Culture

AMHERST, Mass. - In a recent study exploring the feasibility of introducing gun safety discussions and interventions into routine health care settings, investigators suggest that there is some support for promoting firearm safety in pediatric primary care as a universal suicide prevention strategy for adolescents.

John Zeber, a mental health services researcher and associate professor in the School of Public Health and Health Sciences at the University of Massachusetts Amherst, with team leader Rinad Beidas at the University of Pennsylvania and other co-investigators, assessed the needs of stakeholders who would implement a new approach to promoting a program the researchers call Firearm Safety Check. This program is designed for physicians to ask families about the presence of firearms in the home, offer information on safe gun storage and provide free gun locks.

As Zeber explains, "We're not taking a position on gun ownership, but if you have a gun and a child in the home, we believe safe storage will greatly reduce the risk of a tragedy. We're finding that it would be a new role for many physicians, though we previously found the majority do at least discuss guns with their patients. We're looking for fairly simple solutions that don't take a lot of time and that seem feasible. All the stakeholders recognize the problem, they just differ on what to do about it."

He adds, "Some critics say to those of us in public health, 'Stay in your lane, don't get involved,' but we see this as a major problem to be addressed." Zeber and co-investigators point out that youth suicide has increased steadily over the past several decades due in part to an increase in suicide by firearm. Their recent paper on the topic is featured in the American Medical Association's open access online journal JAMA Network Open.

The authors point out, "There is clear consensus that promoting firearm safety in pediatric primary care is essential in reducing youth suicide. Physician groups, including the American Academy of Pediatrics and the National Academy of Medicine recommend that physicians discuss firearm safety with parents." However, "physicians can be reluctant to discuss firearm safety in primary care," and existing strategies "remain underused," they add.

To explore this, Beidas, Zeber and colleagues conducted qualitative interviews with nearly 60 stakeholders in nine groups such as parents of youth, physicians, nurses, other clinical providers, and health system leaders of pediatric primary care and behavioral health practices. Interviews were conducted over a span of seven months at two large health systems, Henry Ford Hospital in inner city Detroit, and Baylor Scott & White Health in the rural central Texas town of Temple. They also talked with gun owner constituents, third-party payers and members of national credentialing bodies.

In this study, Beidas, Zeber and colleagues found that stakeholders "indicated that firearm safety promotion is a health system priority and reported generally favorable perceptions of the Firearm Safety Check approach for suicide prevention." Respondents frequently noted the need for patient interactions about firearms to be brief, and that existing infrastructures such as electronic health record systems should be used. They also identified distribution of firearm locks as "likely the most complex and underutilized component to implement."

Zeber, the site lead co-investigator at the Texas location, says, "We asked how comfortable physicians, for example, would be about counseling patients about gun safety and the danger that a gun in the home may pose. We asked if they'd feel comfortable offering their patients a gun lock, in addition to screening about the presence of a firearm. Each stakeholder group has different perspectives, and doctors understand this, but they also are the ones who see higher risk adolescents in their offices."

He adds, "There was broad consensus about the importance of the conversation and that some intervention would be welcome and helpful in addressing this public health crisis. Reducing access to guns while promoting safe storage was a central theme that emerged. But the details of what that intervention would look like, and what might be feasible to try, remain to be determined. People across the health care spectrum agree it is important to talk about this topic with patients, but what we do next and best approach is still being discussed."

Overall, the authors state that their results "support the development of implementation strategies to support clinician and organizational behaviors around firearm safety." Zeber says their findings will drive an implementation proposal that they are still developing.

New Rochelle, NY, January 7, 2019-An important new article reviews recently discovered properties of adenosine A2A receptor-dopamine D2 receptor (A2AR-D2R) and adenosine A1 receptor-dopamine D1 receptor (A1R-D1R) heteromers--both of which are main targets for caffeine--and discusses the therapeutic implications of these findings. Preclinical evidence is reviewed which indicates that caffeine and selective A2AR antagonists could be used to treat the motivational symptoms of depression as well as cognitive and emotional impairments in attention-deficit/hyperactivity disorder. In addition, new research suggests that the A1R-D1R heteromer, which modulates the excitability of the spinal motoneuron, could be targeted by A1R antagonists to therapeutic effect in spinal cord injury. Caffeine and selective adenosine receptor antagonists as potential new therapeutic tools are discussed in an article published in Journal of Caffeine and Adenosine Research, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. Click here to read the article free on the Journal of Caffeine and Adenosine Research website.

Researchers at the University of Sussex, Imperial College London and Nanyang Technological University in Singapore have for the first time used game theory to enable robots to assist humans in a safe and versatile manner.

The research team used adaptive control and Nash equilibrium game theory to programme a robot that can understand its human user's behaviour in order to better anticipate their movements and respond to them.

The researchers believe the breakthrough could help robots complementing humans for sport training, physical rehabilitation or shared driving.

Lead author Dr Yanan Li, Lecturer in Control Engineering at the University of Sussex, said: "It is still very early days in the development of robots and at present, those that are used in a working capacity are not intuitive enough to work closely and safely with human users. By enabling the robot to identify human users' behaviour and exploiting game theory to let the robot optimally react to them, we have developed a system where robots can work along humans as humans do."

