Culture

COVID-19 outbreaks in French nursing homes almost certainly started in staff - and none of measures put in place stopped the virus from taking hold, new research being presented at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID), held online this year, shows.

Residents of long-term care facilities represent a small fraction of the general population but account for a disproportionate number of SARS-CoV-2-related deaths in many countries.

In France, 5,203 outbreaks (of 1 case or more) were reported in nursing homes during the first wave of COVID-19. In the Auvergne-Rhône-Alpes region, there were 651 outbreaks, 3,885 residents had confirmed COVID-19 infection and 1,772 (46%) subsequently died.

Little is known, however, about how the COVID-19 virus enters nursing homes nor how it spreads in this complex environment.

Emilie Piet, of the Centre Hospitalier Annecy Geneva, Epagny Metz-Tessy, France and colleagues, carried out a cross-sectional survey in nursing homes in the French Alps from March 1 to May 31 May 2020.

The survey covered cases of COVID-19 among residents and staff during the first lockdown, as well as the staffing during the pandemic, including staffing levels and the use of interim carers.

It also asked about the nursing homes' characteristics (e.g. number of residents, whether these were private or public facilities, if they cared for dementia patients) and hygiene measures implemented (these included wearing face masks, confining residents to their rooms, use of alcohol-based hand sanitiser and bans on visits).

Seventy four (33%) of 225 nursing homes completed the survey. A total of 22 homes, with 1,795 residents in total, had an outbreak of COVID-19 - defined as at least three cases. (See table 1 of abstract).

In the homes with outbreaks, 26% (473/1,795) of the residents had a confirmed or probable case of COVID-19; 19% (341/1,795) of residents were hospitalised and 253 (14%) died of any cause.

In contrast, 0.2% (9/4,096 residents) of residents in the outbreak-free homes had confirmed or probable COVID-19, 6% (247/4,096) were hospitalised and 6% (250/4,096) died of any cause during the period studied.

A total of 19% (250/1,348) of staff in the homes with outbreaks had confirmed or probable cases of COVID-19, compared to 1.4% (46/3,304) in the outbreak-free homes.

The results revealed a strong link between cases in staff and cases in residents.

Further analysis showed that cases of COVID-19 in staff were the only predictor of an outbreak among residents.

In other words, none of the nursing homes' characteristics seemed to have any effect and nor did any of the hygiene measures. However, the homes all employed similar hygiene measures, making it difficult to tease apart their effect, says Dr Piet.

She adds: "This study shows that when strict hygiene measures are implemented in nursing homes, factors such as the number of beds, the ratio of staff to residents and the use of temporary staff do not influence outbreaks.

"We found that apart from staff infections, nothing influenced the occurrence of outbreaks and so, during the national lockdown, staff were the likely source of COVID-19 outbreaks among nursing home residents."

The flu vaccine may provide vital protection against COVID-19, new research being presented at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID), held online this year, concludes.

An analysis of patient data from around the world strongly suggests that the annual flu shot reduces the risk of stroke, sepsis and DVT in patients with COVID-19. Patients with COVID-19 who had been vaccinated against flu were also less likely to visit the emergency department and be admitted to the intensive care unit (ICU).

Immunising the world against COVID-19 is a daunting challenge and, although production and distribution of vaccines increases daily, some countries are not expected to vaccinate large numbers of their population until the start of 2023.

Recently, several modestly-sized studies suggested that the flu vaccine may provide protection against COVID-19 - meaning it could be a valuable weapon in the fight to halt the pandemic.

Ms Susan Taghioff, of the University of Miami Miller School of Medicine, Miami, USA, and colleagues carried out a retrospective analysis of data on tens of thousands of patients from around the world to find out more.

In the largest study of its kind, the team screened de-identified electronic health records held on the TriNetX research database of more than 70 million patients to identify two groups of 37,377 patients.

The two groups were matched for factors that could affect their risk of severe COVID-19, including age, gender, ethnicity, smoking and health problems such as diabetes, obesity and chronic obstructive pulmonary disease.

Members of the first group had received the flu vaccine between two weeks and six months before being diagnosed with COVID-19. Those in the second group also had COVID-19 but were not vaccinated against flu. The study was conducted using patients from countries including the US, UK, Germany, Italy, Israel and Singapore.

The incidence of 15 adverse outcomes (sepsis; strokes; deep vein thrombosis or DVT; pulmonary embolism; acute respiratory failure; acute respiratory distress syndrome; arthralgia or joint pain; renal failure; anorexia; heart attack; pneumonia; emergency department visits; hospital admission; ICU admission; and death) within 120 days of testing positive for COVID-19 was then compared between the two groups.

The analysis revealed that those who had not had the flu jab were significantly more likely (up to 20% more likely) to have been admitted to ICU.

They were also significantly more likely to visit the Emergency Department (up to 58% more likely), to develop sepsis (up to 45% more likely), to have a stroke (up to 58% more likely) and a DVT (up to 40% more likely). The risk of death was not reduced.

It isn't known exactly how the flu jab provides protection against COVID-19 but most theories centre around it boosting the innate immune system - "general" defences we are born with that are not tailored to any particular illness.

The study authors say their results strongly suggest that the flu vaccine protects against several severe effects of COVID-19. They add that more research is needed to prove and better understand the possible link but, in the future, the flu shot could be used to help provide increased protection in countries where the COVID-19 vaccine is in short supply.

