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DALLAS, July 20, 2020 -- Nearly 60% of American children do not have healthy cardiorespiratory fitness (CRF), a key measure of physical fitness and overall health, according to "Cardiorespiratory Fitness in Youth - An Important Marker of Health," a new Scientific Statement from the American Heart Association, published today in the Association's flagship journal Circulation.

CRF, also referred to as aerobic fitness, refers to the body's ability to supply oxygen to muscles during physical activity. Children with healthy CRF are more likely to live longer and be healthier as adults. Children with low or unhealthy CRF at higher risk for developing premature heart disease, type 2 diabetes (T2D) and high blood pressure at younger ages, and they are at increased risk for premature death from heart disease and stroke as adults. Children with obesity are the most likely to have poor CRF.

In addition, studies have linked better CRF in children with improved academic achievement, clearer thinking, better mental health and a higher sense of self-worth and life satisfaction, according to studies cited in the statement. Since the 1980s, studies have demonstrated a downward trend for CRF among youth both in the U.S. and internationally.

"CRF is a single measure that shows how strong the heart, lungs and blood circulation are in children. Whereas measuring body weight, blood pressure, cholesterol and blood sugar levels tell us about each of these individual risk factors, measuring CRF provides a comprehensive assessment of a child's overall health," said Geetha Raghuveer, M.D., M.P.H., FAHA, chair of the writing committee for the new scientific statement, a cardiologist at Children's Mercy Hospital and professor of pediatrics at the University of Missouri, both in Kansas City, Missouri.

According to the statement, one of the biggest contributors to low CRF in children is the decline in physical activity among young people. Children play fewer physically active games and are exercising less.

Children are also more sedentary than they were in the past, although it is not clear if the sedentary time itself or the resultant lack of physical activity is correlated with lower CRF in young people. Studies (conducted prior to the COVID-19 pandemic) show that children are spending more time using their electronic devices for recreation and entertainment in addition to education needs - sedentary activities have replaced physical activity. However, a recent meta-analysis that combines the results of multiple studies found that increased sedentary time was correlated with lower levels of CRF in children, yet not among teens.

CRF in youth can be improved by spending more time doing repeated bursts of vigorous physical activity otherwise called high-intensity interval training, such as regular sprint running sessions coupled with periods of rest or low-intensity exercise. Sports that include periods of vigorous physical activity such as basketball, soccer, tennis, swimming among others should be encouraged.

"Cardiorespiratory fitness is crucial for good heart and overall health both in childhood and as children become adults," said Raghuveer. "We've got to get kids moving and engaged in regular physical activity, such as in any sports they enjoy. The best activity is the activity a child or teen likes and that is sustained for a longer period. The habits they learn when they're young will directly benefit their health as they become adults," said Raghuveer.

However, there are many challenges for parents who may want to help children be more physically active. Social determinants of health, such as socioeconomic status and neighborhood characteristics, greatly affect children's CRF. Studies cited in the statement have found that lower-income families tend to have children with lower or unhealthy CRF, possibly because they do not have access to safe places to exercise, play sports and be physically active. In many communities, physical education is not provided in schools, and outdoor recess opportunities have been reduced or eliminated.

In addition, many lower-income families live in food deserts, making it difficult to find or afford healthy foods, factors which contribute to obesity in young people and adults.

"Every child would benefit from CRF testing as part of a yearly physical and doing so may identify children who would benefit from lifestyle interventions that can help improve health," said Raghuveer. Currently, CRF is not routinely measured by health care professionals, except in children with specific conditions such as congenital heart disease, asthma or cystic fibrosis. There are a wide variety of tests and protocols that can be used to measure CRF, some of which can be administered in a pediatric health care office.

The most accurate measure of CRF in children is the cardiopulmonary exercise test, which is conducted while a participant is exercising to exhaustion, typically on a treadmill or cycle ergometer (specially adapted stationary bike).

Other office-based tests include:

the PWC170 test (Physical Work Capacity Corresponding to a Heart Rate of 170 beats per minute), which is conducted with a cycle ergometer;

a six-minute walk test that measures the distance achieved in six minutes; however, this is only considered useful for children with already suspected low CRF; and

step tests, where a participant steps up and down on a 12-inch bench in an effort to engage larger muscle mass, with a goal of 24 steps/minute for a duration of three minutes. (Step tests can be a good alternative when space is limited; they

can be conducted in office settings with minimal equipment or on school bleachers for groups of children.)

Patient questionnaires to assess the level of physical activity for a child or teen tend to be unreliable and not effective for measuring CRF because they are self-reported and do not include testing.

Although the CRF tests noted above can be implemented in a pediatric health care office, many professionals don't have enough time, space or personnel to administer the tests.

In many cases, schools provide a great avenue for CRF testing, because they widely administer the 20-meter Shuttle Run, which is an effective measure of CRF and is the most widely used CRF test in the world. During this test, a student runs between lines set 20 meters apart until a facilitator sounds a "beep." The intervals between beeps accelerate towards the end of the test, and the student must run faster. Students are scored on the number of laps run.

Many schools also measure body mass index (BMI), weight, abdominal strength, upper-body strength and flexibility through a group of tests called Fitness Gram, which is administered in all 50 states.

The other field-based test is a run test where the participant is given a set distance or a maximum duration time and instructed to complete the test in the shortest amount of time or the greatest distance as possible during that time.

"As is current practice for immunization records that health care professionals share with schools with parental consent, schools could share CRF testing results with health care professionals. This bidirectional communication will result in health care professionals knowing more about their young patients, so interventions and counseling can begin," said Raghuveer. "As so happens now, there are important pieces of information regarding a child's health that are not easy to access because they are in a silo."

"Our hope is that this statement will also inspire research into finding valid, lower-cost alternative options for traditional cardiopulmonary exercise testing to assess CRF in all children, and improved CRF tests that can be done in an office with limited space and without the need for formally trained exercise physiology personnel."

