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Sophia Antipolis, France - 28 Aug 2020: A survey of nurses caring for children with heart problems has revealed that more than half are emotionally exhausted. The analysis, presented today at ESC Congress 2020, also found that good working environments were linked with less burnout.1

"Nurses' wellbeing is central to ensuring the best outcomes for patients," said study author Dr. Annamaria Bagnasco of the University of Genoa, Italy. "When wards have poor leadership and fragmented teams with no development prospects for nurses this should raise an alarm that there is a risk of burnout."

Previous research has shown that burnout rates are higher in paediatrics than in other specialties, and that burnout is connected to patient safety. Strategies to reduce burnout and its impact on patient safety are needed.

This study examined emotional exhaustion in nurses providing routine care on paediatric cardiology wards and whether it was related to the working environment.

Data were obtained from the RN4CAST@ITPed study. A web survey was distributed to 2,769 nurses working in children's hospitals throughout Italy between September 2017 and January 2018. A total of 2,205 (80%) nurses responded, of whom 85 worked in cardiology wards and intensive care units (ICUs). Additional data were collected from hospital administrations. Topics included workload, skill mix, work environment, and emotional exhaustion.

The following definitions were used: Workload referred to how many patients each nurse was caring for (nurse-patient ratio). Skill mix included both the education level of nurses working in one unit and the number of nursing assistants providing support during each shift.

Work environment was measured with the Practice Environment Scale of the Nursing Work Index (PES-NWI), which covers issues such as: having a nurse manager or immediate supervisor who is a good manager and leader; opportunities for advancement; opportunities to participate in policy decisions; and collaboration between nurses and doctors.

Emotional exhaustion was investigated using the Maslach Burnout Inventory, which measures feelings about work. For example, feeling emotionally drained, used up, fatigued in the morning, burned out, frustrated, working too hard, stressed, or "at the end of my rope".

This analysis focused on responses from the 85 nurses working in cardiology wards and ICUs at five hospitals. Interviews were also conducted with these nurses. More than half (58%) were emotionally exhausted. The main causes were related to working conditions, including being responsible for high numbers of patients and the complexity of caring for sick children.

"The most important consequence was that 30% of the nurses we interviewed wanted to either go and work in another hospital or even change their career," said Dr. Bagnasco.

The researchers then analysed the relationship between emotional exhaustion and the working environment. Improving the workplace environment was associated with an 81% fall in emotional exhaustion - even with the same skill mix and nurse-patient ratio.

"Our study shows that nurses value good leadership, being involved in decision-making, having chances to develop their career, and team working," said Dr. Bagnasco. "The lack of these conditions is connected to burnout, which we know from prior research could compromise patient safety."

Dr. Bagnasco noted that paediatric cardiac nurses must collaborate with children and their families, who often feel concerned and afraid. She said: "Establishing a trusting relationship is essential but burned out nurses may find it 'too heavy' to bear emotionally. If the working environment is positive for the nurses who work in it, children and their families will receive better and safer care."

Findings from a large-scale clinical trial testing a new palliative care model have shown to be lower cost, viewed positively by patients and their carers while showing no difference in patient-reported outcomes when compared with standard care.

The Short-Term Integrated Palliative Care (SIPC) model seeks to improve quality of life for patients severely affected by long-term neurological conditions (LTNCs). The trial - OPTCARE Neuro - aimed to investigate how effective this short-term palliative care is and whether it represents good value for money. It is the world's largest palliative care intervention in patients severely affected by LTNCs.

LTNCs represents a major health, economic and societal burden. These conditions lead to substantial deterioration in quality of life (QoL), require lifelong support from health and social care services, and often are an immense strain physically and emotionally on informal caregivers and family members. Palliative care has shown to relieve suffering and improve QoL in patients with advanced cancer. Despite experiencing problems and care challenges similar to patients with cancer, patients with LTNCs are less likely to receive palliative care.

The findings from OPTCARE Neuro provide the most robust evidence to date to support service and policy developments that improve palliative care provision for people with LTNCs in the UK or health care systems similar to the NHS.

The study was led by researchers in the Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation at King's College London and funded by the National Institute for Health Research (NIHR). The findings are published in JAMA Network Open.

