programs are implemented by the selective recruitment of micro- and large-scale neural circuits of the ventral CA1 hippocampus. To identify these circuit motifs, we are combining single-unit recordings of ventral CA1 GABAergic interneurons and projection neurons, selective optogenetic strategies, cell-type specific viral tracing and behavioural paradigms in rodents. The results of our experimental approaches will determine fundamental neural computations underlying learning and memory within higher cortical brain regions.

Credit: 
University of Bern

Neuro-evolutionary robotics: A gap between simulation and reality

Neuro-evolutionary robotics is an attractive approach to realize collective behaviors for swarms of robots. Despite the large number of studies that have been devoted to it and although many methods and ideas have been proposed, empirical evaluations and comparative analyses are rare.

A publication in the journal Nature Communications, led by Mauro Birattari and his team at the research center IRIDIA, École Polytechnique de Bruxelles, Université Libre de Bruxelles, compares some of the most popular and advanced neuro-evolutionary methods for offline design of robot swarms.

"Concretely, these methods can enable the development of humanoid robot behavior, but to my knowledge, neuro-evolutionary robotics is not yet routinely adopted in real-world applications," explains Mauro Birattari.

All of these processes use evolutionary algorithms to generate a neural network that controls the robots, i.e., a neural network that takes sensor readings as input and outputs actuator commands. These methods use computer simulations to generate a neural network appropriate for the specific mission that the robots must accomplish. Once the neural network is generated (in simulation), it is installed on the physical robots and tested.

When comparing the different methods, the researchers observed a kind of "overfitting": the design process becomes too specialized in the simulation environment, and the neural network produced fails to "generalize" to the real world. This is a reality gap, i.e. the difference between reality and the simulator used in the design process. Although the simulator is fairly accurate, differences are inevitable.

"For example, if robots need to move back and forth between two areas, one solution that the evolutionary process might find in simulation is to produce a neural network that makes the robot move along a circular path that touches both areas. This solution is very elegant and works very efficiently in simulation. When applied to robots, this solution would fail miserably: for example, if the real diameter of (one of) the robot's wheels differs slightly from the nominal value, the radius of the trajectory will be different... the trajectory will no longer pass through the two given zones as desired and as predicted by the simulation," illustrates Mauro Birattari.

The Chocolate Solution ?

Although counter-intuitive, the solution seems to be to reduce the "power" of the design method: adopt a method that can produce a limited range of behaviors... This clearly means that researchers will have to accept that they will get worse results in simulation. This method will not perform as well in simulation as a "powerful" method because it will not be able to exploit all the characteristics of the simulator... yet, the result will be more general, less specialized to the simulator and therefore more likely to generalize well to reality. The simpler the better...

The chocolate method seems a good illustration of this idea. Chocolate is a process that researchers at the IRIDIA Center proposed a few years ago and that does not belong to neuro-evolutionary robotics but that, in a similar way to neuro-evolution, automatically generates control software for robots, under the same conditions. Chocolat operates on pre-existing software modules that are low-level behaviors (e.g., I go in the direction of the light, I stop, I move away from perceived peers...) and conditions for moving from one low-level behavior to another (e.g., I am surrounded by peers, the color of the floor I am on is black...).

Instead of playing with a very powerful neural network capable of producing a wide range of behaviors, chocolate plays with predefined building blocks that are (comparatively) much more "coarse". The working hypothesis is that by doing so, the risks of "over-fitting" will be reduced...

Credit: 
Université libre de Bruxelles

RUDN University biologists prove the anticancer potential of macrophages

image: RUDN University biologists discovered the way how macrophages (the cells of the "first line" immune response) respond to inflammation and identified how the immune response depends on their origin. It turned out that when exposed to an inflammatory stimulus, two opposing mechanisms are activated in macrophages simultaneously -- inducing and inhibiting inflammation. These data can potentially be useful in the treatment of cancer, as targeted activation of macrophages will strengthen the immune response of the organism in the fight against a tumor.

Image: 
RUDN Unviersity

RUDN University biologists discovered the way how macrophages (the cells of the "first line" immune response) respond to inflammation and identified how the immune response depends on their origin. It turned out that when exposed to an inflammatory stimulus, two opposing mechanisms are activated in macrophages simultaneously -- inducing and inhibiting inflammation. These data can potentially be useful in the treatment of cancer, as targeted activation of macrophages will strengthen the immune response of the organism in the fight against a tumor. The results were published in the journal Biomedicine & Pharmacotherapy.

