Culture

Many Sub-Saharan countries have a desperate shortage of surgeons, and to ensure that as many patients as possible can be treated, some operations are carried out by medical professionals who are not specialists in surgery.

This approach, called task sharing, is supported by the World Health Organisation, but the practice remains controversial. Now a team of medical researchers from Norway, Sweden, Sierra Leone and the Netherlands shows that groin hernia operations performed by associate clinicians, who are trained medical personnel but not doctors, are just as safe and effective as those performed by doctors. The study has been published in JAMA Network Open.

"The study showed that associate clinicians were not inferior to registered doctors when it comes to recurrence, complications, groin pain or patient satisfaction," said co-authors Håkon A. Bolkan and Alex van Duinen at the Department of Clinical and Molecular Medicine, NTNU.

An estimated 220 million people around the world live with an inguinal hernia, which causes significant suffering and, 40,000 deaths each year.

Twenty million inguinal hernia operations are performed every year, making it the most common general surgical procedure in the world, including in low-income countries like Sierra Leone, where the study was conducted.

Sierra Leone has fewer than one surgeon per 100,000 population. The shortage of surgeons in Sierra Leone means that the country's medical doctors, who have no specific training in surgery, routinely perform surgical procedures as part of their regular work.

Since 2011, the Norwegian non-profit organization CapaCare has worked with the Sierra Leone Ministry of Health and Sanitation and the United Nations Population Fund to address the shortage in surgical care through task sharing. CapaCare offers a three-year training programme for community health officers, after which they can perform basic lifesaving surgeries, such as groin hernia repairs.

CapaCare graduates are called associate clinicians and their education level is between that of a nurse and a doctor.

The study included 229 men operated on for inguinal hernia between 2017 and 2018 at a district hospital in rural Sierra Leone. The patients were randomly assigned to a doctor or an associate clinician for their surgery and were followed up after two weeks and one year. The researchers also plan a follow-up visit to patients three years after their surgery.

"There were even fewer cases of recurrence in the patients who had been operated on by associate clinicians compared to the group operated on by medical doctors," Bolkan and van Duinen said. "This was an extremely unexpected finding and task sharing appears to be an attractive option that can help the millions of people suffering from inguinal hernia."

The researchers' next step is to develop training programmes for doctors and associate clinicians in order to expand surgical services. Forthcoming studies will be conducted in Sierra Leone and Uganda.

The study was financed by the Swedish Research Council. Authors Håkon Bolkan, Alex van Duinen and Thomas Ashley are unpaid members of the CapaCare board.

Publication: "Outcomes after elective inguinal hernia repair performed by associate clinicians versus medical doctors - a randomized, single blinded non-inferiority trial." Thomas Ashley, Hannah Ashley, Andreas Wladis, Håkon A. Bolkan, Alex J. van Duinen, Jessica H. Beard, Hertta Kalsi, Juuli Palmu, Pär Nordin, Kristina Holm, Michael Ohene-Yeboah, Jenny Löfgren. JAMA Network Open, Many Sub-Saharan countries have a desperate shortage of surgeons, and to ensure that as many patients as possible can be treated, some operations are carried out by medical professionals who are not specialists in surgery.

This approach, called task sharing, is supported by the World Health Organisation, but the practice remains controversial. Now a team of medical researchers from Norway, Sweden, Sierra Leone and the Netherlands shows that groin hernia operations performed by associate clinicians, who are trained medical personnel but not doctors, are just as safe and effective as those performed by doctors. The study has been published in JAMA Network Open.

"The study showed that associate clinicians were not inferior to registered doctors when it comes to recurrence, complications, groin pain or patient satisfaction," said co-authors Håkon A. Bolkan and Alex van Duinen at the Department of Clinical and Molecular Medicine, NTNU.

Training and task sharing as a way to address shortages

An estimated 220 million people around the world live with an inguinal hernia, which causes significant suffering and, 40,000 deaths each year.

Twenty million inguinal hernia operations are performed every year, making it the most common general surgical procedure in the world, including in low-income countries like Sierra Leone, where the study was conducted.

Sierra Leone has fewer than one surgeon per 100,000 population. The shortage of surgeons in Sierra Leone means that the country's medical doctors, who have no specific training in surgery, routinely perform surgical procedures as part of their regular work.

Since 2011, the Norwegian non-profit organization CapaCare has worked with the Sierra Leone Ministry of Health and Sanitation and the United Nations Population Fund to address the shortage in surgical care through task sharing. CapaCare offers a three-year training programme for community health officers, after which they can perform basic lifesaving surgeries, such as groin hernia repairs.

CapaCare graduates are called associate clinicians and their education level is between that of a nurse and a doctor.

An unexpected finding

The study included 229 men operated on for inguinal hernia between 2017 and 2018 at a district hospital in rural Sierra Leone. The patients were randomly assigned to a doctor or an associate clinician for their surgery and were followed up after two weeks and one year. The researchers also plan a follow-up visit to patients three years after their surgery.

"There were even fewer cases of recurrence in the patients who had been operated on by associate clinicians compared to the group operated on by medical doctors," Bolkan and van Duinen said. "This was an extremely unexpected finding and task sharing appears to be an attractive option that can help the millions of people suffering from inguinal hernia."

The researchers' next step is to develop training programmes for doctors and associate clinicians in order to expand surgical services. Forthcoming studies will be conducted in Sierra Leone and Uganda.

New York, NY--January 11, 2021--Like a longtime couple who can predict each other's every move, a Columbia Engineering robot has learned to predict its partner robot's future actions and goals based on just a few initial video frames.

When two primates are cooped up together for a long time, we quickly learn to predict the near-term actions of our roommates, co-workers or family members. Our ability to anticipate the actions of others makes it easier for us to successfully live and work together. In contrast, even the most intelligent and advanced robots have remained notoriously inept at this sort of social communication. This may be about to change.

