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The new cluster of viral pneumonia cases originating in Wuhan, China, marks the third time in 20 years that a member of the large family of coronaviruses (CoVs) has jumped from animals to humans and sparked an outbreak. In a new JAMA Viewpoint essay, Anthony S. Fauci, M.D., director of the NIH's National Institute of Allergy and Infectious Diseases (NIAID), looks back at two earlier novel CoV outbreaks that initially caused global havoc and describes steps needed to contain the current one.

Dr. Fauci and his co-authors, Hilary D. Marston, M.D., M.P.H., of NIAID, and Catharine I. Paules, M.D., of Penn State University College of Medicine, note that human CoVs historically have been regarded as relatively benign causes of the common cold. In 2002, however, a novel, highly pathogenic CoV emerged in China that caused 8,098 recorded cases of severe acute respiratory syndrome (SARS), including 774 deaths, and cost the global economy billions of dollars. Classic public health measures brought the outbreak to an end.

Another CoV jumped from animals to humans in 2012 to cause of Middle East respiratory syndrome (MERS). Unlike SARS-CoV, which has not caused additional human cases since being eliminated within several months of the initial outbreak, MERS-CoV continues to smolder due to sporadic transmission from camels--the virus's intermediate host--to people, and limited chains of person-to-person transmission.

The latest CoV to emerge is the 2019 novel coronavirus (2019-nCoV), recognized by Chinese authorities in Wuhan on December 31, 2019. It has spread beyond Wuhan to other Chinese cities and to multiple countries, including at least one confirmed case in the United States. The Viewpoint authors write, "While the trajectory of this outbreak is impossible to predict, effective response requires prompt action from the standpoint of classic public health strategies to the timely development and implementation of effective countermeasures."

Current studies at NIAID-funded institutions and by scientists in NIAID laboratories include efforts that build on previous work on SARS- and MERS-CoVs. For example, researchers are developing diagnostic tests to rapidly detect 2019-nCoV infection and exploring the use of broad-spectrum anti-viral drugs to treat 2019-nCoVs, the authors note. NIAID researchers also are adapting approaches used with investigational SARS and MERS vaccines to jumpstart candidate vaccine development for 2019-nCoV. Advances in technology since the SARS outbreak have greatly compressed the vaccine development timeline, the authors write. They indicate that a candidate vaccine for 2019-nCoV could be ready for early-stage human testing in as little as three months as compared to 20 months for early-stage development of an investigational SARS vaccine.

The authors conclude that, "the emergence of yet another outbreak of human disease caused by a pathogen from a viral family formerly thought to be relatively benign underscores the perpetual challenge of emerging infectious diseases and the importance of sustained preparedness."

WASHINGTON--Blood tests could replace menstrual periods as a gauge for when a women is nearing menopause, according to new research published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.

The study found measuring levels of anti-Müllerian hormone (AMH) can predict when a woman's final menstrual period will occur. AMH serves as an indicator of how many eggs a woman has remaining. Women are born with their lifetime supply of eggs, and the supply decreases as women approach menopause.

"Establishing a way to measure time to the final menstrual period has long been the holy grail of menopause research," said co-lead author of the paper Nanette Santoro, M.D., of the University of Colorado Medical School in Aurora, Colo. "Using bleeding patterns or previously available tests to predict the time to menopause can only help us narrow the window to a four-year period, which is not clinically useful. Women can make better medical decisions with the more complete information offered by new, more sensitive anti-Müllerian hormone measurements."

For women who are determining whether to have surgery to manage fibroids or whether it is safe to stop using birth control, having an AMH measurement can provide additional information about the timing of menopause, Santoro said. A low AMH level in a woman who is more than 48 years old indicates that menopause is likely approaching.

The prospective longitudinal cohort study was part of the Study of Women's Health Across the Nation (SWAN). Researchers analyzed blood tests conducted on 1,537 women between the ages of 42 and 63. The long-term SWAN study monitored changes in the women's health as they went through the menopausal transition. For this study, participants' blood samples were tested for AMH levels as well as follicle-stimulating hormone, another reproductive hormone.

Researchers used a more sensitive test than what has been available previously to measure the participants' AMH levels. This process made it possible to predict the final menstrual period's timing within 12 to 24 months in women in their late 40s and early 50s.

"Researchers have long thought AMH would be a superior marker of the time to menopause, but tests haven't been sensitive enough to detect the very, very low levels that occur in the year or two leading up to menopause," said co-lead author Joel S. Finkelstein of Massachusetts General Hospital in Boston, Mass. "It took a cohort like the Study of Women's Health Across the Nation (SWAN), which followed the same women year after year from well before menopause until well after, to get the kind of data necessary to be able to demonstrate the predictive value of AMH."

