Culture

Armed conflict activities increased in five countries during the first wave of the coronavirus (COVID-19) pandemic says new research from the University of Melbourne.

India, Iraq, Libya, Pakistan and the Philippines all saw an escalation of civil wars because conflict parties exploited either state weakness or a lack of international attention due to the pandemic.

"I looked at the countries that had the most palpable records of conflict," said researcher Dr Tobias Ide, a Discovery Early Career Researcher Fellow from the School of Geography.

"What I found was that rebel groups try to exploit situations in which governments are busy with containing the pandemic and its economic fallout. Increased activities of the Islamic State in Iran are just one example. At the same time, there is little international protest or support as each country is focused on its own struggle with the virus."

Armed conflict intensity in four countries (Afghanistan, Colombia, Thailand and Yemen) decreased between March and June, according to the study as a result of both state and rebel forces failing to get traction under the pandemic.

"However, there are few reasons to be enthusiastic about this development," said Dr Ide. "The Taliban in Afghanistan and the ELN rebels in Colombia, for instance, reduced their attacks during the first months of the pandemic. But they also used the COVID-19 crisis to recruit new fighters among impoverished groups, and to gain public support from their own pandemic response."

Dr Ide's paper, Covid-19 and armed conflict, is published today in the World Development journal, focusing on nine countries that experienced significant levels of armed conflict when the pandemic began to unfold in March 2020.

With the pandemic currently raging in the northern hemisphere and several key states in the Asia-Pacific (e.g. India and Indonesia) and international attention preoccupied with the pandemic that has so far infected some 71,581,532 according to the World Health Organisation, the findings provide important insights.

"Escalating armed conflicts pose significant obstacles when dealing with the pandemic as health infrastructure is destroyed and the government losses resources to respond to the virus," said Dr Ide.

More than half of the matter in our universe has so far remained hidden from us. However, astrophysicists had a hunch where it might be: In so-called filaments, unfathomably large thread-like structures of hot gas that surround and connect galaxies and galaxy clusters. A team led by the University of Bonn (Germany) has now for the first time observed a gas filament with a length of 50 million light years. Its structure is strikingly similar to the predictions of computer simulations. The observation therefore also confirms our ideas about the origin and evolution of our universe. The results are published in the journal Astronomy & Astrophysics.

We owe our existence to a tiny aberration. Pretty much exactly 13.8 billion years ago, the Big Bang occurred. It is the beginning of space and time, but also of all matter that makes up our universe today. Although it was initially concentrated at one point, it expanded at breakneck speed - a gigantic gas cloud in which matter was almost uniformly distributed.

Almost, but not completely: In some parts the cloud was a bit denser than in others. And for this reason alone there are planets, stars and galaxies today. This is because the denser areas exerted slightly higher gravitational forces, which drew the gas from their surroundings towards them. More and more matter therefore concentrated at these regions over time. The space between them, however, became emptier and emptier. Over the course of a good 13 billion years, a kind of sponge structure developed: large "holes" without any matter, with areas in between where thousands of galaxies are gathered in a small space, so-called galaxy clusters.

Fine web of gas threads

If it really happened that way, the galaxies and clusters should still be connected by remnants of this gas, like the gossamer-thin threads of a spider web. "According to calculations, more than half of all baryonic matter in our universe is contained in these filaments - this is the form of matter of which stars and planets are composed, as are we ourselves," explains Prof. Dr. Thomas Reiprich from the Argelander Institute for Astronomy at the University of Bonn. Yet it has so far escaped our gaze: Due to the enormous expansion of the filaments, the matter in them is extremely diluted: It contains just ten particles per cubic meter, which is much less than the best vacuum we can create on Earth.

However, with a new measuring instrument, the eROSITA space telescope, Reiprich and his colleagues were now able to make the gas fully visible for the first time. "eROSITA has very sensitive detectors for the type of X-ray radiation that emanates from the gas in filaments," explains Reiprich. "It also has a large field of view - like a wide-angle lens, it captures a relatively large part of the sky in a single measurement, and at a very high resolution." This allows detailed images of such huge objects as filaments to be taken in a comparatively short time.

Confirmation of the standard model

In their study, the researchers examined a celestial object called Abell 3391/95. This is a system of three galaxy clusters, which is about 700 million light years away from us. The eROSITA images show not only the clusters and numerous individual galaxies, but also the gas filaments connecting these structures. The entire filament is 50 million light years long. But it may be even more enormous: The scientists assume that the images only show a section.

"We compared our observations with the results of a simulation that reconstructs the evolution of the universe," explains Reiprich. "The eROSITA images are strikingly similar to computer-generated graphics. This suggests that the widely accepted standard model for the evolution of the universe is correct." Most importantly, the data show that the missing matter is probably actually hidden in the filaments.