In a paper published today in Nature Machine Intelligence, the researchers outline how they adapted game theory for the physical interaction of a robot with a human, and how this can be used to help an impaired stroke survivor retrain their motor control.

Game theory is commonly used to understand how economic agents decide and interact with each other in order to maximise their own gain. To successfully apply game theory to the interaction of a robot and its human user, the researchers had to overcome the issue that the robot cannot know the human's intentions. The researchers thus had to develop a method enabling the robot to identify the human partner while safely and efficiently interacting with their motion.

The reactive robotic programming system enables a robot to continuously learn the human user's control and adapt its own control correspondingly. The robot is able to understand the human user's action and then respond to and assist them to perform tasks successfully and with minimal effort.

Professor Etienne Burdet, Chair in Human Robotics in the Department of Bioengineering at Imperial College London and senior author of the paper, added: "Game theory has had important impacts in economics during the last century and lead to several Nobel prizes such as Nash's one. To apply it for human-robot interaction, it was necessary to understand how the robot can identify the human user's control goals simultaneously to smoothly interacting with them."

Efficiency of community health centers in China during 2013-2015: A synchronic and diachronic study

In the current issue of Family Medicine and Community Health (Volume 6, Number 4, 2018; DOI: https://doi.org/10.15212/FMCH.2018.0119, Lin Zhao, Yao Zhang, Yabing Hou and Guiming Yan of the Tianjin Medical University, Tianjin, China evaluate of the efficiency of CHCs in China at the national level and regional level from synchronic and diachronic perspectives using data collected from China's Health and Family Planning Statistical Yearbook 2014, China's Health and Family Planning Statistical Yearbook 2015, and China's Health and Family Planning Statistical Yearbook 2016.

FMCH is available on the IngentaConnect platform and at Family Medicine and Community Health. Submissions may be made using ScholarOne Manuscripts. There are no author submission or article processing fees. FMCH is indexed in the ESCI, EBSCO, OCLC, Primo Central (Ex Libris), Scopus, Sherpa Romeo, Ulrichsweb, DOAJ, WPRIM, NISC (National Information Services Corporation) and Index Copernicus Databases. Follow FMCH on Twitter @FMCHJournal; or Facebook.

Factors associated with visit-to-visit variability of blood pressure in hypertensive patients at a Primary Health Care Service, Tabanan, Bali, Indonesia

In the current issue of Family Medicine and Community Health (Volume 6, Number 4, 2018; DOI: https://doi.org/10.15212/FMCH.2018.0124, Gusti Ayu Riska Pertiwi, Anak Agung Ngurah Aryawangsa, I Putu Yuda Prabawa, Ida Bagus Amertha Putra Manuaba, Agha Bhargah, Ni Wayan Sri Ratni, I Putu Gede Budiana of the Faculty of Medicine, Udayana University, Denpasar City, Bali, Indonesia, College of Medicine, Taipei Medical University, Taipei, Taiwan and Department of Cardiovascular Medicine, Mangusada General Hospital, Badung, Bali, Indonesia provide an overview of visit-to-visit variability (VVV) in hypertension blood pressure management in a primary health care service setting. There was a significant relationship between the use of antihypertensive drugs and VVV. This finding illustrates that VVV can be used as an additional factor in considering the target of controlling blood pressure in primary health services, given that hypertension has many complications that can arise if management is not done properly

FMCH is available on the IngentaConnect platform and at Family Medicine and Community Health. Submissions may be made using ScholarOne Manuscripts. There are no author submission or article processing fees. FMCH is indexed in the ESCI, EBSCO, OCLC, Primo Central (Ex Libris), Scopus, Sherpa Romeo, Ulrichsweb, DOAJ, WPRIM, NISC (National Information Services Corporation) and Index Copernicus Databases. Follow FMCH on Twitter @FMCHJournal; or Facebook.

Up to 15 million hectares of tropical rainforest in the Brazilian Amazon could lose protection and be clear-cut because of an article in the country's new Forest Code.

The warning comes from Brazilian researchers at the University of São Paulo's Luiz de Queiroz College of Agriculture (ESALQ-USP) and Swedish researchers at KTH Royal Institute of Technology in Stockholm and Chalmers University of Technology in Gothenburg. They recently published a paper on the subject in Nature Sustainability. The study was derived from a project supported by São Paulo Research Foundation - FAPESP.São Paulo Research Foundation.

"The 15 million hectares that could become deprotected as a result of this rule in the new Forest Code are roughly equivalent to the entire legal reserve deficit that needs to be offset or restored in Brazil, and they consist mainly of tropical rainforest," Gerd Sparovek , a professor at ESALQ-USP and a coauthor of the paper, told.

"Loss of these areas to agriculture could nullify the effort to regularize legal reserves in Brazil and result in huge losses of biodiversity, impair ecosystem services of great value to society, such as water supply, and increase greenhouse gas emissions."

Sparovek explained that until 2012, the Forest Code required private landowners in the Amazon region to set aside 80% of their property with native vegetation intact in what the law terms a "legal reserve".

Now, however, under Article 12 (5), added at Amapá State's request when the Forest Code was amended and updated in 2012, any state in the Amazon region is allowed to reduce the legal reserve requirement from 80% to 50% if conservation units and indigenous reservations account for more than 65% of its territory.