Dr Devinder Singh, the study's senior author and a professor of plastic surgery at the University of Miami Miller School of Medicine, says: "Only a small fraction of the world has been fully vaccinated against COVID-19 to date and, with all the devastation that has occurred due to the pandemic, the global community still needs to find solutions to reduce morbidity and mortality.

"Having access to real-time data of millions of patients is a powerful research tool. Together with asking important questions it has allowed my team to observe an association between the flu vaccine and lower morbidity in COVID-19 patients.

"This finding is particularly significant because the pandemic is straining resources in many parts of the world. Therefore, our research - if validated by prospective randomised clinical trials - has the potential to reduce the worldwide burden of disease."

Ms Taghioff adds: "Influenza vaccination may even benefit individuals hesitant to receive a COVID-19 vaccine due to the newness of the technology.

"Despite this, the influenza vaccine is by no means a replacement for the COVID-19 vaccine and we advocate for everyone to receive their COVID-19 vaccine if able to.

"Continued promotion of the influenza vaccine also has the potential help the global population avoid a possible 'twindemic' - a simultaneous outbreak of both influenza and coronavirus.

"Regardless of the degree of protection afforded by the influenza vaccine against adverse outcomes associated with COVID-19, simply being able to conserve global healthcare resources by keeping the number of influenza cases under control is reason enough to champion continued efforts to promote influenza vaccination."

Nashville, Tenn. (July 10 2021--2:25 EDT)--Patients undergoing hip arthroscopy with high-grade cartilage damage do not see as positive results compared with patients with lower grade cartilage damage, according to research reported today at the American Orthopedic Society of Sports Medicine- Arthroscopy Association of North America Combined 2021 Annual Meeting.

The research was presented by Dominic Carreira, MD, of Peachtree Orthopedics in Atlanta, Ga. Dr. Carreira and his colleagues sought to determine what the impact of acetabular cartilage damage on outcomes following primary repair of acetabular labral tears.

When articular cartilage is damaged, joint pain may result. If the articular cartilage damage becomes diffuse, the term arthritis is used.

To determine this, researchers queried a multi-center hip arthroscopy registry for patients undergoing primary labrum repair from 2014-2017 with documented two-year outcomes. They assigned 472 patients to one of three groups according to severity of articular cartilage damage in the Beck classification system: None, Low Grade (Grade 1 or 2), or High Grade (Grade 3 or 4) Damage.

Patients in all three groups experienced statistically significant improvement in iHOT-12 scores from baseline to final follow-up (p

When accounting for age, BMI, gender, and preoperative iHOT12 scores in logistic regression models for clinically significant outcome thresholds, presence of high grade lesions was a negative predictor for achieving the MCID (odds ratio [95% CI], 0.49 [0.25, 0.91]) and the PASS (0.61 [0.38, 0.98]).Among patients with high grade lesions, there was no significant difference in two-year iHOT-12scores between those undergoing chondroplasty (N = 57) and those undergoing microfracture (N =19) (p = 0.13).

"High grade acetabular articular damage portends inferior patient-reported outcomes two years after primary labral repair," Dr. Carreira reported. "And our results suggest no difference between the efficacy of chondroplasty and microfracture with respect to self-reported outcomes."

New research being presented at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID), held online this year, reveals raw dog food to be a major source of antibiotic-resistant bacteria, making it an international public health risk.

With some of the multidrug-resistant bacteria in raw dog food identical to those found in hospital patients in several different European countries, the researchers say the trend for feeding dogs raw food may be fuelling the spread of antibiotic resistant-bacteria.

Drug-resistant infections kill an estimated 700,000 people a year globally and, with the figure projected to rise to 10 million by 2050 if no action is taken, the World Health Organisation (WHO) classes antibiotic resistance as one of the greatest public health threats facing humanity.

To find out if pet food is a potential source of spread of antibiotic-resistant bacteria, Dr Ana R. Freitas, Dr Carla Novais, Dr Luísa Peixe and colleagues from UCIBIO, Faculty of Pharmacy, University of Porto, Portugal analysed dog food from supermarkets and pet shops for Enterococci.

Enterococci are opportunistic bacteria. They live harmlessly in the guts of humans and animals but can cause severe infections if they spread to other parts of the body.

A total of 55 samples of dog food (22 wet, 8 dry, 4 semi-wet, 7 treats and 14 raw-frozen) from 25 brands available nationally and internationally were included in the study. The raw-frozen foods included duck, salmon, turkey, chicken, lamb, goose, beef and vegetables.

Thirty samples (54%) contained Enterococci. More than 40% of the Enterococci were resistant to the antibiotics erythromycin, tetracycline, quinupristin-dalfopristin, streptomycin, gentamicin, chloramphenicol, ampicillin or ciprofloxacin. There was also resistance to vancomycin and teicoplanin (2% each) and 23% of the enterococci were resistant to linezolid.

Linezolid is a last-resort antibiotic, used on severe infections when other drugs have failed, and is considered a critically important treatment by the WHO.

All of the raw dog food samples contained multidrug-resistant Enterococci, including bacteria resistant to linezolid. In contrast, only three of the non-raw samples contained multidrug- resistant bacteria.