Alzheimer's disease is characterized by the presence of amyloid plaques* in the patient's brain. These plaques sequester copper, and contain approximately five times as much as a healthy brain. Two CNRS scientists from the Coordination Chemistry Laboratory recently developed, with their colleagues from the Guangdong University of Technology and Shenzhen University (China), a molecule that regulates the circulation of copper in the brain. This patented molecule** extracts the copper trapped in amyloid plaques, and reintroduces it in the brain's normal enzymatic circuit (which needs copper to function). Administered orally to "Alzheimer" mice,*** this molecule inhibits memory loss among sick mice. These results, which were published in ACS Chemical Neuroscience, open a new therapeutic avenue that could prove effective in early stages of Alzheimer's disease among humans. The scientists are now seeking a pharmaceutical partner to develop preclinical trials for this drug candidate.

Implicit racial bias refers to the automatic non-conscious behaviours, even if one's explicit attitude is not biased at all. Several studies have shown these prejudices are reduced in white people after being in the body of a black person in virtual reality. Now, a study carried out by researchers of the University of Barcelona shows that when the virtual scenario is affectively negative, implicit bias increases, and even the illusion of owning a virtual body is lessened. Researchers argue that negative affect prevents the formation of new positive associations with black, and distress leads to disownership of the virtual body. These results, published in the journal Royal Society Open Science, challenge the vision of virtual reality as an empathy machine and may have implications in the way virtual reality should be used to reduce implicit biases.

The study was led by Mel Slater, researcher at the Institute of Neuroscience of the UB (UBNeuro) and co-director of the Event Lab research group. The first author of the study was postdoc researcher Domna Banakou with Alejandro Beacco, Solène Neyret, Marta Blasco-Oliver, and Sofia Seinfeld (IDIBAPS).

Reacting against a hostile environment

Virtual reality can be used to change the type of body you have, called avatar. This effect is achieved wearing the VR head-mounted display, and thanks to the synchronous real-virtual body movement. A lot of previous research has shown that you would typically have the illusion that the virtual body was ours, even though we know for sure that it is not. This is called a 'body ownership illusion' and it is surprisingly the same whether you have a white virtual body or a black one.

An interesting result that has been replicated several times is that if a white person has a virtual body that is black, after only a few minutes of this experience, the implicit racial bias of white participants against black people decreases. It has even been shown that this lasts for at least a week after the virtual reality experience. In this new study, researchers changed the environment of this classic experiment and have found interesting exceptions to these previous findings. "In the previous studies nothing special was happening during the virtual reality exposure - it was taken as emotionally neutral or positive by participants. Here we changed adding a negative environment", said Slater.

In the new experiment, 92 white female participants stood in a virtual street embodied either in a white or black body, with crowds of virtual people walking by. In one condition the crowd was hostile towards them (for example, some passers-by acted negatively towards the participant sus as standing looking at them while frowning, and then turning away). In another the crowd was neutral, (passers-by did not act in any particular way), and in a third condition the crowd was positive towards participants (nodding towards them with a pleasant facial expression).

This led to negative, neutral or positive feelings by the participants. For those who experienced the neutral or positive crowd the same results as previously found were replicated - participants had the same level of body ownership whether in the white or black body, and the implicit racial bias of those in the black body decreased. However, they found that if the crowd behaved negatively then those in a white body actually had a lower degree of body ownership than those in the neutral or positive surrounding social situation. "It is as if the person was feeling that this situation could not happen to her/him, so this can't be her/him", notes Slater. Additionally, in a negative social situation, those with the Black body showed an increase in their implicit bias rather than a decrease as in earlier studies. The researcher highlights that this may be because "their negative feelings do not allow the formation of new learnings, new associations between black and positive attributes".

A counter-productive approach

These results suggest caution regarding considering virtual reality as an empathy machine -that is, you can put people in the situation of disadvantaged groups or minorities who are discriminated against- and this will somehow automatically increase their empathy towards those groups. "The problem is that the typical empathy machine approach is to put people in the body of a racial outgroup, and in that body subject them to various indignities, in the expectation that this might increase their empathy towards members of that group. What we have shown is that this approach can be counter-productive. If they feel bad during the experience, then this could make things worse," adds Slater.

Despite these results, the research study has shown that immersive virtual reality is useful against implicit racial bias. "Our findings show that reducing implicit racial bias through embodiment does work when the surrounding situation is either a neutral one, or one that induces positive feelings. This result has been replicated many times, including in this new paper. So, being embodied in the body of an 'out-group' but in a positive social situation is a way to reduce bias. Also, to have positive social contact in VR with virtual humans representative of the out-group has been shown to enhance positive relations," said Slater.

COLUMBUS, Ohio - People may cheer the demise of evil villains in fiction, but the deaths we most remember are the meaningful and sad endings of the characters we loved, research suggests.

In a new study, researchers found that when people were asked to recall the death of a fictional character, they were more likely to mention deaths perceived as "meaningful" than those seen as "pleasurable."

"We remember the deaths that made us cry and think more than those that made us cheer," said Matthew Grizzard, co-author of the study and assistant professor of communication at The Ohio State University.

"It seems that when we recall death, even in the relatively consequence-free spaces of media entertainment, we experience it as a meaningful, reflective experience."

Grizzard conducted the research with Kaitlin Fitzgerald, a doctoral student at the University at Buffalo, and C. Joseph Francemone, a doctoral student at Ohio State, both in communication.