The SIPC in OPTCARE Neuro included approximately three contacts with a specialist palliative care team. The teams worked closely with specialist neurology teams and other services including GPs, who continued to support patients as usual. The palliative care teams' aim was to enable people to live well with increasing illness by providing the support they need to pursue the things they and the people close to them feel are important, and to plan future care, particularly for when nearing the end of life.

The trial ran across six centres in the UK: London, Nottingham, Brighton and Hove, Liverpool, Cardiff and Ashford & St Peter's and was coordinated by the research team based at the Cicely Saunders Institute.

The evaluation of the SIPC was based on questionnaires completed by both patients and their informal carers, such as family members. Data from 350 patients and 229 caregivers was analysed. Questionnaires from local health care professionals in palliative care and neurology also gathered information about their expectations and experiences of palliative care for this group of patients and referring patients to the study.

While the findings showed SIPC was not statistically significantly different from standard care for patient-reported outcomes, it was associated with lower cost and was well-received by patients and carers. The research team also concluded that more research into refining the Short-Term Integrated Palliative Care model for people with Long Term Neurological Conditions would further support service and policy developments to improve palliative care for this group.

Professor Wei Gao, Co-Chief Investigator & Trial Statistician from King's College London said: 'Now that we know now the benefits of this new palliative care model for patients with long-term neurological conditions and their unpaid carers, what we should do next is to test how best to implement it more widely so more people will benefit from it.'

WASHINGTON–(Aug. 28, 2020)– New research suggests that children can shed SARS-CoV-2, the virus that causes COVID-19, even if they never develop symptoms or for long after symptoms have cleared. But many questions remain about the significance of the pediatric population as vectors for this sometimes deadly disease, according to an invited commentary by Children’s National Hospital doctors that accompanies this new study published online Aug. 28, 2020 in JAMA Pediatrics. The commissioned editorial, written by Roberta L. DeBiasi, M.D., M.S., chief of the Division of Infectious Diseases, and Meghan Delaney, D.O., M.P.H., chief of the Division of Pathology and Lab Medicine, provides important insight on the role children might play in the spread of COVID-19 as communities continue to develop public health strategies to reign in this disease.

The study that sparked this commentary focused on 91 pediatric patients followed at 22 hospitals throughout South Korea. “Unlike in the American health system, those who test positive for COVID-19 in South Korea stay at the hospital until they clear their infections even if they aren’t symptomatic,” explains Dr. DeBiasi.

The patients here were identified for testing through contact tracing or developing symptoms. About 22% never developed symptoms, 20% were initially asymptomatic but developed symptoms later, and 58% were symptomatic at their initial test. Over the course of the study, the hospitals where these children stayed continued to test them every three days on average, providing a picture of how long viral shedding continues over time.

The study’s findings show that the duration of symptoms varied widely, from three days to nearly three weeks. There was also a significant spread in how long children continued to shed virus and could be potentially infectious. While the virus was detectable for an average of about two-and-a-half weeks in the entire group, a significant portion of the children — about a fifth of the asymptomatic patients and about half of the symptomatic ones — were still shedding virus at the three week mark.

Drs. DeBiasi and Delaney write in their commentary that the study makes several important points that add to the knowledge base about COVID-19 in children. One of these is the large number of asymptomatic patients — about a fifth of the group followed in this study. Another is that children, a group widely thought to develop mostly mild disease that quickly passes, can retain symptoms for weeks. A third and important point, they say, is the duration of viral shedding. Even asymptomatic children continued to shed virus for a long time after initial testing, making them potential key vectors.

However, the commentary authors say, despite these important findings, the study raises several questions. One concerns the link between testing and transmission. A qualitative “positive” or “negative” on testing platforms may not necessarily reflect infectivity, with some positives reflecting bits of genetic material that may not be able to make someone sick or negatives reflecting low levels of virus that may still be infectious.

Testing reliability may be further limited by the testers themselves, with sampling along different portions of the respiratory tract or even by different staff members leading to different laboratory results. It’s also unknown whether asymptomatic individuals are shedding different quantities of virus than those with symptoms, a drawback of the qualitative testing performed by most labs. Further, testing only for active virus instead of antibodies ignores the vast number of individuals who may have had and cleared an asymptomatic or mild infection, an important factor for understanding herd immunity.

