Body

Epidemiologists at The University of Manchester have discovered an association between the number of prescriptions for antibiotics and a higher risk of hospital admissions.

The study, published in BMC Medicine and funded by The National Institute for Health Research and the Connected Health Cities Programme, is based on the data of 2 million patients in England and Wales.

Patients who have had 9 or more antibiotic prescriptions for common infections in the previous 3 years are, say the team, 2.26 times more likely to go to hospital with another infection in three or more months.

The patient records, from 2000 to 2016, covered common infections such as upper respiratory tract, urinary tract, ear and chest infections and excluded long term conditions such as cystic fibrosis and chronic lung disease.

It not clear why hospital admissions are linked to higher prescriptions and, the team say, research is needed to show what or if any biological factors exist.

The risks of going to hospital with another infection were related to the number of the antibiotic prescriptions in the previous three years.

Patients who had 2 antibiotic prescriptions were 1.23 times more likely, patients who had 3 to 4 prescriptions 1.33 times more likely and patients who had 5 to 8 1.77 times more likely to go to hospital with another infection.

A course is defined by the team as being given over a period of one or two weeks.

Professor Tjeerd van Staa from The University of Manchester, said: "GPs care about their patients, and over recent years have worked hard to reduce the prescribing of antibiotics.

"But it is clear GPs do not have the tools to prescribe antibiotics effectively for common infections, especially when patients already have previously used antibiotics.

"They may prescribe numerous courses of antibiotics over a several years, which according to our study increases the risk of a more serious infection. That in turn, we show, is linked to hospital admissions."

He added: "We don't know why this is, but overuse of antibiotics might kill the good bacteria in the gut (microbiota) and make us more susceptible to infections, for example.

"Prescribing antibiotics for a common infection, even though it's not certain whether it's viral - where antibiotics are not indicated - or bacterial - where they are - might be easier when there is little time.

"And in a large practice, where there is no named GP, doctors may be less likely to know their patients and less tuned in to their history and circumstances to make informed decisions."

Clinical project manager Francine Jury also from The University of Manchester said: "GPs often have little time to get to grips with the detail of a patient's history.

"But what makes it even more difficult is that little official guidance exists for patients who already in the recent past had several courses of antibiotics for common infections.

"Our hope is that, however, a tool we are working for GPs, based on patient history, will be able to calculate the risks associated with taking multiple courses of antibiotics."

Turbulence is everywhere -- it rattles our planes and makes tiny whirlpools in our bathtubs -- but it is one of the least understood phenomena in classical physics.

Turbulence occurs when an ordered fluid flow breaks into small vortices, which interact with each other and break into even smaller vortices, which interact with each other and so-on, becoming the chaotic maelstrom of disorder that makes white water rafting so much fun.

But the mechanics of that descent into chaos have puzzled scientists for centuries.

When they don't understand something, physicists have a go-to solution: smash it together. Want to understand the fundamental building blocks of the universe? Smash particles together. Want to unravel the underlying mechanics of turbulence? Smash vortices together.

Researchers at the Harvard John A. Paulson School of Engineering and Applied Sciences (SEAS) may have identified a fundamental mechanism by which turbulence develops by smashing vortex rings head-on into each other, recording the results with ultra-high-resolution cameras, and reconstructing the collision dynamics using a 3D visualization program. Coupled with the analysis of numerical simulations performed by collaborators at the University of Houston and ENS de Lyon, the researchers have gained unprecedented insight into how fluidic systems transform from order to disorder.

The research is described in Science Advances.

"Our ability to predict the weather, understand why a Boeing 747 flies even with turbulent currents in its wake, and determine the global flows in the ocean depends on how well we model turbulence," said Shmuel Rubinstein, Associate Professor of Applied Physics at SEAS and corresponding author of the paper. "However, our understanding of turbulence still lacks a mechanistic description that explains how energy cascades to smaller and smaller scales until it is eventually dissipated. This research opens the door to just that kind of understanding."

"Trying to make sense of what is going on in an exceedingly complex system like turbulence is always a challenge," said Rodolfo Ostilla-Mónico, Assistant Professor of Mechanical Engineering at the University of Houston and corresponding author of the paper. "At every length-scale, vortices are straining and compressing each other to generate a chaotic picture. With this work, we can begin to isolate and watch simple pair interactions, and how these lead to rich dynamics when enough of them are present."

