Culture

BOSTON - New research led by investigators at Massachusetts General Hospital (MGH) and Massachusetts Eye and Ear indicates that the blood pressure drug losartan may benefit patients with neurofibromatosis type 2 (NF2), a hereditary condition associated with vestibular schwannomas, or noncancerous tumors along the nerves in the brain that are involved with hearing and balance. The findings, which are published in Science Translational Medicine, are especially important because vestibular schwannomas are currently treated with surgery and radiation therapy (which carry risks of nerve damage), and no drug is approved by the U.S. Food and Drug Administration to treat these tumors or their associated hearing loss.

"Developing effective therapeutics to preserve hearing function in patients with NF2 is an urgent unmet medical need. The greatest barrier to managing NF2-related auditory impairment is our incomplete understanding of how schwannomas cause hearing loss," says co-senior author Lei Xu, MD, PhD, an investigator in the Steele Laboratories for Tumor Biology within the MGH Department of Radiation Oncology. A previous report showing that scarring, or fibrosis, exists in schwannomas and correlates with hearing loss prompted the team to test whether a drug that blocks fibrosis might be effective.

Losartan blocks a component of the renin-angiotensin system, which is involved not only in regulating blood pressure but also in stimulating fibrosis and inflammation. The entire class of angiotensin-targeting drugs, which includes losartan, has been shown to reduce collagen accumulation in cardiac and kidney fibrotic disease. Using a mouse model of NF2, Xu and her colleagues found that losartan treatment had several effects on vestibular schwannomas and the brain: It reduced inflammatory signaling and swelling and thus prevented hearing loss, and it increased oxygen delivery to enhance the effectiveness of radiation therapy (which may help lower the radiation dose needed to control tumor growth and limit radiation-associated toxicities).

In preparation to translate these findings into the clinic, co-senior author Konstantina Stankovic, MD, PhD, former chief of the Division of Otology and Neurotology at Massachusetts Eye and Ear, now Bertarelli Professor and Chair of the Department of Otolaryngology - Head and Neck Surgery at Stanford University School of Medicine, examined patient samples and data. Her team found that vestibular schwannomas associated with poor hearing had more pronounced inflammatory signaling than tumors associated with good hearing. This inflammatory signaling in tumors was capable of directly damaging cochlear cells that are essential for hearing. Also, patients with vestibular schwannoma who took losartan or other drugs in its class experienced no progression in hearing loss, unlike patients on other or no antihypertensive drugs. This study illustrates the advantages offered by an integrated approach and teamwork that spans basic research, translational investigation and clinical care.

The findings support the need for a prospective clinical trial of losartan in patients with NF2 and vestibular schwannomas. "As one of the most commonly prescribed drugs for hypertension, the safety and low cost of losartan warrants rapid translation of our research to patients with vestibular schwannomas to try to prevent tumor-induced sensorineural hearing loss," Stankovic says.

We sleep on average one third of our time. But what does the brain do during these long hours? Using an artificial intelligence approach capable of decoding brain activity during sleep, scientists at the University of Geneva (UNIGE), Switzerland, were able to glimpse what we think about when we are asleep. By combining functional magnetic resonance imaging (fMRI) and electroencephalography (EEG), the Geneva team provides unprecedented evidence that the work of sorting out the thousands of pieces of information processed during the day takes place during deep sleep. Indeed, at this time, the brain, which no longer receives external stimuli, can evaluate all of these memories in order to retain only the most useful ones. To do so, it establishes an internal dialogue between its different regions. Moreover, associating a reward with a specific information encourages the brain to memorise it in the long term. These results, to be discovered in the journal Nature Communications, open for the first time a window on the human mind in sleep.

In the absence of tools capable of translating brain activity, the content of our sleeping thoughts remains inaccessible. We however do know that sleep plays a major role in memory consolidation and emotional management: when we sleep, our brain reactivates the memory trace built during the day and helps us to regulate our emotions. "To find out which brain regions are activated during sleep, and to decipher how these regions allow us to consolidate our memory, we developed a decoder capable of deciphering the activity of the brain in deep sleep and what it corresponds to", explains Virginie Sterpenich, a researcher in the laboratory of Professor Sophie Schwartz in the Department of Basic Neurosciences at UNIGE Faculty of Medicine, and the principal investigator of this study. "In particular, we wanted to see to what extent positive emotions play a role in this process."

During deep sleep, the hippocampus - a structure of the temporal lobe which stores temporary traces of recent events - sends back to the cerebral cortex the information it has stored during the day. A dialogue is established which allows the consolidation of memory by replaying the events of the day and therefore reinforce the link between neurons.

Combining MRI, electroencephalography and artificial intelligence

To conduct their experiment, the scientists placed volunteers in an MRI in the early evening and had them play two video games - a face-recognition game similar to 'Guess Who?' and a 3D maze from which the exit must be found. These games were chosen because they activate very different brain regions and are therefore easier to distinguish in the MRI images. In addition, the games were rigged without the volunteers' knowledge so that only one of the two games could be won (half of the volunteers won one and the other half won the second), so that the brain would associate the game won with a positive emotion.

The volunteers then slept in the MRI for one or two hours - the length of a sleep cycle - and their brain activity was recorded again. "We combined EEG, which measures sleep states, and functional MRI, which takes a picture of brain activity every two seconds, and then used a 'neuronal decoder' to determine whether the brain activity observed during the play period reappeared spontaneously during sleep", Sophie Schwartz explains.

Even when asleep, the brain likes rewards

By comparing MRI scans of the waking and sleeping phases, the scientists observed that during deep sleep, the brain activation patterns were very similar to those recorded during the gaming phase. "And, very clearly, the brain relived the game won and not the game lost by reactivating the regions used during wakefulness. As soon as you go to sleep, the brain activity changes. Gradually, our volunteers started to 'think' about both games again, and then almost exclusively about the game they won when they went into deep sleep", says Virginie Sterpenich.