If the article is implemented, between 7 million and 15 million hectares of forest will be deprotected and could be legally cut down, according to the researchers. This computation accounts for the fact that states such as Amazonas, Roraima, Acre, and Amapá consist mostly of primary forest and have some 80 million hectares of undesignated public land.

If conservation units and indigenous reservations are created on this public land, the law will allow private landowners in these states to reduce their legal reserves, opening up large areas for legal logging and agricultural expansion.

"The removal of legal protection doesn't automatically mean these forest areas will be clear-cut, but it's important to pay attention to this in the current political context, which suggests a weakening of deforestation prevention mechanisms," said Flávio Luiz Mazzaro de Freitas, a PhD researcher at KTH Royal Institute of Technology and first author of the paper.

Scenario modeling

To assess the possible impact of a reduction in the legal reserve requirement to protect forest areas equivalent to 50% instead of 80% of public and private lands in the Amazon, the researchers used a georeferenced database for the entire country with land tenure datasets including official statistics for national and state conservation units, indigenous reservations and military land, as well as rural property and settlement databases maintained by the National Land Reform Institute (INCRA) and the Rural Environmental Register (CAR).

Using this georeferenced database, housed in the Euler computer cluster at the Center for Mathematical Sciences Applied to Industry - CeMEAI, one of the Research, Innovation and Dissemination Centers - RIDCs supported by FAPESP, the researchers modeled the implementation of Article 12 (5) of the new Forest Code under two different scenarios for the use of undesignated land in the Amazon.

They termed the first land use scenario conservative in the sense that it assumed a high priority for nature conservation. The second scenario assumed full implementation of the new legal provision and was termed a worst-case scenario from the standpoint of protecting nature.

The researchers quantified the potential reduction in forest protection under these two scenarios. They also assessed the risk of legal conversion of deprotected forest areas into agricultural land using measures of land suitability and market access, as well as the potential impact of such land conversion on carbon emissions and biodiversity.

The results of their analysis suggest that Amapá, Roraima and Amazonas States would qualify for a reduction in private property legal reserves as per Article 12 (5) under both scenarios.

Under the conservative scenario, conservation units or indigenous reservations would be created on 97% of the undesignated land in Amazonas and Amapá. Under this scenario, the new article of the Forest Code would remove protection from 6.5?million hectares (ha) of preserved forest - 4.6?m ha in Amazonas, 1.4?m ha in Roraima and 0.5?m ha in Amapá.

The authors note that the more land is allocated to conservation units and indigenous reservations, the greater the aggregate protected area, but when the 65% threshold is reached and article 12 (5) is triggered, the aggregate deprotected area more than doubles.

The researchers also estimated that under the conservative scenario, approximately half the area deprived of forest protection, or 3.14?m ha, would be in registered private properties, while approximately 1.9?m ha would be in land reform settlements and 0.6?m ha in untitled properties that would probably qualify for the ongoing land regularization program.

Under the worst-case scenario, most of the reduction would take place in currently undesignated areas, where newly titled properties would be allowed to reduce legal reserves by more than 8?m ha.

"The creation of conservation units and/or indigenous reservations in these states may have the side effect of increasing the likelihood of more deforestation. That's schizophrenic," Sparovek said.

The researchers suggested that legal measures taken by state governments in the context of the Environmental Regularization Program (PRA) could mitigate the risk of extensive deforestation.

Economic incentives may also help, given the strong global tendency to urge consumers not to buy products that originate in deforestation zones. Brazil's agricultural exports could be severely affected if deforestation increases in the Amazon region, they stressed.

"By drawing attention to the possibility of an increase in legal deforestation in the Amazon, we hope our research findings will contribute to the development of public and private actions and strategies designed to mitigate potential environmental and social damage from this process," Freitas said.

After collecting data and comparing it with every known mammal and bird species on Earth, scientists from the University of California, Davis, have identified wildlife species that are the most likely to host flaviviruses such as Zika, West Nile, dengue and yellow fever. Flaviviruses are known to cause major epidemics and widespread illness and death throughout the world.

The resulting "hot spot" maps show regions of the world with high diversity of potential wildlife hosts of flaviviruses -- viruses mostly spread by mosquitoes and ticks. These include regions where flaviviruses have not been detected but that have wildlife species with the potential to harbor them.

The information provides scientists and health authorities with a road map for disease detection and surveillance efforts.

"Tomorrow, if there's an outbreak anywhere in the world, we now know which wildlife species are most likely to be infected in addition to humans," said lead author Pranav Pandit, a postdoctoral scholar with the UC Davis One Health Institute's EpiCenter for Disease Dynamics in the School of Veterinary Medicine.

PREDICTING POTENTIAL HOSTS

The findings are reported in a recent study published in the journal Nature Communications.

Recently Zika virus emerged and continues to circulate in South America and Southeast Asia. The study predicts potential wildlife hosts in these regions with the ability to maintain Zika virus transmission in nature.

There is also rising concern that Japanese encephalitis virus will emerge and establish in Europe. The study identifies Europe as one of the regions with a high richness of potential Japanese encephalitis hosts, including many common bird species.

For the study, researchers collected all the published data on wildlife species that have tested positive for flaviviruses. They identified important host traits, such as environmental and physiological features. Then they used a machine-learning model that considered the roughly 10,400 avian and 5,400 mammal species in order to identify the most likely species to host viruses.