Physicists have been using vortex colliders to understand turbulences since the 1990s, but previous experiments haven't been able to slow down and reconstruct the mechanics of the collision, the moment it descends into chaos. To do that, the researchers synchronized a powerful scanning laser sheet with a high-speed camera -- capable of snapping hundreds of thousands of images per second -- to rapidly scan the entire collision in real time.

They used vortex cannons in a 75-gallon aquarium to produce the vortices. Each vortex was dyed a different color, so researchers could observe how they interact when they violently collide. It takes less than a second for the rings to disappear into a puff of dye after the collision, but within that time, a lot of physics happens.

First, the rings stretch outward as they smash into each other and the edges form antisymmetric waves. The crests of these waves develop into finger-like filaments, which grow perpendicularly between the colliding cores.

These filaments counter-rotate with their neighbors, creating a new array of miniature vortices that interact with each other for milliseconds. Those vortices also form filaments, which in turn form vortices. The research team observed three generations of this cascading cycle, each one the same as before, only smaller -- a Russian nesting doll of disorder.

"This similar behavior from the large scale to the small scale emerges very rapidly and orderly before it all breaks down into turbulence," said Ryan McKeown, a graduate student at SEAS and first author of the paper. "This cascading effect is really exciting because it could point to a universal mechanism for how these interactions work, independent of scale."

In addition to the experiments, the research team also developed numerical simulations to understand the dynamics of the breakdown and quantify how the energy spectrum of the cascade evolves. Turbulence has a very specific and well-defined energy spectrum. While this system is considerably simpler than the turbulence that rattles a plane, the researchers found that the energy spectrum at the late-stage breakdown of the vortices follows the same tell-tale scaling of fully developed turbulence.

"This is a great indication that while this is a different system--for a brief time--it is creating the same conditions of turbulence. It's a starting point," said McKeown.

Current Physiotherapy techniques require patients to complete exercises at home, which doesn't include much guidance

Virtual reality (VR) combined with 3D Motion capture could allow movements to be translated onto an avatar the patient can follow, thanks to researchers at WMG, University of Warwick

Consumer VR technologies can be used for both providing guidance to physiotherapy exercises, but also to make the exercises more interesting and encourage people to complete the course they need

Virtual reality could help physiotherapy patients complete their exercises at home successfully thanks to researchers at WMG, University of Warwick, who managed to combine VR technology with 3D motion capture.

Currently prescribed physiotherapy often requires patients to complete regular exercises at home. Outside of the clinic, patients rarely receive any guidance other than a leaflet of sketches or static photographs to instruct them how to complete their exercises. This leads to poor adherence, with patients becoming anxious about not getting the exercise right, or simply getting bored by the repetitiveness of the movements.

The advent of consumer virtual reality technology combined with 3D motion capture allows real movements to be accurately translated onto an avatar that can be viewed in a virtual environment. Researchers at the Institute of Digital Healthcare, WMG, University of Warwick are investigating whether this technology can be used to provide guidance to physiotherapy patients, by providing a virtual physiotherapist in the home to demonstrate the prescribed exercises.

Their paper, 'Timing and correction of stepping movements with a virtual reality avatar' published today the 28th of February, in the Journal PLOS ONE, has focused on whether people are able to accurately follow the movements of a virtual avatar.

Researchers had to investigate whether people were able to accurately coordinate and follow the movements of an avatar in a virtual environment. They asked participants to step in time with an avatar viewed through a VR headset.

Unknown to the participants, the researchers subtly slowed down or speeded up one of the avatar's steps, such that the participants would have to correct their own stepping movement to stay in time. The effect this correction had on their step timing and synchronisation with the avatar was measured.

Lead author, Omar Khan from WMG, University of Warwick commented:

"If participants were observed to correct their own stepping to stay in time with the avatar, we knew they were able to accurately follow the movements they were observing.

"We found that participants struggled to keep in time if only visual information was present. However, when we added realistic footstep sounds in addition to the visual information, the more realistic multisensory information allowed participants to accurately follow the avatar."

