Culture

Young athletes with shoulder instability are considered to be a high-risk group of patients following arthroscopic shoulder stabilization given the high recurrence rates and lower rates of return to sport, which have been reported in the literature. However, according to researchers presenting their work today at the American Orthopaedic Society for Sports Medicine's (AOSSM) Annual Meeting in San Diego outcomes may be improved by proper patient selection and reserving arthroscopic stabilization for athletes with fewer incidents of pre-operative instability.

The senior author of this study, Frank A. Cordasco, MD, MS and his colleagues from the Hospital for Special Surgery in New York City presented a series of patients with shoulder instability between the ages of 14 and 20 who were treated with arthroscopic anterior stabilization performed in the beach chair position by a single surgeon. The primary outcomes were the rates of revision surgery and return to sport at a minimum follow-up of 2 years. Sixty-seven athletes were included in the study with 19 females and 48 males who averaged 17 years of age. There was a low rate of revision surgery of 6% and 82% percent of the athletes returned to sport at an average of 7 months following surgery.

"Our study highlights the importance for young athletes with shoulder instability, undergoing a thorough preoperative evaluation to determine the number of instability events and to obtain appropriate advanced imaging when significant bone loss is suspected. Each pre-operative instability episode can result in greater degrees of bone loss, which results in higher failure rates following arthroscopic shoulder stabilization. This pre-operative approach can determine the best procedure to select from the menu of operations we use to manage shoulder instability," said Cordasco. "This menu includes arthroscopic stabilization, open stabilization and bone augmentation such as the Latarjet reconstruction. Providing the young athlete with the appropriate selection from the menu will to lead to the best outcomes in this high-risk group and will allow them to predictably and reproducibly get back in the game.

Forty-two of the 67 (63%) athletes in this study were indicated for surgery after their first dislocation and only a few had more than two instability episodes. "We found a gender-specific difference in that all of the six recurrences occurred in males. This study demonstrates that when the high-risk young athlete with fewer episodes of pre-operative instability is treated with an arthroscopic stabilization, the revision surgery rate is low and the return to sport rate is high. Arthroscopic shoulder stabilization may offer the best outcomes in this group when it is performed after the first dislocation. Additional research needs to be performed to continue to improve the outcomes for this challenging group of young, active high-risk athletes," said Cordasco.

Artificial intelligence (AI) holds real potential for improving both the speed and accuracy of medical diagnostics. But before clinicians can harness the power of AI to identify conditions in images such as X-rays, they have to 'teach' the algorithms what to look for.

Identifying rare pathologies in medical images has presented a persistent challenge for researchers, because of the scarcity of images that can be used to train AI systems in a supervised learning setting.

Professor Shahrokh Valaee and his team have designed a new approach: using machine learning to create computer generated X-rays to augment AI training sets.

"In a sense, we are using machine learning to do machine learning," says Valaee, a professor in The Edward S. Rogers Sr. Department of Electrical & Computer Engineering (ECE) at the University of Toronto. "We are creating simulated X-rays that reflect certain rare conditions so that we can combine them with real X-rays to have a sufficiently large database to train the neural networks to identify these conditions in other X-rays."

Valaee is a member of the Machine Intelligence in Medicine Lab (MIMLab), a group of physicians, scientists and engineering researchers who are combining their expertise in image processing, artificial intelligence and medicine to solve medical challenges. "AI has the potential to help in a myriad of ways in the field of medicine," says Valaee. "But to do this we need a lot of data -- the thousands of labelled images we need to make these systems work just don't exist for some rare conditions."

To create these artificial X-rays, the team uses an AI technique called a deep convolutional generative adversarial network (DCGAN) to generate and continually improve the simulated images. GANs are a type of algorithm made up of two networks: one that generates the images and the other that tries to discriminate synthetic images from real images. The two networks are trained to the point that the discriminator cannot differentiate real images from synthesized ones. Once a sufficient number of artificial X-rays are created, they are combined with real X-rays to train a deep convolutional neural network, which then classifies the images as either normal or identifies a number of conditions.

"We've been able to show that artificial data generated by a deep convolutional GANs can be used to augment real datasets," says Valaee. "This provides a greater quantity of data for training and improves the performance of these systems in identifying rare conditions."

The MIMLab compared the accuracy of their augmented dataset to the original dataset when fed through their AI system and found that classification accuracy improved by 20 per cent for common conditions. For some rare conditions, accuracy improved up to about 40 per cent -- and because the synthesized X-rays are not from real individuals the dataset can be readily available to researchers outside the hospital premises without violating privacy concerns.

