Culture

The Middle East and North Africa Region (MENA) is a climate change hot spot where summers warm much faster than in the rest of the world. Some parts of the region are already among the hottest locations globally. A new international study predicts that ignoring the signals of climate change and continuing business-as-usual will lead to extreme and life-threatening heatwaves in the region. Such extraordinary heat events will have a severe impact on the people of the area.

The study, which aims at assessing emerging heatwave characteristics, was led by scientists from the Climate and Atmosphere Research Center (CARE-C) of The Cyprus Institute and the Max Planck Institute for Chemistry, with the contribution of researchers from the CMCC Foundation - Euro-Mediterranean Center on Climate Change and other research institutes, mainly from the MENA region.

"Our results for a business-as-usual pathway indicate that especially in the second half of this century unprecedented super- and ultra-extreme heatwaves will emerge", explains George Zittis of The Cyprus Institute, first author of the study. These events will involve excessively high temperatures of up to 56 degrees Celsius and higher in urban settings and could last for multiple weeks, being potentially life-threatening for humans and animals, even high-temperature tolerant animals such as camels. In the second half of the century, about half of the MENA population, or approximately 600 million people, could be exposed to such annually recurring extreme weather conditions, which will affect health, agriculture, biodiversity.

The research team used a first-of-its-kind multi-model ensemble of climate projections designed exclusively for the geographic area. The researchers then projected future hot spells and characterised them with the Heat Wave Magnitude Index, which allows quantifying the intensity of single events, considering both their duration and the temperature anomaly.

Such detailed downscaling studies had been lacking for this region. "The scientific community dealing with regional climate modelling is mainly concentrated in Europe and North America, and there is still little interest and funding for studying the impacts of climate change in the Mediterranean and North African region" explains Paola Mercogliano, director of the Regional Models and geo-Hydrological Impacts division at the CMCC Foundation. "Having such an important and detailed study on this area, which is still poor in terms of data and scientific knowledge on climate change, is a great success for us. At CMCC, we believe in the importance of advancing scientific research in the Mediterranean region, which is highly vulnerable to the impacts of climate change, and we are investing strengths and resources to provide these countries with data that can allow them to know more about the characteristics of their future climate and to act accordingly".

To avoid such extreme heat events in the region, the scientists recommend immediate and effective climate change mitigation measures. It is expected that in the next 50 years, almost 90 percent of the exposed population in the MENA will live in urban centers, which will need to cope with these societally disruptive weather conditions.

"Heat waves are among the main climate change impacts affecting the Mediterranean area, including Italy" concludes Edoardo Bucchignani, CMCC research scientist, among the authors of the study. "It is great to have such a valid study focused on this region, with scientific data that can support and guide decision-makers in managing impacts in time, to protect the health of citizens, especially the most vulnerable ones. At CMCC, our investment in this direction now continues to provide even more detailed data and to make it available to the entire scientific community, to encourage the production of knowledge about the expected climate in this area for the next century".

ADELPHI, Md. -- Army researchers developed a technique that allows robots to remain resilient when faced with intermittent communication losses on the battlefield.

The technique, called α-shape, provides an efficient method for resolving goal conflicts between multiple robots that may want to visit the same area during missions including unmanned search and rescue, robotic reconnaissance, perimeter surveillance and robotic detection of physical phenomena, such as radiation and underwater concentration of lifeforms.

Researchers from the U.S. Army Combat Capabilities Development Command, known as DEVCOM, Army Research Laboratory and the University of Nebraska, Omaha Computer Science Department collaborated, which led to a paper featured in ScienceDirect's journal Robotics and Autonomous Systems.

"Robots working in teams need a method to ensure that they do not duplicate effort," said Army researcher Dr. Bradley Woosley. "When all robots can communicate, there are many techniques that can be used; however, in environments where the robots cannot communicate widely due to needing to stay covert, clutter leading to radios not working for long distance communications, or to preserve battery or bandwidth for more important messages, the robots will need a method to coordinate with as few communications as possible."

This coordination is accomplished through sharing their next task with the team, and select team members will remember this information, allowing other robots to ask if any other robot will perform that task without needing to communicate directly with the robot that selected the task, Woosley said.

The robot that remembers a task is based on the topology of their wireless communications network and the geometric layout of the robots, he said. Each robot is assigned a bounding shape representing the area of the environment that they are caching goal locations for, which enables a quick search in the communications network to find the robot that would know if there were any goals requested in that area.

"This research enables coordination between robots when each robot is empowered to make decisions about its next tasks without requiring it to check in with the rest of the team first," Woosley said. "Allowing the robots to make progress towards what the robots feel is the most important next step while handling any conflicts between two robots as they are discovered when robots move in and out of communications range with each other."

The technique uses a geometric approximation called α-shape to group together regions of the environment that a robot can communicate with other robots using multi-hop communications over a communications network. This technique is integrated with an intelligent search algorithm over the robots' communication tree to find conflicts and store them even if the robot that selects the goal disconnects from the communication tree before reaching the goal.

The team reported experimental results on simulated robots within multiple environments and physical Clearpath Jackal Robots.

"To our knowledge, this work is one of the first attempts to integrate geometry-based prediction of potential conflict regions to improve multi-robot information collection under communication constraints, while gracefully handling intermittent connectivity loss between robots," Woosley said.

According to Woosley, other available approaches can only get input from the robots that are inside the same communications network, which is less efficient when robots can move in and out of communications range with the team.

In contrast, he said, this research provides a mechanism for the robot to quickly find potential conflicts between its goal and the goal another robot selected, but is not in the communications network anymore.

What specifically makes this research unique includes:

-Providing an efficient method (fast and with few messages) for resolving goal conflicts between multiple robots that is robust to intermittent communications loss and robots joining or leaving local sets of robots that are in communications with each other

-Performing as good as querying every robot in the communications range while saving radio bandwidth for more important communications

-Performing better than each robot operating fully on its own without communications

Woosley said that he is optimistic this research will pave the way for other communications limited cooperation methods that will be helpful when robots are deployed in a mission that requires covert communications.

He and the research team, including DEVCOM ARL researchers Dr. John Rogers and Jeffrey Twigg and Naval Research Laboratory research scientist Dr. Prithviraj Dasgupta, will continue to work on collaboration between robotic team members through limited communications, especially in directions of predicting the other robot's actions in order to avoid conflicting tasks to begin with.