Macrophages are the cells responsible for phagocytosis -- they capture bacteria, the dead cells remains and other foreign particles. This is the first line of defense of immune system. Most macrophages are formed from blood monocytes, which in turn differ in the level of two proteins on their surface: CD14 and CD16. Until now, it was not known how macrophages derived from the two most polar types of monocytes -- called CD14+monocytes and CD16+monocytes-respond to inflammation. RUDN University biologists have identified these differences.

"Surprisingly, among the published data, there is practically no information about the activation of macrophages obtained from CD14+monocytes and CD16+monocytes. There have only been several published works devoted to the pro-inflammatory polarization of human macrophages with varying monocytic origin. Most data derived from mouse models. We decided to fill this gap and discover how macrophages obtained from CD14+ and CD16+monocytes are activated", said Polina Vishnyakova, PhD, researcher at Medical Biotechnology Laboratory at RUDN University.

The receptors on the surface of macrophages react, for example, to lipopolysaccharides (LPS) -- the main component of bacterial membranes. RUDN University biologists used blood samples from six healthy women aged 26 to 34 years and isolated CD14+monocytes and CD16+monocytes from the blood using magnetic separation. Then the monocytes were "turned" into macrophages - by cultivation with special differentiation factors. Macrophages obtained from different types of monocytes were subjected to LPS and analyzed using flow cytometry, secretome, transcriptomic and proteomic analysis.

The results demonstrated that, firstly, the traditional division of macrophages into pro-inflammatory and anti-inflammatory is not quite correct -- they switch their functions depending on the surrounding conditions. RUDN University biologists also found out that macrophages derived from CD14+monocytes are more prone to a pro-inflammatory response. Flow cytometry showed that these macrophages synthesize more CD86 protein, which is responsible for the activation of T-lymphocytes -- other cells of the immune response. At the same time, secretome analysis showed that macrophages derived from CD14+monocytes secrete more pro-inflammatory and anti-inflammatory cytokine molecules.

These results can be used in the future for the treatment of oncological diseases. The fact is that pro-inflammatory macrophages are able to fight tumors. Picking the most suitable monocytes of the patient (CD14 or CD16), turning them into pro-inflammatory macrophages and transplanting them back to the tumor, one can stimulate the organism's fight against cancer cells.

"The key issue is the choice of monocyte subset for further therapeutic application of macrophages. Thus, macrophages obtained from different populations of human monocytes are potentially relevant for cell therapy in case of malignant oncological diseases", said Polina Vishnyakova, PhD, researcher at Medical Biotechnology Laboratory at RUDN University.

Credit: 
RUDN University

Ludwig Cancer Research study reveals even transient chromosomal errors can initiate cancer

JULY 15, 2021, NEW YORK - A Ludwig Cancer Research study has found that inducing random chromosome instability (CIN) events in mice for as little as one week is enough to trigger harmful chromosomal patterns in cells that spur the formation of tumors.

"We show that you don't need chronic, lifelong chromosomal mistakes to produce tumorigenesis at a quite respectable frequency," said Don Cleveland, Member of the Ludwig Institute for Cancer Research, San Diego, who led the study with Floris Foijer of the University of Groningen, in The Netherlands. "A very transient exposure would likely be sufficient to drive a very substantial increase in tumorigenesis."

The finding, detailed this week in the journal Genes & Development, confirms a nearly 120-year-old hypothesis by the German biologist Theodor Boveri that aneuploidy--an abnormal number of chromosomes--and tumorigenesis are linked.

"Boveri hypothesized that there would be specific combinations of gains and losses of chromosomes that could lead to cancer. We've now tested that and shown that not only was he right, but that even a short burst of chromosome instability is enough to induce these combinations," said Ofer Shoshani, a postdoctoral researcher in Cleveland's lab and the study's first author.

In the study, Shoshani and his colleagues overexpressed the gene polo-like kinase 4 (Plk4) in mice. Plk4 is a master regulator that controls the number of centrosomes present inside a cell. Centrosomes play an important role in cell division by helping separate replicated chromosomes into two daughter cells. Normally, two centrosomes are present inside a cell during division, one at each pole of the cell.

"However, when you overexpress Plk4, you have more than two, and this leads to chromosome missegregation, whereby the chromosomes are not being pulled correctly and the daughter cells inherit an unequal number of chromosomes," Shoshani explained.