"It's exciting because we've been able to overcome a hurdle in applying artificial intelligence to medicine by showing that these augmented datasets help to improve classification accuracy," says Valaee. "Deep learning only works if the volume of training data is large enough and this is one way to ensure we have neural networks that can classify images with high precision."

Our bodies consist of many different kinds of cells, each with their own role. The Japanese scientist Shinya Yamanaka had made earlier the discovery, earning the Nobel Prize in 2012, that cells from adult skin can be converted to cells typical of early embryos, so-called induced pluripotent stem cells (iPSC). This process is called reprogramming.

Up till now, reprogramming has only been possible by introducing the critical genes for the conversion, called Yamanaka factors, artificially into skin cells where they are not normally active at all.

Professor Timo Otonkoski at the University of Helsinki and Professor Juha Kere at Karolinska Institutet and King's College London, with their teams of researchers, have now for the first time succeeded in converting skin cells into pluripotent stem cells by activating the cell's own genes. This was achieved by using gene editing technology - called CRISPRa - that can be directed to activate genes. The method utilizes a blunted version of the Cas9 'gene scissors' that does not cut DNA and can therefore be used to activate gene expression without mutating the genome.

"CRISPR/Cas9 can be used to activate genes. This is an attractive possibility for cellular reprogramming because multiple genes can be targeted at the same time. Reprogramming based on activation of endogenous genes rather than overexpression of transgenes is also theoretically a more physiological way of controlling cell fate and may result in more normal cells. In this study, we show that it is possible to engineer a CRISPR activator system that allows robust reprogramming of iPSC", tells Professor Otonkoski.

An important key for the success was also activating a critical genetic element that was earlier found to regulate the earliest steps of human embryo development after fertilization. "Using this technology, pluripotent stem cells were obtained that resembled very closely typical early embryonal cells", Professor Kere says.

The discovery also suggests that it might be possible to improve many other reprogramming tasks by addressing genetic elements typical of the intended target cell type.

"The technology may find practical use in bio banking and many other tissue technology applications", says PhD student, MSc Jere Weltner, the first author of the article published in Nature Communications. "In addition, the study opens up new insights into the mechanisms controlling early embryonic gene activation."

New research reveals that people are more likely to change jobs when they are younger and well educated, though not necessarily because they are more open to a new experience.

A team from ETH Zurich in Switzerland and the University of East Anglia (UEA) in the UK analysed and compared the effects of individual characteristics and the economic context on career mobility.

The researchers investigated what is more important for people to change their job - the current unemployment rate, their personal openness to new experiences, their age at the time of the job change, or their level of education.

They found that both individual characteristics and the labour market are factors in career mobility. The results, published in the European Journal of Work and Organizational Psychology, show that people were more likely to change their organisations, industries, and occupations when they were younger, with the age effect being strongest.

Contrary to the researchers' initial prediction, people's openness to new experiences did not play a role in them wanting to change their jobs. However, higher levels of education and a lower unemployment rate were related to changing organisation, but unrelated to going into another occupation.

The results also showed that a good education was more important for employees to change into another industry than a positive situation in the labour market.

In recent decades, employees' careers have changed significantly, with long-term employment with one organisation no longer the default career path.

Career mobility has important implications for organisations, for example in terms of their strategic HR management and their success in attracting and retaining talented staff. For employees, every successful job change potentially increases employability and future opportunities for advancing their career.

Study co-author Dr Dana Unger, a lecturer in organisational behaviour in UEA's Norwich Business School, said: "Whether individuals make a career transition depends undoubtedly on a range of factors. Our findings have immediate practical implications by improving our understanding of opportunities and hindrances for different kinds of career mobility.

"Employees who aim to advance their careers by crossing organisational, industrial, or occupational boundaries may gain helpful insights about factors involved in these distinct types of mobility. For example, they might want to align the timing of their career advances with fluctuations in the labour market.

"For organisations, our results highlight the relevance of investing resources in career management programmes for employee retention. Investments in employees' career opportunities might especially pay off in times of a favourable external labour market, when staff have many external options.

"Career counsellors could also use the insights about the relevance of different predictors of career mobility to help their clients successfully plan career moves."

The researchers looked at different types of job changes to determine whether people are changing organisations, the industries they are working in, or even occupations. They surveyed 503 management programme alumni about their career histories dating back up to 44 years, level of education, and openness to new experiences.

They also investigated the effect of yearly changes in the unemployment rate on mobility to address the economic context in which careers unfold.