Dr Mark Elliott, Principal investigator on the project at WMG, University of Warwick added:

"There is huge potential for consumer VR technologies to be used for both providing guidance to physiotherapy exercises, but also to make the exercises more interesting. This study has focused on the crucial question of how well people can follow a virtual guide."

Prof. Theo Arvanitis, co-author and Director of the Institute of Digital Healthcare, said:

"Our work and digitally-enabled technological solution can underpin transformative health innovations to impact the field of physiotherapy, and have a direct benefit to patients' rehabilitation.
"We now plan to investigate other types of movements working closely in partnership with physiotherapists, to establish the areas of physiotherapy that will benefit most from this technology."

Pregnancies among women with disabilities are 42% more likely to be unintended than pregnancies among women without disabilities, says a new report published in the journal Perspectives on Sexual and Reproductive Health.

Using data from the National Survey of Family Growth, researchers at Oregon Health & Science University found that females with independent living challenges, or those who may have difficulty completing day-to-day tasks such as banking or shopping without assistance, have the highest risk for unintended pregnancy. Women with hearing loss or cognitive disability also showed higher proportions of unintended pregnancy, compared with women without disabilities.

"In general, women who experience unplanned or unwanted pregnancy are less likely to obtain timely prenatal care. Unfortunately, delayed care can contribute to poorer pregnancy outcomes," says the study's lead author Willi Horner-Johnson, Ph.D., an associate professor with the Institute on Development and Disability in the OHSU School of Medicine, and the OHSU-PSU School of Public Health. "This concern is greatly exacerbated when we consider women with disabilities. Many already have complex health care needs and are more susceptible to pregnancy complications or postpartum depression."

While additional research is needed to pinpoint exact factors, Horner-Johnson believes the high proportions of unintended pregnancies among women with disabilities may be linked to societal views.

"Perceptions of what is appropriate, in terms of sexuality, family planning and parenting, for individuals with disabilities are likely to influence reproductive education and care in this population," she says. "If we don't provide sex education materials with appropriate accommodations, such as sign language interpretation or tactile learning, or we simply don't ask a woman about her reproductive preferences because of an assumption that a disability would inhibit parenting skills, we are effectively limiting access to critical knowledge and health care services that will ensure optimal timing of pregnancy and ideal birth outcomes."

What The Study Did: This observational study with nearly 6,300 patients who visited the emergency department or who were hospitalized for a traumatic injury examined how implementation of the Patient Protection and Affordable Care Act (ACA) was associated with out-of-pocket and premium spending among those patients.

Authors: Charles Liu, M.D., M.S., of Stanford University in California, is the corresponding author.

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

(10.1001/jamanetworkopen.2020.0157)

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

What The Study Did: Some states have enacted laws restricting opioid prescribing for the treatment of acute pain and this research letter assess the outcomes associated with Florida's restriction law.

Authors: Juan M. Hincapie-Castillo, Pharm.D., M.S., Ph.D., of the University of Florida in Gainesville, is the corresponding author.

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

(10.1001/jamanetworkopen.2020.0234)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflicts of interest and financial disclosures, and funding and support.

Researchers at the Universities of Leicester and Nottingham have discovered parts of the DNA that put some people at higher risk of an incurable lung disease called idiopathic pulmonary fibrosis (IPF). The findings are published in the American Journal of Respiratory and Critical Care Medicine today, after an earlier version was posted online in November 2019 prior to final review.

IPF is a devastating lung disease where scar tissue builds up in the lungs. This scarring makes it difficult to breathe and half of all patients die within three years of diagnosis. About 6,000 people are diagnosed every year in the UK, though this number appears to be rising. There are no cures for IPF and current treatments can only slow the progression of the disease. This means an improved understanding of what causes IPF is vital in the development of more effective treatments.

Professor Louise Wain and Dr Richard Allen from the University of Leicester, and Professor Gisli Jenkins from the University of Nottingham, led the study that included collaborators from over 30 institutions across six countries. The leadership of this collaboration unites the NIHR Biomedical Research Centres (BRCs) of Leicester and Nottingham - partnerships between their respective universities, Nottingham University Hospitals NHS Trust and the University Hospitals of Leicester NHS Trust. The purpose of the NIHR BRCs is to take scientific discoveries and translate them into treatments and care pathways for the direct benefit of patients.

