Culture

This is the finding of new research, published in the journal BMJ Open, led by scientists at Imperial College London.

Burnout is a condition triggered by long-term stress and overload at work, and in particular is associated with emotional exhaustion, lack of empathy and connection with others, and feeling a lack of personal accomplishment. Although burnout can affect individuals in any career, it particularly affects those in those in high-stress jobs - with previous studies suggesting that doctors are twice as likely to suffer burnout compared to those in other professions.

The study, a collaboration between Imperial College London, KU Leuven in Belgium and the Royal College of Obstetricians and Gynaecologists, also revealed that 43 per cent of trainee doctors met the criteria for burnout.

The research, which is the largest UK study on this topic, used a well-accepted tool, called the Maslach Burnout Inventory, to measure burnout on over 3000 doctors. In addition, the research asked doctors specific questions about their physical and mental wellbeing, as well as how they practice medicine- focusing particularly on so-called defensive medicine. The research was carried out on doctors in the field of obstetrics and gynaecology - these specialists are responsible for treating women who are pregnant, delivering babies, as well as treating conditions such as ovarian and cervical cancer.

The study found 36 per cent of doctors met the criteria for burnout. The doctors who met the criteria for burnout were six times more likely to experience suicidal thoughts, four times more likely to report depression, and three times more likely to report anxiety, irritability and anger. They also suffered from sleep and relationship problems.

The work also revealed that doctors with burnout were four times more likely to practice 'defensively' - meaning a doctor may avoid difficult cases or procedures, over prescribe medications, or carry out more investigations or treatments than necessary, for fear of making a mistake or missing a diagnosis.

Previous studies have also linked burnout to lower standards of patient care and reduced patient safety explained Professor Tom Bourne, lead author of the research from the Department of Metabolism, Digestion and Reproduction at Imperial: "We found the results of this survey very worrying. The levels of burnout were high, particularly amongst younger doctors. This has serious implications for patients, as we know burnout reduces patient satisfaction, safety and standards of care.

"These results point to an environment in UK hospitals that makes staff unwell and less able to carry out their jobs safely. There is a clear need to address both the workplace and culture."

The research team caution that people who are suffering from burnout may have been more likely to respond to the survey, which may have affected the result - but equally people experiencing symptoms may have been less inclined to answer questions on the subject.

Professor Bourne explained there has been little research investigating levels of burnout in other medical specialities in the UK. However, US studies show it is prevalent in staff across all areas of medicine, and this situation is likely to be mirrored in the UK.

He explained these current findings add to increasing evidence that suggests the NHS needs to urgently investigate strategies for preventing burnout: "Improving our understanding of doctor burnout must become a priority. Reducing burnout will improve doctors' wellbeing with resultant improvements in staff retention, productivity and patient safety. The report adds critical evidence to the recent review into Doctors Wellbeing published a week ago by the General Medical Council in the UK."

Professor Bourne, a consultant gynaecologist, added: "The solutions lie in improving the environment doctors work in, and relate to reducing workload, rebuilding supportive teams, compassionate leadership, improving the values and culture of hospitals, and giving doctors more autonomy and fairness".

Dr Alison Wright, Vice President of the Royal College of Obstetricians and Gynaecologists, said: "The potential impact of workforce burnout is crucial to our national health service and to patient care. This important study provides compelling evidence that there is an urgent need to improve the workplace environment for doctors. We know burnout is associated with worse outcomes for patients, as well as a lack of empathy and rapport. It is vital the issue of burnout is addressed, so we can sustainably deliver the very best care for our patients.

"A key priority for the RCOG is to ensure the obstetrics and gynaecology workforce is properly supported. We have established a 'Supporting our Doctors' task Group, which includes a 'peer to peer' support service and a network of workforce champions to provide pastoral and practical support to doctors and employers.

"This task group advocates for the changes that need to be made to minimise burnout and attrition. These include all clinicians having acceptable working patterns, for their workload to be controlled, for adequate peer and senior support within teams and for leadership in hospitals to be more compassionate. This will require a real change in culture.

"The RCOG is collaborating with other Colleges, the GMC and government organisations, to understand and address the systemic issues which are associated with burnout so we can, both improve the wellbeing of doctors and the care we provide for women and their families."

Recently discovered immune cells called MAIT cells play a key role in group A streptococcal toxic shock, researchers at Karolinska Institutet in Sweden report. The results, which are published in the journal PNAS, have potential implications for the diagnosis and treatment of this life-threatening condition.

Group A streptococcus is a bacterium commonly found in the population and is the most common bacterial cause of mild throat infection (tonsillitis). However, the bacterium can also cause life-threatening conditions if it enters the blood or other tissue, where it can give rise to sepsis or toxic shock, conditions that develop rapidly and that are associated with a high mortality rate and, often, extensive tissue damage - hence the popular media epithet "killer bacteria".