Two days later, the volunteers performed a memory test: recognising all the faces in the game, on the one hand, and finding the starting point of the maze, on the other. Here again, more the brain regions related to the game were activated during sleep, better were the memory performances. Thus, memory associated to reward is higher when it is spontaneously reactivated during sleep. With this work, the Geneva team opens a new perspective in the study of the sleeping brain and the incredible work it does every night.

The COVID-19 pandemic halted the in-person wintertime survey of wolves and moose on the island for the first time in 63 years. Consequently, there are no estimates of wolf or moose abundance for 2021, and the next estimates are scheduled in February 2022. But though the Isle Royale Winter Study didn't happen quite as planned, researchers were still able to visit the remote national park in the spring.

Now, fieldwork has resumed and Michigan Technological University researchers have already uncovered new information about these two iconic wildlife populations. In particular, wolves produced at least two litters of pups, and moose appear poised for decline.

In the Isle Royale Winter Study, Michigan Tech researchers share other significant developments about curating the world's largest moose bone collection, advances in understanding of wolf foraging behavior and the nutritional health of the moose population.

Key points:

The Isle Royale wolf population is likely growing. "We recovered footage of a group of four wolf pups taken in January 2021 by remote cameras at the east end of Isle Royale," said Sarah Hoy, research assistant professor in Michigan Tech's College of Forest Resources and Environmental Science (CFRES). "Additionally, observations of tracks and scats left by wolf pups last fall at two different locations suggest that there were probably two different litters of pups living at the east end of the island in September 2020."

Wolves are specialized foragers. "Wolf foraging behavior seems driven by minimizing the risks associated with killing large prey, like moose, even when the differences in vulnerability among individual moose might seem relatively subtle compared to when predators are choosing between different prey species," Hoy said.

Nutritional stress stacks the deck against moose, which holds significant implications for how moose will handle a warming climate. "We found that the nutritional health of moose was importantly influenced by how hot it is during the summer, and also by how deep the snow is in winter," Hoy said. "Moose tended to be more nutritionally stressed during winters with deep snow, which may be because deeper snow makes it more difficult for moose to move around and find food."

The moose population is likely declining. "Moose really struggled to find enough food this past winter," Hoy said. "Because there have been such large numbers of moose on the island over the last five years and moose ate branches faster than the trees can recover and replace them, the amount of food available to moose during winter has been getting progressively worse each year since 2017.

Winter ticks are worse than usual this year, as evidenced by moose with very little fur left in spring -- having scratched or bitten off almost all of their winter coats in an effort to rid themselves of the blood-sucking parasites. This is significant because blood loss to ticks can exacerbate the detrimental effects of food shortage. Despite the mild winter, depleted food supplies and ticks made life harder for the island's moose this year.

GAINESVILLE, Fla. --- Two fossil teeth from a distant relative of North American gophers have scientists rethinking how some mammals reached the Caribbean Islands.

The teeth, excavated in northwest Puerto Rico, belong to a previously unknown rodent genus and species, now named Caribeomys merzeraudi. About the size of a mouse, C. merzeraudi is the Caribbean's smallest known rodent and one of the region's oldest, dating back about 29 million years.

It also represents the first discovery of a Caribbean rodent from a North American lineage, a finding that complicates an idea that has persisted since Darwin - that land-dwelling mammals colonized the islands from South America. The presence of C. merzeraudi in Puerto Rico suggests a second possibility: Some species may have rafted from North America.

The tiny rodent joins two other types of animals, an extinct rhinoceros-like species and bizarre, venomous shrews known as Solenodons, as the only known examples of Caribbean land-dwelling mammals with North American roots.

"This discovery demonstrates that overwater dispersal from North America was also a potential pathway to the Caribbean," said study co-author Jorge Velez-Juarbe, associate curator of mammalogy at the Natural History Museum of Los Angeles County. "This challenges what we thought we knew about the origins of Antillean terrestrial mammals."

While Caribbean ecotourism brochures generally don't feature splashy images of rats, the islands were once home to a rich representation of rodents, including spiny rats, chinchillas, rice rats and hutias - all descendants of South and Central American forebears.

Fossil and molecular evidence suggest these rodents arrived in the islands in multiple waves over time, though how they got there - whether by scurrying over an ancient land bridge, island-hopping or rafting - has been hotly contested. The paucity of fossils from the early years of the Caribbean Islands further obscures the picture of the region's past biodiversity.

Caribeomys merzeraudi's teeth were so unusual that researchers initially struggled to discern what kind of animal they had come from, said study co-author Lazaro Vinola Lopez, a doctoral student in vertebrate paleontology at the Florida Museum of Natural History.

"We didn't know what it was for several months," he said. "We wondered whether this could be some other rodent from the Caribbean or even some kind of strange fish. It was so puzzling because they're not similar to anything else we had found in that region."

The team eventually pinpointed several tooth characteristics that are hallmarks of rodents known as geomorphs, a group that includes kangaroo rats, pocket mice and gophers. Caribeomys merzeraudi is the first geomorph found outside North America.

An exceptionally thick layer of tooth enamel, among other features, sets C. merzeraudi apart from its relatives and could indicate these rodents belonged to a distinct West Indian branch that evolved in isolation over several million years, Vinola Lopez said.

Scientists found the teeth while screen-washing sediment collected from a river outcrop in San Sebastian, a site that has yielded fossil sharks and rays, fish, turtles, a gharial, sea cows and the oldest known frog in the Caribbean, a coqui. In 2019, the team excavated fossil evidence of two large chinchillas, which likely grew up to 30 pounds. These South American rodents once shared Puerto Rico with the humble C. merzeraudi, which weighed less than a quarter pound.

Today, hutias, bats and Solenodons are the "last survivors of what was once a much more diverse group of Caribbean mammals" that included sloths and primates, Velez-Juarbe said.

Discovering C. merzeraudi opens up the tantalizing possibility that Caribbean mammals with North American origins may not be as exceptional as previously thought, Vinola Lopez said. But there's only one way to find out: "Go back to the locality and see what else we can find."

