Culture

Body-worn sensors used at home and in clinic by people with mild Alzheimer's to assess walking could offer a cost-effective way to detect early disease and monitor progression of the illness.

A pilot study involving Newcastle University, UK, has revealed low-cost wearable devices could improve clinical trial efficiency and encourage research investment.

Identification of clinical biomarkers, such as changes in walking characteristics and behaviours, are known to be important factors when looking at early warning signs of dementia.

Findings of a feasibility study, published in the Journal of Alzheimer's Disease, shows that wearable sensors offer a good way to assess changes in how a person walks and also can be used for continuous 'free-living' monitoring of gait during everyday activities.

Experts say this method has the potential for affordable, multi-centre and home-based monitoring that benefits patients, clinical management and the efficiency of clinical trials.

Changing dementia research

Lynn Rochester, Professor of Human Movement Science at Newcastle University, leads the gait and wearable technology research across multiple sites in the study.

The human movement laboratory at the Clinical Ageing Research Unit, based at the Campus for Ageing and Vitality, Newcastle University, is dedicated to the investigation of gait, balance and mobility.

Professor Rochester said: "How someone walks is not routinely used in clinical trials because the tools needed are typically restricted to specialised labs and one-off testing, missing subtle fluctuations in symptoms.

"Wearable sensors at home and in the clinic have the potential to change dementia research. The ability to assess gait and walking behaviours in all aspects of life is a major step forwards in data collection.

"Free-living gait analysis at home is particularly useful as it allows objective observation of an individual's day-to-day activity. It also has the benefit of providing continuous data over a prolonged time that may be more sensitive than one-off assessments.

"This is an exciting project to be involved in. Gait assessed in this way could contribute to delivery of more cost-effective clinical trials and may encourage investment and increase the number of such studies in the future."

The feasibility study is part of the £6.9m Deep and Frequent Phenotyping Project, funded by the National Institute for Health Research and the Medical Research Council.

This is the first major clinical study based on Dementias Platform UK and the results could be game changing for research in this area.

Potential diagnostic tool

Six centres from the National Institute for Health Research Translational Research Collaboration in Dementia initiative, including Newcastle University, recruited 20 patients with early Alzheimer's disease.

Volunteers wore a small wearable sensor on their lower back. They carried out walking tasks in the laboratory and then went home wearing the sensor for a week, carrying out everyday tasks.

Gait is emerging as a potential diagnostic tool for cognitive decline. The tools to quantify gait in the clinic and home, and suitability for multi-centre application, have not been examined until now.

Findings show data for comprehensive and clinically appropriate measures can be obtained for walking behaviour and pattern, and gait characteristics relating to the pace, timing, variability, and asymmetry of walking.

Experts have concluded that it is feasible to assess quantitative gait characteristics in both the clinic and home environment in patients with early onset Alzheimer's disease with body-worn sensors.

Professor Rochester said: "Body-worn sensors can provide an enriched picture of an individual's gait function and walking activities that could act as a complimentary diagnostic tools for clinicians.

"Clinical use of body-worn sensors in annual health assessments could track gait changes over time and act as a red flag for cognitive impairment."

Further research is needed to assess the potential of free-living gait as a useful complementary diagnostic marker for dementia.

Targeting people early

An estimated 46.8m people worldwide were living with dementia in 2015, and with an ageing population in most developed countries, predictions suggest this number may double by 2050.

Alzheimer's disease starts long before it is noticed by those with the disease or their doctor. Previous studies have shown changes to the brain as early as 10 to 20 years before symptoms arise.

If experts can identify the biomarkers present in this very early stage, there may be the chance of treating the disease earlier, which is vital to prevent damage to people's memory and thinking.

The Deep and Frequent Phenotyping Project, led by the University of Oxford, is working with eight universities and the Alzheimer's Society, also receiving support from biopharma companies.

New biomarkers will be used alone and alongside tests such as brain imaging and assessment of memory and other cognitive functions. They will allow the researchers to recognise the early stages of the disease and those who may be suitable for trials of possible treatments.

DURHAM, N.C. -- Researchers at Duke University and North Carolina State University have demonstrated the first custom semiconductor microparticles that can be steered into various configurations repeatedly while suspended in water.

With an initial six custom particles that predictably interact with one another in the presence of alternating current (AC) electric fields of varying frequencies, the study presents the first steps toward realizing advanced applications such as artificial muscles and reconfigurable computer systems.

The study appears online on May 3 in the journal Nature Communications.

"We've engineered and encoded multiple dynamic responses in different microparticles to create a reconfigurable silicon toolbox," said Ugonna Ohiri, a recently graduated electrical engineering doctoral student from Duke and first author of the paper. "By providing a means of controllably assembling and disassembling these particles, we're bringing a new tool to the field of active matter."

While previous researchers have worked to define self-assembling systems, few have worked with semiconductor particles, and none have explored the wide range of custom shapes, sizes and coatings that are available to the micro- and nanofabrication industry. Engineering particles from silicon presents the opportunity to physically realize electronic devices that can self-assemble and disassemble on demand. Customizing their shapes and sizes presents opportunities to explore a wide-ranging design space of new motile behaviors.

"Most previous work performed using self-assembling particles has been done with shapes such as spheres and other off-the-shelf materials," said Nan Jokerst, the J. A. Jones Professor of Electrical and Computer Engineering at Duke. "Now that we can customize whatever arbitrary shapes, electrical characteristics and patterned coatings we want with silicon, a whole new world is opening up."

In the study, Jokerst and Ohiri fabricated silicon particles of various shapes, sizes and electrical properties. In collaboration with Orlin Velev, the INVISTA Professor of Chemical and Biomolecular Engineering at NC State, they characterized how these particles responded to different magnitudes and frequencies of electric fields while submerged in water.