The study was published recently in Omega--Journal of Death and Dying.

The study involved 506 people who participated online. They were placed in three groups. One was asked to think of a death scene from a narrative they found particularly meaningful. Another group was asked to think of a death they found pleasurable. The third group was simply asked to think of a death scene from a narrative.

Most people in all groups chose death scenes from visual media, the most common being movies and TV shows. But some chose scenes from video games or comic books.

Participants were asked a variety of questions about their emotional responses to the death scenes, their appreciation and enjoyment of the scenes, and perceptions about the characters who died.

As the researchers expected, people who were asked to recall a character death they found particularly pleasurable tended to choose villains, like Joffrey from "Game of Thrones."

Those who were asked to recall meaningful deaths tended to go with sympathetic characters, but not necessarily ones who were always heroes. Snape in the "Harry Potter" movies and Walter White in "Breaking Bad" both were mentioned often.

"When asked to think of meaningful deaths, many people chose characters who went through some sort of redemption. For example, Roy Batty, who was the antagonist in most of "Blade Runner," but in the end has this redeeming action," Grizzard said. "Darth Vader from "Star Wars" even came up a few times."

Results showed that action, horror and thriller movies were less likely to be associated with meaningful character deaths and more likely to be linked to pleasurable character deaths.

Dramas and tear-jerkers were more likely to be associated with meaningful character deaths.

Some movie genres - comedy, documentary, romance and science fiction - weren't linked to one type of character death over another.

But what was notable in the study, Grizzard said, was that those who were just asked to recall any character death most often gave answers like those who were asked to name "meaningful" deaths, rather than those who recalled "pleasurable" deaths.

Grizzard noted that the deaths people were most likely to recall were closely associated with "appreciation" in the study rather than "enjoyment."

"People recalled deaths that were meaningful, moving and thought-provoking. It provides more confirmation that people don't consume fiction just for enjoyment," Grizzard said.

The deaths of characters that people like may be a way to process grief, or to understand it.

"Film and art in general can expose us to these experiences that we may not want to go through, but we know that we will someday. It can help us learn what that experience will be like," he said.

The world is changing in dramatic ways, especially in the High Arctic. Climate change has meant that spring arrives earlier, but winters have become far more treacherous for Arctic animals that overwinter there, with more rain and ice.

So what about birds that don't overwinter in the Arctic, but nest and raise young there? Researchers have spent nearly three decades collecting data on a group of barnacle geese that migrate to the Norwegian archipelago of Svalbard to see how the geese respond to environmental changes overall.

In one study they found that earlier springs linked with climate change meant better conditions for the geese, but that these benefits were cancelled out by an increase in numbers of hungry foxes -- a precarious balance that could change depending on future conditions.

Now, researchers have looked at the actual physical condition of the geese as their numbers have skyrocketed at their overwintering grounds in the UK.  There are more than 40,000 birds now compared to just 300 individuals in the 1940s, when the birds were still hunted in both UK and elsewhere.

More birds, however, means more competition for food in their summer nesting areas on Svalbard.

There's so much competition, in fact, that the average body weight of the birds has dropped by 10 per cent in the last three decades. In wild animals, reduced body weight often means reduced condition and a low ability to reproduce or survive. The question the researchers have tried to answer in a new publication is, does this really matter?

The answer, it seems, is no.  Not yet.

Kate Layton-Matthews completed her PhD dissertation at the Norwegian University of Science and Technology's (NTNU) Centre for Biodiversity Dynamics on the geese earlier this year.

She worked with a team of researchers from NTNU, the University of Groningen in the Netherlands, the University of Sheffield in the UK and the Norwegian Polar Institute in Tromsø on modelling a long-term population study on the barnacle goose.

Barnacle geese breeding on Svalbard make a 3000 km long trip every spring to their Arctic breeding grounds from their overwintering areas in Scotland. That in itself requires a great deal of energy, but the birds also still need to be in good enough condition when they arrive in the Arctic to lay eggs and raise their young.

As the team of researchers looked at their decades of data, they detected the 10 per cent drop in  the birds' body weight.

So Layton-Matthews used a complex statistical model that could digest information on body condition, reproduction and survival of the geese since 1990. The model allowed her to see if the net effect of lower body weights was actually affecting the ability of the birds to survive and reproduce, and ultimately if this has caused changes in goose population numbers.

"We have this kind of underlying expectation that body condition is so important for herbivores, and especially in the Arctic that your body condition can limit reproduction and probability of survival. So body weight, or body condition, could limit if they manage to have offspring or not, and also whether, especially young geese, survive their first migration," she said.

Surprisingly, however, although changes in body condition do influence reproduction and survival of young geese somewhat, this did not translate into noticeable effects on population numbers.

"We were expecting that something so important at the individual level would have big impact on the population, but it doesn't," she said.

The researchers say this is because it's overridden by other important environmental effects that don't affect the geese through body condition, such as the positive impact of earlier springs on gosling production, and the negative effect of Arctic foxes on goslings' survival.