Genetic sequencing revealed that some of the multi-drug resistant bacteria in the raw dog food were identical to bacteria isolated from hospital patients in the UK, Germany and the Netherlands. Genetically identical bacteria have also been found in farm animals and wastewater in the UK.

In another experiment, the researchers transferred antibiotic resistance genes from the bacteria found in dog food to other, experimental, bacteria - suggesting this can also occur in nature.

The researchers conclude that dog food is a source of bacteria that are resistant to last-resort antibiotics and could potentially spread to humans. Dog food, they add, could be an overlooked driver of antibiotic resistance globally.

Dr Freitas adds: "The close contact of humans with dogs and the commercialisation of the studied brands in different countries poses an international public health risk.

"European authorities must raise awareness about the potential health risks when feeding raw diets to pets and the manufacture of dog food, including ingredient selection and hygiene practices, must be reviewed.

"Dog owners should always wash their hands with soap and water right after handling pet food and after picking up faeces."

Evidence suggests that what happens in one generation--diet, toxin exposure, trauma, fear--can have lasting effects on future generations. Scientists believe these effects result from epigenetic changes that occur in response to the environment and turn genes on or off without altering the genome or DNA sequence.

But how these changes are passed down through generations has not been understood, in part, because scientists have not had a simple way to study the phenomenon. A new study by researchers at the University of Maryland provides a potential tool for unraveling the mystery of how experiences can cause inheritable changes to an animal's biology. By mating nematode worms, they produced permanent epigenetic changes that lasted for more than 300 generations. The research was published on July 9, 2021, in the journal Nature Communications.

"There's a lot of interest in heritable epigenetics," said Antony Jose, associate professor of cell biology and molecular genetics at UMD and senior author of the study. "But getting clear answers is difficult. For instance, if I'm on some diet today, how does that affect my children and grandchildren and so on? No one knows, because so many different variables are involved. But we've found this very simple method, through mating, to turn off a single gene for multiple generations. And that gives us a huge opportunity to study how these stable epigenetic changes occur."

In the new study, Jose and his team found while breeding nematode worms that some matings led to epigenetic changes in offspring that continued to be passed down through as many generations as the scientists continued to breed them. This discovery will enable scientists to explore how epigenetic changes are passed to future generations and what characteristics make genes susceptible to permanent epigenetic changes.

Jose and his team began this work in 2013, while working with nematode worms, Caenorhabditis elegans (C. elegans), a species often used as a model for understanding animal biology. The scientists noticed that worms bred to carry a gene they called T, which produces fluorescent proteins, sometimes glowed and sometimes didn't. This was puzzling because the glowers and the non-glowers had nearly identical DNA.

"Everything began when we stumbled upon a rare gene that underwent permanent change for hundreds of generations just by mating. We could have easily missed it," said Sindhuja Devanapally (Ph.D. '18, biological sciences), a co-lead author of the study who is now a postdoctoral fellow at Columbia University.

To understand the phenomenon better, the researchers conducted breeding experiments in which only the mother or the father carried the fluorescent gene. The team expected that no matter which parent carried the gene, the offspring would glow. Instead, they found that when the mother carried the fluorescent gene, the offspring always glowed, meaning the gene was always turned on. But when the father carried the gene, the offspring usually weakly glowed or did not glow at all.

"We found that there are these RNA-based signals controlling gene expression," Jose said. "Some of these signals silence the gene and some of them are protective signals that prevent silencing. These signals are duking it out as the offspring develop. When the gene comes from the mother, the protective signal always wins, but when the gene comes from the father, the silencing signal almost always wins."

When the silencing signal wins, the gene is silenced for good, or for at least 300 generations, which is how long Jose and his colleagues followed their laboratory-bred worms. Previous examples of epigenetic changes were more complex or they did not last more than a couple of generations. The researchers don't yet know why the silencing signal only wins some of the time, but this new finding puts them in a much better position to explore the details of epigenetic inheritance than ever before.

"While we've found a set of genes that can be silenced almost permanently, most other genes are not affected the same way," said the study's other co-lead author, Pravrutha Raman (Ph.D. '19, biological sciences), who is now a postdoctoral fellow at Fred Hutchinson Cancer Research Center. "After silencing, they bounce back and become expressed in future generations."

With their new findings, the researchers now believe some genes could be more vulnerable to permanent epigenetic change while other genes recover within a few generations. Although studies in worms are not the same as in humans, the research provides a window into biological processes that are likely shared, at least in part, by all animals.

"The two big advantages we now have from this work are that this long-lasting epigenetic change is easy to induce through mating, and that it occurs at the level of a single gene," Jose said. "Now we can manipulate this gene and control everything about it, which will allow us to determine what characteristics make a gene susceptible or resistant to heritable epigenetic change."

Jose and his colleagues expect that future studies may one day help scientists identify human genes that are vulnerable to long-lasting epigenetic changes.

Players of the popular game Red Dead Redemption 2 learn how to identify real American wildlife, new research shows.

The game, set in the American West in 1899, features simulations of about 200 real species of animals.

The new study, by the University of Exeter and Truro and Penwith College, challenged gamers to identify photographs of real animals.

On average, RDR2 players were able to identify 10 of 15 American animals in a multiple-choice quiz - three more than people who had not played the game.