The scientists overexpressed Plk4 in the mice for either one week, two weeks or four weeks, and found that one week was enough to cause the formation of aggressive T cell lymphomas. Whole genome sequencing of the mouse tumors revealed an increased recurrence of a particular chromosome pattern early in the tumor formation process. This "aneuploid profile" involved triple occurrences of chromosomes 4, 5, 14 and 15 (cells normally contain only two copies of each chromosome).

Scientists have long known that certain cancer types are associated with specific chromosome gains--for example, breast cancer often involves a gain of chromosome 1. "What our work potentially shows is that when you induce a transient pulse of chromosome instability, you accelerate the formation of such a recurrent aneuploidy profile," said Shoshani. "We identify the profile originating very early in the formation of cancer, either at, or very close to, the formation of the cell that generates the tumor."

Moreover, the researchers found that transient CIN events can drive tumorigenesis regardless of whether p53--a major tumor suppressor gene and the most commonly mutated gene in human cancer--is inactivated. "This tells you that transient CINs will enhance tumorigenesis independent of whether you have other genetic issues that might predispose you to cancer," Cleveland said.

The findings could be especially relevant to cancer patients undergoing anti-cancer therapy, particularly those being treated with chemotherapeutic agents known as aneugens, which work by driving chromosome instability and aneuploidy.

"Our work suggests that cancer patients who undergo therapy using aneugenic drugs might develop secondary cancers down the road," said Shoshani. "Of course, this would need to be further investigated, in both human patients and by using experimental models in the lab."

Credit: 
Ludwig Institute for Cancer Research

Evaluation of India's 'Mission Indradhanush' finds improvements in vaccination outcomes

Washington, DC / New Delhi, India - Researchers at CDDEP recently published 'Improving vaccination coverage and timeliness through periodic intensification of routine immunization: evidence from Mission Indradhanush' where they evaluated the performance of India's Mission Indradhanush (MI) child vaccination campaign -- a periodic intensification of the routine immunization program.

Each year, 1.2 million Indian children die, accounting for a fifth of global under-5 deaths. Over 400,000 of these deaths are from vaccine-preventable diseases. An estimated 38% of Indian children under the age of two years were not-fully-immunized in 2016. Additionally, vaccinated children received 23%-35% of the doses of polio, diphtheria-pertussis-tetanus DPT, bacillus Calmette-Guérin (BCG), and measles vaccines at later than recommended ages. Low vaccination coverage and frequently delayed vaccinations stand in juxtaposition with India's rapid economic growth in recent decades.

In December 2014, the Government of India launched Mission Indradhanush (MI), with the objective of increasing full immunization coverage. MI was a periodic intensification of the routine immunization (PIRI) program which targeted unvaccinated and under-vaccinated children by allocating more resources to underserved areas. The program was implemented in 528 districts--with low initial full immunization coverage and high dropout rates--in four phases during March 2015-July 2017. An estimated 25.5 million children across India were vaccinated under MI in this time. Despite the substantial resources allocated towards this program, there has been a lack of robust estimates of its true impact.

The study reports on associations between the first and second phases of the MI program, and routine vaccination coverage and timing outcomes by employing difference-in-difference (DID) regression analysis which incorporates a rich set of socioeconomic and healthcare access indicators. The authors find that the full immunization rate was 27% higher among children under 2 years old residing in districts that received the campaign during both phase 1 and 2 (intervention group) as compared with those residing elsewhere (control group). The rate of receiving all vaccines at recommended ages was 8% higher in the intervention group. Receiving doses of oral polio vaccine (OPV) birth dose, OPV dose 1 (OPV1), OPV2, OPV3, BCG, and hepatitis B birth dose vaccines were 9%, 9%, 11%, 16%, 5%, and 19% higher in the intervention group than the control group, respectively. However, the study did not find improved vaccination rates for children who resided in a district that only received treatment in either phase 1 or 2.

According to the lead author of the study, Amit Summan, "Our findings hold tremendous importance for India's Universal Immunization Program. In the short term, MI-like programs could substantially boost vaccine coverage and on-time delivery rates. However, their long-term sustainability and resource allocation decisions for immunization will need to be evaluated further".

Credit: 
Center for Disease Dynamics, Economics & Policy

Psychiatric patients at increased risk of COVID-19 hospitalization and mortality

Main points

Strong evidence that patients with pre-existent mental disorders are twice as likely to die or be hospitalised after SARS-CoV-2 infection

Psychotic and mood disorders are linked with COVID-19-associated mortality, as are exposure to antipsychotic and anxiolytic treatments.

