Culture

A five-year study at Boston Children's Hospital reports success with a program it started in 2013 to bring much-needed behavioral health services directly into primary care pediatricians' offices. As reported today in Pediatrics, the program improved children's access to behavioral health care, with only minor increases in cost, and got high marks from participating pediatric practices.

Based on the findings, Boston Children's Hospital is continuing to expand and evaluate the program, which currently reaches more than 70 of its affiliated pediatric practices in Massachusetts.

Meeting an unmet need

By late adolescence, up to 20 percent of children will have experienced functionally impairing anxiety, depression, and/or ADHD, the most common and treatable mental health conditions. But child behavioral health specialists are in chronic short supply with long wait lists, says Heather Walter, MD, MPH, a child/adolescent psychiatrist at Boston Children's Hospital and first author on the paper. Massachusetts, for example, has nearly 300,000 youths with at least one diagnosable psychiatric disorder -- but only about 400 to 500 practicing pediatric psychiatrists.

"Nearly a decade can elapse between when a child first shows symptoms of a disorder and when it is diagnosed and treated, which has major consequences in their academic, social, and family lives," Walter says. "There aren't enough child psychiatrists to offer this care alone, and we realized we needed partners. The obvious physician partners are pediatricians - they see children for years, know them well, are tuned into child development, and are highly trusted by patients and families."

Empowering pediatricians

Boston Children's Hospital's Behavioral Health Integration Program (BHIP) was designed to empower primary care pediatricians to head off or, if indicated, treat most cases of anxiety, depression, and ADHD, referring only the more complex cases to specialists. This would free up the limited number of child mental health specialists to focus on youths with more severe illness.

"If a child has schizophrenia or bipolar disorder, we'd want them to be cared for in a specialty setting," notes Walter.

The program has three components:

1) in-person and televideo education sessions with child psychiatrists and other behavioral health specialists

2) on-demand phone, in-person and telepsychiatry consultations with child psychiatrists

3) operational and clinical support for integrating psychotherapists into pediatric practices.

5-year outcomes

The BHIP offered its services to primary care practices affiliated with the Pediatric Physicians' Organization at Children's, LLC (PPOC), on a first-come, first-serve basis. The study in Pediatrics looked at outcomes in the first 13 PPOC practices in Greater Boston to enroll in the program. These practices comprised some 105 primary care pediatricians serving some 114,000 children and youth.

"Our over-arching goal was to increase children's access to behavioral health services, without breaking the bank," says Walter.

Study findings included:

Significantly increased visits to primary care providers for behavioral health problems

Significantly increased psychotherapy visits in the primary care setting. From 2013-17, the proportion of all psychotherapy visits that were delivered within participating practices increased from 0.7 percent to 13.3 percent.

Significantly increased pediatrician prescribing of medications for ADHD, anxiety, and depression in accordance with evidence-based guidelines. For instance, SSRI prescriptions for anxiety and depression increased from 55 to 186 per 1000 patients per year for a 30-day supply.

High satisfaction among pediatricians and on-site psychotherapists: more than 90 percent of those surveyed reported an increased ability to effectively manage mild/moderate mental and behavioral health problems in the pediatric setting.

Total ambulatory behavioral care costs rose only 8 percent, as diversion of routine care away from specialists helped offset the increase in behavioral health visits overall.

"We were hoping for a big dip in emergency room utilization, because that's a big problem when mental health services are not widely available," says Walter. "But we need more data before we can make that claim."

The study did, however, find an overall 19 percent decrease in emergency room costs for behavioral health visits.

Although this Pediatrics study did not directly survey parents, pediatricians often reported high satisfaction among families who felt the arrangement was more convenient, less stigmatizing and in some cases more readily covered by insurance.

New initiatives

The BHIP now plans to extend the program to all of the PPOC primary care practices (current participation is 85 percent) and continue to research outcomes. Other recent and future initiatives include:

Expansion of substance abuse and addiction services in 15 to 20 PPOC practices

Family crisis intervention for suicidal adolescents in four PPOC practices

A pilot tele-psychiatry program (currently serving six PPOC practices), allowing a Boston Children's psychiatrist to directly see, talk to and assess a child through a remote web connection.

Interactive, web-based training to reach providers far from Boston -- including a partnership with 34 pediatric practices in the Children's Hospital Los Angeles Health Network.

Partnership with Open Pediatrics, Boston Children's web-based clinical training platform, planned for late 2019/early 2020. "This will allow us to expand our training to a national and international audience, which is very exciting," says Walter.

Ongoing partnership with the state- and payer-funded Massachusetts Child Psychiatry Access Program (MCPAP), extending psychiatric consultation services to nearly all of the state's approximately 500 pediatric practices.

"Providing top-quality behavioral health services to kids in the right setting at the right time will help millions of children receive the care they need and deserve," says David DeMaso, MD, psychiatrist-in-chief in the Department of Psychiatry at Boston Children's Hospital.

New Rochelle, NY, June 13, 2019--The results of a large community-based study have shown that the probability of major depressive disorder in children and adolescents with high, low, or normal body mass index differs according to gender. Underweight boys and overweight girls have an increased risk of depression, according to the study published in Childhood Obesity, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. Click here to read the full-text article free on the Childhood Obesity website through July 13, 2019.

Seyed-Ali Mostafavi, Tehran University of Medical Sciences and a large team of Iranian researchers coauthored the article entitled "Gender Determines the Pattern of Correlation between Body Mass Index and Major Depressive Disorder among Children and Adolescents: Results from IRCAP Study." The Iranian Children and Adolescents' Psychiatric Disorders Study (IRCAP) included BMI results for more than 25,000 youths and compared the likelihood of a diagnosis of depression among the subgroups of girls and boys, dividing them into categories of underweight, normal weight, and overweight.

"There has been some disagreement in the literature about the nature of the relationship between obesity and depression among children and adolescents. Mostafavi and colleagues generated a large Iranian population-based sample and determined that obesity was correlated with depression among boys, but not girls, after controlling for likely confounders. The large sample adds confidence to the findings," says Childhood Obesity Editor-in-Chief Tom Baranowski, PhD, Baylor College of Medicine, Houston, TX. "This relationship needs to be assessed in other countries to assess the extent to which this finding varies by culture, and what it may be about culture that influences this relationship. Weight management interventions for boys should anticipate their possible depression."