The best performers were players who had completed the game's main storyline (meaning they had played for at least 40-50 hours) or had played more recently.

As well as learning to identify wildlife, some players reported learning about animal behaviour and ecology.

One gamer who participated in the study said RDR2 taught them how to spot a ram that's about to charge, adding: "No joke saved me from breaking a leg in real life."

Dr Sarah Crowley, of the Centre for Geography and Environmental Science at the University of Exeter, said: "The level of detail in Red Dead Redemption 2 is famously high, and that's certainly the case in terms of animals.

"Many of the animals not only look and behave realistically, but interact with each other. Possums play dead, bears bluff charge and eagles hunt snakes."

Co-author Dr Matthew Silk added: "The game features a couple of species that are now much rarer, and one - the Carolina parakeet - that's extinct.

"Hunting played a role in the Carolina parakeet's extinction; if players shoot this species in the game, they are warned of their endangered status. If they continue shooting, the species becomes extinct, highlighting the environmental consequences of players' actions."

The study used real photos of 15 species featured in the game, including the white-tailed deer, jackrabbit, alligator snapping turtle, lake sturgeon, blue jay and roseate spoonbill.

Gamers participating in the study could first enter the name of each animal as text, and were then shown multiple choice options.

The difference in identification skills between players and non-players was generally greatest for animals that are useful in the game, such as fish that can be caught and eaten.

Animals that are rarer in the game, such as the golden eagle, were less commonly identified.

The game also includes an online "naturalist" role that allows players to take up a new life as a protector of the Old West's wildlife - and people who had played this were better still at identifying the real-life animals.

In total, 586 people from 55 countries completed the quiz. 444 had played RDR2.

"We know that many gamers value realism, so game producers might be interested to see these findings, but we realise these games aren't designed to be educational," said Ned Crowley, of Truro and Penwith College.

"We don't expect big-budget games to include messages about conservation, but educators and conservationists can learn from the techniques used in games - such as making things immersive, and having each action mean something in terms of wider progress in the game.

"Being indoors on a computer is often seen as the opposite of engaging with nature, but our findings show that games can teach people about animals without even trying.

"Gaming is very popular, and should be taken seriously by ecologists and conservationists as a force for communication."

Eyewitnesses can identify perpetrators more accurately when they are able to manipulate 3D images of suspects, according to a new study.

A team of researchers in the University of Birmingham's School of Psychology developed and tested new interactive lineup software which enables witnesses to rotate and view lineup faces from different angles.

When the eyewitnesses were able to rotate the image to match the alignment of the face in their memory, they were more likely to accurately pick out the criminal from the lineup.

Lineups are used around the globe to help police identify criminals. Typically these involve witnesses examining an image of the suspect alongside 'fillers' - individuals who look similar, but who weren't involved in the crime.

The ability of the eyewitness to accurately identify guilty from innocent suspects is known as discrimination accuracy. According to the US-based Innocence Project, misidentification is the single greatest cause of wrongful conviction in the US. Since 1989, 365 wrongful convictions have been overturned on the basis of new DNA evidence; reliance on inaccurate eyewitness testimony played a role in securing convictions in many of these cases. Improving discrimination accuracy is therefore clearly important for more reliably identifying criminals.

Professor Heather Flowe, co-lead researcher, said: "We worked closely with law enforcement to develop the interactive lineup procedure to be cost effective and work with current police identification systems. The procedure is a significant advance in improving the accuracy of eyewitness identifications."

In the experimental study, published in Nature's Scientific Reports, researchers recruited more than 3,000 volunteer 'witnesses' to test their discrimination accuracy. The volunteers watched a video of a staged crime being committed. They were then shown images of the perpetrator, alongside filler images of similar faces.

The researchers found that accuracy improved significantly when the volunteers viewed the lineup from the same angle at which they had seen the perpetrator commit the crime. Accuracy was the highest when participants rotated the lineup faces to match the angle of the perpetrator.

Interestingly, the researchers also found that witnesses naturally (without instruction) moved the images into the best position for identification.

Co-author Dr Melissa Colloff said: "There are good reasons to predict that accuracy will be higher if witnesses are able to manipulate images and align them to be similar to the angle of the face in their memory. We know that retrieving memories accurately relies on the context in which they are retrieved being similar to when the memory was formed. The experiments we carried out show this theory in practice. Our participants actively sought out a familiar angle for the lineup image, to help them retrieve information from memory."

The team is now recruiting participants for the next phase of eyewitness memory research. If you are interested in taking part, please sign up here.

Oncotarget published "Transcriptome analyses of urine RNA reveal tumor markers for human bladder cancer: validated amplicons for RT-qPCR-based detection" which reported that in case of bladder cancer, urine RNA represents an early potentially useful diagnostic marker.

Here the authors describe a systematic deep transcriptome analysis of representative pools of urine RNA collected from healthy donors versus bladder cancer patients according to established SOPs.

This analysis revealed RNA marker candidates reflecting coding sequences, non-coding sequences, and circular RNAs.

Next, they designed and validated PCR amplicons for a set of novel marker candidates and tested them in human bladder cancer cell lines.

This Oncotarget work strongly suggests exploiting urine RNAs as diagnostic markers of bladder cancer and it suggests specific novel markers.

This Oncotarget work strongly suggests exploiting urine RNAs as diagnostic markers of bladder cancer and it suggests specific novel markers.