Lastly, Drs. DeBiasi and Delaney point out, the study only tested for viral shedding from the respiratory tract even though multiple studies have detected the virus in other bodily fluids, including stool. It’s unknown what role these other sources might play in the spread of this disease.

Drs. DeBiasi and Delaney note that each of these findings and additional questions could affect public health efforts continually being developed and refined to bring COVID-19 under control in the U.S. and around the world. Children’s National has added their own research to these efforts, with ongoing studies to assess how SARS-CoV-2 infections proceed in children, including how antibodies develop both at the individual and population level.

“Each of these pieces of information that we, our collaborators and other scientists around the world are working to gather,” says Dr. DeBiasi, “is critical for developing policies that will slow the rate of viral transmission in our community.”

August 28, 2020 - Breast reconstruction is an important option for women undergoing mastectomy, and a two-stage approach using implants is by far the most common reconstruction technique. Thousands of women undergo this procedure every year - despite the conventional wisdom among many surgeons that the results of implant-based breast reconstruction don't hold up over the long term.

Now a new study goes against that prevailing "surgical dogma," showing that the aesthetic and other outcomes of implant-based breast reconstruction remain stable at up to 12 years' follow-up. "Our study, the largest of its kind, demonstrates that prosthetic breast reconstruction outcomes do not deteriorate over time," write Akhil K. Seth, MD, and Peter G. Cordeiro, MD, of Memorial Sloan Kettering Cancer Center, New York.

"These results contradict the traditional dogma surrounding prosthetic breast reconstruction, and therefore should be given significant consideration when counseling patients on their options for breast reconstruction following mastectomy," the researchers add. Their study appears in the September issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

In 2019, ASPS member surgeons performed 107,000 breast reconstructions, 72,000 of which included a tissue expander followed by implants. Many studies have reported on the outcomes of this approach. However, there's a lack of long-term follow-up data, and little information on outcomes from the patient's point of view.

Despite the limitations of the evidence, some surgeons have come to believe that the results of implant-based reconstruction tend to deteriorate over time - including a decline in aesthetic outcomes, increased scarring around the implant (capsular contracture), and decreased patient satisfaction. Dr. Cordeiro has long questioned that idea, based on his own experience.

He and Dr. Seth performed an objective critical analysis of the long-term outcomes of two-stage implant-based breast reconstruction in 2,284 women. These procedures - including reconstruction of both breasts in 1,205 patients - were all performed by Dr. Cordeiro between 1994 and 2016. Follow-up outcomes were assessed at up to 12 years (average 5.5 years).

Throughout follow-up, scores remained stable for two key surgeon-reported outcomes: aesthetic results and capsular contracture. On a 5-point scale, average aesthetic scores decreased from 4.73 to 4.43 - remaining in the "very good" range at all times. Scores for capsular contracture also decreased slightly over time; the change was statistically but not clinically significant.

The findings were backed up by stable patient-reported outcomes, including physical, psychosocial, and sexual well-being (assessed on the validated BREAST-Q questionnaire). Physical well-being and overall patient satisfaction scores actually increased with long-term follow-up, suggesting that women feel better about their overall health after completing and recovering from their breast cancer treatment. "[S]table surgical outcomes contribute to stable or improved patient satisfaction," Drs. Seth and Cordeiro write.

Breasts treated with radiation had lower scores for aesthetic outcomes. Radiation treatment was also linked to higher rates of capsular contractures, although contractures improved over time for all patients.

The results add new evidence on the long-term outcomes of implant-based breast reconstruction. Other techniques use the patient's own tissue (autologous reconstruction - most commonly using a flap from the abdominal area). However, these approaches entail a longer recovery period and additional risks and are not an option for every patient.

The new study provides "objective, long-term data supporting the concept that prosthetic-based reconstruction is sustainable over time, with stable aesthetic outcomes and capsular contracture rates," Drs. Seth and Cordeiro conclude. They believe that women making decisions about breast cancer treatment should be reassured that implant-based breast reconstruction can provide long-lasting results in terms of appearance and quality of life.