The research teams compared the DNA of 4,000 people with IPF to 20,000 people without IPF. In total they investigated over 10 million changes in the DNA and found that people with IPF were more likely to have changes in three genes that have not previously been known to be involved with the disease. These genes suggest biological pathways which crucially could be potential targets for new drugs.

One of these genes lies in a pathway that has recently been shown to promote fibrosis in the lungs. There are currently drugs under development that can target this pathway and might benefit patients. The other two genes highlight pathways not previously investigated for IPF but which might drive development of new treatments in the future.

Dr Richard Allen, Action for Pulmonary Fibrosis Research Fellow at the University of Leicester, said: "These are really exciting discoveries and improve our understanding of the disease. Hopefully this research will help in the development of treatments which are desperately needed for this devastating disease."

Professor Louise Wain, British Lung Foundation Chair in Respiratory Research at the University of Leicester, said: "Genetic studies hold real promise in helping us find new treatments for IPF. This study was undertaken by a large international team of scientists and doctors and wouldn't have been possible were it not for patients with IPF contributing their genetic data for research. The next step is to find out how these findings can enable us to find new and better treatments for IPF."

Ian Jarrold, Head of Research at the British Lung Foundation, said: "IPF kills more people than leukaemia every year in the UK, but it has been a major challenge to identify the biological factors that are responsible for this insidious lung condition.

"Genomics has helped us to take big steps forward in finding new treatments for this condition. By teasing out the complex relationships between different genes, we have a huge opportunity to turn the tide against IPF.

"We urgently need treatments that can stop lung scarring in its tracks. The exciting prospect of three newly identified genes, which could lead us to these new treatments, brings hope to the many thousands of people whose lives have been devastated by IPF."

Steve Jones, Chair of Action for Pulmonary Fibrosis said: "Idiopathic Pulmonary Fibrosis (IPF) is a devastating disease, which accounts for one percent of all deaths in the UK. To find a cure, it is vital that we understand the genetic changes associated with the process of lung fibrosis. This path-breaking research has identified three genes, which could lead to new treatments bringing hope to the large number of people around the world living with the disease."

Almost every parent knows the drill: When it's your turn, you bring Capri Suns and Rice Krispies Treats to your child's soccer game as a post-game snack. Whether you're a parent that loves the tradition or despises it, new research shows just how detrimental post-game treats are to a child's health.

A new study led by Brigham Young University public health researchers finds the number of calories kids consume from post-game snacks far exceeds the number of calories they actually burn playing in the game.

"Kids are getting inundated with snack culture all the time -- celebrations at school, at birthday parties and youth sports games," said senior study author and BYU professor Lori Spruance. "We don't need to load children up with sugar after a game too."

For the study, Spruance and her students observed 3rd and 4th graders over 189 games of soccer, flag football, baseball and softball, tracking both their physical activity and the treats they consumed. They found parents brought post-game snacks 80% of the time, with almost 90% of the post-game drinks being sugar sweetened. Physical activity was tracked using the SOFIT method, wherein a child's activity was tracked on a scale of 1 to 5 (1 = nothing; 5 = running) every 10 seconds.

The researchers found the average energy expenditure for children observed was 170 calories per game while the average caloric intake from post-game snacks was 213 calories. The average amount of sugar consumed post game was a staggering 26.4 grams -- the total daily recommendation for kids is just 25 grams -- with sugary drinks being the biggest culprits. (Capri Sun drinks and Kool-Aid Jammers were the most common drinks and baked goods were the most common snacks.)

The study, publishing in the American Journal of Health Behavior, also found children averaged just 27 minutes of activity per game, with soccer players being the most active and softball players being the least active. Research shows children should have 60 minutes of physical activity per day starting around age 5.

Study authors said the 43 extra calories the children are gaining may not sound like much, but if kids are playing a game or two a week, it could mean thousands of extra sugary calories a year.

"So many kids are at games just to get their treat afterwards, which really isn't helping to develop healthy habits long term," Spruance said. "The reward should be, 'I got to have fun, I got to run around with my friend or score a goal.'"

How to change snack culture

Spruance and coauthors said youth sports programs would benefit from an intervention aimed at the food environment -- and they're happy to help with that intervention. To that end, the team is already working on their next study by providing fact sheets about the troubles with current post-game snacks to municipal Parks and Recreation departments. Those departments are then, in turn, sharing the information with parents.

