Culture

Knee injuries can be a scourge to collegiate and pro athletes alike, but Penn State researchers say a single measurement taken by a clinician may help predict whether a person is at risk for knee instability.

The researchers found that measuring the distance between the tibial tubercle (TT) -- a bony bump on the tibia, commonly referred to as the shin, below the kneecap -- and the trochlear groove (TG), the joint in which the kneecap sits, using magnetic resonance imaging (MRI) was a reliable, precise and accurate diagnostic of problems with the kneecap moving out of its joint.

John Vairo, clinical associate professor of kinesiology, orthopaedics and rehabilitation, said that ideally, a person's kneecap will align with the midline of the leg -- neither too far to the left or the right. A greater TT-TG distance may suggest that the kneecap is off center and therefore more likely to slip out of the joint.

Vairo said the study -- recently published in Clinical Orthopaedics and Related Research -- may help clinicians refine how they use the measurement in their practice.

"We found that once this measurement reaches 13 millimeters, that individual may be more likely to experience problems with kneecap dislocation," Vairo said. "That being said, it's also not the only thing that should be taken into account if a surgeon is considering more aggressive types of treatment like surgery to decrease this distance, which requires significant recovery time."

According to the researchers, issues with kneecap stability are common, especially among women or people who engage in sports. They said it may not pose an issue for people who are not physically active, but more aggressive treatment -- like surgery -- may be required for athletes.

Vairo said that while clinicians had been using TT-TG distance to predict kneecap instability previously, best practices were unclear. He said that computed tomography (CT) scans have been most commonly used in the past, but some studies have suggested that TT-TG distances were measured differently depending on if a CT or MRI scan was done.

"A novelty to our study was that we wanted to test the reliability of this measurement using MRI in a setting that was more true to how it would be used in current day-to-day clinical settings," Vairo said. "This routinely consists of the measurement being performed one time, often by a surgeon who may be considering surgery."

The researchers used medical records from 131 patients -- 48 who had confirmed cases of kneecap dislocation and 83 controls with meniscal tears. Three clinicians with various levels of experience used the patients' MRI scans to measure TT-TG distance without knowing their diagnosis beforehand.

After analyzing the data, the researchers found that all three clinicians -- regardless of experience -- were able to reliably and precisely measure TT-TG distance. They also found that TT-TG distance tended to be greater in patients with kneecap instability.

"We also wanted to take it a step further and find an accurate distance that could be a good indication for determining likelihood of the condition," Vairo said. "Other studies have used basic descriptive statistics to suggest various distances that could be a potential threshold for instability, but this approach limits the measurement's application. We wanted to identify a specific number so that clinicians reading this paper can have practical information that they can judiciously use in patient care."

The researchers pinpointed 13 mm as a guideline for identifying patients who might be at risk for kneecap instability.

"A TT-TG distance of 13 mm was found two times more frequently in individuals that truly do have this condition than those who don't," Vairo said. "At the same time, there were individuals with this condition who had measurements smaller than 13 mm, driving home the importance of knowing the details associated with different imaging techniques and being aware of other contributing factors to instability. Our paper proposes that using specific MRI scans in a standardized fashion may help produce more accurate readings of this measurement."

In the future, Vairo said he and the other researchers will continue to explore factors that contribute to kneecap instability, including combining TT-TG distance with data about the depth and shape of the kneecap joint to better predict the condition.

MISSOULA - At first glance, there aren't many similarities between westslope cutthroat trout in Montana, wolves on Isle Royale National Park in Michigan and Australia's mountain pygmy possum, a mouse-sized alpine marsupial.

With all three, though, managers have attempted or explored the possibility of genetic rescue, a conservation approach that involves moving a small number of individual animals from one population to another to reduce genetic problems and decrease extinction risk.

Now, a new paper by University of Montana scientists examines the potential and uncertainties of attempting genetic rescue.
The peer-reviewed paper, published this month in the journal Trends in Ecology and Evolution, is a synthesis and summary of the state of genetic rescue. In this opinion piece, the authors focus on what is unknown about genetic rescue and where research could go in the future.

The authors define genetic rescue as a decrease in population extinction probability owning to gene flow, best measured as in increase in population growth.

"Inbreeding can cause genetic defects that lower survival," said Donovan Bell, paper co-author and a doctoral candidate in UM's W.A. Franke College of Forestry and Conservation. "In small populations, every individual becomes closely related and the resulting genetic problems put these populations at a higher risk of extinction. With genetic rescue, introducing unrelated individuals from another population can alleviate these genetic problems."

"It allows natural selection to increase the amount of beneficial genetic material introduced by managers," said co-author Zak Robinson, also a doctoral candidate in the forestry college. "It increases individual survival and lifetime reproductive success, which can increase the population's size and health."

As human development increases, so does fragmentation, and animal populations are increasingly splintered into smaller, isolated populations, the authors say.

"Even if fragmentation was to stop today, there are already millions of populations that are limited to small habitats," Robinson said. "In order to address issues with small, fragmented populations and maintain biodiversity, we're going to have to find ways to mitigate the impacts of inbreeding and the genetic problems it brings."

That's where genetic rescue comes in.

"Habitat fragmentation is incredibly common, and it's a huge problem for conservation," Bell said. "There are a few research groups that are strongly advocating that we start implementing genetic rescue in a much more widespread manner to address issues with habitat fragmentation. We think that genetic rescue is very valuable, but there is a lot left to understand about genetic rescue."

In their paper, Bell, Robinson and their co-authors focus on what is still unknown about genetic rescue and areas where future research could prove beneficial. Some of those big questions include: how long the effects of genetic rescue will last; under what conditions potential negative consequences could occur, including genetic swamping (the loss of unique local adaptations), and outbreeding depression (reduced fitness of offspring with evolutionarily divergent parents); how populations and individuals should be selected for genetic rescue attempts; and how advances in genomics - the study of genomes - fits into the whole picture.

