Body

ROCHESTER, Minn. -- A pair of Mayo Clinic studies shed light on something that is typically difficult to see with the eye: respiratory aerosols. Such aerosol particles of varying sizes are a common component of breath, and they are a typical mode of transmission for respiratory viruses like COVID-19 to spread to other people and surfaces.

Researchers who conduct exercise stress tests for heart patients at Mayo Clinic found that exercising at increasing levels of exertion increased the aerosol concentration in the surrounding room. Then also found that a high-efficiency particulate air (HEPA) device effectively filtered out the aerosols and decreased the time needed to clear the air between patients.

"Our work was conducted with the support of Mayo Cardiovascular Medicine leadership who recognized right at the start of the pandemic that special measures would be required to protect patients and staff from COVID-19 while continuing to provide quality cardiovascular care to all who needed it," says Thomas Allison, Ph.D., director of Cardiopulmonary Exercise Testing at Mayo Clinic in Rochester. "Since there was no reliable guidance on how to do this, we put a research team together to find answers through scientific testing and data. We are happy to now share our findings with everyone around the world." Dr. Allison is senior author of both studies.

To characterize the aerosols generated during various intensities of exercise in the first study, Dr. Allison's team set up a special aerosol laboratory in a plastic tent with controlled airflow. Two types of laser beam particle counters were used to measure aerosol concentration at the front, back and sides of a person riding an exercise bike. Eight exercise volunteers wore equipment to measure their oxygen consumption, ventilation and heart rate.

During testing, a volunteer first had five minutes of resting breathing, followed by four bouts of three-minute exercise staged ? with monitoring and coaching ? to work at 25%, 50%, 75% and 100% of their age-predicted heart rate. This effort was followed by three minutes of cooldown. The findings are publicized online in CHEST.

The aerosol concentrations increased exponentially throughout the test. Specifically, exercise at or above 50% of resting heart rate showed significant increases in aerosol concentration.

"In a real sense, I think we have proven dramatically what many suspected ? that is why gyms were shut down and most exercise testing laboratories closed their practices. Exercise testing was not listed as an aerosol-generating procedure prior to our studies because no one had specifically studied it before. Exercise generates millions of respiratory aerosols during a test, many of a size reported to have virus-carrying potential. The higher the exercise intensity, the more aerosols are produced," says Dr. Allison.

The follow-up study led by Dr. Allison focused on how to mitigate the aerosols generated during exercise testing by filtering them out of the air immediately after they came out of the subject's mouth. Researchers used a similar setup with the controlled airflow exercise tent, particle counter and stationary bike, but added a portable HEPA filter with a flume hood.

Six healthy volunteers completed the same 20-minute exercise test as the previous study, first without the mitigation and then with the portable HEPA filter running.

Also, a separate experiment tested aerosol clearance time in the clinical exercise testing laboratories by using artificially generated aerosols to test how long it took for 99.9% of aerosols to be removed. Researchers performed the test first with only existing heating, ventilation and air conditioning, and then with the addition of the portable HEPA filter running.

"Studying clearance time informed us of how soon we could safely bring a new patient into the laboratory after finishing the test on the previous patient. HEPA filters cut this time by 50%, allowing the higher volume of testing necessary to meet the clinical demands of our Cardiovascular Medicine practice," says Dr. Allison.

"We translated CDC (Centers for Disease Control and Prevention) guidelines for aerosol mitigation with enhanced airflow through HEPA filters and showed that it worked amazingly well for exercise testing. We found that 96% plus or minus 2% of aerosols of all sizes generated during heavy exercise were removed from the air by the HEPA filter. As a result, we have been able to return to our practice of performing up to 100 stress tests per day without any recorded transmission of COVID in our exercise testing laboratories," says Dr. Allison.

A new USC study suggests that certain neighborhoods - particularly those characterized by poverty and unemployment - may pose an environmental risk to the developing brains of children, impacting neurocognitive performance and even brain size.

The research was published May 3 in the journal JAMA Pediatrics.

These findings highlight the importance of neighborhood environments for child and adolescent brain development, the researchers said, and suggest that policies, programs and investments that help improve local neighborhood conditions and empower communities could support children's neurodevelopment and long-term health.

"This is the first large, national study of neurodevelopment to determine that the role of neighborhood disadvantage is similar across all regions of the country, and we found that what mattered most were the local differences in neighborhood disadvantage within each city, rather than how cities differ from each other overall," said lead author Daniel Hackman, assistant professor at the USC Suzanne Dworak-Peck School of Social Work.

Researchers from the USC Suzanne Dworak-Peck School of Social Work and the Keck School of Medicine of USC used data from the Adolescent Brain and Cognitive Development (ABCD) Study, collected from October 2016 - 2018. The ABCD Study is the largest long-term study of brain development and child health in the United States.

Neighborhood disadvantage, after accounting for family socioeconomic status and perceptions of neighborhood safety, showed associations with multiple aspects of neurocognition and smaller total cortical surface area, particularly in the frontal, parietal and temporal lobes.