SAN DIEGO, CA - For patients with rotator cuff tears, improving shoulder function is the most important reason for moving forward with surgical repair, according to research presented today at the American Orthopaedic Society for Sports Medicine's Annual Meeting in San Diego. Researchers also found that through arthroscopic rotator cuff repair (ARCR), these patients consistently saw significant functional improvements and relief from pain.

"Among the many reasons patients in our study chose surgery, 81% reported a desired return to normal shoulder function," noted lead author Danielle Weekes, MD, from the Rothman Institute in Egg Harbor Township, NJ. "At six months post-operation, American Shoulder and Elbow Society (ASES) Scores in the group improved overall from 42.6 to 77, showing the patients' objectives were met."

The study enrolled 149 patients planning to undergo ARCR. A questionnaire was provided to determine influences on the surgery decision-making process. Other key factors leading to patients opting for repair included a surgeon recommendation (80% reported), daily chronic pain (76%), concern for tear enlargement (76%), and an inability to sleep (72%). Males demonstrated a better functional outcome average score of 81.4 vs 69.9 for females after six months, and pre-operative narcotic use significantly correlated with poorer functional outcomes.

"While our study showed outcomes of ACRC are not determined by pre-operative decision-making factors on the part of the patient, it is important for physicians to be mindful of what patients hope to achieve through surgery," commented Weekes. "This research can contribute to making the most informed clinical treatment recommendations."

Inferior vena cava (IVC) filter placement and retrieval procedures have markedly declined over the last decade from previous large growth in Medicare beneficiaries, according to a new Harvey L. Neiman Health Policy Institute® study published online in the Journal of American College of Radiology (JACR).

Using Physician/Supplier Procedure Summary Master Files from 1994 through 2015, Dr. Morris and colleagues calculated utilization rates for IVC filter placement and retrieval procedures in Medicare fee-for-service beneficiaries. Services were classified by provider specialty group and site of service.

IVC filter placement rates dramatically increased from 1994 to 2008 (from 65.0 to 202.1) and then decreased to 128.9 by 2015. This decrease was observed across all specialty groups and sites of service. From 1994 to 2015, placement procedure market share increased for radiologists (from 45.1% to 62.7%) and cardiologists (from 2.5% to 6.7%) but decreased for surgeons (from 46.6% to 27.9. Between 2012 and 2015, retrieval rates increased from 12.0 to 17.7. Retrievals as a percentage of placement procedures were similar across specialties in 2015.

"Although IVC filter retrieval rates have increased in recent years, they remain less than 15% across all provider specialty groups," said Elizabeth Morris, MD, Professor of Radiology, Cornell University-Weill Medical College. "Still the overwhelming majority of IVC filters are placed in the inpatient hospital setting, services have slowly shifted to the hospital outpatient setting."

"Despite prior dramatic growth, the utilization of IVC filters in Medicare beneficiaries markedly declined over the last decade, likely relating to evolving views regarding efficacy and long-term safety," said lead study author, professor and director of health policy in the department of radiology at NYU Langone Health and a Neiman Institute affiliate research fellow. "This decline was accompanied by several filter-related market shifts, including increasing placement by radiologists and cardiologists, increasing outpatient placement procedures, and increasing retrieval rates."

Think of the skin as a kind of raincoat for the inner organs. With its densely packed layers of cells and lipids, it keeps foreign substances from leaking in and keeps water from leaking out, preventing dehydration. But in certain skin disorders, this barrier breaks down, and problems arise.

A particularly serious skin barrier condition is known as ichthyosis in which thick layers of scales can build up. It arises when the lipid-synthesis process in the skin goes awry. Besides causing discomfort and a scaly appearance, the condition can make the skin prone to secondary infections.

No effective treatments currently exist for ichthyosis, but a new study led by pathologist Elizabeth Mauldin of Penn's School of Veterinary Medicine takes a step toward a topical therapy. Using dogs that were born with one form of the disease, she and her colleagues uncovered its cellular and metabolic basis and used that information to create a compound to address the lipid deficits seen in the disease. Using a lotion applied to the skin, they were able to reinstate the corneocyte lipid envelope (CLE) that is typically lacking in these patients.

"We couldn't see a phenotypic difference in the skin," says Mauldin, "but what happened that was amazing was that we reformed the CLE. We were able to topically recreate this structure."

Though the topical treatment was not a cure--toxic byproducts of fatty acid synthesis remained in the skin--the researchers are hopeful that with more research they'll be able to address this aspect of the disease as well.

The findings were published in the June issue of the American Journal of Pathology.

Mauldin began investigating this skin disorder in 2007, when a breeder donated a litter of affected American bulldogs to Penn Vet. Working with Penn Vet geneticist Margret Casal, Mauldin discovered that the puppies had a mutation in the NIPAL4 gene, also called ichthyin. Later a human patient was found to have essentially same mutation in the NIPAL4 genes as the dogs. The mutation caused both humans and dogs to lack the NIPAL4 protein.