Researchers at the University of Illinois at Chicago describe for the first time the role of a unique, pressure-sensing protein in the development of lung edema -- a condition in which chronic high vascular pressure in the lungs causes fluid from the bloodstream to enter the air spaces of the lungs.

The results, which are published in the Proceedings of the National Academy of Sciences, suggest that suppressing the activity of the protein could be a new approach to treating lung edema.

Lung edema can have a variety of causes, including heart failure. Certain types of heart failure -- where the heart is chronically unable to pump blood efficiently -- can cause increased pressure in the blood vessels in the lungs. The high pressure can result in capillary stress failure, where connections between the individual cells that make up the walls of the capillary blood vessels become looser, allowing fluid from the bloodstream to enter the air spaces in the lungs.

Yulia Komarova, UIC associate professor of pharmacology, and Asrar Malik, Schweppe Family Distinguished Professor and head of pharmacology in the UIC College of Medicine, have been studying adherens junctions -- the structures that bind together the cells that make up blood vessels. Adherens junctions act like adjustable nuts and bolts that can be tightened or loosened to modulate the flow of fluids and blood cells into and out of the bloodstream, such as immune cells that travel in the blood to get to areas where they are needed.

Komarova and colleagues wanted to see if a protein called piezo 1 -- which is found in many cell types, including in the endothelial cells that line the blood vessels, and that can sense mechanical pressure -- was involved in triggering adherens junctions to loosen up under conditions of high fluid pressure in the lungs.

The researchers engineered mice where piezo 1 was deleted in the adult animal in the endothelial cells. They then elevated the pressure in blood vessels in the lungs in order to mimic the effects of heart failure. In mice where piezo 1 was deleted in the endothelial cells, minimal fluid was seen entering the lungs, while in mice that had the piezo 1 protein, the lungs filled with fluid as blood pressure increased.

In a separate experiment, Komarova and colleagues used a mouse model where the adherens junctions were artificially reinforced in endothelial cells to keep the connections between individual cells lining the blood vessel cells tight. In these mice, no fluid was seen to enter the lungs when high pressures were induced in the animals even when they had the piezo 1 protein.

"Our experiments suggest that by either blocking the activity of piezo 1 or by bolstering the adherens junctions we can prevent fluid from entering the lungs," Komarova said. "Small drug molecules that achieve these goals could represent novel therapeutic approaches to treat lung edema associated with heart failure."

There were more than 16.9 million Americans with a history of cancer on January 1, 2019, a number that is projected to reach more than 22.1 million by 2030 based on the growth and aging of the population alone, according to estimates from Cancer Treatment and Survivorship Statistics, 2019. The report is produced every three years by the American Cancer Society in collaboration with the National Cancer Institute to help the public health community better serve this growing population. It appears in CA: A Cancer Journal for Clinicians, with a companion consumer edition published as Cancer Treatment and Survivorship Facts & Figures.

The number of cancer survivors continues to increase in the United States even as incidence rates are stable in women and declining in men. This is due to a growing and aging population, as well as increases in cancer survival due to advances in treatment and early detection. The report uses the term "cancer survivor" to describe a person who has a history of cancer, from the time of diagnosis through the remainder of their life. However, it is important to note that many people with a history of cancer do not embrace this term.

The report estimates there are currently 8.1 million males and 8.8 million females in the U.S. with a history of cancer. About two out of three cancer survivors (68%) were diagnosed five or more years ago and nearly one in five (18%) was diagnosed 20 or more years ago. Nearly two-thirds (64%) are aged 65 years or older. In addition, the report estimates that in the U.S., there are 65,850 cancer survivors 14 years and under and 47,760 ages 15 to 19.

The three most prevalent cancers among men in 2019 are prostate (3,650,030), colon and rectum (776,120), and melanoma of the skin (684,470). Among women, the top three prevalent cancers are breast (3,861,520), endometrium (uterine corpus) (807,860), and colon and rectum (768,650). Cancer prevalence figures differ from those for cancer incidence because prevalence reflects not only occurrence but also survival and median age at diagnosis. For example, lung cancer is the second most commonly diagnosed cancer in men, but ranks eighth in prevalence, largely because of the disease's poor overall survival.

The authors' estimate of the number of cancer survivors in 2030 (22.1 million) is based on population projections produced by the United States Census Bureau, using current incidence, mortality, and survival rates. Changes in cancer occurrence and survival due to advances in treatment and early detection could further impact cancer prevalence.

Many survivors cope with long-term physical effects of treatment as well as psychological and socioeconomic sequelae. Challenges also remain for survivors and their caregivers with regard to navigating the health care system, including poor integration of survivorship care between oncology and primary care settings, as well as financial and other barriers to quality care, particularly among the medically underserved.

"People with a history of cancer have unique medical, psychosocial, and economic needs that require proactive assessment and management by health care providers," said Robin Yabroff, Ph.D., senior scientific director of Health Services Research and co-author of the report. "Although there are growing numbers of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care."

The report says identification of the best practices for delivering quality rehabilitation and posttreatment cancer care is needed and points to ongoing efforts by the American College of Surgeons, the Alliance for Quality Psychosocial Cancer Care, and the American Cancer Society. To this end, the American Cancer Society recently released a cancer survivorship blueprint to establish priority areas for care delivery, research, education, and policy. In addition, the American Cancer Society has produced guidelines for selected cancer types to assist primary care and other clinicians in the provision of posttreatment care for people with a history of cancer.

The national monitoring of the availability and use of information systems in healthcare in Finland revealed that the use of e-services in the exchange of health information among health service providers has increased compared to earlier studies performed since 2003.

In particular, the national health information exchange service, Kanta, enables information exchange between private and public health service providers.

"Major progress has been made in the range of e-health services available to citizens," says Professor Jarmo Reponen from the University of Oulu.

"In addition to electronic appointment bookings and advisory services, citizens can view their own data and communicate with health services more frequently than they could three years ago."

In the e-welfare sector, the supply of electronic services that are available to citizens and clients has increased, especially in the public sector. The integrating national infrastructure is actively being developed and currently several electronic document specifications and a client data repository as a part of Kanta Services in social welfare are in development.