Toxic shock occurs when the bacteria produce toxins called superantigens, which cause the immune cells to over-react and produce large amounts of cytokines - proteins/peptides whose normal function is to regulate the body's immunological and inflammatory response. Researchers at Karolinska Institutet now show that MAIT cells, a relatively recently discovered immune cell, play a fundamental role in the cytokine response to superantigens and group A streptococcus.

"MAIT cells are few in number but respond rapidly to group A streptococci to produce large amounts of cytokines," says lead author Johanna Emgård, doctoral student at the Department of Medicine, Karolinska Institutet (Huddinge). "This over-production of cytokines is called a cytokine storm and results in leaking blood vessels, hypotension and organ failure."

The researchers also show that MAIT cells are activated in patients during the acute phase of the infection.

"This discovery is important as it means that we've found a new potential target for diagnosis and treatment," says Anna Norrby-Teglund, professor at the same department and the study's last author. "This is particularly important given the characteristically rapid development of group A streptococcal toxic shock, for which early diagnosis and treatment is critical for the outcome of the infection."

The study is a collaboration between Anna Norrby-Teglund's research group and Johan Sandberg's research group at the Department of Medicine, Karolinska Institutet (Huddinge). The research was financed by the EU's seventh framework programme, Karolinska Institutet, the Swedish Research Council, the Swedish Cancer Society and the Canadian Institute of Health Research.

Publication: "MAIT Cells Are Major Contributors to the Cytokine Response in Group A Streptococcal Toxic Shock Syndrome". Johanna Emgård, Helena Bergsten, John K. McCormick, Israel Barrantes, Steinar Skrede, Johan K. Sandberg, Anna Norrby-Teglund. PNAS, online 25 November 2019, doi: 10.1073/pnas.1910883116.

PITTSBURGH, Nov. 25, 2019 - Though epigenetic disorders - diseases caused by faulty gene expression - are still rare overall, babies born using fertility treatments have up to an 11-fold higher risk of inheriting them. According to a new mouse study from the Magee-Womens Research Institute (MWRI), the problem likely lies with the technology, not the mother's age.

The study, published today in Clinical Epigenetics, found that fertility treatments caused epigenetic changes associated with Beckwith-Wiedemann, Silver-Russell and Angelman syndromes in mouse embryos. Surprisingly, maternal age itself had no such effect.

"Women of advanced maternal age might have one less thing to worry about," said lead author Audrey Kindsfather, a medical student researcher at MWRI. "We need clinical studies to back that up, but this is a promising animal model that clinical studies could be based on."

Women are increasingly delaying childbirth, and as a woman ages, so does her reproductive system. The odds of conception go down, while the odds of genetic disorders, such as Down syndrome, go up.

Maternal age might increase the odds of epigenetic disorders too, the researchers reasoned, which could explain the higher incidence of these rare diseases among children born through fertility treatments, since women using these technologies tend to be older. To dissociate these factors, the scientists turned to mice.

Kindsfather and colleagues grouped female mice by age, ranging from adolescence to the mouse equivalent of a 45-year-old woman. Some of the mice in each age group had hormone injections to kick ovulation into high gear or their embryos cultured in a Petri dish - procedures commonly involved in fertility treatments -- while control mice conceived naturally.

Then, the researchers quantified epigenetic changes in the mouse mothers' embryos by measuring the amount of DNA methylation - molecular locks - clasped around genes associated with epigenetic disorders, preventing them from being expressed.

Hormone therapy and embryo culture both disrupted DNA methylation in these critical spots. When these two procedures were used in combination, the effects were even stronger.

Maternal age, on the other hand, had no impact on DNA methylation patterns around these genes.

"It wasn't what we were expecting," said senior author Mellissa Mann, Ph.D., principal investigator with MWRI and associate professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh. "We know that as a woman ages, there are a lot of molecular changes happening to her eggs, so we thought that these changes could be leading to abnormal DNA methylation. We were quite surprised that it didn't."

Fertility treatments have come a long way since the first "test-tube baby" was born over 40 years ago, but this study highlights that there's still room for improvement.

"These are wonderful technologies, but not the same as spontaneously conceiving," Kindsfather said. "Lots more research needs to be done to improve fertility treatments."

ITHACA, N.Y. - New research reveals that community-based clinics and clinicians play an essential role in reshaping both mental health care for LGBT people and broader attitudes about sexuality and gender.

Stephen Vider, assistant professor of history in the College of Arts and Sciences, is a co-author with David S. Byers, assistant professor at Bryn Mawr College Graduate School of Social Work and Social Research, of "Clinical Activism in Community-based Practice: The Case of LGBT Affirmative Care at the Eromin Center, Philadelphia, 1973-1984," which was published Nov. 9 in American Psychologist.

Their paper uncovers the story of the Eromin Center, one of the first LGBT counseling centers in the United States, which was open in Philadelphia from 1973 to 1984. Eromin was a portmanteau for "erotic minorities."

Historically, LGBT people struggled to find mental health care that didn't treat divergence from sexual and gender norms as a mark of psychopathology. The authors show how Eromin's proactive stance not only provided support for people who needed mental health care but also advanced a new model of LGBT affirmative clinical practice.