"Our findings aren't specific to the child's home life, as we adjusted for socioeconomic factors at each child's home. But the research suggests neighborhoods may have different levels of social and educational resources and opportunities that can impact a child's neurodevelopment," said senior author Megan Herting, assistant professor at the department of preventive medicine at the Keck School of Medicine at USC.

In addition, the researchers said, disadvantaged neighborhoods may lack quality health services, access to nutritional foods, and well-maintained parks and rec facilities; they may also expose residents to more pollutants or social stressors.

"This research is important as it not only highlights that neighborhoods matter, but it also suggests that promoting neighborhood equity based on the unique local conditions within cities may improve short and long-term health and development of children and adolescents," said Hackman.

A state of the art plenary session during the Pediatric Academic Societies (PAS) 2021 Virtual Meeting discussed prenatal environmental contaminants and childhood disease, and the latest evidence for epigenetic mechanisms associated with transgenerational disease and public policy implications.

Three generational animal models now conclusively demonstrate that fetal exposure to the same environmental chemicals now found in virtually every human pregnancy is linked to multigenerational disease. The diseases range from onset of puberty abnormalities, obesity, immune disorders, cancer, polycystic ovaries, abnormal sperm, behavioral abnormalities and perinatal complications. The mechanism of transmission of disease across generations appears to be non-genetic and correlates with epigenetic changes seen in exposed offspring and their descendants.

This session presented the latest animal data after fetal exposure to: pesticides (DDT, permethrin, vinclozolin, atrazine, glyphosate, DEET), dioxins, jet fuel, plastics and BPA. Presenters discussed the latest data on human pesticide exposures and outcomes of pregnancy (glyphosate) and long-term outcomes after organophosphate exposures in pregnancy. Diseases which have been induced in third generation descendants in rodents were compared with human disease trends and latest funded research was reviewed.

Environmental contaminants are pervasive in pregnant women, and diseases which they cause in animals are increasing in humans. Can we begin to apply what has been learned in animals to human health (while we wait the 100 years it might take to follow a three generational human study)? Finally, presenters discussed the state of governmental agencies whose mandate to protect pregnant mothers and children from environmental contamination.

Presentations included:

Pesticides in Pregnancy: Implications for Children's Health & Environmental Health Policy; presenter: Paul D. Winchester, MD, MA - Indiana University School of Medicine

Environmental Toxicant Induced Epigenetic Transgenerational Inheritance of Disease: Generational Toxicology; presenter: Michael Skinner, PhD - Washington State University

In utero exposure to pesticides and child development in an agricultural population; presenter: Brenda Eskenazi, PhD - University of California Berkeley

Protecting Children from Environmental Hazards; presenter: Ruth Etzel, MD, PhD - George Washington University

The objectives of the session were to review:

epigenetic transgenerational inheritance of disease in animal data including DNA methylation, Histone retention and non-coding RNA expression after fetal exposures.

how toxicant-induced transgenerational disease may be transmitted to non-exposed third generation descendants.

human data suggestive of adverse outcomes linked to fetal exposure to pesticides and other toxicants.

pathways to discovering biomolecular mechanisms of disease and to mitigation measures available now and in the future.

how practitioners, basic scientists, government regulators and industry might cooperate to achieve health and wealth in this unusual moment in history.

Dr. Winchester chaired the plenary, "Prenatal Environmental Contaminants and Childhood Disease: Latest Evidence for Epigenetic Mechanisms Associated With Transgenerational Disease and Public Policy Implications," on Saturday, May 1 at 5:30 p.m. EDT. Reporters interested in an interview with the presenters should contact PAS2021@piercom.com.

The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit http://www.pas-meeting.org.

Nearly one in five older adults say their mental health has gotten worse since the pandemic began in March 2020, and an equal percentage say their sleep has suffered in that time too. More than one in four say they're more anxious or worried than before the COVID-19 era, according to a new poll of people age 50 to 80.

Women, people in their 50s and early 60s, and older adults who have a college degree or higher were more likely than others to report worse mental health than before the pandemic, according to the new findings from the National Poll on Healthy Aging. Older adults who say their physical health is fair or poor were most likely to report worse mental health, with 24% saying this.

And when asked about the last two weeks before they were surveyed, the percent who said they had concerning mental health symptoms was even higher, with 28% saying they felt depressed or hopeless in that time, 34% saying they'd been nervous or anxious, and 44% saying they'd recently felt stressed.

Just under two-thirds (64%) said they had had trouble falling asleep or staying asleep at least once in the past week, twice the percentage who said this in a 2017 poll of a similar group of older adults.

The poll is based at the University of Michigan's Institute for Healthcare Policy and Innovation and receives support from AARP and Michigan Medicine, U-M's academic medical center. It draws from the answers of a national sample of more than 2,000 adults aged 50 to 80 to a poll in late January, when COVID-19 case rates were high across the nation and vaccination of older adults had just begun.

The poll also reveals hopeful signs that many older adults are showing long-term resilience. Two-thirds say their current mental health is excellent or very good. Just over 80% say their mental health is as good as, or better than, it was 20 years ago.