However, there is a need for information management tools for professionals working in social services.

A drug interaction alert system is already being widely used

Clinical decision support (CDS) systems add intelligence to the healthcare systems and are both more frequently available and more likely to be integrated into the electronic patient record system compared with when the previous survey was conducted.

The most commonly integrated CDS tools are drug interaction alert systems.

"It is extremely important that we have these warning systems which improve patient safety and increase the quality of care. Moreover, in the future, we shall need even more advanced tools to support clinical workflow and the management of care on a daily basis," emphasises Professor Reponen.

Healthcare professionals are proficient users of electronic patient information systems and want to be part of their development

Nurses rate themselves as proficient users when assessing their competence in using electronic data and information systems. However, poor functionalities of information systems may jeopardise information flow and disturb nurses' work processes.

"When data cannot be accessed in a timely manner or the same data is stored in multiple systems, severe safety concerns, difficulties in decision-making, deficiencies in information exchange, and frustration in work processes may arise," highlights Professor Kaija Saranto from the University of Eastern Finland.

Healthcare professionals are keen to be involved in developing information systems. However, because of changes in the working environment, healthcare professionals need more training in the use of information systems and e-services.

Physicians' user experiences of electronic patient record systems have slightly improved compared with the results of two earlier surveys. However, there are still clear areas for improvement, for example information retrieval from other organisations is estimated to be as time consuming as it was in 2010.

The practical application of healthcare and social welfare data will be monitored and assessed regularly based on a national strategy

The Finnish Ministry of Social Affairs and Health has regularly commissioned national surveys on e-health and e-welfare to monitor the current state and trends in e-health and e-welfare in Finland to gather evidence for use in future development.

The national e-health and e-welfare strategy, 'Information to support well-being and service renewal. eHealth and eSocial Strategy 2020' set the goals for the monitoring.

The information was drawn from five nationwide e-health and e-welfare surveys. The survey aimed at citizens measures e-health and e-welfare service use and utilisation.

Two surveys were targeted at organisations (healthcare/social care), and measure the availability and use of e-health tools and services as well as the availability of e-welfare tools and services. Two surveys were targeted at professionals (physicians and nurses), and measure usability and the benefits of e-health tools and services. All the surveys were produced as part of the project on the Monitoring and assessment of social welfare and health care information system services (STePS 2.0 project).

A Swansea University study has revealed how as little as an hour a week of outdoor learning has tremendous benefits for children and also boosts teachers' job satisfaction.

Through interviews and focus groups, researchers explored the views and experiences of pupils and educators at three primary schools in south Wales that had adopted an outdoor learning programme, which entailed teaching the curriculum in the natural environment for at least an hour a week.

Interviews were held with headteachers and teachers, and focus groups were conducted with pupils aged 9-11 both before and during the implementation of an outdoor learning programme within the curriculum.

The schools in the study reported a variety of benefits of outdoor learning for both the child and the teacher and for improving health, wellbeing, education and engagement in school.

Lead author of the study Emily Marchant, a PhD researcher in Medical Studies at Swansea University, explained: "We found that the pupils felt a sense of freedom when outside the restricting walls of the classroom. They felt more able to express themselves, and enjoyed being able to move about more too. They also said they felt more engaged and were more positive about the learning experience. We also heard many say that their well-being and memory were better, and teachers told us how it helped engage all types of learners."

The benefits of outdoor education for children are well documented, but a finding of this study is the impact that the outdoor learning programme had on teachers.

Emily said: "Initially, some teachers had reservations about transferring the classroom outdoors but once outdoor learning was embedded within the curriculum, they spoke of improved job satisfaction and personal wellbeing. This is a really important finding given the current concerns around teacher retention rates. Overall, our findings highlight the potential of outdoor learning as a curriculum tool in improving school engagement and the health, wellbeing and education outcomes of children.

"The schools within our study have all continued with regular outdoor learning within the curriculum. With support and recognition from education inspectorates of the wider benefits to children's development and education, outdoor learning could be set within the primary school curriculum."

The Estée Lauder Companies Inc. (NYSE: EL) Research & Development (R&D) team will present data focused on new findings in skin metabolomics, skin defense, ingredient science, and anti-aging research at the 2019 World Congress of Dermatology (WCD) in Milan, Italy from June 10 -15.

Additionally, a sponsored symposium, "Metabolomics as a New Diagnostic to Assess Skin Health" will take place on June 12, presented by Session Chair, Leihong Xiang, M.D. Ph.D., Keynote Speaker, Paolo Sassone-Corsi, Ph.D., University of California, Kirk Beebe, Ph.D., Metabolon, Inc. and Nadine Pernodet, Ph.D., The Estée Lauder Companies. The symposium will unveil novel metabolomics research illustrating the complex relationship between genetics and the environment, unveiling the role they play in skin and how their changes reflect skin's condition.

The Estée Lauder Companies' R&D team is a global leader in understanding the factors that impact our skin and in using the data found in the skin to understand how it behaves and appears. The following summarizes the Estée Lauder Companies' R&D team's research that will be presented at the 2019 WCD meeting:

Skin metabolomics can help us better understand young and aging skin and the impact of circadian rhythm changes in the human skin metabolome.

The relationship between autophagy and inflammation in skin cells, with a look at the link between autophagy and resolution phase, a mechanism in the inflammation process that helps protect the skin against chronic inflammation.

Development of a skin model to further understand the causes of post inflammatory hyperpigmentation (PIH) and how those findings offer more options to explore the underlying biological causes.

Macrocystis pyrifera (Kelp) ferment is effective in addressing inflammation and in enhancing fibroblast migration. Together these activities may help skin maintain its natural integrity and a state of visible calm.

UP302, a plant-derived tyrosinase enzyme inhibitor, acts as a whitening agent to reduce pigmentation, outperforming the benchmark compound, Kojic Acid, at the industry-standard concentration.

There is a beneficial link between sirtuins and maintaining the integrity of natural cellular activity.

Examining changes in skin physiology induced by exposure to small particles (PM 2.5) can help inform skin protection against the detrimental effects from the environment.

A multi-prong approach to acne treatment significantly reduced facial lesions after a 12-week trial.

