Culture

Researchers from Oregon Health & Science University and the VA Portland Health Care System conducted in-depth interviews with patients at the VA and came up with a series of six recommendations to reduce the number of times patients miss appointments.

The study is published in the Journal of General Internal Medicine.

"No-shows are a big deal because they are a really preventable source of inefficiency in the health care system," said lead author Alan Teo, M.D., M.S., associate professor of psychiatry in the OHSU School of Medicine and a researcher and psychiatrist at the VA. "Previous research suggests that patients who miss visits are at a higher risk of negative health outcomes, so this is an important population of patients to be thinking about and taking better care of."

From an economic standpoint, missed appointments set off a cascade of costs in the health care system, through the ripple effect created by patients, clinicians and medical assistants in rescheduling.

Previous research led by Teo indicated that directly connecting by telephone with an advance reminder reduces no-shows considerably. The new research expands on that finding through a series of systematic interviews conducted with 27 patients seen at the VA in Portland.

Based on that feedback, researchers developed six key recommendations for appointment reminders, underscored by illustrative quotes from patients:

Mix it up. Varied content and format signal patients to examine reminders more closely. "When I see something different, I usually at least read it once. But if it's the same every time, I don't."

Add a personal touch. Many patients would like communications to be more personable and for the appointment systems to be more human. "You're human, I'm human. Let's interact."

Include clinic specifics. Reminders could be improved by including key location and contact information such as a map, the precise location of a clinic and a direct phone extension for the clinic.

Keep it short and simple. Appointment reminders that are short, simple and direct are preferred. "In a letter, short sweet and to the point. I think less is more in that situation."

Time reminders based on the mode of delivery. Appointment letters and postcards should be delivered about a week in advance, while text message reminders are best-suited to one or two days prior.

Hand over reminder control to the patient. Patients have varied preferences and needs when it comes to appointment reminders. They would like to have a say in the types of reminders they receive, such as through a clear opt-out or opt-in system. "I wish I could opt out of the letter. Because I think it's a waste of paper, personally, for me. Paper, postage, for the government to spend, when I prefer electronic."

The vast majority of Twitter users who vape with JUUL e-cigarettes are not using the devices to stop smoking or to improve their health, according to a research team led by University of Utah Health scientists. The researchers say this finding, which challenges JUUL's stated mission of improving smokers' lives, could help hone anti-smoking and vaping efforts targeted at Twitter users, particularly underage teens.

Based on their manual analysis of more than 4,000 tweets, the scientists concluded that only 1% of Twitter users mentioned JUUL as a smoking cessation method and scarcely 7% referred to any potential health benefits of using the vaping devices.

The study, which was conducted in conjunction with the University of Washington School of Medicine and the University of California, San Diego, appears in the Journal of Medical Internet Research - Public Health & Surveillance.

"Some people thought that my generation was going to end smoking," says Ryzen Benson, lead author of the study and a graduate student in the U of U Health Department of Biomedical Informatics. "For a while, we did see a large decline in smoking among teens and younger adults. But then JUUL and other electronic nicotine delivery systems became popular."

"This emergence is reflected in what we found being posted on Twitter," Benson says. "Based on what we saw in people's tweets, they are clearly not using JUUL as a smoking cessation tool or as a healthier alternative to traditional cigarettes."

Use of e-cigarettes--devices that heat liquid to produce a vapor that users inhale into their lungs--has skyrocketed since they were first introduced in 2007. Between 2017 and 2019, the percentage of high school students who vape rose almost 2.5 times, from 11.7% to 27.5%, according to the Centers for Disease Control. In 2020, that percentage has dipped to about 20%, perhaps due in part to vaping being linked to more than 2,500 hospitalizations nationwide--and 55 deaths, including one in Utah--before the end of 2019. 

Previous studies have suggested that social media, including Twitter, could be driving the popularity of e-cigarette usage as well as providing a forum for misinformation about the risks of using these devices. Intrigued, the researchers involved in the current study sought to find out what Twitter users, particularly teens, are posting about JUUL, the most popular e-cigarette brand, which accounts for 76% of the vaping market. 

Using vaping-related keywords such as "JUUL," "vaping pod," and "pod mod," the researchers accessed a free Twitter application that allowed them to collect 29,590 relevant tweets posted nationwide from July 2018 to August 2019. After eliminating duplicates, they used both manual and computational machine learning techniques to analyze the remaining 11,556 unique English language tweets.

Of the 4,000 tweets that were manually analyzed, the researchers found that 3,152 (79%) specifically mentioned JUUL or JUUL-related products and accessories. Of these, 1,792 (57%) referred to first-person usage such as, "I left my JUUL at the party last night." Overall sentiment was more positive ("I love JUUL") than negative ("I will never touch JUUL again!"). Only 45 tweets (1%) mentioned JUUL as a means of smoking cessation; 216 (7%) referred to possible health benefits or concerns.