The authors also draw attention to the relationships between genetic rescue and boots-on-the-ground conservation efforts - a pairing emphasized by successful genetic rescue stories like the Florida panther or Australia's mountain pygmy possum.

"Genetic rescue is unlikely to be a conservation silver bullet on its own, but instead needs to be attempted as part of a broader conservation strategy that includes habitat improvements," Bell said.

"Genetics and ecology are fundamentally intertwined," Robinson said. "There's a complex relationship between the genetic composition of a population and extinction. We need to understand this better in order to mitigate the part of extinction risk that's associated with the genetic composition of a population."

The synthesis closely ties to Bell and Robinson's ongoing research efforts. As part of their wildlife biology doctoral programs, each is running a genetic rescue experiment testing the conservation approach on wild fish populations.

In partnership with Montana Fish, Wildlife and Parks and with funding from the National Science Foundation, Bell is studying westslope cutthroat trout in Montana - Big Sky Country's state fish and currently listed as at-risk in Montana. On the east side of the Continental Divide, most of the populations that haven't hybridized with rainbow trout are isolated in small headwater streams, and there are concerns that these populations could suffer from genetic problems, Bell said.

Robinson's project, also funded by NSF, encompasses similar research on Eastern brook trout in his home state of Virginia, research he originally embarked on as an undergraduate student.

They hope these projects will help answer some of the questions they acknowledge in their latest paper.

"These are tests. We want to see how it works and see if it's ready for popular consumption for the state agencies managing isolated trout populations," Robinson said. "What we want to do is understand genetic rescue well enough so that managers can prioritize their activities and weigh it against other competing strategies on a limited budget."

"Attempting genetic rescue is a really promising conservation strategy, but there are still uncertainties we need to address in order to make it as useful as possible for conservation and also to increase confidence in using the strategy," Bell said. "It's actually implemented very rarely right now."

What The Study Did: In this secondary analysis of a randomized clinical trial, researchers examined the association of age with the benefit of intensive treatment to lower lipid levels with a combination therapy of simvastatin and ezetimibe compared to treatment with simvastatin alone after acute coronary syndrome in older patients.

Authors: Richard G. Bach, M.D., of Washington University School of Medicine in St. Louis, is the corresponding author.

(doi:10.1001/jamacardio.2019.2306)

Editor's Note: The article includes conflict of interest and 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 (July 17, 2019) -- Multiple violations of injection safety and infection prevention practices--from lack of handwashing to inappropriate re-use of medication vials--were identified after an outbreak of septic arthritis at a New Jersey outpatient facility in 2017, according to an investigation published today in Infection Control & Hospital Epidemiology, the journal for the Society for Healthcare Epidemiology of America. Investigators found 41 patients with osteoarthritis contracted the rare, painful infection following injections in their knee joints, including 33 who required surgical removal of damaged tissue.

"This large, costly outbreak highlights the serious consequences that can occur when healthcare providers do not follow infection prevention recommendations," said Kathleen Ross, an epidemiologist with the New Jersey Department of Health. For 31 affected Medicare patients alone, charges claimed for treatment topped $5 million.

Following initial reports of three cases from a local hospital to state and local health departments and multiple complaints directly to the facility in March of 2017, the facility voluntarily stopped performing procedures. A state infection prevention assessment team identified 41 cases along with multiple breaches of recommended infection prevention practices, including inadequate hand hygiene, unsafe injection practices, and poor cleaning and disinfection processes.

After collecting medical records and self-reported data, the team of medical and public health professionals from state and county health departments, along with the New Jersey Division of Consumer Affairs, conducted an unannounced visit to the facility. The site visit included staff interviews, reviews of medical records, evaluation of regulated medical waste handling, and observation of mock procedures performed by the staff while the facility was closed.

The assessment team found multiple breaches of proper infection prevention and injection safety practices, including the lack of handwashing stations or alcohol-based rub in the exam rooms, exposed syringes, syringes with injectable substances drawn up to four days in advance, and inappropriate handling and re-use of single-use and multi-dose vials. In addition, exam tables where injections occurred were cleaned "at most" once a day, while surface cleaning prior to each preparation is recommended unless a clean barrier is used.

"Nationally recommended infection prevention and control practices are applicable to all settings in which health care is provided; however, outpatient settings sometimes fail to provide the infrastructure and resources needed to support infection prevention activities, and often lack regulatory oversight," said Ross.

Before the facility re-opened, state officials provided recommendations from the Centers for Disease Control and Prevention's 2016 Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care. An infection prevention consultant was recommended to review practices and assist with changes. No additional cases were reported after the prevention recommendations were implemented.

Further research is needed to identify how to best provide infection prevention training and education to healthcare providers in outpatient settings, Ross said. Infection prevention training should be emphasized at all levels of professional training for all healthcare personnel upon hire and on an ongoing basis, with oversight to ensure competency.

"Outbreaks related to unsafe injection practices indicate that certain healthcare personnel are either unaware, do not understand, or do not adhere to basic principles of infection prevention and aseptic techniques, confirming a need for education and thorough implementation of infection prevention recommendations," Ross said.

EAST LANSING, Mich. - Michigan State University researchers have found that many stroke patients feel unprepared when discharged from the hospital. Their caregivers feel the same.

But when a home-based support network using social work case managers and online resources is put into place, quality of life and confidence in managing one's health improve, according to a new study published in the American Heart Association's journal Circulation: Cardiovascular Quality and Outcomes.

Developed by MSU, the Michigan Stroke Transitions Trial, or MISTT, tested three different support strategies involving 265 recovering stroke patients and 169 caregivers, to see which worked best for the hospital-to-home transition.

The study began with a series of focus groups conducted before the clinical trial where MSU researchers asked stroke patients and caregivers about what worried them most.

"Many of the participants said they left the hospital not really knowing what to do when they got home," said Michele Fritz, an epidemiologist and co-author, who worked with lead author Mathew Reeves in MSU's Department of Epidemiology and Biostatistics.