"The Estée Lauder Companies' R&D team is a global leader in understanding the impact of biological processes like those in the skin," said Nadine Pernodet, Ph.D., Vice President, Skin Biology and BioActives, Research and Development, The Estée Lauder Companies. "These new findings provide us with an unprecedented snapshot of skin status, enabling new precision approaches and treatments to improve skin's appearance. As the first in our industry to use metabolomics in relation to time, we have a better understanding of key factors of skin repair efficiency and damage accumulation and their relationship to skin circadian rhythm. We will continue to apply this knowledge to formulate products that can address and improve optimal skin processes, leading to younger looking skin."

The following research posters will be presented by The Estée Lauder Companies R&D at the 2019 WCD meeting, and are summarized below:

First assessment of skin circadian metabolomics on young and aging subjects, The Estée Lauder Companies and Metabolon, Inc., [Poster #5638]

Metabolomics is a comprehensive study of metabolites, which are small molecule (

Autophagy and inflammation relation in skin cells, The Estée Lauder Companies, [Poster #3897]

Autophagy, a major cellular degradative and recycling pathway, is critical for cellular longevity and has been linked to the aging process. A decrease in autophagy leads to increased cellular damage as we age. For the first time in skin cells, a relationship between autophagy and the resolution phase of inflammation has been found, showing their link in protecting the skin against long-lasting inflammation and its visible effects.

Development of a post inflammatory hyperpigmentation model in reconstructed skins, The Estée Lauder Companies [Poster #4263]

Prominently seen in people with darker skin tones, post inflammatory hyperpigmentation (PIH) occurs following an inflammatory insult, such as acne or a cutaneous injury, and results in a hyperpigmented area of the skin. Little is known about the cause of PIH, but new research using in vitro models offers the chance to screen the skin pigmentation effects of migration inhibitors on melanocytes--offering more options to explore the underlying biological causes.

Macrocystis pyrifera ferment: Anti-inflammatory and pro-resolution properties, The Estée Lauder Companies and Max Huber Research Laboratories [Poster #2331]

Research has shown that inflammation, especially chronic inflammation, is a potential cause of accelerated skin aging. The resolution of inflammation is an actively coordinated and dynamic process that attenuates inflammation and enables skin's natural repair and helps skin maintain its natural integrity. In this study, the anti-inflammatory and pro-resolution activities of the Macrocystis pyrifera (kelp) ferment were assessed. Results show that the use of the kelp ferment is effective in addressing all three phases of inflammation and in enhancing fibroblast migration. Together these activities may help skin maintain a state of visible calm and its natural integrity.

Evaluation of a potent skin whitening agent, The Estée Lauder Companies [Poster #4255]

UP302, a plant-derived tyrosinase enzyme inhibitor, acts as a whitening agent by preventing melanin synthesis through the conversion of tyrosinase in human skin. Using a clinical whitening test measuring Skin Lightening Factor, both in vitro and in vivo, against Kojic acid (the industry standard), the UP302 treatments demonstrated a more-significant decrease in melanin, indicating a decrease in tyrosinase activity and pigmentation.

Sirtuins and their importance in skin, The Estée Lauder Companies [Poster #3893]

Increasing evidence has demonstrated the importance of Sirtuins, also known as longevity proteins, in maintaining optimal skin cell processes such as metabolism, genomic stability, inflammation, energy, environmental stress response and aging. The effects of environmental stressors were examined through the response of skin cells to UVB and ozone (measured by the effect on energy (ATP) production and oxidative damage (ROS), along with the effect on mechanical properties). This research demonstrates a beneficial link between sirtuins and cellular integrity and activity, and for the first time, introduces the role of Sirtuin-2 in supporting skin cells' natural mechanical properties.

The effect of exposure to PM 2.5 on skin physiological function, The Estée Lauder Companies [Poster #4260]

Using an in vitro model, changes in skin physiology induced by exposure to fine particles (PM 2.5) were observed. Results suggested that these particles may be damaging to the epidermis and compromise skin barrier function, as well as impact morphology, physiology, and inflammatory response in cells. Findings showed that skins treated with PM 2.5 had compromised skin barrier integrity and an increase in cellular proteins indicating a possible inflammatory response.

A multi-prong approach to acne significantly reduced facial lesions after a 12-week treatment, The Estée Lauder Companies [Poster #4194]

The pathogenesis of acne is complex, with strong evidence supporting the involvement of sebaceous hyperplasia, follicular hyperkeratinization, bacterial hypercolonization, and inflammation. In order to combat acne and address these components, researchers used a multi-prong formulation to assess its effect on the overall lesion count in a population with acne. Findings showed treatments significantly reduced the total lesion count after 12 weeks.

"As science and technology enable more a more holistic and in-depth look at skin over time, The Estée Lauder Companies can continue to better understand the biological mechanisms that drive how skin behaves and how to combat environmental stressors and insults to skin. We will continue to apply our research findings to help define and advance the future of beauty for our global consumers." said Tom Mammone, Ph.D., Vice President, Skin Physiology and Pharmacology, Research & Development, The Estée Lauder Companies.

An analysis of U.S. intelligence programs aimed at collaborating with academic and industry partners finds that these collaborations are valuable for addressing complex intelligence challenges. The study also notes that institutional silos, lack of information sharing and lack of trust are obstacles to getting the most out of these collaborative efforts.

The researchers point to the Laboratory for Analytic Sciences (LAS) as the first long-term, collocated attempt at collaboration between the intelligence community, academia and industry. As such, the study authors report that the LAS holds promise as a laboratory that can be used by the intelligence community and its partners to develop effective approaches to cooperation and collaboration.

The LAS is a research partnership between North Carolina State University and the National Security Agency, based on NC State's campus.

"We looked at five collaborative intelligence programs," says Beverly Tyler, a professor of management, innovation and entrepreneurship at NC State who is co-author of a paper on the work. "Do any of the five provide an ideal model for how cross-sector, interdisciplinary collaborations on intelligence should work? No. But they do offer useful lessons about what can and should be considered to develop successful collaborations: time, effort, leadership, strong communication and dedicated resources."