Just under half (46%) of the respondents say they feel isolated, which is down from 56% in a similar poll taken in spring 2020, but up from 28% before the pandemic. Nearly one in three (29%) say that they have made a lifestyle change to improve their mental health since the start of the pandemic such as exercise, diet, and meditation.

"As we enter a new phase of the pandemic, with most older adults getting vaccinated, it's important to ensure adequate access to mental health screening and care to detect and address any lingering effects of this prolonged period of stress," says Lauren Gerlach, D.O., M.Sc., a geriatric psychiatrist at Michigan Medicine who worked with the poll team. "This is especally important to those who might have a harder time accessing mental health care, including those with lower incomes and worse physical health."

The data also suggest that older adults are more open to seeking mental health help than past research might suggest, with 71% saying they wouldn't hesitate to see a mental health professional in the future, and 13% saying they had talked with their primary care provider about a new mental health concern since the pandemic began.

Poll director Preeti Malani, M.D., a Michigan Medicine infectious disease physician also trained in geriatrics, notes that primary care physicians play a key role in identifying, monitoring and treating the mental health concerns of older adults.

"It's encouraging to see that nearly one-third of the older adults rated their primary care provider as the person they'd most want to talk with about mental health concerns, and that 19% said they'd actually done so in the last two years," she says. "Health systems and insurers should support this role, and efforts to reduce stigma around seeking help for the patients who still feel this way."

Among the 29% of older adults who said they would hesitate to see a mental health professional for treatment in the future, common reasons were that they thought it wouldn't help, that they'd feel embarassed or that they had worries about the cost.

"Older adults have been hit hard by the COVID-19 pandemic, and it has impacted mental health for many," says Alison Bryant, Ph.D., senior vice president of research for AARP. "We are seeing bright spots of resiliency in some during such a difficult time, but we must continue to provide support as we emerge from the pandemic and cope with the aftermath."

May 04, 2021 - In its latest clinical practice guideline on community-acquired pneumonia the American Thoracic Society's guidelines panel addresses the use of nucleic acid-based testing for non-influenza viral pathogens. The guideline was published online in the May 1 issue of the American Journal of Respiratory and Critical Care Medicine. An explainer video may be viewed here.

Community-acquired pneumonia is caused by a wide range of respiratory pathogens, prominently including viruses. However, the only viral pathogen addressed by the 2019 clinical practice guideline was influenza. The panel determined that, given the increasing recognition of non-influenza viral causes of CAP and the expanded availability of diagnostic tests among clinicians, it was necessary to update the previous guideline to help guide treatment.

Using the Grading of Recommendations, Assessment, Development and Evaluation or GRADE framework, the panel made the following recommendations regarding the use of nucleic acid-based viral diagnostic testing for viral pathogens other than influenza in patients with suspected CAP:

Recommendation 1

In outpatients with suspected CAP, we suggest not performing routine nucleic-acid based testing of respiratory samples for viral pathogens other than influenza (conditional recommendation, very low-quality evidence)

Recommendation 2

In hospitalized patients with suspected CAP, we suggest nucleic acid-based testing of respiratory samples for viral pathogens other than influenza only in patients that meet one of the following conditions:

* Patients with severe CAP

* Immunocompromised patients (including neutropenia, active cancer therapy, history of solid organ or blood component transplant, advanced HIV disease, or chronic use of immunosuppressive medications including systemic corticosteroids). (conditional recommendations, very low-quality evidence)

"Molecular diagnostics for lung infections are rapidly evolving. We will continue to monitor developments to determine when additional updates are appropriate," noted guideline panelists Scott Evans, MD and Charles Dela Cruz, MD, PhD. "We also look forward to reviewing more literature that directly link the use of molecular diagnostics on important outcomes, such as death, morbidity, antimicrobial drug use patterns, and costs."

The ATS has published more than 20 clinical practice guidelines on various conditions, ranging from allergy and asthma to TB and other pulmonary infections. For ATS guideline implementation tools and derivatives, go here.

What The Study Did: Study results suggest underuse of coronavirus testing in patients with fever may contribute to community transmission.

Authors: Mark J. Pletcher, M.D., M.P.H., of the University of California, San Francisco, is the corresponding author.

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

(doi:10.1001/jamanetworkopen.2021.8500)

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

Over 400 common disinfectants currently in use could be made safer for people and the environment and could better fight the COVID-19 virus with the simple application of UVC light, a new study from the University of Waterloo shows.

Benzalkonium chloride (BAK) is the most common active ingredient in many disinfectants regularly used in hospitals, households, and food processing plants to protect against a wide range of viruses and bacteria - including all strains of SARS-CoV-2, the coronavirus that causes COVID-19 - but its toxicity means that it can't be used in high concentrations. It also means that products containing BAK are harmful to humans and the environment.

Researchers at Waterloo discovered that the chemical's toxicity could be fully neutralized using ultraviolet light (UVC) when tested on cultured human corneal cells.