However, because there is obviously a limit to how skinny the geese can be and still perform well if their summer habitat continues to degrade, it's likely to restrict population growth at some point.

The good news, Layton-Matthews said, is that this still shows the geese populations are more resilient to changes in habitat quality and body condition than researchers previously thought.

The increase in goose numbers in their wintering areas has led to some places, such as Ireland, to allow the birds to be hunted again. It's also been debated whether barnacle geese hunting should be allowed on Svalbard.

But Layton-Matthews says history has shown that there's a potential risk if the overwintering birds are hunted too heavily.

"If we start hunting a population that is really sensitive to hunting and quite sensitive to climate change, as we know this population is,  we need to be very careful about the hunting levels being set," she said. "If they're going to introduce hunting at wintering or breeding grounds, we need to monitor and account for the other processes going on, notably climate change, so that they can set sensible quotas that won't harm the overall population."

Maarten J.J.E. Loonen started studying barnacle geese on Svalbard three decades ago to determine how the breeding period would limit population size after the growth in population numbers due to changes on the wintering grounds. Winter populations did well because hunting was banned in Scotland in 1950, and the grasslands where they grazed were fertilized.

"In 1990 we thought that the Arctic would not change and Svalbard, being an island, would result in an increase of competition among the geese and a decrease breeding success," Loonen said. "In poor years, we knew that  gosling growth slowed down and as a consequence these geese became smaller adults. But after thirty years of data collection, this paper shows that there is no effect of declines on population size yet."

Multiple studies have evaluated the incidence of back pain among patients who undergo catheter-based heart procedures while conscious. But the impact of back pain on patients who undergo similar procedures for the brain has not been previously examined. These minimally invasive brain procedures are also typically performed while the patient is awake and require an even longer immobilization period.

Researchers from the University of Missouri School of Medicine and MU Health Care performed a prospective study of neuroendovascular patients and found more than 40% suffered back pain during the procedure, signaling a need for clinicians to be more proactive in addressing this complaint.

"Pain management is increasingly recognized as an important marker of high-quality care and is related to patient satisfaction," said lead researcher Adnan I. Qureshi, MD, a professor of clinical neurology at the MU School of Medicine. "The relatively high prevalence of back pain in patients undergoing neuroendovascular procedures while awake must be recognized, and strategies to reduce the occurrence need to be identified."

Qureshi's study included 242 patients undergoing neuroendovascular procedures. Clinicians asked each patient about the presence and location of back pain immediately after their procedure. One hundred patients (41.3%) reported back pain during the procedure, with a median severity of 5 on a 10-point scale. More than 75% of those patients reported pain in the lumbar spine.

"The history of previous back or neck surgery was significantly associated with the occurrence of moderate to severe back pain," Qureshi said. "However, there was no significant difference in the frequency of moderate to severe back pain in patients who were undergoing a procedure lasting more than 60 minutes, compared to shorter-length procedures."

Qureshi's team noted that the high frequency of back pain was reported despite a large proportion of patients receiving intravenous pain medications during the procedure.

"Since our intravenous fentanyl dose was not based on patients' body weight, we tried to identify any role underdosing may have played in those with high body mass index or those with previous neck or back pain with tolerance to opioids," Qureshi said. "However, our analysis found underdosing was not a factor."

The next question clinicians must answer is what strategies can be used to reduce the frequency and intensity of back pain during these procedures. Options range from a pre-procedure nonsteroidal anti-inflammatory medication to premedication with a combination of oral and intravenous medications.

"Further research will be needed to determine what combination of analgesics and sedation methods are optimal to achieve a successful outcome without patient discomfort," Qureshi said.

Climate change mitigation requires curbing emissions from all sectors, including shipping. The European Union has set ambitious targets to achieve this goal. The European regulation number 757 on Monitoring, Reporting, and Verification of CO2 emissions (EU-MRV) contributes to it by collecting CO2 emission data from all vessels above 5,000 GT calling at ports within the European Economic Area.
In this area, ferries represent just 3% of all vessels. However, in 2018 they accounted for 10% of CO2 emissions from all ships in the EU-MRV. Why carbon footprint of ferries is so high? Is it related to sea or navigational conditions? Or perhaps to any characteristics of the vessels?

A CMCC study presented last June during the 21st IEEE International Conference on Mobile Data Management and realized in the framework of GUTTA project’s activities, explores this issue while providing new insights and perspective.
The analysis, led by Gianandrea Mannarini, senior scientist at the CMCC Foundation, explores various energy efficiency indicators. Results reveal some clustering in the vessel population and the key factors are year of build, vessel length, service speed, and fuel type. Georeferencing data provide additional information on the continental patterns of the Ro-Pax emissions.

