Culture

Chicago--October 1, 2020--A mindfulness-based stress reduction (MBSR) course was found to benefit patients with chronic pain and depression, leading to significant improvement in participant perceptions of pain, mood and functional capacity, according to a study in the Journal of the American Osteopathic Association. Most of the study respondents (89%) reported the program helped them find ways to better cope with their pain while 11% remained neutral.

Chronic pain is a common and serious medical condition affecting an estimated 100 million people in the United States, which correlates with annual costs of approximately $635 billion. The small-scale study was conducted in a semi-rural population in Oregon where issues of affordability, addiction and access to care are common. Participants received intensive instruction in mindfulness meditation and mindful hatha yoga during an eight-week period.

"Many people have lost hope because, in most cases, chronic pain will never fully resolve," says Cynthia Marske, DO, an osteopathic physician and director of graduate medical education at the Community Health Clinics of Benton and Linn County. "However, mindful yoga and meditation can help improve the structure and function of the body, which supports the process of healing."

Healing and curing are inherently different, explains Dr. Marske.

"Curing means eliminating disease, while healing refers to becoming more whole," Dr. Marske says. "With chronic pain, healing involves learning to live with a level of pain this is manageable. For this, yoga and meditation can be very beneficial."

The study found mindful meditation and yoga led to significant improvements in patients' perceptions of pain, depression and disability. Following the course, Patient Health Questionnaire (PHQ-9) scores, a standard measure of depression, dropped by 3.7 points on a 27-point scale. According to Dr. Marske, some patients experience a similar drop from the use of an antidepressant.

"Chronic pain often goes hand-in-hand with depression," says Dr. Marske. "Mindfulness-based meditation and yoga can help restore both a patient's mental and physical health and can be effective alone or in combination with other treatments such as therapy and medication."

Study participants received instruction in MBSR, a systematic educational program based on training people to have an awareness of the self in the present moment and a nonjudgmental manner. The findings bolster other evidence that MBSR can be a useful adjunctive treatment for chronic pain while improving perceived depression.

"The bottom line is that patients are seeking new ways to cope with chronic pain and effective non-pharmaceutical treatments are available," says Dr. Marske. "Our findings show meditation and yoga can be a viable option for people seeking relief from chronic pain."

A new study of approximately 80,000 patients shows that people with Parkinson's disease (PD) have a 30% higher risk of dying from COVID-19 than people without the neurodegenerative condition.

The new analysis conducted by researchers with University of Iowa Health Care based on patient data in the TriNetX COVID-19 research network suggests that Parkinson's disease is an independent risk factor for dying from COVID-19.

The UI research team led by neurologists Qiang Zhang, MD, and Nandakumar Narayanan, MD, PhD, identified the COVID-19 patient cohort as of July 15 and analyzed the mortality data eight weeks later. They found that 5.5% (4,290 out of 78,355) of COVID-19 patients without PD died compared to 21.3% (148 of 694) COVID-19 patients who also had PD.

However, the patients with PD were generally older, more likely to be male, and less likely to be African American than the patients without PD. All of these factors also increase the risk of death from COVID-19.

So, the UI team used two approaches to account for these differences: logistic regression with age, sex, and race as covariates, and matching each PD patient with five non-PD patients with the exact age, sex, and race, and performing a conditional logistic regression. In both cases, the researchers found that the risk of dying from COVID-19 was 30% higher for patients with PD. The findings are published in the journal Movement Disorders.

"We recognize the limitations of this study; it is retrospective data from a single database, but we are confident that these data show that Parkinson's disease is independent risk factor for death in COVID-19," says Narayanan, UI associate professor of neurology and a member of the Iowa Neuroscience Institute. "We believe this observation will be of interest to clinicians treating patients with Parkinson's disease, and public health officials."

The researchers say the findings should also inform patients with PD, and their physicians, of the increased importance of preventing COVID-19 infection in these patients.

"For our own patients, we can give advice that it's important that you wear a mask. It's important that you socially distance," says Zhang, an associate in the UI Department of Neurology.

Zhang adds that physicians should also weigh the increased risk of death from COVID-19 when considering how to care for PD patients in person during the pandemic.

A potential reason why PD patients have an increased risk of death from COVID-19 may be related to the fact that COVID can cause pneumonia and pneumonia is a leading cause of death in patients with PD. This is partly because Parkinson's patients can have trouble swallowing or choking that can cause aspiration.

"We are all focused on COVID right now, but this is a clear example of a respiratory illness that leads to increased mortality [in PD patients]. These findings may also have implications for understanding risks for PD patients from other diseases, including influenza," Narayanan says. "I would recommend a flu vaccine and pneumonia vaccine to try to prevent these problems in patients with PD."

In a recently published study in the Journal of Clinical Oncology - Oncology Practice, investigators from MUSC Hollings Cancer Center classify numerous barriers to a recommended therapy for head and neck cancer that may mean the difference between life and death for these patients.

Cancer of the head and neck is one of the deadliest cancers. Only half of those with head and neck cancer are alive five years following initial diagnosis. African Americans, in particular, experience worse survival outcomes. These patients are 50% more likely to die from the disease than white people, a concerning trend that has prompted deeper research into factors that might drive these significant disparities in head and neck cancer mortality.

The Hollings study team is led by Evan Graboyes, M.D., a surgeon scientist who is examining how to improve the timeliness and equity of care delivery to decrease head and neck cancer recurrence and improve survival. "The key measure of timely head and neck cancer care is the time between when patients get surgery and when they start their radiation. When people get their care within six weeks, it is less likely to recur. Unfortunately, we also know that nationally about half of head and neck cancer patients don't get their radiation started on time, and that radiation treatment delays disproportionately burden African Americans."