The study, conducted at Columbia Engineering's Creative Machines Lab led by Mechanical Engineering Professor Hod Lipson, is part of a broader effort to endow robots with the ability to understand and anticipate the goals of other robots, purely from visual observations.

The researchers first built a robot and placed it in a playpen roughly 3x2 feet in size. They programmed the robot to seek and move towards any green circle it could see. But there was a catch: Sometimes the robot could see a green circle in its camera and move directly towards it. But other times, the green circle would be occluded by a tall red carboard box, in which case the robot would move towards a different green circle, or not at all.

After observing its partner puttering around for two hours, the observing robot began to anticipate its partner's goal and path. The observing robot was eventually able to predict its partner's goal and path 98 out of 100 times, across varying situations--without being told explicitly about the partner's visibility handicap.

"Our initial results are very exciting," says Boyuan Chen, lead author of the study, which was conducted in collaboration with Carl Vondrick, assistant professor of computer science, and published today by Nature Scientific Reports. "Our findings begin to demonstrate how robots can see the world from another robot's perspective. The ability of the observer to put itself in its partner's shoes, so to speak, and understand, without being guided, whether its partner could or could not see the green circle from its vantage point, is perhaps a primitive form of empathy."

When they designed the experiment, the researchers expected that the Observer Robot would learn to make predictions about the Subject Robot's near-term actions. What the researchers didn't expect, however, was how accurately the Observer Robot could foresee its colleague's future "moves" with only a few seconds of video as a cue.

The researchers acknowledge that the behaviors exhibited by the robot in this study are far simpler than the behaviors and goals of humans. They believe, however, that this may be the beginning of endowing robots with what cognitive scientists call "Theory of Mind" (ToM). At about age three, children begin to understand that others may have different goals, needs and perspectives than they do. This can lead to playful activities such as hide and seek, as well as more sophisticated manipulations like lying. More broadly, ToM is recognized as a key distinguishing hallmark of human and primate cognition, and a factor that is essential for complex and adaptive social interactions such as cooperation, competition, empathy, and deception.

In addition, humans are still better than robots at describing their predictions using verbal language. The researchers had the observing robot make its predictions in the form of images, rather than words, in order to avoid becoming entangled in the thorny challenges of human language. Yet, Lipson speculates, the ability of a robot to predict the future actions visually is not unique: "We humans also think visually sometimes. We frequently imagine the future in our mind's eyes, not in words."

Lipson acknowledges that there are many ethical questions. The technology will make robots more resilient and useful, but when robots can anticipate how humans think, they may also learn to manipulate those thoughts.

"We recognize that robots aren't going to remain passive instruction-following machines for long," Lipson says. "Like other forms of advanced AI, we hope that policymakers can help keep this kind of technology in check, so that we can all benefit."

The Third Pole centered on the Tibetan Plateau is home to headwaters of over 10 major Asian rivers. These glacier-based water systems, also known as the Asian Water Towers, will have to struggle to quench the thirst of downstream communities despite more river runoff brought on by a warmer climate, according to a recent study published in Nature Climate Change.

By constraining earth system models for precipitation projections, together with estimated glacier melt contributions, the study quantified the wet-season runoff of seven rivers at the Third Pole, and found it would increase 1.0-7.2% by the end of the 21st century for warming in the range of 1.5-4°C. However, the study also showed that rising water demands from the growing population will outweigh warming in determining water scarcity in the Indus and Brahmaputra basins, especially at higher warming levels. "Regretfully, a large proportion of the local population will continue to experience severe water stress even with a wetter climate," said WANG Tao, lead author of the study and a professor at the Institute of Tibetan Plateau Research, Chinese Academy of Sciences.

"Estimates of future Third Pole precipitation in earlier IPCC reports vary greatly, indicating huge uncertainties," said YAO Tandong, co-author of the study and co-chair of Third Pole Environment (TPE), an international science program for the interdisciplinary study of the region. "By constraining earth system models on the basis that westerly-monsoon interaction is the main driver of water cycle changes at the Third Pole, we significantly increased the confidence of future precipitation projection," said YAO.

This study also highlighted the need for policies promoting adaptation in the region. "We recommend measures such as increasing crop use efficiency and dam regulations in these basins to secure future water, food security and environmental sustainability under the Paris climate targets" said YAO.

We are fascinated by machines that can control cars, compose symphonies, or defeat people at chess, Go, or Jeopardy! While more progress is being made all the time in Artificial Intelligence (AI), some scientists and philosophers warn of the dangers of an uncontrollable superintelligent AI. Using theoretical calculations, an international team of researchers, including scientists from the Center for Humans and Machines at the Max Planck Institute for Human Development, shows that it would not be possible to control a superintelligent AI. The study was published in the Journal of Artificial Intelligence Research.

Suppose someone were to program an AI system with intelligence superior to that of humans, so it could learn independently. Connected to the Internet, the AI may have access to all the data of humanity. It could replace all existing programs and take control all machines online worldwide. Would this produce a utopia or a dystopia? Would the AI cure cancer, bring about world peace, and prevent a climate disaster? Or would it destroy humanity and take over the Earth?

Computer scientists and philosophers have asked themselves whether we would even be able to control a superintelligent AI at all, to ensure it would not pose a threat to humanity. An international team of computer scientists used theoretical calculations to show that it would be fundamentally impossible to control a super-intelligent AI.

"A super-intelligent machine that controls the world sounds like science fiction. But there are already machines that perform certain important tasks independently without programmers fully understanding how they learned it. The question therefore arises whether this could at some point become uncontrollable and dangerous for humanity", says study co-author Manuel Cebrian, Leader of the Digital Mobilization Group at the Center for Humans and Machines, Max Planck Institute for Human Development.

Scientists have explored two different ideas for how a superintelligent AI could be controlled. On one hand, the capabilities of superintelligent AI could be specifically limited, for example, by walling it off from the Internet and all other technical devices so it could have no contact with the outside world -- yet this would render the superintelligent AI significantly less powerful, less able to answer humanities quests. Lacking that option, the AI could be motivated from the outset to pursue only goals that are in the best interests of humanity, for example by programming ethical principles into it. However, the researchers also show that these and other contemporary and historical ideas for controlling super-intelligent AI have their limits.