According to Fritz, 72% of stroke patients felt unprepared to go home, 91% were worried about having another stroke and 82% didn't fully understand their medications, such as when to take them and what dosage they needed.

"This caused a lot of anxiety and worry," she said. "These patients get great care when they're in the hospital, but once they get home, they're often lost. It was important for us to really understand what mattered to them and then figure out what kind of support structure could alleviate the worry."

During the study, participants were chosen at random to receive the usual post-hospital care that exists today. This includes leaving the hospital with standard stroke education materials, follow-up medical information, and referrals to out-patient doctor visits and rehabilitation services, if needed.

Another group was randomly assigned a social work case manager who offered emotional and practical support for up to 90 days after leaving the hospital. The remaining group of participants had access to the same case manager but were also given access to a patient website. The site, developed by the MISTT research team, provided unlimited access to stroke education and support resources, including information on stroke prevention and recovery, useful tips to manage medications, and information on community-based services and resources.

In total, 160 patients worked with a social work case manager. The three most common concerns included:

Nearly 70% needing additional information about stroke

More than half wanting help understanding how to prevent another stroke

Slightly more than one-third having financial concerns

Patients with a case manager and the website reported significantly greater improvements in physical health by the end of the study compared to those who had the traditional care. They also said they were more confident in taking control of their care. Those with access only to the case manager also reported some improvements but results were not as strong.

"When you add the website into the mix, we have better results," Fritz said.

However, some patients still struggled with depression, regardless of what support program they had.

"This is an area we need to look further into," Fritz said. "It could mean we need more time to improve participants' mental health. It's all complex to measure, but something we will continue to figure out in future studies."

It’s a case of grand larceny that could lead to new fuels and cleanup chemicals. Ten species of red algae stole about 1 percent of their genes from bacteria to cope with toxic metals and salt stress in hot springs, according to a study in the journal eLife.

These red algal species, known as Cyanidiales, also stole many genes that allow them to absorb and process different sources of carbon in the environment to provide additional sources of energy and supplement their photosynthetic lifestyle.

“The role of stolen genes in eukaryotes, which include most living things such as algae, has been hotly debated and many think it is unimportant and plays little to no role in their biology,” said co-author Debashish Bhattacharya, a Distinguished Professor in the Department of Biochemistry and Microbiology at Rutgers University–New Brunswick. “Our robust genome data provide the first major evidence that this is a false narrative and that adaptation to a challenging environment can be directly facilitated by stolen genes.”

Finding such phenomena in nature inspires scientists to figure out how gene theft happens, and they can use these rules of nature to develop novel genetic engineering methods in the lab to benefit humans. This can be done by designing algae that produce fuels or chemicals that can clean up polluted sites because Cyanidiales can process toxic compounds and metals such as arsenic and mercury, according to Bhattacharya, who works in the School of Environmental and Biological Sciences.

In the new study, the scientists generated 10 novel Cyanidiales genomes in the genus Galdieria that thrive in hot springs such as at Yellowstone National Park, despite high temperatures and highly acidic conditions. The goal was to determine whether these algae adapted to their extreme environment by stealing genes from resident, pre-adapted bacteria that made them resistant to the stresses. Genome analyses showed that about 1 percent of the red algal genes came from bacteria.

The next steps are to build genetic tools to study the red algal species and conduct more lab tests to determine if they turn on bacterial genes, as expected, under stress. Julia Van Etten, a doctoral student in the Bhattacharya lab, recently received a three-year NASA award to conduct these studies with Cyanidiales.

Little is known about how seabirds catch their food outside the breeding season but using modern technology, researchers at the University of Liverpool and the Centre for Ecology & Hydrology have gained new insight into their feeding habits.

Seabirds, including puffins, are often elusive and spend much of their lives at sea, feeding exclusively there. The period outside of the summer breeding season is particularly mysterious as the birds spend their time far away from land.

Using depth recorders, researchers compared the feeding behaviour of puffins with two closely related species, guillemots and razorbills, to find out how deep and how long they dive for during the non-breeding period.

They fitted loggers to seabirds breeding on the Isle of May National Nature Reserve in south-east Scotland. These birds were then recaptured the following breeding season, when they returned to land again after months away at sea.

Puffins are excellent divers and, in a similar way to penguins, use their wings to "fly" underwater to catch their prey.

Yet the study found that despite this great diving ability, both common guillemots and razorbills can dive for even deeper and longer than puffins can and continue to do so outside the breeding season. As well as these important species differences, the study also found that the diving of all three species changed over the course of the year.

Lead author of the study, Ruth Dunn, a PhD student in the University's School of Environmental Sciences, said: "Whilst we already knew that these birds are able to dive to great depths during the breeding season, in this study we found that after they left the breeding colony they didn't dive as deeply as expected, often reaching depths of less than 15 meters, possibly because they were catching different prey.

"Despite these shallow dives, birds were very busy, particularly in in mid-winter when they were working harder than in the autumn and spring."

Researchers also found that some birds were busier than others. Immediately after leaving the breeding colony, guillemot and razorbill fathers both dived more than their female partners.

This is because male parents accompany their chicks to sea and continue to feed it for several weeks after the breeding season has ended. Male birds therefore had to dive more frequently in order to catch enough fish to not only feed themselves, but to also meet the nutritional demands of their growing chicks.

In contrast with the other species, puffin chicks go to sea on their own. Therefore, the adults dive at a similar intensity throughout the post-breeding period, because there is not another hungry seabird beak to feed.

Francis Daunt of CEH, a co-author on the study, said "These insights into the winter feeding behaviour of puffins are extremely valuable since this species has shown marked declines in recent years, linked to higher mortality rates of adult birds in certain winters. These data show that the middle of winter is when birds are working hardest, which suggests that over-winter survival may be closely linked to the ability to find sufficient food."

Oxidative stress could be a driving force in the spreading of aberrant proteins involved in Parkinson's disease. This is the result of lab studies by researchers of the German Center for Neurodegenerative Diseases (DZNE). The findings are published in the "Journal of Clinical Investigation".