As researchers continue to study the neurological impacts of COVID-19, a Houston Methodist international collaboration has documented an unexpectedly frequent occurrence of acute transverse myelitis (ATM) - inflammation of the spinal cord - in 43 COVID-19 patients. Led by Houston Methodist neurologist Dr. Gustavo Roman, the study of existing scientific literature found that patients from 21 countries developed spinal cord lesions after contracting the virus. Symptoms included paralysis and sphincter/bowel dysfunction. The patients ages ranged from 21 to 73 and included about half-and-half women and men. ATM, a rare neurological condition, affects between 1.34 and 4.6 cases per million per year, and researchers believe the unusually high rate in post-COVID-19 patients merits additional investigation. Moreover, 3 ATM cases were reported during the trials of the Oxford AstraZeneca vaccine. The study is published in Frontiers in Immunology. Dr. Roman collaborated with researchers from Hospital Paitilla, Interamerican University of Panama and Hospital Santo Tomas (Drs. Fernando Gracia, Antonio Torres, Alexis Palacios, Karla Gracia and Diogenes Harris).

3D printing has opened up a completely new range of possibilities. One example is the production of novel turbine buckets. However, the 3D printing process often induces internal stress in the components which can in the worst case lead to cracks. Now a research team has succeeded in using neutrons from the Technical University of Munich (TUM) research neutron source for non-destructive detection of this internal stress - a key achievement for the improvement of the production processes.

Gas turbine buckets have to withstand extreme conditions: under high pressure and at high temperatures they are exposed to tremendous centrifugal forces . In order to further maximize energy yields, the buckets have to hold up to temperatures which are actually higher than the melting point of the material. This is made possible using hollow turbine buckets which are air-cooled from the inside.

These turbine buckets can be made using Laser Powder Bed Fusion, an additive manufacturing technology: Here the starter material in powder form is built up layer by layer by selective melting with a laser. Following the example of avian bones, intricate lattice structures inside the hollow turbine buckets provide the part with the necessary stability.

Manufacturing process creates internal stress in the material

"Complex components with such intricate structures would be impossible to make using conventional manufacturing methods like casting or milling," says Dr. Tobias Fritsch of the German Federal Institute for Materials Research and Testing (BAM).

But the laser's highly localized heat input and the rapid cooling of the melt pool lead to residual stress in the material. Manufacturers usually eliminate such stress in a downstream heat-treatment step, which however takes time and thus costs money.

Unfortunately, these stresses can also damage the components as early as during the production process and up until post-processing takes place. "The stress can result in deformations and in the worst cases lead to cracks," says Tobias Fritsch.

Therefore, he investigated a gas turbine component for internal stress using neutrons from the Research Neutron Source Heinz Maier-Leibnitz (FRM II). The component was made using additive production processes by gas turbine manufacturer Siemens Energy.

Post-processing intentionally omitted

For the neutron experiment at the FRM II, Siemens Energy printed a lattice structure only a few millimeters in size using a nickel-chrome alloy typical of those used for gas turbine components. The usual heat-treatment after production was intentionally omitted.

"We wanted to see whether or not we could use neutrons to detect internal stresses in this complex component," explains Tobias Fritsch. He had already gained experience with neutron measurements at the Berlin research reactor BER II, which however was shut down in late 2019.

"We're very glad to be able to make measurements in the Heinz Maier-Leibnitz Zentrum in Garching; with the equipment provided by STRESS-SPEC we were even able to resolve internal stress in lattice structures as intricate and complex as these," the physicist says.

Even distribution of heat during printing

Now that the team has succeeded in detecting the internal stress within the component, the next step is to reduce this destructive stress. "We know that we have to modify the production process parameters and thus the way in which the component is built up during printing," says Fritsch. Here the crucial factor is the heat input over time when building up the individual layers. "The more localized the heat application is during the melting process, the more internal stress results."

For as long as the printer's laser is aimed at a given point, the heat of the point rises relative to adjacent areas. This results in temperature gradients that lead to irregularities in the atomic lattice.

"So we have to distribute the heat as evenly as possible during the printing process," says Fritsch. In the future the group will research the situation with new components and modified printing parameters. The team is already working together with Siemens to plan new measurements with the TUM neutron source in Garching.

Fixing traumatic injuries to the skin and bones of the face and skull is difficult because of the many layers of different types of tissues involved, but now, researchers have repaired such defects in a rat model using bioprinting during surgery, and their work may lead to faster and better methods of healing skin and bones.

"This work is clinically significant," said Ibrahim T. Ozbolat, Hartz Family Career Development Associate Professor of Engineering Science and Mechanics, Biomedical Engineering and Neurosurgery, Penn State. "Dealing with composite defects, fixing hard and soft tissues at once, is difficult. And for the craniofacial area, the results have to be esthetically pleasing."

Currently, fixing a hole in the skull involving both bone and soft tissue requires using bone from another part of the patient's body or a cadaver. The bone must be covered by soft tissue with blood flow, also harvested from somewhere else, or the bone will die. Then surgeons need to repair the soft tissue and skin.

Ozbolat and his team used extrusion bioprinting and droplet bioprinting of mixtures of cells and carrier materials to print both bone and soft tissue. They report their results in Advanced Functional Materials.

"There is no surgical method for repairing soft and hard tissue at once," said Ozbolat. "This is why we aimed to demonstrate a technology where we can reconstruct the whole defect -- bone to epidermis -- at once."

The researchers attacked the problem of bone replacement first, beginning in the laboratory and moving to an animal model. They needed something that was printable and nontoxic and could repair a 5-millimeter hole in the skull. The "hard tissue ink" consisted of collagen, chitosan, nano-hydroxyapatite and other compounds and mesenchymal stem cells -- multipotent cells found in bone marrow that create bone, cartilage and bone marrow fat.

The hard tissue ink extrudes at room temperature but heats up to body temperature when applied. This creates physical cross-linkage of the collagen and other portions of the ink without any chemical changes or the necessity of a crosslinker additive.

The researchers used droplet printing to create the soft tissue with thinner layers than the bone. They used collagen and fibrinogen in alternating layers with crosslinking and growth enhancing compounds. Each layer of skin including the epidermis and dermis differs, so the bioprinted soft tissue layers differed in composition.

Experiments repairing 6 mm holes in full thickness skin proved successful. Once the team understood skin and bone separately, they moved on to repairing both during the same surgical procedure.

"This approach was an extremely challenging process and we actually spent a lot of time finding the right material for bone, skin and the right bioprinting techniques," said Ozbolat.