They describe Eromin's approach as an example of what they call "clinical activism." Without pre-existing models or research to draw upon, Eromin clinicians improvised new therapeutic approaches, guided by their own ethics and experiences.

This improvisational and community-responsive approach to care, the authors argue, was used by many early LGBT counseling centers in the United States, in spite of national leadership and mental health policy that was slower to change.

"Most histories of LGBT mental health point to the removal of homosexuality from the 'Diagnostic and Statistical Manual of Mental Disorders' in late 1973 by the American Psychiatric Association as the crucial turning point in LGBT depathologization," said Vider. "Our research shows, however, the critical role of clinicians working in developing models of affirmative LGBT counseling."

Eromin, in fact, was founded six months before the APA decision.

Their paper, written with Amelia Smith, a social worker at the Mazzoni Center in Philadelphia, is part of an oral history and archival research project that Byers and Vider have been leading since 2015. The oral histories will be archived in Cornell University Library's Rare and Manuscript Collections as part of its Human Sexuality Collection.

The Eromin Center, the authors wrote, "framed the major problem facing LGBT people not as inherent psychopathology but as marginalization." One goal was to counteract the stigma and discrimination; another was to help clients achieve self-acceptance and develop personal strengths. Most of Eromin's counselors were gay or lesbian, and gave treatment rooted in their own experiences.

By 1977, more than 1,000 people had received care. Eromin also pioneered counseling and support services for transgender clients, and by the 1980s, was working to develop more programming for LGBT people of color.

The center closed in 1984, but the impact it and other LGBT clinics have had on counseling in the United States has been crucial, Vider said.

"The APA may have depathologized same-sex desire on paper," he said, "but it was clinicians in programs like Eromin who ultimately made self-acceptance possible."

Even after the APA decision, Vider said, many clinicians continued to treat same-sex sexuality and transgender identity as forms of mental illness that needed to be "cured." Eromin provided and modeled a critical alternative.

Byers said there is still need for change.

"Today, many clinical training programs, social service agencies and professional organizations work to some degree to affirm LGBT people and other marginalized identities, experiences and expressions," he said. "The care remains very uneven, though."

It can be especially difficult, he said, to access thoughtful and individualized mental health care related to transgender identities and experiences. Another challenge is a still-active network of clinicians who claim they can change a client's sexual orientation or gender expression.

Byers stressed the need for clinicians in the field to take a critical and anti-oppressive stance in their work, and for graduate programs and medical schools to empower new clinicians to be responsive to local needs. Byers said, "Today, social workers, psychiatrists and psychologists often fail to listen with an ear to the political aspects of their practice. We are not trained to work together with our clients or to be creative in the collaboration. However, clinicians today absolutely need to pursue new forms of clinical activism. The status quo in community-based mental health care is often ethically unacceptable."

At the same time, Byers said there are many clinicians engaging in clinical activism throughout the country right now, though with little recognition.

"Clinicians face systemic challenges," he said, "and lack of support while working with people with marginalized sexual orientations and gender identities; with individuals experiencing poverty, racism, misogyny or trauma; and in response to anti-immigrant and anti-refugee violence."

"One lesson of the Eromin Center is that change at the level of policy and guidelines is often not enough," said Vider. "Real and lasting change has to start within communities."

CORVALLIS, Ore. - Compounds from hops may combat metabolic syndrome by changing the gut microbiome and altering the metabolism of acids produced in the liver, new research at Oregon State University suggests.

The findings, published in Molecular Nutrition and Food Research, are a key advance in understanding how xanthohumol, a compound that contributes to hops' flavor, and its derivatives work. That is an important step toward improving the lives of the estimated 35% of U.S. adults who suffer from metabolic syndrome.

The study builds on earlier research at OSU that found xanthohumol, often abbreviated to XN, and two hydrogenated derivatives, DXN and TXN, can likely improve cognitive and other functions in people with the syndrome.

People are considered to have metabolic syndrome if they have at least two of the following conditions: abdominal obesity, high blood pressure, high blood sugar, low levels of "good" cholesterol and high levels of triglycerides.

A diet high in saturated fat and refined sugars causes chronic low-grade inflammation that contributes to the development of metabolic syndrome; the syndrome is associated with cognitive dysfunction and dementia as well as being a major risk factor for cardiovascular disease and Type 2 diabetes.

In the previous study, testing in a mouse model showed that XN, DXN and TXN improve glucose intolerance, insulin resistance and sensitivity to leptin - a hormone that tells you to feel full when you have eaten enough and also helps regulate energy expenditure. All of these changes are thought to be beneficial in the fight against metabolic syndrome.

In the most recent research, laboratory animals were given a high-fat diet exclusively, or a high-fat diet that included XN, TXN or DXN. Scientists then measured the compounds' effects on bile acids - bile is a fluid produced by the liver that helps with the digestion of fats - tissue inflammation and gut microbiome composition.