Breast milk strengthens a child's immune system, supporting the intestinal flora. These facts are common knowledge. But how does this work? What are the molecular mechanisms behind this phenomenon? And why is this not possible the same way with bottle feeding? The reasons were unknown until a team from the RESIST Cluster of Excellence at Hannover Medical School (MHH) recently discovered how alarmins are that mechanism in a project involving the University of Bonn. The results have been pre-published online in the medical journal Gastroenterology. The paper will soon be appearing in print.

"Alarmins are the 'gold' in breast milk. These proteins prevent dangerous intestinal colonization disorders that can lead to blood poisoning and intestinal inflammation," relates Team Leader Prof. Dr. Dorothee Viemann of the Hannover Medical School (MHH) Clinic for Pediatric Pneumology, Allergology and Neonatology.

The post-natal intestinal immune system, i.e. intestinal flora and mucosa, mature through interaction with bacteria in the environment. This gives rise to optimal bacteria diversity which lasts a lifetime, affording protection against many diseases. "Alarmins control this adaptation process," explains Professor Viemann, whose research has revealed that these peptides and proteins both derive from breast milk and arise in the child's intestinal tract. The process of labor plays a role in this, as infants born via planned C-section exhibit lower levels of alarmins than vaginally-born infants. Additionally, premature infants are less capable of producing alarmins themselves than full-term infants. Such individuals are thus more prone to suffering from chronic inflammatory diseases.

For this research work, supported in part by the Volkswagen Foundation as part of the "Off the Beaten Track" initiative and by the RESIST Cluster of Excellence, the team measured alarmin concentration in infant stool samples in the first year of life to study the effect thereof on the development of the intestinal flora and mucosa.

"Supplementation with these proteins could support the development of newborns which do not produce enough alarmins or get enough in breast milk. That could prevent a range of long-term conditions linked to intestinal colonization disorders, such as chronic intestinal inflammation and obesity," says Professor Viemann. This statement is supported by the observation, among others, that a single administration of alarmins in the mouse model affords protection against poor colonization and associated diseases. Now building upon their findings, the RESIST researchers are planning further preclinical work, as well as clinical study at a later stage.

The lead authors are Maike Willers of the MHH and Dr. Thomas Ulas of the University of Bonn. "Our contribution was performing all bioinformatic preprocessing and analysis of the genetic data of the totality of all microorganisms derived from infant stool samples, which gave information about the composition of and possible imbalances in the intestinal flora," said Dr. Ulas of the LIMES Institute ("LIfe and MEdical Sciences") at the University of Bonn. Mathematical modeling, he explained, was crucial in enabling the scientists to demonstrate that alarmins significantly impact the development of the intestinal flora.

RESIST: Research to Help the Weakest Among Us

The RESIST (Resolving Infection Susceptibility) Cluster of Excellence led by the MHH is comprised of roughly 45 research teams whose work is focused on a common goal: to better protect those highly susceptible to infection, such as newborn infants. RESIST members include hospital physicians who are highly familiar with the situation of patients and fundamental research scientists who study pathogens and their interaction with the immune system in all possible detail. There are six RESIST partner institutions and the organization's spokesperson is Prof. Dr. Thomas Schulz, Director of the MHH Institute of Virology. RESIST receives funding from the German Research Foundation (DFG). Further information about RESIST is available online at: http://www.RESIST-cluster.de

TROY, N.Y. -- Developing a physiological test for diagnosing autism spectrum disorder (ASD), one that measures certain components in the blood, has the potential to be a paradigm shift for diagnosing ASD. However, the large heterogeneity of how ASD affects individuals has long been viewed as a key obstacle to the development of such a test.

Research conducted at Rensselaer Polytechnic Institute, and published online today in the journal Research in Autism Spectrum Disorders, represents a significant step toward addressing this challenge.

The research, led by Juergen Hahn, the head of the Department of Biomedical Engineering at Rensselaer, builds upon his team's previous discoveries, including the development of a physiological test for autism.

That physiological test relies on an algorithm that analyzes measurements of metabolites in a blood sample to predict whether or not a person has an ASD diagnosis.

Hahn and his team sought to assess the strength of their algorithm even further, by testing it with data collected from children with ASD who also have one or more other conditiosn -- so called co-occurring conditions -- like allergies or gastrointestinal symptoms.