Parkinson's is a neurodegenerative disease with clinical manifestations that include motor (e.g., tremor and slowness in movements) as well as non-motor (e.g., sleep disorders and depression) symptoms. At the microscopic and pathological levels, the disease is characterized by accumulation of abnormal intraneuronal inclusions. They are formed as a result of aggregation of a protein called "alpha-synuclein". In the course of the disease, these inclusions progressively appear in various brain regions, contributing to the gradual exacerbation of disease severity. The mechanisms behind this advancing pathology are poorly understood. Research by DZNE scientists now indicates that "oxidative stress", i.e. an excessive and uncontrolled production of reactive oxygen species, could play an important role in the pathological spreading of alpha-synuclein. The findings are based on in-vivo studies with mice and in-vitro experiments in cultured cells.

"Oxidative stress has long been considered to be involved in the pathogenesis of Parkinson's disease. Our work, however, reveals a new intriguing mechanism that may link oxidative stress to disease development. We show that under oxidative stress the propensity of alpha-synuclein to 'travel' from one neuron to the other is significantly enhanced, thus facilitating the exchange of harmful protein species, occurrence of pathology and the spreading of this pathology throughout the brain," said Professor Donato Di Monte, a senior DZNE scientist, who headed the current research.

He adds, "Although in our study we induced oxidative stress artificially in laboratory models, we know that increased production of deleterious oxygen species could occur in Parkinson's brain. It might be caused by a variety of conditions, such as genetic mutations and environmental exposures and might be related to the aging process itself, as some of the cellular mechanisms counteracting oxidative stress decline with age. Parkinson's is an age-related disease, making it quite likely that aging brain cells would become more vulnerable to pathological processes involving oxidative stress."

Experimental setting

In a series of experiments, Di Monte and colleagues studied mice that overproduced alpha-synuclein in a specific brain region, namely the dorsal medulla oblongata, known to be a primary target of alpha-synuclein pathology in Parkinson's disease. Under this condition, the researchers were able to show oxidative stress, formation of small alpha-synuclein aggregates (so called oligomers) and neuronal damage. Increased production of alpha-synuclein also led to its "jump" from donor neurons in the medulla oblongata into recipient neurons in neighboring brain regions that became affected by progressive alpha-synuclein accumulation and aggregation. Interestingly, treatment of mice with paraquat, a chemical agent that generates substantial amounts of reactive oxygen species and thus triggers an oxidative stress, exacerbated alpha-synuclein pathology and resulted in its more pronounced spreading throughout the brain.

"Our findings support the hypothesis that a vicious cycle may be triggered by increased alpha-synuclein burden and oxidative stress," Di Monte said. "Oxidative stress could promote the formation of alpha-synuclein aggregates which, in turn, may exacerbate oxidative stress. Jumping from neuron to neuron, this toxic process could affect more and more brain regions and contribute to progressive pathology and neuronal demise."

Abnormal proteins

The precise mechanisms underlying enhanced neuron-to-neuron transfer of alpha-synuclein under oxidative stress are not fully understood. However, more detailed analyses by Di Monte and colleagues, including in-vitro experiments, revealed formation and accumulation of abnormal forms of alpha-synuclein that were oxidized and nitrated as a result of oxidative stress. These abnormal protein species were found to be particularly mobile and more prone to travel from donor to recipient cells.

"Identification of toxic alpha-synuclein species with high propensity to aggregation and spreading bears significant implications," Di Monte said. "They could be targeted for therapeutic intervention that may prevent early disease development and/or counteract the progression of pathology at later disease stages."

The concept of work-life balance and its relation to the satisfaction that individuals and groups express regarding the quality of their lives have attracted the attention of policy makers, labor economists, and others. Life satisfaction is central to the general happiness and health of a society or nation. In a new study published in Journal of Happiness Studies, examined data from 34 Organization of Economic Co-operation and Development (OECD) countries and appraised the effects of different factors on the life satisfaction of both women and men in an effort to close some of the gaps in the existing research on the topic.

In recent years, work-life balance has become a major focus in industrialized economies for both organizations and their employees. In a brief survey of the existing literature, Prof Hideo Noda points out, "Many of the existing studies on work-life balance issues have used micro-level data," whether in terms of company size, gender, management level, stages of individuals' career, and so forth. He adds, "Because the implementation of work-life balance policies is an international trend in many 'developed countries,' identifying common characteristics across developed countries using internationally comparable data has the potential to yield findings that are beneficial for many countries, rather than being limited to just a few countries."

Accordingly, Prof Noda assembled data from the Organization of Economic Co-operation and Development (OECD) Better Life Index in an effort to develop a "macro-level" perspective on "life satisfaction elasticity," which is a measure of changes in life satisfaction resulting from changes in efforts to improve work-life balance. Over a database representing both women and men in 34 OECD countries, Professor Noda analyzed the effects of other factors: self-reported health, long-term unemployment, and income inequality.

Prof Noda mentions that previous studies have taken an economic approach and have concluded that, in manufacturing firms, for example, efforts to improve work-life balance, including the introduction of "family-friendly" practices, correlated with improved productivity and life satisfaction. One sociological study using data from European countries found, perhaps unsurprisingly, that working hours correlated with "work-life conflict" or "work-family conflict." A similar European study for found a similar impact of working hours, with Norway and Finland exhibiting the lowest levels of negative impact. Another, larger study of 25 European countries found that workplace autonomy and flexibility varied widely in the impact on work-life with most negative impact in Eastern European countries, along with the UK, Ireland, Spain, and Italy. Finally, several legal studies have described a wide variety of work-life-related practices: family leave, childcare, and labor standards are most favorable in Canada and the European Union; and Japan has an extensive legal framework that supports families, but has yet to address the traditional division of labor according to sex, with men working and women tending to domestic responsibilities.

Prof Noda sought to increase the number of countries included in his study sample and chose the following measures: leisure and personal time; self-reported health; and long-term unemployment. Respondents were asked to score their quality of life on a scale of 0 (worst possible) to 10 (best possible). The data generated were analyzed separately for women and men.