AMHERST, Mass. - Results of a new epidemiological analysis of more than 108,000 women observed a lower risk of early menopause among women who had at least one pregnancy lasting at least six months and among those who had breastfed their infants. Further, risk was lowest among those who breastfed exclusively. The work is by first author and Ph.D. student Christine Langton, with her advisor Elizabeth Bertone-Johnson at the University of Massachusetts Amherst's School of Public Health and Health Sciences.

These two factors, pregnancy (parity) and breastfeeding, generally prevent ovulation and may slow the natural depletion of ovarian follicles over time, the authors point out. Thus pregnancy and breastfeeding are believed to lower the risk of early menopause, which is defined as the end of menstruation before age 45. Early menopause is associated with increased risk of cardiovascular disease, cognitive decline and osteoporosis. Details appear in the online open-access journal JAMA Network Open.

Langton and colleagues suggest that while their results did not demonstrate a clear dose-response for breastfeeding, their findings are consistent with the hypothesis that a biological mechanism is influenced by longer breastfeeding. Also, findings from other studies support that optimal benefits from breastfeeding exclusively, for both mother and baby, reach a threshold between six and 12 months. Breastfeeding exclusively means that the baby receives no liquids or solid foods, only breast milk.

As Langton explains, "In our study, women with three or more pregnancies who breastfed exclusively for a total of 7 to 12 months had about a 32% lower risk of early menopause compared to women with the same number of children who breastfed exclusively for less than one month." Langton and colleagues also observed what they call other notable associations. Compared to women with no full-term pregnancies, women who had two pregnancies had a 16% lower risk of early menopause and women with three pregnancies saw a 22% lower risk.

The authors believe theirs is the first prospective cohort study to look at the relationship between breastfeeding and risk of early menopause. They point out that only one other study had examined the relationship of parity (number of children) to risk of early natural menopause.

Langton says, "Our study has a lot of strength because of the large sample size, the 26 years of follow-up and the prospective design. Also, at baseline we limited our study to women who were premenopausal, which is a key point," she adds, along with their careful control for many confounders.

"Our breastfeeding findings not only add new insight into ways to prevent early menopause," she points out, "but they align nicely with recommendations of both the American Academy of Pediatrics and World Health Organization that US women exclusively feed their infants breastmilk for at least six months and continue breastfeeding for up to one year," Langton notes.

For this work, Langton and colleagues conducted their prospective, population-based study within the on-going Nurses' Health Study II cohort that began collecting data in 1989. They report that response rates were 85-90%. Parity, menopause status and age were measured at baseline and every two years, while breastfeeding factors were assessed three times during follow-up. Women in the study were followed until menopause or age 45, hysterectomy, oophorectomy, death, cancer diagnosis or loss to follow-up.

A group of experts led by Regina Rabinovich and Carlos Chaccour from the Barcelona Institute for Global Health (ISGlobal) has published a roadmap to evaluate - and subsequently implement - ivermectin as a complementary vector control tool against malaria. The Ivermectin Roadmap, published in the American Journal of Tropical Medicine and Hygiene, includes a foreword signed by Nobel laureate William C. Campbell, co-discoverer of the drug.

Mosquitoes have become increasingly resistant to insecticides used on bed nets (ITN) and for indoor spraying (IRS). Furthermore, they can bite outdoors, where humans are not protected, or indoors when people are not sleeping under their nets, leading to what is called residual malaria transmission. These challenges have led to the idea of using ivermectin, a drug normally used to treat parasitic worms but also found to reduce the life span of Anopheles mosquitoes feeding on ivermectin-treated humans and/or livestock, as a complementary vector control tool. The underlying hypothesis is that, when administered at community level, ivermectin can decrease malaria transmission by targeting the vector population.

Indeed, "the results of several studies and recent trials have positioned ivermectin as a first-in-class drug to enhance malaria vector control," says Regina Rabinovich, director of the Malaria Elimination Initiative at ISGlobal, an institution supported by "la Caixa", and Scholar at Harvard TH Chan School of Public Health. The advantage is that the drug has a different mechanism of action than the currently used insecticides, and would target mosquitoes that bite outdoors. "Ivermectin could therefore bypass two major challenges in malaria control (insecticide resistance and residual transmission), and help bring an end to this deadly disease," adds Carlos Chaccour, researcher at ISGlobal and at the University of Navarra, and chief scientific officer of the BOHEMIA project, which will test the impact of mass administration of ivermectin to humans and livestock on malaria prevalence in Tanzania and Mozambique, among other issues.

The Ivermectin Roadmap provides a comprehensive view of what is needed to make ivermectin available as a vector control tool by 2024. It was developed by a multidisciplinary group of experts -from medical entomology and modelling to NTD programs and veterinary medicine)- with funding from the Bill & Melinda Gates Foundation, and is the result of literature reviews and discussions with regulatory agencies, policy and funding bodies, drug manufacturers, and future implementing partners.