Patients with substance use disorders are at increased risk of hospitalisation.

In the largest systematic review and meta-analysis to date on COVID-19 outcomes in individuals with psychiatric disorders, the odds of dying or being hospitalized following COVID-19 infection were determined to be twice as high in comparison to persons without mental disorders.* The study also found ICU admission rates were not affected. This work, initiated by the Immuno-NeuroPsychiatry Network of the European College of Neuropsychopharmacology, is published today in the peer-reviewed journal Lancet Psychiatry**.

The study compiles data from 33 studies from 22 countries, comprising 1 469 731 patients with COVID-19, of whom 43 938 had mental disorders. Twenty-three studies were included in a random-effects meta-analysis of crude and adjusted odds ratios for COVID-19 related mortality, hospitalization, and ICU admission in individuals with comorbid pre-existent mental disorders, investigating different diagnostic groups and classes of psychiatric drugs. Individuals with psychotic disorders and mood disorders, as well as patients receiving treatment with antipsychotics or anxiolytics (anxiety reducing drugs) appear as the most vulnerable groups for COVID-19-associated mortality. Patients with substance use disorders were also at increased risk for hospitalization following COVID-19.

The authors of the paper call for national and international health authorities to take concerted action by offering priority vaccination to patients with severe mental illness, intellectual disability, and substance use disorders, and highlight the urgency of actions to counteract possible reduced access to care.

Corresponding author, Dr Livia De Picker (from the University Psychiatric Hospital Campus Duffel, Belgium) said:

"Together with many colleagues from national and international psychiatric associations, we have been advocating for priority SARS-CoV-2 vaccination of patients with severe mental illness. However, it quickly became apparent that a lack of high-quality evidence on the mortality and hospitalization risks of patients with mental disorders was blocking implementation of our recommendations by healthcare policymakers. In several countries, pleas to change the vaccination strategy were discarded by national health authorities with the argument that the current scientific evidence did not distinguish particular groups of psychiatric patients who have a very high risk for severe Covid-19, hospitalizations, ICU admittance and death due to Covid-19. This paper offers precisely this, and shows that pre-existing mental disorders, in particular psychotic and mood disorders, and exposure to antipsychotics and anxiety-reducing drugs are associated with COVID-19 mortality. With this new evidence, not taking action is no longer an option."

"Importantly, our data revealed a striking contrast in patients with severe mental illness. Patients with psychotic disorders in particular were affected by the highest mortality risk, but did not have increased risk of hospital admission. We know these patients face important barriers to physical healthcare, and our results suggest reduced access to care could have contributed to the increased mortality seen in this group. Public health authorities need to take targeted action to ensure maximum vaccination uptake for all groups of at-risk patients identified in this study. Close monitoring and adequate hospital referral in patients with psychiatric disorders who develop COVID-19 is needed to counteract possible reduced access to care."

The study was initiated by the ImmunoNeuroPsychiatry Network of the European College of Neuropsychopharmacology. Author and director of the Network, Professor Marion Leboyer (University of Paris Est Créteil, France) said,

"This high-quality study was created through the concerted efforts of many international colleagues working together. Further work is needed to determine the causes of the poor COVID-19 outcomes in psychiatric patients, which might reflect biological processes, such as immune-inflammatory alterations related to the psychiatric disorders. In particular the impact of psychopharmacological treatments requires further study. We found that exposure to antipsychotic and anxiolytic drug treatments initiated before contracting COVID-19 was associated with severe COVID-19 outcomes. Antipsychotics might increase cardiovascular and thromboembolic risks, interfere with an adequate immune response, and cause interactions with drugs used to treat COVID-19. Benzodiazepines are associated with respiratory risk, and are known to be associated with all-cause mortality. By contrast, some antidepressants were recently shown to have protective effects. In addition, social and lifestyle factors such as diet, physical inactivity, social isolation, high alcohol and tobacco use, and sleep disturbances, and a higher prevalence of somatic comorbidities might also have detrimental effects on COVID-19 prognosis."