About the half of the total ferry emissions stem from the Mediterranean; this largely reflects a greater number of ships operating in this sea. More in detail, the study highlights a weak correlation between CO2 emission per service hours and the mean annual sea state (significant height of waves where the ferry operates); this correlation is slightly higher just for smaller ferries (i.e., length below 120 meters). Researchers also assess which factors influence ferry carbon intensity, defined as CO2 emissions per transport work, highlighting a great variability spanning five orders of magnitude, while the ferry size varies by less than two.
“This variability is influenced by many factors” Gianandrea Mannarini explains, “such as ferry size, propulsion features, age and other characteristics of the Ro-Pax vessels, such as number of vehicles carries, number of cabins available and other passenger services. However, we will have to use data from multiple years for better analysing how ferries performed with respect to emissions”.

In certain ways, energy efficiency reflects the ship’s age and the tendency to build bigger and bigger ships during the last decades. “The data”, Mannarini adds, “indicate that some of the most carbon intensive vessels were built during the past 20 years. More and better time-resolved emission data from the vessels, possibly at individual voyage level, would enable a better assessment, which is the first step for informing International policies and regulations aimed at reducing both carbon intensity and absolute emissions.”

For further information, read the integral version of study:
EU-MRV: an analysis of 2018’s Ro-Pax CO2 data
G. Mannarini, L. Carelli, and A. Salhi. EU-MRV: an analysis of 2018’s Ro-Pax CO2 data. In 21st IEEE International Conference on Mobile Data Management (MDM), pages 287–292. IEEE, 2020. DOI: 10.1109/MDM48529.2020.00065

The original MRV data used for this work can be downloaded from EMSA

More information on GUTTA aims and activities here.

DOI

10.1109/MDM48529.2020.00065

Research has shown that gut microbes can influence several aspects of the host's life, including aging. Given the complexity and heterogeneity of the human gut environment, elucidating how a specific microbial species contributes to longevity has been challenging. To explore the influence of bacterial products on the aging process, researchers at Baylor College of Medicine and Rice University developed a method that uses light to directly control gene expression and metabolite production from bacteria residing in the gut of the laboratory worm Caenorhabditis elegans.

They report in the journal eLife that green-light-induced production of colanic acid by resident E. coli bacteria protected gut cells against stress-induced cellular damage and extended the worm's lifespan. The researchers indicate that this method can be applied to study other bacteria and propose that it also might provide in the future a new way to fine-tune bacterial metabolism in the host gut to deliver health benefits with minimal side effects.

"We used optogenetics, a method that combines light and genetically engineered light-sensitive proteins to regulate molecular events in a targeted manner in living cells or organisms," said co-corresponding author Dr. Meng Wang, Robert C. Fyfe Endowed Chair on Aging and professor of molecular and human genetics and the Huffington Center on Aging at Baylor.

In the current work, the team engineered E. coli to produce the pro-longevity compound colanic acid in response to green light and switch off its production in red light. They discovered that shining the green light on the transparent worms carrying the modified E. coli induced the bacteria to produce colanic acid, which protected the worm's gut cells against stress-induced mitochondrial fragmentation. Mitochondria have been increasingly recognized as important players in the aging process.

"When exposed to green light, worms carrying this E. coli strain also lived longer. The stronger the light, the longer the lifespan," said Wang, an investigator at Howard Hughes Medical Institute and member of Baylor's Dan L Duncan Comprehensive Cancer Center. "Optogenetics offers a direct way to manipulate gut bacterial metabolism in a temporally, quantitatively and spatially controlled manner and enhance host fitness."

"For instance, this work suggests that we could engineer gut bacteria to secrete more colanic acid to combat age-related health issues," said co-corresponding author Dr. Jeffrey Tabor, associate professor of bioengineering and biosciences at Rice University. "Researchers also can use this optogenetic method to unravel other mechanisms by which microbial metabolism drives host physiological changes and influences health and disease."

Cancer treatment isn't just a matter of shrinking or removing a tumor. It also involves preserving or improving the patient's quality of life. Rehabilitation services--such as behavioral therapies to alleviate pain and exercise to reduce fatigue--are a valuable way to do that. But they often aren't included in cancer patients' plans of care.

"Rehabilitation has been an underdog in cancer treatment," said Nicole Stout, a research assistant professor with the West Virginia University School of Public Health and WVU Cancer Institute. "It hasn't been top of mind."

In a new systematic review, Stout and her colleagues identified the rehabilitation recommendations included in cancer-treatment guidelines from around the world. The guidelines recommended rehabilitation for a variety of cancer types and consequences of cancer treatment. But the researchers discovered a disconnect between what the guidelines suggested and what many doctors do.

Their findings appear in CA: A Cancer Journal for Clinicians.

"When we look at the evidence, somewhere between 2% and 9% of patients who have demonstrated functional impairments actually get referred to rehab," Stout said. "It's very underutilized."

She said there are many reasons for this. Counterintuitively, one of the most significant reasons is how good we've gotten at diagnosing and treating cancer.

"Quite frankly, most people in the past didn't survive a cancer diagnosis," she said. "In the late 1970s, only about 30% to 40% of people who had cancer would live beyond five years. Today that number is over 70%. And for some of the most common cancers--like breast and prostate--90% of those folks will live beyond five years and go on to live their full lifespan. It's not good enough anymore for us to just say, 'Well, look: you're just going to have to live with pain and fatigue.' And the evidence for rehabilitation has just grown so significantly to show us that we can really help those people."