"I was expecting that few tweets would mention smoking cessation but wasn't expecting only 1%", says Mike Conway, Ph.D., senior author of the study and assistant professor of biomedical informatics at U of U Health. "I was also expecting there to be more discussion of health-related issues, which turned out to be largely absent from our dataset."

The researchers manually identified more than 200 tweets that likely were from underage users ("For my 16th birthday, I want mango JUUL pods"). They then used machine-learning algorithms to see if computers could identify these underage tweets faster and more accurately among 7,356 tweets that were not manually analyzed. They did.

"By developing machine-learning algorithms, we can identify underage tweets with 99% accuracy in just minutes or even seconds," Benson says 

The study only analyzed a small number of the total available tweets stored on Twitter. The keyword list was not exhaustive and didn't include all e-cigarette devices used in the United States. The researchers also note that Twitter users may not be representative of the general U.S. population.

Moving forward, the researchers hope this information can be used to generate   tailored health messages. The messages, based on keywords that appear in social media exchanges, could be automatically delivered to JUUL users who use Twitter and other sites, Conway says.

Below please find a summary and link(s) of new coronavirus-related content published today in Annals of Internal Medicine. The summary below is not intended to substitute for the full article as a source of information. A collection of coronavirus-related content is free to the public at http://go.annals.org/coronavirus.

1. Social distance proves key as respiratory route found to be the most common way to spread COVID-19

COVID-19 is spread most often through respiratory droplets or aerosols and little evidence exists supporting transmission through surfaces. As such, social distance and proper ventilation are key determinants of transmission risk. Findings from a review of published research, articles, and reports is published in Annals of Internal Medicine.

Researchers from Montefiore Medical Center, Hospital of the University of Pennsylvania, Massachusetts General Hospital, Harvard Medical School, and Brigham and Women's Hospital studied scientific articles published between January and September 2020, as well as relevant articles and institutional or governmental reports, to determine the viral, host, and environmental factors that contribute to transmission of COVID-19. They found that although several experimental studies suggest that virus particles could live for hours after inoculation in aerosols or on surfaces, the real-world studies that detect viral RNA in the environment report very low levels on surfaces, and few have isolated viable virus. Strong evidence from case and cluster reports indicates that respiratory transmission is dominant, with proximity and ventilation being key determinants of transmission risk. In the few cases where direct contact or transmission from materials or surfaces was presumed, respiratory transmission could still not be ruled out.

The researchers also identified patterns in virus transmission. The evidence showed that COVID-19 virus peaks around a day before symptom onset and declines within a week of symptom onset. All transmissions occur early on and none have ever been documented after a patient has had symptoms for about a week. Most persons do not transmit the virus, whereas some cause many secondary cases in transmission clusters called "superspreading events." According to the authors, their findings should help to inform evidence-based policies and practices to help educate the public and slow the spread of this virus. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-5008.

Media contacts: A PDF for this article is not yet available. Please click the link to read full text. Author Eric A. Meyerowitz, MD can be reached through Elaine Landoli at elaine.iandoli@einsteinmed.org and author Aaron Richterman, MD can be reached through Alex Gardner at alex.gardner@pennmedicine.upenn.edu.

2. Novel, rapidly deployable community isolation quarantine facilities help to manage COVID-19

A substantial proportion of stable patients with COVID-19 can be isolated safely outside a hospital setting with a small health care team. Researchers from Singapore General Hospital discuss how isolation facilities can be created rapidly to care for patients without serious adverse outcomes. An article describing their process and outcomes is published in Annals of Internal Medicine.

Singapore is one of the most densely populated small island-states in the world. During the COVID-19 pandemic, Singapore implemented large-scale institutional isolation units called Community Care Facilities (CCFs) to combat the outbreak in the community. They housed stable, low-risk COVID-19 patients in CCFs from April to August 2020. These CCFs were created rapidly by converting existing public spaces into isolation facilities, and each was augmented by telemedicine to enable a low health care worker-patient ratio (98 health care workers for 3,200 beds).

In the first month, a total of 3,758 patients were admitted to 4 halls and 4,929 in-house medical consults occurred. The authors report that 136 patients were transferred to a hospital and only 1 patient died 2 weeks after discharge. No health care workers became infected. These results demonstrate that such facilities can successfully provide holistic patient care in the face of a public health crisis when health care resources are lean. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-4746.

Media contacts: A PDF for this article is not yet available. Please click the link to read full text. To speak with the lead author, Kheng Sit Lim, B.Comp, MBBS, MMed(Surg), please contact Carol Ang at carol.ang@sgh.com.sg.

How much time does a brain need to learn a new word? A team of Skoltech researchers and their colleagues monitored changes in brain activity associated with learning new words and found that cortical representations of the sound and meaning of these words may form in just 1 to 2 hours after exposure without any night's sleep consolidation, as earlier research suggested. This research has implications for diagnosing speech disorders and improving the efficiency of learning. The paper was published in the journal Frontiers in Neuroscience.