"Our results show that a disinfecting procedure using BAK followed by UVC radiation can minimize the harmful effect of BAK residues on humans and the environment," said Dr. David McCanna of Waterloo's Department of Optometry & Vision Science. "Such a procedure also has a great potential to maximize the disinfection efficacy by utilizing two different antimicrobial mechanisms.

"As the pandemic continues, our findings are especially important as it provides another method to make our hospitals, food, homes, and the environment safer."

While an important ingredient for a disinfectant's efficacy, BAK is a severe human skin and eye irritant. The chemical's high toxicity limits the ability to use products with a high concentration of BAK to better protect against harmful viruses and bacteria. High levels of BAK residue are also harmful to the environment, proving especially toxic to fish, aquatic invertebrates, and birds.

After exposing a BAK solution to germicidal ultraviolet-C lamps, they applied the solution to cultured human corneal cells for five minutes and analyzed for cell metabolic activity and viability. The BAK solutions were completely neutralized by UVC as the solutions no longer harmed the cultured human corneal epithelial cells.

"With concerns about the spread of COVID-19, people are utilizing products with BAK as an active ingredient more than ever," said Waterloo alumnus and lead author Dr. Manlong Xu, who is currently a clinical research fellow in the University of Alberta's Department of Ophthalmology and Visual Science.

"For many industries, there is the demand to improve the efficacy of standard disinfection procedures, while also keeping in mind any potential negative impact on the environment."

Social media may make it easier for people to engage online, but I does not provide certain benefits of real-life human interactions, says a Michigan State University researcher.

"Problematic social media use has been associated with depression, anxiety and social isolation, and having a good social support system helps insulate people from negative mental health," said Dar Meshi, an assistant professor in the Department of Advertising and Public Relations at MSU. "We wanted to compare the differences between real-life support and support provided over social media to see if the support provided over social media could have beneficial effects."

The research was published online April 29 in the journal Addictive Behaviors.

While social media support did not negatively impact mental health, it did not positively affect it either.

"Only real-life social support was linked to better overall mental health," Meshi said. "Typical interactions over social media are limited. We theorize that they don't allow for more substantial connection, which may be needed to provide the type of support that protects against negative mental health."

Meshi and Morgan Ellithorpe, an assistant professor in the Department of Communication at the University of Delaware and a co-author on this paper, conducted a survey of 403 university students to identify how problematic their social media use was and their degree of social support in real-life and on social media.

By also using the PROMIS, or Patient-reported Outcomes Measurement Information System, scales for measuring depression, anxiety and social isolation, the researchers could see how the students' social media use and social support related to their mental health.

Problematic social media use is not a recognized addictive disorder, but there are similarities in the symptoms of someone with a substance use disorder and a person displaying excessive social media use. Examples include preoccupation with social media and signs of withdrawal, such as irritability, when prevented from using social media.

"It appears that the more excessive one's social media use is, the less social support that person gets in real life, which leads to poor mental health," Ellithorpe said.

Meshi and Ellithorpe encourage people who are using too much social media to reach out to people in real life for social support.

Exposure to air pollution, even over the course of just a few weeks, can impede mental performance, according to a new study led by researchers at Columbia University Mailman School of Public Health. However, these adverse effects were lessened in people taking nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin. The study is among the first to explore short-term air pollution exposures and the use of NSAIDs to mitigate their effects. The results are published in the journal Nature Aging.

Examples of events that would increase someone's exposure to air pollution over the short term could include forest fires, smog, second-hand cigarette smoke, charcoal grills, and gridlock traffic.

The researchers examined the relationship between exposures to fine particulate matter (PM2.5) and black carbon, a component of PM, and cognitive performance in 954 older white males from the Greater Boston Area enrolled in the Normative Aging Study. They also explored whether taking NSAIDs could modify their relationships. Cognitive performance was assessed using the Global Cognitive Function (GCF) and Mini-Mental State Examination (MMSE) scales. Air pollution levels were obtained from a site in Boston.

Elevated average PM2.5 exposure over 28 days was associated with declines in GCF and MMSE scores. Men who took NSAIDs experienced fewer adverse short-term impacts of air pollution exposures on cognitive health than non-users, though there were no direct associations between recent NSAID use and cognitive performance. The researchers postulate that NSAIDs, especially aspirin, may moderate neuroinflammation or changes in blood flow to the brain triggered by inhaling pollution.

"Despite regulations on emissions, short-term spikes in air pollution remain frequent and have the potential to impair health, including at levels below that usually considered hazardous," says senior author Andrea Baccarelli, MD, PhD, chair of the Department of Environmental Health Sciences. "Taking aspirin or other anti-inflammatory drugs appears to mitigate these effects, although policy changes to further restrict air pollution are still warranted."

The link between long-term PM exposure and impaired cognitive performance in the aging population is well-established. Reported effects include reduced brain volume, cognitive decrements, and dementia development. Air pollution has also been associated with poor cognition of children and adults. Until now, however, little was known about the effects of short-term exposure to air pollution.