To understand more fully factors contributing to head and neck cancer treatment delays, Graboyes and his team conducted structured interviews with patients, providers, nurses, nurse practitioners, surgeons and radiation and medical oncologists across South Carolina. "It's a qualitative study," Graboyes explained, "where the key unit of analysis isn't numbers but rather words and stories. Qualitative studies are really helpful for providing an in-depth understanding of experiences that patients, providers and other interviewees can offer us."

Multiple levels of barriers

What makes this issue complex is that there are multiple obstacles that interact to prevent a patient from getting radiation treatment in a timely manner. The researchers found those obstacles include:

A lack of patient and provider education on national standards of care.

Unexpected post-surgical complications that interrupted tight treatment timelines.

Poor communication between medical teams.

Burdensome travel requirements to see different specialists.

"One of the interesting things we found is that patients might experience several of these barriers, just at different points in time during their treatments," Graboyes said. "Their difficulties were constantly evolving as they progressed through the cancer care continuum."

The study presents a novel theory-driven conceptual framework that classifies common treatment hurdles. The categories include problematic individual behaviors of patients and providers (intrapersonal barriers); insufficient communication between patients, providers, and caregivers (interpersonal barriers); insufficient communication between disparate care teams (health care barriers); inefficiencies related to fragmentation of care across organizations (organizational barriers); and challenges in health care access (community-level barriers).

"Within the cancer care delivery research spectrum, we as cancer researchers have spent a lot of time trying to understand how and why people do or don't participate in screening activities and then developing interventions to implement into health care systems to help address those determinants," he said. "There is a much less concerted effort and less scientific progress in trying to understand how the actual cancer care delivery itself happens. That's why I think this research really is exciting."

Beyond the study

Graboyes hopes that their model will facilitate future head and neck cancer interventions that target treatment barriers at one or more levels. "We know a lot about who is at risk for experiencing treatment delays, but before this study, we didn't really understand why," said Graboyes. "What this study does is give us a framework, a vocabulary and an understanding of how to relate these themes together in future quantitative studies."

Graboyes credits the resources of the Hollings Cancer Control Research Program; the expertise of his team, including center members Chanita Hughes-Halbert, Ph.D., Katherine Sterba, Ph.D., Hong Li, Ph.D., and Graham Warren, M.D., Ph.D.; and the outstanding multidisciplinary head and neck oncology group as being critical to the success of the study.

"Hollings Cancer Center has been a major enabler of this research where we are trying to understand cancer care delivery across the state, with a specific focus on the racial minority patient population and the challenges they face."

Next, Graboyes intends to test whether an intervention strategy funded by the National Cancer Institute, referred to as NDURE (Navigation for Disparities and Untimely Radiation thErapy), can improve patient outcomes. A major feature of this intervention will be the role of an assigned navigator who will work with head and neck cancer patients to create a tailored and dynamically evolving plan based on which barriers they are experiencing. A patient and referral tracking system also will be employed to check on the patient's progress across health care systems, remind them of upcoming appointments and help to identify needed travel resources to keep care timelines on track.

Graboyes anticipates that his conceptual framework will facilitate novel intervention strategies for other cancers besides head and neck cancer. "There are many other cancer types besides head and neck cancer that are treated with multimodal, sequential cancer treatment paradigms. The work we are doing, trying to understand the determinants of head and neck cancer, certainly can benefit other cancers with similar care delivery challenges."

For many developing countries, it is difficult to break the cycle of corruption on their own. Historically, multinational firms have assumed that they have two options available when dealing with corruption in developing countries: "play the game," meaning pay bribes or engage in corrupt activities, or "leave the table" by avoiding investing in countries where corruption is widespread. New research from Charles E. Stevens, associate professor of management in Lehigh's College of Business, shows firms taking a third approach-managing corruption by promoting positive engagement with the host country.

The study, "Avoid, acquiesce ... or engage? New insights from sub-Saharan Africa on MNE strategies for managing corruption," funded by a Social Sciences and Humanities Research Council of Canada grant, is published in the latest issue of Strategic Management Journal.

Using an inductive, qualitative research design, Stevens, in collaboration with Aloysius Newenham-Kahindi, associate professor at the University of Victoria, was able to better understand how and why issues relating to corruption arose and how firms dealt with them. According to Stevens, firms may typically "tread lightly," but his research shows firms having success by making deeper, long-term commitments.

"Within the last decade, a number of developing country firms, many of them from China, were taking a different approach that we termed an engagement strategy that, in many ways, was unexpected and counter-intuitive because it tended to involve greater commitment and greater investment to countries where there was more corruption," said Stevens.

Stevens and Newenham-Kahindi were curious to see if these firms were less concerned with corruption, but research found that was not the case.

"Many of these firms were following rather interesting and complex strategies, many that involved multiple actors that were designed at minimizing the ability of host-country actors to request bribes by maximizing their bargaining power or by minimizing the motivation of host-country actors to request bribes by increasing their legitimacy," explained Stevens.

Facing challenges related to studying corruption due to the illegal activity often being hidden, Stevens and Newenham-Kahindi surveyed those who experience dealing with corruption directly. Among those interviewed for the study were 445 individuals representing industries such as construction, mining, manufacturing, energy, and telecommunications in both developed and developing country firms; 126 host country government officials and employees; 34 local private sector employees; 44 local institutional researchers; and 142 members of the general public.

According to Stevens, this paper fills an important gap in corruption literature by increasing the understanding of the options and strategies that firms have at their disposal when they invest in countries where corruption is a greater problem.

With this study, the researchers are hoping to change policies and practices by both firms and governments.

"We hope that this research allows firms, governments, and the general public to achieve economic prosperity, reduce corruption, and create mutually-beneficial solutions through investment and growth," said Stevens. "Firms shouldn't automatically be afraid to invest in countries where risks like corruption are present. Such countries present many challenges, but for firms that go in with a comprehensive plan, are prepared to make a long-term commitment, and find ways to leverage partnerships with governments and other firms, the rewards can be worth the risks."