Leisure and personal time--the indicator for work-life balance--was highest among European Union member countries, with Norway and Denmark scoring notably high on life satisfaction as well as leisure and personal time. Over all 34 countries, scores were similar for women and men.

Prof Noda also found a rough correlation between GDP and life satisfaction in higher-GDP countries, e.g., EU countries, New Zealand, Australia, Israel, Canada, and the United States.

Prof Noda then turned to income inequality, as measured "within-country" or domestic (among the residents of individual countries) and "between-countries," i.e., international (comparing individual countries with the OECD aggregate). From 2002 to 2005, between-country inequality increased somewhat while within-country inequality showed a more significant increase, leaving Prof Noda to conclude that the rise in international inequality was largely the result of increasing within-country inequality. When income inequality is included in the analysis (Noda's "extended model") the additional factor did not have a meaningful impact. While it is perhaps obvious, as Prof Noda writes, "For people with low levels of happiness . . . income inequality is a serious problem . . . we may not find a significant association between actual income inequality and life satisfaction."

One surprising finding of Prof Noda's study is that although work-life balance accommodations are usually aimed at women's concerns, men, in fact, demonstrate a higher elasticity, especially for personal and leisure time. This suggests that the time devoted to leisure and personal care is more important to men than it is to women.

In the future, policies that enhance individuals' life satisfaction can play a major role in improving both productivity and the general well-being of a population. Prof Noda maintains, "The findings of this study could provide useful suggestions for labor policy design in OECD countries." On the other hand, although income inequality did not register as statistically significant, more research, accounting for additional variables, may be necessary.

COLUMBUS, Ohio - Sorry, marijuana moms and dads: Using pot may not make you a more relaxed parent, at least when it comes to how you discipline your children.

A study of California parents found that current marijuana users administered more discipline techniques of all kinds to their children on average than did non-users. That includes everything from timeouts to, in some cases, physical abuse.

"The acceptability of marijuana is growing in the United States and with that, more parents feel free to use the drug, sometimes even in front of their children," said Bridget Freisthler, co-author of the study and professor of social work at The Ohio State University.

"Some parents claim it makes them a better, more relaxed parent, but that may not be the case."

The effect of marijuana use on parenting is a relevant concern: A 2017 survey from Yahoo News and Marist College found that 54 percent of adults who use marijuana in the United States are parents. A majority of those parents have children under the age of 18. Some groups of "marijuana moms" claim that use makes them better parents.

The results of this new study suggest that marijuana users - who are nearly always (92 percent of the time) also alcohol users - are trying to control their kids more than non-users, Freisthler said.

"It appears that users may be quicker than other parents to react to minor misbehavior," she said.

"We can't tell from this study, but it may be that parents who use marijuana or alcohol don't want their children to spoil the buzz they have, or bother them when they have a hangover."

Freisthler conducted the study with Nancy Jo Kepple of the University of Kansas. Their results were published online this week in the Journal of Social Work Practice in the Addictions.

The researchers interviewed 3,023 randomly selected California parents of children 12 years old or younger by telephone in 2009. They asked participants about their recent use (in the past year) and past use (a year or more ago) of alcohol, marijuana, methamphetamine and other drugs.

They also asked how often the parents used non-violent discipline (such as timeouts or taking away privileges), corporal punishment (such as spanking) and physical abuse (such as hitting a child with a fist).

This is one of the first studies to look at how use of specific types of substances are related to a variety of parental discipline practices in the general population, Freisthler said.

The findings revealed that parents who used marijuana in the past year tended to use more of all types of discipline compared to non-users, even after taking into account a variety of other factors that could impact use of discipline, such as parental stress and depression and child and parent demographics. The same was true of alcohol users.

Parents who had used alcohol or marijuana in the past, but were not at the time of the research interview, also applied most types of discipline more often than did non-users.

And the more substances that parents used, the more often they disciplined their children in all types of ways, according to the study. For example, parents who reported using the most substances practiced physical abuse at a rate about 1.45 times greater than those who used only one substance.

Results showed that the annual frequency of physical abuse was 0.5 times higher among parents who used both alcohol and marijuana in the past year, compared to those who consumed only alcohol.

"The use of several different kinds of substances certainly is a warning sign that parents may be relying more heavily on discipline to control their children," she said.

Freisthler said this study shows that while marijuana use has become more mainstream and is legal in more states, there is still need for caution.

"Marijuana use is not risk-free. It affects a lot of behaviors, including parenting."

Researchers at Boston Children's Hospital report creating the first human tissue model of an inherited heart arrhythmia, replicating two patients' abnormal heart rhythms in a dish, and then suppressing the arrhythmia with gene therapy in a mouse model. Their work, published in two papers in the July 30 print issue of the journal Circulation, opens the possibility of developing single-dose gene therapy treatments for inherited arrhythmias, and perhaps more common arrhythmias such as atrial fibrillation.

"Our hope is to give gene therapy in a single dose that would work indefinitely," says Vassilios Bezzerides, MD, PhD, an attending cardiologist in the Inherited Cardiac Arrhythmias Program at Boston Children's Hospital who was involved in both studies. "Our work provides proof-of-concept for a translatable gene therapy strategy to treat an inherited cardiac arrhythmia."

The two studies focused on catecholaminergic polymorphic ventricular tachycardia (CPVT), a leading cause of sudden death in children and young adults. The arrhythmia is typically triggered by exercise or emotional stress, and first becomes apparent at an average age of 12, often as a sudden loss of consciousness.

Current treatment consists of drugs such as beta-blockers and flecainide, surgery to disconnect nerves innervating the left side of the heart, an implanted cardioverter-defibrillator (which can lead to life-threatening complications in CPVT), and simply having children exercise as little as possible.

"Treatments for CPVT are currently pretty inadequate: 25 to 30 percent of patients will have recurrent life-threatening arrhythmias despite treatment," says Bezzerides.