"In the meantime, requiring physical activity for every grade level through high school would be a step in the right direction," said Raghuveer.

For the first time, a single, twisted nanoparticle has been accurately measured and characterised in a lab, taking scientists one vital step closer to a time when medicines will be produced and blended on a microscopic scale.

Physicists at the University of Bath who study materials on the nanoscale - that is, molecules 10,000 smaller than a pinhead - made their groundbreaking observations using a new method for examining the shape of nanoparticles in 3D. This technique, called the hyper-Rayleigh scattering optical activity (HRS OA) technique, was used to examine the structure of gold (among other materials), resulting in an exceptionally clear image of the 'screw thread' twist in the metal's shape.

Understanding the twists within a material (known as its chirality) is vital in industries that produce medicines, perfumes, food additives and pesticides, as the direction in which a molecule twists determines some of its properties. For instance, a molecule that twists clockwise will produce the smell of lemons while the identical molecule twisting anticlockwise (the mirror image of the lemon-smelling molecule) smells of oranges.

"Chirality is one of the most fundamental properties of nature. It exists in sub-atomic particles, in molecules (DNA, proteins), in organs (the heart, the brain), in bio-materials (such as seashells), in storm clouds (tornadoes) and in the shape of galaxies (spirals hurling through space)." said Professor Ventsislav Valev, who led the project.

Until now, physicists have relied on 200-year-old optical methods for determining the chiral properties of molecules and materials, but these methods are weak and require large amounts of molecules or materials to work. Through their use of a technique based on powerful laser pulses, Professor Valev and his team at Bath's Centre for Photonics and Photonic Materials have produced a far more sensitive probe for chirality, one that can detect a single nanoparticle as it floats freely in a liquid.

This discovery was made by Bath's Department of Physics in collaboration with the Department of Chemistry. The researchers' findings are published in Nano Letters.

"This is both a record and a milestone in nanotechnology," said Professor Valev. "Pursuing this line of research has been one of the most rewarding achievements in my career."

"The observation by Valev's group is historic, and scientifically it inspires us in our work to synthesise new chiral 3D nanomaterials," said study co-author Professor Ki Tae Nam from Material Science and Engineering at the Seoul National University in Republic of Korea.

The potential applications for ultra-sensitive chiral sensing are many. For instance, many pharmaceuticals are chiral. Local pharmacists will be able to harness the technology to mix substances in a completely new way, producing pharmaceuticals from minute droplets of active ingredients rather than from large beakers of chemicals.

"You'll be able to go to the chemist with a prescription and instead of receiving a medicine that has to be mixed from bottles of chemicals and then stored in the fridge for several days, you'll walk away with pills that are mini-labs. Upon cracking the pill, a precise number of micro-droplets will flow through microchannels to mix and produce the needed medicine." said Professor Valev.

"For these mini-labs to produce chiral drugs, you'll need to know the number of molecules and catalysts within each micro droplet, as well as their chirality." said PhD student Lukas Ohnoutek, who is the first author on the paper. "This is where our result is really important. We can now aim to produce microdroplets containing a single chiral nanoparticle, to use as catalysts in chemical reactions."

Professor Valev added: "Looking ahead, we can imagine building up chiral materials and even machines, one nanoparticle at a time, from such microdroplets. To do so would be amazing."

Michigan coyotes in most of the Lower Peninsula are the "top dogs" in the local food chain and can dine on a wide variety of small animals, including rabbits and rodents, along with berries and other plant foods, insects, human garbage and even outdoor pet food.

But in the Upper Peninsula, coyotes coexist with gray wolves and play a subordinate role in the food web. As a result, the diets of U.P. coyotes contain less meat than Lower Peninsula coyotes.

That's one of the findings of a University of Michigan study of the diets and gut microbiomes of three Michigan coyote populations, published in the Journal of Animal Ecology.

The food-web study involved the genetic analysis of more than 350 carnivore scat samples--58 of which were confirmed as coyote scat--collected at three Michigan locations, one in the Upper Peninsula and two in the Lower Peninsula: the Huron Mountain Club in the U.P.; the University of Michigan Biological Station, at the northern tip of the Lower Peninsula near Pellston; and the Shiawassee National Wildlife Refuge near Saginaw.

The study also used photos from hundreds of motion-triggered wildlife cameras at the three sites to document local mammal populations, which include various coyote prey species. The camera network was established over the last several years by U-M wildlife ecologist Nyeema Harris, director of the Applied Wildlife Ecology Laboratory in the Department of Ecology and Evolutionary Biology and senior author of the new study.

In the scat analysis, Harris and her graduate students used the ratios of stable carbon and nitrogen isotopes to examine variations in coyote diet at the three sites and to determine the animal's position in the local food web. They also sequenced RNA from the scat to investigate interactions between diet and gut microbiomes.

Higher levels of the heavy nitrogen isotope N-15 in coyote scat indicates a higher position in the local food chain and generally corresponds to a diet richer in meat. In the U-M study, N-15 levels were highest at the southernmost site, the Shiawassee National Wildlife Refuge near Saginaw, where coyotes are the top predators. As so-called apex predators, they have their pick of what's for dinner, as well as where and when they roam the landscape.

N-15 levels and dietary breadth were both lowest at the Huron Mountain Club in the Upper Peninsula, where coyotes live alongside gray wolves. There, coyotes most likely play a subordinate role in the local food web and have a more limited diet.

"The co-occurrence of gray wolves and coyotes at the Huron Mountain Club may cause the suppression of subordinate coyotes, forcing individuals to alter their consumption patterns and switch to alternate food sources," said Harris, an assistant professor in the U-M Department of Ecology and Evolutionary Biology.

The study's findings are in accord with a phenomenon called mesopredator release, which occurs when populations of medium-sized predators are freed from top-down competition after the removal of traditional apex carnivores.