After careful imaging to determine the geometry of the defect, the researchers laid down the bone layer. They then deposited a barrier layer mimicking the periosteum, a heavily vascularized tissue layer that surrounds the bone on the skull.

"We needed the barrier to ensure that cells from the skin layers didn't migrate into the bone area and begin to grow there," said Ozbolat.

After laying down the barrier, the researchers printed the layers of dermis and then the epidermis.

"It took less than 5 minutes for the bioprinter to lay down the bone layer and soft tissue," said Ozbolat.

The researchers performed more than 50 defect closures and achieved 100% closure of soft tissue in four weeks. The closure rate for bone was 80% in six weeks, but Ozbolat noted that even with harvested bone replacement, bone closure usually does not reach 100% in six weeks.

According to Ozbolat, blood flow to the bone is especially important and inclusion of vascularizing compounds is a next step.

The researchers also want to translate this research to human applications and are continuing to work with neurosurgeons, craniomaxillofacial surgeons and plastic surgeons at Penn State Hershey Medical Center. They operate a larger bioprinting device on larger animals.

One in five pharmacies refuse to dispense a key medication to treat addiction, according to new research.

The study, published in the journal Drug and Alcohol Dependence, was conducted by researchers at Oregon Health & Science University and the Oregon State University College of Pharmacy. Researchers called hundreds of pharmacies around the country to ask whether they would dispense Suboxone, also known as buprenorphine.

"Buprenorphine is a vital, lifesaving medication for people with opioid use disorder, but improving access has been a problem for a variety of reasons," said senior author Daniel Hartung, Pharm.D., M.P.H., professor in the College of Pharmacy. "Although anecdotes and smaller studies have suggested problems, our study is the first to systematically characterize this barrier."

It turns out it's quite common for pharmacies to block access.

"This study is the largest and most comprehensive pharmacy-focused assessment of buprenorphine availability to date and confirms that pharmacies can be a significant barrier to buprenorphine access nationwide," the authors write.

Four researchers called a total of 921 pharmacies around the country in May and June of 2020, focusing on 473 U.S. counties with high rates of death from opioid-related overdoses. Of all the pharmacies contacted, they found that 183 - 20% of the total - indicated they would not dispense buprenorphine. They found that independent pharmacies and those in southern U.S. states were significantly more likely to restrict buprenorphine.

Any disruption in access to buprenorphine can put a patient's recovery at serious risk.

"If I see a patient and they want to get started on buprenorphine, they've already gone through a lot of processing to make that behavior change," said co-author Ximena A. Levander, M.D., M.C.R., clinical instructor (general internal medicine and geriatrics) in the OHSU School of Medicine. "Any barrier can be very disruptive, especially when initiating treatment because they're at high risk to return to use."

Buprenorphine, approved by the Food and Drug Administration in 2002, relieves withdrawal symptoms and pain, and normalizes brain function by acting on the same targets in the brain as prescription opioids or heroin. It is one of three medicines approved by the FDA to treat opioid dependence, along with methadone and naltrexone.

Lead author Neda Kazerouni, a fourth-year student in the OHSU/OSU College of Pharmacy, said she hopes the research raises awareness of the stigma against people with opioid use disorder. As the nation's opioid epidemic continues to claim more than 70,000 lives annually in overdose deaths, Kazerouni said she hopes the new findings will encourage pharmacists to do their part to roll back the epidemic.

"Pharmacists can have a role in reducing opioid use disorder by reducing stigma," Kazerouni said. "Furthermore, community pharmacists should be encouraged to work collaboratively with a patient's provider to ensure there is continuity of care in all stages of treatment."

Nearly 80 percent of higher education faculty report dealing with student mental health issues—issues that more than 90 percent of faculty believe have worsened or significantly worsened during the pandemic, according to a new nationwide survey led by a Boston University mental health researcher.

"The vast majority of faculty members, myself included, are not trained mental health professionals, but we have a role to play in supporting student well-being," says survey principal investigator Sarah Ketchen Lipson, a BU School of Public Health assistant professor of health law, policy, and management. "These data underscore a real opportunity to better equip faculty with knowledge and basic skills to support and refer students."

These findings, detailed in a first-of-its-kind report, underscore faculty's growing involvement in the health and well-being of students and their willingness to serve as mental health "gatekeepers"—a role that has become increasingly important as students continue to navigate online learning, social isolation, and other COVID-19-related stressors.

But the survey revealed that less than 30 percent of faculty have received training from their academic institutions to handle these issues, even though almost 70 percent say they would welcome this guidance and are eager to strengthen their support for students experiencing mental or emotional health challenges.

Another key survey finding: more than one in five faculty members said that students' mental health has taken a toll on their own mental health. Almost half of respondents said that their institution should invest more in supporting faculty mental health and well-being.

"I am hopeful that our new research in this area will raise awareness of the reality that many faculty members are struggling with their own mental and emotional health," Lipson says.

She says she leveraged BU's mental health resources to help her find a therapist. "I know that I am a better teacher, advisor, and colleague because I am able to prioritize my own mental health in a way that meets my needs," she says.

The pilot survey, which was funded by the Hazelden Betty Ford Foundation and conducted in partnership with the Mary Christie Foundation and the Healthy Minds Network, was administered during the spring 2021 semester to almost 1,700 faculty members at 12 colleges and universities across the United States. The results indicate that more work needs to be done on campuses to enable faculty to identify and refer students in mental distress.

"These data make it clear that college and university faculty members are attuned to the mental health needs of their students," Lipson says.

Importantly, she says, while 75 percent of faculty reported that they would reach out to a student in mental or emotional distress, only 51 percent were confident that they could recognize signs of student mental distress. More than 60 percent of faculty believe that it should be mandatory for institutions to provide basic training on handling student mental health, and faculty want additional resources, such as a checklist of warning signs, guides for how to initiate conversations, and a list of available mental health resources.

The survey also found that while 55 percent of faculty believe their institutions are welcoming or somewhat welcoming towards students of color, 58 percent of Hispanic or Latinx faculty and 39 percent of Black or African American faculty believe their institution is hostile or somewhat hostile towards students of color. These results indicate that institutions should not only make campuses more inclusive for students, but also build the level of trust needed among faculty of color to refer students to campus resources, the report said.

"Data are powerful in creating change in higher education, and for so long, there has been a lack of national data on the mental health of college and university faculty," says Lipson. "I hope that investments in new resources to support faculty well-being will yield benefits not only to individual faculty members, but also to students and institutions writ large."