Initial efforts in one city have already shown marked decreases in the number of unhealthy snacks being provided at youth games: 16% of snacks in a new season of tracking included water instead of a sugary beverage, and parents who brought fruits and vegetables increased from 3% to 15% overall.

"Little changes can make a big difference in promoting healthy body weights in our children," wrote study co-author Jay Maddock, a professor of public health at Texas A&M University. "So when your children are playing sports, we recommend making the healthy choice an choosing water, fruits an vegetables and a healthy protein source too, like nuts."

MINNEAPOLIS - Children and teens with epilepsy who were treated with pharmaceutical cannabidiol (CBD) had much better seizure control than those who were treated with artisanal CBD, according to a preliminary study to be presented at the American Academy of Neurology's 72nd Annual Meeting in Toronto, Canada, April 25 to May 1, 2020.

CBD is a cannabis component that relieves stress and anxiety and has anti-seizure properties. It does not produce a "high" like another cannabis component called tetrahydrocannabinol (THC). Pharmaceutical CBD for epilepsy does not have THC. It is FDA approved for use in two severe forms of childhood epilepsy, Dravet syndrome and Lennox-Gastaut syndrome, which do not respond well to other medications. Artisanal CBD is manufactured using varying techniques and contains variable amounts of CBD and THC.

"The use of medical cannabis to treat various medical conditions has grown in recent years. While not always legal, artisanal CBD has been available longer, so some people have been using it to treat epilepsy for years," said study author Nathan T. Cohen, M.D., of Children's National Hospital in Washington D.C., and a member of the American Academy of Neurology. "They may want to reconsider because our research indicates that pharmaceutical CBD may indeed be more effective than artisanal CBD."

For the study, researchers reviewed the medical charts of 31 children and teens with an average age of 10 who were followed for an average age of one year. All had some form of epilepsy including 32% with Lennox-Gastaut syndrome and 6% with Dravet syndrome. Of the group, 22 were taking pharmaceutical CBD and nine were taking artisanal CBD. Researchers recorded medication doses, levels of CBD in the blood, seizure history and reduction in seizures with medication and side effects.

Those taking artisanal CBD had an average level of CBD in the blood of 31 nanograms per milliliter (ng/mL) compared to 124 ng/mL for those taking pharmaceutical CBD.

Researchers found children and teens taking artisanal CBD had a 70% increase in seizures during the study. Those taking prescription CBD had a 39% reduction in seizures.

However, 11 participants reported side effects. All were taking pharmaceutical CBD. Side effects included sleepiness, low appetite, nausea and diarrhea. Six of those participants stopped taking pharmaceutical CBD due to side effects.

"The difference in seizure control is dramatic and is definitely of concern since many people continue to use artisanal CBD," said Cohen. "However, a limitation of our study is that it was small. More research is needed to see if similar results are found in larger groups of people."

Another limitation of the study was that it was a look back at medical records. It did not involve participants who were given either pharmaceutical or artisanal CBD and then followed over time.

Denver--An international team of clinicians and researchers for the first time have described the pathology of the SARS-CoV-2, or coronavirus, and published their findings in the Journal of Thoracic Oncology, the journal of the International Association for the Study of Lung Cancer.

The article's senior author, Shu-Yuan Xiao, M.D., from the University of Chicago Medicine in Chicago, teamed up with a small group of clinicians from the Zhongnan Hospital of Wuhan University, in Wuhan, China.

"This is the first study to describe the pathology of disease caused by SARS-CoV-2, or COVID-19 pneumonina, since no autopsy or biopsies had been performed thus far," Dr. Xiao said. "This would be the only descriptions of early phase pathology of the disease due to this rare coincidence. There would be no other circumstance that this will happen. Autopsies will only show late or end stage changes of the disease."

The article describes two patients who recently underwent lung lobectomies for adenocarcinoma and were retrospectively found to have had COVID-19 at the time of surgery. Pathologic examinations revealed that, apart from the tumors, the lungs of both patients exhibited edema, proteinaceous exudate, focal reactive hyperplasia of pneumocytes with patchy inflammatory cellular infiltration, and multinucleated giant cells. Fibroblastic plugs were noted in airspaces.