Credit: 
European College of Neuropsychopharmacology

Researchers reveal cause of Jupiter's x-ray aurorae

image: NASA's Juno Mission observed pulsating electromagnetic ion cyclotron waves in Jupiter's dawn magnetosphere that periodically expel energetic heavy ions into the atmosphere, producing stunning X-ray pulsations as captured by ESA XMM-Newton

Image: 
YAO Zhonghua's group

An international research team led by YAO Zhonghua from the Institute of Geology and Geophysics of the Chinese Academy of Sciences (IGGCAS) has explained the cause of Jupiter's X-ray aurorae, a mystery that has puzzled scientists for 40 years.

The findings were published in Science Advances on July 9.

It is the first time planetary researchers have described the entire causality chain for Jupiter's X-ray auroral flares. The mechanism in producing X-ray auroral flares at Jupiter may have potential applications in X-ray astronomy.

The X-ray auroral spectra tell us these aurorae are produced by heavy ions with energies in the mega electron volt range. But how they are formed and why these ions enter Jupiter's atmosphere was previously unknown.

To understand the energetic processes associated with Jupiter's polar emissions, researchers organized, over the last four years, a series of paradigm-shifting observation campaigns from Earth in tandem with in situ measurements by ESA's flagship X-ray observatory, XMM-Newton, and NASA's Juno spacecraft. These efforts included the most extensive X-ray campaign and the most extensive Hubble Space Telescope campaign ever conducted for Jupiter.

Using these tools, the researchers were able to probe the physics behind the phenomenon and reveal the processes that lead planets to produce X-ray aurorae.

"These are strikingly similar to the processes of producing ion aurorae on Earth, suggesting that ion aurorae share common mechanisms across planetary systems, despite temporal, spatial and energetic scales varying by orders of magnitude," said YAO Zhonghua, first author of the study.

"What we see in the Juno data is this beautiful chain of events. We knew that the auroral ions are stored in the magnetosphere, originated from the volcanic activities of Jupiter's moon Io. In the magnetosphere, now we see the magnetic compression happen, the electromagnetic ion cyclotron wave triggered, the ions, and then a pulse of ions traveling along the field line. A few minutes later, XMM sees a burst of X-rays," said William Dunn from University College London, who co-led the study.

It is noteworthy that Jupiter's X-ray auroral flares are often correlated with ultraviolet auroral flares, which are the most common auroral form. Indeed, the study of the latter may benefit from the wealth of Hubble Space Telescope data acquired through this research. "The discovery of Jupiter's X-ray processes may have implications for our understanding of stunning ultraviolet auroral flares," said Denis Grodent from the University of Liege, a co-author of the study.

Credit: 
Chinese Academy of Sciences Headquarters

New model can predict multiple RNA modifications simultaneously

The ability to predict and interpret modifications of ribonucleic acid (RNA) has been a welcome advance in biochemistry research.

However, existing predictive approaches have a key drawback--they can only predict a single type of RNA modification without supporting multiple types or providing insightful interpretation of their prediction results.

Researchers from Xi'an Jiaotong-Liverpool University, led by Dr Jia Meng, have addressed this issue by developing a model that supports 12 RNA modification types, greatly expanding RNA research prediction and interpretation.

"To the best of our knowledge, these 12 are the only widely occurring RNA modifications that can be profiled transcriptome-wide with existing base-resolution technologies. This makes them highly desirable for reliable large-scale prediction," Dr Meng said.

Transcriptomes are the set of all RNA transcripts in a cell. By analysing these sequences, researchers can understand which genes are turned 'on' or 'off' in the cells and related tissues.

The research proved the efficacy of their MultiRM model--described by Dr Meng as an attention-based multi-label neural network approach for integrated prediction and interpretation of RNA modifications from the primary RNA sequence. Attention mechanisms weigh the contributions of inputs to optimise the process of learning target results.

The study states that the primary purpose of the MultiRM research is to establish an interpretable predictor that could achieve state-of-the-art accuracy when identifying these RNA modifications and primary RNA sequences.

The prediction method helps researchers understand the sequence-dependent mechanisms of RNA modification, cuts wet-lab experiment costs and provides insights into the regulatory circuit of RNA metabolism.

The approach is still primarily for fundamental research only, Dr Meng said. The tool, however, may help scientists design more efficient RNA therapeutics.

"It is hard to predict which diseases will benefit from the research, but studies indicate the enzymes of m6A RNA methylation play a key role in leukaemia, lung cancer and breast cancer," he said.

To get the multiple, simultaneous predictions, the researchers used a multitask-learning framework that integrates the prediction tasks for all the 12 RNA modifications into a single prediction task, Dr Meng said.