Though ichthyoses can manifest in different forms depending on the gene mutation causing the problem, about 17 percent of cases involve a mutation in the ichythin gene. The ichthyin protein plays a role in lipid metabolism.

Mauldin spent a sabbatical at the University of California, San Francisco, working in the lab of Peter Elias, a dermatologist who investigates skin-permeability disorders, including ichthyoses. Together they worked to understand what this particular NIPAL4 mutation was doing to cause the problems seen in both the human and canine patients.

"This was a study aiming for a pathogenesis-based therapy," Mauldin says. "If we could figure out what was wrong, then perhaps we could bypass the problem and topically correct the phenotype."

Studying the dogs with the mutation in partnership with the company cyberDERM, the researchers found that the skin condition in the dogs mirrored that seen in human patients; their skin barrier was leaky so it lost water at higher rates than normal. The dogs also lacked the primary component of the CLE, a lipid called omega-hydroxy ceramide, and thus failed to form the lipid envelope that acts as the skin's water barrier.

Finally, the researchers discovered the presence of non-esterified free fatty acids, lipids that were being overproduced as the body's way of compensation for the defects in lipid production. Unfortunately, instead of acting to block water loss, these fatty acids "acted as a detergent in the cytoplasm of the cells," Mauldin says, stripping even more water from the cells on the outer layer of skin.

The researchers worked with the Korean company Neopharm to produce a lipid-containing lotion aimed at restoring the CLE. While applying it to the skin didn't show great clinical improvements, examining a skin biopsy using high-powered microscopy revealed that it did reform the CLE. The researchers next goal will be to block the accumulation of fatty acids that contribute to the water loss and cell-membrane stripping.

"Now we know we can add back the CLE, we only need one more thing to see improvement," Mauldin says.

"With a lot of diseases involving enzyme deficiencies," Casal adds, "people realize they can fix the deficiency but, if you don't get rid of the byproducts, you don't treat the disease."

In addition to the potential benefits to human and canine sufferers of ichthyoses, Casal notes that this vein of research also gives dog breeders the information they need to potentially breed out the gene from their litters, as this form of ichthyosis is a recessive condition.

CORVALLIS, Ore. - Nanofiber-based wound dressings loaded with vitamin D spur the production of an antimicrobial peptide, a key step forward in the battle against surgical site infections, or SSIs.

The findings by Oregon State University researchers and other collaborators, published Wednesday in Nanomedicine, are important because SSIs are the most common healthcare-associated infection and result in widespread human suffering and economic loss.

Each year in the U.S. alone, nearly 300,000 surgical patients develop an infection within 30 days of their operation - accounting for an estimated $10 billion in additional healthcare costs - and more than 13,000 of those people die.

Researchers used electrospinning to prepare dressings containing the bioactive form of vitamin D: 1,25-dihydroxyvitamin D3, or 1,25(OH)2D3.

"Electrospinning is a versatile, simple, cost-effective and reproducible technique for generating long fibers with nanoscale diameters," said Adrian Gombart, co-corresponding author and professor of biochemistry and biophysics in OSU's College of Science. "Electrospun nanofiber wound dressings offer significant advantages over hydrogels or sponges for local drug delivery. They provide several functional and structural advantages, including scar-free healing."

The dressings the researchers created proved capable of delivering vitamin D on a sustained basis over four weeks, and they significantly induced production of a peptide, hCAP18/LL37, that kills microbes by disrupting their membranes.

"In past research with nanofiber-based sutures we used the inactive form of vitamin D - which is 25-hydroxyvitamin D3 - and a toll-like receptor ligand that was activating cells to convert 25D3 to the bioactive form, 1,25D3," said the other co-corresponding author, Jingwei Xie, assistant professor at the University of Nebraska Medical Center. "Here we bypassed that and went straight to the active form. The dressing just released it and it started turning on the vitamin D target genes, one of which produces the LL37 peptide."

Because the dressings work by enhancing innate immune responses rather than by containing conventional, single-target antimicrobial compounds, they are less likely to contribute to drug resistance. The dressings were tested on human skin (collected from plastic surgery patients) in a culture dish, as well as in vitro with keratinocyte and monocyte cell lines, and in vivo in a mouse model.

"This study was proof of principle," said co-author Arup Indra, associate professor of pharmacy at OSU. "It looks like we can induce the genes in a model system and now we can start looking at healing and infection."