New Rochelle, NY, July 14, 2021-Firsthand reports from nurses in correctional facilities detail the challenges they faced during the COVID-19 pandemic. These firsthand accounts are reported in a special issue on correctional nursing in the Journal of Correctional Health Care. Click here (https://www.liebertpub.com/toc/jchc/27/2) to read the issue now.

Karen Monsen, PhD, RN, School of Nursing, University of Minnesota, and colleagues present the Omaha System COVID-19 Response Guidelines, which provide evidence-based pandemic response interventions used in correctional nursing. The guidelines are illustrated with examples from correctional nursing practice.

Also in this special issue is an article titled "Leadership in Correctional Nursing: The First Step" by Jennifer Clifton, DNP, College of Nursing, University of Utah. "The first step in developing leadership skills requires introspection and contemplation," she says. She guides nurses through the development of a Personal Professional Philosophy Statement, which should have two components: one's core beliefs and values; and the values of the profession.

Brenda Baker, PhD, RNC, presents "Mothering and Incarceration: A Conceptual Model Supporting Maternal Identity." The model "focuses on four areas of influence for women who experience incarceration: the community before incarceration, individual characteristics, carceral experience, and the post release community for reentry and reunification of the family," states Dr. Baker. "The most significant implication of the conceptual model is ending the intergenerational influences of incarceration on children."

"Correctional nurses, once considered invisible to the public and to other professionals because they serve patients who reside behind bars, are understanding more about their own practice," says Deborah Shelton, PhD, RN, Guest Editor of the special issue. "Correctional nurses are participating in larger numbers on boards and in professional activities to form consensus about the future of nursing. They are claiming their place as leaders."

Indiana Jones hates snakes. And he's certainly not alone. The fear of snakes is so common it even has its own name: ophidiophobia.

Kibret Mequanint doesn't particularly like the slithery reptiles either (he actually hates them too) but the Western University bioengineer and his international collaborators have found a novel use for snake venom: a body tissue 'super glue' that can stop life-threatening bleeding in seconds.

Over the past 20 years, Mequanint has developed a number of biomaterials-based medical devices and therapeutic technologies - some of which are either licensed to medical companies or are in the advanced stage of preclinical testing.

His latest collaborative research discovery is based on a blood clotting enzyme called reptilase or batroxobin found in the venom of lancehead snakes (Bothrops atrox), which are amongst the most poisonous snakes in South America.

Taking advantage of this clotting property, Mequanint and the international research team designed a body tissue adhesive that incorporates the special enzyme into a modified gelatin that can be packaged into a small tube for easy, and potentially life-saving, application.

"During trauma, injury and emergency bleeding, this 'super glue' can be applied by simply squeezing the tube and shining a visible light, such as a laser pointer, over it for few seconds. Even a smartphone flashlight will do the job," said Mequanint, a Western engineering professor.

Compared to clinical fibrin glue, considered the industry gold standard for clinical and field surgeons, the new tissue sealant has 10 times the adhesive strength to resist detachment or washout due to bleeding. The blood clotting time is also much shorter, cutting it in half from 90 seconds for fibrin glue to 45 seconds for the new snake venom 'super glue.'

This new biotechnology translates to less blood loss and more life-saving. The super-sealant was tested in models for deep skin cuts, ruptured aortae, and severely injured livers - all considered as major bleeding situations.

"We envision that this tissue 'super glue' will be used in saving lives on the battlefield, or other accidental traumas like car crashes," said Mequanint. "The applicator easily fits in first aid kits too."

In addition, the new snake venom 'super glue' can be used for suture-free, surgical wound closures.

Snake extract-laden hemostatic bioadhesive gel cross-linked by visible light was published today in the journal Science Advances. For the discovery, Mequanint collaborated with bioengineers, scientists and medical practitioners at the University of Manitoba and Army Medical University in Chongqing, China.

"The next phase of study which is underway is to translate the tissue 'super glue' discovery to the clinic," said Mequanint.

Penn State College of Engineering researchers set out to develop technology capable of localizing and imaging blood clots in deep veins. Turns out their work may not only identify blood clots, but it may also be able to treat them.

The team, led by Scott Medina, assistant professor of biomedical engineering, published its results in Advance Healthcare Materials.

"Deep vein thrombosis is the formation of blood clots in deep veins, typically in a person's legs," said Medina. "It's a life-threatening blood clotting condition that, if left unaddressed, can cause deadly pulmonary embolisms -- when the clot travels to the lungs and blocks an artery. To manage DVT, and prevent these life-threating complications, it's critical to be able to rapidly detect, monitor and treat it."

The challenge, according to Medina, is that current diagnostic imaging methods lack the resolution required to precisely pinpoint potential breeding grounds for clots and monitor the clots in real time. DVT can sometimes present as swelling and aching in a person's leg, which can then be examined via ultrasound.

"Ultrasound isn't great for diagnosing DVT," Medina said. "It can tell you that a region of fluid flow may look odd, which might be related to a clot -- but maybe not. You follow up with blood tests to look for specific factors, and, together, you might be able to diagnose a clot."

Once a clot is diagnosed, a clinician may order either pharmaceuticals to help break it apart or a procedure that involves snaking a probe to the clot to grab it and physically remove it from the body. The pharmaceuticals may not be enough to break the clot apart, though, or they could trigger bleeding issues elsewhere in the body, while the procedure option is invasive and carries risks, including potential infection.

To better identify the location, composition and size of clots, which informs how to treat them, Medina and his team used a particle approach they developed in 2017. Called nanopeptisomes (NPeps), the particles comprise a shell around a droplet of fluorine-based oil similar to liquid Teflon. The surface of the shell holds a molecule that finds and binds a protein on the surface of activated platelets, a key cellular component of clots.

"The particles bind to the surface of the clots, we apply the ultrasound, and the droplet turns to gas and forms a bubble under the shell," said Medina. "It gives an excellent contrast for imaging. The bubbles appear exactly where the clots are forming."