Treating the whole person

As a medical domain, rehabilitation focuses on functionality--or, someone's ability to think, speak, move and carry out the countless other activities that make up daily life. It encompasses a wide range of treatments, from music therapy to transcutaneous electrical nerve stimulation.

Although rehabilitation is often associated with learning to walk again after a stroke or a joint-replacement surgery, it can also be crucial to preventing problems before they arise.

"There's no such thing as a little bit of pain or a little bit of swelling or a little bit of limited movement in your joint," Stout said. "Today it might be a little bit, but in three weeks or three years, those things can escalate."

Where are all the patients?

To be included in Stout's review, guidelines had to meet several criteria. For example, they had to be published between Jan. 1, 2009 and June 1, 2019. They had to deal specifically with cancer patients. And they had to be endorsed by a professional oncology or rehabilitation organization.

Sixty-nine guidelines met all of the criteria. Of those, 37 recommended that cancer patients be referred to rehabilitation services but gave no additional guidance. The other 32 suggested specific rehabilitation assessments and interventions.

"For us on the rehabilitation end of things, we're always asking, 'Gosh, why are these doctors not sending more of their patients to rehab?'" Stout said. "Then we do this systematic review, and we see 69 guidelines, and we're like, 'There are all these guidelines. Why aren't we seeing more patients referred? How do we implement the guidelines into practice?"

'Greatest hits album' of rehabilitation recommendations

To make these guidelines more effective, the World Health Organization launched its Rehabilitation 2030 initiative, which Stout's review supports.

As part of the initiative, the WHO is identifying rehabilitation-specific recommendations in a variety of medical disciplines, including oncology. The WHO will then compile the "greatest hits" of those guidelines into one toolkit, Stout said.

"This is where the greatest hits album that the WHO puts together will really be impactful because it will synthesize all of these findings into one place and break it out by disease type or type of impairment," she said.

Providing a single, trustworthy source of guidelines may improve the likelihood that physicians will refer their patients to rehabilitation services.

In the meantime, Stout recommends that patients be their own advocate.

"I encourage patients to not just ask, 'Do you think we should do something about this swelling that I'm having?'" she said. "They need to tell their physician, 'I'm having swelling. I need a referral to see a rehabilitation specialist.' And you know what? The doctor and the nurse, they'll do it."

Female COVID-19 patients face less severe disease complications and a lower risk of dying than male patients thanks to hormones and chromosomes that contribute to a stronger immune response, according to new research from a University of Alberta-led team.

"The highlight of our study is how the sex differences in COVID-19 are linked to ACE2," said senior author Gavin Oudit, professor of medicine in the Faculty of Medicine & Dentistry, Canada Research Chair in Heart Failure and director of the Heart Function Clinic at the Mazankowski Alberta Heart Institute.

ACE2 is the enzyme that acts as the receptor allowing SARS-CoV-2 to enter the body, but it is also key in protecting against cardiovascular, lung and kidney diseases.

"Because of their chromosomes, women have two copies of the ACE2 gene and men have only one copy," Oudit said. "This does not seem to make women more susceptible to COVID-19 infection, but it does protect them from the complications associated with the virus."

Oudit explained that ACE2 is an X chromosome-linked gene. To avoid duplication, one X chromosome tends to be inactivated, but due to its location ACE2 escapes inactivation, meaning women have twice as many active genetic instructions to make ACE2.

Another gene that is twice as strong in women due to this X-inactivation escape is called Toll-like receptor seven, a key part of the innate immune system.

"The stronger presence of Toll-like receptor seven in women explains why women's immune systems are stronger than men's and can tolerate virus infection better, including the common cold," Oudit said. "The man-cold phenomenon is real."

In the study, the researchers report that men face more severe illness and poorer outcomes around the world, including in Alberta. They note that women likely face more exposure to SARS-CoV-2 than men--for example, 70 per cent of health-care workers are female--but this is not reflected in their outcomes.

"Due to gender issues, women face more risk, so it's reassuring to know that their outcomes are not any worse; in fact they are clearly better than men's," Oudit said.

Research is underway to understand how manipulating ACE2 levels might help COVID-19 patients, to prevent infection by blocking the enzyme or to protect the cardiovascular system, lungs and kidneys by enhancing it.

"We need to look at the factors that are responsible for better outcomes for everyone, taking sex differences into consideration when we test new therapies and provide COVID-19 care," said Oudit.

The ASH Research Collaborative (ASH RC) and the International Society of Haemostasis and Thrombosis (ISTH), two organizations with multidisciplinary expertise in blood clotting and bleeding disorders, have developed a toolkit to help clinical researchers from across medical disciplines design clinical trials that further the understanding of blood clotting events associated with COVID-19.