The model predicted hundreds of previously unobserved host species. For example, it predicted 173 host species for dengue virus, of which 139 have not been previously recognized.

HELPING HUMANS AND OTHER PRIMATES

Co-leading author and UC Davis professor Christine Kreuder Johnson said the modeling work can help researchers identify which primate species could be potential virus hosts. For example, the model indicated that primates are the main hosts of Zika and yellow fever, but only nine of the 21 primate species predicted to be hosts have been detected with either of those viruses due to limited surveillance activities among these species to date.

UC Davis One Health Institute scientists have established noninvasive sampling techniques for primates, such as collecting saliva from sticks and plants chewed by primates or from ropes coated with strawberry jam. But flaviviruses can be difficult to detect, especially in wildlife.

"We needed this modeling technique to help us understand the most likely hosts for these viruses in their natural habitat," said Johnson, director of the EpiCenter for Disease Dynamics. "That's important for both global health and wildlife conservation. Many of these primates are already endangered, and these diseases burden an already strained population."

TORONTO, JANUARY 4, 2019 - A new multi-site brain imaging study in The American Journal of Psychiatry shows that sub-groups of people use their brains differently when imitating emotional faces - a task that reflects their ability to interact socially. Interestingly, individuals with schizophrenia do not have categorically different social brain function than those without mental illness, but fall into different sub-groups that may respond to different types of treatments. These findings call into question the most common research approaches in mental health.

"We know that, on average, people with schizophrenia have more social impairment than people in the general population," says senior author Dr. Aristotle Voineskos in the Campbell Family Mental Health Research Institute at the Centre for Addiction and Mental Health (CAMH) in Toronto. "But we needed to take an agnostic approach and let the data tell us what the brain-behavioural profiles of our study participants looked like. It turned out that the relationship between brain function and social behaviour had nothing to do with conventional diagnostic categories in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders)."

Most brain research in the mental health field compares a disease group to a non-disease or "healthy" group to search for biomarkers, a biological measure of mental health symptoms. This search for biomarkers has been elusive. This multi-site research study - which included 179 participants recruited at CAMH in Toronto, Zucker Hillside Hospital in New York and the Maryland Psychiatric Research Center in Baltimore - calls that paradigm into question because people with the same mental illness may not show the same biological patterns.

The study, which involved participants completing a facial imitation task while undergoing functional MRI brain scans, found three "activation profiles," says first author Dr. Colin Hawco, also of CAMH. These can be described as typical, over-activated and de-activated profiles.

"We think those with over-activated networks may be 'inefficient' in terms of brain activity - they probably struggled more and needed to work harder to do the same task compared to the other groups," says Dr. Hawco. "The 'de-activating' group seemed to show very efficient use of their brain, and did better on behavioural tests of social processing as well." These findings were true for participants with and without schizophrenia.

"There is really no effective treatment to deal with these social impairments, which is why we're really invested in figuring out the brain networks of social behaviours as targets for treatment and research," says Dr. Anil Malhotra, Director of Research at the Zucker Hillside Hospital. "We are now positioned to test treatments to help change brain function, rather than focusing on symptoms alone, when it comes to helping people with social impairment."

People with social impairments may not be able to react as expected to emotions they see in others, such as fear, sadness or happiness. "As social impairments become more severe, people are more likely to be isolated, unable to function in daily life, and have a marked reduction in their quality of life," says Dr. Robert Buchanan, Director of the Maryland Psychiatric Research Center, a psychiatrist and researcher who has been working to find new treatments to improve social function over the past three decades.

The findings were bolstered by an independent replication sample of 108 participants, which showed the same brain function findings as in the original sample.

Writing in the January 3 issue of Cancer Cell, researchers at University of California San Diego School of Medicine report that detection of "copy editing" by a stem cell enzyme called ADAR1, which is active in more than 20 tumor types, may provide a kind of molecular radar for early detection of malignancies and represent a new therapeutic target for preventing cancer cell resistance to chemotherapy and radiation.

Adenosine deaminases are a family of three enzymes encoded by the ADAR genes, which stand for adenosine deaminase acting on RNA. They regulate gene expression by modifying nucleotides within double stranded RNA molecules, serving as fundamental editors in the development of new stem cells.

The enzyme, however, is also activated in cancers as diverse as liver, breast and leukemia. A research team led by senior author Catriona Jamieson, MD, PhD, deputy director of the Sanford Stem Cell Clinical Center and deputy director of the UC San Diego Moores Cancer Center, found that the normal functions of the ADAR1 enzyme are hijacked by pre-malignant cells, leading to a cascade of molecular consequences that promote malignant transformation, dormant cancer stem cell generation and resistance to treatment.

"We were able to illuminate the abilities of ADAR1 to 'hyper-mutate' tumor suppressor RNAs in leukemia and, at the same time, edit the microRNA aimed at targeting the tumor suppressor RNA. This enzyme turns on cancer resistance via a domino effect on RNA instead of DNA," said first author Qingfei Jiang, PhD, assistant project scientist in Jamieson's lab.

Jamieson characterized RNA editing as tweaking basic genetic blueprints, not fundamentally rewriting them. Nonetheless, the results might be dramatic. "One result of detection of malignant RNA editing could be exposing dormant cancer stem cells that often escape therapies that target dividing cells, which leads to therapeutic resistance and disease relapse, and also highlight ADAR as a potentially tractable target for cancer stem cell elimination," said Jamieson.

