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A new series of computational fluid dynamics simulations suggests that, for two people who must travel together in the same passenger car, the safest way to prevent possible transmission of COVID-19 in such a risky, enclosed environment is to do so with all four windows down and the passenger seated as far as possible from the driver, in the rear seat on the opposite side. Varghese Mathai and colleagues found that this modeled configuration created two distinct flows of air in the car's cabin, separated along the midline of the car and moving - perhaps counterintuitively - from the rear towards the front of the car, due to exterior pressure differentials dictated by the car's aerodynamics. This separated airflow configuration was the most effective at reducing the transmission of simulated infectious droplets from either driver to passenger, or vice versa. However, recognizing that such a breezy configuration may be less desirable for many travelers, the researchers also tested the opposite scenario - all four windows up - as well as four other scenarios with either one or two windows closed. The fully enclosed scenario, which relied only on simulated, non-recirculated airflow from the car's air conditioning system, was the riskiest of all six simulated scenarios, conferring the highest risk of droplet transmission. Traveling with three open windows fared better than only two open windows, but the researchers found that choosing which window to close may in fact matter a great deal. In scenarios that simulated either an infected driver or an infected passenger, closing only the window closest to the non-infected person conferred the greatest protection, second only to the scenario with all four windows open. Mathai et al. note that their simulations, based on an idealized model sedan patterned after the body shape of a Toyota Prius, may not accurately reflect airflow dynamics in other vehicles such as trucks, minivans, and cars with an open sunroof. They also note that their models may also miss some other nuances of airflow and particle residence times that may result from, for example, strong crosswinds or otherwise exceptionally windy conditions. All the same, the authors conclude that "these results will have a strong bearing on infection mitigation measures for the hundreds of millions of people driving in passenger cars and taxis worldwide, and potentially yield to safer and lower-risk approaches to personal transportation."

When the COVID-19 lockdowns began in mid-March 2020, hospitals and clinics faced a new challenge: How could they continue to provide care to those who could not leave their homes?

The answer lay in virtual visits -- doctor visits that take place over the phone or through videoconferencing -- but for many healthcare providers, these virtual visits were a new frontier.

University of Chicago Medicine, like many hospital systems across the country, quickly built a telehealth infrastructure to support these visits. From mid-March to the end of May, the system provided nearly 50,000 virtual visits to patients.

A new study published December 4, 2020, in the journal JMIR Medical Informatics examines the increase in these visits, and recommends adopting policies that encourage virtual visits going forward.

"Oftentimes, virtual visits are just as good as in-person visits, and we found that telephone visits are particularly important going forward if we are going to keep providing service to communities that do not have access to the technology needed for video visits," said Craig Umscheid, MD, Vice President of Healthcare Delivery Science and Chief Quality and Innovation Officer at the University of Chicago Medicine and co-author of the study.

When the University of Chicago Medical Center and its five practice sites began giving patients the option of rescheduling their appointment or switching to a virtual visit, either via videoconferencing or over the phone, it entered a new era of widespread telehealth.

Though technology has existed to make virtual visits possible, the Centers for Medicare and Medicaid Services (CMS) and commercial insurance providers generally did not cover those visits. That changed during the COVID-19 public health emergency, when CMS expanded coverage to include virtual visits. Many commercial insurance companies followed suit.

To understand the effects of these visits, a UChicago research team, including senior author Sachin Shah, MD, Associate Chief Medical Information Officer for UChicago Medicine, set out to analyze the data to find out who was using the virtual visit option during the first 11 weeks of the stay-at-home order.

In that timeframe, 60 percent of UChicago Medicine visits were virtual. Of those, 60 percent were by video and 40 percent were by phone.

But use of virtual visits was not equal across demographics. Virtual visits were more likely among patients with Medicare. Those less likely to use virtual visits included men, the very young and very old, and patients with Medicaid.

The research team also studied the demographics of video visit use versus telephone visit use. Telephone visits were more likely to be used by older patients, Black patients, and patients with Medicare and Medicaid (as opposed to commercial) insurance.

In fact, Black patients were half as likely as white patients to use video for their virtual visits. Though video visits generally provide a higher quality experience, many patients do not have access to a computer or the internet, or do not have the digital literacy to download and use a mobile application.

After analyzing the data, the researchers made five recommendations for virtual visits going forward, including creating a reimbursement parity between video and telephone visits. Right now, physicians who conduct a video visit are reimbursed for all time spent on patient care for that visit, including time spent on documentation. For telephone visits, they can only bill for time spent in direct communication with a patient.

Many are worried that once the pandemic is over, insurers will stop covering virtual visits or will only cover video visits. "Our research shows that if telephone visits aren't covered going forward, many patients will not have the same access to healthcare," Shah said. "There is widespread agreement among patients and providers that virtual visits shouldn't go away. But we need to make sure that policymakers understand how different types of virtual visits benefit different populations."