Building arrhythmic tissue

One study, published online by Circulation July 17, used tissue engineered models to investigate how CPVT works at the cellular and molecular level. It was led by William T. Pu, MD, of Boston Children's Hospital and Kevin Kit Parker, PhD, of Boston Children's and Harvard's School of Engineering, Arts, and Sciences (SEAS).

Working with the Inherited Cardiac Arrhythmias Program, led by Dominic Abrams, MD, MBA, the researchers obtained blood samples from two patients at Boston Children's Hospital who had CPVT caused by separate mutations in RYR2, the gene linked to most cases of CPVT. RYR2 encodes a channel that enables cells to release calcium -- the first step in initiating a heart contraction.

The scientists then reprogrammed the patients' blood cells to become induced pluripotent stem (iPS) cells, capable of making virtually all cell types. From these, they made cardiomyocytes (heart muscle cells) carrying the CPVT mutations and used them to construct models of heart-muscle tissue.

"The cells were seeded on an engineered surface so that they lined up in a specific direction similar to how heart muscle is organized," explains Pu, who is director of Basic and Translational Cardiovascular Research at Boston Children's. "The cells have very abnormal beating individually, but after assembly into tissue, they beat together, better modeling the actual disease. That's why tissue-level models are important."

Exercise test in a dish

Using a so-called optogenetic system, the team then applied blue light to one end of the tissue to activate the cells. This created an impulse that moved along the sheet of cells to produce a contraction. Using this system, they created an "exercise test in a dish." To simulate exercise, they added the drug isoproterenol (similar to the stress hormone adrenaline) and applied infrared light to initiate faster heartbeats.

This testing helped reveal CPVT's underlying mechanisms. When healthy heart tissue underwent the exercise test, calcium moved through the tissue in even waves. But in tissue models made from patients with CPVT, calcium waves moved at varying speeds, and in some parts of the tissue not at all, resulting in an abnormal circular motion known as re-entry -- much like what happens in real life.

"When we paced the cells faster, the CPVT tissue sustained re-entrant arrhythmias, whereas normal tissue could handle it fine," says Pu.

To understand how stress makes CPVT patients vulnerable to life-threatening arrhythmias, Pu, Parker, and colleagues identified signaling molecules that are activated by adrenaline, and then used drugs and CRISPR/Cas9 genome editing to selectively inhibit or modify them.

Through this strategy, they found that in healthy heart tissue, an enzyme called CaM kinase (CaMKII) chemically modifies RYR2, triggering the heart-muscle cells to release more calcium. In CPVT cells, this modification combines with the inherited RYR2 mutation to cause excessive calcium levels in cells, which precipitates arrhythmias.

"Nature designed CaMKII as part of the fight-or-flight response," explains Pu. "When you get excited, you release more calcium so the heart can beat faster. But when RYR2 is mutated, the channel is leaky, so the cell releases way too much calcium, which causes arrhythmia."

When the researchers blocked the CaMKII modification, they eliminated the arrhythmias in the tissue model. They got the same effect when they blocked CaMKII itself with the peptide AIP, a potent and selective CaMKII inhibitor.

"The coupling of iPS technology and organs on chips offers new opportunities for studies in precision medicine and the benefit of patients," notes Parker. "Our vision is to use these technologies to screen patients with rare diseases for clinical trial enrollment. By replicating the patient's disease in vitro, we can test candidate therapies on the patient's disease and measure safety and efficacy, so that the right patients get tested with the right drug."

Inhibiting CaMKII with gene therapy

Because the CaMKII enzyme acts on many tissues beside the heart -- and is required by the brain for memory formation -- the team wanted to be able to inhibit CaMKII in the heart specifically. In a separate study, published online by Circulation on June 3, a team led by Bezzerides and Pu tested a gene therapy approach in a mouse model of CPVT.

They engineered a special virus which, injected into mice with CPVT, selectively travelled to the heart and delivered AIP. Testing showed that AIP was expressed in about 50 percent of heart cells, enough to suppress arrhythmias, but not significantly expressed in non-heart tissues including the brain.

The researchers now plan to refine their gene therapy strategy and test it in a large animal model and eventually in patients with CPVT, likely in collaboration with other medical centers.

A general approach to heart disease?

Bezzerides and Pu believe the therapy could be effective for patients with CPVT caused by a variety of RYR2 mutations (more than 160 mutations have been reported). And they believe their overall strategy of inhibiting CaMKII in the heart could help treat more common causes of heart disease.

"CaMKII is not needed for normal heart function, but it becomes activated in many forms of heart disease," says Pu. "In mouse models of many forms of heart disease, such as ischemic cardiomyopathy, atrial fibrillation, or hypertrophic cardiomyopathy, chronic CaMKII activation is detrimental. It is possible that our gene therapy approach to CaMKII inhibition could improve outcomes in these other types of heart disease."

More "intensive" beekeeping does not raise the risk of diseases that harm or kill the insects, new research suggests.

Intensive agriculture - where animals or plants are kept crowded together in very high densities - is thought to result in higher rates of disease spreading.

But researchers from the University of Exeter and the University of California, Berkeley found this is not the case for honeybees.

Their study modelled the spread of multiple honeybee diseases and found that crowding many colonies together was "unlikely to greatly increase disease prevalence".

However, the research only applies to existing honeybee diseases - and the findings suggest intensive beekeeping could accelerate the spread of new diseases.

"Crowding of animals or crops - or people - into minimal space usually increases rates of disease spread," said Lewis Bartlett, of the University of Exeter and Emory University.

"We carried out this study because beekeepers were worried about this - especially given the many threats currently causing the decline of bees.

"To our surprise, our results show it's very unlikely that crowding of honeybees meaningfully aids the spread of diseases that significantly harm honeybees.

"Honeybees live in close proximity to each other naturally, and our models show that adding more bees does little to raise disease risk.

"So, beekeepers don't need to worry about how many bees they keep together as long as there is enough food for them.

"The key is not whether they encounter a disease - it's whether they are fit and healthy enough to fight it off."