Shopping habits and escalating consumption of many consumers are inflicting a heavy environmental toll, and while the majority of customers seem hesitant to act "green" on their own, companies are increasingly expected to implement effective eco-friendly tactics. But efforts to increase towel reuse at hotels, paperless adoption in the banking industry or "ugly" food consumption at grocery stores have been challenging.

As a result, millions of tons of cosmetically imperfect produce are wasted every year in the United States while about one billion trees worth of paper are thrown away. Electricity consumption is impacted when those plain nonverbal stickers used in hotel bathrooms fail to significantly alter towel usage habits.

So, what's missing in the messaging? Persuasive language that combines peer pressure with what the consumer, or broader world, can gain by lightening carbon footprints. Humanize the earth with a smiling face or give the visually unappealing potato a name, and the persuasive green impact is further amplified, according to a study led by the University of Houston Conrad N. Hilton College of Hotel and Restaurant Management.

Researchers presented hypothetical scenarios to 776 experimental respondents across the hotel, banking and retail industries to identify low-cost and useful means to facilitate pro-environmental appeals. The work is published in Psychology & Marketing.

"Gain language is messaging that says 'you can save this amount of water if you reuse your towel or save this amount of electricity.' Highlight the positive benefit of the proposed action," said study co-author Priyanko Guchait, associate professor at UH's Hilton College. "Combine that strategy with peer pressure, or what's called normative influence, and convey that 75% of customers reuse towels, for example. Then customers will be more likely to do the same because of that established social norm."

Guchait collaborated on the research with visiting scholar The Khoa Do and Chen-Ya Wang from National Tsing Hua University in Taiwan.

Gain language does not work in all social situations, just those defined as "low risk," such as green behavior, according to Guchait. "It's low risk because no one is going to die if you don't reuse a towel," he said. Loss language, or highlighting negative possible outcomes, is more effective in "high risk" situations where lives could be at stake, such as calls to practice physical distancing during the COVID-19 pandemic, according to his previous research.

The study also uncovered that by adding anthropomorphism to the messaging, or giving objects human characteristics, green compliance increased. The researchers suggest that hoteliers should add a happy facial expression of the earth to their green signs in bathrooms to encourage the reuse of towels as well as discourage the excessive use of water and toilet paper.

"Retailers such as supermarkets can give a name to their ugly food promotion programs (e.g., Mr. Potato) to better entice customers' engagement in their green campaigns. Similarly, restaurant managers who want to sell foods made of ugly vegetables can create a menu with an anthropomorphized character," the authors wrote. "Banking managers who want to promote paperless behavior may also think of assigning a first-person pronoun to their green paperless initiatives." 

Not only could these efforts positively impact the environment, the researchers suggest that by shifting customers' behaviors to be greener, businesses can save money while increasing their reputation.

"Businesses could reduce their losses and generate more revenue all while showing their customers they care about the environment," said Guchait. "That's a win-win situation."

SILVER SPRING, Md.--A new Australian study reveals that changes in lifestyle patterns were longitudinally associated with concurrent changes in body mass index (BMI) z scores, and maternal pre-pregnancy BMI, maternal dietary patterns and television viewing time are significant determinants, according to a paper published online in Obesity, The Obesity Society's (TOS) flagship journal. This is the first study that used multi-trajectory modeling to examine the longitudinal relationship between concurrent changes in lifestyle patterns and BMI z scores in early childhood.

"The findings will inform early childhood obesity prevention intervention and policy, and will be of great interest to pediatricians, researchers, policymakers and the general public," said Miaobing Zheng of the Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, in Geelong, Australia. Zheng is the corresponding author of the study.

Experts explain that longitudinal studies investigating the association between lifestyle patterns and obesity in children are scarce. An association between a healthy lifestyle pattern and lower obesity risk has, however, been previously reported in a few cross-sectional studies. In the present study, the co-occurrence of stable healthy lifestyle patterns along with a concurrent normal BMI z score trajectory of one unit from 18 to 60 months in about half of the children provides new longitudinal evidence supporting that children with healthy lifestyles were more likely to concurrently have normal BMI z score development.

Data of 439 children were used from the Melbourne Feeding Activity and Nutrition Trial (InFANT) program. This longitudinal cohort of children commenced in 2008 as a 15-month parent-focused cluster randomized controlled trial aiming to reduce obesity risk behaviors in children until 18 months. Additional follow-ups without interventions occurred for children aged 42 and 60 months. Multi-trajectory modeling identified groups of children following similar lifestyle patterns and BMI z score trajectories and multi-nomial logistic regression assessed the determinants of the trajectory groups.

Three trajectory groups of child lifestyle patterns and BMI z scores were identified and distinguished, showing a mixture of healthy and unhealthy lifestyle behaviors and
BMI z scores. Compared to Groups 1 "Unhealthy lifestyle pattern, Low BMI z" and 3 "Unhealthy lifestyle pattern, High BMI z", Group 2 "Healthy lifestyle pattern, Mid BMI z" revealed the most distinctive trajectories across lifestyle patterns and BMI z scores. Group 2 comprised nearly 53 percent of children and followed a stable and low trajectory for an unhealthy lifestyle pattern characterized by energy-dense and nutrient poor discretionary food consumption and television viewing time and a high and rising trajectory for a healthy lifestyle pattern of fruit and vegetable intakes and time outdoors, along with a mean BMI z score of +1 unit over time.

Groups 1 and 3 shared similar high trajectories for an unhealthy lifestyle pattern of discretionary food consumption and television viewing time, and low trajectories for a healthy lifestyle pattern of fruit and vegetable intakes and time outdoors. The two groups however differed in BMI z score trajectories, showing stable patterns but at mean scores of 0 and +2 units, respectively. Child sex, breastfeeding duration and maternal physical activity were not associated with the identified trajectory groups.

The study's authors note that the co-occurrence of stable lifestyle patterns and BMI z score trajectories in early childhood highlight the importance of initiating lifestyle obesity prevention early in life, and such interventions could target both children and the mother. A multi-behavior approach to simultaneously target healthy diet, physical activity and sedentary behaviors could be adapted.

"Young children learn by imitating that which they see daily. There is no doubt that children copy the behaviors observed in the presence of parents: healthy and unhealthy," said Liliana Aguayo, PhD, MPH, a childhood obesity expert, TOS member and research assistant professor from the Hubert Department of Global Health at Emory University in Atlanta, Ga. "Evidence from this study highlights the importance of early childhood as a critical period for development of obesity. More research is needed to identify effective approaches to simultaneously address parent and child health behaviors." Aguayo was not associated with the research.