Trauma is a leading cause of disability in the world, resulting in more disability-adjusted life years than any other disease. While in-hospital, trauma-related mortality has decreased to just 4 percent in the U.S., little is known about what happens to the 96 percent of patients who survive their trauma injuries but may suffer debilitating long-term effects. Through the Functional Outcomes and Recovery after Trauma Emergencies (FORTE) project, Brigham and Women's Hospital researchers followed 1,736 trauma patients over 30 months to determine the long-term functional, physical, and mental health consequences of trauma and the factors associated with them. The FORTE project's findings show that long-term sequelae of trauma exceed previous expectations and identified that patient sociodemographic factors such as female gender and low education were associated with worse recovery. This suggests that social support systems are an essential component of recovery. The findings appeared in Annals of Surgery.

"For more than two decades, trauma surgeons and patients have been hoping to change trauma care to be more responsive to long-term outcomes. This study shows that with just incremental effort we can fundamentally change how we assess trauma outcomes, enabling a paradigm shift that will benefit our patients and trauma systems," said Adil Haider MD, MPH, a trauma surgeon and Kessler Director of the Center for Surgery and Public Health at Brigham and Women's Hospital, and first author of the study.

The FORTE project began in response to the lack of comprehensive evaluations of long-term trauma outcomes in the United States, since most trauma outcome studies rely on trauma registry data, which only captures in-hospital outcomes. Recognizing the gap in trauma surveillance and quality improvement, the National Academies of Sciences, Engineering, and Medicine (NASEM) recommended the development of measures related to quality of trauma care and long-term outcomes in their June 2016 report, "A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury." The FORTE project evaluated the feasibility of a standardized approach for collecting long-term patient-reported outcomes (PROs) after trauma in the U.S., starting with three Level 1 trauma centers: Brigham and Women's Hospital (December 2015), Massachusetts General Hospital (June 2016), and Boston Medical Center (June 2016). Since initiation of data collection, adult trauma survivors admitted to the participating institutions with moderate or severe injuries (Injury Severity Score (ISS) ? 9) were routinely contacted between 6-12 months after injury. With a cooperation rate of 65 percent (1,736 out of 2,691), interviews were conducted via telephone by a trained member of the research team using a structured telephone survey in English or Spanish. Using institutional trauma registries, patient data was linked to patient-report outcome measures, including work status, quality of life (emotional well-being, recovery and resilience, physical well-being, and functional engagement), physical and mental health, and post-traumatic stress disorder (PTSD).

The multi-center study found that nearly half of the patients (48 percent) reported physical limitations and daily pain. Over one-third (37 percent) needed help for at least one activity of daily living due to the traumatic injury, and 20 percent screened positive for PTSD. Of those patients who were employed prior to injury, 40 percent had not returned to work at the time of follow-up. Quality-of-life measures such as general health, physical and social functioning, and bodily pain were also significantly below U.S. norms.

Diverging from previous research on short-term outcomes, specific patient sociodemographic factors such as gender and education, in addition to a number of comorbidities and length of hospital stay, had more impact in predicting long-term outcomes than injury severity. While some studies have shown that females have better short-term trauma outcomes, this study found the female gender was an important predictor of decreased long-term functionality and physical health. Although it is well known that education plays a significant role in all health outcomes, this is the first study to show that the relationship extends to long-term functional, physical, and mental health outcomes after trauma. Level of education, the most predictive variable of long-term outcomes, is not currently captured in trauma registries. Traditional injury severity markers were created to predict mortality and appear to be less effective in predicting long-term trauma outcomes, failing to capture key elements that influence recovery.

"The FORTE study offers a new and revealing window into the outcomes of trauma patients. Often focused in short-term gains, physicians ignore the long-lasting impact that sudden injury and its treatment has on our patients' lives. Through FORTE, we will be able to understand more and treat better," said George Velmahos, MD, PhD, Division Chief of Trauma, Emergency Surgery and Surgical Critical Care at Massachusetts General Hospital and author on the study.

The unexpected severity of the long-term consequences of traumatic injury makes it critical to better understand the link between long-term outcomes, its predictors, and the types of specific trauma services and processes that could be used for interventions. The researchers encourage the collection of long-term trauma outcomes with the goal of standardizing them as the American College of Surgeons did with in-hospital outcomes through the creation of the National Trauma Data Standard.

Research from King's College London finds smokers and ex-smokers in the UK overestimate the harm from vaping, with fewer than 6 out of 10 accurately believing that e-cigarettes are less harmful than tobacco cigarettes. Misperceptions appear to be on the increase and are particularly strong in smokers and those who have never tried vaping.

The Cancer Research UK-funded study, published today in the journal Addiction, used an online Ipsos Mori survey of 1720 UK smokers and ex-smokers to assess knowledge about nicotine and perceptions of the relative harms of smoking, e-cigarettes and nicotine replacement therapy (NRT).

Lead researcher Dr Leonie Brose, from the Institute of Psychiatry, Psychology & Neuroscience, said 'Tobacco cigarettes kill over half of those who smoke long-term, yet very few people know that nicotine is not the direct cause of smoking-related death and disease. We found those people who think nicotine is to blame for harms from smoking are more likely to think e-cigarettes and NRT are just as bad as smoking.'