Consider the word snollygoster, which means someone without principles, especially a politician. It is likely that you did not know this word before, but you do know now -- repeat it several times, and you have learned it. This rather simple and everyday task of learning new words, however, is quite poorly understood in terms of neurocognitive mechanisms that ensure you will remember what snollygoster is days, weeks and years later.

"By nature, every word has two aspects: a particular phonetic pattern that is effectively detected by the brain and the semantics associated with the phonology (an object or an action). In order to dig into the word learning mechanism, one should provide word learning in both aspects: a pseudoword should have original phonetics, i.e. the word should not be constructed from the known roots or other morphemes, and it should acquire original meaning, i.e. not be a synonym for any known word. These restrictions are rather tough to satisfy and control in an experimental setting. The second difficulty is the separation of sematic and phonological processes as they overlap in time and brain localization. Also, the design of effective learning procedure that mobilizes the participant's brain is challenging," Alexandra Razorenova, a coauthor of the paper, explains.

Razorenova and Anna Butorina of the Skoltech Center for Computational and Data-Intensive Science and Engineering (CDISE) in collaboration with the Moscow Center for Neurocognitive Research (MEG Center) tried to look for evidence on how the brain learns both a phonological representation of a new word (how it sounds) and its meaning, or the semantic aspect of new word acquisition. They were also searching for what's called rapid cortical plasticity, i.e. immediate changes in brain activity that follow the learning of a new word. Earlier studies of this particular design have been rare and inconclusive.

The team used magnetoencephalography (MEG) to observe how 24 participants in the experiment learned eight Russian pseudowords carefully designed for the study. A participant had to associate four particular pseudowords with hand and foot movements (so that these pseudowords would mean something). Unlike their colleagues in earlier studies, the researchers did not focus on any specific cortical regions or time intervals, performing an unbiased data search to find neural activity changes induced by word learning.

Not only were they able to observe immediate changes in cortical activity during the process of word learning, but the team also showed that these changes were significantly different for 'meaningful' pseudowords compared to those that were not assigned any meaning.

"The contrast between neural responses elicited by action-associated, and "empty" pseudowords before and after learning procedure answers the question regarding the "semantic network" localization and the relation between sematic and phonological learning. Our findings present the evidence of short-term effortful semantization of word-form and suggest that this semantization facilitates or even triggers strengthening of the cortical network that underlies the phonological aspect of lexicality. That is, "meaningful" pseudowords acquire priority to be recognized and remembered," Razorenova says.

Some earlier electroencephalography and MEG studies also reported rapid cortical plasticity within short experiments; in these studies, repetition suppression was characteristic for real words, while for pseudowords repetition caused response enhancement. Razorenova's group found the opposite to be true. The scientists hypothesize that this might be due to the fact that deep familiarization with word-forms during the experiment completely changed the repetition effect: instead of increasing neural responses to previously unfamiliar word-forms, it decreased them when the word-forms became well-recognized concatenations of phonemes. "The above considerations suggest that our findings most probably reflect a mechanism of familiarization memory that, once formed, lasts over days," Razorenova notes.

The researchers believe their experimental paradigm and data analysis methods will be useful for diagnostics of speech disorders, as it will help differentiate the phonological processes disorders associated with Broca's complex dysfunction from the sematic network failure.

"In a wider perspective, our results evidence the crucial role of interactive learning in contrast with passive learning procedures widely used in the literature. The key role of personal experience, or action or emotion association with the task, are consistent with the Pavlovian learning paradigm. However, this reinforcement method is still underestimated in linguistic methodology. The research may be used as experimental evidence for modification of foreign language learning programs for adults and in programs working with children with developmental disorders of speech and language. These programs should be realized in interactive way with wide usage of simulators of active search and reinforcement," Alexandra Razorenova concludes.

Other organizations involved in this research include Moscow State University of Psychology and Education, Higher School of Economics, and Lomonosov Moscow State University. This research was also supported by a grant from the Russian Foundation for Basic Research 17-29-02168.

In the 2019 Boeing 737 Max crash, the recovered black box from the aftermath hinted that a failed pressure sensor may have caused the ill-fated aircraft to nose dive. This incident and others have fueled a larger debate on sensor selection, number and placement to prevent the reoccurrence of such tragedies.

Texas A&M University researchers have now developed a comprehensive mathematical framework that can help engineers make informed decisions about which sensors to use and where they must be positioned in aircraft and other machines.

"During the early design stage for any control system, critical decisions have to be made about which sensors to use and where to place them so that the system is optimized for measuring certain physical quantities of interest," said Dr. Raktim Bhattacharya, associate professor in the Department of Aerospace Engineering. "With our mathematical formulation, engineers can feed the model with information on what needs to be sensed and with what precision, and the model's output will be the fewest sensors needed and their accuracies."

The researchers detailed their mathematical framework in the June issue of the Institute of Electrical and Electronics Engineers' Control System Letters.

Whether a car or an airplane, complex systems have internal properties that need to be measured. For instance, in an airplane, sensors for angular velocity and acceleration are placed at specific locations to estimate the velocity.