The researchers say future studies should investigate the specific effects of chemical components of air pollution on cognitive performance, exposure sources in the environment, and whether cognitive impairments due to short-term air pollution exposures are transient or persistent. Randomized clinical trials of NSAID use are needed to validate their protective effects.

SEATTLE--A new study of hospital deaths in the United States, published today in JAMA Network Open, is the most comprehensive look yet at changes in hospital mortality during the pandemic. Researchers analyzed data on more than 20,000 patients admitted to hospitals for COVID-19, over nine full months, from March to November of 2020. They found that rates of in-hospital mortality among COVID patients fell 38% between March and May, but there was little further decline through November 2020.

The researchers aimed to uncover the most likely cause of the observed trend by controlling for patient age, sex, comorbidities, and severity of disease when the patient was admitted. However, they found that none of these factors fully explained the decline in mortality rates.

"Understanding why mortality rates changed is important for clinicians working to improve outcomes for patients hospitalized with COVID-19," said Dr. Gregory Roth, the study's lead author and an Associate Professor of Medicine at the Institute for Health Metrics and Evaluation at the University of Washington. "Further analysis is needed to understand the drivers more precisely, but it speaks to a crucial need for information sharing and identifying hospital best practices that can prevent mortality rates from increasing again, particularly during possible future waves of COVID-19 infections."

The researchers analyzed records from the American Heart Association's COVID-19 Cardiovascular Disease Registry, including 107 hospitals in 31 states. Mortality rates for patients in the registry were 19.1% in March and April, 11.9% in May and June, 11% in July and August, and 10.8% from September through November. Almost one-third of patients were admitted to intensive care, and 1 in 5 were placed on mechanical ventilation.

The study found that there were only small changes in patient characteristics during the observed period, including a small decrease in age, increase in proportion of women, and increase in BMI.

"Our findings suggest that the decline in mortality could be due to overloaded hospitals and changes in treatment," Roth explained. "With more variants circulating and many countries still struggling with overloaded hospitals and scarce resources, the more we know about this the better."

The American Heart Association's COVID-19 CVD patient data registry was launched within months of the beginning of the COVID-19 pandemic in 2020, to provide insights to care and adverse cardiovascular outcomes. James de Lemos, MD, volunteer co-chair of the steering committee for the registry and professor of medicine and the Sweetheart Ball-Kern Wildenthal distinguished chair in Cardiology at the University of Texas Southwestern Medical Center in Dallas, who co-led the steering committee of Association volunteers to establish the registry, said, "The findings such as the ones from this study reflect the importance and value of collecting this rapidly growing dataset to conduct multiple analyses and research projects in a much shorter period of time."

More than 25% of the world's population (greater than 1.5 billion people) face the burden of soil-transmitted helminth (STH) infections, a species of intestinal parasite whose eggs develop in the soil before finding a new host. The main cause of this high infection rate is lack of access to adequate sanitation facilities (toilets) and the consequent contamination of the environment with human feaces. While universal access to adequate sanitation is one of the sustainable development goals, parasite burdens are still causing harm. Fortunately, deworming medicines are highly effective and safe. Researchers from Syracuse University, the World Health Organization, and SUNY Upstate measured the impact of deworming medicine during pregnancy on the subsequent risk of neonatal mortality and low birthweight. The study has been conducted on 95 Demographic Health Survey data collected on more than 800 000 births and the results are published on the current issue of PLoS Neglected Tropical Diseases

When women receive deworming medicine during pregnancy, we find two specific benefits for the baby: first, the risk of neonatal mortality (a baby's death within the first 4 weeks of life) decreases by an estimated 14%; second, the odds of low birthweight are an estimated 11% lower in countries with lower transmission of soil-transmitted helminths. These results vary somewhat by transmission rate across different countries.

Given the low cost of deworming medicine and fundamental health advantages, these findings call for an increased global effort toward widescale distribution of deworming medicine for pregnant women. Global effort toward reducing STH infections is affordable, and the benefits far outweigh the program costs.

A recent study has found that mothers receiving deworming treatment during pregnancy reduce by 14% the risk of their child dying within the first four weeks after birth. Another benefit is that treating pregnant women with anthelminthic medicines can avoid low birthweight.

The study, conducted on 95 Demographic Health Survey datasets and collected on more than 800 000 births, utilized birth histories to measure the impact of routine deworming medicine during antenatal care on subsequent neonatal mortality and low birthweight for births between 1998 and 2018 in 56 lower income countries.

"Pregnant women who received deworming medication were associated with a 14% reduction in risk for neonatal mortality, with no difference between high and low transmission countries," said Bhavneet Walia of the Department of Public Health, Syracuse University, New York, USA. "We also found that in countries with low transmission of soil-transmitted helminths, deworming treatment decreased the odds of low birthweight by 11%, although these somewhat varied in relation to transmission rates across different countries."

Routine deworming during antenatal care decreases risk of neonatal mortality and low birthweight: a retrospective cohort of survey data' (to hyperlink) authored by Syracuse University, the World Health Organization (WHO) and SUNY Upstate is published in the journal, PLoS Neglected Tropical Diseases.