The different actions and steps required for this 'One Health' approach, from proof of concept to field deployment, have been carefully described in the roadmap. It covers aspects including the definition of optimal doses and regimens for the mass administration of ivermectin in humans and livestock, management strategies for the risk of drug resistance, the relevance of environmental impact, ethical issues, political and community engagement, translation of evidence into policy, and aspects related to large scale implementation of ivermectin MDA, including coordination with campaigns against NTDs already using ivermectin in malaria-endemic countries.

Key issues discussed in the roadmap include establishing the safety of using higher or more frequent doses of the drug. For William C. Campbell, feasibility will "not only be a matter of pharmacodynamic efficacy, or just managerial efficiency. Safety is critical; and it will not just be a matter of human safety. It will also be a matter of ecological safety."

A critical aspect will be ensuring acceptability and adherence by the community and explaining that, although ivermectin has a direct personal benefit against worms and ectoparasites, its benefit in terms of malaria is indirect, by reducing the risk of malaria transmission at the community level. "The concept of community impact needs to be well understood by the communities, as well as by the global and national policymakers," says Chaccour.

Community-based wellness instructors can provide tailored wellness care to older adults, according to researchers at Columbia University Mailman School of Public Health. A randomized controlled trial assessing whether community self-management with wellness coaching could improve participants' overall wellbeing was the foundation to outline the components of a new model of community-based wellness called the Person-centered Wellness Home (PCWH). The PCWH helps patients manage chronic diseases and maintain wellness. Findings were published in a special issue on aging and public health in Innovation in Aging, a publication of the Gerontological Society of America.

The researchers enrolled 121 participants over the age of 55 with two or more chronic diseases from New York City Housing Authority communities in the South Bronx. All participants completed a six-week workshop in which trained community lay leaders encouraged self-management skills for diseases such as arthritis, diabetes, HIV, chronic pain, and cancer that are highly prevalent in the South Bronx. Participants in the treatment arm received a wellness self-coaching program that guided them to set health goals aligning with their needs.

"There was an improvement in self-reported physical functioning by the wellness coaching group," says first author Thelma J. Mielenz, PhD, assistant professor of epidemiology. She noted that people with better physical functioning often have an easier time being physically active. The wellness coaches and participants maintained their social connection.

The study also examined the benefits of patient health information availability in wellness care, including providing patients and their caregivers/coaches with personalized health records. Researchers found this measure encourages patients to familiarize themselves with their health information so they can set goals and track their progress. Together, the availability of community-based wellness programs and the provision of transparent wellness records empowers older adults to take control of their health in a community setting along with the support of wellness program instructors.

"By establishing personalized wellness care within the community, older adults can easily access and frequently take advantage of services that promote healthy lifestyle changes," says Mielenz. "In underserved areas where gaps exist between the clinic and community, the Person-centered Wellness Home model may start to provide the needed support for a patient in the community and improve overall health outcomes."

Surgeons at Houston Methodist Hospital are stemming the tide of addiction to prescription opioids by managing patients' pain after surgery. By using long-acting local anesthetics at the site of surgery and scheduled non-narcotic pain medicine, they decreased opioid prescriptions from 87% to 10% after surgery.

According to the National Institute on Drug Abuse, more than 130 people die every day from opioid overdosing, and a portion of these deaths may be due to the availability of opioids after elective surgery. Up to 10% of patients develop addictions after taking opioids following elective surgery.

In a Jan. 22 paper in The Journal of Thoracic and Cardiovascular Surgery, Houston Methodist surgeons and researchers showed that using a pre-emptive pain management program reduced their need for narcotics prescriptions. The six-year retrospective study (2012-2018) evaluated more than 400 Houston Methodist patients. "Just a decade ago we routinely prescribed narcotics to treat pain at home after surgery." said Min Kim, M.D., corresponding author and head of the division of thoracic surgery at Houston Methodist Hospital. "With the current opioid epidemic, we wanted to determine if we could manage pain at home after surgery with over-the-counter pain medication. We developed and implemented the pre-emptive pain control program, which led to excellent pain control at home without requiring prescription narcotics."

The study included patients undergoing minimally invasive esophageal and GI-related procedures, such as hiatal hernia repair, reflux surgery and achalasia surgery:

· Enhanced recovery after surgery with pre-emptive pain management group - Patients and surgeons discussed enhanced patient education about managing pain with scheduled over-the-counter pain medication pre-emptively. Long-acting local anesthetics were also placed at each incision, and patients maintained scheduled doses of non-narcotic pain medication in the hospital and at home (e.g., Tylenol). Approximately 9.6% of these patients went home with opioid prescriptions, and this group had the lowest post-operative complications at 3.2%.

· Control group - This group was prior to the adoption of pre- or post-surgical pain management and had the most post-operative complications (15.1%), where 87% were discharged with opioid prescriptions.