When asked about the relative harms of e-cigarettes and tobacco cigarettes only 57.3% correctly said vaping was less harmful than smoking, while 21.8% said equally harmful, 3.3% said more harmful and 17.6% didn't know. For NRT, 63.4% said it was less harmful than smoking.

Previous research from the same team suggests the proportion of people with accurate knowledge is dropping: in 2012, 66.6% said vaping was less dangerous than smoking, with 60.4% in 2014 and 57.3% in 2017. At the same time, the proportion of people who think smoking and vaping are equally harmful is rising, from 9% in 2012 to 16.9% in 2014 and 21.8% in 2017.

While efforts were made to make sure participants represented different demographics, the authors note that the results may not fully represent the general smoking population.

Knowledge about nicotine was particularly poor, with nearly nine out of ten misattributing a greater portion of the risk in smoking to nicotine, and nearly four out of ten wrongly believing nicotine is what causes cancer from smoking.

Smokers who have never vaped were more likely to have misperceptions about nicotine and the relative harm of e-cigarettes and NRT compared with tobacco cigarettes. On the other hand, smokers who had tried vaping or were regular vapers were more likely to say that a very small portion of the health risk in cigarettes comes from nicotine.

Dr Brose said: 'It is possible that smokers may not try e-cigarettes or NRT due to inaccurate beliefs about nicotine and vaping. A lot of public discussion and media reporting focuses on harms from vaping, but we rarely see any reports on how deadly smoking is - 1500 people die from smoking-related illness every week in England alone. Correcting misperceptions around nicotine may help smokers move towards less harmful nicotine delivery methods.'

Previous research by the same team found that smokers who perceived vaping to be less harmful than smoking were more likely to try e-cigarettes. The researchers are planning a study to see if it is possible to change smokers' behaviour by correcting their misperceptions about nicotine, smoking and vaping.

Professor Linda Bauld, Cancer Research UK's prevention expert, said: 'While nicotine is addictive, it's the cocktail of 5000 different chemicals released during smoking that damages our DNA and can cause cancer. Nicotine products have been proven to help smokers quit and they're most effective when combined with behavioural support from Stop Smoking Services. It's vital that smokers aiming to quit have accurate information to help them find the best way to stop.'

Responding to the new study, Martin Dockrell, Tobacco Control Lead at Public Health England, said: 'There is still work to do to reassure smokers that vaping, while not risk free, is much less harmful than smoking. If you smoke, switching to an e-cigarette could save your life.'

If teen partner rape could be predicted, it could be better prevented. Social scientists from Michigan State University are helping close that gap by identifying risk factors linked to sexual violence in young women's first relationships in life.

"There's this idea that sexual violence doesn't happen in relationships - certainly not in young women's first relationships - which is absolutely not the case," said Angie Kennedy, associate professor of social work and lead author. "We wanted to examine the most severe forms of sexual violence - rape and attempted rape - to better understand the specific risk factors linked to partner rape among young women. Our results can be used to inform prevention and intervention efforts aimed at reducing sexual violence among young people."

Kennedy and colleagues interviewed 148 college-aged women between the ages of 18 and 24 who experienced partner violence in at least one prior relationship. To get a diverse sample, the researchers recruited participants from a university, a two-year college and community sites serving low-income young women, including a county health clinic and a transitional living program.

In the interviews, the researchers asked the young women to talk about all of their partner relationships, starting with their first relationship, which began when they were around 15 years old on average.

The results, published in the Journal of Interpersonal Violence, showed consistent risk factors for partner rape across the three groups of women. During their first relationships, lower socioeconomic status, being of a younger age, and higher levels of physical abuse and coercive control predicted sexual violence. Key risk factors across all of the young women's relationships include a greater age difference between them and their partners, as well as physical abuse and coercive control.

"Rape or attempted rape in a relationship isn't typically an isolated incident. It's usually connected with other forms of abuse or coercion," Kennedy said. "Young age and higher age difference between adolescent girls and their male partners may make them more vulnerable to experiencing abuse, particularly partner rape."

The researchers also found differences in the rate of sexual violence across the three groups.

While young women from the university group had a higher rate of partner rape in their first relationship, their rate dropped significantly over the course of all of their relationships in comparison to the two-year college students, who experienced an increase in partner rape over the course of their relationships. These results suggest that experiences with partner abuse, much like the three groups of young women, are diverse.

"We shouldn't assume that young women are all alike in terms of what they go through, or that experiences are consistent across all relationships. For prevention and intervention efforts to work, we will need to take this diversity into account," Kennedy said.

Past studies tended to focus on sexual assault as it relates to college campuses. Kennedy's research, however, focuses on young women's first relationships as well as all of their relationships over the course of adolescence and emerging adulthood; it's also the first to compare these different groups in terms of their experiences with partner abuse.

"Most college-aged sexual assault research focuses on residential colleges and universities where there is dorm life, drinking on campus and co-ed living," Kennedy said. "But there are more than 5 million students enrolled at two-year community colleges in the United States and even more who don't pursue a higher ed degree. We need to get beyond four-year institutions and learn more about these other groups' experiences with partner abuse."