For thousands of years, North American coyotes were outcompeted by gray wolves and other apex predators. But the vast majority of gray wolves in the contiguous United States were exterminated by the mid-20th century, allowing coyotes to assume the mantle of top predator in many places.

Gray wolf populations have rebounded in recent years in parts of the West and the Upper Midwest, including Michigan's Upper Peninsula, where the gray wolf population has grown to more than 600.

But at Lower Peninsula locations such as the Shiawassee National Wildlife Refuge, coyotes remain the top predator, with no observed pressure from gray wolves. These peninsular differences are reflected in the nitrogen-isotope ratios observed in the U-M scat study, said Shawn Colborn, the first author of the Journal of Animal Ecology paper.

"As coyotes shifted from being a mid-level predator to being an apex predator at places like Shiawassee, they found themselves at the top of the food chain with no pressure from wolves," said Colborn, who conducted the scat analysis for his master's thesis in the U-M Department of Ecology and Evolutionary Biology, along with former EEB master's student Corbin Kuntze.

"So, they could change what they ate, where they roamed across the land, and when they were active. Those changes are reflected in their increased nitrogen level. Alternatively, N-15 values are lower in coyotes at the Huron Mountain Club in the Upper Peninsula, where they are most likely experiencing top-down pressure from gray wolves."

The researchers also found that coyotes at the three locations harbored distinct gut microbial communities. About 500 types of bacteria were identified from the coyote scat samples collected at the three Michigan sites. As expected, the diversity of gut microbes was lowest at the northernmost site, the Huron Mountain Club.

There floats an enormous plastic garbage island in the North Pacific that is seven times the size of the Korean Peninsula. The island, called the Great Pacific Garbage Patch, is the result of 13 million tons of plastic that flow into the ocean annually from the 20,000 units of plastic consumed per second around the world. Plastic takes decades to hundreds of years to decompose naturally with plastic bags taking 10 to 20 years, nylon products or disposable straws 30 to 40 years, and plastic water bottles - commonly used once then thrown away -500 years to decompose. This problem of plastic, which has been labeled a human disaster, has been recently proven to be decomposable by beetles common in Korea.

A joint research team consisting of Professor Hyung Joon Cha and a doctoral student Seongwook Woo of the Department of Chemical Engineering at POSTECH with Professor Intek Song of Andong National University has uncovered for the first time that the larvae of the beetle in the order Coleoptera (Plesiophthophthalmus davidis) can decompose polystyrene, a material that is tricky to decompose.

By 2017, 8.3 billion tons of plastic waste were produced across the globe, of which less than 9 percent were recycled. Polystyrene, which accounts for about 6% of total plastic production, is known to be difficult to decompose due to its unique molecular structure.

The research team found that the larvae of a darkling beetle indigenous to East Asia including the Korean peninsula can consume polystyrene and reduce both its mass and molecular weight. The team also confirmed that the isolated gut flora could oxidize and change the surface property of the polystyrene film.

Meanwhile, the research team isolated and identified Serratia from the intestinal tract of P. davidis larvae. When polystyrene was fed to the larvae for two weeks, the proportion of Serratia in the gut flora increased by six fold, accounting for 33 percent of the overall gut flora. Moreover, it was found that the gut flora of this larvae consisted of a very simple group of bacterial species (less than six) unlike the gut flora of other conventional polystyrene-degrading insects.

The unique diet of the darkling beetle larvae that was uncovered in this study presents the possibility that polystyrene can be broken down by other insects that feed on rotten wood. In addition, the development of an effective polystyrene-decomposing flora using the bacterial strains found in the simple gut flora of P. davidis is highly anticipated.

The study is also noteworthy in that the paper's first author, Seongwook Woo, who has been interested in insects since childhood and wished to make the world a better place through them, sought out Professor Cha as soon as he entered POSTECH and focused on research under his supervision over the years.

As the corresponding author of the paper, Professor Cha commented, "We have discovered a new insect species that lives in East Asia - including Korea - that can biodegrade plastic through the gut flora of its larvae." He concluded, "If we use the plastic-degrading bacterial strain isolated in this study and replicate the simple gut floral composition of P. davidis, there is the chance that we could completely biodegrade polystyrene, which has been difficult to completely decompose, to ultimately contribute to solving the plastic waste problem that we face."

In a new study, published in Pediatrics, researchers have shown that being African American was strongly associated with a higher risk of postoperative complications and mortality among apparently healthy children. In fact, compared to their white peers, apparently healthy children who were African American were nearly 3.5 times more likely to die within 30 days after surgery.

"That African American patients have poorer surgical outcomes compared to white patients has been established for a long time," says Olubukola Nafiu, MD, FRCA, pediatric anesthesiologist and vice chair for Academic Affairs and Research at Nationwide Children's Hospital and lead author of the study. "The prevailing assumption was that the disparities in outcomes were largely due to higher preoperative comorbidity burden among African American patients."

Dr. Nafiu and his team challenged that assumption and began a retrospective study analyzing the National Surgical Quality Improvement Pediatric Database from 2012 through 2017. They identified children who underwent inpatient operations and were assigned an American Society of Anesthesiologists (ASA) physical status of 1 or 2. The ASA physical status designation is a tool developed to help clinicians categorize a patient's physiological status in a way that could be helpful in predicting operative risk.

"Generally, we expect that healthier patients should do well with surgeries. Healthy kids have low complication rates," says Dr. Nafiu. "The expectation should be that complication rates and/or mortality among healthy children won't vary based on racial category - what we found is that they do."

The team's statistical analysis of the outcomes for the 172,549 apparently healthy children studied showed that overall, about 14% of children developed postoperative complications during this time. Being African American conferred 27% relative greater odds of developing postoperative complications, relative to being white. African American children also had 8% higher odds of developing severe adverse events after surgery. Finally, compared to their white peers, African American children had 3.43 times higher odds of dying within 30 days after surgery. These results did not change significantly after adjusting for variables such as sex, age, year of the procedure, case urgency and operating time.