Based on these observations, the researchers then fabricated new batches of customized particles that were likely to exhibit the behaviors they were looking for, resulting in six different engineered silicon microparticle compositions that could move through water, synchronize their motions, and reversibly assemble and disassemble on demand.

The thin film particles are 10-micron by 20-micron rectangles that are 3.5 microns thick. They're fabricated using Silicon-on-Insulator (SOI) technology. Since they can be made using the same fabrication technology that produces integrated circuits, millions of identical particles could be produced at a time.

"The idea is that eventually we're going to be able to make silicon computational systems that assemble, disassemble and then reassemble in a different format," said Jokerst. "That's a long way off in the future, but this work provides a sense of the capabilities that are out there and is the first demonstration of how we might achieve those sorts of devices."

That is, however, only the tip of the proverbial iceberg. Some of the particles were fabricated with both p-type and n-type regions to create p-n junctions -- common electrical components that allow electricity to pass in only one direction. Tiny metal patterns were also placed on the particles' surfaces to create p-n junction diodes with contacts. In the future, researchers could even engineer particles with patterns using other electrically conductive or insulating materials, complex integrated circuits, or microprocessors on or within the silicon.

"This work is just a small snapshot of the tools we have to control particle dynamics," said Ohiri. "We haven't even scratched the surface of all of the behaviors that we can engineer, but we hope that this multidisciplinary study can pioneer future studies to design artificial active materials."

Philadelphia, May 3, 2018 - Japanese physicians highlight the risks and clinical significance for individuals who remain seated and immobile in vehicles for prolonged periods. They call for preventive awareness activities and education about the risk of venous thromboembolisms (VTE) in a Letter to the Editor in the Canadian Journal of Cardiology.

Earlier reports have identified a sharp increase in sudden cardiac death following natural disasters like earthquakes, but less is known about the risk of other secondary health damage such as acute cerebral and cardiovascular diseases, and in particular, the risk of VTE as a result of being confined in a car for a long time.

Following the Kumamoto earthquake in April 2016, there was a high number of night aftershocks. Because many people were afraid to return to their homes, they chose to evacuate. Although some individuals reached a public evacuation shelter, many others were forced to stay in their vehicles overnight.

In order to assess the impact of remaining seated in cars for extended periods of time, the Kumamoto Earthquake Thrombosis and Embolism Protection (KEEP) project investigators gathered data from the aftermath of the Kumamoto earthquakes. They found an "epidemic" of blood clots developing in the legs, and in numerous cases going to the lungs, in many of the people forced to evacuate. Analysis of questionnaires from 21 local medical institutions established that 51 patients were hospitalized following the earthquakes due to VTE. Of these, 42 patients (82.4 percent) had spent the night in a vehicle. VTE was complicated by pulmonary thromboembolism (PTE) in 35 cases.

"Preventive awareness activities by professional medical teams, supported by education in the media about the risk of VTEs after spending the night in a vehicle, and raising awareness of evacuation centers, could lead to a reduced number of victims of VTE," noted lead investigator Seiji Hokimoto, MD, PhD, from the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.

"This is a dramatic example of the risks inherent in spending prolonged periods immobilized in a cramped position," commented Stanley Nattel, MD, Editor-in-Chief of the Canadian Journal of Cardiology. "It is an important reminder of a public health point and reinforces the need to get up and walk around regularly when on an airplane or when forced to stay in a car for a long time."

ANN ARBOR, Mich. -- They're in the country illegally. Or maybe they had protected status before, but lost it due to policy changes by the current presidential administration.

Or they're waiting for word from Congress or the courts on whether they'll get to stay.

Whatever their situation under the law, the 11.3 million undocumented immigrants currently in the United States still need, and sometimes get, health care.

Even if they don't have health insurance, federal law requires hospitals to care for them in emergencies. They can turn to safety-net clinics for basic needs.

Now, a new analysis highlights an ironic development in the intertwined issues of immigration and health care - two areas where the current and previous administrations differ greatly.

Undocumented people in certain states may get more medical help while they are here, it finds, thanks to the current administration's effort to give states more flexibility with their health care spending. And in a reversal of the previous administration's stance, states may find it easier to get that permission.

In a new article in the New England Journal of Medicine, two members of the University of Michigan Institute for Healthcare Policy and Innovation unpack recent events, political philosophies and medical evidence about caring for the undocumented.

They conclude that more states may want to apply for permission to use state and federal dollars to pay safety-net hospitals that care for everyone - whether or not they are here legally.

Waivers already in action

Such permission, which requires the government to approve an application called a waiver, has already gone into effect in Florida and Texas.

As two of the states with the highest numbers of undocumented immigrants living in their borders, they've seen the amount of money they can award to safety-net hospitals rise by 50 percent to 70 percent.

"Ironically, the same administration that is targeting undocumented immigrants with one set of policies may be helping them get care by preserving hospitals' abilities to serve them with other policies," says A. Taylor Kelley, M.D., M.P.H., who led the analysis.

Kelley says their example may bode well for other states that, like Florida and Texas, didn't choose to expand Medicaid under the ACA.

"The United States has one of the highest rates of uninsured people in the world among developed countries, and the Affordable Care Act was designed to increase health insurance options for men, women and children across the country. But undocumented immigrants were excluded," so they can't enroll in Medicare or Medicaid, or buy a plan on the ACA marketplace, explains Kelley, who is a clinical lecturer in general internal medicine at the U-M Medical School and a National Clinician Scholar at IHPI.

"Undocumented immigrants rely on safety-net institutions that deliver care for people, with insurance or without insurance," he explains. "Safety net hospitals are also major employers and economic drivers in their communities. And so to keep their doors open, states can seek federal permission to increase the funding they get. And generally, the current administration has been very receptive."

States didn't get a warm welcome from the Obama administration for such waivers, because that administration's priority was encouraging states to expand Medicaid coverage to all low-income adults - or at least those who had legal status. In fact, the previous administration said it would take away existing funding for safety-net hospitals in states that didn't expand Medicaid.