The researchers recommend developing legislation that makes virtual visit reimbursement permanent. But because virtual visits aren't appropriate for every visit, they recommend that guidance be developed to distinguish which visits are best suited for the virtual environment.

They also recommend that the usability of video visits be improved, and they advocate for universal broadband access to close the digital divide among populations. "A lot of software isn't as easy to navigate as you might think," Shah said. "We should incentivize companies to make it more usable for providers and patients."

The researchers hope to continue to study virtual visits, since it will continue to be a significant part of healthcare delivery in the future.

"There has been a lot of excitement around the pivot to virtual visits, because it allows us to broaden our reach to communities that don't normally leverage the services of UChicago Medicine," Umscheid said. "This is opening a completely new frontier around patient engagement and accessibility and ultimately the quality of care we deliver."

While multiple research studies show that Black and Hispanic patients are more likely to test positive for COVID-19, a team of investigators at NYU Langone Health has found that once hospitalized, Black patients (after controlling for other serious health conditions and neighborhood income) were less likely to have severe illness, die, or be discharged to hospice compared to White patients.

The study -- recently published online in JAMA Network Open - is, according to its authors, one of the first to examine the impact of comorbid conditions and neighborhood socioeconomic status (SES) on outcomes for Black, Hispanic and Asian patients hospitalized for COVID-19. Findings indicate that Black and Hispanic populations are not inherently more susceptible to poor COVID-19 outcomes compared to other groups, and that once hospitalized, their outcomes are equal to or better than their White counterparts.

"We know that Black and Hispanic populations account for a disproportionate share of COVID-19-related deaths relative to their population size in New York and major cities across the country," says Gbenga Ogedegbe, MD, MPH, Dr. Adolph and Margaret Berger Professor of Medicine and Population Health at NYU Langone Health, and the study's lead author. "We were, however, surprised to find that Black and Hispanic patients were no more likely to be hospitalized across NYU Langone than White patients, which means we need to look at other structural factors at play that are negatively affecting outcomes in these communities. These factors include poor housing conditions, unequal access to health care, differential employment opportunities, and poverty--and they must be addressed," says Ogedegbe, who is also director of NYU Langone's Institute for Excellence in Health Equity.

How the Study Was Conducted

The team of investigators obtained all data from NYU Langone Health's electronic health record (EHR) of 9,722 patients tested for COVID-19 at the health system's 260 outpatient office sites and four acute care hospitals in Manhattan, Brooklyn, and Long Island between March 1, 2020 and April 8, 2020, and followed them through May 13, 2020. The patients' race and ethnicity data was self-reported.

For every patient who tested positive for COVID-19 , the researchers compiled race/ethnicity data, patient characteristics such as body mass index (BMI), age and sex, and neighborhood socioeconomic (SES) data contained in a weighted index of seven indicators (including median household income, level of education and housing value, among others).

Study Findings

Among the 4,843 patients who tested positive for COVID-19, 39 percent were White, 15.7 percent were Black, 25.9 percent were Hispanic, 7 percent were Asian, and 7.4 percent were multiracial/other; 2,623 patients were hospitalized.

Of 2,623 patients hospitalized, 39.9 percent were White, 14.3 percent were Black, 27.3 percent were Hispanic, 6.9 percent were Asian, and 7.9 percent were multiracial/other. Hospitalized patients were older and had higher comorbidity than patients who tested positive but were not hospitalized. 70.8 percent were discharged, 36.3 percent experienced critical illness, 24.7 percent died or were discharged to hospice, and 4.5 percent remained hospitalized as of May 13, 2020.

Black and Hispanic patients had a lower risk of critical illness and were less likely to die or be discharged to hospice compared to White patients. After adjusting for age, sex, insurance status and comorbidity, Black patients continued to have lower risk of death compared to White patients, while Hispanics and Asian patients had similar rates to White patients.

After adjusting for all the above factors, Asian patients had higher odds of being hospitalized than White patients even though they were less likely to test positive for COVID-19.

"Our findings provide more evidence that the social determinants of health play a critical role in determining patient outcomes, particularly for Black patients, before they ever get to the hospital," said Joseph Ravenell, MD, associate professor in the Department of Population Health and associate dean for Diversity Affairs and Inclusion at NYU Langone.

"However, we do see a bit of a paradox," said Ravenell. "In keeping with other research, we've found that once Black patients with COVID-19 make it to the hospital-- despite coming from lower-income neighborhoods--their odds of dying are similar to or lower than White patients. Meanwhile, we also know that Black and Hispanic people are disproportionately contracting and dying of COVID-19 across the country."

According to Ogedegbe and Ravenell, Black populations are more likely to be uninsured and underinsured than White populations and thus more likely to die at home as opposed to in hospital due to poorer access to care. Another predictor of poor outcomes for patients hospitalized with COVID-19 is male sex. In this particular study cohort, 62 percent of Black hospitalized patients were female, which could explain their relatively better outcomes. The study population may also not be representative of the overall New York City population, they said.