Sensors can also have different accuracies. In technical terms, accuracy is measured by the noise or the wiggles in the sensor measurements. This noise impacts how accurately the internal properties can be predicted. However, accuracies may be defined differently depending on the system and the application. For instance, some systems may require that noise in the predictions do not exceed a certain amount, while others may need the square of the noise to be as small as possible. In all cases, prediction accuracy has a direct impact on the cost of the sensor.

"If you want to get sensor accuracy that is two times more accurate, the cost is likely to be more than double," said Bhattacharya. "Furthermore, in some cases, very high accuracy is not even required. For example, an expensive 4K HD vehicle camera for object detection is unnecessary because first, fine features are not needed to distinguish humans from other cars and second, data processing from high-definition cameras becomes an issue."

Bhattacharya added that even if the sensors are extremely precise, knowing where to put the sensor is critical because one might place an expensive sensor at a location where it is not needed. Thus, he said the ideal solution balances cost and precision by optimizing the number of sensors and their positions.

To test this rationale, Bhattacharya and his team designed a mathematical model using a set of equations that described the model of an F-16 aircraft. In their study, the researchers' objective was to estimate the forward velocity, the direction of wind angle with respect to the airplane (the angle of attack), the angle between where the airplane is pointed and the horizon (the pitch angle) and pitch rate for this aircraft. Available to them were sensors that are normally in aircraft for measuring acceleration, angular velocity, pitch rate, pressure and the angle of attack. In addition, the model was also provided with expected accuracies for each sensor.

Their model revealed that all of the sensors were not needed to accurately estimate forward velocity; readings from angular velocity sensors and pressure sensors were enough. Also, these sensors were enough to estimate the other physical states, like the angle of attack, precluding the need of an additional angle of attack sensor. In fact, these sensors, although a surrogate for measuring the angle of attack, had the effect of introducing redundancy in the system, resulting in higher system reliability.

Bhattacharya said the mathematical framework has been designed so that it always indicates the least sensors that are needed even if it is provided with a repertoire of sensors to choose from.

"Let's assume a designer wants to put every type of sensor everywhere. The beauty of our mathematical model is that it will take out the unnecessary sensors and then give you the minimum number of sensors needed and their position," he said.

Furthermore, the researchers noted that although the study is from an aerospace engineering perspective, their mathematical model is very general and can impact other systems as well.

"As engineering systems become bigger and more complex, the question of where to put the sensor becomes more and more difficult," said Bhattacharya. "So, for example, if you are building a really long wind turbine blade, some physical properties of the system need to be estimated using sensors and these sensors need to be placed at optimal locations to make sure the structure does not fail. This is nontrivial and that's where our mathematical framework comes in."

The stem cells tasked with creating and maintaining biological tissues have a difficult job. They have to precisely divide to form new specialized cells, which are destined to different fates even though they contain identical DNA. An obvious question then is: How do the cells divide in all the right ways to produce a healthy tissue? This was the grand motivating question for Andrew Muroyama, a postdoctoral scholar in the lab of Stanford University biologist Dominique Bergmann, as he monitored days of leaf development in the flowering plant Arabidopsis thaliana. There, amongst a thousand cells under his microscope, he noticed that the nucleus - the DNA-containing control center in the cell - moved in unexpected and strangely purposeful ways as stem cells divided.

Previous research from the Bergmann lab identified a set of proteins that shuffle to one side of the stem cell before division. These proteins seemed to regulate how the stem cell divided, but the actual control mechanisms were unknown. These moving nuclei turned out to be a key to this mystery.

In a paper published Sept. 17 in Current Biology, the researchers report that these asymmetrically distributed proteins act like a compass within the cell to instruct the nucleus where to go. The nuclear position, in turn, controls the patterns of stem cell divisions, which ultimately create tiny pores, called stomata, throughout the leaf surface. Because stomata allow leaves to balance their water and carbon dioxide levels, nuclear alignment via these miniature protein compasses within individual stem cells have the potential to affect leaf function.

"I think our research highlights that the ability to watch the behaviors of cellular machines within living organisms can reveal unexpectedly elegant ways that individual cells cooperate to build tissues," said Muroyama, who is lead author of the paper. "You might think that something as fundamental as cell division would be completely solved by now but there is still so much to learn."

Follow the bouncing nucleus

The Bergmann lab makes Arabidopsis into fluorescent art under the microscope. Bright green nuclei wiggle within purple cell membranes. Watch closely, like Muroyama did, and you would see the usual process for asymmetric cell division: when an Arabidopsis stem cell first divides, the nucleus moves to one side. That way, the resulting daughter cells will be different sizes and will face different neighbors. Eventually, these two cells are destined to play different roles in the intricate final pattern of the leaf.

But continue watching and the nucleus of one daughter cell moves again, hurrying to the opposite side of the cell where it will undergo a second asymmetric split.

"When Andrew showed me the videos of the cells, it was so bizarre," said Bergmann, who is a professor of biology in the School of Humanities and Sciences and senior author of the paper. "I thought, 'Why on Earth would a nucleus behave that way?' The first move makes sense but the second, in the complete opposite direction, was weird."