Florida actually decided to redirect some of its own funds to help its hospitals, rather than expand Medicaid, when its waiver was ended by the Obama administration.

A door closes, a door opens

But with the change in administrations, Kelley and co-author Renuka Tipirneni, M.D., M.Sc., write, the states that didn't expand Medicaid and have high numbers of undocumented residents may find it easier.

States along the Mexican border, for instance, may want to seek a waiver - or apply to take part in a program that incentivizes new care delivery models for poor patients.

As for the states that did expand Medicaid, only time will tell if the government will also approve waivers to further ease the financial burden on safety net hospitals and clinics there.

A recent IHPI report about Michigan's Medicaid expansion finds that while hospitals saw their uncompensated care drop by an average of 50 percent in the first year after expansion, the level has stayed flat since that time.

So hospitals are still absorbing the cost of caring for many people who can't pay their medical bills, whether it's because they have no insurance or they can't afford the part of their bill that their insurance expects them to pay. Around half of the undocumented immigrants in the U.S. lack insurance of any kind, according to estimates.

"The major question when talking about state flexibility is, where are the limits? And how much are we going to honor states' rights?" says Kelley. "Both Medicaid expansion and support for the safety net are programs where states are now being given the autonomy to act as they feel best for the people within their borders. Will these approaches be honored by the administration as a state right?"

Spending up front, or later

At the same time, Kelley notes, the inpatient hospitals that have historically received the waiver funds are more and more likely to be part of new network-based models of care, such as accountable care organizations, which makes it easier for them to offer integrated care for those who come through the doors of their emergency rooms.

That may mean it's easier to care for undocumented immigrants in a preventive or early-stage way, rather than waiting for an emergency.

In addition, Congress recently extended funding for federally qualified health centers that provide care to underserved patients outside of the hospital.

Such care can actually save money, according to research cited in the new piece. For instance, one study showed that states can save money by covering dialysis care for undocumented immigrants whose kidneys are failing, rather than waiting to provide the legally required emergency dialysis when they are in crisis. Illinois has even gone so far as to cover kidney transplants for undocumented people, because of the potential long-term cost savings.

Other research shows that expansion of individual insurance coverage provides better outcomes and use of resources than insurance for some and no insurance for others who must turn to safety net care, says Kelley. But the political philosophies and policy stances of current leadership don't make expanded coverage likely right now.

"We've come out of eight years of one way of thinking, now we're in a new way of thinking," says Kelley. "And it's a new shift for states if they're going to cover the people they need to cover and help institutions out, then they have to shift their focus and their thinking."

"Some might ask, what does care for the undocumented have to do with me as an American citizen. And the reality is that, because we provide care to anyone who stands in need of a health emergency, we all pay for everyone's healthcare sooner or later," he says. "When we provide access to care for undocumented immigrants, it's not necessarily going to be a cost burden every time. In some ways, it may be beneficial to us in both indirect ways and even in direct ways."

PLAYING with an imaginary companion (IC) helps children learn essential social skills such as empathy with other people. It is often believed that autistic youngsters are incapable of creating pretend play pals - a further hindrance to their development of emotional understanding.

But now a project headed by a University of Huddersfield researcher confirms that children diagnosed with autism are able to create and play with ICs. Further research is to be conducted and could eventually help to develop new therapies.

The current findings - based on data collected in the USA and the UK - are reported in a new article for which the lead author is Dr Paige Davis, who lectures in psychology at the University of Huddersfield. Imaginary companions are one of her key specialities.

The research described in the Journal of Autism and Developmental Disorders by Dr Davis and her three co-authors is based on evidence gathered from 215 questionnaires completed by approximately equal numbers of parents of children with typical development (TD) and of children diagnosed with autistic spectrum disorder (ASD).

The findings do indicate that fewer children with ASD create an imaginary companion - 16.2 per cent as opposed to 42 per cent of TD youngsters. Also children with autism began playing with their ICs at a significantly later age and were proportionately more likely to play with a "personified object" such as a stuffed toy or doll.

But the argument of the new article from Dr Davis is that while there is a quantitative difference between the developments of ICs between the two categories of children, there is no difference in the quality of the play.

The article includes examples of some of the imaginary companions created by children with autism whose parents took part in the project. They include Ghosty Bubble, an invisible bubble person who slept on a bubble bed next to the child; Mikey, an invisible Ninja who lived in a sewer; and Pretend Ada, an invisible version of a real school pal who played with the child when she needed a friend.

"The finding that children diagnosed with ASD even spontaneously create such imaginary companions refutes existing beliefs that they are not imagining in the same way as typically developing children," said Dr Davis.

"Imaginary companions are special because they are social in nature and children with autism have issues with social development and communication. So if you are actually creating a mind for an imaginary person you are involving yourself in a range of social activities that the autism diagnosis itself would say you couldn't do."

Dr Davis argues that if children with ASD are showing the same positive social developments as TD youngsters from the creation of ICs, then that could have implications for future intervention and lead to new therapies based on the imagination.

Her collaborators on the research and co-authors of the article were Elizabeth Meins of the University of York, Haley Simon of Drexel University in Philadelphia, USA, and Diana Robins of the AJ Drexel Autism Institute in Philadelphia. The article - titled Imaginary Companions in Children with Autism Spectrum Disorder - describes the research methodology and the findings in detail.

Now there are plans for further research into the benefits of imaginary companions to typically developing children and whether the same applies to autistic youngsters.

The research could eventually help to develop new therapies

PORTLAND, Oregon/BOSTON, Massachusetts - An algorithm that uses artificial intelligence can automatically and more accurately diagnose a potentially devastating cause of childhood blindness than most expert physicians, a paper published in JAMA Ophthalmology suggests.