Study senior author Leora Horwitz, MD, associate professor in the Departments of Population Health and Medicine and director of the Center for Healthcare Innovation and Delivery Science at NYU Langone, says that future studies need to better examine the direct impact of structural inequities on racial and ethnic disparities in COVID-19 related hospitalization, morbidity, and mortality.

Los Robles Health System is leading the way in neurovascular clinical trials enrolling the first patient in the nation in STEM, the Squid trial for the treatment of chronic subdural hematoma (cSDH). Chronic subdural hematoma is a disease that presents as a collection of blood that positions itself between the surface of the brain and the outermost layer of the brain covering, called the dura. cSDH is a debilitating, causing many neurologist deficits and often requiring invasive surgery to open the skull. The patient population most commonly affected by cSDH are older adults, who are more likely to experience bleeding and rebleeding in the small vessels of the brain due to atrophy.

"This is a landmark trial that can change the management of chronic subdural hematomas completely," says Dr. Asif Taqi, principal investigator for the trial and medical director of Neurosciences at Los Robles Health System. "Recent medical literature suggests there is a benefit in the liquid embolization of the middle meningeal artery to prevent future reaccumulation of blood and help reduce the present SDH."

The STEM trial is a prospective, multicenter and randomized controlled trial at 25 different sites across the US, which aims to assess the safety and effectiveness of the Squid embolic agent. Leading this national trial, Los Robles enrolled the first ever patient in United States into this trial. "We are very excited to be leading this exciting research study that will potentially change the management of this disease in our community," says Dr. Taqi.

"Los Robles is thrilled to have the first patient enrolled in the STEM trial in the nation," says Chief Medical Officer, Dr. Gabriella Sherman. "We know that the results of STEM are crucial as they will add to our overall knowledge of chronic subdural hematomas a common and disabling disease in the senior population." The trial has the potential to determine whether treatment of cSDH with the Squid liquid embolic system is safe and effective. In addition, the trial will allow for a better understanding into the disease's natural progression and the safety and efficacy of current treatment strategies.

December 4, 2020 -- Unless we take urgent action to tackle climate change, we can expect an ever-hotter world that threatens global health, disrupts lives and livelihoods and overwhelms healthcare systems, according to The Lancet's Global Countdown on Health and Climate Change, a comprehensive global analysis tracking the impact of climate change on human health across 41 key indicators.

Experts from institutions across the globe who work at the nexus of climate change and health contributed to the published findings, including faculty from Columbia University Mailman School of Public Health. While the report presents the most worrying outlook to date as key trends worsen, the collaborators also find that with urgent climate action and a holistic response to the converging crises, the lives of millions can be improved and saved.

The 41 indicators are organized across five categories: 1) climate change impacts, exposures and vulnerabilities; 2) adaptation planning and resilience for health; 3) mitigation actions and health co-benefits; 4) economics and finance; and 5) public and political engagement.

Jeffrey Shaman, PhD, professor of environmental health sciences, director of the climate and health program and vice chairman of Columbia's Climate School, was a report contributor and reviewer. Lewis Ziska, PhD, associate professor of environmental health sciences, contributed to the chapter on food insecurity following extreme climate events where he also addressed structural and social determinants of food insecurity. "An important aspect of public health involves ensuring food security following a climate change induced extreme event. Here we look for common occurrences, problems and potential solutions that can be used as recommendations to ensure that no one goes hungry following a hurricane, flood or intense windstorm. But more needs to be done," noted Ziska.

According to Kim Knowlton, DrPH, assistant professor of environmental health sciences at Columbia Mailman and senior scientist, Natural Resources Defense Council, "This year's Lancet Countdown is the latest warning that the U.S. is going in the wrong direction on climate change and health. But it's not too late to change course. The incoming Biden/Harris administration should seize this opportunity to embrace the knowledge, expertise, and passion of the American public health and healthcare community. Together, we can build back a healthier, more equitable, and climate-resilient nation."

"Whether it's the spread of viruses and infectious diseases, heat exposure, or wildfires, the 2020 Lancet Countdown on Health and Climate Change U.S. Policy Brief shows how climate change makes communities and health care systems more vulnerable. The Brief lays out how climate action across sectors will lead to major environmental and public health gains," said Brittany Shea, Project Director, Global Consortium on Climate & Health Education, Columbia University Mailman School of Public Health.

Astronomers have caught a rare glimpse of a rapidly fading shroud of gas around an aging star. Archival data from the NASA/ESA Hubble Space Telescope reveal that the nebula Hen 3-1357, nicknamed the Stingray nebula, has faded precipitously over just the past two decades. Witnessing such a swift rate of change in a planetary nebula is exceedingly without precedent, researchers say.

Even though the Universe is constantly changing, most processes are too slow to be observed within a human lifespan. However, the Stingray Nebula is now offering scientists a special opportunity to observe a system's evolution in real time.