A group led by researchers at Butantan Institute in Brazil and supported by FAPESP has described for the first time the presence of venom glands in the mouth of an amphibian. The legless animal is a caecilian and lives underground. It has tooth-related glands that, when compressed during biting, release a secretion into its prey - earthworms, insect larvae, small amphibians and snakes, and even rodent pups. A paper reporting the study is published
in iScience.

"We were analyzing the mucus glands in the skin of the animal's head, which it uses to burrow down into the soil, when we discovered these structures. They're located at the base of the teeth and develop out of the dental lamina, the tissue that typically gives rise to teeth, as is the case with snakes' venom glands," said Pedro Luiz Mailho-Fontana, first author of the paper and a postdoctoral intern at Butantan Institute with a scholarship from São Paulo Research Foundation - FAPESP.

An article by the same group published in 2018 in Scientific Reports showed that in addition to mucus glands in the skin all over the body caecilians have many poison glands in the skin of the tail as a passive defense against predators. This system, which is also found in frogs, toads and salamanders, poisons predators when they bite caecilians.

In the new report the researchers show that caecilians can be venomous, and indeed are the first amphibians to have an active defense system. Biologists apply the term venomous to organisms that bite or sting to inject their toxins, such as snakes, spiders, and scorpions, whereas poisonous refers to organisms that deliver toxins when touched or eaten.

In these caecilians, the secretion released by the glands also serves to lubricate a prey so that it is easier to swallow.

"Snakes have pouches to accumulate venom, which they inject through fangs when the pouches are squeezed by muscles. In rattlesnakes and pit vipers, for example, the teeth are hollow like hypodermic needles. In caecilians, gland compression during biting releases the venom, which penetrates the puncture wound. The same goes for lizards like the Komodo dragon and Gila monster," said Carlos Jared, a researcher at Butantan Institute and principal investigator for the study.

The study was part of the FAPESP-funded project "Unraveling parental care in caecilians: nutritional and toxinological implications in Siphonops annulatus". In a paper published in Nature in 2006, the researchers were the first to show that offspring of the caecilian species Boulengerula taitanus feed solely on the mother's skin in the first two months of their lives. In 2008 the group described the same behavior for Siphonops annulatus in a paper published in Biology Letters .

Except for a group that lives in aquatic environments, caecilians spend their entire lives in burrows or underground tunnels. As a result, they have very small eyes, which sense light but do not form images. They are also the only vertebrates that have tentacles. In caecilians, these are near the eyes and act as feelers equipped with chemical sensors that test the environment for sensory data.

Characterization of venom

The researchers' biochemical analysis showed that the secretion released from the animal's mouth while it is biting contains phospholipase A2, an enzyme commonly found in the venom of bees, wasps, and snakes. They found the enzyme to be more active in caecilians than in rattlesnakes. However, this trait is not sufficient to prove they are more venomous than snakes.

The group will now conduct tests using molecular biology techniques to characterize caecilians' dental gland secretion more precisely and confirm that it is venomous. In the future they may test any proteins they find in order to explore possible biotechnological applications such as drug development.

Four species were analyzed in the study. In Typhlonectes compressicauda, the only one that lives in aquatic environments, the glands were found only in the lower jaw. The researchers believe it may have lost the upper-jaw glands during the evolutionary process (as did some water snakes) since the water in the environment naturally lubricates prey. The mandibular glands were retained, probably for venom.

Most of the 214 known species of caecilians live underground in the humid forests of South America, India, and Africa. Owing to their subterranean habits, biologists rarely have a chance to find out more about these animals.

More than new data about caecilians, the study offers important information regarding the evolution of amphibians and reptiles. "For snakes and caecilians, the head is the only tool for exploring the environment, fighting, eating and killing. This may have fueled evolutionary pressure for these limbless animals to develop venom," said Marta Maria Antoniazzi , also a researcher at Butantan Institute and a co-author of the study.

October 1, 2020 -- Menthol could be exacerbating deep social inequities according to a paper just published in Nicotine & Tobacco Research. Researchers at Columbia University Mailman School of Public Health and colleagues at CUNY and Rutgers School of Public Health suggest that a ban on menthol cigarettes could have monumental implications for both the short- and long-term physical and mental health of communities of color.

"Assessing menthol smoking status should be a priority in all substance use research and smoking cessation interventions," observed Renee Goodwin, PhD, an epidemiologist at Columbia Mailman School, and senior author. "A decade after Congress exempted menthol from the flavored cigarette ban, preference for menthol remains more popular among young smokers and extremely high among Black smokers."

Overall estimates indicate that over 630,000 deaths would be averted and that one of three of these would be a Black life if menthol was included in the flavored cigarette ban.

Using data from the most recent National Survey on Drug Use and Health (NSDUH), the analysis showed that 10 years after the exemption of menthol from the ban, its preference among cigarette smokers remains inversely correlated with age and race. Among black smokers, 85 percent had a preference for menthol cigarettes while only 29 percent of Non-Hispanic Whites expressed the same penchant.

According to Goodwin, in the context of inaction on menthol, young people and Black smokers are not the only vulnerable populations that warrant attention with respect to menthol smoking. Preference for menthol among cigarette smokers was also disproportionately high among lesbian and gay smokers (51 percent), bisexual smokers (46 percent), and smokers with mental health problems (45 percent). The analyses also highlighted disproportionately high percentages among socioeconomically disadvantaged populations and pregnant women.