Results show that each of the hops compounds decreased the amount and diversity of microbes, reduced inflammation and changed bile acid metabolism - there was a reduction in secondary bile acid production and an increase of conjugated bile acids, which are indicators of improved energy metabolism, glucose metabolism and cholesterol metabolism.

"Changes in gut microbiota and bile acid metabolism seem to explain at least partially why XN and its derivatives lead to improvements in obesity and other aspects of metabolic syndrome," said the study's corresponding author, Adrian Gombart, professor of biochemistry and biophysics in the College of Science and a principal investigator at OSU's Linus Pauling Institute. "But this is not necessarily cause and effect - we need to know which changes to the microbiota are beneficial."

Collaborator Fred Stevens, professor of pharmaceutical sciences in the OSU College of Pharmacy and also a principal investigator at the Linus Pauling Institute, found it surprising that the benefits were accompanied by a decrease rather than increase in microbiome diversity.

Gombart noted that the hops compounds have previously been shown to have antimicrobial properties, "so they may be killing off certain bugs that aren't beneficial and preserving other ones that are."

Stevens added: "And further research will try to determine what the compounds are doing directly to the body in addition to what they're doing through the gut microbiota. These compounds must be having some direct effect on the body through their specific molecular size and shape."

The mystery of the role of people and climate in the fate of Australian megafauna might have been solved in a breakthrough study.

'Megafauna', giant beasts that once roamed the continent -- including wombat-like creatures as big as cars, birds more than two metres tall, and lizards more than seven metres long -- became extinct about 42,000 years ago. But the role of people in their demise has been hotly debated for decades.

For the first time, the research suggests a combination of climate change and the impact of people sealed the fate of megafauna, at least in south-eastern Australia. And that distribution of freshwater -- a precious commodity for animals and people alike as the climate warmed -- can explain regional differences in the timing at which megafauna died out.

The new study, led by a team of researchers from the ARC Centre of Excellence for Australian Biodiversity and Heritage (CABAH), analysed fossil data, climate reconstructions, and archaeological information describing patterns in human migration across south-eastern Australia.

The team developed and applied sophisticated mathematical models to test scenarios to explain regional variation in the periods during which people and megafauna coexisted.

"There has been much debate among scientists about what conditions led to this extinction event," said lead author Dr Frédérik Saltré, Research Fellow and Coordinator of the Global Ecology Lab at Flinders University.

"Resolving this question is important because it is one of the oldest such extinction events anywhere after modern human beings evolved and left Africa", he added.

The findings, published in Nature Communications, are the result of analysis and complex modelling based on data including more than 10,000 fossils and archaeological records. Using high-quality fossil data and archaeological evidence of human activity, the researchers were able to map regional patterns of megafauna extinction.

They developed sophisticated models to test the impact of factors including climate, water availability, and human activity on localised patterns of megafauna extinction.

The extinction pattern could only be explained by the combination of people sharing the environment and the reduced of availability of freshwater due to climate change.

"The regional patterns in extinction are best explained by the hypothesis that people migrated across Australia, exploiting lakes and other sources of drinking water connecting the drier regions in between," said co-investigator Professor Corey Bradshaw of the Global Ecology Lab at Flinders University.

"It is plausible that megafauna species were attracted to the same freshwater sources as humans, thus increasing the chance of interactions."

The new insight that human pressure and climate change work together to trigger species extinction is a "stark warning" for the immediate future of the planet's biodiversity facing even stronger climate and habitat disruption, Dr Saltré concluded.

People who offer prayers for victims of natural disasters may be less likely to donate to those victims, according to research by a University of Wyoming economist.

Linda Thunstrom, an assistant professor in the UW College of Business' Department of Economics, led the groundbreaking research to shed light on the controversial topic of the value of "thoughts and prayers" in response to natural and human-caused disasters. Her study, now available online at https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3272028, will appear in the Journal of Risk and Uncertainty in early 2020.

"The results suggest that the act of praying is a substitute for material help -- in other words, prayers crowd out donations, at least in some contexts," Thunstrom says.

In the study, Thunstrom conducted multiple, first-of-their-kind economic experiments on the topic. Three experiments focused on whether people, given the opportunity to donate to hurricane victims, would do so after they pray and think about the victims. A previous study -- conducted in conjunction with former UW sociology faculty member Shiri Noy, now with Denison University in Ohio -- placed actual economic values on thoughts and prayers through an economic experiment involving victims of Hurricane Florence in North Carolina last year.

The latter study received major national and international attention after it appeared in the journal Proceedings of the National Academy of Sciences earlier this year. That study found that, from the perspective of Christian hurricane victims, the monetary value of prayers by others on their behalf was significant. In contrast, atheists and agnostics were actually "prayer-averse," placing a negative monetary value on prayers on their behalf by others.

This new study found that people who prayed for hurricane victims before donating gave less than they would have otherwise: Because those who prayed believed that prayers improved the victims' well-being, they donated less. On the other hand, simply taking a moment to think about victims didn't have a significant effect on the level of donation. It should be noted that these results are not entirely conclusive, though: In one experiment -- in which possible donations were much smaller than in the other experiments -- prayers had no impact on subsequent donations.