But, Medina said, a mystery unfolded as they tested their technique. To analyze how to diagnose and treat clots, the researchers first induce clots in bovine veins by injecting an enzyme that triggers clot formation.

"The enzyme induces clot formation generally 100% of the time -- but when we applied the particles, we only saw clot formation about 30% of the time," Medina said. "We had to wonder: were the particles not only binding to the clots, but somehow breaking them down?"

The team tested its hypothesis, but the researchers would lose the bubble signal after 15 minutes of ultrasound every time.

"We think that once our particles start to decorate the clot, they saturate the surface and inhibit the mechanisms of further clot growth," said Medina. "And under the ultrasound, the particles are disrupting the clot or inhibiting its mechanism to persist. While we don't understand the underlying mechanism yet, it's clear that these particles can image and help treat clots in real time."

The researchers plan to continue investigating how the particles are disrupting the clots, as well as develop more control over how the particles behave.

About 70-80% of crop losses due to microbial diseases are caused by fungi. Fungicides are key weapons in agriculture's arsenal, but they pose environmental risks. Over time, fungi also develop a resistance to fungicides, leading growers on an endless quest for new and improved ways to combat fungal diseases.

The latest development takes advantage of a natural plant defense against fungus. In a paper published in Biotechnology and Bioengineering, engineers and plant pathologists at UC Riverside describe a way to engineer a protein that blocks fungi from breaking down cell walls, as well as a way to produce this protein in quantity for external application as a natural fungicide. The work could lead to a new way of controlling plant disease that reduces reliance on conventional fungicides.

To gain entrance into plant tissues, fungi produce enzymes that use catalytic reactions to break down tough cell walls. Among these are polygalacturonases, or PGs, but plants are not helpless against this attack. Plants produce proteins called PG-inhibiting proteins, or PGIPs, that slow catalysis.

A group of UC Riverside researchers located the segment of DNA that tells the plant how to make PGIPs in common green beans. They inserted complete and partial segments into the genomes of baker's yeast to make the yeast produce PGIPs. The team used yeast instead of plants because yeast has no PGIPs of its own to muddy the experiment and grows quicker than plants.

After confirming the yeast was replicating with the new DNA, the researchers introduced it to cultures of Botrytis cinerea, a fungus that causes gray mold rot in peaches and other crops; and Aspergillus niger, which causes black mold on grapes and other fruits and vegetables.

Yeast that had both the complete and partial DNA segments that coded for PGIP production successfully retarded fungal growth. The result indicates the yeast was producing enough PGIPs to make the method a potential candidate for large-scale production.

"These results reaffirm the potential of using PGIPs as exogenous applied agents to inhibit fungal infection," said Yanran Li, a Marlan and Rosemary Bourns College of Engineering assistant professor of chemical and environmental engineering, who worked on the project with plant pathologist Alexander Putman in the Department of Microbiology and Plant Pathology. "PGIPs only inhibit the infection process but are likely not fatal to any fungi. Therefore, the application of this natural plant protein-derived peptide to crops will likely have minimal impact on plant-microbe ecology."

Li also said that PGIPs probably biodegrade into naturally occurring amino acids, meaning fewer potential effects for consumers and the environment when compared with synthetic small molecule fungicides.

"The generation of transgenic plants is time-consuming and the application of such transgenic crops in agricultural industry requires a long approval period. On the other hand, the engineered PGIPs that are derived from natural proteins are applicable as a fast-track product for FDA approval, if they can be utilized exogenously in a manner similar to a fungicide," Li said.

By tweaking the yeast a slightly different way, the researchers were able to make it exude PGIPs for external application. Previous studies have shown freeze drying naturally occurring microbes on apples, then reconstituting them in a solution and spraying them on crops, greatly reduces fungal disease and loss during shipping. The authors suggest that PGIP-expressing yeast could be used the same way. They caution, however, that because plants also form beneficial relationships with some fungi, future research needs to ensure plants only repel harmful fungi.

Li will continue to engineer PGIPs for enhanced efficiency and broader spectrum against various pathogenic fungi. Meanwhile, Li and Putman will keep evaluating the potential of using engineered PGIPs to suppress fungi-induced pre-harvest and post-harvest disease.

What are the fundamental skills that young children need to develop at the start of school for future academic success? While a large body of research shows strong links between cognitive skills (attention, memory, etc.) and academic skills on the one hand, and emotional skills on the other, in students from primary school to university, few studies have explored these links in children aged 3 to 6 in a school context. Researchers from the University of Geneva (UNIGE) and Valais University of Teacher Education, Switzerland (HEP-VS), in collaboration with teachers from Savoie in France and their pedagogical advisor, examined the links between emotion knowledge, cooperation, locomotor activity and numerical skills in 706 pupils aged 3 to 6. The results, to be read in the journal Scientific Reports, show for the first time that emotion knowledge, cooperative social behaviour and locomotor activity are interrelated and associated with numerical skills. These results are in line with the political and scientific consensus on the importance of social-emotional skills in early schooling and suggest that locomotor activity should be added to these fundamental skills.

A growing number of studies are examining the fundamental abilities that prepare children for school and that are particularly crucial for their future academic success. "Among these abilities, 'emotion knowledge' contributes significantly and is a long-term predictor of social behaviour and academic success", says Edouard Gentaz, professor in the Department of Psychology at the Faculty of Psychology and Educational Sciences (FPSE) of the UNIGE and the last author of this study. On the other hand, few studies have examined the links between socio-emotional and academic skills in preschool children. "To fill this gap, we joined forces with the HEP-VS and a team of teachers from Savoie in France and their pedagogical advisor to examine how emotion knowledge, social behaviour and locomotor activity are associated and linked to the numerical skills in 706 pupils aged between 3 and 6 years old", continues the Geneva-based researcher. Unlike most research that generally examines school results through reading tests, this study focuses on numerical learning, the performance of which is less correlated with parents' socio-economic level than language skills.