A study led by researchers at the Centre for Palaeogenetics in Stockholm shows that the last remaining populations of the Sumatran rhinoceros display surprisingly low levels of inbreeding. The researchers sequenced the genomes from 21 modern and historical rhinoceros' specimens, which enabled them to investigate the genetic health in rhinos living today as well as a population that recently became extinct. These findings are published today in the journal Nature Communications.

With less than 100 individuals remaining, the Sumatran rhinoceros is one of the most endangered mammal species in the world. Recent reports of health issues and low fecundity have raised fears that the remaining populations are suffering from inbreeding problems. However, very little has been known about the genetic status of these enigmatic rhinos.

To investigate whether the Sumatran rhinoceros is threatened by genetic factors, the researchers sequenced the genomes from 16 individuals representing the present-day populations on Borneo and Sumatra and the recently extinct population on the Malaysian Peninsula. This enabled them to estimate inbreeding levels, genetic variation, and the frequency of potentially harmful mutations in the populations. Moreover, by also sequencing the genomes from five historical samples, the researchers could investigate the genetic consequences of the severe population decline of the past 100 years.

"To our surprise, we found relatively low inbreeding levels and high genetic diversity in the present-day populations on Borneo and Sumatra", says Johanna von Seth, PhD student at the Centre for Palaeogenetics and co-lead author on the paper.

The researchers think that the comparatively low inbreeding levels in the present-day rhinos is due to the decline in population size having happened very recently. This means that inbreeding hasn't yet caught up with the current small population size. This is good news for the conservation management of the remaining populations, since it implies that there is still time to preserve the species' genetic diversity. However, the researchers also found that there are many potentially harmful mutations hidden in the genomes of these individuals, which could spell bad news for the future.

"Unless the populations start increasing in size, there is a high risk that inbreeding levels will start rising, and consequently that genetic diseases will become more common", cautions Nicolas Dussex, postdoctoral researcher at the Centre for Palaeogenetics who also co-led the study.

The research team's findings from the recently extinct population on the Malaysian Peninsula serve as a stark warning of what might soon happen to the remaining populations in Borneo and Sumatra. A comparison of historical and modern genomes showed that the Malaysian Peninsula population experienced a rapid increase in inbreeding levels before it went extinct. Moreover, the researchers observed changes in the frequency of potentially harmful mutations that are consistent with inbreeding depression, a phenomenon where closely related parents produce offspring that suffer from genetic disease. These results imply that the two remaining populations could suffer a similar fate if their inbreeding levels start to increase.

"The Sumatran rhino is by no means out of the woods. But at least our findings provide a path forward, where we might still be able to rescue a large part of the species' genetic diversity", says Love Dalén, professor of evolutionary genetics at the Centre for Palaeogenetics.

In order to minimize the risk of extinction, the researchers say that it is imperative that the population size increases. They also suggest that actions can be taken to enable the exchange of genes between Borneo and Sumatra, for example by translocating individuals or using artificial insemination. A comparison of genomes from these two islands provided no evidence that such genetic exchange could lead to an introduction of genes that are less well adapted to the local environment. The researchers also point out that genome sequencing could be used as a tool to identify particular individuals with low amounts of potentially harmful mutations, and that such individuals would be especially well-suited for this type of genetic exchange.

In a wider perspective, the study highlights the potential of modern-day genome sequencing technology in guiding conservation efforts for endangered species across the globe. The study was supported by the National Genomics Infrastructure at SciLifeLab in Sweden, and was a collaboration between researchers from several different countries that included geneticists as well as experts on conservation management and reproductive biology.

The Centre for Palaeogenetics is a joint research centre funded by Stockholm University and the Swedish Museum of Natural History.

A majority of gay and bisexual Generation Z teenage boys report being out to their parents, part of an uptick in coming out among young people that researchers have noted in recent decades, according to research published by the American Psychological Association. However, stigma and religious beliefs still prevent some young people from disclosing their sexual identity.

This study offers a glimpse into the coming out practices of Generation Z, those born between 1998 and 2010, a group that researchers are only beginning to study.

"This study is encouraging in that it shows that many teens, including those under 18 years old, are comfortable with their sexuality," said lead author David A. Moskowitz, PhD, assistant professor of medical social sciences at Northwestern University's Institute for Sexual and Gender Minority Health and Wellbeing. "At the same time, we must be cautious, as the data also point to some of the same barriers and discrimination that previous generations have faced. Work still needs to be done."

In the study, published in the journal Psychology of Sexual Orientation and Gender Diversity, researchers examined survey data from 1,194 13-to-18-year-old boys, all of whom identified as gay, bisexual or as being attracted to people regardless of gender. The data were collected as part of an HIV prevention study between January 2018 and January 2020.

Participants were asked demographic questions, such as their race and age and social questions such as their religious affiliations and the frequency with which they attended religious events. They were also asked to respond on a scale of 1 to 4, with 1 being strongly agree and 4 being strongly disagree, to a series of statements to gauge their attitudes about their own sexual identities. These statements included, "Sometimes I think that if I were straight, I would be happier" and "If there were a pill to make me straight, I'd take it." They were also asked a series of questions, such as, "How many times has someone chased you because of your sexuality?"

Researchers found that 66% of those surveyed were out to their mothers or other female parental figures and 49% were out to their fathers or other male parental figures. In the 1990s, in contrast, an estimated 40% of adolescent boys were out to their mothers and less than 30% were out to their fathers, according to the researchers.

The study also found that white participants were more likely than Black participants to be out to a parent or parental figure. Those identifying as gay were more likely to be out to a parent than bisexuals or those unsure of their sexuality. Participants who said they were not religious were more likely to say they were out to a parent than teens who identified as religious. Teens who were not fully accepting of their identity were less likely to come out than those who embraced their identity.

"This gives us an understanding of the factors that move teenagers to share this type of information with the people closest to them," said Moskowitz. "We can now compare these practices with how other generations deal with these issues and think about what it all means for future generations."

More study is needed to fully understand how this generation views sexuality, according to the researchers.

"An important next step would be to determine the coming out practices of females in this age group," Moskowitz said. "This study provides a roadmap for such an effort. In the meantime, these findings should be helpful to those who work with teenagers identifying as sexual minorities."