"Importantly, we want to highlight that these findings are from observational data. Race doesn't cause these outcomes, but it is strongly associated with them," says Dr. Nafiu. "Our next job is to look at what postoperative complications are driving the observed morbidity and mortality pattern in order to identify modifiable outcomes."

New research indicates that mailing colorectal cancer screening kits to Medicaid enrollees is a cost-effective way to boost screening rates. The findings are published early online in CANCER, a peer-reviewed journal of the American Cancer Society (ACS).

Colorectal cancer is one of the most commonly diagnosed cancers, but routine screening (such as colonoscopies and at-home stool testing) can identify cases early, when treatment is most effective. Despite recommendations that adults undergo regular screening from ages 50 to 75 years, more than one-third of eligible Americans are not up to date with screening. Strategies to boost screening in these adults include mailing screening reminders and mailing fecal immunochemical test (FIT) kits, which detect blood in stool samples.

To estimate and compare the costs and effectiveness of these two strategies in low-income Medicaid-insured populations, a team led by Alison Brenner, PhD, MPH, and Stephanie Wheeler, PhD, MPH, of the University of North Carolina at Chapel Hill's Lineberger Comprehensive Cancer Center, developed a simulation model of 35,000 Medicaid-insured adults aged 52 to 64 years who were overdue for colorectal cancer screening to project costs and benefits over time associated with receiving either a mailed reminder or a mailed reminder plus a FIT kit. These simulations were based, in part, on a randomized trial conducted by these investigators comparing these strategies in the Medicaid population.

Over the course of one year, the number of colorectal cancer screenings, including both FITs and screening colonoscopies, was higher for the mailed reminder plus FIT alternative (23.2 percent) than for the mailed reminder-only alternative (15.8 percent).

The mailed reminder plus FIT alternative saved costs compared with the mailed reminder-only alternative from the Medicaid/state perspective because some patients who received only the reminder would schedule a more costly colonoscopy, which Medicaid must reimburse, rather than a FIT.

From the health clinic/facility perspective, the mailed reminder plus FIT alternative required an additional cost of only $116 per person screened over the mailed reminder-only alternative. This cost falls within the range of what decision-makers would typically be willing to pay for an additional person to be screened for colorectal cancer.

"By investing in sending the test kits with the reminder letters, health departments are expected to successfully screen more individuals for colorectal cancer at relatively low incremental costs, and Medicaid organizations are expected to actually save costs per additional person screened," said Dr. Wheeler. "This analysis provides strong evidence that health departments and payers like Medicaid can substantially improve colorectal cancer screening in low-income and medically underserved populations at a reasonable cost, even given limited budgets, through the implementation of mailed FIT programs." Dr. Wheeler noted that medically underserved populations are more likely to die from colorectal cancer than other groups and extending screening to them in an efficient manner may help address this disparity.

The findings are especially timely considering the recent need for alternatives to face-to-face visits with physicians during the COVID-19 pandemic. "Many aspects of preventive health care have moved to virtual delivery or mailed outreach delivery for the time being, and it is quite likely that some of these services will never fully return to in-person, visit-based delivery," said Dr. Brenner. "Decision-makers critically need guidance on how to allocate resources for virtual or mailed outreach care delivery." This study provides such guidance for one important preventive service: colorectal cancer screening.

An accompanying editorial states that "it is time for incentives and laws that motivate payers to cover full screening costs and evidence-based programs to increase screening toward a goal of at least 80% colorectal cancer screening in every community."

Ithaca, NY--A new study from the Cornell Lab of Ornithology highlights specific features of urban green spaces that support the greatest diversity of bird species. The findings were published today in the journal Landscape and Urban Planning.

The study focuses specifically on parks in New York City. It uses observations submitted to the eBird citizen-science database from 2002 through 2019 to estimate the variety of species found on an annual and seasonal basis.

Bottom line: the more green space available, the greater the diversity of birds. Models show that Increasing the area of green space by 50% would result in an 11.5% increase in annual and an 8.2% increase in seasonal species diversity.

Trees are also important, particularly for migratory species during spring when models show a 50% increase in canopy cover would result in a 23.3% increase in species diversity.

"Our findings emphasize the broad importance of area and the value of tree canopy cover for spring migrants," said lead author Frank La Sorte at the Cornell Lab. "It also shows that ecological data from citizen scientists can be useful in urban planning and management."

A new relationship between humanity and the ocean is required to secure the continuity of the diverse life support roles provided by the sea, according to a paper published in Nature Communications on 17 July 2020.

Titled "A transition to sustainable ocean governance", it describes three key transition pathways that can make complex ocean systems more resilient and ensure a more sustainable future.

"Complex systems are such that small disruptions can have disproportionately large impactful system-wide effects," explains one of the authors*, Tanya Brodie Rudolph, a research fellow at the Centre for Complex Systems in Transition at Stellenbosch University South Africa.

Brodie Rudolph says "the COVID-19 crisis is the classic example of this well-known 'butterfly effect': from the over-exploitation of nature in a Wuhan wild meat market to a global pandemic, this crisis demonstrates the absolute necessity to build the kind of resilience that enables effective, agile responses to sudden system changes.

"This is as true for the complex ocean system we depend on. Should the ocean system collapse, the resultant crisis could be as devastating as the COVID-19 crisis. In fact, it is now more important than ever to understand complex systems and how they can be made more resilient for the benefit of people, the economy and the environment."

Three key transition pathways

The first of the three key transition pathways is the need to re-configure governance--including top-down and bottom-up nested scales from local to international--and informed by a shared vision. The second is by empowering people who depend on the ocean commons through knowledge sharing for adaptive learning and conferring rights to the ocean as a public good. The third is by reforming ownership in stewardship terms through mechanisms such as certification and pre-competitive collaboration, which will provide incentives and help build accountability.