"This study provides us with a strategy to successfully manage pain after surgery using over-the-counter pain medication. This led to fewer narcotic prescriptions which proactively decreases the chance of patients becoming addicted to narcotics," Kim said.

Houston Methodist Hospital will next look at the impact of the pre-emptive pain management program in pulmonary surgery patients.

The intestinal commensal microbial community (or microbiota) is composed of several microorganisms that, among other functions, are beneficial for the protection against infectious agents. When the microbiota is altered many bacteria are lost, compromising the protective ability and enabling the invasion by harmful bacteria. Antibiotics, despite being the best way to treat infections, can lead to changes in the microbiota and to the loss of some of these protective bacteria.

As recently published in Nature Microbiology, researchers from Instituto Gulbenkian de Ciência (IGC), in collaboration with Stanford University (USA), studied the effect of antibiotics on the microbiota composition, using mice as a model organism. In this study, researchers observed that some individuals, when treated with antibiotics, lost the protective abilities and were very susceptible to infections, while others, despite receiving the same treatment, were resistant.

Rita Oliveira, researcher and main author of the study, states that "mice did not all show the same response post-antibiotic treatment" and explains: "we observed that the exchange of microorganisms among cohoused individuals was determinant for reacquisition of members of the microbiota post-antibiotic treatment and consequently in the reduction of the risk of developing new infections". The presence of the low abundant bacterium, member of the microbiota, Klebsiella michiganensis was shown to be sufficient to explain the resistance to invasion by other bacteria like E. coli or Salmonella, "because it can metabolize the nutrients available in the intestine more efficiently", competing against potential invaders and preventing the entry of other bacteria that can harm the host.

The increasing consumption of antibiotics is a public health problem that can compromise the effectiveness of future treatments, highlighting the importance of the identification of bacteria and mechanisms that can minimize the negative effects associated with their consumption. "This study opens doors to the hope that for each human pathogen there is one or more bacteria of the microbiota that can be administered as a direct competitor of that pathogen, concluded Rita Oliveira.

Karina Xavier, leader of the IGC research group responsible for the study, reinforces that "in the future, what is desirable is that anytime we use antibiotics we also take complements that can restore the microbiota and potentiate the beneficial effects it entails. For that, the identification of super competitive bacteria like this one is essential". The research group aims now at expanding the study to different antibiotics and continue to explore the protective effect of Klebsiella michiganensis against other pathogens.

NEW YORK, January 21, 2020- Childhood obesity is a growing problem in the United States. For children, obesity is defined as having a body mass index (BMI) at or above the 95th percentile, and according to the Centers for Disease Control and Prevention, 18.5% of children between the ages of 2 and 19 meet this criteria.

Diet, exercise, and genetics are familiar risk factors in childhood obesity. Prenatal origins also play a role, yet they are underexplored, said Yonglin Melissa Huang, a Ph.D. student at The Graduate Center, CUNY and lead author of a new study that shows a link between multiple metabolic disorders in pregnant women and their children's BMI later in life.

The study, which appears in Archives of Gynecology and Obstetrics and comes from the lab of Graduate Center, CUNY and Queens College Psychology Professor Yoko Nomura, asked how pregnancy conditions can play a role in childhood obesity. The researchers found that when a mother experiences both gestational diabetes and preeclampsia, the child has a growth trajectory that leads to an increased risk of high childhood BMI over time.

"Prospective parents may benefit from our findings by better understanding the effects of gestational diabetes and preeclampsia on their child," Huang said. "These findings can provide added incentive for pregnant women and their health care providers to work closely to manage and treat these conditions during pregnancy so they can address both the mother's safety and the child's long-term health."

The study results should also encourage health care providers to coordinate care of mothers and children who experience these dual conditions over a longer period of time following birth, said researchers.

"OB-GYNs have experience in managing gestational diabetes and preeclampsia but they do not provide care to the children or help reduce their obesity risk," said Nomura. "Coordinating between obstetricians, endocrinologists, and pediatricians could help prevent childhood obesity."

When a pregnant woman has gestational diabetes, a hormone produced by the placenta stops the body from effectively using insulin, causing blood sugar to rise. Preeclampsia is a more serious and potentially life-threatening complication in which the mother experiences high blood pressure and often damage to the kidneys or liver.

Nomura and her group have previously studied the associations of gestational diabetes and preeclampsia, independently, with children's BMI. In the new study, the team collaborated with Daniel W. Skupsky, M.D., chair of the Obstetrics and Gynecology Department at New York Presbyterian Queens, and explored what happens when a pregnant mother has both conditions at once since those two illness are relatively common and often comorbid. The team monitored the children of 356 mothers from 18 to 72 months.