Images captured by Hubble in 2016, when compared to Hubble images taken in 1996, show a nebula that has drastically dimmed in brightness and changed shape. Bright blue shells of gas near the centre of the nebula have all but disappeared, and the wavy edges that earned this nebula its aquatic-themed name are virtually gone. The young nebula no longer pops against the black velvet background of the distant Universe.

Researchers discovered unprecedented changes in the light emitted by glowing gas -- nitrogen, hydrogen and oxygen -- that is being blasted off by the dying star at the centre of the nebula. The oxygen emission, in particular, dropped in brightness by a factor of nearly 1000.

"In most studies, the nebula usually gets bigger," said Bruce Balick of the University of Washington, USA, who led the new research. "Here, it's fundamentally changing its shape and getting fainter, and doing so on an unprecedented timescale."

"Because of Hubble's optical stability, we are very, very confident that this nebula is changing in brightness," said team member Martin Guerrero of the Instituto de Astrofísica de Andalucía in Granada, Spain. "That easy to see since, unlike the nebula, all of the other stars in the Hubble image - including a distant companion star - stayed constant in brightness."

The researchers note that while speculating on causes for this surprising finding, it's important to explore the properties of the dying star at the centre of the Stingray nebula, which influences the structure and brightness of the nebula.

A 2016 study by Nicole Reindl of the University of Leicester, UK, and a team of international researchers, also using Hubble data, noted that the star at the centre of the Stingray nebula, SAO 244567, is special in its own right.

Observations from 1971 to 2002 showed the temperature of the star skyrocketing to almost ten times hotter than the surface of our Sun. Reindl speculates the temperature jump was caused by a brief flash of helium fusion that occurred outside the core of the central star. After that the star began to cool again, returning to its previous stage of stellar evolution.

The team studying the rapid fading of the Stingray nebula can only speculate at this time what's in store for the future of this young nebula.

URBANA, Ill. - An aging U.S. population is rapidly increasing the demand for nursing care. The number of U.S. citizens aged 65 and over is expected to almost double from 43.1 million in 2012 to 87.5 million by 2050, while the workforce is shrinking. The COVID-19 pandemic has further exacerbated the need for health care professionals.

One strategy to meet rising health care needs is to hire foreign nurses to fill the gaps. The availability of immigrant visas for nurses has fluctuated considerably over the years with different policy approaches. Opponents of immigration have asserted that the influx of foreign nurses has resulted in unemployment and lower wages for domestic nurses. However, a new study from the University of Illinois found no such displacement effects.

"Our findings show relying on foreign-educated registered nurses to balance demand and supply in the U.S. healthcare workforce does not hurt the employment of U.S.-educated nurses," says Hyeran Chung, a doctoral student in the Department of Agricultural and Consumer Economics (ACE) at U of I and the lead author on the paper.

Chung and co-author Mary Arends-Kuenning, associate professor in ACE, analyzed data from the U.S. Census and the American Community Survey from 1980-2015. Their research measures the inflow of foreign-educated registered nurses per 1,000 people in commuting zones across the U.S.

Some studies have found foreign nurses displaced U.S. nurses, but Arends-Kuenning and Chung questioned those findings and wanted to do a deeper dive into the complex factors that influence the nursing labor market.

Their research differs in important ways from previous studies by other scientists. One major difference is their definition of foreign nurses as those who are foreign-educated rather than foreign-born.

"It really matters whether you're looking at nurses who were born in the United States versus nurses who were trained here. We believe the real issue is the foreign-educated nurses; it's bringing nurses from abroad to work in hospitals," Arends-Kuenning explains. "The difference between our results and those of previous studies is primarily driven by the use of foreign-educated instead of foreign-born nurses."

A foreign-born nurse could have come to the U.S. as a child and obtained their education in this country, she notes. To adjust for this, the researchers assumed that a foreign-born registered nurse was educated in the U.S. if the nurse was younger than 25 when first arriving to live in the U.S.

Another distinct feature is that the research covers a large geographical area, including every commuting zone in the U.S. where registered nurses are employed.

"Many previous studies have used metropolitan statistical areas, which does make sense because many of the immigrant nurses settle down in bigger cities. But we wanted to include rural America, where the health care issues often have been severe," Chung says.

To further amplify the validity of their results, the researchers used several multiple variable techniques in their analyses, allowing them to capture separately the short- and long-term effects of foreign-educated nurses on the labor outcomes of native nurses. This also helped them take into account possible unobserved characteristics that might be affecting both immigration and other general hiring.

The researchers found no significant effect of foreign-educated nurses on the employment of native nurses in either the short or the long term. They found marginally significant displacement effects on the youngest native nurses in the long run, whereas highly educated natives were positively affected by the foreign-educated nurses in the short run.

They suggest these positive effects may be due to the higher skill level of immigrant nurses. To obtain a work visa, a foreign nurse must have at least a bachelor's degree and two years of work experience. Arends-Kuenning says, "Hospitals might find that foreign-educated nurses are more productive when they work with highly educated native nurses, so they hire accordingly."