The researchers matched births on the probability of receiving deworming during pregnancy. They then modelled birth outcomes with the matched group to estimate the effect of deworming during antenatal care after accounting for various risk factors. They also tested for effect modification of soil-transmitted helminth prevalence on the impact of deworming during antenatal care.

"Intestinal worms impact the health of women and girls of reproductive age and this study supports the fact that treating pregnant women can be beneficial," said Dr Antonio Montresor, Medical Officer, WHO Department of Control of Neglected Tropical Diseases. "WHO has long recommended the deworming women of reproductive age after their first trimester of pregnancy and in areas where the prevalence of worm infections is 20% or higher."

Soil-transmitted helminths2 are transmitted by ingesting microscopic eggs that are passed in the faeces of infected people and disperse in the environment. Adult worms live in the intestines where they produce thousands of eggs each day. In areas that lack adequate sanitation, these eggs contaminate the soil.

More than 1.5 billion people, or 24% of the world's population, are infected with soil-transmitted helminths. Infections are widely distributed in tropical and subtropical areas, with the greatest numbers occurring in sub-Saharan Africa, the Americas, China and East Asia.

Approximately 688 million girls and adult women of reproductive age live in areas which are endemic for intestinal worms, in more than 100 countries. The greatest number is found in sub-Saharan Africa, the Americas and Asia where reinfection is frequent in areas of high transmission.

WHO coordinates shipment of donated medicines to countries requesting them. They are then distributed freely by national disease control programs during mass treatment campaigns.

Periodic deworming should be available to children and to all pregnant women in endemic countries.

Deworming is not the only answer, however. A permanent solution can only be obtained by a substantial improvement in access to sanitation - a process that is normally slow and expensive.

EL PASO, Texas -- For more than a year, researchers at The University of Texas at El Paso's Stanley E. Fulton Gait Research & Movement Analysis Lab in the College of Health Sciences have been using real-time 3D animation to investigate motor impairments in children who have autism spectrum disorder (ASD). Their aim is to understand how children with autism can learn motor skills, so that they can receive effective therapies.

The results of their study, titled "Children With Autism Exhibit More Individualized Responses to Live Animation Biofeedback Than Do Typically Developing Children," were recently published in the journal of Perceptual and Motor Skills. The paper's release coincides with National Autism Awareness Month in April.

"The greatest takeaway from this study is that when teaching or coaching new movements to an individual with autism, the teacher or coach needs to understand the individual with autism's specific motor learning characteristics," said Jeffrey Eggleston, Ph.D., assistant professor of kinesiology and Gait lab director. He is the study's lead author. "They need to look specifically at each child's needs because each child is different."

The study's other authors include Alyssa N. Olivas, a student in the doctoral biomedical engineering program; Heather R. Vanderhoof and Emily A. Chavez, students in the Interdisciplinary Health Sciences (IHS) doctoral program; Carla Alvarado, M.D., board certified psychiatrist; and Jason B. Boyle, Ph.D., associate professor and interim chair of Kinesiology at UTEP.

More than 80% of children with ASD have gross motor skills issues, such as problems with balance and coordination, which can interfere with their communication and social interactions.

The 18-month UTEP study incorporated live animation biofeedback to teach 15 children who have ASD and were between the ages of 8 and 17 how to do a squat, a strength exercise that works multiple muscle groups in the body's lower extremities.

Researchers compared their movement patterns to children without the disorder. They found that children with ASD displayed highly individualized responses to the live animation biofeedback, much more so than children with typical development, Eggleston said.

In the lab, children had 1-inch cubes called inertial measurement unit (IMU) sensors strapped to their pelvis, thighs, lower legs and feet. They followed an animation model on a computer screen, which showed them how to squat. The children would then try to perform the squat without looking at the animation.

IMU sensors captured the movement of the child's lower extremities. The data was relayed to a computer graphics program via Bluetooth, which was transposed into a skeletal animation of the child squatting and then standing back up on the computer screen.

New research shows that planned cesarean deliveries on maternal request are safe for low-risk pregnancies and may be associated with a lower risk of adverse delivery outcomes than planned vaginal deliveries. The study is published in CMAJ (Canadian Medical Association Journal).

The study used province-wide data from the Better Outcomes Registry & Network (BORN), Ontario's provincial birth registry. The authors analyzed data on 422,210 low-risk pregnancies over 6 years (2012 to 2018). There were 46,533 cesarean deliveries, of which 1827 (3.9%) were planned at the request of the mother; this proportion was unchanged during the years of study. Mothers who requested cesarean delivery were more likely to be White, to be aged 35 years or older, to have conceived by in vitro fertilization, to be delivering their first baby, and to live in a higher-income neighbourhood, among other characteristics.

"Our finding that CDMR [cesarean delivery on maternal request] rates have remained stable in Ontario provides reassurance to those concerned about the potential contribution of CDMR to rising cesarean delivery rates," writes Dr. Darine El-Chaâr, Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, with coauthors.