Original tests adapted to the preschool age and educational context

To examine the links between the four variables studied, age-appropriate tests were developed in close collaboration with 33 volunteer teachers, who participated in an interactive workshop in which they were trained to set up, perform and evaluate the different tests in a standardised manner. Thus, emotion knowledge was assessed through two emotion comprehension tasks. The first measured the recognition of the primary emotions of anger, fear, joy and sadness as well as a neutral facial expression and the second measured the understanding of the external causes underlying these emotions in others. This second task was subdivided into two different subtasks: the teacher successively presented the student with five drawing scenarios illustrated by a picture of a character with a blank face facing a particular situation (e.g., 'This boy has just received a present for his birthday') and then asked the student to indicate, among five illustrations of facial expressions, the one that corresponded to what the character felt in each situation, first by pointing to it (non-verbal responses) and then by naming it. The assessment of mathematical skills included three numerical tests. For example, the first test sought to assess whether students understood that the cardinal of a collection does not change when the spatial arrangement or nature of its elements is modified: the teacher placed a photograph in front of the student showing four collections of objects (two of which were composed of the same number of elements) and asked the student to indicate which collection contained the largest number of objects, which contained the fewest, and which two collections contained the same number.

Working closely with the teachers and their advisor, the psychologists developed observation grids to assess the locomotor activity and social behaviour of the pupils. For locomotor activity, the grid created made it possible to rate the children's performance on an agility course consisting of various installations on the ground and in the air. As for social behaviour, the grid developed made it possible to evaluate the children's reactions and attitudes during the practice of two different team games (one with a ball and the other without) observed by the teachers.

Key skills to promote numerical learning

The results of this study reveal that emotion knowledge, locomotor activity and social behaviour are interdependent and associated with pupils' numerical skills from the age of 3 to 6 years. "Indeed, specific statistical analyses (regression and mediation) show that high scores on tests assessing emotion knowledge, locomotor activity and social behaviour predict better mathematical performance in these students", notes Thalia Cavadini, researcher in the Department of Psychology at FAPSE and first author of the study. "Thus, our results are in line with the scientific consensus on the importance of social-emotional skills at the beginning of schooling and suggest that locomotor activity should be added to these fundamental skills", she concludes. Furthermore, this study is the first to show that emotional, social and locomotor skills promote school learning in toddlers.

Contamination of urban lakes, rivers and surface water by human waste is creating pools of 'superbugs' in Low- and Middle-Income Countries (LMIC) - but improving access to clean water, sanitation and sewerage infrastructure could help to protect people's health, a new study reveals.

Researchers studied bodies of water in urban and rural sites in three areas of Bangladesh - Mymensingh, Shariatpur and Dhaka. They found more antibiotic resistant faecal coliforms in urban surface water compared to rural settings, consistent with reports of such bacteria in rivers across Asia.

Publishing their findings in mSystems today, researchers from the University of Birmingham and the International Centre for Diarrhoeal Disease Research, Bangladesh call for further research to quantify the drivers of antibiotic resistance in surface waters in Bangladesh.

Lead author Willem van Schaik, Professor of Microbiology and Infection at the University of Birmingham, commented: "The rivers and lakes of Dhaka are surrounded by highly-populated slums in which human waste is directly released into the water. The presence of human gut bacteria links to high levels of antibiotic resistance genes, suggesting that such contamination is driving the presence of these 'superbugs' in surface water.

"Interventions aimed at improving access to clean water, sanitation and sewerage infrastructure may thus be important to reduce the risk of antimicrobial resistance spreading in Bangladesh and other LMICs. While levels of antibiotic resistance genes are considerably lower in rural than in urban settings, we found that antibiotics are commonly used in fish farming and further policies need to be developed to reduce their use."

The prevalence of antibiotic-resistant bacteria causing infections is increasing globally, but the clinical issues, including significant morbidity and mortality, posed by these bacteria are particularly alarming in LMICs. The prevalence multidrug-resistant E. coli among healthy humans is relatively high in Bangladesh, as it is in other LMICs.

Dhaka, has a population of around 16 million people, with a population density that ranks among the highest of any megacity, but less than 20% of households are directly connected to sewerage infrastructure.

The research team found that urban surface waters in Bangladesh are particularly rich in antibiotic resistance genes, with a higher number of them associated with plasmids indicating that they are more likely to spread through the population.

Antibiotic-resistant bacteria that colonize the human gut can be passed into rivers, lakes and coastal areas through the release of untreated wastewater, the overflow of pit latrines during monsoon season or by practices such as open defecation.

These contaminated environments are often used for bathing, for the washing of clothes and food preparation equipment, thus increasing the risk of human gut colonisation by antibiotic-resistant bacteria.

COVID-19 NEWS: CAN DIETARY SUPPLEMENTS HELP THE IMMUNE SYSTEM FIGHT CORONAVIRUS INFECTION?

Media Contact: Patrick Smith, pjsmith88@jhmi.edu

Johns Hopkins Medicine gastroenterologist Gerard Mullin, M.D., and a team of co-authors published an article May 11, 2021, in Advances in Experimental Medicine and Biology that details the scientific rationale and possible benefits -- as well as possible drawbacks -- of several dietary supplements currently in clinical trials related to COVID-19 treatment.

According to business analysts, the U.S. nutritional supplement industry grew as much as 14.5% in 2020, due in large part to the COVID-19 pandemic.

Mullin, associate professor of medicine at the Johns Hopkins University School of Medicine, and his colleagues shine a light on melatonin, vitamin C, vitamin D, zinc and several plant-based compounds, such as green tea and curcumin. For instance, the authors explain that ascorbic acid -- also known as vitamin C -- "contributes to immune defense by supporting cell functions of both the innate and adaptive immune systems."

In the journal article, they discuss the mechanics of how each of the supplements works and how each might benefit a patient fighting COVID-19.

Zinc, they write, has been shown "to inhibit coronavirus RNA replication." They also note that, when administered at symptom onset, zinc "can reduce the duration of symptoms from illness attributed to more innocuous coronavirus infections, such as the common cold."

Finally, Mullin and his colleagues provide short explanations of the clinical trials underway to test each supplement's effectiveness in fighting COVID-19.