"We wanted to see if the results from our previous analysis still hold up even in the presence or absence of a number of co-occurring conditions," said Hahn, who is also a member of the Center for Biotechnology & Interdisciplinary Studies at Rensselaer. "We found that, for the conditions that we looked at, the accuracy of the prediction results was only minimally affected by the presence of co-occurring conditions."

The model, according to the research, was able to successfully identify 124 of 131 children with ASD -- 94.7% -- regardless of whether or not the child also had a co-occurring condition. In general, Hahn said, the algorithm actually worked slightly better when a co-occurring condition was present. The reason for that finding, he said, needs to be examined further.

Hahn's big data approach to uncovering new insights about autism has also been used to examine the effectiveness of possible treatments, and the idea that ASD -- although extremely heterogonous -- may have some subgroups.

He and his team use depersonalized medical data to perform these analyses, and continue to dig deeper into their model and its abilities as more data becomes available.

"This was a question we definitely had to answer as many individuals with ASD have one or more co-occurring condition," Hahn said. "These findings will also guide some of our future research."

Below please find a summary and link(s) of new coronavirus-related content published today in Annals of Internal Medicine. The summary below is not intended to substitute for the full article as a source of information. A collection of coronavirus-related content is free to the public at http://go.annals.org/coronavirus.

Salivary Detection of COVID-19

Standard testing for SARSCoV-2 requires a nasopharyngeal or oropharyngeal swab but has several limitations, such as the need for health care human resources and PPE, and also has the potential for transmission in transit to or at the testing center. There is an urgent need for innovative testing strategies to expedite identification of cases and facilitate mass testing.

Researchers from the University of Ottawa, Dalhousie University, and the National Microbiology Laboratory, determined that standard diagnostic methods of nasopharyngeal and oropharyngeal swabs detected more COVID-19 cases than saliva testing among patients who were asymptomatic but at high risk or who were mildly symptomatic. Despite a lower estimated rate of detection compared to swab testing, saliva testing has several advantages, as it does not require trained staff or PPE, can be done outside testing centers, and may be better tolerated in challenging or pediatric populations. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-4738.

DARIEN, IL - Feeling angry these days? New research suggests that a good night of sleep may be just what you need.

This program of research comprised an analysis of diaries and lab experiments. The researchers analyzed daily diary entries from 202 college students, who tracked their sleep, daily stressors, and anger over one month. Preliminary results show that individuals reported experiencing more anger on days following less sleep than usual for them.

The research team also conducted a lab experiment involving 147 community residents. Participants were randomly assigned either to maintain their regular sleep schedule or to restrict their sleep at home by about five hours across two nights. Following this manipulation, anger was assessed during exposure to irritating noise.

The experiment found that well-slept individuals adapted to noise and reported less anger after two days. In contrast, sleep-restricted individuals exhibited higher and increased anger in response to aversive noise, suggesting that losing sleep undermined emotional adaptation to frustrating circumstance. Subjective sleepiness accounted for most of the experimental effect of sleep loss on anger. A related experiment in which individuals reported anger following an online competitive game found similar results.

"The results are important because they provide strong causal evidence that sleep restriction increases anger and increases frustration over time," said Zlatan Krizan, who has a doctorate in personality and social psychology and is a professor of psychology at Iowa State University in Ames, Iowa. "Moreover, the results from the daily diary study suggest such effects translate to everyday life, as young adults reported more anger in the afternoon on days they slept less."

The authors noted that the findings highlight the importance of considering specific emotional reactions such as anger and their regulation in the context of sleep disruption.

The "Waiting for Godot Metaphor" for the COVID-19 response is carried forward and in an "Epilogue" a series of questions that have no clear answer are used to guide the discussion.

The lead question examines the justification of the WHO Declaration of a Pandemic back in March in light of the heightened socio-economic damage that followed in it's wake.

To more objectively provide an answer to help in future events, a gradated Pandemic Index is suggested and a rudimentary example presented as an initial effort in an ongoing developmental process. On a linear 10-point scale (10 most severe) it is suggested that COVID-19 would be a 2-3.

Other questions addressed are: What is the usefulness of the COVID-19 PCR test?; Does the risk (of COVID-19) justify the level of fear?, and; What is the consequence of a herd immunity (HI) effect?