Dr. Georg Sczakiel from The Universität zu Lübeck and UKSH, said "Human bladder cancer (BCa) is one of the most common cancer types in humans."

With regard to BCa, RNA markers have been studied by transcriptome analyses of single cells, tissue samples and urine.

In case of BCa, urine is thought to be the most promising source for RNA-based tumor markers as direct physical contact between tumor cells and urine seems to be given.

On the other hand, urine RNA samples contain RNAs which are suitable for cDNA synthesis and RT-qPCR detection.

Cell-free RNA contained in urine samples can be protected against degradation, i.e., stabilization of RNA markers is possible such that shipping of samples and storage is possible.

This consists of SOP-based acquisition of urine, stabilization of urine RNA, delivery and storage of samples, RNA preparation, and deep transcriptome analyses.

The Sczakiel Research Team concluded in their Oncotarget Research Output that while all of these hits focus on conventional linear transcripts the authors also noted experimental evidence supporting the existence of circular RNAs that seem to be able to monitor differences between the healthy state and the cancer state.

This is reflected by a number of recent studies describing a link between circular RNA and cancer.

However, such evidence derived from in silico analyses does not necessarily prove that such circRNAs exist in reality.

A set of experimental evidence is necessary to sufficiently strongly verify their existence.

However, such assays go beyond the scope of this study although this is one promising way to proceed in order to identify new and potent RNA markers.

A new study by Thomas Le Barbanchon and Julien Sauvagnat, two Associate Professors at Bocconi University, published in the Journal of the European Economic Association, finds that electoral districts with a larger gender pay gaps show favoritism toward male political candidates in Parliamentary elections, with fewer female candidates on the ballot.

Professors Le Barbanchon and Sauvagnat gathered data for seven parliamentary elections in France between 1988 and 2017. They studied candidates from the Left and Right political coalitions, which account for 80% of elected members of Parliament. The researchers consulted administrative and web data on candidates and electoral outcomes, survey data on voters' attitude towards gender, as well as census data on earnings, and voters' demographics across electoral districts.

Analysis found that female candidates made up approximately 15% of all Parliamentary candidates in the 1980s and 1990s. The figure doubled to nearly 30% following the implementation of the Parity Law in 2000, which stipulated that each party should have an equal fraction of male and female candidates across electoral districts in Parliamentary elections. Noncompliance with the parity rule results in a financial penalty to the public funding provided to political parties.

Researchers analyzed local gender pay gaps compared to voting support for male and female candidates in the same electoral districts. "We found a positive and strong correlation between gender earnings gaps and electoral gaps across municipalities of the same electoral district: a €150 increase in gender monthly earnings gap leads to an increase by 0.6 percentage points in vote share gap between male and female candidates," Professor Le Barbanchon said.

"Female candidates obtain lower votes in areas with less favorable attitudes towards women, including significant gender pay gaps, and thus women are less likely to run for elections in these areas," Professor Sauvagnat said.

Indeed, researchers found that voters' attitudes towards gender are strongly associated with the gender distribution of candidates across electoral districts within France. A 10 percentage points increase in survey respondents who thought that men were better political leaders than women correlated with a 2.3 percentage points decrease in the share of female candidates.

Researchers concluded that in districts with strongest electoral competition, the electoral cost of selecting women outweighs the cost of the financial penalty under the Parity Law. When voters are biased against female candidates, electoral competition limits the effectiveness of "soft" quota rules on candidates. In the last Parliamentary election (17 years after the Parity rule was introduced) the two main political parties still selected an average of 40% of female candidates, significantly below the 50% objective of the Parity Law.

"Overall, we find that parties allocate female candidates across districts strategically," the authors concluded. "This is very clear after the introduction of the Parity Law. Then parties avoid putting women on the ballot of the most contested districts. In such districts, voters biased against female politicians may lead women to lose the few votes that matter for winning the close race, and parties internalize this competitive disadvantage."

Researchers at the University of Freiburg and the University of Stuttgart have developed a new process for producing movable, self-adjusting materials systems with standard 3D-printers. These systems can undergo complex shape changes, contracting and expanding under the influence of moisture in a pre-programmed manner. The scientists modeled their development based on the movement mechanisms of the climbing plant known as the air potato (Dioscorea bulbifera). With their new method, the team has produced its first prototype: a forearm brace that adapts to the wearer and which can be further developed for medical applications. This process has been collaboratively developed by Tiffany Cheng and Prof. Dr. Achim Menges from the Institute of Computational Design and Construction (ICD) and the Integrative Computational Design and Construction for Architecture Cluster of Excellence (IntCDC) at the University of Stuttgart, together with Prof. Dr. Thomas Speck from the Plant Biomechanics Group and the Living, Adaptive and Energy-autonomous Materials Systems Cluster of Excellence (livMatS) at the University of Freiburg. The researchers are presenting their results in the journal Advanced Science.

4D-printing defines shape changes

3D-printing has established itself as a manufacturing process for a wide range of applications. It can even be used to produce intelligent materials and material systems that remain in motion after printing, autonomously changing shape from external stimuli such as light, temperature or moisture. This so-called '4D-printing', in which predetermined shape changes can be triggered by a stimulus, immensely expands the potential applications of material systems. These changes in shape are made possible by the chemical composition of the materials, which consist of stimuli-responsive polymers. However, the printers and base materials used to produce such materials systems are usually highly specialized, custom-made and expensive - until now.