"Since both patients did not exhibit symptoms of pneumonia at the time of surgery, these changes likely represent an early phase of the lung pathology of COVID-19 pneumonia," Dr. Xiao said.

CASE 1 was a female patient of 84 years of age who was admitted for treatment evaluation of a tumor measuring 1.5 centimeters in the right middle lobe of the lung. The tumor was discovered on chest CT scan at an outside hospital. She had a past medical history of hypertension for 30 years, as well as type 2 diabetes. Despite comprehensive treatment, assisted oxygenation, and other supportive care, the patient's condition deteriorated, and she died. Subsequent clinical information confirmed that she was exposed to another patient in the same room who was subsequently found to be infected with the 2019 novel coronavirus.

CASE 2 was a male patient of 73 years of age, who presented for elective surgery for lung cancer, in the form of a small in the right lower lobe of the lung. He had a past medical history of hypertension for 20 years, which had been adequately managed. Nine days after lung surgery, he developed a fever with dry cough, chest tightness, and muscle pain. A nucleic acid test for SARS-CoV-2 came back as positive. He gradually recovered and was discharged after twenty days of treatment in the infectious disease unit.

According to the study, these two incidences also typify a common scenario during the earlier phase of the SARS-CoV-2 outbreak, during which a significant number of healthcare providers became infected in hospitals in Wuhan, and patients in the same hospital room were cross-infected, as they were exposed to unknown infectious sources. The presence of early lung lesions days before the patients developed symptoms, corresponds to the long incubation period (usually 3-14 days) of COVID-19. Making it difficult to prevent transmission during the early days of this outbreak, as many healthcare workers in Wuhan became infected, when they were seeing patients without sufficient protection, according to Dr. Xiao. As of today, more than 15 doctors in Wuhan died of COVID-19, from infections while they were taking care of patients. Some of them were previously healthy and as young as 29 years old.

"We believe it is imperative to report the findings of routine histopathology for better understanding of the mechanism by which the SARS-CoV-2 causes lung injury in the unfortunate tens and thousands of patients in Wuhan and worldwide," Dr. Xiao said. Further studies by Dr. Xiao's team and collaborators on COVID-19 pathology through postmortem biopsies are ongoing, which should provide data on the late changes of this disease.

The body's immune response to fungal infections changes when a patient is also infected by a virus, according to new research which investigated the two types of infection together for the first time.

The study, carried out by researchers at the University of Birmingham, The Pirbright Institute and University College London, sheds fresh light on the immune system's ability to deal with co-infection.

Fungal infections are major killers of patients with impaired immunity, such as AIDS patients or transplant recipients, but they usually occur alongside a secondary, viral infection. Although clinicians understand how the immune system responds to each of these types of pathogen, much less is known about what happens when both occur together.

Typically, white blood cells will attack pathogens through a process called phagocytosis - where a pathogen is engulfed by the white blood cell. In fungal infections, however, this process sometimes 'reverses' - ejecting the fungus back out of the white blood cell via a process called vomocytosis.

In a new study, published in PLOS Pathogens, the researchers were able to show that this process of expulsion is rapidly accelerated when the white blood cell detects a virus.

The team used advanced microscopy techniques to study live white blood cells exposed to two different types of virus, HIV, and measles, alongside the fungal pathogen, Cryptococcus neoformans. This opportunistic pathogen is particularly deadly among HIV+ patients, where it causes around 200,000 deaths per year worldwide.

The researchers found that, instead of becoming simply less able to deal with the fungus, the white blood cells began expelling the fungal cells much more rapidly.

Lead author, Professor Robin May, Director of the Institute of Microbiology and Infection at the University of Birmingham, explains: "We found the macrophages ejected their prey - the fungal cells - much more quickly when the virus was present. This was very unexpected, but could be an attempt to 'free up' those white blood cells to deal with the new viral invaders."

Because the vomocytosis occurred with both viruses, the researchers concluded that the effect was likely to be a general response to viral co-infection.

Professor Robin May adds: "This is the first time that scientists have studied our immune system's response to fungal infection in the much more realistic setting of a secondary (viral) infection. We don't yet know whether this mechanism makes the white blood cells more or less effective in fighting off either infection. Although expelling the fungal cell will free up the macrophage to attack the virus, it also sets free the fungal cell to continue its spread through the body."