"Existing tools focused on the interpretation of the model," he said. "The MultiRM model provides a more comprehensive view of the epitranscriptomes and discovers underlying mechanisms of the prediction results."

The study discovered a surprising finding--the RNA modifications show significant positive associations among each other, including those originating from different nucleotides. This suggests regions exist that are intensively modified by multiple RNA modifications, which are likely to be the key regulatory components for the epitranscriptome layer of gene regulation.

How MultiRM was built

MultiRM uses a deep-learning framework on the TensorFlow platform. The researchers' approach accommodates the shared structure of different modifications while fully exploiting their distinct features.

As some modifications are more abundant than others, additional algorithms were used to balance the training data issue in multi-label learning. The researchers then implemented other machine-learning algorithms to create MultiRM's baseline benchmark.

The MultiRM model has implications for other researchers. The research team developed a web server that was designed and made accessible to serve the research community, accessible here.

Researchers can freely download the data, code, and model. It takes as input an RNA sequence and returns the predicted RNA modification sites and the key sequence contents that drive the positive predictions.

Credit: 
Xi'an Jiaotong-Liverpool University

New UK study reveals extent of brain complications in children hospitalized with COVID-19

Although the risk of a child being admitted to hospital due to COVID-19 is small, a new UK study has found that around 1 in 20 of children hospitalised with COVID-19 develop brain or nerve complications linked to the viral infection.

The research, published in The Lancet Child and Adolescent Health and led by the University of Liverpool, identifies a wide spectrum of neurological complications in children and suggests they may be more common than in adults admitted with COVID-19.

While neurological problems have been reported in children with the newly described post-COVID condition paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), the capacity of COVID-19 to cause a broad range of nervous system complications in children has been under-recognised.

To address this, the CoroNerve Studies Group, a collaboration between the universities of Liverpool, Newcastle, Southampton and UCL, developed a real-time UK-wide notification system in partnership with the British Paediatric Neurology Association.

Between April 2020 and January 2021, they identified 52 cases of children less than 18 years old with neurological complications among 1,334 children hospitalised with COVID-19, giving an estimated prevalence of 3.8%. This compares to an estimated prevalence of 0.9% in adults admitted with COVID-19.

Eight (15%) children presenting with neurological features did not have COVID-19 symptoms although the virus was detected by PCR, underscoring the importance of screening children with acute neurological disorders for the virus.

Ethnicity was found to be a risk factor, over two thirds of children being of Black or Asian background.

For the first time, the study identified key differences between those with PIMS-TS versus those with non-PIMS-TS neurological complications. The 25 children (48%) diagnosed with PIMS-TS displayed multiple neurological features including encephalopathy, stroke, behavioural change, and hallucinations; they were more likely to require intensive care. Conversely, the non-PIMS-TS 27 (52%) children had a primary neurological disorder such as prolonged seizures, encephalitis (brain inflammation), Guillain-Barré syndrome and psychosis. In almost half of these cases, this was a recognised post-infectious neuro-immune disorder, compared to just one child in the PIMS-TS group, suggesting that different immune mechanisms are at work.

Short-term outcomes were apparently good in two thirds (65%) although a third (33%) had some degree of disability and one child died at the time of follow-up. However, the impacts on the developing brain and longer-term consequences are not yet known.

First author Dr Stephen Ray, a Wellcome Trust clinical fellow and paediatrician at the University of Liverpool said: "The risk of a child being admitted to hospital due to COVID-19 is small, but among those hospitalised, brain and nerve complications occur in almost 4%. Our nationwide study confirms that children with the novel post-infection hyper-inflammatory syndrome PIMS-TS can have brain and nerve problems; but we have also identified a wide spectrum of neurological disorders in children due to COVID-19 who didn't have PIMS-TS. These were often due to the child's immune response after COVID-19 infection."

Joint senior-author Dr Rachel Kneen, a Consultant Paediatric Neurologist at Alder Hey Children's NHS Foundation Trust and honorary clinical Senior Lecturer at the University of Liverpool said: "Many of the children identified were very unwell. Whilst they had a low risk of death, half needed intensive care support and a third had neurological disability identified. Many were given complex medication and treatments, often aimed at controlling their own immune system. We need to follow these children up to understand the impact in the long term."