The results showed that the combination of both gestational diabetes and preeclampsia during pregnancy was especially effective in driving high BMI during early childhood -- more so than either condition alone. Confirming previous findings, the researchers also saw that children born from mothers with only one of these conditions are also at risk for a higher BMI, though the trend for gestational diabetes was not as strong.

These preliminary findings lay the groundwork for future studies to further explore these effects with larger sample sizes, the authors say.

PITTSBURGH, Jan. 22, 2020 - Advanced stage cancer diagnoses declined following health insurance expansion in Massachusetts, likely due to increased access to screening and diagnostic services that identified cancers earlier, according to new research led by health economists at the University of Pittsburgh Graduate School of Public Health.

The analysis, published online and scheduled for the February edition of the journal Medical Care, specifically found the decline in colorectal cancers, the second-leading cause of cancer deaths nationwide. The U.S. Preventive Service Task Force recommends everyone over age 50 receive routine screening for colorectal cancer, which has a 90% survival rate when treated early. That rate drops substantially when the cancer is diagnosed in advanced stages.

"Colorectal cancer frequently occurs in adults under 65 who are not yet eligible for Medicare. And we know from previous research that people who do not have health insurance or who are underinsured are less likely to get recommended preventive health screenings," said lead author Lindsay Sabik, Ph.D., associate professor in Pitt Public Health's Department of Health Policy and Management. "Cancer is only one disease area where preventive care and early diagnosis can make a big difference in survival and cost of treatment. Our study demonstrates the public health value of expanded health insurance coverage."

In 2006, Massachusetts passed a health insurance reform law with the aim of providing health care access to nearly all of its residents. The national Patient Protection and Affordable Care Act, signed into law in March 2010, was partly modelled on Massachusetts' reform.

Sabik and her team pulled data from the Massachusetts Cancer Registry on all colorectal and breast cancer cases in people ages 50- to 64-years-old from 2001 through 2013. They selected those two cancers for their study because both are common, have routine screening guidelines and have high survival rates when caught early. The age range captured people covered by the recommended screening guidelines but not old enough to qualify for Medicare. The team also pulled similar data from several other states for comparison.

For colorectal cancer, the researchers found a 7% decline in the likelihood of advanced stage diagnosis after Massachusetts health insurance reform was enacted relative to trends in comparison states. They did not find a comparable decline in advanced stage breast cancer diagnosis.

"Before Massachusetts enacted its health insurance reform, there already were well-established state and federal safety net programs that highly encouraged breast cancer screenings and provided them at low or no cost, regardless of insurance status," Sabik said. "So, we believe that those programs were already catching people who otherwise might not have been screened due to insurance status, which is good news -- it demonstrates that those safety net programs appear to work."

When the team extrapolates its findings in Massachusetts to the entire U.S., they estimate that there would be 2,100 fewer late-stage colorectal cancer diagnoses annually among non-elderly people. According to the National Cancer Institute, colorectal cancer care in the U.S. costs an estimated $16.3 billion annually.

"Our study is the first to present evidence that Massachusetts' health reform may be associated with a shift to earlier stage diagnosis for a cancer that has a high cure rate when caught early," said Sabik. "This is exciting because key elements of the Affordable Care Act parallel those of the Massachusetts reform. While data on the long-term impacts are still emerging, we expect that early cancer diagnosis will likely be one of the major success stories of national health insurance reform."

CLEVELAND, Ohio (January 21, 2020)--Almost 40% of women experience symptoms of depression during perimenopause, yet it often goes undetected and untreated because many healthcare providers aren't screening for it and aren't prepared with treatment options. A new study analyzed screening practices by women's healthcare providers and their management of depression during perimenopause. Study results are published online in Menopause, the journal of The North American Menopause Society (NAMS).

The high number of women experiencing symptoms of depression has been linked to hormone changes, historical depressive episodes, life events, and a genetic predisposition to depression. As more data emerges to support the presence of risk factors for depression during perimenopause and as the patient population continues to age, healthcare providers need to become better educated in order to recognize and manage depression.

Rates of routine screening and healthcare-provider beliefs and knowledge about symptoms of depression in perimenopause remained unstudied until now. The aim of this new study was to better understand clinical practice patterns of obstetrician-gynecologists regarding their screening practices and management of depression.

The survey was sent to 500 practicing obstetrician-gynecologists who were fellows of the American College of Obstetricians and Gynecologists and members of the Collaborative Ambulatory Research Network. It found that more than a third of respondents (34.1%) did not regularly screen perimenopausal women for depression and that more than half (55%) believed they were not equipped to manage the problem.

Higher-quality education about depression was associated with higher rates of screening. These findings suggest that improved training for obstetrician-gynecologists in the diagnosis, treatment, and management of depression, both in residency and later, could improve rates of screening.

Study results appear in the article "Obstetrician-gynecologists' screening and management of depression during perimenopause."