Although the paper says intensification of beekeeping does not boost diseases among honeybees, Bartlett points out that intensive agriculture - especially use of pesticides and destruction of habitats - harms bee species including honeybees.

Giving credence to the saying, "While the cat's away, the mice will play," a new study indicates that pumas and medium-sized carnivores lie low when they sense the presence of humans, which frees up the landscape for rodents to forage more brazenly.

Humans are top predators of many wildlife species, and our mere presence can create a "landscape of fear," according to researchers at the University of California, Santa Cruz. Fear of humans suppresses the movement and activity of pumas, bobcats, skunks, and opossums, which benefits small mammals. As their own predators respond to their fear of humans, deer mice and wood rats perceive less risk and in turn forage for food farther away and more intensively, they found.

The new study, "Fear of Humans as Apex Predators has Landscape-scale Impacts from Mountain Lions to Mice," appears in the July 17 online edition of the journal Ecology Letters.

"Humans are sufficiently scary to pumas and smaller predators that they suppressed their behavior and changed the way they used their habitats when they thought we were around," said lead author Justin Suraci, a postdoctoral researcher at UC Santa Cruz. "The most surprising part was seeing how those changes benefit rodents."

The findings are significant because as humans encroach on wild lands around the globe, ecologists are eager to understand the effects humans and development have on wildlife.

"We've spent 10 years learning how fear of humans drives mountain lion physiology, behavior, and ecology," said senior author Chris Wilmers, a professor of environmental studies at UC Santa Cruz and director of the Santa Cruz Puma Project. "This is the first large-scale experiment I'm aware of that documents how fear cascades through the food web from top predators to the smallest prey."

The research reveals that the presence of humans can have fairly profound effects, even without activities and infrastructure like hunting or housing or roads, said Wilmers, who studies human-wildlife interactions in California, Africa, and elsewhere.

"With human population growth and development, there is often a dual mandate to preserve wildlife and give people access to open spaces," he said. "This research starts to get at how we can realistically do both. We need to understand how animals react to our presence to make decisions and craft policies that protect their wellbeing."

Experiment design and results

Suraci and Wilmers designed a clever experiment that used recordings of human voices to assess the landscape-level effects of fear of humans. At two remote research sites in the Santa Cruz Mountains that are closed to public access, they placed 25 speakers in a grid pattern across a one-square-kilometer area. The speakers broadcast human voices, and recordings of tree frogs as a control.

Pumas, the researchers found, responded to the sound of human voices by significantly reducing their activity, keeping their distance, and slowing their movements. "When the frog recordings played, they would move right through the landscape," said Suraci. "But when they heard human voices, they went out of their way to avoid the grid."

Medium-sized predators changed their behavior in significant ways, too: Bobcats became much more nocturnal; skunks reduced their overall activity by 40 percent; and opossums reduced their foraging activity by a stunning 66 percent. "Bobcats pretty much gave up on daytime activity, shifting almost entirely to the night, when they presumably feel safer," said Suraci. "These predators aren't necessarily leaving the area, they're just less active, presumably because they're hiding more."

Over time, these behavioral changes could have dire consequences for pumas and the other predators if their food intake drops, said Suraci.

By contrast, deer mice increased their range by 45 percent, and the intensity of foraging by mice and wood rats increased by 17 percent. "They were apparently responding to the reduced activity of everybody else," Suraci added. "They're feeling braver, so they're moving around more and finding more food. They're not too averse to people, so they're taking advantage of the opportunity."

For wildlife, fear amounts to the perception of predation risk, explained Suraci. "Humans are incredibly lethal," he said. "We are major predators, and thus a source of fear, for a lot of these species. What's novel about this study is that we can see what that fear looks like in the environment at a relatively large scale."

Unlike studies that assess the impacts of development and subsequent habitat fragmentation, this research focused on the impacts of humans themselves.

"Just the fear of humans can affect how wildlife use the landscape and how they interact with each other," said Suraci. "It turns out, the mere perceived presence of humans triggers a disruption of natural predator-prey interactions--and rodents really benefit."

Suraci is eager to investigate the relative impacts, or "cost/benefits," of living near humans for certain species. "Smaller carnivores don't want to interact with humans, but that may be outweighed by the benefits of feeding on trash--and potentially being protected from pumas," he said. "We are working on some longer-term studies to explore that."

PITTSBURGH--Carnegie Mellon University's Assistant Professor of Electrical and Computer Engineering (ECE) Maysam Chamanzar and ECE Ph.D. student Matteo Giuseppe Scopelliti today published research that introduces a novel technique which uses ultrasound to noninvasively take optical images through a turbid medium such as biological tissue to image body's organs. This new method has the potential to eliminate the need for invasive visual exams using endoscopic cameras.

In other words: one day, scopes may no longer need to be inserted into the body, such as down the throat or under the skin, to reach the stomach, brain, or any other organs for examination.

Endoscopic imaging, or using cameras inserted directly inside the body's organs to investigate symptoms, is an invasive procedure used to examine and diagnose symptoms of deep tissue disease. Endoscopic imagers, or cameras on the end of catheter tubes or wires, are usually implanted through a medical procedure or surgery in order to reach the body's deep tissues, but Chamanzar's new technique provides a completely non-surgical and noninvasive alternative.

The lab's paper published in Light: Science and Applications, a journal published by Springer Nature, shows that they can use ultrasound to create a virtual "lens" within the body, rather than implanting a physical lens. By using ultrasonic wave patterns, the researchers can effectively "focus" light within the tissue, which allows them to take images never before accessible through noninvasive means.

Biological tissue is able to block most light, especially light in the visible range of the optical spectrum. Therefore, current optical imaging methods cannot use light to access deep tissue from the surface. Chamanzar's lab, however, has used noninvasive ultrasound to induce more transparency to enable more penetration of light through turbid media, such as biological tissue.