In their study, the team conceived a theoretical containment algorithm that ensures a superintelligent AI cannot harm people under any circumstances, by simulating the behavior of the AI first and halting it if considered harmful. But careful analysis shows that in our current paradigm of computing, such algorithm cannot be built.

"If you break the problem down to basic rules from theoretical computer science, it turns out that an algorithm that would command an AI not to destroy the world could inadvertently halt its own operations. If this happened, you would not know whether the containment algorithm is still analyzing the threat, or whether it has stopped to contain the harmful AI. In effect, this makes the containment algorithm unusable", says Iyad Rahwan, Director of the Center for Humans and Machines.

Based on these calculations the containment problem is incomputable, i.e. no single algorithm can find a solution for determining whether an AI would produce harm to the world. Furthermore, the researchers demonstrate that we may not even know when superintelligent machines have arrived, because deciding whether a machine exhibits intelligence superior to humans is in the same realm as the containment problem.

When an accident occurs, the reactions of bystanders are important. Researchers have studied whether laypeople realise the severity of the situation when someone in their proximity begins to bleed, and whether they can estimate how much the person is bleeding. The results show a discrepancy related to the victim's gender: for a woman losing blood, both blood loss and life-threatening injuries were underestimated. The study has been published in the scientific journal PLoS One.

Researchers from Linköping University and Old Dominion University in the United States wanted to study the ability of laypeople to visually assess blood loss, and what influences them when judging the severity of an injury.

"Laypeople's knowledge of haemorrhage is very important because many deaths occur outside the hospital. Our study showed, among other things, that haemorrhage in women is perceived as less serious, which can have profound consequences", says Erik Prytz at Linköping University and the Centre for Teaching & Research in Disaster Medicine and Traumatology.

Previous research has shown that people have difficulty estimating how much an injured person is bleeding. Those with medical training often overestimate small volumes of blood, and underestimate larger volumes. Also, previous studies point to differences in how laypeople treat victims, depending on the victim's gender. For this reason, the researchers wanted to investigate the role of victim gender in the laypeople's ability to estimate blood loss - a factor that has never been studied.

The researchers had 125 study participants view 78 video clips of female or male actors who appear to be bleeding from the inside of the thigh. The participants got to see the simulated injuries from various angles, and the victims bled at different rates and with different volumes. Based on this, the participants were to assess whether the blood loss was not dangerous, dangerous or life-threatening. Bleeding is normally considered life-threatening when 1.5 litres of blood is lost.

The result supported previous research; laypeople also overestimated small volumes of blood and underestimated larger volumes of blood. However the study, unlike previous studies, also showed at which volumes the test participants made incorrect estimates. Blood losses of up to 2 decilitres were perceived as larger than they actually were, while volumes of more than 4 decilitres were underestimated. Blood volumes of 3 decilitres, however, were estimated correctly.

The study also showed that the participants underestimated blood loss among female victims more than for male victims, regardless of volume. And for female victims, the loss was classified as less life-threatening.

In Sweden, and especially in the United States, laypeople are trained to intervene in the event of an accident. In the United States, this training has become more common as a response to the many school shootings; more people must know how to stop a haemorrhage. What the researchers learn from the study, they will incorporate in the design of this training.

"If gender affects how a layperson perceives an injury, we must include this in the calculation when planning the training" says Erik Prytz.

Erik Prytz stresses that further study is required into how gender affects the response given to haemorrhaging victims.

During April 2020, while the UK was in full lockdown, there was a drop of more than a third in the number of people seeking help for mental illness or self-harm according to research involving 14 million people registered at general practices across the four nations of the UK which was published today in The Lancet Public Health*.

The research, 'Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort study', was conducted by the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC). The Centre is a partnership between The University of Manchester and Salford Royal NHS Foundation Trust. The research was jointly funded by the NIHR and UK Research and Innovation as part of their COVID-19 Rapid Response Initiative.

The research looked for the first time people sought help for their mental health and this could be at their general practice or at a hospital A&E department. Researchers discovered that during the first full month of the UK wide lockdown, in April 2020, the number of incidents of depression recorded in general practice records dropped by 43%, anxiety disorders by 47.8% and prescribing of antidepressants also dropped significantly, by 36.4%.

Dr Matthew Carr from The University of Manchester, and lead for this study at the GM PSTRC, said: "It is widely believed that there was an increase in the number of people with symptoms of mental illness in April due to the extra pressures from the lockdown. However, our research has revealed a sharp reduction in recorded illness diagnoses and self-harm episodes. By September 2020 our data shows that these frequencies had returned to near normal in England."

As well as identifying the general trend of people not seeking help during April 2020, the research also uncovered significant treatment gaps. This was greatest for people of working age and those registered at general practices in more deprived areas where the reduction in diagnoses coded was greatest.

Dr Carr, continued: "This research is so important because it shows the scale of the drop in the number of people seeking help, and, crucially, the treatment gaps"

Another important finding reveals the number of people presenting with self-harm was 37.6% lower than expected in April and the reduction was greatest for females and those aged under 45.

Dr Sarah Steeg, Presidential Fellow in mental health epidemiology at The University of Manchester jointly led the research, and said: "It is understandable that people didn't seek help at the height of the pandemic in the spring of 2020. However, GPs moved quickly to offer remote consultations for many appointments. The consequences of patients not receiving help when they need it could result in further struggles for those individuals, and therefore they must be encouraged to seek support if they are worried about their mental health

"This research has shown how addressing delays in diagnosis and treatment for mental illness and self-harm requires prioritisation, particularly for the groups of people we've identified as experiencing the biggest treatment gaps. As we manage ongoing fluctuations in COVID-19 rates, we hope our research findings can be used to inform public health messaging targeted at specific groups of patients which will help to improve patient safety in the near future."