Now, using standard 3D-printers, it is possible to produce materials systems that react to changes in moisture. Given their structure, these materials systems can undergo shape changes in the entire system or simply in the individual parts. The researchers at the Universities of Freiburg and Stuttgart combined multiple swelling and stabilizing layers to realize a complex movement mechanism: a coiling structure that pulls tighter by unfolding 'pockets' as pressors and which can loosen up again on its own when the 'pockets' release and the coiled structure returns to the open state.

Natural movement mechanisms transferred to technical material systems

For this new process, the scientists used a mechanism from nature: the air potato climbs trees by applying pressure to the trunk of the host plant. To do this, the plant first winds loosely around a tree trunk. Then it sprouts 'stipules', basal outgrowths of the leaves, which increase the space between the winding stem and the host plant. This creates tension in the winding stem of the air potato. To imitate these mechanisms, the researchers constructed a modular material system by structuring its layers so that it can bend in different directions and to different degrees, thereby coiling and forming a helix structure. 'Pockets' on the surface cause the helix to be pushed outwards and put under tension, causing the entire material system to contract.

"So far, our process is still limited to existing base materials that respond to moisture," says Achim Menges. "We're hoping," Thomas Speck adds, "that in the future, inexpensive materials that also respond to other stimuli will become available for 3D-printing and can be used with our process."

Living, Adaptive and Energy-autonomous Materials Systems Cluster of Excellence (livMatS)

Researchers at the University of Freiburg's Living, Adaptive and Energy-autonomous Materials Systems Cluster of Excellence (livMatS) are developing life-like materials systems that are inspired by nature. Like living structures they adapt autonomously to different environmental factors, generate clean energy from their environment and are impervious to damage or can heal themselves. Nevertheless these materials systems will be purely technical objects, so they can be produced using synthetic methods and deployed in extreme conditions. Thomas Speck is a member of the team of speakers at the Cluster of Excellence.

Nashville, Tenn. (4:14 p.m. EDT--July 9, 2021)--Orthopedic surgeons know that knee surgeries that require revisions have inferior outcomes compared with primary surgeries but until now, the reason for this was unknown. Today a team of orthopedic physicians reports that opting for a transtibial surgical approach and choosing an inference screw for femoral and tibial fixation will improve the patient's odds of having a significantly better six-year clinical outcome.

The research was presented today at the American Orthopedic Society of Sports Medicine- Arthroscopy Association of North America Combined 2021 Annual Meeting by Rick Wright MD, Vanderbilt University Medical Center, Nashville, TN.

A team of orthopedic physicians and researchers from Washington University, St. Louis, MO., and Vanderbilt University Medical Center in Nashville, Tenn., designed a study to determine if surgical factors performed at the time of revision anterior cruciate ligament reconstruction have the ability to influence a patient's outcome at six-year follow-up.

Anterior cruciate ligament injury, which usually comprises a complete rupture or tear of the ligament, is one of the most common knee injuries. Surgery comprises ACL reconstruction, where the damaged ACL is replaced by either an autograft (tissue, such as part of the patellar tendon or hamstring tendons, extracted from the person's own body) or an allograft (a specially treated tendon or ligament extracted from a human cadaver) under arthroscopic control.

The researchers enrolled 1,234 revision ACL reconstruction patients (58 % male and 42 % female) between 2006 and 2011. Data collected included baseline demographics, surgical technique and pathology, and a series of validated patient-reported outcome instruments (IKDC, KOOS, WOMAC, and Marx activity rating score). Patients were followed up for 6 years and asked to complete the identical set of outcome instruments.

At six years, follow-up was obtained on 77% (949/1234) of the patients. The researchers found three significant drivers of poor outcomes among these patients, including that surgical variables driving outcome in revision patients were related to femoral and tibial fixation.

Using an interference screw for femoral fixation compared with a cross-pin resulted in significantly better outcomes in six-year IKDC scores (OR=2.2; 95% CI=1.2, 3.8; p=0.008), KOOS sports/rec and KOOS QOL subscales (OR range = 2.2-2.7; 95% CI=1.2, 3.8; p

Using an interference screw for tibial fixation compared to any combination of tibial fixation techniques also resulted in significantly improved IKDC (OR=2.0; 95% CI=1.3, 2.9; p=0.001), KOOS pain, ADL, sports/rec (OR range=1.5-1.6; 95% CI=1.0, 2.4; p

Using a transtibial surgical approach compared to an anteromedial portal approach resulted in significantly improved KOOS pain and QOL subscales at six years (OR=1.5; 95% CI=1.02, 2.2; p

Regarding tunnel position at the time of the revision surgery, surgeons who noted that the tibial tunnel aperture position was in the 'optimum position' fared significantly worse in six-year IKDC scores (OR=0.6; 95% CI=0.4, 0.8; p=0.003), Marx activity levels (OR=0.20; 95% CI=0.07, 0.6; p=0.005), KOOS symptoms, pain, sports/rec, and QOL subscales (OR range=0.56-0.68; 95% CI=0.38, 0.47; p

The research team also noted other factors that affected outcomes, including: lower baseline outcome scores, lower baseline activity level, being a smoker at the time of the revision, higher BMI, female gender, shorter time since the patient's last ACL reconstruction, and having a previous ACL reconstruction on the contralateral side all significantly increased the odds of reporting poorer clinical outcomes at 6 years.