The researchers found that ten countries account for the majority of immigrant nurses. The largest group is from the Philippines, followed by India and Canada. The foreign nurses are more likely to be older and male. They are also more likely to earn more than their domestic counterparts, possibly because of their higher education level.

Overall, the study found no displacement effects of bringing in foreign-educated nurses. Hiring foreign-educated nurses does not lower U.S.-educated nurses' wages, either. Those findings have policy implications, Chung says.

"With an aging population and increasing health care needs, hiring foreign nurses might be a viable way to meet the high demand for nursing care," she concludes.

For a caterpillar, a green leaf can make a nice meal. But to the plant itself, it's an attack. And very hungry caterpillars can do a lot of damage as they eat their way through life.

Plants can fight back, unleashing an array of chemical defenses to discourage wayward foragers -- from releasing chemicals that attract caterpillar predators to secreting compounds that make the plant taste so foul that desperate caterpillars resort to cannibalism. But scientists know little about how plants detect these attacks and marshal defenses.

In a paper published Nov. 23 in the Proceedings of the National Academy of Sciences, a team led by scientists at the University of Washington and the University of California, San Diego reports that cowpeas -- a type of bean plant -- harbor receptors on the surface of their cells that can detect a compound in caterpillar saliva and initiate anti-herbivore defenses.

"Despite chemical controls, crop yield losses to pests and disease generally range from 20-30% worldwide. Yet many varieties are naturally resistant or immune to specific pests," said lead author Adam Steinbrenner, a UW assistant professor of biology. "Our findings are the first to identify an immune recognition mechanism that sounds the alarm against chewing insects."

The receptor is a protein known by the acronym INR. The team showed that, in response to both leaf wounds and the presence of a protein fragment specific to caterpillar saliva, the cowpea's INR protein boosts the production of ethylene, a hormone that plants often produce in response to munching by herbivores and other types of environmental stress. The protein fragment in caterpillar spit that elicited this response, Vu-IN, is actually a fragment of a cowpea protein, which gets broken down by the caterpillar as it dines on cowpea leaves.

Researchers have fewer methods to study cowpeas compared to other plants. So to learn more cellular details about INR's function, they popped the gene for INR into tobacco plants. These tobacco plants, when exposed to Vu-IN, increased production of ethylene as well as reactive oxygen species, another anti-herbivore defense that consists of chemically reactive forms of oxygen. In addition, the team's experiments showed that a tobacco-eating caterpillar -- the beet armyworm -- munched less on INR-harboring tobacco plants than plants without INR.

The research shows that plants like the cowpea sound the alarm only after their cells detect specific molecules associated with herbivory. Vu-IN is a trigger for cowpea defenses. Other plants likely have different molecular triggers for their own defensive systems, the researchers believe.

Understanding how plants activate their immune systems could help scientists develop more effective strategies to defend crop plants against hungry insects.

LA JOLLA, CA--As the consumer genetics industry rapidly expands, more and more people are turning to DNA-based services to learn their risk of developing a wide range of diseases.

However, the risk scores from these genetic tests are not always as precise as they could be, according to a new study from Scripps Research. The scientists, whose research appears in the journal Genome Medicine, examine many approaches to calculating the scores and recommend that personal genomics organizations adopt standards that will raise the bar for accuracy.

"Polygenic risk scores can be incredibly useful and affordable tools to guide preventative health decisions," says the study's senior author Ali Torkamani, PhD, director of Genomics and Genome Informatics at Scripps Research Translational Institute and Associate Professor of Integrative Structural and Computational Biology at Scripps Research. "Given the increasing utility of these scores, it's important to remove variability as much as possible and ensure the data is updated regularly to reflect new knowledge from genomic studies."

Companies such as 23andMe and Ancestry--along with dozens of others--need only a small sample of a person's saliva to generate estimations known as "polygenic risk scores," which are determined by comparing snippets of an individual's DNA with findings from large-scale genome studies. Examining these small segments of genomic variation, known as SNPs, is faster and far more economical than sequencing a person's entire genome. But one drawback is that the results can sometimes vary unexpectedly.

Torkamani notes that in most cases, the degree of fluctuation in a risk score is small and doesn't change the overall interpretation of the result; most individuals remain in the same risk category. Also, fluctuations are especially minor at the extremes of the risk distribution, where disease risk implications are most critical. Yet any variation can lead to a loss of consumer confidence in these important scores, and that can undermine preventative health. And in some rare cases, the scores can fluctuate substantially.

For their study, Torkamani and his team used various methods of calculating polygenic risk scores for conditions including coronary artery disease, atrial fibrillation, type 2 diabetes, Alzheimer's disease, glaucoma and breast cancer. They found that regardless of the method used, the computational algorithms are prone to introduce random variability for individuals due to how the calculations incorporate data from population-level genetic studies.