For example, Mullin says that, "to date, there are abundant data associating low vitamin D status to higher vulnerability to COVID-19 and poor clinical outcomes."

The authors caution that "any benefit of dietary supplements against COVID-19 depends on results of randomized controlled trials" and peer-reviewed literature.

Mullin is available for interviews.

JOHNS HOPKINS MEDICINE HELPS DEVELOP PHYSICIAN TRAINING TO PREVENT GUN INJURIES, DEATHS

Media Contact: Kim Polyniak, M.A., kpolyni1@jhmi.edu

Each year, nearly 40,000 people in the United States die because of guns, making firearm-related injuries a leading cause of death for adults and children. According to a recent report, gun violence surged during the COVID-19 pandemic, making 2020 one of the nation's deadliest years for firearm-related casualties on record. Health care professionals could help reduce the toll, but only about 20% receive any education on firearm injuries or their prevention. To help change that, Johns Hopkins Medicine experts and collaborators across the United States established a national consensus guideline on educational priorities regarding firearm injury prevention for health care professionals.

The guideline appeared July 6, 2021, in the journal Academic Medicine.

"In many cases, physicians haven't felt comfortable talking about firearms with patients because it's been viewed as a divisive subject," says Katherine Hoops, M.D., M.P.H., assistant professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine.

"We set out to change that by being the first to create standards for undergraduate, graduate and continuing medical education, so clinicians and educators have a foundation from which they can develop educational programming for their learners," says Hoops, who cares for patients -- including those with gun-related injuries -- in the pediatric intensive care unit at Johns Hopkins Children's Center.

In April 2019, Hoops and Jahan Fahimi, M.D., M.P.H., an associate professor of emergency medicine at the University of California, San Francisco, convened a diverse group of more than 30 subject matter experts in medicine, nursing and public health from academic institutions across the United States to create a comprehensive and adaptable framework for firearm injury education.

The group outlined six categories previously identified in medical research as priorities. These include a general category with priorities applicable to all types of gun-related injuries and five specific categories focused on intimate partner violence, peer violence, mass violence, suicide and unintentional injury.

According to the researchers, training based on the new standards should enable clinicians to describe fatal and nonfatal firearm injury epidemiology; understand firearm access, possession, ownership, transfer and use; and be familiar with basic types of firearms and ammunition. They also should be able to provide counseling about firearm injury prevention -- such as safe gun storage -- to their patients.

Regarding suicide and suicide prevention, the researchers say clinicians should be able to describe the epidemiology of suicide and suicide attempts relating to firearm injury and death, as well as have the ability to assess patient suicide risk and understand how to escalate concerns for patients who may be at risk.

The published paper includes more guidelines and can serve as a resource for educators in health care professional schools.

"We hope that this educational framework will fundamentally change how physicians talk about violence in their practices," Fahimi says. "It's engaging with patients, talking about their experiences, helping them understand the risk of injury, and ultimately preventing injuries and saving lives."

Along with Hoops and Fahimi, Megan Ranney, M.D., M.P.H., of Brown University was a key researcher on this project.

Hoops is available for interviews.

COVID-19 NEWS: STUDY SAYS PANDEMIC IMPAIRED REPORTING OF INFECTIOUS DISEASES

Media Contact: Michael E. Newman, mnewma25@jhmi.edu

With the health care community heavily focused on COVID-19 since the first quarter of 2020, there have been concerns that reporting of other infectious diseases -- and the resulting data that enables them to be more effectively treated and controlled -- may have been impacted.

Researchers at Johns Hopkins Medicine and the University of Southern California analyzed the number of reported cases of 42 infectious diseases at the state and national levels between March 2020 and March 2021, compared with those recorded over the previous five years. Their findings were reported online June 7, 2021, in the journal Clinical Infectious Diseases.

The researchers looked for reporting differences by geographic location and by five routes of transmission: sexual, foodborne/waterborne, vectorborne (such as mosquito transmission), injection drug-use associated and respiratory.

Among the study's highlights was a nationwide 82% drop in the number of cases of mumps reported in 2020, compared with the previous year. Between the same dates, the number of reported cases of chlamydia in the United States fell almost 15%, from 1.57 million to 1.34 million.

"We found substantial differences in the reporting of diseases between 2019 and 2020 by route of transmission, with the greatest relative decrease -- nearly 51% -- seen for respiratory diseases," says Matthew Crane, a medical student at the Johns Hopkins University School of Medicine and the study's lead author. "There also were significant decreases for drug use-associated diseases [47%], vector-borne diseases [44%] and foodborne/waterborne diseases [40%]."

Regarding reporting variation by geographic location, Crane says he and his colleagues found decreases of 50% or greater in 2020 relative to 2019 in five states: Hawaii (75%), Kentucky (66%), Nebraska (65%), Missouri (59%) and North Dakota (55%). Five other states had decreases between 40% and 49%, three states were between 30% and 39%, and seven states were between 20% and 29%. There were decreases in reporting of infectious diseases in 34 states during the pandemic compared with the 2015-2019 period.

"Overall, we found decreased reporting of almost all nationally notifiable infectious diseases and conditions during the COVID-19 pandemic," Crane says. "These decreases were found nationwide and at the state level, and appeared in all of the disease transmission routes we studied."

Crane says it's unknown whether the observed decreases indicate true reductions in infectious disease cases or an impairment of typical disease reporting during the pandemic.

"We believe that both factors likely contributed to our findings," he says.

Based on these findings -- and similar results in an earlier study looking at pandemic-driven reporting variations for sexually transmitted infections -- the researchers feel there is a critical need for more investment in disease surveillance in order to understand whether infectious disease transmission may have been underreported during the COVID-19 pandemic.

Crane is available for interviews.

JOHNS HOPKINS MEDICINE HELPS CREATE TREATMENT GUIDE FOR NEURODEGENERATIVE DISORDERS

Media Contact: Michel Morris, melben1@jhmi.edu

Some people may think nothing can be done for neurodegenerative disorders such as progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). However, a Johns Hopkins Medicine researcher and his colleagues are adamant that is not the case.