Importantly, the findings also showed that cesarean deliveries that were performed following maternal request and vaginal deliveries were both safe delivery options for mother and baby, with planned cesarean deliveries on maternal request being associated with a lower risk of adverse delivery outcomes for both the mother and the baby than planned vaginal births.

The authors caution that research is needed to understand potential longer-term effects of planned cesarean deliveries.

"Although our study addresses concerns related to the immediate implications of planned CDMR, exploration of longer-term risks is needed, including its impact on breastfeeding, and the child's risk for infection and respiratory illness," they conclude.

On September 28, 2018, an inexplicably large tsunami devastated the Indonesian coastal city of Palu and several others nearby. Between the tsunami and the magnitude 7.5 earthquake that caused it, some 4,340 people were killed, making it the deadliest earthquake that year.

The tsunami's waves reached around six meters high, which was a shock to geophysicists who had believed that earthquakes along a strike-slip fault could only trigger far smaller tsunamis for that particular region. Now, new research describes a mechanism for these large tsunamis to form, and suggests that other coastal cities that were thought to be safe from massive tsunamis may need to reevaluate their level of risk.

Most large tsunamis are triggered by earthquakes along thrust faults, where one piece of crust is shoving its way over the top of another. Motion along such a fault creates a large vertical displacement, which, when the fault is under water, generates massive waves.

Strike-slip faults, by contrast, occur where two pieces of crust are moving horizontally and alongside one another, yielding very little vertical displacement.

"Whenever we saw large tsunamis triggered by earthquakes along strike-slip faults, people assumed that perhaps the earthquake had caused an undersea landslide, displacing water that way," says Ares Rosakis, the Theodore von Kármán Professor of Aeronautics and Mechanical Engineering at Caltech and corresponding author of a paper on the new research that was published in the Proceedings of the National Academy of Sciences (PNAS) on May 3.

About a month after the Palu tsunami, Rosakis attended a National Science Foundation (NSF) seismology workshop at Caltech organized by Nadia Lapusta, the Lawrence A. Hanson, Jr., Professor of Mechanical Engineering and Geophysics; there, he connected with Ahmed Elbanna (PhD '11), who worked with Lapusta and Professor of Engineering Seismology, Emeritus, Tom Heaton (PhD '78) while earning his degree at Caltech.

"The workshop wasn't supposed to be about Palu, but you get a bunch of seismologists together right after an event like that, and of course we'll be discussing it," says Elbanna, associate professor and Donald Biggar Willett faculty fellow at the University of Illinois Urbana-Champaign (UIUC), and lead author of the PNAS paper. "It puzzled the community. Why would these types of faults create this effect?"

At that time, very little was known about the quake. Early evidence suggested that the earthquake rupture had been supershear, meaning that the speed of the rupture exceeded the velocity of seismic shear waves. The existence of supershear ruptures was first discovered experimentally at Caltech in 2000 by Rosakis and Hiroo Kanamori, the John E. and Hazel S. Smits Professor of Geophysics, Emeritus.

These hyper-fast earthquakes tend to occur on long faults (on the order of 100 kilometers or more), where the rupture can gain speed as it rips along. The phenomenon is much like an aircraft breaking the speed of sound, generating a Mach wave that manifests as a sonic boom; in the case of hyper-fast earthquakes, a destructive Mach wave front is emitted from the fast-traveling tip of the rupture zone.

"Ares is a pioneer in the area of supershear quakes, and Palu was a supershear quake, so we started questioning whether there was a connection that created the tsunami," Elbanna says.

"I always suspected that the supershear nature of the quake was the reason, and I thought that the interaction of the Mach fronts with sides of the Palu bay may have had something to do with it. I shared my thoughts with Ahmed, and we decided to join forces and numerically explore this issue," Rosakis says. "A few months later, we also joined forces with my longtime collaborators in France: Harsha Bhat of ENS, my former postdoc at Caltech; and Faisal Amlani (PhD '13). They were also looking at a possible connection between the supershear nature of the earthquake and the tsunami characteristics at Palu and had, by that time, obtained conclusive evidence, from near-fault GPS station data, that the Palu rupture was indeed supershear," Rosakis adds.

To jump-start this research, Rosakis and Elbanna pooled funding. Elbanna used funding from his NSF CAREER award that supports his research on faults and fluids. Rosakis applied for and quickly received seed funding from the Caltech/Mechanical and Civil Engineering (MCE) Big Ideas Fund, established in 2018 by members of MCE's External Advisory Board including chairman and alumnus Lon Bell (BS '62; MS '63, PhD '68), founder of Gentherm.

Meanwhile, in then-unrelated work, Costas Synolakis (BS '78, MS '79, PhD '86), an expert on tsunamis and tsunami-hazard mitigation, was also trying to learn more about what happened at Palu. Synolakis, who is currently president of Athens College in Greece while on sabbatical from his position as professor of civil/environmental engineering at the USC Viterbi School of Engineering, convinced the Indonesian government to let him bring a small team of scientists to the area shortly after the disaster to document any ephemeral evidence that might explain the cause of the large tsunami.