"And the payoff for such collaborations can be invaluable," Tyler says. "For example, the LAS was created in 2013, and it has received a number of awards for its work - including two National Intelligence Awards for mission contributions."

"Given today's fiscal realities and intelligence challenges, the need for cross-sector collaboration is only going to increase," says Kathleen Vogel, an associate professor of public policy at the University of Maryland and lead author of the paper.

For this study, the researchers drew on interviews with members of the intelligence and academic communities, as well as reports and journal articles related to LAS and four other collaborative intelligence programs. Their analysis led them to identify certain key themes related to intelligence collaborative efforts, as well as factors that they identified as being essential to success.

One of the key themes was that the hybrid organizations used by the intelligence community for cross-sector, interdisciplinary collaborations are particularly vulnerable to budget cuts. They also found that these collaborations can vary widely in terms of how interdisciplinary they are - and that the broader the interdisciplinary focus, the less likely they are to survive.

However, the researchers say that the LAS gives the intelligence community an opportunity to learn more about how it can design and maintain a more complex program that incorporates a broader interdisciplinary collaboration over a longer period of time.

The study also identified a number of factors that are key to the success of collaborative intelligence programs. Four of those factors are:

High-level support within the collaborating organizations;

Long-term commitment by collaborating organizations to accomplish the program's intended goals;

Internal communications mechanisms to evaluate how ongoing research efforts are going; and

Open lines of communication with the relevant intelligence organizations to ensure that research remains mission-focused, relevant and meaningful.

"We want to be clear that we found all collaborative efforts by the intelligence community to be valuable," Tyler says. "Our goal here is not to nitpick what has been done. It's simply to identify ways to make these programs even better moving forward."

Smalleye stingrays are the largest marine stingrays on record, reaching disc widths of up to 222 cm, and yet almost nothing is known about them. Scientists from the Marine Megafauna Foundation have for the first time used photo IDs to study this elusive animal in southern Mozambique, one of the only locations where it is regularly seen in the wild. Their findings are published today in the journal PeerJ.

"We reported the first sightings of smalleye stingray in 2004 and have since been racing against the clock to learn more about their ecology before it is too late", said Dr Andrea Marshall, co-founder and principal scientist of the Marine Megafauna Foundation. 31% percent of the world's sharks and rays are threatened with extinction according to the IUCN Red List of Threatened Species ? due to lack of scientific effort and information, it has not been possible to evaluable the conservation status of smalleye stingrays to date. "This species of ray is likely in trouble too but we can't protect what we don't know much about. Our study is an important first step in understanding more about the animal's ecology and behaviour", she added.

"These mysterious giants are thought to be patchily distributed across the Indian Ocean and Western Pacific, but southern Mozambique is probably the best location to encounter them on inshore reefs", Marshall added.

The marine biologists tested whether photographs of the stingrays' (Megatrygon microps) white dorsal spots could be used to distinguish and track individuals over long periods of time.

"Through local dive centers, we called on tourists to help us collect images of this solitary stingray. Fortunately for us, southern Mozambique and its rich marine life attract many passionate scuba divers, most of which own GoPros or other lightweight cameras and will happily make their images and footage available for research", said Atlantine Boggio-Pasqua who volunteered with the Tofo-based foundation.

She added: "Their contributions proved immensely valuable, we managed to gather more than 140 photographs suitable for comparison and identification, with some images dating as far back as 2003."

The team was able to visually identify 70 different individuals, including 15 that had been seen on several occasions in the area. The dorsal spot patterns looked unchanged over the years indicating they may be permanent markings like in manta rays.

Boggio-Pasqua said: "Smalleye stingrays may look intimidating at first glance with their large, razor-sharp tail spines, but they're actually really charismatic and easy to approach. We hope to receive many photo and video contributions from citizen scientists in future. They could tell us more about the species' habitat preference as well as feeding and cleaning behavior."

The encountered stingrays were often spotted at cleaning stations where reef bannerfish and other small fish appeared to be removing parasites from the rays' skin.

The photographic study also provided a glimpse into the migratory behaviour of Megatrygon microps. Some individuals traveled hundreds of kilometers along the coastline, including a near-term pregnant female which traveled from Tofo to the Bazaruto Archipelago and back (200km in a minimum of 102 days and a total 400km return trip). She returned to Tofo, no longer visibly pregnant, suggesting this individual had pupped during her journey.

This proved to be the longest straight-line distance ever recorded for any species of whiptail stingrays (Dasyatidae family). Unlike other stingrays, smalleye stingrays are rarely seen resting on the seabed and are thought to be semi-pelagic.

Smalleye stingrays are likely under threat from increasing fishing pressures. Targeted and incidental catch in coastal gillnets and industrial purse seiners operating offshore are an ongoing issue in Mozambique.

"There are so many questions that remain unanswered about this rare species. Where do they live, how fast do they mature and how do they reproduce? Filling these knowledge gaps is crucial to figuring out how to protect them properly in Mozambique and other parts of the Indian Ocean", concluded Dr Marshall.

Addressing the lack of available data will eventually allow scientists to formally assess the species' conservation status in the IUCN Red List and inform management practices.

The ability to hear depends on proteins to reach the outer membrane of sensory cells in the inner ear. But in certain types of hereditary hearing loss, mutations in the protein prevent it from reaching these membranes. Using a zebrafish model, researchers at Case Western Reserve University School of Medicine have found that an anti-malarial drug called artemisinin may help prevent hearing loss associated with this genetic disorder.

In a recent study, published in the Proceedings of the National Academy of Sciences (PNAS), researchers found the classic anti-malarial drug can help sensory cells of the inner ear recognize and transport an essential protein to specialized membranes using established pathways within the cell.

The sensory cells of the inner ear are marked by hair-like projections on the surface, earning them the nickname “hair cells.” Hair cells convert sound and movement-induced vibrations into electrical signals that are conveyed through nerves and translated in the brain as information used for hearing and balance.

The mutant form of the protein–clarin1–render hair cells unable to recognize and transport them to membranes essential for hearing using typical pathways within the cell. Instead, most mutant clarin1 proteins gets trapped inside hair cells, where they are ineffective and detrimental to cell survival. Faulty clarin1 secretion can occur in people with Usher syndrome, a common genetic cause of hearing and vision loss.