PSP is a rare brain disorder that causes serious problems with walking, balance and eye movements, and later with swallowing. CBS is a condition that causes changes in movement, language skills or both. Both are characterized by deposition in the brain of abnormal, malfunctioning proteins known as tau proteins. These usually show up in people of mid-60s age, leading to death after an average of seven years.

In a study published July 1, 2021, in the journal Frontiers in Neurology, Alexander Pantelyat, M.D., assistant professor of neurology at the Johns Hopkins University School of Medicine, and 35 colleagues at the non-profit organization CurePSP, outline best practices in the management of these difficult-to-treat disorders. Pantelyat is the study's joint first author and a member of the four-person steering committee that oversaw the project's completion.

"There is still a lingering impression that nothing can be done for these conditions and I hope that this comprehensive review can do a lot to dispel this notion," says Pantelyat, director of the Johns Hopkins Atypical Parkinsonism Center/CurePSP Center of Care. "Time is really of the essence with these conditions and it's important to understand that much can be done to improve a patient's quality of life."

Pantelyat says most physicians, including many neurologists, are reluctant to care for patients with these conditions because they are unfamiliar with the wide range of interacting symptoms and neurological deficits (abnormal functioning, such as the inability to speak). While there currently is no specific or disease-modifying treatment for either PSP and CBS, their symptoms are amenable to a variety of treatment strategies.

Pantelyat says several pharmacological and nonpharmacological interventions can meaningfully improve quality of life for patients with PSP and CBS. With a lack of approved pharmaceuticals for these conditions, the guidelines recommend useful off-brand medications to physicians and clinicians.

"One aspect that the guidelines discuss is avoiding medications that can worsen cognitive function, since in some ways, these diseases are closer to Alzheimer's disease than Parkinson's disease," says Pantelyat.

"In the case of CBS, it's like having a severe stroke except that it happens over months to years," he explains. "We encourage physicians to refer patients to a CurePSP Center of Care as soon as possible, enabling them to take advantage of resources like physical therapy, occupational therapy and speech-language pathology that can improve their daily function."

Pantelyat says the guidelines also address the use of botulinum toxin injections. For patients with excessive saliva, an injection of botulinum toxin can alleviate drooling, and it may improve symptoms for those with dystonia and pain. Since it's injectable, botulinum toxin doesn't have systemic side effects.

"We hope this comprehensive guide helps physicians identify patients as early as possible so they can get the appropriate care, and refer them appropriately," Pantelyat says.

Pantelyat and his colleagues hope to next look at how multidisciplinary care can be delivered remotely to patients with PSP and CBS using a virtual environment.

Pantelyat is available for interviews.

The UK government's latest pandemic plan involves recklessly exposing millions of people to the acute and long-term effects of mass infection, warn experts in The BMJ today.

A strategy that chooses mass infection in the young now over vaccination in order to achieve greater population immunity to protect the vulnerable in winter, is "unethical and unscientific" say Dr Deepti Gurdasani and colleagues.

Instead of allowing infections to rise, they urge the government to take urgent actions to inform and protect the public and prepare for autumn.

These include outlining a long-term strategy for pandemic control, keeping basic measures such as masks and physical distancing until cases return to low levels, investing in workplaces, schools and public transport to make them safer, and providing the means for extensive testing and support for people to isolate.

The prime minister's argument that it is better to accept mass infection now than to postpone until winter, when 'the virus has an advantage' is deeply flawed and misleading, they write. Instead, this strategy will place around 48% of the population (children included) who are not yet fully vaccinated, including the clinically vulnerable and those with compromised immune systems, at unacceptable risk.

This approach is already putting intense pressure on struggling healthcare services and will lead to many avoidable deaths and long-term illness, they add. It also provides a fertile environment for selection of escape variants which could have huge consequences for the UK and countries globally.

They point out that more than 1,000 scientists have already signed a letter to the Lancet setting out why allowing mass infection this summer is a 'dangerous and unethical experiment'. The British Medical Association, Directors of Public Health, SAGE, the Academy of Medical Royal Colleges, the Royal College of Nursing and NHS leaders have all highlighted the dangers inherent in allowing mass infection.

Opening the UK up further is billed as "freedom day," but for too many people, removing mandated measures such as wearing masks and physical distancing restrict, rather than enable, freedom.

This, they say, is unlikely to bolster public confidence and engagement in economic activity. And if the government strategy leads us into yet another lockdown, they warn that this could have an even more devastating impact on the economy.

What's more, the public overwhelmingly supports sensible public health measures such as masking indoors. "This begs the question why dangerous public health decisions that are neither in the public interest, or in line with public sentiment, have been made in the midst of a raging pandemic," they write.

WHAT:

Among 6- and 7-year-olds who were born extremely preterm--before the 28th week of pregnancy--those who had more than two hours of screen time a day were more likely to have deficits in overall IQ, executive functioning (problem solving skills), impulse control and attention, according to a study funded by the National Institutes of Health. Similarly, those who had a television or computer in their bedrooms were more likely to have problems with impulse control and paying attention. The findings suggest that high amounts of screen time may exacerbate the cognitive deficits and behavioral problems common to children born extremely preterm.

The study was conducted by Betty R. Vohr, M.D., and colleagues. It appears in JAMA Pediatrics. Funding was provided by NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Heart, Lung, and Blood Institute; and National Center for Advancing Translational Sciences.

Previous studies have linked high amounts of screen time among children born full-term to language and developmental, behavioral and other problems. In the current study, researchers analyzed data from a study of children born at 28 weeks or earlier. Of 414 children, 238 had more than two hours of screen time per day and 266 had a television or computer in their bedrooms. Compared to children with less screen time per day, those with high amounts of screen time scored an average deficit of nearly 8 points on global executive function percentile scores, roughly 0.8 points lower on impulse control (inhibition) and more than 3 points higher on inattention. Children with a television or computer in their bedrooms also scored lower on measures of inhibition, hyperactivity and impulsivity.