She points to the Marine Stewardship Council's fishery certification system and rights-based fishery reforms like catch shares as promising examples of such innovations.

"These pathways are important because human wellbeing relies on the Biosphere, including natural resources provided by ocean ecosystems. As multiple demands and stressors threaten the ocean, transformative change in ocean governance is required to maintain the contributions of the ocean to people," explains Brodie Rudolph.

"The health of the ocean is crucial for humanity. We need to take better care of this shared resource, for the health and prosperity of current and future generations, for the environment, for biodiversity and for the climate. The way we have governed the ocean in the past has not been effective, and hasn't reflected these complex relationships."

Brodie Rudolph says their paper suggests a new way of thinking about the ocean as a shared resource and shows how social and economic systems can adapt and transform.

"A governance system which recognises the complex role the ocean plays as a shared resource, and builds on changes already underway, would support the transition to a thriving relationship between humanity and the ocean."

Findings from the first international prostate cancer quality of life study conducted by patients themselves reports that significant numbers of men treated for the disease are struggling with continence and sexual problems after treatment. Results suggest that any treatment apart from active surveillance may negatively affect quality of life, and indicate that for many men these effects may be greater than previously thought.

The findings of the Europa Uomo Patient Reported Outcomes Study (EUPROMS) were announced today by Europa Uomo Chairman André Deschamps at the European Association of Urology's Virtual Congress. He reported that "The analysis of survey responses showed that urinary incontinence and sexual function were the two areas where men reported the lowest quality of life scores - much lower compared to the averages reported in clinical studies".

EUPROMS gathered data from 2,943 European men from 25 countries. The respondents had an average age of 70 (all were over 45), and on average had been diagnosed with prostate cancer at the age of 64, meaning that they were reporting on quality of life 6 years after treatment.

Overall, 50% of men who replied to the questionnaire and had been treated for prostate cancer said that loss of sexual function (including the ability to have an erection or reach orgasm) was a big (28%) or moderate (22%) problem for them.

"We often hear that decline in sexual functioning is a relatively small problem for prostate cancer patients and the effect on their quality of life should not be exaggerated," said André Deschamps. "We also hear that prostate cancer is typically a disease of 'old men', implying that the loss of sexual function is less relevant. This survey paints a different picture."

Respondents also report that different treatments have different effects on quality of life; radical prostatectomy (surgical removal of the prostate) has the largest reported impact on urinary incontinence. Radiotherapy was shown to double the fatigue a patient experiences in comparison to surgery, whereas chemotherapy triples the fatigue score. The impact of radiotherapy on sexual function is worse than radical prostatectomy but both have a severe impact.

Results indicate that the best quality of life scores are seen where the cancer is discovered in an early, curable stage. "This means efforts toward early detection and awareness are essential to avoid unnecessary deterioration in quality of life. Wherever it is possible and safe, active surveillance should be considered the first line treatment to ensure best quality of life." said André Deschamps.

He continued, "Our findings provide patients and health care professionals with a snapshot of the impact of treatments. We hope they will be used to set realistic expectations of the effects of the different treatments for prostate cancer on quality of life. They show that the effects of prostate cancer often don't stop after treatment, and even those who are treated successfully for their cancer may have significant problems".

He added "The results of this survey are different from clinical studies using the same validated questionnaires. This doesn't replace previous studies, but it does, suggest further investigation is needed. This is a huge survey, which is the great strength of the work, so I'd like to say thank you to all patients and volunteers who spent hours making this survey a success."

Commenting, Professor Arnulf Stenzl (Tübingen University, Germany), the European Association of Urology's Adjunct Secretary General - Executive Member Science, said:

"This is a valuable survey, the largest of its kind ever undertaken. It uses the same questionnaires used in standard clinical settings, but it is both qualitatively and quantitatively different to the kind of study usually undertaken, so it needs to be read alongside these previous studies. It has several strong points, not least that this is multi-national, and so will reflect the impact of treatment on a wide range of patients, with different health systems. We completely agree that early detection and treatment is essential if we are to avoid problems with quality of life later on. It shows that for many men, quality of life can be poor after most prostate cancer treatment, especially in advanced disease. This message is clear, and we need to listen to the voices of these patients".

Survey details

The EUPROMS survey was available in nineteen languages, via a link advertised by Europa Uomo's member organisations, its website, newsletter and social media. Europa Uomo also used its network of supportive urologists to promote the survey and encourage patients to complete it. Respondents were asked to complete a 20-minute online survey, using the following 3 standard validated quality of life questionnaires, EPIC-26, EORTC-QLQ-C30, and EQ-5D-5L

Analysis of the data was conducted by Professor Monique Roobol of the Erasmus University Medical Centre, Department of Urology, Rotterdam, who said:

"This study is important because it was initiated by patients and meant for patients. The questionnaires were completed unrelated to a hospital visit, which means respondents had more freedom to answer and provides insight into the effect of treatment on quality of life over a longer period."

FINDINGS

A UCLA-led study has found that dermatopathologists, who specialize in diagnosing skin diseases at the microscopic level, are motivated both by patient safety concerns and by malpractice fears -- often simultaneously -- when ordering multiple tests and obtaining second opinions, with a higher proportion of these doctors reporting patient safety as a concern.

When ordering additional microscopic tests for patients, 90% of the dermatopathologists surveyed cited patient safety as a concern and 71% of them reported malpractice fears. Similarly, when obtaining second reviews from a consulting pathologist or recommending additional surgical sampling, 91% cited safety concerns and 78% malpractice concerns.