The study found artemisinin restores inner ear sensory cell function—and thus hearing and balance—in zebrafish genetically engineered to have human versions of an essential hearing protein.

Senior author on the study, Kumar N. Alagramam, PhD, The Anthony J. Maniglia Chair for Research and Education, and associate professor at Case Western Reserve University School of Medicine Department of Otolaryngology at University Hospitals Cleveland Medical Center, has been studying ways to get mutant clarin1 protein to reach cell membranes to improve hearing in people with Usher syndrome.

“We knew mutant protein largely fails to reach the cell membrane, except patients with this mutation are born hearing,” Alagramam said. “This suggested to us that, somehow, at least a fraction of the mutant protein must get to cell membranes in the inner ear.”

Alagramam’s team searched for any unusual secretion pathways mutant clarin1 could take to get to hair cell membranes. “If we can understand how the human clarin1 mutant protein is transported to the membrane, then we can exploit that mechanism therapeutically,” Alagramam said.

For the PNAS study, Alagramam’s team created several new zebrafish models. They swapped the genes encoding zebrafish clarin1 with human versions—either normal clarin1, or clarin1 containing mutations found in humans with a type of Usher syndrome, which can lead to profound hearing loss.

“Using these ‘humanized’ fish models,” Alagramam said, “we were able to study the function of normal clarin1 and, more importantly, the functional consequences of its mutant counterpart. To our knowledge, this is the first time a human protein involved in hearing loss has been examined in this manner.”

Zebrafish offer several advantages to study hearing. Their larvae are transparent, making it easy to monitor inner ear cell shape and function. Their genes are also nearly identical to humans—particularly when it comes to genes that underlie hearing. Replacing zebrafish clarin1 with human clarin1 made an even more precise model.

The researchers found the unconventional cellular secretion pathway they were looking for by using florescent labels to track human clarin1 moving through zebrafish hair cells. The mutated clarin1 gets to the cell membrane using proteins and trafficking mechanisms within the cell, normally reserved for misfolded proteins “stuck” in certain cellular compartments.

“As far as we know, this is the first time a human mutant protein associated with hearing loss has been shown to be ‘escorted’ by the unconventional cellular secretion pathway,” Alagramam said. “This mechanism may shed light on the process underlying hearing loss associated with other mutant membrane proteins.”

The study showed the majority of mutant clarin1 gets trapped inside a network of tubules within the cell analogous to stairs and hallways helping proteins, including clarin1, get from place to place. Alagramam’s team surmised that liberating the mutant protein from this tubular network would be therapeutic and tested two drugs that target it: thapsigargin (an anti-cancer drug) and artemisinin (an anti-malarial drug).

The drugs did enable zebrafish larvae to liberate the trapped proteins and have higher clarin1 levels in the membrane; but artemisinin was the more effective of the two. Not only did the drug help mutant clarin1 to reach the membrane, hearing and balance functions were better preserved in zebrafish treated with the anti-malarial drug than untreated fish.

In zebrafish, survival depends on normal swim behavior, which in turn depends on balance and the ability to detect water movement, both of which are tied to hair cell function. Survival rates in zebrafish expressing the mutant clarin1 jumped from 5% to 45% after artemisinin treatment.

“Our report highlights the potential of artemisinin to mitigate both hearing and vision loss caused by clarin1 mutations,” Alagramam said. “This could be a re-purposable drug, with a safe profile, to treat Usher syndrome patients.”

Alagramam added that the unconventional secretion mechanism and the activation of that mechanism using artemisinin or similar drugs may also be relevant to other genetic disorders that involve mutant membrane proteins aggregating in the cell’s tubular network, including sensory and non-sensory disorders.

A group of researchers from Japan has discovered a novel enzyme from a soil fungus. In their study published in the Journal of Biological Chemistry, they speculate that this enzyme plays important roles in the soil ecosystem, and then describe its structure and action. Once the usefulness of the main product of this enzyme is better understood in the future, this enzyme could also be exploited for industrial purposes. The researchers state, "Our study sheds light on the fact that new enzymes are still being discovered. It possibly lays the foundation for further research to identify new enzymes that yield carbohydrates that were once thought to be extremely difficult to prepare."

Carbohydrates are probably the most versatile organic molecules on the planet, as they play various roles in organisms. Accordingly, the functions and structures of enzymes related to carbohydrate are just as diverse. Glycoside hydrolases (GHs) are enzymes that break "glycosidic bonds" in carbohydrates or sugars. GHs are the largest known group of carbohydrate-related enzymes, and the group keeps expanding. A novel family, GH144, was identified by the same research group in the past from a soil bacterium Chitinophaga pinensis and called CpSGL.

The enzyme endo-β-1,2-glucanase (SGL), a member of the GH family, is involved in the metabolism of β-1,2-glucan, which is a polysaccharide (sugar chain) composed of β-1,2-linked glucose units. β-1,2-glucan serves as an extracellular carbohydrate that plays important roles in the symbiosis or infectivity of some bacteria. However, the role of SGLs in eukaryotic cells and their relationship with bacterial SGLs are not well understood.

This group of Japanese scientists from different universities and a research institute, working on a collaborative project led by Masahiro Nakajima, has discovered a novel SGL enzyme from a soil fungus, Talaromyces funiculosus. The enzyme, hereafter called TfSGL, showed no significant sequence similarity to other known GH families. However, it showed significant similarities to other eukaryotic proteins with unknown functions. The researchers thus propose that TfSGL and these related GH enzymes be classified into a new family, which they call GH162.

Usually when scientists find a novel protein--in this case, an enzyme--they further clone the gene containing the sequence that encodes it to better understand its functionality. This clone is called a "recombinant" sequence. The recombinant TfSGL protein (TfSGLr) was found to break down both linear and cyclic β-1,2-glucans to sophorose, a simpler and smaller carbohydrate.

Stereochemical analysis done by these researchers revealed that it is an inverting enzyme, a characteristic that is associated with its mechanism of action. They found that TfSGL breaks down sophorooligosaccharides (β-1,2-glucooligosaccharides), with degree of polymerization of 5 or more, to the disaccharide sophorose as the main product.