The researchers' next steps include examining young women's disclosure of physical and sexual partner abuse, as well as the role of labeling and stigma in shaping mental health outcomes associated with abuse.

A natural antioxidant found in grain bran could preserve food longer and replace synthetic antioxidants currently used by the food industry, according to researchers at Penn State.

"Currently, there's a big push within the food industry to replace synthetic ingredients with natural alternatives, and this is being driven by consumers," said Andrew S. Elder, doctoral candidate in food science. "Consumers want clean labels -- they want synthetic chemical-sounding ingredients removed because of the fact that they don't recognize them, and that some of them (the ingredients) have purported toxicity."

The Penn State researchers studied a class of compounds called alkylresorcinols (AR). Plants such as wheat, rye and barley produce ARs naturally to prevent mold, bacteria and other organisms from growing on the grain kernels. The researchers wondered if ARs could also preserve food in the same way from a chemical standpoint.

Along with using more natural ingredients, the food industry is also supplementing more foods with healthy oils rich in omega-3 fatty acids. Adding these healthy oils to foods that normally would not contain them could boost the health benefits of these foods to consumers. However, omega-3 rich oils have a shorter shelf life, which could cause these foods to spoil more rapidly.

"Most people consume omega-3s from marine sources," said Elder. "As they break down, they can make the product smell and taste fishy. Consumers then throw these products out and don't buy them again, and this results in an economic loss."

Antioxidants are compounds that slow the rate at which omega-3 fatty acids degrade, preserving their health benefits and preventing food from spoiling as quickly. While consumers demand more natural ingredients, the food industry has struggled to find natural antioxidants that are as effective as synthetic ones.

"There are not many natural alternatives for synthetic antioxidants," said Elder. "Our work is focused on identifying new natural antioxidants to extend the shelf life of food and meet consumer demands."

ARs have health benefits for humans as well and can help protect against cancer, according to a review published in European Food Research and Technology, making them ideal natural additives. ARs also come from the bran layer of cereal plants, which the food industry usually discards or uses for animal feed.

"Bran is often a waste stream," said Elder. "We're taking something that's usually discarded in a waste stream and turning it into something useful."

The team developed a technique to extract and purify ARs from rye bran, then studied how well ARs were able to preserve omega-3-rich oils in emulsions, where two fluids do not fully mix -- for example, vinegar and oil. The researchers chose to study AR action in emulsions because most people consume oils as emulsions, such as salad dressings. The researchers reported their findings online in Food Chemistry, and the study will be published in the January print edition.

The researchers found that ARs did act as antioxidants in an emulsion, preventing omega-3 oils from spoiling as rapidly as they did in emulsions with no antioxidants added. Then, they compared ARs to two antioxidants widely used by the food industry -- alpha-tocopherol or Vitamin E, a natural antioxidant; and butylated hydroxytoluene, a synthetic antioxidant. However, ARs were not as effective as either the natural or the synthetic antioxidant.

Although the ARs did not work as well as other antioxidants in this round of experiments, the researchers noted that their AR extracts were not completely pure, which could have reduced the effectiveness of the ARs. Also, the researchers used a blend of different ARs that had different molecular structures. Future work looking at different types of ARs will reveal whether an individual AR type is more or less effective than conventionally-used antioxidants.

"We're trying to identify natural antioxidants that are consumer-friendly, safe and effective," said Elder. "We hope that one day this work will lead to ARs being available on the market and provide more options for the food industry to use."

Cells along the brain's cavities are equipped with tiny hair-like protrusions called cilia. Cilia are still poorly understood, but we know a few things about what can happen if they are not doing their job.

People with ciliary defects can develop neurological conditions like hydrocephalus and scoliosis.

New research from the Yaksi group at Kavli Institute for Systems Neuroscience at the Norwegian University of Science and Technology (NTNU) shows that cilia are essential for the brain to develop normally.

An article just published in Current Biology gives us more insight into how cilia work and why they are so important to our brains.

The human brain has four fluid-filled cavities called ventricles, all of which are interconnected. The ventricles are filled with cerebrospinal fluid, which is also produced here. The cerebrospinal fluid is in constant motion, but the movement varies depending on what we are doing.

"Several theories exist, but for many years this circulation of fluid has been recognized as supplying nutrients to the brain, while also removing waste products," says senior researcher Nathalie Jurisch-Yaksi at NTNU's Kavli Institute.

"The cerebrospinal fluid flow also contributes to transmitting molecular signals across the brain," says Emre Yaksi, a professor at the Kavli Institute.

It would not be possible to conduct this kind of research on humans, due to ethical and practical reasons. Hence, the research group has chosen to do their research on zebrafish larvae.

Zebrafish larvae are ideal for this type of research. They are vertebrates just like humans, and can often tell us something about how the human brain develops and works.

On a practical note, zebrafish are transparent during their larval stage. This means that it is possible to investigate the brain development and functioning of zebrafish in astonishing detail, without any intervention and without causing them any pain.

"We could even investigate each individual cell and cilia," says PhD candidate and co-author Christa Ringers.

The Yaksi group researchers found that groups of cells with cilia are organized in different zones of the ventricles, which together create a stable, directional flow of the fluid.

Heartbeat pulsations and body movements also affect the circulation of cerebrospinal fluid, but the movements of the cilia appear to provide a stable fluid flow within individual ventricles.