BACKGROUND

The medical subspecialty of dermatopathology ranks second highest in malpractice verdicts over $1 million, with misdiagnosed skin cancer being the most common reason for these claims. When diagnosing skin biopsies, dermatopathologists will frequently order additional tests for their patients. Published research has noted that many physicians practice "defensive medicine" by ordering sometimes unnecessary tests and consultations in order to protect themselves from malpractice lawsuits.

METHOD

The researchers conducted online surveys with 160 dermatopathologists in 33 states. The team notes that because the survey was based on self-reported behavior, it is possible that some respondents provided the most professionally desirable answers. The study's design may also have minimized biases in self-reported motivation, and the researchers did not study all reasons that could motivate physician behavior.

IMPACT

The findings provide evidence that physicians are strongly motivated by concerns for patient safety and run counter to concerns that physicians are primarily motivated by fears of being sued for malpractice when they request additional tests, services and consultations. Physicians take a Hippocratic oath to do no harm, and concerns for patients' safety and a desire to provide optimal care may reinforce a dermatopathologist's tendency to take thorough precautions.

In the first study to comprehensively track how different types of brain cells respond to the mutation that causes Huntington's disease (HD), MIT neuroscientists found that a significant cause of death for an especially afflicted kind of neuron may be an immune response to genetic material errantly released by mitochondria, the cellular components that provide cells with energy.

In different cell types at different stages of disease progression, the researchers measured how levels of RNA differed from normal in brain samples from people who died with Huntington's disease and in mice engineered with various degrees of the genetic mutation. Among several novel observations in both species, one that particularly stood out is that RNA from mitochondria were misplaced within the brain cells, called spiny projection neurons (SPNs), that are ravaged in the disease, contributing to its fatal neurological symptoms. The scientists observed that these stray RNAs, which look different to cells than RNA derived from the cell nucleus, triggered a problematic immune reaction.

"When these RNAs are released from the mitochondria, to the cell they can look just like viral RNAs and this triggers innate immunity and can lead to cell death," said study senior author Myriam Heiman, Associate Professor in MIT's Department of Brain and Cognitive Sciences, The Picower Institute for Learning and Memory, and the Broad Institute of MIT and Harvard. "We believe this to be part of the pathway that triggers inflammatory signaling which has been seen in HD before."

Picower Fellow Hyeseung Lee and former visiting scientist Robert Fenster are co-lead authors of the study published in Neuron.

Mitochondrial mishap

The team's two different screening methods, "TRAP," which can be used in mice, and single nucleus RNA sequencing, which can also be used in mice and humans, not only picked up the presence of mitochondrial RNAs most specifically in the SPNs but also showed a deficit in the expression of genes for a process called oxidative phosphorylation that fuel-hungry neurons employ to make energy. The mouse experiments showed that this downregulation of oxidative phosphorylation and increase in mitochondrial RNA release both occurred very early in disease, before most other gene expression differences were manifest.

Moreover, the researchers found increased expression of an immune system protein called PKR, which has been shown to be a sensor of the released mitochondrial RNA. In fact, the team found that PKR was not only elevated in the neurons, but also activated and bound to mitochondrial RNAs.

The new findings appear to converge with other clinical conditions that, like Huntington's disease, lead to damage in a brain region called the striatum, Heiman said. In a condition called Aicardi-Goutières syndrome, the same brain region can be damaged because of a misregulated innate immune response. In addition, children with thiamine deficiency suffer mitochondrial dysfunction and a prior study has shown that mice with thiamine deficiency show PKR activation, much like Heiman's team found.

"These non-HD human disorders that are characterized by striatal cell death extend the significance of our findings by linking both the oxidative metabolism deficits and autoinflammatory activation phenomena described here directly to human striatal cell death absent the [Huntington's mutation] context," they wrote in Neuron.

Other observations

Though the mitochondrial RNA release discovery was the most striking, the study produced several other potentially valuable findings, Heiman said.

One is that the study produced a sweeping catalog of substantial differences in gene expression, including ones related to important neural functions such as their synapse circuit connections and circadian clock function. Another, based on some of the team's analysis of their results, is that a master regulator of these alterations to gene transcription in neurons may be the retinoic acid receptor b (or "Rarb") transcription factor. Heiman said that this could be a clinically useful finding because there are drugs that can activate Rarb.

"If we can inhibit transcriptional misregulation we might be able to alter the outcome of the disease," Heiman speculated. "It's an important hypothesis to test."

Another more basic finding in the study is that many of the gene expression differences the researchers saw in neurons in the human brain samples matched well with the changes they saw in mouse neurons, providing additional assurance that mouse models are indeed useful for studying this disease, Heiman said. The question has dogged the field somewhat because mice typically don't show as much neuron death as people do.

"What we see is that actually the mouse models recapitulate the gene expression changes that are occurring in these stage HD human neurons very well," she said. "Interestingly some of the other, non-neuronal, cell types did not show as much conservation between the human disease and mouse models, information that our team believes will be helpful to other investigators in future studies."

The single nucleus RNA sequencing study was part of a long-standing collaboration with Manolis Kellis's group in MIT's Computer Science & Artificial Intelligence Laboratory. Together the two labs hope to expand these studies in the near future to further understand Huntington's disease mechanisms.

NEW YORK, July 17, 2020 -- In a breakthrough for physics and engineering, researchers from the Photonics Initiative at the Advanced Science Research Center at The Graduate Center, CUNY (CUNY ASRC) and from Georgia Tech have presented the first demonstration of topological order based on time modulations. This advancement allows the researchers to propagate sound waves along the boundaries of topological metamaterials without the risk of waves traveling backwards or being thwarted by material defects.

The new findings, which appear in the journal Science Advances, will pave the way for cheaper, lighter devices that use less battery power, and which can function in harsh or hazardous environments. Andrea Alù, founding director of the CUNY ASRC Photonics Initiative and Professor of Physics at The Graduate Center, CUNY, and postdoctoral research associate Xiang Ni were authors on the paper, together with Amir Ardabi and Michael Leamy from Georgia Tech.