Professor Carolyn Chew-Graham, a GP in Manchester and Professor of General Practice Research at Keele University, and part of the research team, said: "This research mirrors my clinical experience. Consultation rates reduced in April and May, with people following the 'Save the NHS' message. Since the early summer we have noticed increasing demand and, particularly, increasing distress in patients.

"The impact of this work for primary care is that we need to make it as easy as possible for people who are distressed to consult their GP, but balance this with the need to keep footfall as low as possible in the practice, in accordance with NHSE guidance and COVID-19 restrictions. Primary care clinicians need to ensure that when consulting patients remotely, they offer time, empathy and understanding and facilitate people to disclose their concerns, which both parties might find more difficult in telephone or video consultations. Managing risk and dealing with uncertainty are now even more important for primary care clinicians."

Nav Kapur, Professor of Psychiatry at The University of Manchester and lead for the Mental Health Research programme at the GM PSTRC, said: "For me this paper tells one of the big and perhaps forgotten stories of the pandemic - the fall in health care use for mental health problems during the early part of lockdown. This is particularly important because we know from other work that, on average, population mental health got worse after March compared to pre-pandemic levels.

"It's so important that we continue to carefully monitor the mental health effects of COVID-19 and I'm pleased that the NIHR Greater Manchester Patient Safety Translational Research Centre continues to make this kind of cross disciplinary collaboration possible."

Lucy Schonegevel, Deputy Campaigns & Policy Associate Director for Rethink Mental Illness said:

"GPs are often the first port of call for people struggling with their mental health, so it's concerning to see a significant drop in appointments during the first lockdown. There's a worrying disconnect here, as we saw demand for advice and information on our website double in the six months after lockdown was first introduced, in particular, there was an increase in the number of people seeking advice about self-harm.

"It's crucial that the NHS continues to promote the message that it is open for business, despite the pressures of COVID-19, and that this message reaches everyone in need of support. Mental health is just as important as physical health and people should be encouraged to contact their GP as soon as possible to discuss any concerns. The effects of the pandemic on people's mental health may be felt for years to come, so it's crucial that everyone can access the right treatment at the right time through their GP."

Professor Dame Til Wykes, Senior NIHR Mental Health Researcher, said: "As this research makes clear, now is not the time to suffer in silence. More than ever, people experiencing depression, anxiety and other mental health issues should seek the help they need from the health service, and family and friends.

"NIHR have recognised the challenges that mental health issues have posed during COVID-19 so have funded this project with UKRI as well as other research to investigate and reduce the impact of the COVID-19 pandemic on mental health."

To perform calculations, quantum computers need qubits to act as elementary building blocks that process and store information. Now, physicists have produced a new type of qubit that can be switched from a stable idle mode to a fast calculation mode. The concept would also allow a large number of qubits to be combined into a powerful quantum computer, as researchers from the University of Basel and TU Eindhoven have reported in the journal Nature Nanotechnology.

Compared with conventional bits, quantum bits (qubits) are much more fragile and can lose their information content very quickly. The challenge for quantum computing is therefore to keep the sensitive qubits stable over a prolonged period of time, while at the same time finding ways to perform rapid quantum operations. Now, physicists from the University of Basel and TU Eindhoven have developed a switchable qubit that should allow quantum computers to do both.

The new type of qubit has a stable but slow state that is suitable for storing quantum information. However, the researchers were also able to switch the qubit into a much faster but less stable manipulation mode by applying an electrical voltage. In this state, the qubits can be used to process information quickly.

Selective coupling of individual spins

In their experiment, the researchers created the qubits in the form of "hole spins". These are formed when an electron is deliberately removed from a semiconductor, and the resulting hole has a spin that can adopt two states, up and down - analogous to the values 0 and 1 in classical bits. In the new type of qubit, these spins can be selectively coupled - via a photon, for example - to other spins by tuning their resonant frequencies.

This capability is vital, since the construction of a powerful quantum computer requires the ability to selectively control and interconnect many individual qubits. Scalability is particularly necessary to reduce the error rate in quantum calculations.

Ultrafast spin manipulation

The researchers were also able to use the electrical switch to manipulate the spin qubits at record speed. "The spin can be coherently flipped from up to down in as little as a nanosecond," says project leader Professor Dominik Zumbühl from the Department of Physics at the University of Basel. "That would allow up to a billion switches per second. Spin qubit technology is therefore already approaching the clock speeds of today's conventional computers."

For their experiments, the researchers used a semiconductor nanowire made of silicon and germanium. Produced at TU Eindhoven, the wire has a tiny diameter of about 20 nanometers. As the qubit is therefore also extremely small, it should in principle be possible to incorporate millions or even billions of these qubits onto a chip.

Leading research at Newcastle University has been used to shape how dentistry can be carried out safely during the Covid-19 pandemic by mitigating the risks of dental aerosols.

It is well known that coronavirus can spread in airborne particles, moving around rooms to infect people, and this has been a major consideration when looking into patient and clinician safety.

Research, published in the Journal of Dentistry, has led the way in helping shape national clinical guidance for the profession to work effectively under extremely challenging circumstances.

The findings have been used by the Dental Schools' Council, Association of Dental Hospitals and the Scottish Dental Clinical Effectiveness Programme to guide key Covid-19 policies for the profession.

Research findings

Research revealed that aerosol generated procedures - such as fillings and root canal treatment - can spray aerosol and saliva particles from dental instruments large distances and contamination varied widely depending on the processes used.

In the open clinic settings, dental suction substantially decreased contamination at sites further away from the patient, such as bays five meters away. Often these distant sites had no contamination present or if contamination was detected it was at very low levels, diluted by 60,000 - 70,000 times.

It was also found that after 10 minutes, very little additional contaminated aerosol settled onto surfaces and therefore is a suitable time to clean a surgery after an aerosol-generating procedure.