To reduce variability in individual polygenic risk scores, the team recommends running the algorithms multiple times, which would help smooth out random imperfections. By paying attention to variable elements in a score calculation, actions can be taken to either eliminate those elements or create an average, Torkamani explains.

"While we identified some clear challenges in applying population genetics tools to individual-level genetic analysis, we also see ways to overcome these issues to produce results that will inspire confidence," he says.

He and his team decided to pursue the study after making updates to different project they developed called MyGeneRank, which predicts risk of heart disease and other conditions by looking at specific genetic markers. They sought to identify a computational process that would lead to the greatest degree of stability and accuracy in the face of a score that is expected to evolve over time as new data becomes available.

The recommendations put forth in the new study could help personal genomics companies improve the quality of the scores they deliver to customers--and ultimately, encourage more individuals take smart preventative health actions based on what they learn in genotyping reports.

LA JOLLA, CA--A new study on Alzheimer's disease by Scripps Research scientists has revealed a previously unknown biochemical cascade in the brain that leads to the destruction of synapses, the connections between nerve cells that are responsible for memory and cognition.

The findings present a fresh angle for discovering drugs that treat Alzheimer's disease, which affects roughly 50 million people worldwide. The study, led by Scripps Research Professor and Step Family Foundation Endowed Chair Stuart Lipton, MD, PhD, appears in the journal Science.

This newly-discovered series of abnormal chemical events, termed "protein transnitrosylation reactions," contribute to synapse loss, the main driver of memory loss and cognitive decline in Alzheimer's.

Lipton, who is also a clinical neurologist, explains that most recent attempts to develop Alzheimer's treatments have targeted the sticky protein known as beta amyloid that accumulates in the brain of patients, disrupting cell communication and causing inflammation. However, for a variety of reasons, these attempts have failed in clinical trials.

"This work gives us new hope for better therapeutic targets, as the reactions we discovered are downstream of amyloid action," Lipton says. "We've opened up a whole new avenue for drug development."

Lipton is no stranger to drug development for Alzheimer's and Parkinson's diseases. Drugs developed in and patented by his laboratory have led to four FDA-approved medicines for these diseases, including the widely prescribed drug, memantine (Namenda®). "Much better drugs are needed, however," Lipton says.

A chemistry success story

In the new study, Lipton and his team used physical chemistry techniques to quantify how electrons participate in chemical reactions, as they suspected unknown processes may be taking place in the brain. Through this, they uncovered the entirely new series of biochemical events in nerve cells affected by Alzheimer's.

They found that small clumps of beta amyloid protein trigger excessive neuron activity and inflammation, leading to the destructive series of transnitrosylation reactions.

The process begins with excessive levels of nitrogen (N) and oxygen (O) atoms joining together as an "NO group," which is then transferred to a protein building block called cysteine to regulate the activity of the protein. A series of these aberrant protein reactions cuts off energy to the brain's nerve cells by disrupting their mitochondria--organelles that generate power for the cell's biochemical reactions. This eventually leads to loss of synapses connecting the nerve cells.

"We were able to show that these reactions occur in brains of Alzheimer's patients, and when we prevented these reactions in the brains of animal models of the disease, we protected the synapses," Lipton says. "Our findings suggest that it may be possible to intercede to reverse synapse damage in spite of plaques and tangles," he added, referring to "plaques" of beta amyloid and "tangles" of misfolded tau protein, both of which are characteristic of Alzheimer's disease.

He notes that while normal levels of NO foster memory and learning, excessive levels can build up as we age and become harmful to synapses.

"With this new knowledge, we may be able to restore synaptic connections in Alzheimer's patients after extensive plaques and tangles have formed in their brains," adds Tomohiro Nakamura, PhD, senior staff scientist in the Lipton laboratory group and first author of the study.

Revealing secret connections

Lipton says that one of the team's most incredible findings was that the three enzymes discovered to pass NO to each other along a concerted chain of events, resulting in energy failure, were previously not thought to be even remotely related to one another. Each of the enzymes is important in its own right in a completely disparate normal biochemical pathway, and yet they interact under disease conditions in a novel manner to trigger intense neuronal stress and synapse damage.

"This type of hidden or 'ghost' pathway may only become evident under disease conditions and may represent an important fundamental tenet of why we did not understand the disease process previously," Lipton says. "If we do not know about a pathway, scientists cannot study its contribution to disease or develop drugs to treat it."

While many molecular biochemical pathways have been discovered, an over-reliance on this existing body of evidence can actually impede discovery of disease processes, he adds.

"Hence, the most important aspect of the work is that we have to be on our guard to look for new pathways and new relationships of existing enzymes in order to understand and treat neurodegenerative disorders such as Alzheimer's," Lipton says.

Many everyday foods--from yogurt and other fermented foods to fresh fruits and vegetables--contain live microorganisms. And although humans have consumed these safe and potentially beneficial bacteria in their daily diets for millennia, live microbes have received much less attention than other components of the diet. With a rising global awareness of the importance of gut health, many people believe intake of live microbes is health-promoting, but so far it has not been possible for experts to create a guideline on how many we should be consuming on a daily basis.