In order to understand what they were seeing, the researchers conducted several experiments to tease apart the different factors that influence the cells during division.

The researchers already knew about the cellular compass but were unsure what it was guiding or how it worked. By repelling the nucleus before the first division, the compass creates the first set of asymmetric daughters. But by attracting the nucleus immediately afterward, the compass can create a new set of asymmetric daughters on the other side.

"A critical step to understanding the function of the second migration was thinking about the longer history of the stem cells," said Muroyama. "The plant doesn't want to generate new stem cells right next to the ones that were just created. It wants to space them out, so moving the nucleus right after division sets it up for success when creating a second set of daughters."

The researchers also discovered a protein that assists nuclear movement - think a motor that powers the nucleus in the right direction. Disabling that motor prevented the second migration of the nucleus and the resulting leaves had fewer stomata than usual, which could impair the plant's ability to regulate water content and take in carbon dioxide.

It was also known that cells in the leaf surface communicate with each other to regulate stem cell divisions. Curious about whether the cellular compass or cell-to-cell communication was the dominant cue to control how stem cells divide, the researchers modified cells so that they could not receive signals from neighboring cells and watched the bouncing nuclei. Without this communication, the compass appears in the wrong place within the cell, but could still move the nucleus around in predictable ways. This showed that, when it comes to leaf stem cells, the nucleus will follow the instructions from the cellular compass, even if it steers it wrong.

Proving themselves wrong

As a next step, one graduate student in the Bergmann lab is already digging deeper into the purpose of the cellular compass, with particular interest into the different ways this compass can control cell divisions and fate.

More broadly, these findings point to a different way of studying stem cells that focuses less exclusively on the journey of one cell. In some systems, the individual divisions that seem to define a cell's life may actually only be meaningful given what happens next and nearby.

"Looking back 10 years at what we thought was important for a stem cell, we've pretty much proven ourselves wrong," said Bergmann. "We were so focused on the details of what one stem cell did at a specific time and place. Now we understand that history and community matter. We have to look at the stem cell and its mother and grandmother and its neighbors."

BOSTON - Scientists at the Massachusetts General Hospital (MGH) have developed a molecular imaging probe to reveal Alzheimer's disease (AD)-related γ-secretase in rodents and macaques with translational potentials in humans. γ-Secretase is a key player in the etiology of AD and a prime drug target for AD, whose brain regional expression and distribution have yet remain largely unknown. This study describes the development of a molecular imaging probe to reveal γ-secretase in rodents and macaques with translational potentials in humans. This study is to be published in the Journal of Experimental Medicine.

"Our study describes the invention of a positron emission tomography (PET) tracer that enables us to visualize gamma-secretase related to AD," says Changning Wang, PhD, investigator in the Martinos Center for Biomedical Imaging at MGH and co-corresponding author of the study. "The etiology of AD is complex and has not been completely elucidated," says Can (Martin) Zhang, a co-corresponding author and investigator in the Genetics and Aging Research Unit at MGH, a faculty member of the McCance Center for Brain Health in the MassGeneral Institute for Neurodegenerative Disease (MGH-MIND). "These findings may not only better understand the etiology of AD, but also can support the ongoing effort to develop molecules that target gamma-secretase for the treatment and prevention of AD. "

The most common neurodegenerative disorder, AD is characterized by the buildup of amyloid plaques and neurofibrillary tangles in several brain regions. The leading hypothesis for its pathogenesis is the amyloid cascade - which suggests that the amyloid beta-protein, and particularly the amyloid-beta 42 peptide, initiates the disease process. An imbalance between the production and clearance of amyloid-beta results in the protein's aggregation into larger plaques that lead to the death of brain cells and the cognitive symptoms seen in Alzheimer patients. Several potential treatments have been developed that specifically target amyloid, but none have been effective in halting disease progression.

Rudolph Tanzi, PhD, director of the MGH Genetics and Aging Research Unit and co-director of the McCance Center for Brain Heath, a co-corresponding author of this study, and Steven Wagner, PhD, of the USCD Department of Neurosciences, a co-author of the study, first developed the concept of gamma-secretase modulators (GSMs), which preferentially reduce amyloid-beta 42 peptide levels by modulating, without totally suppressing the enzyme's activity, in 2000. Very recently their teams developed a group of soluble GSMs, one of which, SGSM15606, has served as a valuable molecule for better understanding how gamma-secretase contributes to AD pathogenesis.

"Our study takes advantage of the rich expertise of our cross-disciplinary team and uses chemistry, biochemistry, genetics in diverse biomedical technologies on suitable disease models, which has resulted in the discovery of a PET tracer that will open new avenues for us to better understand the complex puzzle and facilitate drug discovery in AD," says Yulong Xu, PhD, investigagor in the Martinos Center and first author of the study.

Wang adds that "our study provides a great example of our effort in developing aging-related probes; additionally, this probe can be used, in combination with our RIPK1 and SIRT1-based novel probes currently under development, to provide a comprehensive and unprecedented level of knowledge in not only AD, but also other aging-related neurodegenerative disorders."