"Given the prevalence of depressive symptoms in perimenopausal women, the recent publication of guidelines for the diagnosis and management of depression in this population, and the availability of safe and effective therapies, all healthcare providers should be screening their female patients for depression. Improving training for healthcare providers in the evaluation and treatment of depression is important to optimizing patient outcomes," says Dr. Stephanie Faubion, NAMS medical director.

Amsterdam NL, January 22, 2020 - Progress in research and technology is giving rise to an optimistic future for compensation and restoration of low vision, according to research in a special issue of Restorative Neurology and Neuroscience, published by IOS Press. Seven studies explore different aspects of vision loss after damage to the retina, optic nerve or brain due to diseases such as glaucoma or optic neuropathy. Remarkable progress is being made to treat conditions of partial blindness that have previously been considered irreversible.

"The findings in this special issue of Restorative Neurology and Neuroscience showcase how basic science, clinical care and innovation including drugs and devices are being used to stop cell death and induce regeneration to restore vision," explained Guest Editor Andrea Antal, PhD, Group Leader at the Institute of Medical Psychology, University of Magdeburg, Magdeburg, Germany.

In this issue behavioral training and electrical/sensory devices that strengthen residual visual capacities through brain plasticity and restore some vision are also presented and the application possibilities are discussed. "If the retina and/or the optic nerve are completely damaged, then the recovery is not possible. However, with partial damage where there is even a small amount of residual vision still present, almost all patients can achieve some degree of improvement," Prof. Dr. Antal added.

Neurons in the visual system can become silent because they are either anatomically or physiologically damaged, inhibited by toxic substances or lack of oxygen and glucose supply. From the clinical point of view, damaged cells in the visual system are not always dead, but may be inactive, in a hibernation-like mode, or in a hypometabolic stage. It may be possible to reactivate them through medication, training and/or electrical stimulation.

Contributions to this issue demonstrate that uncovering the mechanisms of action of vision recovery and repair is paving the way for a better understanding of neuroplasticity in the visual sciences. Mechanisms currently under study include the replacement (augmentation) of the lost nervous tissue itself, in particular the retina or optic nerve, by means of axonal regeneration, stem cell transplantation and retinal chip implants ("bionic eye"). Another approach aims to make more efficient use of the remaining brain tissue by "reprogramming" or "reorganizing" nerve cell activities and their connections with the goal of activating residual vision using training and electrical stimulation. These advances impact different visual disorders including typical eye-related diseases such as glaucoma and optic neuropathy, and also more brain-related disorders, such as stroke or brain trauma.

"The topic of low vision is gaining scientific momentum. However, despite remarkable progress in the last few years, this subject deserves more attention. Publication of this dedicated issue is timely and will significantly advance the field, providing a source of inspiration as the basis of progress," noted Prof. Dr. Antal and Bernhard Sabel, PhD, Professor of Medical Psychology, Otto-v.-Guericke University of Magdeburg, Germany.

The special issue grew out of a series of conferences on "Low Vision and the Brain" (http://www.4r-vision.com). These conferences addressed the eye-brain interaction in an interdisciplinary manner that touched on ophthalmology, neurology, neuropsychology, rehabilitation medicine, engineering and pharmacology.

While many animal experiments have been successful, the results have not been directly transferrable to human studies. The investigators point to the need to further explore other factors related to vision loss. This research has the potential to greatly influence patient care in the future.

Emerging viral infections--from bird flu to Ebola to Zika infections--pose major threats to global public health, and understanding their origins can help investigators design defensive strategies against future outbreaks. A new study provides important insights on the potential origins of the most recent outbreak of viral pneumonia in China, which started in the middle of December and now is spreading to Hong Kong, Singapore, Thailand, and Japan. The findings are published early online in the Journal of Medical Virology.

The study notes that patients who became infected with the virus--which is a type of virus called a coronavirus and was named 2019-nCoV by the World Health Organization--were exposed to wildlife animals at a wholesale market, where seafood, poultry, snake, bats, and farm animals were sold.

By conducting a detailed genetic analysis of the virus and comparing it with available genetic information on different viruses from various geographic locations and host species, the investigators concluded that the 2019-nCoV appears to be a virus that formed from a combination of a coronavirus found in bats and another coronavirus of unknown origin. The resulting virus developed a mix or "recombination" of a viral protein that recognizes and binds to receptors on host cells. Such recognition is key to allowing viruses to enter host cells, which can lead to infection and disease.

Finally, the team uncovered evidence that the 2019-nCoV likely resided in snakes before being transmitted to humans. Recombination within the viral receptor-binding protein may have allowed for cross-species transmission from snake to humans.

"Results derived from our evolutionary analysis suggest for the first time that snake is the most probable wildlife animal reservoir for the 2019-nCoV," the authors wrote. "New information obtained from our evolutionary analysis is highly significant for effective control of the outbreak caused by the 2019-nCoV-induced pneumonia."