WASHINGTON--A new artificial pancreas system can prevent hypoglycemia--episodes of dangerously low blood sugar--during and after heavy exercise in people with type 1 diabetes, according to a small study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.

Despite advances in treatment, blood sugar control in type 1 diabetes remains challenging. The artificial pancreas has the potential to automate much of the continuous work people with type 1 diabetes do to control their blood glucose levels, but exercise-related hypoglycemia is a major obstacle.

"Our new artificial pancreas system with a coordinated eating carbohydrate recommendation is both safe and effective in avoiding hypoglycemia and maintaining blood sugar control during and after heavy physical exercise in people with type 1 diabetes," said the study's corresponding author, Marga Giménez, M.D., Ph.D. of the Hospital Clínic de Barcelona in Barcelona, Spain. "Although exercise provides many health benefits, it has unpredictable effects on blood sugar control, making it difficult for people with type 1 diabetes to exercise daily. The artificial pancreas is emerging as the most promising treatment for managing type 1 diabetes, but exercise-related hypoglycemia remains a challenge."

The researchers tested their new artificial pancreas system on 10 adults with type 1 diabetes during an in-hospital clinical trial, measuring their blood sugar during and three hours after exercise. They found that the artificial pancreas system performed well and was safe during and after heavy exercise in people with type 1 diabetes in comparison with standard therapy.

GENEVA, SWITZERLAND - Today, the way a physician gets an idea of how many seizures a person with epilepsy has had is through the patient's own record of seizure activity in his day-to-day life. Despite all the technological advances in devices monitoring the human body, a patient's seizure diary, as it is often called, remains the only means to record and count epileptic seizures outside the clinic. Any insights that such a diary can provide on the effects of medication, seizure frequency or seizure triggers depend on the reliability and detail of the patient's reporting. Even accurate recognition of seizures is a problem since about half of seizures are not known to the patient.

A new generation of long-term brain monitoring technologies that continuously record brain activity in the clinic or at home is emerging and could greatly improve disease management for epilepsy patients. In an article published today in the journal Epilepsia, a team of scientists, engineers and clinicians from around the world describe how an innovative approach that records neural activity from beneath the scalp could provide a reliable alternative to subjective seizure diaries. These innovative devices are subscalp electroencephalography (EEG) systems that are minimally invasive and could remain underneath the scalp for long periods of time.

Maxime Baud, MD, PhD, epileptologist at Bern University Hospital, Wyss Center Staff Neurologist and co-author of the paper said: "Our current epilepsy treatment plans are primarily based on short-term brain activity data from EEG caps during a hospital visit. Epileptic seizures can occur months apart and come in cycles, so we need ways to, continuously and accurately, monitor brain activity in the home environment. With the Wyss Center's Epios system, we are excited to be part of the movement developing such new technologies, that can ultimately enable us to optimize and personalize treatment for each patient."

Six new technologies, commercially available or under development, are described in the paper each with a different primary value including seizure counting and recording, seizure forecasting and alerting, and neuro-stimulation. These minimally invasive techniques may help avoid some of the risks linked to directly intervening in the brain.

One of these subscalp devices is Minder, being developed by the Australian company Epi-Minder. Currently in clinical trials, the device's multichannel electrode is placed across the skull so that both brain hemispheres are covered. "Through long-term and continuous EEG measurements, Minder aims to provide accurate knowledge of brain activity and seizures to help people with epilepsy take back control of their lives," said Professor Mark Cook, MD, PhD, Chair of Medicine at the University of Melbourne, Director of Neurology at St Vincent's Hospital, Melbourne and co-author of the paper.

Another technology reviewed in the paper is the Wyss Center's EpiosTM system, designed to offer flexible subscalp configurations, from focal or bitemporal electrode layouts to broad head coverage and high-channel-count neural recording, through a series of thin sensing electrodes connected to a miniature implant, all inserted beneath the skin. The neural signals are wirelessly transmitted to an external (behind-the-ear) receiver, while a wearable data processor enhances brain data with heart rate, accelerometry and audio data and uploads it to the Epios Cloud, which offers secure and centralized data storage, annotation and visualization.