"Being able to relay images from organs such as the brain without the need to insert physical optical components will provide an important alternative to implanting invasive endoscopes in the body," says Chamanzar. "We used ultrasound waves to sculpt a virtual optical relay lens within a given target medium, which for example, can be biological tissue. Therefore, the tissue is turned into a lens that helps us capture and relay the images of deeper structures. This method can revolutionize the field of biomedical imaging."

Ultrasound waves are able to compress and rarefy, or thin, whatever medium they are flowing through. In compressed regions, light travels more slowly compared to rarefied regions. In this paper, the team shows that this compression and rarefication effect can be used to sculpt a virtual lens in the target medium for optical imaging. This virtual lens can be moved around without disturbing the medium simply by reconfiguring the ultrasound waves from outside. This enables imaging different target regions, all noninvasively.

The published method is a platform technology that can be applied in many different applications. In future, it can be implemented in the form of a handheld device or wearable surface patch, depending on the organ being imaged. By placing the device or patch on the skin, the clinician would be able to easily receive optical information from within the tissue to create images of what's inside without endoscopy's many discomforts and side effects.

The closest current applications for this technology would be endoscopic imaging of brain tissue or imaging under the skin, but this technique can also be used in other parts of the body for imaging. Beyond biomedical applications, this technique can be used for optical imaging in machine vision, metrology, and other industrial applications to enable non-destructive and steerable imaging of objects and structures at the micron scale.

The researchers showed that the properties of the virtual "lens" can be tuned by changing the parameters of the ultrasonic waves, allowing users to "focus" images taken using the method at different depths through the medium. While the LSA paper is focused on the method's efficacy for closer-to-the-surface applications, the team has yet to find the limit to how deep within the body's tissue this ultrasonically-assisted optical imaging method can reach.

"What distinguishes our work from conventional acousto-optic methods is that we are using the target medium itself, which can be biological tissue, to affect light as it propagates through the medium," explains Chamanzar. "This in situ interaction provides opportunities to counterbalance the non-idealities that disturb the trajectory of light."

This technique has many potential clinical applications, such as diagnosing skin disease, monitoring brain activity, and diagnosis and photodynamic therapy for identifying and targeting malignant tumors.

In addition to the direct implications this research has on clinical medicine, it will also have indirect clinical applications. By using this acousto-optic technology to view mouse models of brain disorders in action and selectively stimulate different neural pathways, researchers would be able to study the mechanisms involved in disease conditions such as Parkinson's, informing the design of next generation clinical therapeutic interventions to treat these diseases in humans.

"Turbid media have always been considered obstacles for optical imaging," says Scopelliti. "But we have shown that such media can be converted to allies to help light reach the desired target. When we activate ultrasound with the proper pattern, the turbid medium becomes immediately transparent. It is exciting to think about the potential impact of this method on a wide range of fields, from biomedical applications to computer vision."

How you spend your money can signal aspects of your personality, according to research published in Psychological Science, a journal of the Association for Psychological Science. Analyses of over 2 million spending records from more than 2,000 individuals indicate that when people spend money in certain categories, this can be used to infer certain personality traits, such as how materialistic they are or how much self-control they tend to have.

"Now that most people spend their money electronically - with billions of payment cards in circulation worldwide - we can study these spending patterns at scale like never before," says Joe Gladstone of University College London, who co-led the research. "Our findings demonstrate for the first time that it is possible to predict people's personality from their spending."

We all spend money on essential goods, such as food and housing, to fulfill basic needs - but we also spend money in ways that reflect aspects of who we are as individuals. Gladstone and colleagues wondered whether the variety in people's spending habits might correlate with other individual differences.

"We expected that these rich patterns of differences in peoples spending could allow us to infer what kind of person they were," says Sandra Matz, who co-led the project.

In collaboration with a UK-based money management app, Gladstone and Columbia Business School researchers Sandra Matz and Alain Lemaire received consent and collected data from more than 2,000 account holders, resulting in a total of 2 million spending records from credit cards and bank transactions.

Account holders also completed a brief personality survey that included questions measuring materialism, self-control, and the "Big Five" personality traits of openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism.

Participants' spending data was organized into broad categories -- including supermarkets, furniture stores, insurance policies, online retail stores, and coffee shops - and the researchers used a machine-learning technique to analyze whether participants' relative spending across categories was predictive of specific traits.

Overall, the correlations between the model predictions and participants' personality trait scores were modest. However, predictive accuracy varied considerably across different traits, with predictions that were more accurate for the narrow traits (materialism and self-control) than for the broader traits (the Big Five).

Looking at specific correlations between spending categories and traits, the researchers found that people who were more open to experience tended to spend more on flights, those who were more extraverted tended to make more dining and drinking purchases, those who were more agreeable donated more to charity, those who were more conscientious put more money into savings, and those who were more materialistic spent more on jewelry and less on donations.

The researchers also found that those who reported greater self-control spent less on bank charges and those who rated higher on neuroticism spent less on mortgage payments.

"It didn't matter whether a person was old or young, or whether they had a high or low salary, our predictions were broadly consistent," says Matz. "The one exception is that people who lived in highly deprived areas were more difficult to predict. One possible explanation may be that deprived areas offer fewer opportunities to spend money in a way that reflects psychological preferences."

Viewed in the context of previous research that has attempted to use online behavior to predict personality, these results suggest that spending-based predictions of personality are less accurate than predictions based on Facebook "likes" or status updates, which offer a more direct reflection of individual preferences and identity. However, spending-based predictions seem to be just as accurate as predictions based on individuals' music preferences and Flickr photos.

The findings have clear applications in the banking and financial services industries, which also raises potential ethical challenges. For example, financial services firms could use personality predictions to identify individuals with certain traits, such as low self-control, and then target those individuals across a variety of domains, from online advertising to direct mail.

"This means that as personality predictions become more accurate and ubiquitous, and as behavior is recorded digitally at an increasing scale, there is an urgent need for policymakers to ensure that individuals (and societies) are protected against potential abuse of such technologies," Gladstone, Matz, and Lemaire write.