In addition to Indra, Xie and Gombart, a principal investigator at OSU's Linus Pauling Institute, the collaboration also included OSU pharmacy research associate professor Gitali Indra and scientists from the University of California, San Diego, and the VA Nebraska-Western Iowa Health Care System.

"Our study suggests that 1,25D3-induced expression of hCAP18 by these nanofiber dressings is a step forward to improving wound healing," Gitali Indra said.

An international team of researchers from Russia and India has created a narrow-band UV photodetector based on indium oxide nanocrystals embedded in a thin film of aluminum oxide

Semiconductor quantum dots (nanocrystals just a few nanometers in size) have attracted researchers' attention due to the size dependent effects that determine their novel electrical and optical properties. By changing the size of such objects, it is possible to adjust the wavelength of the emission they absorb, thus implementing selective photodetectors, including those for UV radiation.

Narrow-band UV photodetectors find application in many areas, in particular in biomedicine where they are used for fluorescence detection or UV phototherapy. The materials commonly used in the manufacture of such photoreceivers are wide-bandgap oxides and nitrides, which offer a greater range of operating temperatures and transparency for visible and solar light in addition to a smaller size of the device.

Indium oxide (In2O3) is a transparent wide-bandgap semiconductor oxide with a direct band gap of about 3.6 eV and an indirect band gap of ~ 2.5 eV. It is well known that highly sensitive UV photodetectors can be created based on In2O3.

According to Alexey Mikhaylov, head of the laboratory at the UNN Research Institute of Physics and Technology, researchers together with their Indian colleagues from Indian Institute of Technology Jodhpur and Indian Institute of Technology Ropar managed to synthesize In2O3 nanocrystals in an aluminum oxide (Al2O3) film on silicon by implanting indium ions.

Ion implantation is a basic method in modern electronic technology, which makes it possible to control the size of inclusions thus allowing the optical properties of the photodetector to be tuned. The Al2O3 matrix used for indium oxide nanocrystals offers some advantages over other dielectrics in that this wide-bandgap material (8.9 eV) is transparent for a wide range of wavelengths.

"In the process of our work, we managed to achieve a significant reduction in the dark current (more than two times as compared to a similar photodetector based on In2O3 nanowires). By integrating the In2O3 phase into the wide-band matrix and due to its low dark current, the new photodetector shows record values of the responsivity and external quantum efficiency," Alexey Mikhaylov notes.

The sensitivity band in the UV range has a width of only 60 nm and shows a high UV-visible rejection ratio (up to 8400). This photodetector is highly suitable for practical applications such as narrow-band spectrum-selective photodetectors. The device design based on ion-synthesized nanocrystals could provide a new approach for realizing a visible-blind photodetector.

Gene therapy has gained momentum in the past year, following the federal government's approval of the first such treatments for inherited retinal diseases and hard-to-treat leukemia. Now, research led by Washington University School of Medicine in St. Louis has shown, in mice, that genetic material can be delivered to damaged cells in the kidneys, a key step toward developing gene therapy to treat chronic kidney disease.

The potentially fatal condition affects 30 million Americans, most of whom don't realize they have chronic kidney disease. No cure exists, and current treatments for end-stage disease mostly are limited to dialysis and kidney transplant. However, the researchers said gene therapy could provide a way to deliver genes that slow or reverse cell damage that leads to chronic kidney disease.

The findings are published July 5 in the Journal of the American Society of Nephrology.

"Chronic kidney disease is an enormous and growing problem," said senior author Benjamin D. Humphreys, MD, PhD, director of the Division of Nephrology at Washington University. "Unfortunately, over the years, we haven't developed more effective drugs for the condition, and this reality is leading us to explore gene therapy."

Diabetes, hypertension and other conditions cause chronic kidney disease, which occurs when damaged kidneys cannot effectively filter waste and excess fluids from the body. Because symptoms such as nausea, vomiting, sleep disturbances and swollen limbs are common and nonspecific to the disease, most people don't realize they have chronic kidney disease until irreparable organ damage occurs. Advanced chronic kidney disease also leads to cardiovascular disease, and patients with kidney failure have much higher rates of death from cardiovascular causes than those with healthy kidneys.

"Part of the reason there have been so few advances in kidney disease treatment is because the kidney is complex, and we don't fully understand the disease process," said Humphreys, the Joseph Friedman Professor of Renal Diseases in Medicine. "However, scientists are making progress, and I am optimistic."

To that end, Humphreys and his team -- including researchers from Harvard University and Massachusetts Institute of Technology -- focused on whether adeno-associated virus (AAV), a relative of the virus that causes the common cold, could deliver genetic material to targeted kidney cells. Until now, no such virus has been capable of delivering genetic material to the kidney, and the new research provides a proof of concept for this approach.