"The result implies that victims of natural disasters may be financially worse off from people expressing their sympathy through the act of praying," Thunstrom says. "However, this does not mean that recipients of prayers are worse off in terms of welfare. It is entirely possible that a recipient of prayers assigns a positive (monetary) value to a prayer, which may or may not exceed the value by which monetary donations drop due to the act of praying."

The debate over the value of "thoughts and prayers" has come to the forefront as a result of the verbal responses of political and other leaders to mass shootings and natural disasters such as hurricanes and wildfires. Critics argue that expressing sympathy through thoughts and prayers is a meaningless gesture in response to tragedy -- and that, in some cases, it's an excuse to not take action.

Thunstrom's new article notes that previous research has found that religiosity is positively associated with behavior that benefits other people, such as volunteer work in the community. She also notes that intercessory prayers increase awareness and empathy. But, because religious people believe that prayer directly impacts other people's well-being -- in other words, that prayer is a "moral action" similar to a charitable donation -- prayers can act as a substitute for donations.

"The results suggest that calls for thoughts and prayers in response to major catastrophes -- whether conducted individually or by entire communities -- might affect, in unexpected and important ways, people's related behavior to benefit others," Thunstrom says, suggesting further research that examines contexts in which complementarity between prayers and donations could exist.

You're standing in the bread aisle, faced with an array of loaves with a variety of claims. There's low GI, multigrain, added vitamins, unbleached, gluten free... Which one do you buy? And what is the main influence on that decision - health, value, taste?

Australians spend more than $90 million a year on bread, so understanding the intricacies of our bread preferences is big business. Our choice of bread also influences our health, so policymakers are keen to know what might nudge us in healthier directions.

Researchers at the University of Technology Sydney (UTS) have developed a new marketing research tool that provides a deeper insight into how we choose between products that have multiple features and benefits, and what drives these preferences - and they've tested it on bread shoppers.

They surveyed Australian consumers who evaluated bread according to brand and product features such as type of flour, low GI, enriched with Omega 3, presence of seeds, grains, vitamins and minerals, expiry date, loaf size and price.

The results, just published in the Journal of Marketing Research, provide a fascinating insight into our bread buying behaviour. They reveal that brand is the biggest influence on our selection, with supermarket brands dominating the list (34%), followed by Helga's (23%), Abbott's (11%), and Tip Top (10%).

"A lot of bread manufacturers play around with product features and the claims they make on the front of pack, but what we found is that brand dominates consumers' decisions," says Associate Professor Paul Burke, Deputy Director of UTS Centre for Business Intelligence and Data Analytics.

"It seems that brands provide a short-cut to our preferences - so if we care about health we buy Helga's, or if our focus is value for money we buy a supermarket brand.

"Companies might advertise a product as 'low carb' or highlight the additional minerals and vitamins to improve perceptions around health. However, consumers judge the healthiness of a product mostly according to brand," he says.

As well as brand, the type of wheat was also an important factor, with more than half of those surveyed (52%) opting for wholemeal breads compared with 35% who bought white varieties and 10% who bought unbleached varieties.

"Brand and flour type dominated other considerations, including various key claims such as whether a product is promoted as being low GI, high fibre, or "stone-milled". The respondents also preferred breads that were larger, cheaper and had a longer expiration date," says Associate Professor Burke.

Value was also an important consideration, with nearly half of all shoppers surveyed buying bread on special, at an average discount of around 19% off the shelf price. Most shoppers bought either one or two loaves at a time.

After screening out those with allergies and other specific dietary requirements, the researchers found that only 1% of those surveyed reported regularly purchasing gluten-free breads, however this rejection was mostly due to perceived lack of value for money.

Associate Professor Burke says the new marketing research model disentangles multiple results to provide information about how each feature drives perceptions such as health and value. For example, Abbott's is perceived to be relatively healthy but is poorly positioned in terms of value.

"It's about the relative importance of attributes that drive perceptions and choices. It's those trade-offs that ratings scale based approaches do not always allow you to see in the consumer."

"Our method allows companies to understand how the market will respond to product alterations not just in terms of overall demand, but the reasons behind why that demand is shifting among certain segments," he says.

For policy makers the method also offers insights into potential policy failures. For example, consumers may agree that a certain ingredient or calorie count represents an unhealthy product, but that may not be a driving factor in their buying decision.

Associate Professor Burke also notes the new research method is not just suitable for understanding fast moving consumer goods such as bread. Manufacturers of products such as cars would also benefit from understanding how perceptions drive preferences.

"Car manufacturers offering new engine types need to understand that while the innovation may have perceived environmental outcomes, the same feature might create poor perceptions around power, performance, safety, value and resale value.

"When these other benefits dominate choices it makes no difference how environmentally friendly the car is - consumers will buy elsewhere," he says.