The finding could help prevent blindness in more babies with the disease, called retinopathy of prematurity, or ROP. Musician Stevie Wonder went blind due to this condition.

The algorithm accurately diagnosed the condition in images of infant eyes 91 percent of the time. On the other hand, a team of eight physicians with ROP expertise who examined the same images had an average accuracy rate of 82 percent.

"There's a huge shortage of ophthalmologists who are trained and willing to diagnose ROP. This creates enormous gaps in care, even in the United States, and sadly leads too many children around the world to go undiagnosed," said the study's co-lead researcher, Michael Chiang, M.D., a professor of ophthalmology and medical informatics & clinical epidemiology in the OHSU School of Medicine and a pediatric ophthalmologist at the Elks Children's Eye Clinic in the OHSU Casey Eye Institute.

"This algorithm distills the knowledge of ophthalmologists who are skilled at identifying ROP and puts it into a mathematical model so clinicians who may not have that same wealth of experience can still help babies receive a timely, accurate diagnosis," said the other lead researcher, Jayashree Kalpathy-Cramer, Ph.D., of the Athinoula A. Martinos Center for Biomedical Imaging at Massachusetts General Hospital, who is also an associate professor of radiology at Harvard Medical School.

Leading cause of childhood blindness

Retinopathy of prematurity is caused by abnormal blood vessel growth near the retina, the light-sensitive portion in the back of an eye. The condition is common in premature babies and is the leading cause of childhood blindness globally.

The National Eye Institute of the National Institutes of Health reports that up to 16,000 U.S. babies experience retinopathy of prematurity to some degree, but only up to 600 become legally blind each year as a result. The condition is becoming more common as medical care for premature babies improves.

The disease is diagnosed by visually inspecting a baby's eye. Physicians typically use a magnifying device that shines light into a baby's dilated eye, but that approach can lead to variable and subjective diagnoses.

Computational smarts

Artificial intelligence, also called AI, enables machines to think like humans and is a growing field in health care. Last month, the FDA approved an AI device that detects diabetes-related eye disease. Others have tried developing computerized systems to diagnose retinopathy of prematurity, but none have been able to match the accuracy of visual diagnosis by physicians.

This algorithm specifically uses deep learning, a form of AI that mimics how humans perceive the world through vision, including identifying objects. The MGH researchers combined two existing AI models to create the algorithm, while the OHSU researchers developed extensive reference standards to train it.

They first trained the algorithm to identify retinal vessels in more than 5,000 pictures taken during infant visits to an ophthalmologist. Next, they trained it to differentiate between healthy and diseased vessels. Afterward, they compared the algorithm's accuracy with that of trained experts who viewed the same images and discovered it performed better than most of the expert physicians.

The full research team is now working with a collaborator in India to see if the algorithm can diagnose ROP in Indian babies as well as it did for the group of primarily Caucasian babies involved in this study. They are also exploring whether the algorithm can diagnose the condition in images of other parts of the retina besides vessels. The ultimate goal is to enable physicians to incorporate the technology into their clinical practices.

French Bulldogs, predicted soon to become the most popular dog breed in the UK, are vulnerable to a number of health conditions, according to a new study published in the open access journal Canine Genetics and Epidemiology.

Researchers at The Royal Veterinary College (RVC), UK found that the most common issues in French Bulldogs over a one year period were ear infections, diarrhea and conjunctivitis (inflammation of the eye surface).

Dr. Dan O'Neill, RVC Senior Lecturer and the main author, said: "French Bulldogs are a relatively new arrival to the list of common UK breeds so there is very little current research on them in the UK. Our study - the first on this breed in the UK - is based on anonymised records gathered from hundreds of UK vet clinics. It provides owners with information on the issues that they could expect and should look out for in French Bulldogs. It may also help potential new owners to decide if a French Bulldog really is for them."

Dr. O'Neill adds: "One of the interesting finding from our research is that male French Bulldogs appear to be less healthy than females. Males were more likely to get 8 of the 26 most common health problems while there were no issues that females were more likely to get than males."

The authors suggest that the distinctive appearance of the French Bulldog, with their short muzzles and wide, prominent eyes, may be a key factor influencing their popularity. However, these characteristics may also increase the risk for some of the health problems seen in French Bulldogs. For example breathing issues, seen in 12.7% of the dogs in this study, are a known problem in breeds with short noses and flat faces. Skin problems overall were the most common group of health issues and the authors suggest that this may be due to the skin folds that are characteristic of the breed.

Dr. O'Neill said: "This study also documents the dramatic rise in popularity of the French Bulldog, from 0.02% of puppies born in 2003 to 1.46% of puppies born in 2013. This level of population growth in a single dog breed is unprecedented. There is a worry that increased demand for the French Bulldog is damaging to these dogs' welfare because of the health risks associated with their extreme physical features."

The authors analyzed data on 2,228 French Bulldogs under veterinary care during 2013 from 304 UK clinics, collected in the VetCompass™ database. The French Bulldogs had a median age of 1.3 years old compared to a median age of 4.5 years for the other dog breeds in the VetCompass™ database. This reflects the growth in popularity of French Bulldogs.

The authors caution that the study may even under-estimate the true number of dogs with health problems as the data may include more severely affected animals that require veterinary management. Additionally, as French Bulldogs have only recently become popular the data was mostly collected from young dogs and it is well recognized that health problems generally become more common with age.

Emollient bath additives provide no meaningful benefit when used in addition to standard eczema care in children, finds a trial published by The BMJ today.

Bath additives are widely prescribed at a cost of more than £23m ($33m; €26m) annually to the NHS in England. The researchers say their findings may help guide decisions around effective prescribing in this area.

Eczema (also known as atopic eczema or atopic dermatitis) is the most common inflammatory skin condition in childhood and can have a substantial impact on patients' and families' quality of life and NHS resources.