The researchers evaluated six AAV viruses, both natural and synthetic, in mice and in stem-cell-derived human kidney organoids. A synthetic virus, Anc80, created by one of the researchers proved successful in reaching two types of cells that contribute to chronic kidney disease; these cells secrete proteins that gum up the organ and cause irreversible damage. The researchers also showed that the genetic material carried by Anc80 was transferred successfully to the targeted kidney cells. That same virus also was used by the researchers in gene therapy strategies to treat mice with kidney scarring.

"This was a happy surprise," Humphreys said. "We were not expecting this."

However, Humphreys cautioned that researchers are still early in the process. In future research, scientists will encounter several challenges, such as the need to identify a gene that can extensively correct damaged kidney cells, he explained. Another issue involves refining the boundaries of gene delivery to prevent delivery of the synthetic virus to other organs.

"The interesting thing about the adeno-associated viruses is that they persist in the body for many months, potentially giving a therapeutic gene a chance to do its work," Humphreys said. "Chronic kidney disease is a slowly progressive disease so that is an advantage. After many more years of research, we could envision that patients would need injections maybe twice a year as opposed to every week, like with chemo.

"There has been so little innovation in kidney treatment," he said. "We believe this is a positive step forward."

Tropical forests are important to all of us on the planet. As well as being home for rare and fascinating biodiversity (like the lemurs of Madagascar), tropical forests lock up enormous amounts of carbon helping to stabilise our climate. However tropical forests are also home to many hundreds of thousands of people whose lives can be affected by international conservation policies.

Multilateral donors such as the World Bank have made clear commitments that those negatively impacted by their projects should be compensated. This includes those affected by conservation projects such as those intended to slow climate change by preventing tropical deforestation (a scheme known as REDD+ or Reducing Emissions from Deforestation and Forest Degradation). Researchers have, for the first time, studied one such compensation scheme in depth and revealed it to be inadequate.

The researchers from Bangor University in the UK and the University of Antananarivo in Madagascar looked at a new protected area and REDD+ pilot project in the eastern rainforests of Madagascar called the Coridor Ankeniheny Zahamena (or CAZ). This conservation project is conserving very high profile biodiversity (including the Indri-the largest lemur in the world), but a big part of the rationale for protecting the area is climate mitigation; locking up carbon to combat climate change.

In their paper, peer-reviewed and published in PeerJ - the Journal of Life & Environmental Sciences, the researchers show that the new conservation restrictions bring very significant costs to local people (representing up to 85% of local annual incomes). Compensation, in the form of help with improved agriculture, was offered to a small subset of people but none were fully compensated.

The researchers estimate that 27,000 people have been negatively impacted by the conservation project. These are people who are extremely poor by any measure.

The cost of conservation are real as Dr Sarobidy Rakotonarivo, a Malagasy researcher involved in the research, explains: "Those who clear land for agriculture are often those that are most food insecure. Beyond the economic costs of not being able to grow food to feed their family, local people suffer from conservation enforcement. I have heard first hand reports of people being arrested and held in deplorable conditions for cultivating on forest fallow which they consider ancestral land. In a country where jail conditions are inhumane, this shows how desperate people are."

The compensation offered was in the form of agricultural development support. While many people appreciated this support, too few people received it, those who did receive it tended not to be the most in need, and the value of the support was very low when compared to the costs of conservation.
Professor Julia Jones, one of the researchers, suggests that proper, effective compensation should be affordable. "While our results show that policies which promise to compensate communities for the cost of conservation are not being met, this is not a case of corruption. Money has not gone missing. The truth is that the world is not currently paying enough to ensure that poor local people are properly compensated. We show that if rich countries were willing to pay the full social cost of carbon, proper compensation could be affordable."

The conclusions were based on in-depth interviews with a sample of 603 people from several communities over a period of more than 2 years. Fieldwork was very intensive and households were visited up to three times over the course of the study.

The researchers point out that excluding local people from protected areas can create other problems. Apart from being environmentally unjust, uncompensated losses can cause antagonism between conservationists and local people whereas cooperation is vital to successful management of protected areas.

Professor Jones adds: "These are difficult results to present. I strongly believe that conservation of Madagascar's rainforests is hugely important (for Madagascar and for the world) and know many dedicated and extremely hard working people working in conservation in Madagascar. This is no criticism of them. However if the international community underpay for the true cost of conservation, then the rich world is essentially freeloading on extremely poor forest residents; gaining benefits while they bear the costs."