According to a recently published study of Finnish twins, smoking most likely causes a significant share of all cases of subarachnoid haemorrhage, the most fatal type of cerebrovascular disturbances. In the study, smoking was identified as the explanation as to why only one twin in pairs of twins develops a fatal brain haemorrhage. The finding is the first proof of an actual causality between smoking and subarachnoid haemorrhage.

In spite of advances in the treatment of subarachnoid haemorrhage (SAH), it remains the most fatal among cerebrovascular disturbances, with as many as half of the patients dying in the first few months after the haemorrhage.

Due to the high mortality rate, causes leading to this life-threatening disorder that are preventable have been feverishly investigated in recent decades all over the world. Several prior studies have reported a link between smoking and a heightened SAH risk, but no studies have so far been able to demonstrate that smoking directly causes these types of brain haemorrhages. In other words, the problem was similar to the situation with lung cancer several decades ago. It took a long time before evidence was found that smoking causes lung cancer, instead of only being associated with a heightened risk of developing lung cancer in an unknown way.

A study of Finnish twins recently published in Stroke, the world's foremost scientific journal on cerebral circulation, aimed to determine why only one twin in pairs of twins died of a fatal subarachnoid haemorrhage. The follow-up study included specific life-style data on as many as over 13,000 pairs of twins. The study indicates that it is precisely differences in smoking among the twins that appear to explain why only one twin in the pairs, namely the twin who smoked, developed a fatal cerebral haemorrhage, while their non-smoking twin brother or sister did not.

Ilari Rautalin, the principal investigator, says that the finding is historic and enormously important.

"Our findings confirm, for the first time, previous suspicions of an actual causal relation between smoking and fatal brain haemorrhage," says doctoral student Rautalin, Bachelor of Medicine, from the University of Helsinki.

The findings make it likely that smoking causes a significant share of subarachnoid haemorrhages in both men and women, which, in turn, markedly highlights the previously known adverse effects of smoking associated with many other diseases.

The two other members of the research group and authors of the article are Miikka Korja, a neurosurgeon at Helsinki University Hospital, and Jaakko Kaprio, professor of genetic epidemiology at the University of Helsinki.

"It's practically impossible to carry out a conventional clinical trial proving causality with regard to smoking, as it would require exposing healthy individuals to smoking and, subsequently, to many adverse health effects associated with smoking. This is why twin studies are an effective way of demonstrating direct causalities related to smoking," Docent Korja and Professor Kaprio point out.

Rautalin, Korja and Kaprio conclude by emphasising the major importance of quitting smoking or never starting the habit in the first place to minimise the risk of fatal cerebral haemorrhage.

Children who experience neglect are seven times more likely than other abuse victims to have a teen pregnancy say University of Queensland researchers.

A study of the long-term impact of child abuse and neglect found that neglect was one of the most severe types of maltreatment when compared to emotional, sexual and physical abuse.

UQ researcher Emeritus Professor Jake Najman said the 20-year study found neglected children had the highest rates of teen pregnancy, and were at a three-to five-fold increased risk of failing school, unemployment, delinquency, anxiety, depression, psychosis and cannabis abuse problems.

"Although most children in our study experienced multiple types of maltreatment, child neglect and emotional abuse were specifically linked to the worst outcomes," Emeritus Professor Najman said.

"Neglected children, in particular, experienced higher rates of promiscuity, cannabis abuse and visual hallucinations as a result of their maltreatment."

Child neglect was defined in the study as not providing the child with necessary physical requirements (food, clothing or a safe place to sleep) and emotional requirements (comfort and emotional support) a child should receive, as determined by the Queensland Government's Department of Child Safety.

The study found children who experienced emotional abuse were also worse off than sexually or physically abused children.

"Emotionally abused kids were particularly prone to experiencing harassment, psychosis and injecting drugs," he said.

The researchers looked at data from 8000 women and children beginning in pregnancy and continuing into early adulthood.

Emeritus Professor Najman initiated the data project called Mater Hospital-University of Queensland Study of Pregnancy (MUSP) in 1981.

The study, led by UQ medical school and PhD graduate Dr Lane Strathearn, anonymously linked the data with state government reports of child abuse and neglect to examine how child maltreatment was associated with a broad range of outcomes over two decades, including cognitive, educational, psychological, sexual and physical health, and addiction.

Data showed that sexual and physical abuse led to fewer negative outcomes overall.

"Sexual abuse victims experienced early sexual activity, teen pregnancy, depressive symptoms, and post-traumatic stress disorder, but to a lesser severity than neglected children," he said.

"Physical abuse specifically tended to result in delinquency and externalising behavior problems as well as drug abuse."

Emeritus Professor Najman said the findings stressed the need to prioritise support for at-risk parents and young children.

"These problems are extremely serious and difficult to treat in adulthood," he said

"We need to do all that we can to prevent them from happening in the first place.