"The menthol loophole and subsequent inaction on menthol comes down to policy makers, political influence, and power," noted Cristine Delnevo of Rutgers and the first author. "For decades, tobacco companies have been targeting marginalized populations with advertising for menthol cigarettes. It's clear that a ban on menthol is not only necessary for the protection of public health, but also to achieve health equity in the U.S."

Studies have long reported that Black cancer patients have poorer outcomes than their white counterparts. But two University of Colorado Cancer Center researchers decided to investigate the data further and figure out why. What they found was that the outcome disparity was caused not by biology, but simply by differences in access to health care.

The researchers, Jessica McDermott, MD, an assistant professor in the Department of Medical Oncology, and Sana Karam, MD, PhD, an associate professor in the Department of Radiation Oncology, examined Medicare data for individuals suffering squamous cell cancer of the head and neck. All 13,117 patients in this study were diagnosed with their first and only malignant tumor at age 66 or older sometime between 2006 and 2015.

The data confirmed what has been widely reported for years ¬- that the Black head and neck cancer patients had worse outcomes than the white cancer patients.

"But then when we controlled for access to care, those differences suddenly disappeared," says McDermott. "When you closely examine the data, it becomes clear what is going on."

Their findings were published this week in the Journal of the National Comprehensive Cancer Network. The physicians hope their research will catch the attention of those who can help narrow those disparate outcomes.

McDermott and Karam identified two major differences for Black patients: first, they presented at later stages of cancer, and second, they were less likely to receive treatment.

"This is an interesting finding," says McDermott. "A lot of the reasons driving the disparate outcomes came down to socially related things - they were less likely to be married, lived in poor areas, had comorbidities [presence of two or more chronic diseases], were less likely to see a primary care provider in the year leading up to the diagnosis, and were more likely to present in the emergency room."

For most cancers, where and when a patient first presents can make a large difference both in the care received and in the outcome.

"Just a reminder that we are talking about a curable disease, a disease that, if treated properly, can be eradicated with a high degree of certainty," says Karam. "I hope that more targeted interventions can be developed as a result of our findings. The problem lies not so much in biological differences, but access. If Black patients get the treatment, they do just as well."

A teaching and research hospital like the University of Colorado can lead the way in improving the care of underserved communities.

"Like many other tertiary care centers, we have a great number of clinical trials, but not everyone who could benefit from them enjoys access," says Karam. "We need to enhance our ability to deliver more broadly the best and newest trials that can extend life and decrease symptom burden."

Black lives matter

The disparities that Black community members face are gaining national attention after the deaths of George Floyd and other Black men and women. But one area of inequity that has not received as much attention is access to medical care. Last month, dozens of providers gathered at the Anschutz Medical Campus to support a national movement by kneeling with fellow White Coats for Black Lives members.

"Speaking up is an important first step towards change," says Karam. "But it must be accompanied by policy change aimed at expanding access to care. We invest billions in new therapies that might or might not work but devote far less attention to helping our socially challenged patients get through the door, which our study shows does work."

The doctors say that more work is needed to overcome hurdles to health care access.

"We also need to educate the next generation of doctors on showing compassion and sensitivity to issues of race, income, social challenges, addiction, and other access barriers," says Karam.

What the CU Cancer Center is doing to help

Prior to this study's publication, Dr. McDermott was awarded a grant from the CU Cancer Center Office of Community Outreach and Engagement to increase the representation of the Hispanic populations in head and neck cancer clinical trials. Colorado has a large population of Hispanics, which makes that population an easier place to begin making changes.

"Our goal is to use that project to branch out to Hispanics, Blacks, and anyone else with socioeconomic issues that currently compromise their access to care," says McDermott.

The CU Cancer Center will continue studying the health disparities for different types of cancer and investigating strategies for eliminating the barriers faced by those needing care.

PHILADELPHIA (October 1, 2020) - Insulin pumps are widely used in the management of type 1 diabetes (T1D) and reviews have shown insulin pump therapy to be associated with improved glycemic control, fewer severe hypoglycemia events, and improved quality of life. Yet, non-Hispanic white children (NHW) are more than twice as likely as non-Hispanic Black children (NHB) to use this technology.

In an article in the Journal of Pediatric Nursing, researchers outline their study findings which have determined that this gap has persisted for 15 years. They consider that this inequity among children with T1D may not be simply attributable to socioeconomic status. They also believe it plays a role in the racial disparities in clinical outcomes seen in type 1 diabetes as NHB children have worse glycemic control and higher rates of complications of the disease.

"This study demonstrates a remarkable lack of progress in addressing racial and ethnic disparities in the area of T1D over the past decade. The extent of these disparities must be fully investigated through research with parents of children with diabetes, and with providers, to determine the contributing factors -- including the impact of implicit bias and structural racism," writes Terri H. Lipman, PhD, CRNP, FAAN, the Miriam Stirl Endowed Term Professor of Nutrition, Professor of Nursing of Children and Assistant Dean for Community Engagement at the University of Pennsylvania School of Nursing (Penn Nursing)

The researchers suggest that increasing diversity in the health care workforce or adding community health workers to the team may play an important role in overcoming these barriers to equitable care. "Interventions must be developed to address these disparities so that optimal diabetes care can be provided to children of all racial, ethnic, and socioeconomic backgrounds," writes Lipman.

"It's exciting. I love this stuff!" said Bashar Badran, Ph.D. "This is so fun."

Not many researchers get the chance to float, weightless, 32,000 feet above the Earth. Medical University of South Carolina scientists usually conduct research in labs - controlled settings where they can carefully repeat experiments to double-check results. But with an eye toward what real astronauts might experience in future space travel, a few scientists recently took to the skies to do brain research in zero gravity.

Neuroradiologist Donna Roberts, M.D., and neuroscientist Badran collaborated on the project to conduct transcranial magnetic stimulation, or TMS, on themselves and a group of volunteer assistants, mostly from the Department of Psychiatry and Behavioral Sciences in the MUSC College of Medicine.