An accompanying editorial notes that although the ultimate control of emerging viral infections requires the discovery and development of effective vaccines and/or antiviral drugs, currently licensed antiviral drugs should be tested against the 2019-nCoV.

LONDON, ON - A new study from ICES, Lawson Health Research Institute and Western University suggests that injection drug users prescribed controlled-release hydromorphone are three times more likely to develop endocarditis, a serious bacterial heart infection, when compared to those prescribed other opioids. The findings, published today in The Lancet Infectious Diseases, build on growing evidence that some controlled-release opioids may lead to higher risk of infectious disease among persons who inject drugs.

The researchers looked at de-identified Ontario health data for hospital admissions related to injection drug use between 2006 and 2015. Of 60,529 admissions, 733 patients had infective endocarditis. The team found that regions with high hydromorphone prescription rates had more than double the cases of infective endocarditis (254 cases) when compared to regions with low prescription rates (113 cases).

The study also analyzed individual prescription records and found that among persons who inject drugs, those prescribed controlled-release hydromorphone were three times more likely to develop infective endocarditis when compared to those prescribed any other opioid. There was no increased risk for those prescribed the immediate-release form of hydromorphone.

"Added to the existing data, these findings make a compelling argument for the role of controlled-release hydromorphone in the growing risk of infective endocarditis among persons who inject drugs," says Dr. Matthew Weir, Adjunct Scientist at ICES, Associate Scientist at Lawson and Assistant Professor at Western's Schulich School of Medicine & Dentistry.

Opioids are often manufactured as controlled-release or 'slow-release' capsules to prevent rapid absorption of the drug. Properties in the capsules help to spread pain relief over a longer period of time.

This is the latest in a series of studies from the research team that suggest some controlled-release opioids may be leading to increased risk of infectious disease among persons who inject drugs.

In one study, they demonstrated that polymer-coated beads used to provide the slow-release property make controlled-release hydromorphone difficult to dissolve. They found equipment used to dissolve the drug retains up to 45 per cent of the initial dose, leading injection drugs users to save and reuse equipment.

With frequent re-handling of equipment, there are multiple opportunities for bacterial and viral contamination. The team found that HIV and a dangerous bacterium called Staphylococcus aureus are more likely to survive in equipment used to prepare controlled-release hydromorphone since added chemicals that make the drug slow-release promote survival of bacteria and viruses.

"There's been a global increase in infectious diseases among persons who inject drugs and our research suggests that controlled-release prescription opioids may be a major culprit," says Dr. Michael Silverman, Associate Scientist at Lawson and Associate Professor at Schulich Medicine & Dentistry. "We now have evidence that suggests the injection of controlled-release hydromorphone is increasing the spread of HIV, hepatitis C and endocarditis in Canada."

The team believes these findings could also explain the increase in infectious complications in the USA and other countries where controlled-release hydromorphone is not on the market. There are other controlled-release opioids, such as controlled-release morphine, that use a similar slow-release mechanism and may carry similar risks.

"It's important that people are aware of the infectious risks of injecting opioids and, if necessary, practice harm reduction techniques," says Dr. Silverman. "We've found you can use a cigarette lighter to destroy bacteria and viruses by heating the cooker used to prepare the drug for about 10 seconds or until the mixture bubbles. We've termed the technique 'cook your wash.'"

The waters of Puget Sound support many species, including mussels, salmon and killer whales. But researchers know that runoff from land in the urbanized areas might contain chemicals that could harm these creatures, even if it's not always clear which chemicals are the most harmful.

Existing methods track specific chemicals of known concern. Until recently, however, there was no way to find out what other potentially harmful compounds might be present in the water.

Using a new "non-targeted" approach, researchers at the University of Washington and UW Tacoma screened samples from multiple regions of Puget Sound to look for other concerning chemicals. The team identified 64 chemicals never detected before in this waterway. Eight chemicals were at potentially hazardous concentrations that will need further investigation. The team published these results Dec. 30 in Environmental Science & Technology.

"Historically we've done a decent job of categorizing legacy chemicals in Puget Sound, but we also know there are a lot more chemicals that get into the water every day," said senior author C. Andrew James, a research scientist at the Center for Urban Waters at UW Tacoma. "If we can understand what's there and at what concentrations it's occurring, then we can start to figure out which chemicals will likely impact the health of fish, killer whales and other marine organisms."

The researchers collected water from 18 regions -- from Port Townsend to Olympia -- of Puget Sound's nearshore, meaning the team collected the water samples while standing on docks or the shore, not a boat.

"Our sampling sites covered areas of different land use. For instance, we have relatively clean sites such as the Hood Canal near Holly, Washington, as well as urbanized or industrial sites such as the cruise terminal at Smith Cove and the Thea Foss waterway at Commencement Bay," said lead author Zhenyu Tian, a research scientist at the Center for Urban Waters. "With such a wide range, we hoped to see a link between contamination and land use."