NEW YORK (November 25, 2019) -- Healthcare-associated infections (HAIs) related to the use of medical devices are more likely to be antibiotic resistant than HAIs that result from surgical procedures, according to a report from the Centers for Disease Control and Prevention's (CDC's) National Healthcare Safety Network (NHSN) published today in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

"Combating antimicrobial resistance is a top clinical and public health priority in the United States," said Lindsey Weiner-Lastinger, MPH, an epidemiologist at the CDC. "These data show that the threat of exposure to bacteria that are resistant to antibiotics extends across the nation. The data also serve as an urgent call for healthcare facilities and public health agencies to intensify their efforts to prevent the emergence and spread of antimicrobial resistance."

The report, which summarizes data from 5,626 facilities from 2015 to 2017, shows that resistance was consistently higher for device-associated HAIs than for the same bacteria identified after surgical procedures. Devices studied were not permanent implants but rather devices used for limited time in a hospital setting such as central lines, ventilators, and urinary catheters. For instance, 48 percent of tested Staphylococcus aureus isolated from device-associated infections were methicillin resistant (MRSA), compared to 41 percent among those isolated from surgical site infections; and 82 percent of tested device-associated Enterococcus faecium bacteria were resistant to vancomycin (VRE) compared to 55 percent among surgical site infections.

Researchers note that germs in adult and pediatric facilities varied by infection type and care location. The most common HAI bacteria among adult patients were Escherichia coli (18%), Staphylococcus aureus (12%) and Klebsiella (9%). A companion report on pediatric healthcare-associated infections, with data from 2,454 facilities, found the most prevalent pathogens among pediatric patients were Staphylococcus aureus (15%), Escherichia coli (12%), and coagulase-negative staphylococci (12%).

The data also show that bacteria associated with long-term acute care hospitals are more likely to be antibiotic resistant than those acquired in short-stay acute care hospitals; and HAIs in adult healthcare settings are more likely to be resistant than those in pediatrics.

NHSN collects and tracks data to identify problem areas in facilities, states, regions, and the nation, and to help measure the progress of prevention efforts.

Lastinger said the increasing availability of clinical and laboratory data in electronic form provides new opportunities to quickly identify resistance to antibiotic therapies and to inform antibiotic stewardship programs. Appropriate resources should be allocated to ensure proper infection prevention methods of devices and the environment across the healthcare continuum.

Environmental enrichment can partially correct miswired neurons in the visual pathway, according to research in mice recently published in eNeuro.

During normal development, neurons exit the retina and form connections in specific area of the lateral geniculate nucleus, a part of the brain involved in visual processing. In mice with a genetic mutation, the neurons land throughout the entire lateral geniculate nucleus in a thin, dispersed line. Such mapping errors lead to vision issues in adulthood.

Eggins et al. raised mice with genetic mapping errors in a standard cage or in an enriched environment with a variety of toys and stimulation. The mice living in an enriched environment from birth displayed less mapping errors in the lateral geniculate nucleus than those raised in standard cages. Mice without enrichment until adolescence or adulthood had the same mapping errors as the mice that lived in a standard cage.

Enrichment can counteract mapping errors, but within a strict critical period after birth. These findings point to the potential of using early childhood enrichment as a treatment for neurodevelopmental disorders rooted in miswired neurons, such as autism.

A comparison of mouse Alzheimer's disease models shows changes in the number of cells and the genes they express remain consistent throughout all stages of the disease. The new research published in eNeuro could reveal new targets for disease intervention and therapies.

Many studies have investigated how cells and genes change during Alzheimer's disease, but they haven't employed the same mouse models and statistical methods, making comparison and broader conclusions difficult. Zhuang et al. reanalyzed data from 10 previous studies in four types of mouse models of Alzheimer's disease. The research team sorted the samples into early and late Alzheimer's pathology and examined how cell types and gene expression changed.

The team identified consistent changes in early and late phase samples across the different mouse models. The early samples showed subtle but consistent changes in gene expression, including increased expression of genes involved in the body's immune response and cholesterol production.

The analysis provides additional support for the involvement of the immune system in early stages of Alzheimer's disease and increases understanding of early progression of the disease. The genes that are over-expressed in early stages could be potential targets for treatment and prevention of Alzheimer's disease.

ANN ARBOR, Mich. -- Eighteen pediatric heart centers were able to significantly reduce deaths and improve care for children with critical heart conditions after committing to transparent data sharing between one another, a new study suggests.

Postoperative mortality dropped by 24 percent among participating sites between 2014 and 2018, according to the Michigan Medicine-led research published in the Journal of the American College of Cardiology.

Improvements in perioperative care appear to be associated with hospitals' participation in the Pediatric Cardiac Critical Care Consortium, authors say. Launched by Michigan Medicine in 2013, PC4 aims to improve the quality of care for pediatric heart patients, including those who have surgery.

Researchers analyzed 19,600 hospitalizations at the participating sites in the PC4 clinical registry that included cardiac surgery.

"These changes in outcomes seem to reflect PC4's commitment to transparency between institutions and collaboration to share best practices," says lead author and cardiac intensivist Michael Gaies, M.D., PC4 founder and executive director and director of quality at the Congenital Heart Center at Michigan Medicine's C.S. Mott Children's Hospital.