Dr Richard Holliday, NIHR Clinical Lecturer in Restorative Dentistry at Newcastle University, UK, said: "Our research has improved our understanding of dental aerosol generated procedures and identified how cross-contamination could be a risk for spreading Covid-19.

"When the pandemic began, dental services were significantly reduced and there was an urgent need by the profession to focus on how dental clinics could work in a safe environment for patients and staff.

"We now have a much greater understanding of where the splatter of aerosols go and how far they travel during different procedures and settings, allowing clinical teams to make informed decisions to protect people.

"I am pleased that our research here at Newcastle has been used nationally by leading dental bodies to inform their policies on how the profession should carry out procedures during the pandemic."

Collaborative effort

A research team from the School of Dental Sciences, including clinicians, dental nurses, microbiologists and scientists carried out the study.

The team used the tracer dye, fluorescein, while carrying out aerosol-generating procedures on a dental mannequin to analyse how far and where aerosol particles and saliva travelled from the patient's mouth.

A range of procedures were done and the effect of suction and ventilation analysed. Experts looked at contamination close by and also in an open plan clinic.

Kimberley Pickering, a research dental nurse involved in the study, said: "For the safe re-opening of dental services, it was essential to understand the behaviour of the aerosols that come out of a patient's mouth during dental work.

"We now better understand where the aerosols go and how far they travel during different procedures and settings.

"We also understand how dental aerosols settle over time, which has helped inform cross-infection control procedures."

Further research will continue to focus on where aerosol and droplets from dental instruments travel and how far they go. Experts will also look at how long aerosols hang around in the air and examine a number of common dental procedures and methods of controlling aerosols.

A key part of the research will investigate if viruses can be carried in dental aerosols, and if viruses remain infective at a distance from the procedure. This will help experts to understand how to reduce the risk of microbes, like Covid-19, being spread by aerosols during dental treatment.

Student case study

The research led the team to develop a new clinic configuration to allow the safe return of dental students and their patients.

Newcastle University's School of Dental Sciences is one the first universities in the country to recommence teaching aerosol-generating procedures to students in person during the pandemic.

Fourth year student Paddy Crawshaw said: "Being a dental student during the pandemic has been a big challenge, but dental students feel lucky to come into University every day and get in-person teaching as it's a privilege to treat our patients.

"The Dental School has been very supportive since the pandemic began. It is clear that senior clinicians and academics have worked hard behind the scenes to allow us to return to clinical teaching.

"The common goal of delivering first-class treatment for our patients has enhanced the Dental School's sense of community and this has really helped me through this term.

"I am proud of the way Newcastle Dental School and all of its staff and students have come together in the face of adversity through the Covid-19 pandemic. To know we are one of the first schools in the country offering a full range of student-led treatments for our patients makes me feel lucky to be studying here.

"Due to the extensive research undertaken by the School I have never felt unsafe, whether extracting a tooth or doing a simple examination I know the School's protocols are allowing me to work safely."

Heidelberg/Germany, 11 January 2021 - Development of an in vitro human-derived tissue model for studying virus infection and disease progression in the alveolar cells of the lungs responsible for oxygen and carbon dioxide exchange with the blood might enable the study of possible therapies for acute respiratory distress syndrome (ARDS) triggered by SARS-CoV-2. Researchers in the Netherlands have demonstrated that the SARS-CoV-2 replicates efficiently in their model resembling the human bronchioalveolar system that is thought to play a critical role in progression of infection towards pneumonia and ARDS.

It is already established that in people infected with COVID-19 or some other respiratory viruses, alveolar injury can trigger a cascade of events that leads to ARDS, restricting transport of oxygen into the blood to dangerously low levels. There is also mounting evidence that the epithelium lining the alveoli plays a major role in progression of COVID-19. However, in vitro models for replicating disease progression in the alveoli of human lungs have proven difficult to establish, especially models that are also permissive to SARS-CoV-2 infection. This has greatly limited our understanding of COVID-19.

The Dutch team has now remedied this deficiency through application of self-renewing organoid models containing stem cells capable of differentiating into relevant cell types for study of disease processes. Organoids are tiny 3D tissues typically around 2 mm in diameter across derived from stem cells to mirror the complex structures of an organ, or at least to express selected aspects of it to meet a given biomedical research objective. Such organoids can then provide continuous sources of 2D tissues that mimic more accurately the geometry or cellular alignment of the structures under study.

A self-renewing organoid model for the epithelium of the airways conducting the gases, has already been developed by the same team, but the alveolar epithelium has proven a greater challenge to generate so far. The Dutch team has overcome this challenge and developed a 2D "air interface" system comprising a basal layer of stem cells in contact with the culture media and a top layer exposed to the air just as it would be in the lungs.

Multiple cultures were generated and infected successfully by SARS-CoV-2 targeting primarily alveolar type-II-like cells, known as ATII-L, confirmed by Transmission Electron Microscopy (TEM), surface marker stainings and single-cell sequencing. The study then shed light on the sequence of events following infection.

The study also identified through messenger RNA expression analysis a cellular immune response to the virus by infected cells. When the cultures were treated with the antiviral signaling molecule interferon lambda early in infection, SARS-CoV-2 replication was almost completely blocked, indicating that - when timed right - interferon lambda could be an effective treatment. These results also indicate that these cultures could be helpful for the development of a therapeutic intervention against acute respiratory distress syndrome (ARDS) from COVID-19.

Two billion years after the Big Bang, the Universe was still very young. However, thousands of huge galaxies, rich in stars and dust, were already formed. An international study, led by SISSA - Scuola Internazionale Superiore di Studi Avanzati, now explains how this was possible. Scientists combined observational and theoretical methods to identify the physical processes behind their evolution and, for the first time, found evidence for a rapid growth of dust due to a high concentration of metals in the distant Universe. The study, published in Astronomy&Astrophysics, offers a new approach to investigate the evolutionary phase of massive objects.