Breathing in additional oxygen improves the function of blood vessels in the brain of people with breathing difficulties caused by lung conditions, according to new research published in Experimental Physiology. These findings could have implications for future research aiming to prevent the development of diseases affecting the brain, such as dementia.

Chronic obstructive pulmonary disease (COPD) is the collective term for a group of lung conditions that cause long term breathing difficulties. It is a common condition affecting mainly middle-aged or older adults who smoke, with symptoms including breathlessness and a chesty 'smokers' cough. Individuals with COPD are at higher risk of dementia - one current theory suggests that this is due to lower brain oxygen levels as a result of problems with blood supply from blood vessels in the brain. In line with this theory, some studies have reported that giving COPD patients additional oxygen reduced their risk of developing dementia. However, until now, the mechanisms underlying this positive effect had not been fully investigated.

The research aimed to establish the effect of supplying additional oxygen on both blood flow to the brain and blood vessel function in COPD patients. The researchers used ultrasound to view and measure blood flow in the brain in these patients at rest, before and during delivery of this additional oxygen. The oxygen was delivered through the nasal passage for 20-30 minutes. In addition to testing blood flow in the brain, the authors also tested the link between brain activity and blood flow in the brain. Participants began this test with their eyes shut, having to open them and then read standardised text. This task was designed to increase activity in the brain, and as a result brain blood flow was expected to increase to provide adequate oxygen supply. Ultrasound was used to measure the extent to which brain blood flow increased. Pairing these ultrasound measures with a measurement of blood oxygen levels allowed authors to estimate how much oxygen delivery to the brain increased during the eyes open reading test.

The research team found that blood flow and oxygen delivery to the brain was significantly increased during reading. This was due to blood vessels in the brain becoming dilated in response to the greater oxygen demand when the brain was active. It can thus be concluded that when COPD patients receive additional oxygen it improves the function of blood vessels in their brain.

This study showed that providing extra oxygen improves the function of blood vessels in the brain by matching blood supply to the demands of the brain activity. However, COPD patients typically use this extra oxygen therapy throughout the day and for long periods of time, potentially years. This study does not indicate the influence of long term oxygen therapy on the function of blood vessels in the brain. Despite these potential limitations, this work has set the foundation for the researchers to investigate the biological systems that control oxygen delivery to the brain.

Lead author Ryan Hoiland, an early career researcher, learned much from the research process: "I am typically used to working with young, healthy individuals, and so this study in patients with lung disease was an eye-opening experience. I learned more about where I want to take my research career in the future, and how I want to design my research to hopefully improve treatments for people with breathing difficulties."

Isoglucose, also known as high-fructose corn syrup (HFCS), is used in the food industry as a substance to sweeten processed foods such as soft drinks, creams, cakes, confectionery, yogurts etc. The Federal Institute for Risk Assessment (BfR) has been asked by various parties whether these sweeteners, which contain a high proportion of the free monosaccharide (simple sugar) fructose, pose a particular risk to health as compared to other sweeteners such as sucrose (household sugar, beet sugar, cane sugar).

Isoglucose contains variable amounts of the simple sugars glucose and fructose in unconnected forms. This means that the two sugars are present as monosaccharides. In comparison, sucrose also contains glucose and fructose, but in this case the sugars are present in a connected form in a ratio of exactly one-to-one as a disaccharide. In the variants of isoglucose that are frequently used at the present time, the two monomers glucose and fructose are present in roughly comparable amounts; with respect to the fructose level, the difference as compared to sucrose is relatively low. In this case, it can be expected that there are no differences or no significant differences between isoglucose and sucrose from a nutritional perspective and that their health assessments are thus also similar. However, the prerequisite for this is that the intake level of added sugars does not increase significantly overall. If isoglucose variants with a significantly higher proportion of fructose are to be added to processed foods, it must be pointed out that the consumption of high amounts of fructose can have adverse effects on the metabolism. In concrete terms, it can contribute to metabolic syndrome as well as lipometabolic disorders, fatty liver, obesity and diabetes mellitus type 2. In addition, there are known intolerances to fructose.

It is considered scientifically proven that regular excessive consumption of sugar added to foods (including added fructose) is detrimental to health and should be reduced. Consumers should ensure that their daily intake of added sugar does not exceed 10 % of their total daily intake of energy from food, including beverages. The consumption of added sugar should be even lower if possible. Therefore, an adult with energy requirements of approximately 2000 kilocalories should not consume more than 6 - 12 teaspoons of added sugar per day from all food, including beverages.