The authors concluded that the findings support the need for physicians to discuss the potential effects of screen time with families of children born extremely preterm.

WHO:

Andrew Bremer, M.D., Ph.D., Acting Chief, NICHD Pregnancy and Perinatology Branch, is available for comment.

ARTICLE:

Vohr, BE, et al. Association of high screen-time use with school-age cognitive, executive function, and behavior outcomes in extremely preterm children. JAMA Pediatrics.2021. doi:10.1001/jamapediatrics.2021.2041

Leesburg, VA, July 15, 2021--According to ARRS' American Journal of Roentgenology (AJR), return to routine screening for BI-RADS 3 lesions on supplemental automated whole-breast US (ABUS) substantially reduces the recall rate, while being unlikely to result in adverse outcome.

"This prospective study supports a recommendation for routine annual follow-up for BI-RADS 3 lesions at supplemental ABUS," wrote lead author Richard G. Barr of Northeastern Ohio Medical University in Rootstown.

From August 2013 to December 2016, Barr and colleagues' prospective study (NCT02650778) enrolled patients with BI-RADS 1 or 2 on screening mammography and breast density C or D to undergo supplemental ABUS, which was interpreted as BI-RADS 1, 2, 3, or 0. For ABUS BI-RADS 1, return to routine screening was recommended, whereas ABUS BI-RADS 0 lesions underwent targeted hand-held ultrasound.

In 2,257 women (mean age, 58 years), routine follow-up of BI-RADS 3 lesions detected on supplemental ABUS screening in women with dense breasts and any risk resulted in a recall rate of 3.8% (85/2,257), biopsy rate of 0.5% (12/2,257), and positive biopsy rate of 58.3% (7/12)--with no missed cancers (95% CI, 0.0-0.86%).

Noting that ABUS can help mitigate acquisition variability by standardizing the documentation, recording, and archiving of ultrasound images from the entire breast (excluding the axilla), Barr et al. reiterated that ABUS images of similar quality can be obtained from adequately trained ultrasonographers and mammographers.

"Avoiding earlier follow-up for these probably benign lesions can be associated with substantial cost savings," the authors of this AJR article added.

Concern has grown about prison systems' use of extended solitary confinement as a way to manage violent and disruptive incarcerated people. A new study identified groups that are more likely to be placed in extended solitary management (ESM). The study found that individuals sent to ESM differed considerably from the rest of the prison population in terms of mental health, education, language, race/ethnicity, and age.

The study, by researchers at Florida State University and the University of Cincinnati, appears in Justice Quarterly, a publication of the Academy of Criminal Justice Sciences.

"Many states and the federal prison system rely on long-term solitary confinement as a management tool, so it is important to shed light on the placements and disparities in this form of incarceration," according to Daniel P. Mears, professor of criminology at Florida State University, who led the study.

Prisoners have been placed in solitary confinement for more than 200 years. But in recent decades--especially with the rise of "supermax" prisons in the 1980s--correctional facilities have increased their reliance on the practice, with less focus on rehabilitation and more on control and punishment. Recent decades have also seen the rise of "restrictive housing" of incarcerated people, which includes confinement used for punishment or protection, and can limit privileges significantly.

ESM stands at the center of debates about solitary confinement: Critics argue that it is inhumane, unconstitutional, and harmful, especially to individuals with mental health disorders, while proponents say it is necessary for prison safety and order. Research on ESM is limited.

In this study, researchers used administrative records from the Florida Department of Corrections for approximately 192,000 individuals who entered or were released between 2007 and 2015. In this prison system, one of the largest in the United States, ESM typically entails a minimum stay of six months and up to 23 hours per day in isolation in a separate facility.

The study sought to identify disparities along a broad range of characteristics, including those related to demographics (e.g., age at admission, gender, race/ethnicity), mental health, substance abuse, education, language (i.e., English language proficiency), and prior criminal records (e.g., prior admissions, offense, time served). It also looked at disparities in placement, including multiple, early, and longer-duration placements.

Several patterns emerged from the study:

The profile of the population sent to ESM differed substantially from that of the rest of the admission-and-release population: Those sent to ESM were much more likely to be adolescents or young adults, males were more likely than females to be sent to ESM, and Blacks comprised 63 percent of the ESM population but just 43 percent of the overall prison population.

Mental health disparities were also pronounced: Individuals who spent time in a mental health unit or required outpatient care with medication were more likely to be placed in ESM early in their incarceration and have longer stays.

Other disparities appeared: Education among the ESM population was 1.6 grade levels lower than that for the prison population as a whole. Non-English speakers had a lower likelihood of an ESM stay than English speakers after controlling for age, sex, and other factors. Hispanics were more likely than others to be placed in ESM within six months of admission to prison. And stays of a year or longer in ESM were less likely among Hispanics and more likely among males and individuals with no prior prison admissions.

Early, repeated, and longer-duration placement in ESM was not the norm: 11 percent of all ESM incarceration stays entailed two or more ESM placements, 21 percent entailed an ESM placement within six months of admission, and 27 percent spent a year or more in ESM. There were relatively few differences in the profiles of these three groups.

"A focus on disparities in ESM placements is important for advancing research and policy," notes Jennifer M. Brown, a post-doctoral research fellow at Florida State University, who coauthored the study. "We need to understand more about the factors that contribute to placements. For example, some groups may engage in more violent or disruptive behavior, which could create the disparities. It also is possible that prison system practices may disadvantage certain groups or contribute to conditions that increase problematic behavior among those groups. In addition, it is possible that some groups may benefit more or be harmed more by ESM."

The authors point to a few limitations of their study, including that it focused on one state and one time period, so studies of other states and longer time periods might differ. In addition, the study did not include individuals who served more than eight years, which likely excluded inmates serving sentences for extremely violent crimes. Finally, the study relied on administrative records, which are not always accurate in capturing information such as individuals' mental health or organizational factors that might contribute to placements.