Roberts has spent years studying how zero gravity and microgravity affect the human brain - in fact, that was her motivation for going to medical school. This experiment was primarily a test case to show that TMS could be safely used in zero gravity and to compare participants' results under the force of Earth's gravity to their results in zero gravity.

During a TMS procedure, a magnetic pulse is sent through the skull into the brain to stimulate electrical activity. The pulse is highly localized - it doesn't reach the entire brain. The TMS administrator places a coil over the subject's head; when the subject's thumb twitches, the administrator knows the TMS coil is in the right spot.

Here on Earth, TMS is FDA approved for hard-to-treat depression. Scientists at MUSC and elsewhere are also investigating using TMS for post-traumatic stress disorder; to treat cravings and pain in people under treatment for opioid use disorder; and in physical and mental rehab for stroke patients. Depression could be a concern for people on long-term missions far from Earth who don't expect to set foot on solid ground for years, and Roberts and Badran said TMS could be a useful and space-saving tool to pack on long-term space missions, rather than an entire pharmacy's worth of medications.

"Ultimately, you don't want to go to Mars or an interplanetary mission with all these medications. And you can't easily set up a chemistry lab to synthesize all of them. So TMS would be a very clear, easy solution for neuropsychiatric issues. That's the long 20-year vision," Badran said.

It also has the potential to keep astronauts in good shape cognitively on long-term flights so they're ready to get to work when they land on the moon or the red planet.

But first, researchers must figure out what a "normal" reading in zero gravity should look like.

It's already known that medications metabolize differently when a person is in space. Astronauts who take sleeping pills, for example, have to figure out through trial and error the proper dosage in space, Roberts said.

And Roberts' previous research, comparing astronauts' brain MRIs before and after a trip to the International Space Station, showed physical changes in the brain that correlated to changes in the astronauts' motor skills and cognitive performance.

"If there were a way to keep the brain in shape on the way to Mars, that would be very useful. That's why NASA is interested in this technology. But in order to use it in space, we have to understand, 'Is there a difference in the way astronauts respond to it here on Earth versus up in space?' just like the difference they experience in medications. So that was what this study was really based on," she said.

And this is where the scientists got to have a little fun. To test TMS in zero gravity, they would board a special plane operated by Zero Gravity Corporation, which offers zero gravity flights for personal adventure, media productions and research.

The plane, dubbed G-Force One, flies a series of arcs, heading upward at 45 degrees and then back down at 45 degrees. For the brief 20 to 30 seconds between going up and coming down, everyone in the plane becomes weightless. Anything not bolted down floats up. And that mere 20- to 30-second window was the time during which Roberts and Badran had to run their TMS test.

They would have a total of 30 arcs, or parabolas, to work with. There were 10 people in their group, split between men and women, and each person needed to do the test at least twice to get a good sample.

But first, there were some logistics to overcome. In the lab, there can be a lot of fussing with the equipment to get the coil to the exact right spot on someone's head. With such a short window for performing the test on the plane, there wouldn't be time to futz with the machinery. They needed a foolproof way to ensure the coil would be in the right place at the right time.

"We all really focused on the small things," Badran said. "This study was really a one-shot deal. The flight was prebooked. Everything was set. We had a fixed start date, a fixed time period to do the experiment and everything had to go perfectly - and everything hinged on creating this thing that didn't exist."
So Badran got hold of a motorcycle helmet and a Dremel saw and got to work. He found he could fit a TMS coil into a niche he cut into the helmet, but the contraption was too heavy and wobbly to be practical.

Next, he turned to using fiberglass casting tape, the same material used to make casts for broken bones. Each participant sat for a fitting, and Badran crafted a lightweight, durable helmet that fit the individual's head, with an attachment area for the TMS coil that ensured the magnetic pulse would reach the right spot on that individual's brain - no tinkering required.

Roberts and Badran's volunteer team consisted of people from the Department of Psychiatry and Behavioral Sciences with experience administering TMS, since they all would need to take turns as both subjects and administrators. They wanted people who were roughly the age of actual astronauts, so the average age was in the 30s.

"Everyone that was a flier, they didn't just get to come and fly and have fun. They were actively part of the research team, too," Badran said.

Roberts and Badran knew they had one chance to make the experiment work. These flights are costly, and the bulk of the research grant was going toward that expense. In each 20 to 30 seconds of weightlessness, they would need to start the software on their computers, which would send a signal to the coil, register a thumb twitch and then report back that the TMS had worked. If it didn't register a thumb twitch, then the system would increase power and send another signal until a thumb twitch registered. But if it didn't work at all, they would have to troubleshoot on the fly - or face the possibility of the entire experiment being a complete failure.

The MUSC group shared the flight with three other organizations conducting space research. Because the TMS machines pulled power from the aircraft, Badran had to run a test on the ground first, at full power, to ensure they wouldn't overload the plane. It was pretty close, he said, but the flight crew gave them the go-ahead. So up they went.

The handcrafted helmets performed beautifully. They got at least three measurements for each person, which they could compare to multiple measurements taken on the ground before and after the flight. And as a bonus, the experiment was way more fun than your typical lab experiment.

Their paper, published Sept. 21 in Nature Microgravity, shows that less electromagnetism was needed in zero gravity than on Earth to induce a thumb twitch. That suggests neurophysical changes happening in the brain, but there are several possible explanations, ranging from the brain physically shifting within the skull to neurons reacting more strongly to stimulation. There's more to be learned, they said.

It's an issue near to Roberts's heart, as she has argued multiple times, most recently in an opinion piece in The Lancet Neurology, for more research into brain changes in space explorers.

Having shown that TMS is possible in zero gravity, the team is well-equipped to continue finding answers to these questions.