Emollients are the mainstay of treatment, providing a barrier over the skin, reducing moisture loss, and protecting against skin irritants. There are three methods of application of emollients; leave-on emollients, soap substitutes and emollient bath additives.

Although evidence supports the use of leave-on emollients and there is clinical consensus around soap substitutes, little good evidence exists on the benefits of emollient bath additives.

So a team of UK researchers, led by Miriam Santer at the University of Southampton, set out to determine both the clinical and cost effectiveness of including emollient bath additives in the management of eczema in children.

The trial included 482 children (244 girls / 238 boys) aged 1-11 years diagnosed with eczema from 96 general practices in England and Wales. Most participants had moderate eczema.

Children were randomly assigned to two groups. For one year, children in the intervention group were prescribed one of three bath additives, while the control group was asked to use no bath additives.

All participants received written instructions to use leave-on emollients as soap substitutes. They were advised to continue all other eczema care as usual, including regular use of leave-on emollients and corticosteroid creams as required.

Eczema control was measured weekly for 16 weeks using the patient oriented eczema measure (POEM, scores 0-7 mild, 8-16 moderate, 17-28 severe).

The researchers found no statistically significant difference in weekly POEM scores between the two groups over the 16 week period (mean POEM score of 7.5 in the bath additives group and 8.4 in the no bath additives group).

After taking account of eczema severity and other factors that could have affected the results, the POEM score in the no bath additives group was 0.41 points higher than in the bath additives group over 16 weeks, which is substantially lower than the minimal clinically important difference for POEM of 3 points.

There were also no significant differences between the two groups for additional measures, including eczema severity over one year, number of eczema flare-ups, quality of life, cost effectiveness, and adverse effects.

While the researchers cannot exclude the possibility of a small benefit among children bathing more than five times a week or among children aged less than 5 years, they say differences are sufficiently small to be unlikely to be clinically useful.

As such, they say this trial "found no evidence of clinical benefit from including emollient bath additives in the standard management of eczema in children."

In a linked editorial, Carsten Flohr, Consultant Dermatologist from St John's Institute of Dermatology at Guy's & St Thomas' NHS Foundation Trust in London says: "Important remaining evidence gaps are optimal regimen for leave-on treatments, soap substitutes, and frequency of bathing in children with eczema."

So there is still some room for further work, "but it is heartening to see that an important evidence gap has been closed," he concludes. Both the NHS and families of children with eczema can now better invest in more effective treatments for this common and distressing condition.

Robots that can build homes, marathoners' running shoes and NASA's upcoming spacecraft all have one thing in common: 3-D printed parts. But as enthusiasm for 3-D printing continues to grow and expand across markets, the objects printed by the process can have weaknesses. Now, one group reports in ACS Applied Materials & Interfaces that using a simple modification to the manufacture of the starting materials improves the toughness of these printable plastics.

As the 3-D printing market not only expands but also becomes more affordable, it is finding applications in many different areas. But this versatility is limited by the strength and durability of the printed parts. Most of these objects are printed in layers, which inherently results in weak spots where the layers meet. Thus, 3-D printed objects are not as strong as those made with current methods in which plastics are injected into molds. To create stronger 3-D printed parts, Miko Cakmak, Bryan D. Vogt and colleagues wanted to explore whether the starting materials could be changed to self-reinforce the printed parts.

The researchers made a structured, core-shell polymer filament in which a polycarbonate core acts as a stiff skeleton to support and reinforce the 3-D printed shape. An olefin ionomer shell around the polycarbonate core improves and strengthens the connection between the printed layers. During testing, printed parts with the filaments could withstand impacts without cracking, unlike parts made without them. The new filaments bring 3-D printed parts closer to the strength of parts manufactured by current methods. 

Emerging evidence suggests that microbes in the digestive system have a big influence on human health and may play a role in the onset of disease throughout the body. Now, in a study appearing in ACS Chemical Biology, scientists report that they have potentially found a way to use chemical compounds to target and inhibit the growth of specific microbes in the gut associated with diseases without causing harm to other beneficial organisms.

The digestive system is crammed with trillions of bacteria, fungi, and other microbes that help process food. Recent studies suggest that the changes in these gut flora, or microbiome, may play a role in the onset of a host of diseases and conditions including obesity, diabetes, cancer, allergies, asthma, autism and multiple sclerosis. Antibiotics can help regulate the microbiome, but bacterial resistance is on the rise. In addition, antibiotics can wipe out some of the organisms that contribute to a healthy microbiome, and the microbes that take their place can sometimes cause more harm than good. Researchers have also investigated using probiotics and fecal transplants to resolve some of these problems. But to date, few have really looked at using non-microbicidal small molecules to alter the microbiome in a targeted way to improve health. To help fill this gap, Daniel Whitehead, Kristi Whitehead and colleagues sought to use a chemical compound to precisely target and disrupt the metabolic processes of members of the Bacteroides genus, a group of bacteria commonly found in the gut that appear to be associated with the onset of type I diabetes in genetically susceptible individuals.

In laboratory studies, the researchers found that small concentrations of acarbose, a drug used to treat diabetes, significantly disrupted the activity of a group of proteins involved in the Starch Utilization System (Sus). The model bacteria called Bacteroides thetaiotaomicron (Bt), as well as other Bacteroides members, have this system. With Sus inhibited, Bt couldn't metabolize a pair of complex carbohydrates that are not digested by humans once they reach the colon, but that are vital to the survival of the microbes. As a result, the bacteria cannot grow. The team found that acarbose was specific, having similar effects on another Bacteroides bacteria, but little or no effect on other types of gut microbes. The researchers conclude that with further study it may be possible to develop drugs that target gut bacteria with pinpoint accuracy to permanently alter the composition of the microbiome and, in turn, prevent or treat disease.

DURHAM, N.C. -- More than 2 million people worldwide live with inherited and untreatable retinal conditions, including retinitis pigmentosa, which slowly erodes vision.