"In parallel to the recording devices, we are constantly optimizing our high performance analytics software with algorithms that could help clinicians draw meaningful conclusions from the vast amount of data recorded by these long-term systems," George Kouvas, MBA, Chief Technology Officer at the Wyss Center and co-author of the paper said. "We are already working towards adapting these new technologies to help patients with other brain disorders manage their daily life, such as with tinnitus and stroke," Kouvas added.

Future uses for long-term, subscalp brain monitoring include biomarker detection and efficacy monitoring of pharmaceuticals as well as well as closed-loop neuromodulation applications.

The technologies reviewed in the paper are:

24/7 EEG™ SubQ from UNEEG medical A/S, Lynge, Denmark;

The Epicranial Application of Stimulation Electrodes for Epilepsy (EASEE) from Precisis AG, Heidelberg, Germany;

The Epios™ system from the Wyss Center for Bio and Neuroengineering, Geneva, Switzerland;

Minder from Epi-Minder Pty Ltd, Melbourne, Australia;

The Neuroview Technology from Englewood, USA;

UltimateEEG from BrainCare Oy Ltd., Tampere, Finland.

The article: A new era in electroencephalographic monitoring? Subscalp devices for ultra-long-term recordings is published in Epilepsia and will be available at: https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16630

Hennigsdorf/Berlin, Germany, August 27, 2020 - Diagnostics company SphingoTec GmbH ("SphingoTec") announced today the publication of first data (1), proving that its real-time kidney function biomarker penKid® is a reliable biomarker for the diagnosis of acute kidney injury (AKI) in infants. With the incidence of pediatric AKI increasing globally, there is a high need for non-invasive, diagnostic solutions to improve the early diagnosis of AKI in children to prevent adverse events and improve recovery.

penKid® is an established biomarker for detecting AKI in adults. The current study shows that reference values for penKid® in children are much higher than in adults. However, when considering these higher reference values in critically ill children under one year of age, high or increasing penKid® concentrations accurately predict AKI and its severity.

Dr. Andreas Bergmann, CEO of SphingoTec, commented: "The data confirm, that penKid® predicts AKI also in challenging settings such as the pediatric critical care. In critically ill children, AKI has a high prelevance, is associated with poor outcomes and the possibilities for pharmacological intervention are limited. Therefore, the early detection of AKI is paramount in improving the prognosis for these children."

In children admitted to hospital, AKI is a common complication especially among those requiring intensive care, affecting up to 51% admitted to ICU (2). Pediatric AKI is often diagnosed too late for successful therapeutic interventions leading to adverse outcomes and chronic kidney impairment. The data from the recent study highlight that penKid® has the potential to address this diagnostic shortcoming. The study data add to the rapidly growing body of evidence in by now more than 30,000 adult patients, showing that penKid® is an early and accurate indicator for the worsening or improvement of kidney function. Importantly, penKid® is independent of inflammation and comorbidities and, as recently published, the most accurate surrogate marker for true glomerular filtration rate (true GFR) in patients with renal impairment (3) and hence ideally suited for the real-time assessment of kidney function and the early prediction of AKI.

Artificial intelligence, or "supervised machine learning," could help identify which well-appearing infants with fever, who are 60 days old or younger, are at low risk for a serious bacterial infection, according to a study published in Pediatrics. Accurate risk determination could reduce unnecessary lumbar puncture, antibiotics and hospitalizations for these infants, as well as decreasing parental anxiety.

"In the Emergency Department, it is critical to determine which infants are at high risk for a serious bacterial infection, and which infants are at low risk," says lead author Sriram Ramgopal, MD, pediatric emergency medicine physician at Ann & Robert H. Lurie Children's Hospital of Chicago and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. "We trained and assessed four different machine learning algorithms and found that the type called 'random forest' yields the most accurate results, surpassing the predictive capability of the current decision rules we use. Our results are very promising and may pave the way to an eventual use of this type of artificial intelligence clinically."

Fever in young infants is very common, but only about 10 percent turn out to have a serious bacterial infection, such as urinary tract infection, bacterial meningitis, or bacteremia (bacteria in the blood). However, using the available decision rules to determine risk produces too many false positives, meaning that those infants undergo invasive procedures, receive antibiotics and might be hospitalized unnecessarily.