"There are surgical variables that the physician can control at the time of an ACL revision which have the ability to modify clinical outcomes," said Dr. Rick Wright, "Based on outcomes at 6 years, opting for a transtibial surgical approach and choosing an inference screw for femoral and tibial fixation, will improve the patient's odds of having a significantly better 6-year clinical outcome."

Plants have microscopically small pores on the surface of their leaves, the stomata. With their help, they regulate the influx of carbon dioxide for photosynthesis. They also use the stomata to prevent the loss of too much water and withering away during drought.

The stomatal pores are surrounded by two guard cells. If the internal pressure of these cells drops, they slacken and close the pore. If the pressure rises, the cells move apart and the pore widens.

The stomatal movements are thus regulated by the guard cells. Signalling pathways in these cells are so complex that it is difficult for humans to intervene with them directly. However, researchers of the Julius-Maximilians-Universität (JMU) Würzburg in Bavaria, Germany, nevertheless found a way to control the movements of stomata remotely - using light pulses.

Light-sensitive protein from algae used

The researchers succeeded in doing this by introducing a light-sensitive switch into the guard cells of tobacco plants. This technology was adopted from optogenetics. It has been successfully exploited in animal cells, but the application in plant cells it is still in its infancy.

The team led by JMU biophysicist and guard cell expert Professor Rainer Hedrich describes their approach in the prestigious scientific journal Science Advances. JMU researchers Shouguang Huang (first author), Kai Konrad and Rob Roelfsema were significantly involved.

The group used a light-sensitive protein from the alga Guillardia theta as a light switch, namely the anion channel ACR1 from the group of channelrhodopsins. In response to light pulses, the switch ensures that chloride flows out of the guard cells and potassium follows. The guard cells lose internal pressure, slacken and the pore closes within 15 minutes. "The light pulse is like a remote control for the movement of the stomata," says Hedrich.

Anion channel hypothesis confirmed

"By exposing ACR1 to light, we have bridged the cell's own signalling chain, thus proving the hypothesis that the opening of anion channels is essential and sufficient for stomatal closure," Hedrich summarises the results of the study. The exposure to light had almost completely prevented the transpiration of the plants.

With this knowledge, it is now possible to cultivate plants with an increased number of anion channels in the guard cells. Plants equipped in this way should close their stomata more quickly in response to approaching heat waves and thus be better able to cope with periods of drought.

"Plant anion channels are activated during stress; this process is dependent on calcium. In a follow up optogenetics project, we want to use calcium-conducting channelrhodopsins to specifically allow calcium to flow into the guard cells cell through exposure to light and to understand the mechanism of anion channel activation in detail," Hedrich outlines the upcoming goals of his research.

Basic scientific research can also benefit from the results from Würzburg: "Our new optogenetic tool has enormous potential for research," says the JMU professor. "With it, we can gain new insights into how plants regulate their water consumption and how carbon dioxide fixation and stomatal movements are coupled."

We know that turning goals into a game can increase people's physical activity. We also know that financial incentives can be effective, especially when they're framed in a way where people lose money if they don't reach their goals. But a new Perelman School of Medicine at the University of Pennsylvania study adds to evidence that combining the two can result in significant gains.

Researchers affiliated with Penn Medicine's Center for Health Care Innovation showed that a group of veterans who were overweight or obese and receiving care from a Philadelphia hospital were able to increase their daily step counts by more than 1,200, on average, when their personalized goals were paired with a game in which they received support from a buddy, all while they stood to potentially lose reward money if they didn't hit their targets.

The research, believed to be the first of its kind among veterans, was published in JAMA Network Open.

"What our study begins to show is that the combination of varying approaches can be effective, but we need to learn more about the duration and ability to sustain an effect over longer-periods of time," said the study's lead author, Anish Agarwal, MD, a clinical innovation manager in the Penn Medicine Center for Digital Health and an assistant professor of Emergency Medicine.

Often, companies create programs to encourage healthier behavior among employees. These programs typically involve step counts measured by some form of pedometer and daily or weekly goals, but leave it at that. Agarwal believes that it's important to study how different framings of goals and the accomplishment of them is important to improving them and actually helping people improve their behaviors.

"The world of mobile and digital health has created an environment where rolling these programs out is easier and more interactive," Agarwal said. "Time will certainly tell in how these incentives can be used to in equitable and sustainable ways."

For this study, Agarwal and his fellow researchers - including senior author Mitesh Patel, MD, an associate professor of Medicine - recruited 180 participants. They were randomly assigned to one of three different, equal groups. Everyone, including those in the control group, received an electronic, wearable device to track steps and selected a personalized goal. But two of the groups utilized a behavioral science concept called "gamification," in which their goals were tied to a game in which they achieved points and levels for hitting their step goals. The progress of these participants was shared weekly via email with a buddy the participant had designated who could review them and encourage them.

One of those groups, though, had money riding on their goals. In total, they stood to make $120 if they hit their goals each week for the study's 12-week intervention period. Every week that they didn't achieve their goals, the participants lost $10 from the total they'd be issued at the end of the study.