Developing treatments is challenging for scientists, as these conditions are caused by more than 4,000 different gene mutations. But many of these mutations have something in common -- a propensity for creating misfolded proteins that cells in the eye can't process. These proteins build up inside cells, killing them from the inside out.

Now Duke University scientists have shown that boosting the cells' ability to process misfolded proteins could keep them from aggregating inside the cell. The researchers devised and tested the strategy in mice, significantly delaying the onset of blindness. Their findings are outlined in the journal Nature Communications.

Their approach potentially could be used to prevent cell death in other neurodegenerative diseases, such as Huntington's, Parkinson's and Alzheimer's, said Vadim Arshavsky, Ph.D., senior author of the paper and Helena Rubenstein Foundation Professor of Ophthalmology at the Duke University School of Medicine.

"You can offer almost nothing in terms of treatment to a patient with retinitis pigmentosa or other inherited blindness today," Arshavsky said. "This investigation provides evidence that enhancing the capacity of the cell to process misfolded proteins is worth pursuing. Another important piece is that inherited blindness is just a subset of a larger category of neurodegenerative diseases, so this concept could be tested in other conditions, as well."

The Duke team collaborated with colleagues from the California Institute of Technology. They focused on the proteasome: machinery inside all cells that eliminates misfolded proteins. Arshavsky compares the barrel-shaped structure to a paper shredder, with the cutting elements hidden inside.

Misfolded proteins must pass through a "lid" on the shredder to be processed, but cells in diseased mice do not have enough lids, enabling the buildup of the damaged proteins.

Instead of trying to alter the shredders, Arshavsky and his team genetically increased the quantities of lids for the shredders, allowing cells to process more misfolded proteins.

In trials, mice with added proteasome lids retained four times the number of functional retinal cells by adulthood than mice with the same form of retinitis pigmentosa, which went blind as adults.

The lids were introduced genetically in the line of lab mice. In humans, lids could potentially be added through gene therapy or drug compounds.

"If you can retain four times the number of the functional cells in the eye, that would mean decades more vision in a human patient," Arshavsky said. "It's not a complete cure, but it's a tremendous delay. This type of treatment has the potential to defer the onset of blindness beyond the human lifespan."

High dose vitamin D supplements improve weight gain and the development of language and motor skills in malnourished children, according to a study led by University of the Punjab, Pakistan, and Queen Mary University of London.

Vitamin D - the 'sunshine vitamin' - is well known for its beneficial effects on bone and muscle health, and a study by Queen Mary researchers last year found that it could also protect against colds and flu. Now new research from the team is revealing further benefits.

Lead author Dr Javeria Saleem from University of the Punjab and Queen Mary University of London said: "High-dose vitamin D significantly boosted weight gain in malnourished children. This could be a game-changer in the management of severe acute malnutrition, which affects 20 million children worldwide."

Senior author Professor Adrian Martineau from Queen Mary University of London added: "This is the first clinical trial in humans to show that vitamin D can affect brain development, lending weight to the idea that vitamin D has important effects on the central nervous system.

"Further trials in other settings are now needed to see whether our findings can be reproduced elsewhere. We are also planning a larger trial in Pakistan to investigate whether high-dose vitamin D could reduce mortality in children with severe malnutrition."

The study, published in The American Journal of Clinical Nutrition, took place in Pakistan, where an estimated 1.4 million children live with severe acute malnutrition and are at increased risk of long-term effects on their physical and mental health.

High energy food sachets are the standard treatment for the condition, but they contain relatively modest amounts of vitamin D.

In the study, 185 severely malnourished children aged 6-58 months were treated with an eight-week course of high energy food sachets, and were also randomised to either receive additional high-dose vitamin D (two doses of 200,000 international units / 5 milligrams, given by mouth) or placebo.

After eight weeks, vitamin D supplementation led to clinically significant improvements in weight (on average gaining an extra 0.26 kg compared to the control group).

Vitamin D supplementation also resulted in substantial reductions in the proportion of children with delayed motor development, delayed language development and delayed global development (reaching certain milestones such as learning to walk or talk).

Senior author Dr Rubeena Zakar from University of the Punjab added: "Our findings could be a great help to the Health Ministry of Pakistan in dealing with the issue of malnutrition."

The study was funded by the Higher Education Commission of Pakistan.

The researchers say their study has some limitations including that it did not look at varying the dose of vitamin D to see if a lower dose would have been sufficient to boost weight gain and brain development. While they saw no overt adverse reactions, the possibility of side effects arising with clinical use of this high dose of vitamin D cannot be excluded.

Plants--Surviving the heat

A study by Oak Ridge National Laboratory detailed the response and recovery of certain tree species after short-term, extreme weather events such as heat waves. Scientists exposed sets of four different saplings to dramatic temperature swings that peaked above 120 F, or around 50 C, in a climate-controlled test chamber. Sensors attached to each tree and located throughout the chamber tracked telltale signs of heat and drought stress such as fluxes in carbon uptake and shifts in water demand. "By monitoring specific trait behavior, we characterized each tree's reaction to being kicked into survival mode for brief periods of time," said ORNL's Anirban Guha. "We found that during simulated heat waves, the entire plant mechanism was impacted, which affects its year-long survival." The ORNL-led team's findings, which were published in Environmental Research Letters, will improve predictive Earth system models. [Contact: Sara Shoemaker, (865) 576-9219; shoemakerms@ornl.gov]

Image: https://www.ornl.gov/sites/default/files/ORNL_heat_wave_chamber2.jpg

Caption: ORNL's Jeffrey Warren (left) and Anirban Guha used a climate-controlled test chamber to simulate heat waves that peaked above 120 F and analyzed the impact on certain tree species. Credit: Genevieve Martin/Oak Ridge National Laboratory, U.S. Dept. of Energy.