In the study, among 1,240 patients who received a lumbar puncture, the artificial intelligence model could have prevented 849 (over 68 percent) of such procedures. The model produced results with both high sensitivity (accurate detection of true positives) and specificity (accurate detection of true negatives).

"It may still take many years before artificial intelligence algorithms become standard practice in medicine," says Dr. Ramgopal. "It is an exciting area of research with great potential to improve care of our patients."

"One day at a time" is a mantra for recovering alcoholics, for whom each day without a drink builds the strength to go on to the next. A new brain imaging study by Yale researchers shows why the approach works.

Imaging scans of those diagnosed with alcohol use disorder (AUD) taken one day to two weeks after their last drink reveal associated disruptions of activity between the ventromedial prefrontal cortex and striatum, a brain network linked to decision making. The more recent the last drink, the more severe the disruption, and the more likely the alcoholics will resume heavy drinking and jeopardize their treatment and recovery, researchers report Aug. 28 in the American Journal of Psychiatry.

However, the researchers also found that the severity of disruption between these brain regions diminishes gradually the longer AUD subjects abstain from alcohol.

"For people with AUD, the brain takes a long time to normalize, and each day is going to be a struggle," said Rajita Sinha, the Foundations Fund Professor of Psychiatry and professor in the Child Study Center, professor of neuroscience and senior author of the study. "For these people, it really is 'one day at a time.'"

The imaging studies can help reveal who is most at risk of relapse and underscore the importance of extensive early treatment for those in their early days of sobriety, Sinha said.

"When people are struggling, it is not enough for them to say, 'Okay, I didn't drink today so I'm good now.'" Sinha said. "It doesn't work that way."

The study also suggests it may be possible to develop medications specifically to help those with the greatest brain disruptions during their early days of alcohol treatment. For instance, Sinha and Yale colleagues are currently investigating whether existing high blood pressure medication can help reduce disruptions in the prefrontal-striatal network and improve chances of long-term abstinence in AUD patients.

N95 respirators, which are widely worn by health care workers treating patients with COVID-19 and are designed to be used only once, can be decontaminated effectively and used up to three times, according to research by UCLA scientists and colleagues.

An early-release version of their study has been published online, with the full study to appear in September in the journal Emerging Infectious Diseases.

N95 respirators reduce exposure to airborne infectious agents, including SARS-CoV-2, the virus that causes COVID-19, and are one of the key pieces of personal protective equipment used by clinical workers in preventing the spread of the virus. Critical shortages of these masks have driven efforts to find new decontamination methods that can extend their use.

"Although N95 respirators are designed for just one use before disposal, in times of shortage, N95 respirators can be decontaminated and reused up to three times," said James Lloyd-Smith, a co-author of the study and a UCLA professor of ecology and evolutionary biology. "But the integrity of the respirator's fit and seal must be maintained."

In a controlled laboratory setting, the researchers tested several decontamination methods on small sections of N95 filter fabric that had been exposed to SARS-CoV-2. The methods included vaporized hydrogen peroxide, dry heat at 70 degrees Celsius (158 degrees Fahrenheit), ultraviolet light and a 70% ethanol spray. All four methods eliminated detectable viable virus from the N95 fabric test samples.

The investigators then treated fully intact, clean respirators with the same decontamination methods to test their reuse durability. Employees with the National Institutes of Health's Rocky Mountain Laboratories in Montana volunteered to wear the masks for two hours to determine if they maintained a proper fit and seal over the face. The scientists decontaminated each mask three times, using the same procedure with each.

The masks treated with vaporized hydrogen peroxide experienced no failures, suggesting they potentially could be reused three times, Lloyd-Smith said. Those treated with ultraviolet light and dry heat began showing fit and seal problems after three decontaminations, suggesting these respirators potentially could be reused twice.

The study authors concluded that vaporized hydrogen peroxide was the most effective method because no traces of the virus could be detected after only a 10-minute treatment. They found that ultraviolet light and dry heat are also acceptable decontamination procedures, as long as the methods are applied for at least 60 minutes.

The ethanol spray, the scientists discovered, damaged the integrity of the respirator's fit and seal after two sessions, and they do not recommend it for decontaminating N95 respirators.

The researchers stressed that anyone decontaminating an N95 respirator should closely check the fit and seal over the face before each reuse.