Joint senior-author Dr Benedict Michael, a senior clinician scientist and MRC Fellow at the University of Liverpool said: "Now we appreciate the capacity for COVID-19 to cause a wide range of brain complications in those children who are hospitalised with this disease, with the potential to cause life-long disability, we desperately need research to understand the immune mechanisms which drive this. Most importantly- How do we identify those children at risk and how should we treat them to prevent lasting brain injury? We are so pleased that the UK government has funded our COVID-CNS study to understand exactly these questions so that we can help inform doctors to better recognise and treat these children."

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University of Liverpool

New theory suggests blood immune and clotting components could contribute to psychosis

A scientific review has found evidence that a disruption in blood clotting and the first line immune system could be contributing factors in the development of psychosis.

The article, a joint collaborative effort by researchers at RCSI University of Medicine and Health Sciences, Cardiff University and the UCD Conway Institute, is published in Molecular Psychiatry.

Recent studies have identified blood proteins involved in the innate immune system and blood clotting networks as key players implicated in psychosis.

The researchers analysed these studies and developed a new theory that proposes the imbalance of both of these systems leads to inflammation, which in turn contributes to the development of psychosis.

The work proposes that alterations in immune defense mechanisms - including blood clotting - lead to an increased risk of inflammation, which is thought to contribute to the development of psychosis.

The new theory further refines the prevailing 'two-hit' hypothesis, where early genetic and/or environmental factors disrupt the developing central nervous system (the "first-hit") and increases the vulnerability of the individual to subsequent, late environmental disruptions (the "second-hit").

"Early identification and treatment significantly improves clinical outcomes of psychotic disorders. Our theory may provide a further step to biomarkers of psychosis and allow the identification of therapeutic targets for early and more effective treatment," said Dr Melanie Föcking, joint first author on the paper and Lecturer in Psychiatric Neuroscience at RCSI Department of Psychiatry.

"While the idea of psychosis resulting from some form of inflammation and immune activation is not new, our data suggest a new understanding and change of focus towards a combined function of the innate immune complement system and coagulation pathways to the progression to psychotic disorder," said Dr Meike Heurich, joint first author on the paper and lecturer at School of Pharmacy and Pharmaceutical Sciences, Cardiff University.

"The works builds on our recent studies which increasingly implicate dysregulation of the complement and coagulation pathways both in and preceding psychotic disorder," said Professor David Cotter, senior author of the paper and Professor of Molecular Psychiatry at RCSI Department of Psychiatry.

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RCSI

When mad AIOLOS drags IKAROS down: A novel pathogenic mechanism

image: The transcription factors IKAROS and AIOLOS (named after Greek mythology characters) regulate lymphocyte development. According to Greek mythology, Ikaros had wings that were made of feathers and wax; one day, he flew too close to the sun and his wings melted which resulted in his fall and subsequent death. Aiolos, on the other hand, was a god of wind and, upon the command of the higher-ranking gods, he brought violent stormy winds to bring devastation and despair. In this artwork, the mutant Aiolos loses his control and power over stormy winds and going berserk. The artwork illustrates the fallen Ikaros not due to being very close to the sun, but instead as a result of being blown away by the mutant Aiolos.

Image: 
Department of Pediatrics and Developmental Biology,TMDU

Tokyo, Japan - Primary immunodeficiencies, such as severe combined immunodeficiency disease (SCID), occur when the immune system does not work properly, leading to increased susceptibility to various infections, autoimmunity, and cancers. Most of these are inherited and have an underlying genetic causes. A team at TMDU has identified a novel disorder resulting from a mutation in a protein called AIOLOS, which functions through a previously unknown pathogenic mechanism called heterodimeric interference.

The gene family known as IKAROS zinc finger proteins (IKZFs) is associated with the development of lymphocyte, a type of white blood cell involved in the immune response--meaning that mutations in this family can be involved in immune system deficiencies. Most research so far has focused on IKAROS protein, encoded by the gene IKZF1, although the underlying mechanism by which IKAROS mutations cause the deficiencies is not yet fully understood. A mutation in AIOLOS--another member of the IKZF family that is encoded by the gene IKZF3--has now also been revealed to cause a hereditary immune deficiency. In addition to not functioning properly itself, the resultant mutant protein interferes with the functioning of IKAROS protein.

TMDU researchers uncovered this new mechanism while investigating the cause of a previously undescribed inherited B cell deficiency observed in a family of patients. After sequencing all of the protein-coding genes, the team focused their research on AIOLOS as IKAROS is known to be the cause of B cell deficiency. They showed that the mutant form of AIOLOS that was present in this family did not just fail to function, but actively bound to a different DNA sequence than the normal version of the protein.