The new Toolkit for the Collection of Thrombosis-Related Data Elements in COVID-19 Clinical Studies, published today in Blood Advances, defines a series of endpoints - events or outcomes that are measured in a clinical study - that should be included in study design to collect and analyze important, relevant, and standardized data on dangerous blood clots that form in the veins or arteries of patients with COVID-19. The goal of this initiative is to maximize high-quality collection of COVID-19-associated clotting and bleeding events across diverse medical fields, such as internal medicine, infectious disease, pulmonology, and emergency or critical care medicine, which may capture these events as secondary endpoints or outcomes.

"Researchers across various disciplines are conducting clinical trials in COVID-19, and because they are not attuned to collecting these data we are seeing ranges of incidences," said 2020 ASH RC President Stephanie Lee, MD, MPH of the Fred Hutchinson Cancer Research Institute and President of the American Society of Hematology (ASH). "ASH RC and ISTH developed this toolkit to harmonize data collection and help all clinical researchers speak the same language. Standardizing how thrombosis is defined and measured across all COVID-19 trials will give us a more complete picture of the magnitude of risk - who is experiencing blood clots, what predisposes them to clotting - which could lead to the development of more targeted interventions and treatments."

While abnormal blood clotting is an established complication of COVID-19, particularly in hospitalized patients, the precise incidence, risk factors, and natural history of these events remains uncertain due to inconsistencies in how studies are being designed and conducted. As a result, it has been challenging to apply clinical insights from studies into practice. To address this issue, the ASH RC and ISTH established uniform definitions of thrombosis-related outcomes for incorporation into COVID-19 clinical trials addressing a diverse range of interventions.

"The ISTH is pleased to collaborate with ASH on this important initiative, and we encourage investigators to use this toolkit, which will standardize data collection and allow for better comparison of findings across trials," said Jeffrey Weitz, MD, ISTH President. "The collaboration utilized the recently approved ISTH Common Data Elements for venous thromboembolism, supporting the ISTH CDE project's goal of establishing a consistent vocabulary for clinical research."

The toolkit includes a customizable range of options for maximal flexibility, from a limited set of essential variables to a comprehensive set of clinical and biological variables, including variable definitions, permissible values, and measurement tools and units. Depending on the individual study objectives, design, and available resources, investigators can select from three levels of detail in seven domains: venous thromboembolism, myocardial infarction, stroke/transient ischemic attack, peripheral artery thrombosis, bleeding, laboratory investigations, and antithrombotic therapy. This turnkey solution is designed to create efficiency in study design and implementation by providing a pre-established, standardized set of variables vetted by individuals with expertise in thrombosis and hemostasis and clinical trial development.

Countries worldwide face challenges meeting the growing needs for long-term care services because of high costs. A study led by researchers from McGill University and Université du Québec en Outaouais shows that introducing nurse practitioners can significantly reduce costs and improve patient safety.

According to the study, published in Nursing Outlook, cost savings for on-site nurse practitioner care for adverse events were between 1.9 and 3.2 million dollars across the six sites, including the reduction of nursing administration time for medications. Once introduced, nurse practitioners managed patients' medications and adverse events including falls, pressure ulcers, and short-term transfers to the hospital.

"Internationally, most studies have focused on quality and safety in long-term care. Little is known about the economic impacts of the care provided to patients by nurse practitioners, particularly in Quebec, where the roles are still new," says co-author Kelley Kilpatrick, an associate professor at the Ingram School of Nursing at McGill University. The study is the first to look at cost savings resulting from their work in decreasing adverse events.

Pilot project: a success

Nurse practitioner roles were introduced in the United States and some provinces in Canada in the 1960s. However, their history is fairly recent in Quebec, due to differences in regulatory laws in the province. Up until early 2019, the diagnosis of a health condition needed to be made by a physician. Those laws are now under revision.

In 2015, Quebec implemented nurse practitioner roles in six long-term care facilities as a pilot project. Nurse practitioners are trained at the graduate level with a specialty certificate in primary care. Working in partnership with physicians and an interprofessional team, they assess residents' condition, adjust medications, order and interpret diagnostic tests, and provide ongoing chronic illness care.

"Put together, our research shows that close collaboration between nurse practitioners, physicians, and the rest of the healthcare team, helps all team members play their role more effectively," says Kilpatrick, who is also a researcher at the Centre de recherche de l'Hôpital Maisonneuve-Rosemont, part of the CIUSSS de l'Est-de-l'Île-de-Montréal.

The researchers note that sixteen percent of the world's population, 1.5 billion people, will be 65 years or older by 2050. Because countries must respond to increasing needs of this population, innovative approaches are needed to improve long-term care services.

"Nurse practitioners are part of the solution to meet the growing needs for quality long-term care. They play a key role in ensuring high quality care for residents in long-term care and reduce costs," says co-author Eric Tchouaket, a professor at the Department of Nursing at Université du Québec en Outaouais.

A pattern in how the brain breaks down tryptophan, a common amino acid consumed through food, was discovered by researchers at The University of Texas Health Science Center at Houston (UTHealth). The finding, which could help physicians more accurately diagnose and treat several major mental health disorders, was recently published in Molecular Psychiatry.