KANSAS CITY, MO--One of the evolutionary disadvantages for mammals, relative to other vertebrates like fish and chickens, is the inability to regenerate sensory hair cells. The inner hair cells in our ears are responsible for transforming sound vibrations and gravitational forces into electrical signals, which we need to detect sound and maintain balance and spatial orientation. Certain insults, such as exposure to noise, antibiotics, or age, cause inner ear hair cells to die off, which leads to hearing loss and vestibular defects, a condition reported by 15% of the US adult population. In addition, the ion composition of the fluid surrounding the hair cells needs to be tightly controlled, otherwise hair cell function is compromised as observed in Ménière's disease.

While prosthetics like cochlear implants can restore some level of hearing, it may be possible to develop medical therapies to restore hearing through the regeneration of hair cells. Investigator Tatjana Piotrowski, PhD, at the Stowers Institute for Medical Research is part of the Hearing Restoration Project of the Hearing Health Foundation, which is a consortium of laboratories that do foundational and translational science using fish, chicken, mouse, and cell culture systems.

"To gain a detailed understanding of the molecular mechanisms and genes that enable fish to regenerate hair cells, we need to understand which cells give rise to regenerating hair cells and related to that question, how many cell types exist in the sensory organs," says Piotrowski.

The Piotrowski Lab studies regeneration of sensory hair cells in the zebrafish lateral line. Located superficially on the fish's skin, these cells are easy to visualize and to access for experimentation. The sensory organs of the lateral line, known as neuromasts, contain support cells which can readily differentiate into new hair cells. Others had shown, using techniques to label cells of the same embryonic origin in a particular color, that cells within the neuromasts derive from ectodermal thickenings called placodes.

It turns out that while most cells of the zebrafish neuromast do originate from placodes, this isn't true for all of them.

In a paper published online April 19, 2021, in Developmental Cell, researchers from the Piotrowski Lab describe their discovery of the occasional occurrence of a pair of cells within post-embryonic and adult neuromasts that are not labeled by lateral line markers. When using a technique called Zebrabow to track embryonic cells through development, these cells are labeled a different color than the rest of the neuromast.

"I initially thought it was an artifact of the research method," says Julia Peloggia, a predoctoral researcher at The Graduate School of the Stowers Institute for Medical Research, co-first author of this work along with another predoctoral researcher, Daniela Münch. "Especially when we are looking just at the nuclei of cells, it's pretty common in transgenic animal lines that the labels don't mark all of the cells," adds Münch.

Peloggia and Münch agreed that it was difficult to discern a pattern at first. "Although these cells have a stereotypical location in the neuromast, they're not always there. Some neuromasts have them, some don't, and that threw us off," says Peloggia.

By applying an experimental method called single-cell RNA sequencing to cells isolated by fluorescence-activated cell sorting, the researchers identified these cells as ionocytes--a specialized type of cell that can regulate the ionic composition of nearby fluid¬. Using lineage tracing, they determined that the ionocytes derived from skin cells surrounding the neuromast. They named these cells neuromast-associated ionocytes.

Next, they sought to capture the phenomenon using time-lapse and high-resolution live imaging of young larvae.

"In the beginning, we didn't have a way to trigger invasion by these cells. We were imaging whenever the microscope was available, taking as many time-lapses as possible--over days or weekends--and hoping that we would see the cells invading the neuromasts just by chance," says Münch.

Ultimately, the researchers observed that the ionocyte progenitor cells migrated into neuromasts as pairs of cells, rearranging between other support cells and hair cells while remaining associated as a pair. They found that this phenomenon occurred all throughout early larval, later larval, and well into the adult stages in zebrafish. The frequency of neuromast-associated ionocytes correlated with developmental stages, including transfers when larvae were moved from ion-rich embryo medium to ion-poor water.

From each pair, they determined that only one cell was labeled by a Notch pathway reporter tagged with fluorescent red or green protein. To visualize the morphology of both cells, they used serial block face scanning electron microscopy to generate high-resolution three-dimensional images. They found that both cells had extensions reaching the apical or top surface of the neuromast, and both often contained thin projections. The Notch-negative cell displayed unique "toothbrush-like" microvilli projecting into the neuromast lumen or interior, reminiscent of that seen in gill and skin ionocytes.

"Once we were able to see the morphology of these cells--how they were really protrusive and interacting with other cells--we realized they might have a complex function in the neuromast," says Münch.

"Our studies are the first to show that ionocytes invade sensory organs even in adult animals and that they only do so in response to changes in the environment that the animal lives in," says Peloggia. "These cells therefore likely play an important role allowing the animal to adapt to changing environmental conditions."

Ionocytes are known to exist in other organ systems. "The inner ear of mammals also contains cells that regulate the ion composition of the fluid that surrounds the hair cells, and dysregulation of this equilibrium leads to hearing and vestibular defects," says Piotrowski. While ionocyte-like cells exist in other systems, it's not known whether they exhibit such adaptive and invasive behavior.

"We don't know if ear ionocytes share the same transcriptome, or collection of gene messages, but they have similar morphology to an extent and may possibly have a similar function, so we think they might be analogous cells," says Münch. Our discovery of neuromast ionocytes will let us test this hypothesis, as well as test how ionocytes modulate hair cell function at the molecular level," says Peloggia.

Next, the researchers will focus on two related questions--what causes these ionocytes to migrate and invade the neuromast, and what is their specific function?

"Even though we made this astounding observation that ionocytes are highly motile, we still don't know how the invasion is triggered," says Peloggia. "Identifying the signals that attract ionocytes and allow them to squeeze into the sensory organs might also teach us how cancer cells invade organs during disease." While Peloggia plans to investigate what triggers the cells to differentiate, migrate, and invade, Münch will focus on characterizing the function of the neuromast-associated ionocytes. "The adaptive part is really interesting," explains Münch. "That there is a process involving ionocytes extending into adult stages that could modulate and change the function of an organ--that's exciting."

Other coauthors of the study include Paloma Meneses-Giles, Andrés Romero-Carvajal, PhD, Mark E. Lush, PhD, and Melainia McClain from Stowers; Nathan D. Lawson from the University of Massachusetts Medical School; and Y. Albert Pan, PhD, from Virginia Tech Carilion.