One feature of the COVID-19 virus that makes it so difficult to contain is that it can be easily spread to others by a person who has yet to show any signs of infection. The carrier of the virus might feel perfectly well and go about their daily business--taking the virus with them to work, to the home of a family member, or to public gatherings.

A crucial part of the global effort to stem the spread of the pandemic, therefore, is the development of tests that can rapidly identify infections in people who are not yet symptomatic.

Now, Caltech researchers have developed a new type of multiplexed test (a test that combines multiple kinds of data) with a low-cost sensor that may enable the at-home diagnosis of a COVID infection through rapid analysis of small volumes of saliva or blood, without the involvement of a medical professional, in less than 10 minutes.

The research was conducted in the lab of Wei Gao, assistant professor in the Andrew and Peggy Cherng department of medical engineering.. Previously, Gao and his team have developed wireless sensors that can monitor conditions such as gout, as well as stress levels, through the detection of extremely low levels of specific compounds in blood, saliva, or sweat.

Gao's sensors are made of graphene, a sheet-like form of carbon. A plastic sheet etched with a laser generates a 3D graphene structure with tiny pores. Those pores create a large amount of surface area on the sensor, which makes it sensitive enough to detect, with high accuracy, compounds that are only present in very small amounts. In this sensor, the graphene structures are coupled with antibodies, immune system molecules that are sensitive to specific proteins, like those on the surface of a COVID virus, for example.

Previous versions of the sensor were impregnated with antibodies for the hormone cortisol, which is associated with stress, and uric acid, which at high concentrations causes gout. The new version of the sensor, which Gao has named SARS-CoV-2 RapidPlex, contains antibodies and proteins that allow it to detect the presence of the virus itself; antibodies created by the body to fight the virus; and chemical markers of inflammation, which indicate the severity of the COVID-19 infection.

"This is the only telemedicine platform I've seen that can give information about the infection in three types of data with a single sensor," Gao says. "In as little as a few minutes, we can simultaneously check these levels, so we get a full picture about the infection, including early infection, immunity, and severity."

Established COVID-testing technologies usually take hours or even days to produce results. Those technologies also require expensive, complicated equipment, whereas Gao's system is simple and compact.

So far, the device has been tested only in the lab with a small number of blood and saliva samples obtained for medical research purposes from individuals who have tested positive or negative for COVID-19. Though preliminary results indicate that the sensor is highly accurate, a larger-scale test with real-world patients rather than laboratory samples must be performed, Gao cautions, to definitively determine its accuracy.

With the pilot study now completed, Gao next plans to test how long the sensors last with regular use, and to begin testing them with hospitalized COVID-19 patients. Following in-hospital testing, he would like to study the suitability of the tests for in-home use. Following testing, the device will need to receive regulatory approval before it is available for widespread use at home.

"Our ultimate aim really is home use," he says. "In the following year, we plan to mail them to high-risk individuals for at-home testing. And in the future, this platform could be modified for other types of infectious disease testing at home."

PHILADELPHIA -- A new, rare genetic form of dementia has been discovered by a team of Penn Medicine researchers. This discovery also sheds light on a new pathway that leads to protein build up in the brain -- which causes this newly discovered disease, as well as related neurodegenerative diseases like Alzheimer's Disease -- that could be targeted for new therapies. The study was published today in Science.

Alzheimer's disease (AD) is a neurodegenerative disease characterized by a buildup of proteins, called tau proteins, in certain parts of the brain. Following an examination of human brain tissue samples from a deceased donor with an unknown neurodegenerative disease, researchers discovered a novel mutation in the Valosin-containing protein (VCP) gene in the brain, a buildup of tau proteins in areas that were degenerating, and neurons with empty holes in them, called vacuoles. The team named the newly discovered disease Vacuolar Tauopathy (VT)--a neurodegenerative disease now characterized by the accumulation of neuronal vacuoles and tau protein aggregates.

"Within a cell, you have proteins coming together, and you need a process to also be able to pull them apart, because otherwise everything kind of gets gummed up and doesn't work. VCP is often involved in those cases where it finds proteins in an aggregate and pulls them apart," Edward Lee, MD, PhD, an assistant professor of Pathology and Laboratory Medicine in the Perelman School of Medicine at the University of Pennsylvania. "We think that the mutation impairs the proteins' normal ability to break aggregates apart."

The researchers noted that the tau protein they observed building up looked very similar to the tau protein aggregates seen in Alzheimer's disease. With these similarities, they aimed to uncover how this VCP mutation is causing this new disease -- to aid in finding treatments for this disease and others. Rare genetic causes of diseases can very often offer insight into more prevalent ones.

The researchers first examined the proteins themselves, in addition to studying cells and an animal model, and found that the tau protein buildup is, in fact, due to the VCP mutation.

"What we found in this study is a pattern we've never seen before, together with a mutation that's never been described before," Lee said. "Given that this mutation inhibits VCP activity, that suggest the converse might be true -- that if you're able to boost VCP activity, that could help break up the protein aggregates. And if that's true, we may be able to break up tau aggregates not only for this extremely rare disease, but for Alzheimer's disease and other diseases associated with tau protein aggregation."

Sitting atop power transformers are wavy shaped bushing systems that play a critical role in supplying communities with electricity. However, these objects are also susceptible to breaking during earthquakes. Once damaged, bushings can cause widespread outages and burden the state with expensive repairs.

In a recent study, Texas A&M University researchers have shown that during high seismic activity, the structural integrity of bushing systems can be better maintained by reinforcing their bases with steel stiffeners. Also, by using probability-based loss assessment studies, they found that the economic burden due to damage to bushing systems from earthquakes is up to 10 times lower for steel-reinforced transformer bushing systems compared to other bushing configurations.