"Other studies have shown that simple interventions, such as nurses doing home visits for pregnant women and new mothers, can reduce rates of child maltreatment and help prevent some of these negative outcomes."

September 17, 2020 - SEOUL, South Korea - A new study conducted by IVI in collaboration with SK bioscience shows that single-dose and two-dose regimens of Vi-DT typhoid conjugate vaccine (TCV) are safe and immunogenic in children 6-23 months of age, a group with high rates of typhoid fever in resource-limited settings. The findings from this study newly published online in The Lancet's EClinicalMedicine describe the successful completion and analysis of a Phase II clinical trial of Vi-DT six months after vaccination.

The World Health Organization (WHO) recommends TCVs for use in endemic settings with Gavi, the Vaccine Alliance providing the vaccines to eligible countries. However, with only one TCV pre-qualified by the WHO, demand currently exceeds supply. This study is a critical step toward gaining licensure and WHO-prequalification of an additional TCV to increase the global stockpile.

"Our findings show that a single dose of conjugated Vi-DT vaccine is safe and provides anti-Vi seroconversion rates similar to the two-dose regimen in children between 6 months and 2 years of age," said Dr. Birkneh Tilahun Tadesse, a Research Scientist at the International Vaccine Institute (IVI), which conducted the study at the Research Institute for Tropical Medicine in Manila, the Philippines.

"This is an important advance considering the significant burden of disease in infants and young children, and our goal remains developing a safe, single-dose vaccine with long-lasting immunogenicity to protect more children against typhoid fever," said Dr. Sushant Sahastrabuddhe, Director of the Typhoid Program at IVI.

Increasing global supply of typhoid conjugate vaccines

Vi-DT was developed at IVI and its technology was transferred in 2013 to SK bioscience in South Korea for manufacturing and commercialization. A Phase I safety trial of Vi-DT was first conducted in the Philippines with participants 2-45 years of age and showed that the vaccine was safe and immunogenic four weeks after first dose. Following the successful completion of a Phase II trial with infants under 2 years, large-scale Phase III studies with a single-dose of Vi-DT have started in the Philippines and Nepal in 2020.

The WHO recommends programmatic use of typhoid vaccines to prevent and control typhoid fever with preference for TCVs for their longer-lasting protection, fewer doses, and suitability for children under 2. (1) For treatment, antibiotics are currently the frontline intervention for typhoid fever, but drug-resistant typhoid has emerged across Asia and Africa, highlighting the need for sufficient supply of TCV and sustainable vaccination programs.

DALLAS (SMU) - Think spending time with your kids and spouse is the key to your happiness? You may actually be happier getting together with your friends, said SMU psychology professor Nathan Hudson. 

Hudson's research finds that people report higher levels of well-being while hanging with their friends than they do with their romantic partner or children. In fact, being around romantic partners predicted the least amount of happiness among these three groups, reveals a study published in the Journal of Personality and Social Psychology.   

Hudson stressed, however, that the finding has more to do with the activity than the person it is shared with. That's because people tend to spend more of their time doing enjoyable activities with friends than they do with family members, who occasionally find themselves together doing unpleasant tasks like chores or caretaking duties.   

"Our study suggests that this doesn't have to do with the fundamental nature of kith versus kin relationships," he said. "When we statistically controlled for activities, the 'mere presence' of children, romantic partners, and friends predicted similar levels of happiness. Thus, this paper provides an optimistic view of family and suggests that people genuinely enjoy their romantic partners and children." 

More than 400 study participants were asked to think back on times with their friends or family - identify the activity they shared - and rate whether those experiences left them feeling various emotions, such as happy, satisfied, and with a sense of meaning. Each emotion was rated from 0 (almost never) to 6 (almost always).  

This information and other responses about how study participants felt at different times allowed Hudson and his co-authors, Richard E. Lucas and M. Brent Donnellan, to estimate rates of happiness with their friends and family. Lucas and Donnellan are both from Michigan State University.

The activities people most frequently perform while they're with their romantic partners include socializing, relaxing, and eating. People tend to do similar activities when they are with their friends, too. They just do a lot more of these enjoyable tasks while hanging with their friends and a lot less housework, the study found. For instance, 65 percent of experiences with friends involved socializing, but only 28 percent of the time shared with partners. 

Spending time with their children also meant more time doing things that had a negative association, such as housework and commuting.  

However, the activity that people reported most often with their offspring - childcare - was viewed positively. And overall, people report feeling similar levels of well-being while in the presence of friends, partners, and children once the activity was taken out of the equation.    

There's a lesson here, Hudson said. "It's important to create opportunities for positive experiences with romantic partners and children - and to really mentally savor those positive times. In contrast, family relationships that involve nothing but chores, housework, and childcare likely won't predict a lot of happiness."

Children who take oral steroids to treat asthma or autoimmune diseases have an increased risk of diabetes, high blood pressure, and blood clots, according to Rutgers researchers.