The field of topology examines properties of an object that are not affected by continuous deformations. In a topological insulator, electrical currents can flow along the object's boundaries, and this flow is resistant to being interrupted by the object's imperfections. Recent progress in the field of metamaterials has extended these features to control the propagation of sound and light following similar principles.

In particular, previous work from the labs of Alù and City College of New York Physics Professor Alexander Khanikaev used geometrical asymmetries to create topological order in 3D-printed acoustic metamaterials. In these objects, sound waves were shown to be confined to travel along the object's edges and around sharp corners, but with a significant drawback: These waves weren't fully constrained -- they could travel either forward or backward with the same properties. This effect inherently limited the overall robustness of this approach to topological order for sound. Certain types of disorder or imperfections would indeed reflect backwards the sound propagating along the boundaries of the object.

This latest experiment overcomes this challenge, showing that time-reversal symmetry breaking, rather than geometrical asymmetries, can be also used to induce topological order. Using this method, sound propagation becomes truly unidirectional, and strongly robust to disorder and imperfections

"The result is a breakthrough for topological physics, as we have been able to show topological order emerging from time variations, which is different, and more advantageous, than the large body of work on topological acoustics based on geometrical asymmetries," Alù said. "Previous approaches inherently required the presence of a backward channel through which sound could be reflected, which inherently limited their topological protection. With time modulations we can suppress backward propagation and provide strong topological protection."

The researchers designed a device made of an array of circular piezoelectric resonators arranged in repeating hexagons, like a honeycomb lattice, and bonded to a thin disk of polylactic acid. They then connected this to external circuits, which provide a time-modulated signal that breaks time-reversal symmetry.

As a bonus, their design allows for programmability. This means they can guide waves along a variety of different reconfigurable paths, with minimal loss. Ultrasound imaging, sonar, and electronic systems that use surface acoustic wave technology could all benefit from this advance, Alù said.

A detailed study of a SARS-Cov-2 protein, Nsp1, with a central role in weakening the host anti-viral immune response shows that it effectively shuts down production ofproteins in the host. Although SARS-Cov-2 features additional inhibitors of host innate immune defenses, targeting the interaction of this protein, Nsp1, with the host may be an important therapeutic strategy, the authors say. A major virulence factor of SARS-CoVs, including the SARS-CoV-2 virus causing the current COVID-19 pandemic, is the protein Nsp1. Upon infection, it suppresses protein production in the host ,including production of proteins active in cellular anti-viral defense mechanisms, by binding to the cell's protein production machinery, the ribosome. Targeting the pocket on the ribosome that Nsp1 binds to could be an important potential therapeutic strategy. Here, Matthias Thoms and colleagues set out to structurally characterize the Nsp1 of SARS-CoV-2 bound to the ribosome. As part of their approach, they tested the ability of a mutant form of Nsp1, known as mt-Nsp1, to affect protein production related to host immune response, in both in vitro and in vivo experiments. The mutant version did not bind in the same way, the authors showed, and did not shut down host translation (or protein production). Through further experiments, the authors' results demonstrate that SARS-CoV-2 Nsp1 almost completely prevents production of various immune molecules that fight viral infection, including interferons. "Our data establish that one of the major immune evasion factors of SARS-CoV-2, Nsp1, efficiently interferes with the cellular translation machinery resulting in a shut-down of host protein production," the authors write. Even while noting that important questions remain to be addressed in this space, they say their data may provide a starting point for rational structure-based drug design targeting the interaction between Nsp1 and the ribosome.

Two-dimensional (2D) organic-inorganic halide perovskites are emerging materials for photovoltaic and optoelectronic applications due to their unique physical properties and a high degree of tunability. Despite impressive advances, challenges remain, including unsatisfactory performance and a vague understanding of their structure-property relationships. Addressing these challenges requires more suitable material systems and advanced in situ characterization methods.

An international team led by Dr. Xujie Lü and Dr. Wenge Yang from the Center for High Pressure Science and Technology Advanced Research (HPSTAR) and Prof. Song Jin from the University of Wisconsin-Madison discovered that lattice compression under a mild pressure considerably suppresses the carrier trapping of a 2D perovskite (HA)2(GA)Pb2I7, leading to significantly enhanced emission. Intriguingly, a new phase obtained after pressure-treatment possesses a higher crystallographic symmetry, fewer trap states, and enhanced PL intensity. The findings were recently published in Angew. Chem. Int. Ed.

Lattice compression through hydrostatic pressure is an effective way to tune the structural and optical properties of two-dimensional (2D) halide perovskites - a new class of emerging materials for photovoltaic and light-emitting applications. However, few examples exhibit improved photoluminescence (PL) performance of 2D perovskites upon compression, and the structure-property relationship remains unclear.

In this work, the team used pressure to modulate a recently developed 2D perovskite (HA)2(GA)Pb2I7, whose structure features an enormous cage previously unattainable. This affords a rare opportunity to understand the structure-property relationship and explore emergent phenomena. Impressively, a remarkable 12-fold PL enhancement was achieved under a mild pressure within 1.6 GPa. The underlying mechanism was systematically investigated by in situ structural, spectroscopic, and theoretical analyses. The lattice contraction leads to phonon hardening that considerably reduces the exciton-phonon interaction and, thus, enlarges the potential barrier for carrier trapping. Therefore, the photogenerated carriers can barely form the trapped states, and the nonradiative recombination pathway is primarily blocked, resulting in an enhanced emission from the free excitons.