The work was funded by the Stowers Institute for Medical Research and the National Institute of Child Health and Human Development of the National Institutes of Health (award 1R01DC015488-01A1). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Lay Summary of Findings

Humans cannot regenerate inner ear hair cells, which are responsible for detecting sound, but non-mammalian vertebrates can readily regenerate sensory hair cells that are similar in function. During the quest to understand zebrafish hair cell regeneration, researchers from the lab of Investigator Tatjana Piotrowski, PhD, at the Stowers Institute for Medical Research discovered the existence of a cell type not previously described in the process.

The research team found newly differentiated, migratory, and invasive ionocytes located in the sensory organs that house the cells giving rise to new hair cells in larval and adult fish. The researchers published their findings online April 19, 2021, in Developmental Cell. Normal invasive (that is, non-metastatic) behavior of cells after embryonic development is not often observed. Future research by the team will focus on identifying triggers for such behavior and the function of such cells, including how this process may relate to hair cell regeneration.

Protecting long-term care residents from outbreaks requires different infrastructure, proper staffing conditions and a culture of quality assurance, researchers have found.

The experts further determined that designing smaller, more homelike spaces would minimize the spread of viruses while promoting better health and quality of life for residents.

"Community outbreaks and lack of personal protective equipment were the primary drivers of outbreak occurrence in long-term care homes, and the built environment was the major determinant of outbreak severity," said George Heckman, a professor in Waterloo's School of Public Health and Health Systems and Schlegel Research Chair in Geriatric Medicine with the Research Institute for Aging.

"We need to distinguish between small-scale living and small-scale housing, using architectural features to create uncrowded and home-like spaces - but within a sufficiently resilient infrastructure to avoid critical staff shortages such as those experienced by some very small homes in Italy and the United States."

In the U.S., data from geospatial analysis and cellphone tracking showed that outbreaks were more likely when staff commuted from neighbourhoods with high viral circulation, and in large homes with more staff traffic.

The researchers said that in the case of Ontario, simulations found that 31 per cent of infections and 31 per cent of deaths could have been prevented if all Ontario long-term care residents had had single rooms. However, 30,000 new private rooms would have been needed.

"Policymakers need to reimagine long-term care infrastructure in a post-pandemic world, keeping in mind that smaller homes support better resident outcomes and are more resilient against infectious outbreaks," Heckman said. "New large-scale long-term care home developments should be strongly discouraged."

Other factors that would improve resident well-being and curb the spread of viral infections include a dedicated infection control officer in all long-term care homes, proper staffing conditions and high-quality assurance frameworks.

Hong Kong, for example, learned from the 2003 SARS outbreak and implemented several policies that led to success when it came to COVID-19. They developed guidelines for the prevention of communicable diseases in long-term care, including that all homes have an infection control officer, conduct annual outbreak drills and have a permanent stockpile of personal protective equipment and establish visitation rules that address hygiene and PPE use.

In addition to robust infection control and communication technologies used in Hong Kong, Heckman believes full-time positions, paid sick leave and mental health and well-being supports for staff would make a big difference.

The Hong Kong experience underscores the critical importance of learning health systems, of which a culture of quality assurance is an intrinsic component. Ontario, and most Canadian provinces, already have the required information infrastructure to achieve a learning health system. Based on standardized international Resident Assessment Instrument systems, developed by an international consortium of which Waterloo is a principal leader, their use by communities of practice has led to reductions in inappropriate antipsychotic use and better health outcomes for long-term care residents.

The University of Southern Denmark (SDU), Rigshospitalet and the University of Copenhagen have come together to study the effects of Football Fitness on various health parameters and self-rated health following treatment for breast cancer.

The results of the project, called Football Fitness After Breast Cancer (ABC), have now been published in three scientific articles published in international sports medicine, cardiology and oncology journals.

"The main conclusion is that Football Fitness is an intense and good form of training for women treated for breast cancer, with beneficial effects on balance, muscle strength and bone density," says Professor Peter Krustrup, Head of Research at SDU's Department of Sports Science and Clinical Biomechanics, who has been studying the health effects of football and other sports for more than 15 years.

Twice weekly training sessions for a year

The researchers from SDU and the University Hospitals Centre for Health Research at Rigshospitalet joined with doctors and nurses from the Department of Oncology at Rigshospitalet and researchers at the University of Copenhagen to investigate whether Football Fitness offered twice weekly for 12 months can boost various health parameters in women treated for breast cancer.

The study involved 68 women aged 23 to 74, with an average age of 48, who were randomised 2:1 to a training group (46 participants) and a control group (22 participants). The trial ran for 12 months, during which the training group was offered Football Fitness training sessions twice a week comprising a warm-up, fitness and football drills, and small-sided games of 5v5 and 7v7 using two goals.

At the start of the study and after 6 and 12 months, respectively, health parameters such as fitness, bone and muscle strength, balance, body fat percentage, blood pressure and cholesterol were measured and the participants completed questionnaires to rate their quality of life and energy in everyday activities.

It was also investigated whether participation in Football Fitness increased the risk of the participants developing chronic swelling (lymphoedema) on the side where they had been treated for breast cancer.

Football Fitness improves balance, strengthens muscle and counteracts bone weakening

In an article just published in the Scandinavian Journal of Medicine and Science in Sports, the researchers show that 12 months of football training, performed on average 0.8 x 1 hour per week, gave the women better balance and greater muscle strength in the legs, while at the same time increasing bone density in the lumbar spine.

The participants who took part in at least one weekly session also achieved an improvement in bone strength in the femur.

"It's encouraging that even a modest amount of training can produce these improvements because we know that treatment for breast cancer can accelerate the natural age-related loss of bone mass and thereby increase the risk of osteoporosis," says Jacob Uth, assistant professor and PhD at University College Copenhagen, who has been the project leader in the study.

"The fact that balance and muscle strength are improved at the same time is a big plus, because in the longer term this can reduce the risk of falls and broken bones," he says.

Everyday activities become easier - but improving fitness requires more training

In another recently published article in US journal Progress in Cardiovascular Diseases, the researchers show that the intensity is high, corresponding to a heart rate of more than 80% of maximum heart rate for 70% of the time the participants are playing with two goals. But this did not improve the participants' fitness compared with the participants in the control group over the 12 months of the intervention.

On the other hand, the study showed that, after 6 months of Football Fitness training, the participants reported that health-related problems were less of a barrier to participating in and accomplishing everyday activities.

"While just one weekly training session on average was enough to produce positive effects on muscles and bones, and also to give a reduction in self-rated problems with everyday activities, it was not enough to produce a significant improvement in aerobic fitness for the football group. Our previous studies show a good improvement in maximal oxygen uptake of average 11% for 3-6 months' football training comprising 2-3 weekly sessions, but the attendance in this study was obviously lower," says Peter Krustrup.