"Transformer bushing systems are vital to electrical substation networks, and these components are especially vulnerable in high-seismic regions, like in California or parts of the northeast," said Dr. Maria Koliou, assistant professor in the Zachry Department of Civil and Environmental Engineering. "We have conducted a full risk and loss assessment of the impact of damaged bushings in terms of cost and time to recovery for electrical power networks."

The details of the study are provided in the July issue of the journal Structure and Infrastructure Engineering.

An electrical bushing is a sleeve-like covering that surrounds a conductor carrying a high voltage electrical current. Generally found at close proximity to transformers or circuit breakers, these systems ensure that electric currents do not leak out of metal wires. Thus, bushings are made of insulators, porcelain in particular, and are filled with mineral oil.

Despite their ability to withstand strong electric fields, bushings are brittle and can crack easily in the event of high seismic activity. Consequently, any damage to them is an electrical hazard. More extensive structural injuries to the bushing system can cause widespread power outages and high replacement costs.

One possible way to mitigate damage and thereby repair is by strengthening the bushing with steel plates. Just like a strong foundation can improve a building's stability, steel flexural stiffeners as close as possible to the bushing base has been shown to improve bushing stability during earthquakes. However, Koliou said a more comprehensive analysis of the impact of seismic vulnerability on bushing systems in terms of recovery costs has been lacking.

To address this gap, Koliou and her graduate student, Andrew Brennan, conducted a probabilistic analysis to compare the economic losses incurred from the damage of bushings for different intensities of ground motions. They investigated bushings of different geometries representative of medium- and high-voltage scenarios. More importantly, some bushings had steel plate stiffeners and others did not in their original designs.

Koliou and Brennan found that the economic losses for the earthquake intensities considered in the study were 33-55% lesser when the bushings' bases are reinforced with steel plates. In fact, the expected annual losses for bushings without the steel stiffeners were at least 2.5-10 times larger when subjected to different ground motions.

"Our results show that steel stiffeners are effective at preventing bushings from damage, but what 'effective' means for a structural engineer can have little meaning for someone who is not. We wanted to generalize our findings in more practical terms for stakeholders other than engineers," said Koliou. "And so, we quantified the benefit of using steel stiffeners in terms of a dollar value and the time it would take to recover for a variety of earthquake scenarios, which is more easily interpretable."

Although there is still uncertainty about the clinical benefits and role of convalescent plasma to treat COVID-19, new research suggests that the earlier plasma is collected after the donor's recovery from COVID-19, the better, as antibodies start to disappear after three months of symptom onset. The results, which authors say may also have implications for vaccine design and for prevalence studies in communities trying to gauge how many people have recovered from the virus, are published today in the journal Blood.

When someone is infected with a virus, their body makes antibodies to fight the infection. After recovery, antibodies may remain in a person's blood plasma for months or even years. In convalescent plasma treatment, people who are newly ill - in this case with the coronavirus - receive plasma from a recovered person in the hopes that it will bolster their own ability to fight off the virus and limit its severity.

"While many clinical trials are underway to better understand whether convalescent plasma is clinically beneficial for treating COVID-19, a key question is at what time point is it most effective to collect donor plasma based on the presence of antibodies that help fight the virus," said Renée Bazin, PhD, of the Héma-Québec blood center (Canada) and author of the study. "Based on our findings, antibodies against the new coronavirus are not eternal."

This small study, which drew from 282 COVID-19 plasma donors in Quebec, Canada, followed 15 adults (11 males and 4 females) who were diagnosed with and subsequently recovered from COVID-19. While symptoms ranged from mild to severe, none of these donors were hospitalized for their COVID-19 infection. Participants each donated their plasma between four and nine times with the first donation occurring between 33 and 77 days after symptom onset and the last donation between 66 and 114 days.

Dr. Bazin said the present study is one of the first longitudinal analyses to show that people who were seropositive - that is, they had produced antibodies against the virus that causes COVID-19 - become seronegative, which means there were no detectable antibodies after a certain point. The decline in antibodies over time appears unrelated to the number of times someone donated blood plasma and is, instead, due to the elapsed time since the infection and a natural waning of the immune response. All 15 donors showed decreases in antibodies at the same time, around 88 days, and half of the detectable antibodies decreased within 21 days afterward.

"The antibodies disappear rapidly, so people recovering from COVID-19 who want to donate blood plasma should not wait too long once they become eligible to donate," said Dr. Bazin.

For this analysis, the research team focused on antibodies to one target for the virus called the receptor binding domain (RBD). RBD is a protein on the surface of the virus that acts like a key. It binds to the ACE-2 receptor on the surface of cell, in turn, unlocking a door through which the virus enters and infects the cell. But the immune system can develop RBD antibodies that inhibit the protein's ability to fit into and open the door through the ACE-2 receptor, thereby preventing the virus from entering the cells.

"Based on our findings, clinicians should ideally use plasma that is collected early on after a donor's onset of symptoms and check for the presence of antibodies before giving donor plasma to a patient," said Dr. Bazin.

She noted that nearly 7% of the original 282 donors did not have detectable antibodies at their first donation and this proportion doubled when considering donors who waited more than 11 to 12 weeks after symptom onset before donating.

Of course, understanding the drop-off of antibodies following natural infection with COVID-19 has practical applications not only to help inform policies for when convalescent plasma is most effective (i.e. before immune response starts to decline), but it may also have implications for seroprevalence studies that gauge how many people in a community have antibodies against the virus. "Based on our findings, if antibodies wane three to four months after a peak of infection, we could underestimate the prevalence of the infection in communities or populations," said Dr. Bazin.

Researchers plan to follow plasma blood donors over time and while they did not select for specific plasma (for example, those with only high antibody titers) for this analysis, future studies will try to determine if certain plasma is more beneficial.