Interestingly, for the first time, they revealed an irreversible and anomalous process during decompression, obtaining a yellow, non-luminescent, amorphous phase of (HA)2(GA)Pb2I7 with a higher bandgap. The emission can be triggered and dramatically increased under laser irradiation when the pressure was released to 1.5 GPa, accompanied by a color change from yellow to orange. Based on this observation, they used the laser beam to draw an "HP" pattern on the yellow sample surface in the DAC chamber. When the pressure was released entirely, the amorphous yellow phase could spontaneously transform into a new orange phase with enhanced PL by over 100% compared with the pristine sample. Further structural characterization and spectra analysis reveals that the new phase possesses a higher crystallographic symmetry and less carrier trapping.

By using pressure to engineer the highly-distorted 2D halide perovskite, this work provides fresh insights into the structure-property relationships of perovskites and also enables the discovery of new high-performance materials through pressure-induced phase transitions.

In low precipitation periods - where and how is the limited available water distributed and what possibilities are there for improving retention in the soil and the landscape? Doerthe Tetzlaff and her team from the Leibniz-Institute of Freshwater Ecology and Inland Fisheries (IGB) have discovered that vegetation has a major influence on this. The researchers are investigating the storage, distribution and quality of water in the landscape. Using the example of the drought-sensitive Demnitzer Mühlenfliess in Brandenburg, a sub-catchment area of the Spree, they quantified visible and invisible water flows during and shortly after the drought of 2018.

The annual rainfall in Brandenburg is 560 litres per square metre. This makes Brandenburg a region with the lowest rainfall in Germany. In 2018 there were 390 litres of water per square metre, which is about 40 percent less precipitation than usual.

Even under "normal" climatic conditions, about 90 percent of the precipitation is released back into the atmosphere and does not flow into groundwater or rivers. Groundwater levels in the area today show that the decreased water levels due precipitation deficits from 2018 could not be returned to normal conditions between the growing seasons.

Land use critical for water resource management

Doerthe Tetzlaff is a researcher at the IGB and Professor for Ecohydrology at the Humboldt University of Berlin. She and her team investigated how the process of evaporation and groundwater recharge differ under different soils and land uses.

"Due to the current climate crisis with increasing droughts, we need to know how much water different plants use. As researchers, we ask ourselves: Can we apply sustainable land use to control water consumption and make entire landscapes more resilient towards climate extremes? These findings are the basis for meeting the demands for food production and water supply," says Doerthe Tetzlaff explaining her motivation for her research topic.

Forest soil drier than grassland

In the Demnitzer Mühlenfliess, the team investigated two sites with land uses typical for the region: a mixed forest site with sandy soils and a deep rooting zone; and grassland site with loamier soils and a shallower rooting zone. The forest soil was much drier, which is due to the characteristics of soil and plants.

For example, during the drought, the uppermost metre of the sandy soil in the forest contained only 37 litres per square metre, and under grassland there were as much as 146 litres of water per square metre. The treetops/leaf canopy of the forest shielded part of the rain that evaporated directly from the leaves and never reached the ground. Moreover, the sandy forest soil caused faster water flow through the soil and decreased water storage. Rainfall penetrated deeper into the soil, but was reabsorbed by the trees during the growing season before reaching the groundwater.

Under the grassland, the water continuously recharged the groundwater. The soil could store more water. As the plants only took water from the upper soil, this led to "older" soil water.

"We were able to show how poorly the landscapes in Brandenburg store precipitation, limiting drought resistance. The type of forest we investigated is typical for the Northern European Plain. It was sad to see that even a natural mixed forest is suffering greatly from drought. For economically used forests that are dominated by conifers, the situation is even worse. In fact, the conifer mortality in Brandenburg is now obvious," says Lukas Kleine, doctoral student in Tetzlaff's team.

"Planting water" - How agriculture can take advantage of the research results

The researchers work together with the agricultural and forestry sectors to bring their research results into practice. One of their most important partners is Benedikt Boesel, owner of "Gut & Boesel". The agricultural holding "Gut & Boesel" tests and develops multifunctional land use concepts of regenerative agriculture and forestry and confirms the observations of the IGB researchers: "The regeneration of our soils and soil health is the greatest and most important task of our generation. For this we need innovative solutions in agriculture and forestry to fight the causes of our problems instead of just curing the symptoms. Only in this way can we act in accordance with the complexity of the ecosystems. We are trying to develop these solutions based on the findings of Prof. Tetzlaff's team, among others".

"We see that after the further dry seasons in 2019 and so far in 2020, the groundwater levels will continue to fall. The vegetation has still not been able to recover due to the low rainfall in the winter months. Unfortunately we are far from "normal" conditions. In order to improve the resistance of Brandenburg's ecosystems to droughts and other climate changes, measures must be implemented that promote groundwater recharge and create soils that can store more water. Our results underline the central role of vegetation in the development of such strategies," summarizes Doerthe Tetzlaff.

Background information:

Water in the landscape: blue and green water

Researchers distinguish between the so-called blue water, which fills lakes, rivers and aquifers and is immediately available for water supply; and the green water, which is directly influenced by vegetation and is returned to the atmosphere through evaporation and transpiration after being absorbed by plants. Doerthe Tetzlaff and her team are investigating the interactions between blue and green water fluxes. They are analysing what happens in the critical zone and what influence vegetation has on the overall water regime.

The critical zone - the thin, dynamic and life-supporting skin of the earth

The layer of earth that extends between the canopy, the soil and the groundwater is called the critical zone. For a long time it was a "black box"; in particular, the role of plants in the distribution of water has been neglected, as science has focused on the blue water fluxes.

In this study, the researchers investigated the water fluxes in the critical zone with stable isotopes in the water. Stable isotopes in water can be used as "markers" to determine flow paths, age and origin of water. For a comprehensive understanding, it is not only the absolute amounts of the water flows in the landscape that are important, but also how long the water is stored on site and which flow paths it takes. When this information is integrated with data on vegetation dynamics, tracer-based modelling can reveal some of the most important processes in the ecohydrological system, such as where and at what rate plants draw water from the soil.