Video: https://youtu.be/5j-jEEJwLCU

Caption: ORNL scientists exposed sets of four different saplings to dramatic temperature swings that peaked above 120 F, or around 50 C, in a climate-controlled test chamber. Credit: Jenny Woodbery/Oak Ridge National Laboratory, U.S. Dept. of Energy.

Sensors--Vehicle fingerprinting

Algorithms designed to parse data gathered by roadside sensors could make it easier to identify vehicles sought in AMBER Alerts and to assist researchers studying traffic patterns. Oak Ridge National Laboratory scientists built a sensor platform to collect detailed images of cars, as well as electrical pulses and audio signals from engines, to uniquely identify vehicles. "Two cars with an identical make, model and color would be difficult to differentiate on the road," said ORNL's Ryan Kerekes. "With data pulled from sensors, we can use machine learning to extract important features to create a vehicle 'fingerprint.'" The algorithms could be deployed with specialized sensor arrays or modified to apply to existing traffic cameras. The ORNL team presented their work at an IEEE Vehicle Technology Conference. Research is ongoing to upgrade sensors to capture larger vehicles and to improve matching algorithms. [Contact: Stephanie Seay, (865) 576-9894; seaysg@ornl.gov]

Image #1: https://www.ornl.gov/sites/default/files/VehicleIDSensorinCone2.jpg

Caption: ORNL researchers test a sensor array inside a traffic cone as they developed a method to more accurately identify vehicles. Credit: Jason Richards/Oak Ridge National Laboratory, U.S. Dept. of Energy.

Image #2: https://www.ornl.gov/sites/default/files/VehicleIDSensorKerekesTokola.jpg

Caption: ORNL scientists Ryan Kerekes (left) and Ryan Tokola codeveloped a prototype of the sensor platform for vehicle fingerprinting. Credit: Jason Richards/Oak Ridge National Laboratory, U.S. Dept. of Energy.

Computing--Filling the gaps

Researchers from the Max Planck Institute, renowned for advances in nonmetallic catalysis, leveraged computational modeling support from Oak Ridge National Laboratory to overcome a major limiting factor in the breakdown of simple organic compounds called olefins. Olefins are among nature's most abundant chemical compounds and are commonly obtained from crude oil. But current industrial processes to catalyze olefins into useful products are energy-intensive and costly. ORNL's Dmytro Bykov ran a series of calculations on experimental data provided by Max Planck to fill in the gaps. "The team had theorized the most promising catalysis candidates, but they needed details on the reaction mechanisms that are difficult to determine in a lab setting," Bykov said. The resulting three-dimensional models helped the team better predict the most plausible ways to catalyze olefins. Their discovery was published in the journal Science. [Contact: Sara Shoemaker, (865) 576-9219; shoemakerms@ornl.gov]

Image: https://www.ornl.gov/sites/default/files/ORNL_catalysis_of_olefins_0.png

Caption: Computational modeling helped researchers visualize possible reactions when olefins are exposed to various catalysts. Credit: Dmytro Bykov/Oak Ridge National Laboratory, U.S. Dept. of Energy.

Materials--Taking the heat

A shield assembly that protects an instrument measuring ion and electron fluxes for a NASA mission to touch the Sun was tested in extreme experimental environments at Oak Ridge National Laboratory--and passed with flying colors. Components aboard Parker Solar Probe, which will endure the heat near the Sun, will get closer to the Sun than prior missions. The ORNL team exposed the shield assembly to a searing 3,227 F for up to 72 hours and simulated solar intensity of 65 watts per square centimeter using ORNL's Radioisotope Power Systems Program and Plasma-Arc Lamp facilities, respectively. This exceeded the worst conditions that the mission is predicted to experience in the corona. Andrew Driesman, project manager of the Johns Hopkins University Applied Physics Laboratory, which designed, built and will operate the spacecraft for NASA, said, "ORNL's support was crucial in completing our testing on time by helping to solve difficult materials and technical challenges." [Contact: Dawn Levy, (865) 576-6448; levyd@ornl.gov]

Image: https://www.ornl.gov/sites/default/files/NASA_Parker_Solar_Probe_rendering.jpg

Caption: NASA's Parker Solar Probe, shown in this artist's concept, is scheduled to launch on July 31 to contribute data that may improve the agency's ability to forecast space weather, which can disrupt communications satellites and power grids, and may demystify why the Sun's corona is hotter than its surface. Credit: Steve Gribben/NASA, Johns Hopkins APL.

Neutrons--On the down-low

An Oak Ridge National Laboratory-led team has observed how a prolific class of antibiotics may be losing its effectiveness as certain bacteria develop drug resistance by acquiring enzymes known as aminoglycoside modifying enzymes. Aminoglycosides are commonly used in antibiotics to treat tuberculosis, meningitis and listeriosis. Using X-rays and neutron diffraction, researchers found a known but previously undetected biological architecture called a catalytic triad within this enzyme group. The team identified a low-barrier hydrogen bond, involving a single hydrogen atom formed in this catalytic triad, which is crucial for the enzyme's ability to disrupt the drugs' molecular structure and render them ineffective to combat pathogenic bacteria. Detailed in Science Advances, this information provides new insights that could help improve future drug design. [Contact: Sara Shoemaker, (865) 576-9219; shoemakerms@ornl.gov]

Image: https://www.ornl.gov/sites/default/files/ORNL_neutrons_low-barrierH.png

Caption: The ORNL-led team identified a low-barrier hydrogen bond, involving a single hydrogen atom formed in this catalytic triad, which is crucial for the enzyme's ability to disrupt the drugs' molecular structure and render them ineffective to combat pathogenic bacteria. Credit: Oak Ridge National Laboratory, U.S. Dept. of Energy.