"Tryptophan can be metabolized to either a route where serotonin is produced, or to the kynurenine pathway," said Brisa Fernandes, MD, MSc, PhD, a postdoctoral research fellow with the Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School at UTHealth and co-senior author of the paper. "The research shows that people with mood disorders and schizophrenia not only have decreased levels of tryptophan overall, but the tryptophan they do have is being broken down more often in the kynurenine pathway, shifting away from the production of serotonin, the chemical made from tryptophan that is thought to regulate anxiety and improve mood."

Researchers conducted a systematic review of more than 100 peer-reviewed studies assessing kynurenine metabolites, which are the tryptophan amino acids being broken down in the kynurenine pathway, in people with major depressive disorder, schizophrenia, or bipolar disorder, compared to healthy controls. Within those studies, which included more than 10,000 study participants, they examined the difference in metabolite concentrations between each group.

"We chose these disorders because they share several biological pathways, meaning the same root causes and pathophysiology. We tried to find biomarkers that are common among these disorders, but most importantly, biomarkers that distinguish them. This is essential to help clinicians guide treatment and implement personalized medicine in psychiatry - not the 'one-size-fits-all' approach that is so prevalent today," Fernandes said.

As the tryptophan breaks down in the brain, it can use the kynurenine pathway to turn into quinolinic acid, which is considered neurotoxic, or kynurenic acid, which is considered neuroprotective.

Researchers identified several patterns that occur as tryptophan breaks down that collectively suggest there is a shift from serotonin production to the kynurenine pathway, which could lead to increased neurotoxicity from the quinolinic acid.

"This can help us to develop new tests for diagnosing these disorders and, more importantly, of discovering and selecting new treatments for people with mood disorders and schizophrenia that will be more personalized," Fernandes said.

"The major challenge that we have in psychiatry is having biomarkers to differentiate one diagnostic from the other, as our diagnoses are 100% clinical. This is the type of research we need to identify those biomarkers, and the next step for us now is to see if we can validate these findings in our patients," said João de Quevedo, MD, PhD, professor of psychiatry and behavioral sciences and co-author of the study.

"This is important research that hopefully will lead to a better understanding of mechanisms involved in major mental illnesses, as well as a higher level of personalization in treatments so we can best match patients to a treatment plan we know will help them," said Jair Soares, MD, PhD, the Pat R. Rutherford, Jr. Chair in Psychiatry in the Faillace Department of Psychiatry and Behavioral Sciences and co-senior author. Soares and de Quevedo see patients at UT Physicians, the clinical practice of McGovern Medical School.

The economic challenges caused by the coronavirus pandemic have grown worse since the spring for many American families, with an increasing number reporting that they have trouble paying bills, according to a new RAND Corporation study.

Surveyed several times over the course of the pandemic, nearly 45% of study participants report that they had difficulty paying bills at some point since February and 13% reported it had been been very difficult to pay bills at some point during the period.

Preliminary results from another wave of the survey conducted in early December suggests that many people plan to spend less than usual on holiday gifts this year, which also could indicate continuing financial hardship.

"Despite some recent increases in employment and consumer spending, many American families continue to struggle financially," said Katherine G. Carman, the study's lead author and a senior economist at RAND, a nonprofit research organization. "The challenges are particularly severe among lower income workers, and among Black and Hispanic households."

The survey was fielded using the RAND American Life Panel, a nationally representative internet panel, to assess the effects of the COVID-19 pandemic on individuals and households across a variety of topics.

The RAND study analyzes results from 1,277 people who were working during February 2020 and were asked them about their finances during May, June, August and September.

The number of Americans who reported troubles paying bills increased from 27% in May (7% reported that it was very difficult and 20% that it was somewhat difficult) to 32% in September (9% reported that it was very difficult and 23% that it was somewhat difficult).

Researchers found that people who report financial difficulties were more likely to turn to formal credit such as credit cards or payday loans, in addition to informal methods such as borrowing from friends or selling belongings. Over time, those who report financial difficulty became even more likely to turn to one of these strategies or to report that they could not cover expenses at all.

For example, among those reporting trouble paying bills, the number of people who reported using formal credit to meet obligations rose from 41% in May to 47% in September. Those reporting they could not pay their bills rose from 25% in May to 30% in September.

Only those who had experienced financial difficulties reported that they have asked or would ask for an extension in paying their rent or mortgage, both of which are easier under the terms of the CARES act.

People who reported using stimulus funds declined over time, likely because people had already spent the funds or because they had become less salient.

Researchers say the differences across racial groups was striking. In May, 20% of Non-Hispanic White respondents reported financial difficulties, compared with 42% of Non-Hispanic Black respondents and 47% of Hispanic respondents.

As in the overall sample, the share of Americans who reported financial difficulties at any point during the four waves of the study is about 15 percentage points higher than the share who experience difficulty in the first wave, for all three of the racial groups.

Unsurprisingly, financial difficulties were more common among lower income households. Among study participants who were working in February, more than 70% of low-income households (under $25,000 in annual income) reported financial difficulties at some point during the four waves of the survey.

Meanwhile, 47% of middle-income households (income between $25,000 and $125,000), and 20% of high-income households (income above $125,000) reported financial difficulties at some point from May to September.