X-ray crystal structure analysis revealed that the overall structure of TfSGLr is similar to that of members of the GH144 family mentioned earlier, notably CpSGL. However, the two enzymes are very different in amino acid sequences, as well as substrate recognition sites and the positions of the base catalyst. This difference indicates that TfSGL and its homologs probably make up a novel family, and that there could be a molecular evolutionary relationship between GH144 and GH162.

In fact, most TfSGL homologs are found in eukaryotic organisms, particularly fungi (Basidiomycota and Ascomycota), and slime molds (Mycetozoa). Some of these species are associated with the rhizosphere, which is the ecosystem around the root and the soil, where the metabolism of cyclic β-1,2-glucan might occur as part of this symbiotic relationship with plants. Other species are parasitic, and thus, it is believed that the cyclic β-1,2-glucan might be used to reduce immune responses in hosts. TfSGL homologs are also speculated to be involved in interactions with other organisms.

This novel enzyme, TfSGL, breaks down β-1,2-glucan into sophorose. According to Nakajima, "As the functions and applications of sophorose become more apparent in the future, the enzyme could potentially be used for sophorose production. β-Glucanases already play an important role in our lives, as they are widely used in biofuel production.

Nakajima concludes by surmising, "The structures of sugar chains are complex and diverse, and sugar chains are also involved in various life phenomena. Synthesis and degradation of such diverse sugar chain structures are performed by enzymes, but only one end of the diversity seems to have been understood. With our research, we hope to identify genes encoding novel enzymes that break down sugar chains and yield carbohydrates that were once considered extremely difficult to prepare."

A study from Massachusetts General Hospital (MGH) researchers finds that electronic consultations (e-consults) in allergy and immunology can simplify the process of providing the most appropriate care, often reducing the need for in-person specialist visits. The paper, which has been published online in the Journal of Allergy and Clinical Immunology: In Practice, reports on the first two years of the MGH program and finds a significant reduction in the time needed to access specialist guidance.

"We found that e-consults expedite care for all patients with allergy/immunology conditions," says senior author Kimberly Blumenthal, MD, MSc, MGH Division of Rheumatology, Allergy and Immunology. "Whereas wait times for an in-person patient visit with an allergist often exceed three weeks, e-consults can provide allergist guidance to referring physicians within 72 business hours. For many patients, e-consults avert the need for an in-person visit entirely; and even when an in-person consult is required, the initial e-consult provides valuable information - including additional patient history, previous diagnostic testing and treatment trials - that can make the in-person consult more productive and valuable for the allergist, the referring provider and the patient."

Electronic, clinician-to-clinician consultations based on data in the electronic health record do not require real-time communication and are designed to address non-urgent questions specific to the care of an individual patient. The MGH began offering e-consults in Cardiology and Dermatology in late 2013 and extended the program to Allergy/Immunology in August 2016. As of January 2019, the MGH e-consult program involves 47 specialty areas, and almost 10,000 e-consults were provided during 2018.

The current study, led by first author Neelam Phadke, MD, MGH Division of Rheumatology, Allergy and Immunology, looked at data regarding allergy/immunology e-consults provided from August 2016 through July 2018, as well as in-person consults beginning in August 2014. Of approximately 300 e-consults completed during the study period, around 60 percent led to recommendations for in-person specialty visits, while 27 percent provided only advice and education to the referring practitioner. When the e-consult led to a recommendation for an in-person specialty visit, information from the e-consult made visits more productive by allowing the allergist to be better prepared. Educational information provided via e-consults benefited both referring physicians and the patients, often providing reassurance on the appropriateness of a planned course of action.

Two-thirds of e-consults related to patients with histories of potentially allergic reactions to drugs, primarily antibiotics like penicillin, many in conjunction with a program to evaluate pregnant patients with a history of penicillin allergy. Immunology e-consults could result from patient or provider concerns about frequent infections or abnormal antibody levels. While the average wait time for an in-person allergist visit before institution of the e-consult program was 22.5 days, the wait time reduced to 21.0 days after the program began. Allergists completed e-consults in an average of 11 minutes, and the average turnaround time for the referring provider to receive allergy specialist guidance was less than 24 hours.

Study co-author Jason H. Wasfy, MD, MPhil, MGH Cardiology - who founded the MGH e-consult program in 2013 and now directs population health management at MGH - says, "E-consults have become a critical tool in our efforts to innovate in outpatient care delivery. We believe they can increase patient satisfaction, since we always give patients the choice between e-consults and regular in-person consults, and they reduce the burden for primary care providers. We also believe they can improve the quality of care and reduce costs, since electronic consults can substitute for in-person consults that are billed to insurance companies and to patients themselves."

Lead author Phadke notes that a key limitation to broader use of e-consults is the reliance on electronic medical records systems that may not be shared between specialists and referring physicians, a problem that could disproportionately affect smaller hospitals that already lack access to subspecialists like allergists. But when the required systems are in place, she says, "E-consults can allow primary care physicians to receive guidance from one or more subspecialists, synthesize messages that may have been conveyed from multiple providers, and delivery neatly packaged recommendations to the patient."

ST. LOUIS, MO, June 11, 2019 - Overdose from opiates has skyrocketed. According to the National Center for Health Statistics, on average, 130 Americans die every day from an opioid overdose.1 The high cost of antidotes such as NARCAN® prevents many first responders from having access to lifesaving antidotes when they need it most.2 Researchers at the Donald Danforth Plant Science Center have identified a new method of producing these compounds using a microorganism discovered in a waste stream associated with the processing of opium poppy. This green chemistry process has the potential to greatly reduce the cost of the antidote drugs as well as decrease chemicals currently used that result in large amounts of harmful waste. Details of the discovery were published as the cover story in the journal Nature Sustainability: "Enzyme morphinan N-demethylase for more sustainable opiate processing".

"Enzymes perform reactions at efficiencies that surpass synthetic chemistry, thereby reducing the cost and impact of drug production on the environment. We work now to optimize production levels of the enzyme to a scale sufficient for industrial processes. Greener manufacturing would make a difference in people's lives," said Megan Augustin, lead author and research associate in the Kutchan lab at the Danforth Center.