BOSTON - Twenty-five million Americans suffer from asthma, a chronic lung disease that has been on the rise since the 1980s. While physicians have long known that smog and pollution can bring on an asthma attack among children and adults suffering from asthma, researchers remained uncertain about what role long-term exposure to certain pollutants might play in the development of the disease in children.

New research led by scientists at Beth Israel Deaconess Medical Center (BIDMC) and the Harvard T.H. Chan School of Public Health suggest that long-term exposure to traffic-related pollution significantly increases the risk of pediatric asthma, especially in early childhood. Their findings were published today in a Letter to the Editor in the Journal of Allergy and Clinical Immunology.

"Our previous research demonstrated that living close to a major roadway and lifetime exposure to air pollutants were associated with lower lung function in seven- to ten- year-old children," said corresponding author Mary B. Rice, MD, MPH, a pulmonary and critical care physician at BIDMC. "We suspected that these exposures would also be associated with pediatric asthma."

To find out, Rice and colleagues analyzed data from 1,522 Boston-area children born between 1999 and 2002 whose mothers had enrolled in a long-term study called Project Viva, which was established to examine how behavioral and environmental factors - such as sleep and eating habits or exposure to pollution - impact children's health. As part of Project Viva, mothers provided comprehensive medical, socio-economic and demographic information, including residential address histories.

Rice and colleagues used mapping technologies to determine the distance between each child's home address and the nearest major roadway. The researchers also linked home addresses to census data and satellite-derived atmospheric data to calculate each participant's daily exposure to fine particulate matter (PM) - tiny particles suspended in the air that when inhaled deposit in the terminal sacs of the lung. Fine PM originates from fuel combustion, including traffic, power plants, and other pollution sources.

The research team also examined children's daily exposure to soot, a component of fine PM also known as black carbon. Incompletely burned fossil fuels expelled from engines (especially diesel) and power plants produce black carbon, which is a known carcinogen and potent contributor to climate change. In the Boston area, the presence of black carbon is linked to traffic-related pollution - as opposed to other regions where soot may come from a mix of sources.

Further analysis of the geographic data and Project Viva questionnaires revealed clear patterns. Most strikingly, living close to a major road was linked to childhood asthma at all ages examined.

"Children living less than 100 meters from a major road had nearly three times the odds of current asthma - children who either experience asthma symptoms or use asthma medications daily - by ages seven to 10, compared with children living more than 400 meters away from a major road," said Rice, who is also an assistant professor of medicine at Harvard Medical School. "Even in the Boston area, where pollution levels are relatively low and within Environmental Protection Agency standards, traffic-related pollutants appear to increase the risk of asthma in childhood."

"Lifetime exposure to black carbon and fine PM were also linked to the asthma in early childhood (ages three to five years), but in mid-childhood (ages seven to 10 years), these pollutants were associated with asthma only among girls. "Younger children spend a larger proportion of their time at home than school-aged children, and their airways are smaller and may be more likely to wheeze in response to pollution," says Rice. "This may explain why pollution exposure was most consistently linked to asthma in young children.

The stronger link between lifetime pollution and asthma among school-age girls was somewhat surprising. According to Rice, "Future work will need to investigate whether girls are more susceptible to pollution than boys."

With the 2018 World Cup just around the corner, soccer players and coaches are preparing to perform at their best. A recent article proposes that soccer coaches should be empowered to make reliable assessments of player psychological characteristics, based on their behavior during matches and training. Published in Frontiers in Psychology, the article suggests that coaches, with their extensive experience, could provide unique insights into the psychological characteristics required for player success. Using coach assessments could help teams to foster talented players and enhance their performance and well-being.

Previous research has identified that psychological skills and traits are important in sporting success. Researchers are increasingly investigating the psychological characteristics that make for a successful mindset on the pitch, such as commitment, discipline and resilience.

Recognizing and measuring these characteristics allows teams to identify and foster talented players. Currently, some soccer teams ask their coaches to assess their players' psychological characteristics. However, these assessments involve scouting sheets that haven't necessarily been approved by sports psychologists and which may not cover the most relevant psychological characteristics.

So far, studies on player psychology have been mostly based on standardized questionnaires filled out by the players themselves. While this is undoubtedly valuable, players may be tempted to overrate their own performance or downplay psychological issues. So far, these studies have not yet resulted in guidelines that teams can easily put into practice to identify and assist talented players.

In the new article, researchers based at the German Sport University Cologne propose that soccer coaches could provide a unique perspective on player psychology. So far, sports psychology researchers have largely overlooked coaches as a source of information on player psychology.

"We see coaches as experts who have an intuition about the relevant psychological characteristics a talented soccer player should have or develop," says Lisa Musculus, a sports psychologist who wrote the article along with Dr. Babett Lobinger.

Through working with a variety of players with different temperaments and skill levels, coaches have unique insight into the characteristics of successful players. While players may overestimate their performance, previous studies have shown that coaches do not. In addition, coaches can more easily compare players to each other. The authors propose that coach assessments could complement standard questionnaires completed by the players themselves.

However, if coaches are to contribute in assessing player psychology, it is important that they make sound judgements about players' psychological characteristics.

"We see great potential in getting coaches involved in assessing psychological characteristics that are relevant for sports performance," says Musculus. "However, it is important that we provide them with support, so that their assessments can be objective, reliable and valid."

By including many practical suggestions in their article, the authors aim to facilitate researchers and coaches in making robust and accurate assessments. These include providing coaches with clear definitions and explanations of each psychological characteristic when they complete an assessment.

The authors also advise that researchers should consult coaches on the most appropriate questions and criteria to include when developing these tests and that sports psychologists should also be involved in the process.

"Sports psychology should be included in youth coach education programs, so that coaches get a better understanding of these issues," says Musculus.

The authors conclude their article by stressing that the benefits of assessing and fostering player psychology may extend beyond enhanced performances on the pitch, to increased player well-being and positive relationships among the squad.