Since their initial discovery 20 years ago, very distant and massive galaxies that form prodigious amount of young stars - so-called dusty (star-forming) galaxies - represent a serious challenge for astronomers: "On one hand, they are difficult to detect because they reside in dense regions of the distant Universe and contain dusty particles which absorb most of the optical light radiated by young stars", explains Darko Donevski, postdoctoral fellow at SISSA. "On the other hand, many of these dusty 'giants' have been formed when the Universe was very young, sometimes even less than 1 billion years-old, and scientists have been wondering how could such large amount of dust have been produced so early in time".

The study of these exotic objects is now possible thanks to the Atacama Large Millimeter/submillimeter Array (ALMA). This interferometer of 66 telescopes in the Atacama Desert of northern Chile is able to detect the infrared light which penetrates the dusty clouds, revealing the presence of newly forming stars. However, the origin of large amount of dust at early cosmic time is still an open question to astronomers. "Throughout many years scientists thought that production of cosmic dust was exclusively due to supernovae explosion. However, recent theoretical works suggest that dust can also grow through collisions of particles of cold, metal-rich gas which fills the galaxies," explains the researcher.

An international team of researchers from institutions based in Europe, US, Canada and South Africa, led by Donevski, combined observational and theoretical methods to study 300 distant, dusty galaxies in order to unveil the origin of these "Giants". In particular, they inferred the physical properties of these dusty galaxies by fitting their spectral energy distributions. "We found a huge amount of dust mass in most of our galaxies. Our estimates showed that supernovae explosions could not be responsible for all of it and a part had to be produced through particle collisions in the gaseous metal-rich environment around massive stars, as previously supposed by theoretical models" says Donevski. "This is the first time that observational data support the existence of both production mechanisms."

Scientists also looked at dust to star mass ratio over time to study how efficiently galaxies create and destroy dust during their evolution. "This allowed us to identify dust life cycle in two different populations of galaxies: normal, so-called 'main-sequence', galaxies, which are slowly evolving, and more extreme, rapidly evolving galaxies, called 'starbursts'", said Lara Pantoni, PhD student at SISSA, who developed the analytic model used for data interpretation. The model shows the great potential in describing differences in these two groups of observed galaxies. "Interestingly, we also showed that irrespective of their distance, stellar mass or size, compact 'starburst' galaxies always have dust-to-stellar mass ratio higher than the normal galaxies."

To fully evaluate the observational findings, the team of astronomers also confronted their data with the state-of-the-art galaxy simulations. They used SIMBA, a new suite that simulates the formation and evolution of millions of galaxies since the beginning of the Universe to present time, tracking all their physical properties, including dust mass. "Up to now, theoretical models had problems in matching both galaxy dust and stellar properties simultaneously. However, our new cosmological simulation suite, SIMBA, could reproduce most of the observed data," explains Desika Narayanan, professor of astronomy at the University of Florida and member of the DAWN institute in Copenhagen.

"Our study shows that dust production in 'giants' is dominated by very rapid growth of particles through their collisions with gas. Thus, it provides the first strong proof that dust formation occurs both during stars death and in the space between these massive stars, as assumed from theoretical studies," concludes Donevski. "Moreover, it offers a new mixed approach to investigate the evolution of massive objects in the distant Universe that will be tested with future space telescopes such as the James Webb Space Telescope."

Patients with severe COVID-19 disease have significantly shorter telomeres, according to a study conducted by researchers at the Spanish National Cancer Research Centre (CNIO) in collaboration with the COVID-IFEMA Field Hospital, published in the journal Aging. The study, led by Maria A. Blasco and whose first authors are Raúl Sánchez and Ana Guío-Carrión, postulates that telomere shortening as a consequence of the viral infection impedes tissue regeneration and that this is why a significant number of patients suffer prolonged sequelae.

Blasco was already developing a therapy to regenerate lung tissue in pulmonary fibrosis patients; she now believes that this treatment -which should still take at least a year and a half to become available- could also help those who have lung lesions remaining after overcoming COVID-19.

Telomeres and tissue regeneration

The Telomeres and Telomerase Group, led by Blasco at the CNIO, has been researching the role of telomeres in tissue regeneration for decades. Telomeres are structures that protect the chromosomes within each cell of the organism. It is known that telomere length is an indicator of ageing: each time a cell divides, its telomeres shorten until they can no longer perform their protective function and the cell, which now becomes damaged, stops dividing. Throughout life, cells are constantly dividing to regenerate tissues, and when they stop doing so because the telomeres are too short, the body ages.

In recent years, researchers have shown in mice that it is possible to reverse this process by activating the production of telomerase, which is the enzyme in charge of making the telomeres longer. In animals, telomerase activation is effective in treating diseases associated with ageing and telomere damage, such as pulmonary fibrosis.

COVID-19 as a regenerative disease

In pulmonary fibrosis the lung tissue develops scars and becomes rigid, causing a progressive loss of breathing capacity. The CNIO group has shown in previous studies that one of the causes of the disease is damage to the telomeres of the cells involved in regenerating the lung tissue, the alveolar type II pneumocytes. And these are precisely the cells that the SARS-CoV-2 coronavirus infects in lung tissue.

"When I read that type II alveolar pneumocytes were involved in COVID-19, I immediately thought that telomeres might be involved," says Blasco.

In the Aging paper, the researchers write: "It caught our attention that a common outcome of SARS-CoV-2 infection seems to be the induction of a fibrosis-like phenotype in lung and kidney, suggesting that the viral infection may be exhausting the regenerative potential of tissues."

The authors propose that it is the short telomeres that hamper tissue regeneration after infection. As Blasco explains, "we know that the virus infects alveolar type II pneumocytes and that these cells are involved in lung regeneration; we also know that if they have telomeric damage they cannot regenerate, which induces fibrosis. This is what is seen in patients with lung lesions after COVID-19: we think they develop pulmonary fibrosis because they have shorter telomeres, which limits the regenerative capacity of their lungs."

Samples of patients in a field hospital

The data presented in the 'Aging' paper provide evidence in favour of this hypothesis, by finding an association between greater severity of COVID-19 and shorter telomeres.