SAN DIEGO, CA - Returning to your sport after an anterior cruciate ligament (ACL) injury and not suffering a second injury is often difficult but for a kid who suffers an ACL injury figuring out how to prevent reinjury is even more tricky, say researchers presented today at the American Orthopaedic Society for Sports Medicine's Annual Meeting in San Diego. This research study also received the STOP Sports Injuries Award during the meeting.

The incidence of a second ACL injury after having it repaired ranges from 25 - 33% in young, active individuals, with the greatest risk being in the first year after treatment. Recent research has highlighted that standard return to play criteria may help identify athletes at an increased risk of injury. This study looked at how the criteria that is normally applied to young athletes being able to return to play is accurate and whether that leads to any decreased risk of reinjury.

"The findings of our study suggest that current return to play measures may not correctly assess young patients who are at risk for a future injury," said lead researcher, Mark Paterno, PhD, PT, MBA, ATC from the Cincinnati Children's Hospital Medical Center in Ohio. "Additional work needs to be undertaken that can better identify, validate and incorporate clinically important measurements such as functional hop testing, strength testing and patient reported outcome scores into injury prevention strategies."

Paterno and his team evaluated 159 individuals ranging in age from 13-25 years old. The participants all underwent a primary, unilateral ACL reconstruction, performed rehabilitation and were released to continue to play pivoting/cutting sports. At the time the patients returned to sports, only 26% of the individuals met the standard return to play criteria at a >90 criterion level, which is considered "passing." They were tracked for a reoccurrence of a 2nd ACL injury for 24 months. Within this 2-year time frame 35 patients suffered a 2nd ACL injury, 26 of the 35 occurred within the first 12 months after injury. Interestingly, there was no difference in 2nd injury rates when comparing those who met all current return to sport criteria and those who failed to meet all return to sport criteria, suggesting the current criteria are not identifying young athletes at high risk for future injury.

"Our results further highlight that there may be gaps in function, strength, movement quality and psychological factors which relate to how frequently an adolescent reinjures their ACL. We hope that our work along with many others, will help to better identify the relationship between these diverse factors as a better measure of readiness to safely return to sport," said Paterno.

Boston, MA - Children and adolescents whose mothers follow five healthy habits--eating a healthy diet, exercising regularly, keeping a healthy body weight, drinking alcohol in moderation, and not smoking--are 75% less likely to become obese when compared with children of mothers who did not follow any such habits, according to a new study led by Harvard T.H. Chan School of Public Health. When both mother and child adhered to these habits, the risk of obesity was 82% lower compared with mother and children who did not.

The study will be published online in BMJ on July 4, 2018.

"Our study was the first to demonstrate that an overall healthy lifestyle really outweighs any individual healthy lifestyle factors followed by mothers when it comes to lowering the risk of obesity in their children," said Qi Sun, associate professor in the Department of Nutrition and senior author of the study.

One in five children in the U.S aged 6-19 have obesity, putting them at risk of diabetes, heart disease, and other metabolic conditions later in life. While it is known that genetics play a role in obesity, the rapid increase of the disease in recent years is likely due to changes in lifestyle and diet, indicating that "nurture" more than "nature" is fueling the current obesity epidemic.

For this study, researchers focused on the association between a mother's lifestyle and the risk of obesity among their children and adolescents between 9 and 18 years of age. They examined data from 24,289 children enrolled in the Growing Up Today Study who were born to 16,945 women enrolled in the Nurses' Health Study II.

The researchers found that 1,282 of the children, or 5.3%, developed obesity during a median five-year follow-up period. Maternal obesity, smoking, and physical inactivity were strongly associated with obesity among children and adolescents.

While the greatest drop in obesity risk was seen when mothers and children followed healthy lifestyle habits, many of the healthy habits had a noticeable impact on the risk of childhood obesity when assessed individually. Children of women who maintained a healthy body weight (body mass index 18.5-24.9) had a 56% lower risk of obesity compared with children of women who did not maintain a healthy weight, while children of mothers who did not smoke had a 31% lower risk of obesity compared with children of mothers who smoked.

The risk of obesity was also lower among children of mothers who consumed low or moderate levels of alcohol compared with children of mothers who abstained from alcohol. Because so few mothers in the Nurses' Health Study II were considered heavy drinkers, the researchers could not determine the association between heavy use of alcohol had the risk of obesity in children.

To the surprise of the researchers, mothers' dietary patterns were not associated with obesity in their children, possibly because children's diets are influenced by many factors, including school lunches and available food options in their neighborhoods.

The findings of this study highlight the crucial role a mother's lifestyle choices can have on their children's health and bolster support for family- or parent-based intervention strategies for reducing childhood obesity risk.