The researchers collected water at the 18 sites multiple times over 2018, leading to 78 water samples. Then they used a method called high-resolution mass spectrometry to help them identify what chemicals were in each sample.

"Our method allows us to detect hundreds to thousands of chemicals at once in a single sample. It determines a compound's mass really accurately," said co-author Edward Kolodziej, an associate professor in both the UW Department of Civil & Environmental Engineering and the UW Tacoma Division of Sciences & Mathematics.

The researchers use the mass of each compound to figure out the chemical formula, and then use other information to identify it.

"On CSI when they have these instruments, they turn on the instrument and it tells them: 'That's ibuprofen.' But in reality it's a lot of work to get to get to a point where you are absolutely sure you know what that chemical really is," Kolodziej said.

The team found at least 205 different chemicals across their samples. Of those compounds, researchers were able to reliably confirm the identity of 75, of which 64 were reported for the first time in Puget Sound.

The 75 confirmed chemicals included pesticides, herbicides, food additives and pharmaceuticals -- antidepressants and blood pressure medications, for example -- and compounds related to vehicles, such as tire rubber chemicals.

"Our goal is to really figure out which chemicals matter from a biological perspective -- how a fish or a shellfish will react," James said. "So we compared the levels of the chemicals we found to concentrations toxicologists have deemed concerning for marine life."

The eight chemicals found at concerning levels were:

Two vehicle-related contaminants that are found in tires and other sources

The antidepressant drug Venlafaxine

Two herbicides, including an aquatic one used for controlling weeds and algae

Two chemicals found in plastics

A persistent, well-studied chemical called PFOS, which is known to be harmful to humans and animals

These concerning chemicals were localized to specific "hot spots" in Puget Sound, and most of them weren't always present in different samples from the same site. This is in contrast to other chemicals that the team found in almost all of the samples but deemed less of a concern, such as the artificial sweetener Splenda and a drug used to treat seizures and bipolar disorder.

The next step, the researchers say, is to dive into what these data mean for marine life in the nearshore, specifically in shellfish and salmon. The team also hopes to continue to investigate the eight concerning chemicals and better understand the hot spots.

"Some way or another, a huge fraction of the things we buy and use end up in the rivers and Puget Sound," Kolodziej said. "Everyone thinks chemicals hit the ocean and disappear because there's so much water in the ocean that the concentrations go way down. But if you took the concentration of a chemical in wastewater effluent or storm water, it's not like you can just divide by total water volume of Puget Sound, and that's the concentration you'd detect in Puget Sound. The concentration in the nearshore is a lot higher because there hasn't been enough time for mixing to occur. So exposure levels for aquatic organisms in the nearshore can be much higher than you might expect."

TORONTO – Female and male soccer players had similar rates of head collision events during elite tournaments such as the World Cup but half of the female players involved received medical assessments, compared with only one third of the impacted male players, according to research led by St. Michael’s Hospital of Unity Health Toronto.

The study, publishing in JAMA on Jan. 21, 2020, did not find significant differences in the numbers of female players removed from play compared with male players. The median time that play was stopped for a medical assessment in women’s tournaments was 70 seconds compared to about 50 seconds in men’s matches. Researchers pointed out, a minimum 10 minutes is required to perform a concussion assessment.

“There is international consensus that athletes who sustain a potentially concussive head collision should be given a proper medical assessment and be removed from play until a qualified professional can determine that it is safe for them to return to play,” said Dr. Michael Cusimano, lead researcher and a neurosurgeon at St. Michael’s Hospital.

“It is clear that this is not happening in elite women’s or men’s play at this time.”

Researchers reviewed 52 matches of the 2019 FIFA Women’s World Cup and monitored for the frequency and medical assessment of head collision events, time stopped for assessment, and visible concussion signs. The data was compared against the 2014 and 2018 FIFA Men’s World Cup and the 2016 UEFA Euro Cup. In the matches reviewed, 84 per cent of female athletes and 88 per cent of male athletes showed two or more visible signs of concussion after a head collision event, including vacant stares or disequilibrium.

Dr. Cusimano, who is also a scientist at the Li Ka Shing Knowledge Institute of St. Michael’s, said the popularity of soccer internationally, as well as the frequency of concussions in the sport, creates an urgency to address this issue.

“We need a culture change in this sport starting with increasing the role of video assistant referees and independent medical assessors, allowing temporary player substitutions to provide sufficient time for medical assessments, and having those with financial interests in the sport demand more attention to player’s health,” he said.

“Hundreds of millions of people play soccer – it is the world’s largest and fastest growing sport. Tournaments like the FIFA World Cup attract millions of viewers, and the examples set by elite athletes and officials affect how players and officials globally, at any level, deal with concussions.”