Naturally occurring opiates, such as morphine and thebaine, are produced in poppy species. Thebaine is converted into painkillers and opiate addiction treatments, the latter requiring a chemical reaction called N-demethylation. Current opiate N-demethylation utilizes noxious reagents, resulting in harmful waste. One way to make opiate production more sustainable is to use enzymes rather than chemicals. Microorganisms provide a rich source of enzymes useful for metabolizing unique compounds in their environment. Augustin and her colleagues probed an opium processing waste stream sample to identify an organism capable of catalyzing opiate N-demethylation. To identify a biocatalyst, a sludge sample was subjected to minimal medium containing thebaine as the sole carbon source. This led to the discovery of Thebainfresser, a Methylobacterium that metabolizes opiates by removing the N-methyl group. N-demethylation was induced following growth in minimal medium, a characteristic that led to discovery of the underlying gene MND (morphinan N-demethylase). The enzyme MND was found to be robust and versatile, N-demethylating structurally diverse substrates at varying temperatures and pH levels. In addition, MND tolerated selected organic solvents and maintained activity when immobilized. These properties make it an attractive candidate for further development for pharmaceutical manufacture.

We all say we don't like liars. But when it comes time to negotiating a big sale, it turns out we tolerate people stretching the truth, and even expect it.

New research from the University of Chicago Booth School of Business finds that the ability to deceive is viewed as a sign of competence in jobs that require selling.

In the study, Deception as Competence: The Effect of Occupational Stereotypes on the Perception and Proliferation of Deception, Chicago Booth Assistant Professor of Behavioral Science Emma Levine and Johns Hopkins University's Brian Gunia find that people don't always disapprove of deception. In fact, they perceive the ability to deceive as an asset in occupations that are stereotyped as high in "selling orientation."

"Deception, in the form of fraud, embezzling, and corruption, costs the economy a great deal of money and undermines the economy's underlying moral fabric," Gunia and Levine explain. "Companies expose themselves to greater risk by hiring deceivers."

In two pilot studies, the researchers asked participants to rate 32 occupations as "high" or "low" in selling orientation, reflecting the degree to which occupational members persuade others to make immediate purchases as part of their jobs. In four subsequent studies, the researchers honed in on three occupations that are stereotyped as particularly high in selling orientation--sales, investment banking, advertising--and three occupations that participants viewed as relatively low in selling orientation--consulting, nonprofit management, accounting.

The researchers then ran experiments in which participants observed individuals lying or acting honestly in a variety of circumstances (for example, when reporting their expenses after a business trip or when completing an economic game in the laboratory). Finally, participants judged how successful and competent a liar or honest individual would be in occupations that were high or low in selling orientation--and, in two of the studies, whether to hire them into those occupations.

Among the key findings: Participants believed that liars would be more successful in high-selling orientation occupations (such as banking, advertising, and sales) than low selling-orientation occupations (such as nonprofit management and accounting). Furthermore, participants believed that liars would be more successful than honest people in high-selling orientation occupations.

Indeed, when participants had the opportunity to hire individuals to complete selling-oriented tasks, they were more likely to hire deceivers for these tasks, even when their own money was on the line.

"We found that people don't always disapprove of liars," Levine says. "Instead, they think liars are likely to be successful in certain occupations--those that do a lot of high-pressure selling."

The paper is published in the journal, Organizational Behavior and Human Decision Processes.

The findings may help to explain why deception persists in certain occupations: because hiring managers and other organizational actors see deceivers as more competent for high-pressure sales roles, and hire them at an elevated rate, the researchers find.

High-pressure selling occupations, which include investment bankers and advertisers, are some of society's highest-status and highest-paid occupations, so prospective employees and employers should worry "if deception is a prerequisite for employees to get hired and rewarded," Levine says.

Organizations intent on reducing deception should avoid framing occupational tasks as requiring high-pressure sales tactics to succeed, the study says. Instead, they would do well to align their job requirements with a customer-oriented approach to selling that emphasizes how the employee can help fulfill a client's long-term interests. Such a shift could reduce hiring managers' tendencies to see deceivers as competent and reduce the temptation to recruit deceivers into key roles.

"Armed with the knowledge that deception is perceived to signal competence in high-pressure sales occupations," the researchers write, "companies may want to explicitly deem deception as incompetent."

A finding from University of Alberta researchers is shining new light on the role fibrinogen has in regulating a natural defence mechanism in the body. The discovery is hoped to contribute to improved diagnosis and treatments for patients in a variety of diseases ranging from inflammation, to heart failure, to cancer.

Fibrinogen is a well-known protein that is essential for wound healing and blood clotting in the body. But a study published in Scientific Reports shows it is also a natural inhibitor of an enzyme named MMP2 that is important for normal organ development and repair.

MMP2 is typically found in increased levels in the blood in disease conditions. The researchers believe a vital function of fibrinogen is to allow or disallow the enzyme to carry out its normal functions. However, high levels of fibrinogen may excessively inhibit MMP2, which could result in arthritic and cardiac disorders similar to those seen in patients with MMP2 gene deficiency.

"Whenever there's an infection or there's an injury, fibrinogen can go up by tenfold in the blood. So at that concentration it would excessively inhibit MMP2," said Hassan Sarker, a PhD candidate at the U of A and study lead author.

"Binding of fibrinogen in the circulation to MMP2 enzymes prevents them from docking to target tissues," added Carlos Fernandez-Patron, a professor of biochemistry at the U of A, who directed this research. "It affects their activity and we don't know exactly whether that results in a beneficial or deleterious effect. It's something we need to investigate."

The finding opens a new window into the inner workings of the MMP family of enzymes. The researchers say having a greater understanding of how MMPs are regulated creates opportunities for future treatments. They also suspect that abnormal MMP2 activity could be an undesirable side effect of important common medications such as the cholesterol-lowering drug known as statins and the antibiotic doxycycline, both of which are known to inhibit MMPs.

The researchers emphasize that future therapeutic developments must strike a balance between the levels of MMPs and their inhibitors, such as fibrinogen, so that net MMP activity in the body remains at nearly normal levels. "We don't want to inhibit them more than needed and we don't want to cause their expression to be higher than it should," said Fernandez-Patron. "Knowing how those enzymes are regulated is key to improving diagnosis, prognosis and treatment of patients experiencing abnormal levels of either MMP2 or fibrinogen."