Despite the difficulties arising from conducting research at the height of the pandemic -"the hospital facilities for COVID-19 patients were overwhelmed," Blasco says- it was possible to analyse the telomeres of 89 patients admitted to the field hospital at the IFEMA in Madrid using several techniques.

As in the general population, the average length of the telomeres decreased as age increased in the patients studied. Furthermore, as the most severe patients are also the oldest patients, there is also a correlation between greater severity and shorter telomere length.

What could not be foreseen, and this is the most important finding, is that the telomeres of the most seriously ill patients were also shorter, irrespective of age.

The researchers write: "Interestingly, we also found that those patients who have more severe COVID-19 pathologies have shorter telomeres at different ages compared to patients with milder disease."

And they add: "These findings demonstrate that molecular hallmarks of ageing, such as the presence of short telomeres, can influence the severity of COVID-19 pathologies."

Gene therapy for patients with post-COVID-19 pulmonary injury

The intention of the researchers is now to demonstrate a causal relationship between reduced telomere length and pulmonary sequelae of COVID-19. To do this, they will infect mice that have short telomeres and are not able to produce telomerase with SARS-CoV-2; without telomerase, the telomeres cannot be repaired and as a consequence lung tissue regeneration cannot take place. If the hypothesis of Blasco's group is correct, mice with short telomeres and without telomerase should develop more severe pulmonary fibrosis than normal mice.

Confirmation that short telomeres hamper the recovery of severe patients would open the door to new treatment strategies, such as therapies based on telomerase activation.

"Given that short telomeres can be made longer again by telomerase, and given that in previous studies we have shown that telomerase activation has a therapeutic effect on diseases related to short telomeres, such as pulmonary fibrosis, it is tempting to speculate that this therapy could improve some of the pathologies that remain in COVID-19 patients once the viral infection has been overcome, such as pulmonary fibrosis."

Last year the CNIO and the Autonomous University of Barcelona, UAB, created a new spin-off company, Telomere Therapeutics, with the specific aim of developing a telomerase-based gene therapy for the treatment of different pathologies related to telomere shortening, such as pulmonary fibrosis and renal fibrosis. This would be a potentially useful type of therapy in patients with remaining lung damage after COVID-19.

EAST LANSING, Mich. - Michigan State University is leading a global research effort to offer the first worldwide view of how climate change could affect water availability and drought severity in the decades to come.

By the late 21st century, global land area and population facing extreme droughts could more than double -- increasing from 3% during 1976-2005 to 7%-8%, according to Yadu Pokhrel, associate professor of civil and environmental engineering in MSU's College of Engineering, and lead author of the research published in Nature Climate Change.

"More and more people will suffer from extreme droughts if a medium-to-high level of global warming continues and water management is maintained at its present state," Pokhrel said. "Areas of the Southern Hemisphere, where water scarcity is already a problem, will be disproportionately affected. We predict this increase in water scarcity will affect food security and escalate human migration and conflict."

The research team, including MSU postdoctoral researcher Farshid Felfelani, and more than 20 contributing authors from Europe, China and Japan are projecting a large reduction in natural land water storage in two-thirds of the world, also caused by climate change.

Land water storage, technically known as terrestrial water storage, or TWS, is the accumulation of water in snow and ice, rivers, lakes and reservoirs, wetlands, soil and groundwater -- all critical components of the world's water and energy supply. TWS modulates the flow of water within the hydrological cycle and determines water availability as well as drought.

"Our findings are a concern," Pokhrel said. "To date, no study has examined how climate change would impact land water storage globally. Our study presents the first, comprehensive picture of how global warming and socioeconomic changes will affect land water storage and what that will mean for droughts until the end of the century."

Felfelani said the study has given the international team an important prediction opportunity.

"Recent advances in process-based hydrological modeling, combined with future projections from global climate models under wide-ranging scenarios of socioeconomic change, provided a unique foundation for comprehensive analysis of future water availability and droughts," Felfelani said. "We have high confidence in our results because we use dozens of models and they agree on the projected changes."

The research is based on a set of 27 global climate-hydrological model simulations spanning 125 years and was conducted under a global modeling project called the Inter-Sectoral Impact Model Intercomparison Project. Pokhrel is a working member of the project.

"Our findings highlight why we need climate change mitigation to avoid the adverse impacts on global water supplies and increased droughts we know about now," Pokhrel said. "We need to commit to improved water resource management and adaptation to avoid potentially catastrophic socio-economic consequences of water shortages around the world."

Researchers at Columbia University Mailman School of Public Health developed an infectious disease early warning system that includes areas lacking health clinics participating in infectious disease surveillance. The approach compensates for existing gaps by optimally assigning surveillance sites that support better observation and prediction of the spread of an outbreak, including to areas remaining without surveillance. Details are published in the journal Nature Communications.

The research team, including Jeffrey Shaman and Sen Pei, have been at the forefront of forecasting and analyzing the spread of COVID-19. Their highly cited paper in the journal Science Advances estimated the number of lives saved had physical distancing and other measures taken effect one week earlier. They have also led the development of methods to forecast other infectious diseases, including seasonal influenza.

The new early warning system optimizes the selection of surveillance sites then applies a computer model to data from these sites in order to forecast the geographic spread of influenza, including to rural areas lacking surveillance. The researchers say their method would be effective for other respiratory outbreaks, including human metapneumovirus and seasonal coronavirus, which have similar transmission routes. It can also be modified to work with other diseases.

"Our goal was to design a way to provide a cost-effective early warning system so public health officials can quickly respond to outbreaks and prevent further spread," says first author Sen Pei, PhD, associate research scientist in the Department of Environmental Health Sciences at the Columbia Mailman School. "Our method can be used to support development of a more robust surveillance system and to identify where to set up or improve surveillance."