They went on to use a mouse model that harbors equivalent AIOLOS mutation identified in the patients to outline the underlying pathogenic mechanism. AIOLOS and IKAROS bind together to form a "heterodimer". The mutant form of AIOLOS retained the ability to bind IKAROS but then interfered with the normal function of IKAROS, and led to the heterodimer being recruited to the incorrect regions of the genome.

"This is a novel pathogenic mechanism that we termed heterodimeric interference," says lead author Motoi Yamashita, "where a mutant protein in a heterodimer hijacks the function of the normal partner protein."

The team were then able to rescue some of the immune function in the mouse model by deleting the dimerization domain of the mutant AIOLOS.

"The fact we could rescue the phenotype in our mouse model indicates a potential therapeutic approach," says Tomohiro Morio, senior author. "The deletion of the domain responsible for binding IKAROS in the mutant AIOLOS protein could ameliorate the immunodeficiency observed in the patients."

The discovery of this new pathogenic mechanism, heterodimeric interference, may well help to shed light on many other disease processes such as autoimmunity and cancer development where mutant proteins act in the same way.

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Tokyo Medical and Dental University

US corn and soybean maladapted to climate variations, study shows

image: Madhu Khanna and Chengzheng Yu, Department of Agricultural and Consumer Economics, University of Illinois, studied corn and soybean adaptation to climate variations in the U.S.

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Laura Mabry, College of ACES, University of Illinois.

URBANA, Ill. - U.S. corn and soybean varieties have become increasingly heat and drought resistant as agricultural production adapts to a changing climate. But the focus on developing crops for extreme conditions has negatively affected performance under normal weather patterns, a University of Illinois study shows.

"Since the 1950s, advances in breeding and management practices have made corn and soybean more resilient to extreme heat and drought. However, there is a cost for it. Crop productivity with respect to the normal temperature and precipitation is getting lower," says Chengzheng Yu, doctoral student in the Department of Agricultural and Consumer Economics (ACE) at the University of Illinois and lead author on the new paper, published in Scientific Reports.

Climate projections indicate a mix of extreme and normal weather patterns in the next 50 years, so crops must perform well under a variety of conditions, explains study co-author Madhu Khanna, ACES distinguished professor of environmental economics in ACE.

"It is not enough to just focus on extreme weather conditions. We can't look at the impacts of climate change in a piecemeal fashion and develop varieties only to cope with certain aspects of it," Khanna states.

Yu, Khanna, and co-author Ruiqing Miao, Auburn University, studied corn and soybean yield from 1951 to 2017 in the eastern part of the U.S., an area where crops can grow without irrigation. Crop yield increased significantly during this period due to a wide range of technological and breeding improvements. But when the researchers isolated the effect of climate-related adaptations, they found significant negative impacts on yield.

While heat and drought tolerance increased yield by 33% for corn and 20% for soybean over this period, the gain was offset by reduced productivity under normal conditions. Overall, maladaptation due to climate-related factors reduced corn and soybean yield by 8% and 67%, respectively, the researchers found.

"There's been this trade-off; crops become better adapted to extreme weather, but less adapted to normal conditions," Khanna says. "Overall, crop yields went up by 100% to 200% over the past decades. We break this down into the components that happened because of climate-related changes, and components that happened irrespective of climate change. And we find the impact of climate-related adaptation has been negative," she explains.

The researchers also projected net effects of climate change adaptation on crop yields by 2050 under a range of warming scenarios. In the most extreme scenarios, weather-adapted variations will perform better. But under less extreme scenarios varieties that perform well in normal climate would be more productive.

Khanna and Yu conclude that crop breeders should focus on developing crop varieties for diverse weather patterns. Flexibility is important for agricultural producers to be well prepared for future conditions.

"There will be a very significant reduction in crop yield for both corn and soybean over the next 50 years under some extreme warming scenarios, even though the crops are supposedly adapted to extreme conditions. There's overall maladaptation, because the crops are not fully adapted to every possible combination of extreme and normal conditions. And the overall impact is going to be very negative," Khanna says. "We need to drastically change how we're adapting our crops so that they're better prepared for the mix of conditions we are likely to encounter in the following years."

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University of Illinois College of Agricultural, Consumer and Environmental Sciences