It was this group, the researchers found, who made the largest strides during the intervention period. Compared to the control group, they significantly increased their steps by an average of 1,224. The other gamified group did increase their steps above the control group, but it was only by 433, which was not significant.

"Loss aversion is a very powerful motivator," Patel said. "Most programs deliver rewards after the goal is achieved, but this clinical trial, similar to previous ones, shows that offering financial upfront and letting participants know they can be an effective strategy."

After the 12-week intervention period ended, the researchers continued to observe participants' step counts when the games were turned off. In the eight weeks following, neither group sustained their progress compared to those who were not part of the games. The group with financial incentives did still have an average 564 step increase in their daily totals, but the non-incentive group actually decreased their daily steps by an average of 160.

Agarwal said that more research is needed to determine exactly why they got the results they did when research has supported gamification both with and without financial incentives. Their main focus is to increase the intervention time, and, ultimately, achieve longer term changes.

"Next steps for us are to begin to design and test approaches which help sustain the effect beyond the intervention period," Agarwal said. "One could imagine varying financial amounts at risk, duration of the intervention, and a strong social incentive. In this study the social incentive was passive, a weekly email to a social support person, but we could imagine more social connection or competition to test for individuals or groups."

What The Study Did: This survey study examined disparities in COVID-19 vaccine acceptance and approaches to improve vaccination rates among adults in China.

Authors: Jingjing Ma, Ph.D., of Peking University in Beijing, 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.2021.1466)

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.

A research team co-led by UCL (University College London) has solved a decades-old mystery as to how Jupiter produces a spectacular burst of X-rays every few minutes.

The X-rays are part of Jupiter's aurora - bursts of visible and invisible light that occur when charged particles interact with the planet's atmosphere. A similar phenomenon occurs on Earth, creating the northern lights, but Jupiter's is much more powerful, releasing hundreds of gigawatts of energy, enough to briefly power all of human civilisation*.

In a new study, published in Science Advances, researchers combined close-up observations of Jupiter's environment by NASA's satellite Juno, which is currently orbiting the planet, with simultaneous X-ray measurements from the European Space Agency's XMM-Newton observatory (which is in Earth's own orbit).

The research team, led by UCL and the Chinese Academy of Sciences, discovered that X-ray flares were triggered by periodic vibrations of Jupiter's magnetic field lines. These vibrations create waves of plasma (ionised gas) that send heavy ion particles "surfing" along magnetic field lines until they smash into the planet's atmosphere, releasing energy in the form of X-rays.

Co-lead author Dr William Dunn (UCL Mullard Space Science Laboratory) said: "We have seen Jupiter producing X-ray aurora for four decades, but we didn't know how this happened. We only knew they were produced when ions crashed into the planet's atmosphere.

"Now we know these ions are transported by plasma waves - an explanation that has not been proposed before, even though a similar process produces Earth's own aurora. It could, therefore, be a universal phenomenon, present across many different environments in space."

X-ray auroras occur at Jupiter's north and south poles, often with clockwork regularity - during this observation Jupiter was producing bursts of X-rays every 27 minutes.

The charged ion particles that hit the atmosphere originate from volcanic gas pouring into space from giant volcanoes on Jupiter's moon, Io.

This gas becomes ionised (its atoms are stripped free of electrons) due to collisions in Jupiter's immediate environment, forming a donut of plasma that encircles the planet.

Co-lead author Dr Zhonghua Yao (Chinese Academy of Sciences, Beijing) said: "Now we have identified this fundamental process, there is a wealth of possibilities for where it could be studied next. Similar processes likely occur around Saturn, Uranus, Neptune and probably exoplanets as well, with different kinds of charged particles 'surfing' the waves."

Co-author Professor Graziella Branduardi-Raymont (UCL Mullard Space Science Laboratory) said: "X-rays are typically produced by extremely powerful and violent phenomena such as black holes and neutron stars, so it seems strange that mere planets produce them too.

"We can never visit black holes, as they are beyond space travel, but Jupiter is on our doorstep. With the arrival of the satellite Juno into Jupiter's orbit, astronomers now have a fantastic opportunity to study an environment that produces X-rays up close."

For the new study, researchers analysed observations of Jupiter and its surrounding environment carried out continuously over a 26-hour period by the Juno and XMM-Newton satellites.

They found a clear correlation between waves in the plasma detected by Juno and X-ray auroral flares at Jupiter's north pole recorded by X-MM Newton. They then used computer modelling to confirm that the waves would drive the heavy particles towards Jupiter's atmosphere.

Why the magnetic field lines vibrate periodically is unclear, but the vibration may result from interactions with the solar wind or from high-speed plasma flows within Jupiter's magnetosphere.

Jupiter's magnetic field is extremely strong - about 20,000 times as strong as Earth's - and therefore its magnetosphere, the area controlled by this magnetic field, is extremely large. If it was visible in the night sky, it would cover a region several times the size of our moon.

The work was supported by the Chinese Academy of Sciences, the National Natural Science Foundation of China, and the UK's Science and Technology Facilities Council (STFC), Royal Society, and Natural Environment Research Council, as well as ESA and NASA.

* Jupiter's X-ray aurora alone releases about a gigawatt, equivalent to what one power station might produce over a period of days.