Tests for skin treatments could be screened using flatworms rather than other animals such as rabbits, according to new research.

A team at the University of Reading and Newcastle University have found that planaria, a type of flatworm, can be used as a reliable alternative for testing topical skin products used to treat human tissues such as the eyes, nose or vagina to ensure that they are not harmful.

The paper, published in Toxicology in Vitro, shows how the use of a fluorescent dye mixed with a potential skin product is absorbed through the outer layers of skin in the planaria.

The tests are cheaper and more ethical than existing animal tests, because planaria are readily available and easily cultured in a laboratory - and don't experience suffering. While other tests are carried out on human skin cells in a petri dish, the new screening method would provide a more accurate test of how the potential skin product would interact with living tissue.

Professor Vitaliy Khutoryanskiy, a Professor of Formulation Science at the University of Reading said:

"Developing more ethical alternatives to tests that others do on rabbits, known as the Draize test, has been a major challenge, especially in relation to evaluating products for sensitive human tissue. Our tests with flatworms show that there are potential ways to screen skin irritants in a more ethically responsible way.

"While the vast majority of cosmetic skin products are no longer tested on animals, it remains critical that new developments for clinical treatments are tested robustly and we hope that we can find solutions that consign the Draize test to history. We also hope to continue planaria research and develop further tests for probe irritation potential of chemicals to other human tissues."

A series of tests with the flatworms looked at whether they can be used to screen for products that are irritants to human skin. Two of the methods, which involved observing the movement of the worms when exposed to known irritants and measuring acute toxicity were not useful.

However, there was a positive result in tests which used the common fluorescent dye alongside short-term and low concentration exposure to various chemicals. The planaria which were exposed to known human skin irritants had significant levels of the fluorescent dye under their skin.

About Planaria:

Planaria are a freshwater-living flatworms which are already widely used in scientific research. They are advanced invertebrates with a primitive brain and share similar features with the vertebrate nervous system found in animals including mammals, examples of the ways that planaria are used include testing the neurotoxicity of potentially hazardous substances. Planaria have a simple but well-characterised epidermal membrane similar to skin that acts as the first point of contact between the worm and a foreign substance.

With the help of ESO's Very Large Telescope (VLT), astronomers have found six galaxies lying around a supermassive black hole when the Universe was less than a billion years old. This is the first time such a close grouping has been seen so soon after the Big Bang and the finding helps us better understand how supermassive black holes, one of which exists at the centre of our Milky Way, formed and grew to their enormous sizes so quickly. It supports the theory that black holes can grow rapidly within large, web-like structures which contain plenty of gas to fuel them.

"This research was mainly driven by the desire to understand some of the most challenging astronomical objects -- supermassive black holes in the early Universe. These are extreme systems and to date we have had no good explanation for their existence," said Marco Mignoli, an astronomer at the National Institute for Astrophysics (INAF) in Bologna, Italy, and lead author of the new research published today in Astronomy & Astrophysics.

The new observations with ESO's VLT (https://www.eso.org/public/teles-instr/paranal-observatory/vlt/) revealed several galaxies surrounding a supermassive black hole, all lying in a cosmic "spider's web" of gas extending to over 300 times the size of the Milky Way. "The cosmic web filaments are like spider's web threads," explains Mignoli. "The galaxies stand and grow where the filaments cross, and streams of gas -- available to fuel both the galaxies and the central supermassive black hole -- can flow along the filaments."

The light from this large web-like structure, with its black hole of one billion solar masses, has travelled to us from a time when the Universe was only 0.9 billion years old. "Our work has placed an important piece in the largely incomplete puzzle that is the formation and growth of such extreme, yet relatively abundant, objects so quickly after the Big Bang," says co-author Roberto Gilli, also an astronomer at INAF in Bologna, referring to supermassive black holes.

The very first black holes, thought to have formed from the collapse of the first stars, must have grown very fast to reach masses of a billion suns within the first 0.9 billion years of the Universe's life. But astronomers have struggled to explain how sufficiently large amounts of "black hole fuel" could have been available to enable these objects to grow to such enormous sizes in such a short time. The new-found structure offers a likely explanation: the "spider's web" and the galaxies within it contain enough gas to provide the fuel that the central black hole needs to quickly become a supermassive giant.

But how did such large web-like structures form in the first place? Astronomers think giant halos of mysterious dark matter are key. These large regions of invisible matter are thought to attract huge amounts of gas in the early Universe; together, the gas and the invisible dark matter form the web-like structures where galaxies and black holes can evolve.

"Our finding lends support to the idea that the most distant and massive black holes form and grow within massive dark matter halos in large-scale structures, and that the absence of earlier detections of such structures was likely due to observational limitations," says Colin Norman of Johns Hopkins University in Baltimore, US, also a co-author on the study.

The galaxies now detected are some of the faintest that current telescopes can observe. This discovery required observations over several hours using the largest optical telescopes available, including ESO's VLT. Using the MUSE (https://www.eso.org/public/teles-instr/paranal-observatory/vlt/vlt-instr/muse/) and FORS2 (https://www.eso.org/public/teles-instr/paranal-observatory/vlt/vlt-instr/fors/) instruments on the VLT at ESO's Paranal Observatory in the Chilean Atacama Desert, the team confirmed the link between four of the six galaxies and the black hole. "We believe we have just seen the tip of the iceberg, and that the few galaxies discovered so far around this supermassive black hole are only the brightest ones," said co-author Barbara Balmaverde, an astronomer at INAF in Torino, Italy.

These results contribute to our understanding of how supermassive black holes and large cosmic structures formed and evolved. ESO's Extremely Large Telescope, currently under construction in Chile, will be able to build on this research by observing many more fainter galaxies around massive black holes in the early Universe using its powerful instruments.