The study, which was published in the American Journal of Epidemiology, examined the records of more than 933,000 US children from ages 1 to 18 with or without autoimmune diseases, such as inflammatory bowel disease, juvenile arthritis or psoriasis. Among those without an autoimmune disease, about two in three children who received prescriptions for steroids had evidence of asthma.

"The rates of diabetes, high blood pressure and blood clots from oral steroids have been studied in large populations of adults. However, there are reasons to think these findings might be different in children, who not only tend to take steroids differently than adults but also have much lower baseline risks of developing these same cardiovascular and metabolic conditions. This study allowed us to put numbers on the association between oral steroids and rare, but potentially serious, complications in children," said study author Daniel Horton, an assistant professor of pediatrics and epidemiology at Rutgers Robert Wood Johnson Medical School.

The researchers found that children who were receiving high steroid doses experienced these complications at much higher rates than children taking low doses or who had taken steroids previously. Among the complications studied, high blood pressure occurred most commonly with steroid treatment. All of these complications were more common among children with autoimmune diseases, independent of the steroid effect.

"While children receiving high-dose steroids were at substantially higher risk for developing diabetes, high blood pressure or blood clots relative to children not taking these medicines, the absolute risks of these complications were still small. The vast majority of children taking brief courses of steroids for conditions such as asthma, for instance, will not experience these complications," Horton said.

Researchers have gained a better understanding of the complexity of the environment in which T cells thrive and, by extension, the tolerance mechanisms of these cells which are an obstacle to cellular immunity.

Published in Nature Communications, the new study was directed by Dr. Marie-Ève Lebel, a post-doctoral intern at the Maisonneuve-Rosemont Hospital Research Centre, which is part of the Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal (CIUSSS-EMTL).

Ms. Lebel works in the laboratory of Dr. Heather Melichar, a researcher at CR-HMR and assistant professor in the Department of Microbiology, Infectiology and Immunology at Université de Montreal.

Carried out in collaboration with researchers at the Lady Davis Institute of McGill University and at Harvard University, Lebel's work promises to improve the efficacy of cell therapy.

T cells are an important component of the immune system, which allows the body to be protected against infections, as well as contributing to eliminating cancer cells that are recognized as being foreign to the organism.

The use of the immune system to destroy tumour cells, called immunotherapy, has not only allowed for an increase in the survival rate of cancer patients, but has also meant a cure for patients with advanced stage cancer and/or those patients for whom traditional therapies have failed.

Nevertheless, several obstacles can hinder the efficacy of immunotherapy due to T cell tolerance mechanisms that produce a state of immune non-response to a specific antigen. Lebel has focused on understanding these tolerance mechanisms in order to counteract the inability of certain T cells to attack diseased cells.

She and her colleagues have been able to identify certain factors that influence the development of T cells by better understanding the environment in which they develop and the interaction between cells.

Ultimately, these elements have a major impact on the body´s capacity to control an infectious agent, or even the growth of tumour cells.

"This discovery is a powerful scientific breakthrough, as these results will help us identify new targets and approaches to increase the anti-cancer activity of T cells in order to improve the survival of our patients," said Dr. Denis Claude Roy, director of the Institut universitaire en hémato-oncologie et en thérapie cellulaire (IUHOTC) and the Centre d'excellence en thérapie cellulaire (CETC) Maisonneuve-Rosemont Hospital, in Montreal.

BACKGROUND

Tracking the passage of time to the second is critical for motor control, learning and cognition, including the ability to anticipate future events. While the brain depends on its circadian clock to measure hours and days, the circadian clock does not have a second hand.

Instead the brain measures seconds through changing patterns of cellular activity. Much like a line of falling dominoes, each neuron activates the next, and time is marked by the neuron that is currently active. By analogy, if a sequence of falling dominoes takes 10 seconds from start to finish, one can deduce that 5 seconds has elapsed when the middle domino falls.

FINDINGS

UCLA neuroscientists introduced mice to two different scents. The mice learned that one odor predicted the arrival of a sweet liquid reward after three seconds, while the other odor predicted a reward after six seconds. The mice started licking the spout earlier in anticipation of the reward after they sniffed the first scent than when they smelled the second.

Recordings in the striatum and premotor cortex of the brain revealed that changing patterns of neural activity in both regions encoded time--consistent with the notion that the brain has multiple clocks. But the pattern in the striatum was closer to the sequence of falling dominoes--a pattern referred to as a neural sequence--compared to the patterns in a motor area that provides input to the striatum.

IMPLICATIONS

Timing is a fundamental part of human behavior, learning and thought. By revealing how and where the brain counts and represents seconds, the UCLA discovery will deepen scientists' understanding of normal and abnormal brain function.

What The Study Did: Researchers in this observational study examined the association between wearing eyeglasses daily and susceptibility to COVID-19.

Authors: Yiping Wei, M.D., Ph.D., and Jianjun Xu, M.D., Ph.D., of the Second Affiliated Hospital of Nanchang University in Nanchang, China, are the corresponding authors.

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

(doi:10.1001/jamaophthalmol.2020.3906)

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