"Hospitals are working together to create a culture of collaboration rather than competition. This work is having a tremendous impact on children and families battling critical heart disease."

Authors hypothesized that outcomes would improve after two years of participation in the collaborative during which they could evaluate their own outcomes and seek insight from high-performing PC4 hospitals.

Outcomes were compared between the two-year baseline period and all months after the baseline. In addition to declines in mortality rates, major complications dropped by 12 percent, time on a ventilator fell by 13 percent and length of stay in the ICU was down by 5 percent.

Researchers analyzed mortality, complications, and length of stay trends over the same time period at 17 comparable hospitals that were not part of PC4 and found no evidence of improvement at these hospitals. Authors note that these data strengthen the conclusion that improvement seen at the PC4 hospitals is more likely the result of participation in PC4, and not due to a secular trend in improvement across the field.

Learning from top-performers

Many children with critical pediatric and congenital cardiovascular disease require surgery in the newborn period or later in infancy. While outcomes for pediatric cardiac surgery have improved over several decades, the improvements appeared to be leveling off in the most recent era, Gaies says.

Mortality remains high for complex operations while postoperative complications result in morbidity that can affect survivors across their lifespan. Variations in outcomes also persist across hospitals, particularly for complex surgery.

"Our data told us there were opportunities to learn from each other to improve the quality of ICU care for babies and children who require heart surgery," Gaies says.

PC4 is modeled after similar collaboratives nationally and in the state of Michigan that work to reduce postoperative morbidity and mortality. A National Institutes of Health grant to the University of Michigan provided initial funds for PC4, but the initiative now relies on hospital and donor investments.

Member hospitals are required to share clinical outcome data through a registry that includes information about perioperative practices and outcomes that include postoperative mortality, complications, duration of mechanical ventilation, and length of stay.

More than 50 hospitals now contribute data to the registry, up from just six hospitals in 2013 when it began. Cases can be submitted in real-time immediately after a patient's discharge and participants have access to a web-based reporting platform that is updated each morning.

"Access to timely, actionable, and transparent clinical outcome data likely creates an important Hawthorne effect for hospitals that previously had limited opportunities to critically evaluate their quality of care," Gaies says. "Just being aware of your own performance has a powerful impact. We get motivated to change our practice when we see what is possible by our peers."

Participants regularly reach out to high-performing hospitals in areas of care in which they seek to improve and work with them to adopt successful practices at their own sites. Panels of experts from high-performing hospitals also explain their practices at PC4's annual meeting and through webinars.

There's still a lot of work ahead, Gaies says. Implementing and sustaining new practices that improve cardiac ICU care requires long-term commitment across multiple care teams.

But he and colleagues are encouraged by the difference the collaboration is already making.

"Institutions are sharing insight on practices and resources that underlie their excellent performance," Gaies says. "We are seeing experts across the country committed to working together to improve the care of kids with congenital heart disease. This collaboration reveals the very best of people who care for these children and families"

What The Study Did: This observational study investigated whether the continuity of hospitalists' work schedules, such as working more days consecutively compared to intermittently, was associated with outcomes for patients admitted to Texas hospitals.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

Authors: James S. Goodwin, M.D., of the University of Texas Medical Branch at Galveston, is the corresponding author.

(doi:10.1001/jamainternmed.2019.5193)

Editor's Note: The article includes funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

New York, NY -- Nov 25, 2019 -- A process called sporulation that helps the dangerous bacterium Clostridium difficile (C. difficile) to survive inhospitable conditions and spread is regulated by epigenetics, factors that affect gene expression beyond the DNA genetic code, researchers at the Icahn School of Medicine at Mount Sinai report. This is the first discovery that epigenetics regulate sporulation in any bacteria. Their research, published November 25th in Nature Microbiology, opens a new window to developing treatments for this devestating infection.

C. difficile infects nearly half a million people each year, causing severe diarrhea and killing just under 10 percent of those over 65 who contract it. Spores of the bacteria, which are spread through feces, are extremely resilient and can survive outside the body for weeks or months, infecting individuals who come in contact with contaminated surfaces.

Since the infection is so common and devastating, the C. difficile genome has been well studied, but Gang Fang, PhD, Associate Professor of Genetics and Genomic Sciences at Mount Sinai's Icahn Institute for Data Science and Genomic Technology and senior author of the study, says he and his colleagues took a different approach in their research. "We wanted to study beyond the genetic code of the bacteria and look at what chemical modifications were being made to the genome," said Dr. Fang. While these epigenetic chemical modifications, called methylation, do not alter the sequence of a gene, they can modify a particular gene's activity to render it more or less active, which has profound impacts on the organism's function.