A group of seven interdisciplinary scientists recently published a review paper in The Journal of Nutrition, titled: Should There Be a Recommended Daily Intake of Microbes? They explain that only weak evidence to date confirms the link between live microbes and better human health, highlighting specific gaps in the research and laying out a plan for quantifying the relationship between consumption of live microbes and health outcomes across populations.

In the review, the authors outline why this scientific endeavour is worthwhile, but far from straightforward. Challenges include the scant records on consumption of microbes in past human populations; frequent mis-reporting of dietary intakes in current nutrition research; and the complex biology of the digestive tract, which makes the mechanisms of microbial health benefits difficult to discover.

"People frequently hear that they should keep adding 'good microbes' to their gut microbiomes," says Dr. Mary Ellen Sanders, co-author of the paper and Executive Science Officer of the International Scientific Association for Probiotics and Prebiotics (ISAPP). "This makes intuitive sense, but it's important to build up the scientific evidence for the idea rather than just assume this is true. Our paper is a call for scientists around the world to start building the evidence base in a rigorous way."

The publication builds on a discussion group held at the 2019 ISAPP annual meeting in Belgium, which aimed to explore evidence that live microbes in general - and not only the bacterial strains that have special status as probiotics - form an essential part of the human diet.

"Currently, food guides around the world do not recommend daily intake of live microbes," says Sanders. "Although continual doses of live microbes may not be critical for our survival, by ignoring them we may be missing out on an important opportunity to support the health of different populations."

What The Study Did: State crisis standards of care (CSC) guidelines in the U.S. allocate scarce health care resources among patients, and this study examined the implications of these guidelines for patients with cancer, including allocation methods, cancer-related categorical exclusions and deprioritizations, and provisions for blood products and palliative care.

Authors: Gregory A. Abel, M.D., M.P.H., of the Dana-Farber Cancer Institute in Boston, is the corresponding author.

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

(doi:10.1001/jamaoncol.2020.6159)

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

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JAMA Oncology

Children grow taller in rural households where their mothers are supported to grow their own food - according to new research from the University of East Anglia (UEA).

The research, which looked at households in low- and middle-income countries, showed growing their own food helped mothers to prevent stunting, wasting and underweight in their children. Their children's food was more varied, meaning they had access to different classes of food nutrients.

The study, 'Impact of home food production on nutritional blindness, stunting, wasting, underweight and mortality in children: a systematic review and meta-analysis of controlled trials', is published today in the journal Critical Reviews in Food Science and Nutrition.

The team from the Norwich Medical School and the School of International Development at UEA analysed studies that introduced women to home farming in African and Asian countries including Nigeria, Ghana, India, Cambodia, Mozambique, Uganda, Kenya and Burkina Faso. The home farming included growing brightly coloured Vitamin A-rich fruit and vegetables such as sweet potatoes, and sometimes also included chicken farming.

The health of these women's children was assessed over the next year or more. The children of the women who were introduced to home farming did better than children of other women, in that they were less likely to suffer from wasting, stunting and underweight.

No studies, however, reported on children's eye health. The researchers concluded that high-quality trials are needed to assess the impact of home food production on nutritional blindness in children, especially in rural areas.

Xerophthalmia is abnormal dryness and inflammation of the eye, leading to irreversible blindness, and is predominantly caused by an insufficient intake of Vitamin A. Vitamin A supplementation prevents children from dying and improves their health in other ways, such as reducing the risk from measles. Many countries run Vitamin A supplementation programmes for children, but these often leave out children in rural areas.

Approximately 250 million preschool children are still Vitamin A deficient, according to the World Health Organization. Vitamin A deficiency is the main global cause of preventable childhood blindness with about 2.8 million preschool-age children at risk of blindness. Vitamin A deficiency also increases the risk of mortality from other childhood diseases, such as diarrhoea and measles, and plays a significant role in normal immune function. It remains one of the most prevalent micronutrient deficiencies globally.

Mrs Chizoba Bassey, a postgraduate researcher in UEA's Norwich Medical School, led the team conducting the systematic review.

Mrs Bassey said: "Well-evidenced interventions such as Vitamin A supplementation programmes should be adopted and expanded to children at greatest risk to prevent nutritional blindness.

"Currently there is not enough evidence of the effects of home gardening on xerophthalmia, night blindness or mortality in children, but the evidence from our research shows that if women take up home gardening the risk of stunting, wasting and underweight in their children is reduced.

"The introduction of home food production may be appropriate in areas where nutritional blindness, underweight, stunting and wasting are prevalent and where more intensive nutritional support, such as Vitamin A supplementation programmes, are not available."

Home farming may help to achieve sustainability in controlling Vitamin A deficiency and can complement Vitamin A supplementation programmes where they are available.