This flow is local, so it is largely limited to each of the ventricles. But at the same time it seems that the compartmentalized flow is necessary to keep the ducts between the different cavities open.

"If we stop the cilia's motion, the ducts close," says Jurisch-Yaksi.

The fluid flow in each ventricle and the exchange of fluid between the different ventricles depend on whether we are at rest or moving.

"We found surprisingly little exchange of fluid between the ventricles as long as the fish were at rest, even though the heartbeat pulsations caused some flow between them," says PhD candidate Emilie Willoch Olstad, who is the first author of the article in Current Biology.

But all this changes when we move. Locomotion leads to a great degree of fluid exchange between the different ventricles.

Cilia fall into one of two main groups, motile or non-motile, also called primary cilia. The Yaksi groups examined motile cilia.

Unlike most other cilia in the human body that contribute to the transfer of fluids - such as the brush-like respiratory cilia that protect the lung - the Kavli researchers found that the cilia along the brain ventricles of the developing zebrafish brain have a propeller-like motion, much like the tail of sperm.

The cilia may also indirectly contribute to keeping the brain young and healthy.

New nerve cells are born near the wall of the fluid-filled brain ventricles. From here, they migrate to different areas of the brain.

The differentiation of these new born cells was suggested to be influenced by nutrients and molecular signals that are distributed by the flow of the cerebrospinal fluid near the ventricular walls.

In zebrafish, the birth of new neurons, also called neurogenesis, happens not only in the developing brain, but also in adult fish. Recent studies revealed that this kind of adult neurogenesis also happens in humans.

Studying the dynamic movements of fluids is extremely complicated and requires a multidisciplinary approach. Mathematicians, engineers and physicists are among those who can help understand how cilia movement occurs and generates flow.

The Yaksi group at the Kavli Institute is eager to collaborate with engineers who can help develop better analytical tools and computer models to study fluid circulation in the brain. They are actively looking for people and collaborators with the right skills.

And their research is far from over. The next step is to see if it is possible to influence the brain functioning of the zebrafish by manipulating the cilia and vice versa.

For example, how would the neural activity, or even circadian rhythms, change when cilia mediated flow is perturbed? The zebrafish are usually far more active during the day than at night. Would altering the cerebrospinal fluid flow change the way fish perceive and respond to their environment during different times of the day?

These are the next questions the researchers plan to address.

"What we're looking at is evolution at a structural level. A receptor with a toadstool structure that stems from way back and the common ancestors of insects and humans..."

A receptor that is a 'recipient' for the absorption of vitamin B12 is what he is talking about here - Associate Professor, PhD Christian Brix Folsted Andersen from the Department of Biomedicine at Aarhus University in Denmark. Vitamin B12 is the vitamin that we - even with a healthy diet - most often lack which in turn can lead to serious anaemic diseases and symptoms from the central nervous system.

Working together with his research group, Christian Brix Folsted Andersen has now described the body's largest cell receptor: A mysterious prehistoric construction that 'back in the day' was created by the meeting of two proteins and which - for reasons we do not yet understand - is preserved in what is in molecular terms a colossal structure that has never been seen before. In the 1960s, the female scientist Dorothy Hodgkin received the Nobel Prize for her scientific breakthrough in determining the structure of the B12 vitamin. Now we are also aware of the more than one thousand times larger receptor structure which the B12 vitamin is completely dependent on and which enables it to be absorbed in the body.

The research results which have recently been published in the scientific journal Nature Communications, shed fundamental light on the issue of why people in some cases have problems with vitamin B12 absorption and lose nutrients in the kidneys.

"With the help of x-ray crystallography, we've succeeded in determining how the receptor is able to organise itself in a previously unknown way in human biology. With this new knowledge we're finally able to explain why thousands of people around the world with specific genetic changes are unable to absorb the vitamin," explains Christian Brix Folsted Andersen over the phone from the University of Washington in USA.

"But in my mind, the most interesting aspect is that with the help of advanced electron microscopy, which I'm learning about in detail here in Seattle, we have been able to see how the receptor as a whole looks and thus also see how the receptor absorbs the B12 vitamin in the intestines and various other substances in the kidneys. It's fantastic to have the opportunity to see this as the first person ever," he says.

Christian Brix Folsted Andersen points out that in an evolutionary context, there is something very mysterious about the receptor as it does not resemble anything seen previously.

"At the same time, by comparing genes we can see that the receptor has the same structure as we find in insects and that it must have been evolved very early in evolution - many millions of years ago and thus long before the origin of mammals," he says.

Christian Brix Folsted Andersen's research is a continuation of his long-standing work together with Søren K. Moestrup into B12 transport. In 2010, this research led to new and pivotal knowledge about how the receptor specifically recognises B12 in the small intestine.

"The research we're carrying out today is a continuation of decades of research into the vitamin B12. Indeed, twenty-five years ago we had no idea about what was going on the shadowy recesses of the intestines. Now the lights have been turned on and we can see how it all works in a way that none of us could have imagined," says Søren K. Moestrup.

"Apart from obviously being very satisfying from a scientific viewpoint, it also opens completely new perspectives for medical treatment. For example, we now have in-depth knowledge about a receptor that could evidently be used to transport drugs into the kidneys and intestines," he says.