"Too often infectious outbreaks spread undetected due to gaps in surveillance at the community level. These gaps have contributed to tragic and unnecessary illness and loss of life, as we have seen over the past year," says senior author Jeffrey Shaman, PhD, a professor in the Department of Environmental Health Sciences at the Columbia Mailman School. "Our method can help fill these gaps to prevent these unwanted outcomes, and provide guidance on where to invest in greater surveillance."

The researchers validated their approach using historical data, demonstrating its ability to forecast the spread of past outbreaks at the state and county levels. At state level, they used real-world data in 35 states from the U.S. Armed Forces Health Surveillance Branch (AFHSB), for influenza during nine seasons (2008-2009 to 2016-2017), and human metapneumovirus and seasonal coronavirus during four seasons (2013-2014 to 2016-2017). At the county level, they validated their method using a model-generated (virtual) outbreak since there are no historical data available in the majority of counties. The method they developed can generate more accurate near-term forecasts than alternative methods tested by the researchers, such as those that prioritize locations with large populations or use a random selection.

According to U.S. Centers for Disease Control and Prevention, the U.S. Influenza Surveillance System collects data from participating outpatient healthcare clinics in all U.S. states, Puerto Rico, the District of Columbia, and the U.S. Virgin Islands--but not in every U.S. county. Participation of healthcare providers is voluntary, and may change over time. Each week, approximately 3,000 providers report data to CDC on the total number of patients seen for any reason and the number of those patients with influenza-like illness.

New research from Swansea University suggests that a simple nurse- or carer-led medicines' monitoring system can help reduce medication-related illness for people living in residential care homes - and the process takes just a few minutes per patient.

The research paper published in the PLOS ONE journal looked how the monitoring system, known as the Adverse Drug Reaction Profile (ADRe-p), can help nurses or carers identify medicines' mismanagement or adverse drug reactions in patients prescribed multiple medicines, and can help avoid medication-related harm and improve prescribing.

Professor Sue Jordan, who led the study said: "The problem presented by the scale and complexity of inadvertent harm from both use and misuse of medicines is very real, which is reflected in the World Health Organisation's (WHO) Third Global Patient Safety Challenge aiming to reduce avoidable medication-related harm by 50% by next year.

"Our study took place in three independent private sector registered care homes. All the homes were very good, and we witnessed excellent nursing care. Nevertheless, ADRe helped to improve medicines management. Nurses or carers using the ADRe monitoring system identified possible medication-related harms and, following a review by doctors or pharmacists, new medication regimens were introduced.

The outcomes for the 19 patients involved meant that:

6 residents were no longer in pain

3 no longer experienced convulsions

3 no longer experienced aggression

2 had swallowing difficulties treated

4 no longer reported insomnia

1 had breathing difficulties treated

2 had their laxative prescriptions adjusted to reduce diarrhoea

falls ceased for 2 residents (of 4 noted as falling and of 5 able to stand).

The research team also found that few new problems arose, there was no clinical deterioration, and no harms were associated with the intervention.

Professor Jordan said: "What was really important about this study was that it showed that just 10 minutes of nurses' or carers' time, along with 10 minutes for a pharmacist review, made a huge difference to patient wellbeing. The use of ADRe not only improved residents' health, but also changed prescription regimens to ensure the maximum clinical benefits for patients, which ultimately helps to optimize healthcare resources."

Fast facts:

This study describes essential differences between marine and freshwater species and the contributions of viruses to such differences

The results may help guide future bioengineering efforts to develop plant strains adapted to grow in salt-water, which is of local and regional food security interest

Microalgae are fundamental to global ecosystems due to their ability to sustain coral reef species and produce atmospheric oxygen

Before this study, many important algal phyla did not have sequenced representatives

Viruses have contributed to the evolution of algae and their genome makeups

Abu Dhabi, UAE, January 11, 2021: NYU Abu Dhabi (NYUAD) Associate Professor of Biology Kourosh Salehi-Ashtiani and NYUAD Senior Research Scientist David Nelson report in a new study that they have successfully cultured and sequenced 107 microalgae species from 11 different phyla indigenous to varied locations and climates to gain insights on genomic differences in saltwater and freshwater microalgae. The researchers have also discovered that these algae genomes show widespread viral-origin gene content.

In the paper titled Large-scale genome sequencing reveals the driving forces of viruses in microalgal evolution , published in the journal Cell Host & Microbe, the researchers present the whole-genome sequencing of 107 different species of microalgae from a broad range of evolutionary groups. In addition to these newly-sequenced algal genomes, microalgal genomes from the National Center for Biotechnology Information (NCBI) were included to investigate genomic differences between microalgae from a more extensive variety of habitats, specifically salt-water (marine) and fresh-water. The comparison of genomes led to the conclusion that freshwater and marine species had fundamental differences in their nuclear and cellular membranes. Additionally, marine species contained significantly more viral-origin genes in their genomes.

The paper describes differences in marine and freshwater algae to better understand how organisms deal with salt-water. These results may help guide future bioengineering efforts to develop plant strains adapted to grow in salt-water, which is of local and regional food security interest. The discovery of viral families in marine algae species shows that many genes were shared between viruses and algae in the past, likely due to viral infections, and retained by the algae to help them deal with habitat-specific challenges. These findings provide new perspectives on the positive contributions that viruses can make to the evolution of organisms they infect.

"The discovery that genes containing mainly membrane and viral proteins were shared among marine microalgae from different lineages indicates their importance for the maintenance of membrane integrity in a saline environment," said Salehi-Ashtiani. "This brand-new genomic information can guide the development of bio-saline agriculture in regions where the water has a high salinity."

"Recent studies have shown that viruses frequently acquire host genes. Here, we show that the reverse has occurred repeatedly throughout algal evolution. Viruses appear to be a major driving force in microalgal evolution through widespread gene donation to diverse lineages," said Nelson.

Salehi-Ashtiani and Nelson point out that the discoveries from the genomic sequencing of microalgae species have shown that environmental sources of viruses should be more seriously considered and evaluated to anticipate future potential public health crises.