Dr. Fang's team pioneered the use of third-generation DNA sequencing to map epigenetic factors in bacteria in 2012 and began studying C. difficile epigenetics in 2015. First, the team isolated C. difficile from fecal samples of 36 patients in the intensive care unit (ICU) at Mount Sinai Hospital who had been infected with it. They analyzed the samples and found one particular epigenetic pattern that was highly conserved throughout all the samples. Next, they checked about 300 C. difficile genomes from GenBank, a databank of genetic sequences run by the National Institutes of Health, and found that all shared the same gene responsible for the epigenetic pattern found in the ICU patients.

Suspecting this epigenetic pattern was playing a crucial role in the function of the bacteria, Dr. Fang's team collaborated on two further studies of C. difficile sporulation and mice infected with C. difficile, with the lab of Aimee Shen, PhD, Associate Professor of Molecular Biology & Microbiology at Tufts University Medical School and a co-senior author of the study, and with the lab of Rita Tamayo, PhD, Associate Professor of Microbiology and Immunology at the University of North Carolina, Chapel Hill. In one study with mice, the researchers found that when they inhibited the gene responsible for the epigenetic pattern, as much as 100 times less bacteria was present after 6 days compared to unaltered bacteria.

Dr. Fang says the findings in these studies underscore the significance of epigenetics in the study of bacteria and drug development for infection.

In addition to offering new epigenetic insights into the study of C. difficile and possible targets for drug development, Dr. Fang hopes this research will encourage further studies of the epigenetic characteristics of bacteria. "This is just the beginning of our understanding of epigenetic regulation in bacteria; there are still so many questions yet to be answered," said Dr. Fang. "We hope this exciting discovery will encourage further interdisciplinary collaborations to investigate epigenetics of bacteria and how we can use these new insights to develop life-saving treatments for infection."

TROY, N.Y. -- By folding snippets of DNA into the shape of a five-pointed star using structural DNA nanotechnology, researchers have created a trap that captures Dengue virus as it floats in the bloodstream. Once sprung, the trap - which is non-toxic and is naturally cleared from the body - lights up. It's the most sensitive test for the mosquito-borne diseases yet devised.

Published today in Nature Chemistry, this detection technique could be expanded to other viruses and adapted to kill the viruses it snares.

"This is more sensitive than any other way of detecting Dengue, beating the clinical test by more than 100 fold," said Xing Wang, the corresponding author of the study, an assistant professor of chemistry and member of the Center for Biotechnology and Interdisciplinary Studies (CBIS) at Rensselaer Polytechnic Institute at the time of the research. "The binding is tight and the specificity is high, enabling us to distinguish the presence of Dengue on the first day of infection."

A trap could be effective against many different viruses because, in order to infect their host, all viruses must first latch onto a cell wall and disgorge their genetic instructions into the cell. In 2016 research conducted at CBIS, Rensselaer chemist Robert Linhardt and Rensselaer chemical engineer Jonathan Dordick constructed a synthetic polymer configured to match a sequence of sialic acid latch points on the influenza virus. In the lung, influenza must bind to sialic acid to invade lung cells. The synthetic trap worked as a decoy, catching influenza before it latched onto lung cells.

The treatment reduced influenza A mortality in mice from 100% to 25% over 14 days. However, Linhardt and Dordick, who are both co-authors on the new study, expected that the synthetic polymer they had used as framework for the trap might prove toxic to the body and was unlikely to be accepted as a therapeutic.

Structural DNA nanotechnology -- an established method of folding strands of DNA into designed, customized geometric shapes and objects -- offered the research team a non-toxic, biodegradable alternative on which to construct a new trap, said Wang. The spherical surface of Dengue, like the closely related Zika virus, are studded with multiple latch points to catch a cell surface.

By superimposing various DNA nanostructural shapes onto images of the virus, the team settled on a five-pointed star -- they call it a "DNA star" -- as the best match between points on the DNA shape and latch points on the virus.

Wang took the lead on producing the DNA star. He also attached specific aptamers -- molecules the viral latches will bind to -- precisely to the tips and vertices of the star so that they would align with the distribution of the latches on the virus.

"You could overlay the star onto the virus and target a whole hemisphere of the sphere precisely," said Wang, now at the University of Illinois at Urbana-Champaign. "All the ligands that would target the antigens of this virus would overlay perfectly with a DNA star. If we were only able to make a connection in one place it would be a weak binder, but with ten aptamers connecting the virus to the star, we have a tight hold on the target."

Once bound to the virus, the DNA star starts to fluoresce, making it easily visible in a blood test.

"Using designer DNA nanoarchitecture as a diagnostic is a first step. The next step would be to kill the virus once it's bound. This can also be done by using a DNA origami nanoplatform, showing an even better biostability, to reconstruct a DNA star shape of aptamers," said Linhardt. "This is the first time people have used DNA nanostructure this way, but the technology is broad, and we can expect to see it used in many other applications."

The work is one of many promising strategies to emerge from CBIS.

"This transformative development combines a novel strategy with emerging technology for medical solutions that have eluded more conventional approaches. It's exactly the kind of research that the inter-disciplinary environment at CBIS is designed to enable, and is an excellent example of the caliber of work we are producing," said Deepak Vashishth, director of the CBIS.