Allowing families to choose schools that are more suited to their children may play a key role in improving student mental health, including reducing adolescent suicide rates, suggests new research published in the peer-reviewed journal School Effectiveness and School Improvement.

The study is the first of its kind to examine the relationship between U.S. school choice policies and teen suicide and mental health issues.

U.S. states are expanding private school options through charter schools--which are publicly funded but granted charters to operate outside many of the regulations of regular neighbourhood schools--and voucher programs for students to attend a private school of choice. More than 6% (over 3.1 million) of all public school students attend charter schools, and over 5.7 million students attend private schools [1]. However, little is known about whether these choices affect students' mental health.

The U.S. National Institute of Mental Health estimates that around half of teenagers (aged 13-18 years) will experience a mental health disorder in their lifetime. Between 2007 and 2015, suicide rates doubled among girls aged 15-19 years, and rose by 30% in boys of the same age. Suicide is the second leading cause of death in Americans aged 15-34 years old, and the third in those aged 10-14 years.

To examine the relationship between school choice and adolescent suicide and the impact of private schooling on adult mental health, researchers analysed public and private school data from 49 states between 1976 and 2016, coupled with nationally representative data from 4,353 students participating in the 1997-1998 cohort of the National Longitudinal Survey of Youth (who were followed up for around 15 years).

The findings suggest that states adopting voucher and charter school choice laws witnessed declines in suicide rates among young people, even after accounting for demographic (e.g., age, race) and economic (e.g., unemployment rate, percentage of state below poverty line) factors. The researchers estimate that the effect of the charter school law translated to around a 10% decline in the suicide rate among 15 to 19-year-olds.

Further analyses of survey data suggest that private schooling was associated with better mental health in adulthood, even after controlling for important sociodemographic and health factors including gender, parental education level, household income, race, and measures of mental health near the start of the study.

Compared with public schools, individuals attending private school were about 2 percentage points less likely to report having a mental health condition at around 30 years old, and to be treated for a mental illness.

"Our findings raise the question of whether increased school choice could improve students short- and long-term mental health", says Professor Angela Dills from Western Carolina University, NC, USA who co-led the research. "It's likely that private schools face stronger competitive pressures to provide a safer school environment and improve mental health if they want to remain open. Public schools, on the other hand, are more likely to be burdened with government regulations that make it difficult for them to control discipline policy and create strong school cultures."

According to co-lead author Corey DeAngelis from the Reason Foundation in Washington, DC, USA: "Our results suggest that expanding school choice could help address the roots of the student mental health problem. Unfortunately, many students are stuck in unhealthy or unsafe school environments, which can have extremely harmful effects on their mental health. With further research the mechanisms that promote mental health in charter schools and private schools could be identified."

Published today in The Lancet Public Health, a study by researchers at King's College London research team detail the modelling behind the ZOE COVID Symptom Study App.

They found that self-reported data from over 2.8 million volunteer users of the app living in England, including more than 120 million daily assessments logged by those users, can be used to provide accurate estimates of COVID-19 prevalence and incidence, and timely identification of regional infection hotspots.

Joint first author Dr Mark Graham from King's College London said: "The data accurately predicted many of the hotspots that were significantly affected by the second wave, including detecting Leicester in June which then became the first region to be placed under local lockdown. In mid-July they detected many regions around Manchester, which was also placed under local restrictions in late July. The data will also likely prove valuable for detecting regional hotspots if we experience a third wave after lockdown is eased.

"The reduced reliance on PCR tests means this could be a cost-effective, complementary and rapid way for governments to monitor the spread of COVID-19 and identify potential areas of concern. Detection of hotspots should encourage additional testing capacity to be focused on these regions, to ensure as many new cases are captured as possible and onwards transmission chains broken."

The study's joint first author Thomas Varsavsky from King's College London said: "We also found that regions where more tests are being carried out have better agreement with our predictions of incidence. We hope that this can inform policy makers about which areas would benefit from additional testing, thus detecting hotspots earlier."

Researchers found that one advantage of the app is the data is released every day, while ONS is released weekly and REACT every few weeks - this means that the app team might be able to pick up changes in incidence or prevalence earliest with their data.

"Our results show that a mobile-based approach detects similar incidence and prevalence to the more traditional but less cost effective ONS/REACT-1 approaches, which is encouraging," Dr Graham said. "To make better public health decisions, the ZOE Covid Symptom Study data should be seen as a complementary data source to ONS and REACT. Like all the surveys, our sample is not fully representative of the population, and while the team seek to address this with our modelling, the results need to be interpreted with this in mind."

Professor Sebastien Ourselin, lead senior author from King's College London said: "Using the data from the ZOE COVID Symptom Study App as an adjunct to other sources of information means that we can equip communities with the most up to date and reliable information with which the best actions can be taken to tackle the pandemic. Earlier identification of hotspots, more information on prevalence and incidents builds a stronger defence in conjunction with the latest data being released."