"However, we were able to establish that the intensity of the football training was just as high as for other target groups with hypertension and type 2 diabetes and also that there was a good improvement in maximal oxygen update in the 50% of participants who had a low aerobic fitness rating at the start of the study".

Risk of lymphoedema does not increase with participation in Football Fitness

Around one in three women treated for breast cancer experiences chronic swelling in the arm on the side where the breast has been removed, which is known as lymphoedema.

Previously, professionals advised their patients to be cautious in exerting themselves physically, because it was suspected that this increased the risk of developing lymphoedema. Many studies have now shown that this fear is unfounded, but there is only limited data insofar as this concerns participation in team sport, where physical contact between players is an expected part of the activity.

The researchers in Football Fitness ABC therefore measured whether the women who took part in the football training developed lymphoedema more often, or were more likely to experience worsening of an existing lymphoedema, compared to the women in the control group.

Results from the study have now shown that there was no difference between the groups, and thus no reason to believe that Football Fitness increases the risk of lymphoedema, and this result was recently published in the Nordic cancer journal Acta Oncologica.

Football Fitness ABC has upscaling potential

Overall, the study shows that Football Fitness is an intense form of training for women treated for breast cancer, and Football Fitness appears to be able to counteract established long-term consequences of breast cancer treatment, such as loss of bone mass and lack of physical energy in everyday activities. These benefits are achieved without an increased risk of developing lymphoedema.

Peter Krustrup and Jacob Uth see potential in extending this form of training as a nationwide offering run by local football clubs under the Danish Football Association (DBU), ideally in partnership with hospitals and local health centres, in the same way as FC Prostate. At the same time, they stress that this is the first study in this area, and there remains a need for larger studies in order to be able to generalise the results to women treated for breast cancer generally, including women older than those participating in this study.

About the study

68 women aged 23-74, with an average age of 48, participated in the study.

2/3 were randomly assigned to Football Fitness training, which was offered twice weekly over 12 months. 1/3 were randomly assigned to a control group, which did not participate in the training. Participants in the control group were given the opportunity to participate in Football Fitness training after the project period.

Compared with the control group, the Football Fitness group improved balance, muscle strength in the legs and bone density in the lumbar spine. At the same time, they experienced a reduction in physical barriers to everyday activities.

Compared with the control group, the Football Fitness group improved balance by 27.5%, leg muscle strength by 8.4% and lumbar spine bone density by 2.5%.

Breast cancer is the most commonly diagnosed cancer worldwide with 2.3 million women diagnosed in 2019. In the USA alone, 268.600 women were diagnosed with breast cancer in 2019.

NEW YORK, NY (April 26, 2021) -Brain research and advocacy nonprofit Cohen Veterans Bioscience (CVB) today announced the launch of a National TBI Precision Solutions Research Roadmap, with the advent of the first in a series of publications resulting from its Brain Trauma Blueprint framework program.

The Brain Trauma Blueprint is a framework that enables stakeholder groups across government, academia, foundations, and industry to advance precision diagnostics and treatments for brain trauma through a coordinated effort. The framework comprises a 12-step process to jointly identify unmet patient needs, associated research priorities, landscape state of the science, identify research gaps and barriers, and provide recommendations for progress. The framework also provides a call to action for funders and collaborators across the broader stakeholder community to engage in a transparent & coordinated network.

Advancing TBI Care Through a Research Roadmap

Authored by leading experts in the traumatic brain injury (TBI) field, the six-part series is being published in the Journal of Neurotrauma and will lay the framework for a roadmap to advance the field, based on a State-of-the-Science consensus conference held in 2019 with >125 leaders in the field. The first installment focuses on the complex nature of brain trauma and how variability in clinical presentation (phenotypes) has confounded research. The consensus roadmap recommended that a streamlined method for characterizing data collected in different settings could lead to more targeted care and improved patient outcomes.

As a direct outcome of the collaboration fostered through the Blueprint, CVB and its collaborators have developed the first of a suite of tools to capture the variability of subject-level data across the spectrum of TBI. Using this standardized approach, the new tool, PhenoBench, is made freely available via a public code repository to enable researchers to evaluate phenotyping data collected across different studies.

"TBI presents differently from one patient to the next, and so it is important to have the ability to predict who might recover versus who is susceptible to long-term effects. This set of tools is anticipated to provide researchers with the means to standardize how they analyze and subsequently interpret TBI phenotyping data across different patient populations," said Lee Lancashire, PhD, CVB Chief Information Officer, and collaborating author on the publication. "We expect PhenoBench to have a significant impact on the field by ensuring that new and existing data can be used to discover reproducible and transparent signatures of patient phenotypes. This will enable prediction of TBI outcomes and move us closer to tailored treatments that improve recovery."

Toward a Personalized Approach to TBI Care

TBI is a leading cause of death and disability in the U. S. Yet despite the personal, economic, and societal costs of TBI, as well as the significant research investments to date, there are no FDA-approved treatments that address the long-term consequences many individuals who have sustained a TBI will go on to develop. Although most individuals who experience a TBI recover, a significant subset have persistent symptoms, including mental health conditions, sleep disturbances, and memory impairment, further increasing the personal and economic burden. Many researchers believe that studying the clinical features--or phenotype--of patients who recover from a TBI versus those who develop chronic effects could lead to better, more personalized treatment options for all TBI patients.

To understand the challenges of a phenotype-based strategy for TBI care, the authors of the Journal of Neurotrauma's first Brain Trauma Blueprint publication--Phenotyping the Spectrum of Traumatic Brain Injury: A Review and Pathway to Standardization [10.1089/neu.2021.0059]--describe the current research on approaches to patient phenotyping, and the need to consider new approaches such as unsupervised machine-learning, a type of artificial intelligence that looks for patterns and similarities across vast amounts of data without needing to know the clinical outcomes.

According to Mary Jo Pugh, PhD, RN, professor in the Department of Medicine, Division of Epidemiology at the University of Utah School of Medicine and Investigator at the Informatics, Decision-Enhancement and Analytic Science Center of Innovation at the VA Salt Lake City and lead author on the manuscript, "Phenotyping is becoming an increasingly popular approach to the evaluation of TBI and trajectories of TBI-related outcomes. It has great potential to identify the right patient for the right treatment at the right time."