Dr Dalan Bailey, head of the Viral Glycoproteins group at Pirbright, comments: "This is another interesting example of transkingdom interactions between microbes, this time fungi and viruses. We are only beginning to understand the complexity of microbe interactions within the host, and this collaboration sheds new light on this exciting new area of research"

Investigating these processes in animal models will be the next step for the team, with a longer term goal of harnessing the mechanisms used to trigger the expulsion of fungi and use them to help clear these pathogens from the body.

Philadelphia, February 27, 2020--Researchers at Children's Hospital of Philadelphia (CHOP) have developed a novel computational algorithm to track the epidemiology of pediatric sepsis, allowing for the collection of more accurate data about outcomes and incidence of the condition over time, which is essential to the improvement of care.

The tool was described in a paper published in the February 2020 issue of Pediatric Critical Care Medicine.

"We were able for the first time to have a consistent, objective, and unbiased definition of sepsis applied over a period of eight years, without having to rely on laborious and expensive manual chart review or claims data that suffer from variability across providers and time," said Scott Weiss, MD, MSCE, an attending physician in the pediatric intensive care unit at CHOP and first author of the study.

Sepsis is a deadly complication to infection that occurs when the immune system stops fighting the infectious agent and instead turns on itself, attacking tissue in the lungs, kidneys and other vital organs. It is a leading cause of death in hospitals and contributes significantly to high health care costs.

Tracking the incidence of sepsis is critical to understanding the prevalence of the condition and improving outcomes and survival, but to date there has not been an effective tool for monitoring sepsis incidence in the pediatric population. Current methods that involve gathering insurance claims data or manual chart review are inconsistent and often leave out patients groups, such as those who transfer to a hospital for sepsis treatment when their sepsis was diagnosed elsewhere.

To allow for more precise tracking, the research team developed an algorithm with the help of the CHOP Research Institute's Arcus Pediatric Knowledge Network, an integrated data science platform that links the clinical and research data of more than 2 million patients. The program developed the algorithm using data from suspected or confirmed sepsis cases seen at CHOP between September 1, 2017 and June 30, 2018. Researchers then validated the algorithm on suspected or confirmed sepsis cases seen at CHOP between July 1, 2018 and January 31, 2019.

Once researchers had developed and validated the algorithm, they then applied it to the 832,550 patients seen at CHOP in an emergency department or inpatient visit between 2011 and 2018 to gather the epidemiology of sepsis at CHOP.

They found that among more than 200,000 hospital admissions over the study period, the incidence of sepsis was 2.8%, and the incidence of sepsis among all hospital encounters increased over time after controlling for age, sex, and race. They also found that mortality was 6.7% and did not change over time, in contrast to claims-based sepsis data that has shown mortality has trended downward over time.

"This study is one example of how our program can partner with Arcus and the CHOP Research Institute to become a national leader in sepsis care," said Fran Balamuth, MD, PhD, Co-Director of CHOP's Center for Sepsis Excellence, Director of Research in the Emergency Department, and co-author of the paper. "The next step will be to externally validate the algorithm across different hospitals to make sure that it is not just applicable to CHOP, but at other academic children's hospitals and community hospitals as well."

When disease epidemics and outbreaks occur, conspiracy theories often emerge that compete with the information provided by public health officials. A Dartmouth-led study in Science Advances finds that information used to counter myths about Zika in Brazil not only failed to reduce misperceptions but also reduced the accuracy of people's other beliefs about the disease.

The results provide important context as countries launch public information campaigns about the new coronavirus (COVID-19), including how to protect oneself and prevent the spread of the disease.

"It is essential to evaluate public health messaging and information campaigns," said co-author Brendan Nyhan, a professor of government at Dartmouth. "Our results indicate that efforts to correct misperceptions about emerging diseases like Zika may not be as effective as we might hope."

The study was based on a nationally representative survey conducted in Brazil in 2017 and online survey experiments conducted there in 2017 (not long after the 2015-2016 Zika epidemic) and in 2018 (just after an unusually severe yellow fever outbreak). Using survey data, the team first demonstrated the prevalence of misperceptions among Brazilians about whether Zika can be transmitted through sexual contact (true) or casual contact (false).

The researchers then conducted three preregistered experiments testing the effectiveness of information provided by public health officials to dispel myths about Zika and yellow fever. These studies, which were conducted online among Brazilian adults, showed that corrective information about Zika not only failed to reduce misperceptions but also frequently reduced the accuracy of other beliefs people held about the disease (a finding that was replicated in both the 2017 and 2018 data).

The researchers found that corrective information about yellow fever was more effective than the material about Zika. However, exposure to this information did not increase support for public policies aimed at preventing the spread of either disease nor did it change people's intentions to engage in preventive behaviors.

CLEVELAND -- According to a new study published Feb. 25 in the Journal of the American Medical Association, abbreviated breast magnetic resonance imaging (also known as "Fast Breast MRI") detected significantly more cancers than digital breast tomosynthesis (3-D mammography) in average-risk women with dense breast tissue.

The study compared Fast Breast MRI, which is a 10-minute MRI exam, to 3-D mammography, in women with dense breasts, because the ability of mammography to detect breast cancer is limited in these women.

UH was one of the sites that enrolled patients for the national study, which closed to new patients in the end of 2017. University Hospitals, has been offering Fast Breast MRI screenings for women with dense breasts at multiple sites in the health system since 2018 and has completed over 1,300 exams.

Donna Plecha, MD, Chair of the Department of Radiology at UH, said, "When screening women at average risk for breast cancer with dense breasts, the study found that Fast Breast MRIs detected significantly more (almost two and a half times as many) breast cancers as 3-D mammography. While mammography is less expensive than MRIs, it is less effective at detecting cancers in dense breasts. MRIs have been limited to women with high risk factors, but this study showed that 10 minute MRIs were more effective than 3-D mammograms at finding cancers in dense tissue in women of average risk."

Currently, Fast Breast MRI is not covered by insurance and has an out of pocket cost of $250. "Our hope is that this study will help insurers see the benefit of the new test to improve early detection of breast cancer," said Dr. Plecha, although she said more research needs to occur on its cost-effectiveness and impact on reducing deaths from breast cancer.

UH was part of the ECOG-ACRIN Cancer Research Group (ECOG-ACRIN) which designed and conducted the study with funding from the National Cancer Institute, part of the National Institutes of Health, and Bracco Diagnostics Inc. (Monroe Township, NJ).

Despite current screening methods, more than 40,000 women die annually from breast cancer. The ability of mammography to detect breast cancer is especially limited in women with dense breast tissue. Having dense breasts is not an abnormal condition; in fact, about half of all women over the age of 40 have dense breasts.

Women in the study were between the ages of 40 and 75, had dense breasts on their prior mammogram, and did not currently have breast cancer or any clinical symptoms. A total of 1,444 women were in the study, all of whom were screened with both 3-D mammography and Fast Breast MRI within 24 hours. Participants were screened twice in the study, first as a baseline and again after one year, and are being followed for three additional years.

Biofluorescence, where organisms emit a fluorescent glow after absorbing light energy, may be widespread in amphibians including salamanders and frogs, according to a study in Scientific Reports. Biofluorescence had previously been observed in only one salamander and three frog species.

Jennifer Lamb and Matthew Davis exposed one to five individuals from 32 amphibian species to blue or ultra-violet light and measured the wavelengths of light emitted by the animals using spectrometry. The authors found that all species examined were biofluorescent, although the patterns of fluorescence differed substantially between species ranging from fluorescent blotches and stripes to fluorescent bones or all-over fluorescence.

The authors suggest that biofluorescence may enable amphibians to locate each other in low-light conditions as their eyes contain rod cells that are sensitive to green or blue light. Biofluorescence may create more contrast between amphibians and their environment, allowing them to be more easily detected by other amphibians. It could also aid amphibians in camouflage, predator mimicry or mate choice, as has been observed in other biofluorescent species.

Mechanisms underlying biofluorescence may include the presence of fluorescent proteins and compounds in skin, secretions and bones or may relate to the chemical and structural composition of some amphibians' chromatophores (pigment-containing and light-reflecting cells), according to the authors.

The findings suggest that ancestors of modern amphibians were able to biofluoresce, resulting in the phenomenon being widespread among amphibians alive today.