Funded by an NSF grant, Synolakis and his crew of five researchers arrived in Palu about three weeks after the tsunami and deployed airborne drones, shot video, interviewed eyewitnesses, and conducted surveys using LIDAR (an acronym for Light Detection and Ranging; a three-dimensional laser-scanning technology). "The tsunami was totally out of scale, about three times the size you'd expect." Synolakis says. "We carefully documented the impact of the tsunami and its height. And then we had to think, 'How could this have happened from an earthquake that was not supposed to do this?'"

Synolakis and his team stayed in the devastated area for a week, trying to learn as much as they could before the evidence was erased as the cleanup and reconstruction began. "The hardest part is talking to people about something like that," Synolakis says. "It looked like a bulldozer had come in and leveled the town. We talked to the relatives and friends of people who had died; people whose homes and possessions were all washed away. This is why it is so important that we try to understand what really happened."

When he returned to the States, Synolakis talked to his old friend Rosakis about what he had seen. Synolakis and Rosakis attended Athens College together in the early 1970s.

While their research does not typically overlap--Rosakis deals with the solid mechanics of the moving earth, while Synolakis deals more with the fluid mechanics of the ocean--in this case, they found common ground, so to speak. "Here, we are coupling solid mechanics with fluid mechanics," Rosakis says. "The fully 3-D solid mechanics model creates the earthquake, which shakes the seafloor and walls of the bay and drives a fluid-mechanics event with the water that is sitting inside."

Through 3-D computer simulations conducted by the two UIUC graduate students, Mohamed Abdelmeguid and Xiao Ma, the team found that a supershear strike-slip earthquake that occurs beneath a narrow, shallow bay can trigger a massive tsunami. Even though the earthquake does not cause a major vertical displacement, the sides of the bay almost instantaneously interact with the substantial horizontal displacements carried by the Mach fronts of the supershear rupture. The sides of the bay then focus and direct the supershear rupture's energy, much like the walls of a bathtub direct bathwater sloshed around by a child. After that initial mega-jolt sends water sloshing vertically, gravity takes over and a tsunami is created.

"What is unique about our study is that we focused on extracting the fundamental mechanisms through which a strike-slip fault system interacting with the boundaries of a narrow bay may possess enough potential for triggering destructive tsunamis," Elbanna said. "We opted to simulate a very basic, planar fault passing through a very simplified smooth-bottomed bay similar to a bathtub. Having this simplified baseline model allows us to generalize to any place on the planet that may be at risk."

The computer simulations generated by the team matched the field evidence that Synolakis had gathered. For example, the simulation suggested that a strike-slip fault, in which one side slides one direction and the other side slides the opposite way, would generate an asymmetric tsunami wave with greater inundation on one side of the fault than the other. Images of the damage at Palu show exactly that.

Furthermore, the model identified three distinct phases of the tsunami's motion: an instantaneous dynamic phase right as the rupture crosses the bay; a co-seismic lagging phase that occurs as the rupture has passed by, but the earthquake waves are still shaking an affected region; and a post-seismic phase dominated by gravity as well as reflections and wave-focusing from the shore and bay apex. Each may affect coastal areas differently.

"The tsunami risk from strike-slip faulting needs to be reevaluated," Rosakis says. He notes that similar conditions exist along the San Andreas Fault in the Bay Area, as well as in the highly developed Gulf of Aqaba that shares coastline with Egypt, Israel, Jordan, and Saudi Arabia.

A study published today in Nature Communications shows that the drug rucaparib has been effective in treating certain types of ovarian cancers if used early in treatment, after a diagnosis, and before the cancer cells build up a resistance to chemotherapy.

Rucaparib is in a relatively new class of drugs - Poly(ADP-ribose) polymerase or PARP inhibitors - which have been approved for therapy in ovarian cancers. This study provides insights into both how the cancers resist treatments, and which patients may respond favorably to the drug, said lead author Dr. Elizabeth Swisher, a UW Medicine gynecologic oncologist and a professor of obstetrics and gynecology at the University of Washington School of Medicine. She also co-directs the Breast and Ovarian Cancer Research Program at the Seattle Cancer Care Alliance.

The paper represents collaborative work of researchers in 75 universities and focuses on treatments of 493 patients between April 2013 and October 2016.

"PARP inhibitors are a drug class that has become an important therapeutic for ovarian and some other cancers. This study looked at pretreatment biopsies to define predictors of response to treatment and mechanisms of resistance (within the cancer cells), which is critical to understanding best use of these therapies," Swisher said.

The best responders included those patients with ovarian cancer associated with inherited or somatic (not inherited) mutations in the ovarian cancer susceptibility genes BRCA1, BRCA2, RAD51C and RAD51D, all genes involved in DNA repair, Swisher noted.

"PARP inhibitors target the Achilles heel of cancers which have certain types of defects in DNA repair," she said.

The study found that cancers exposed to previous platinum chemotherapy have built up resistance by improving their DNA repair capabilities, which then creates cross-resistance to rucaparib. This explains why PARP inhibitors work better earlier in the course of treatment, Swisher said.

The researchers correlated many molecular alterations to response to treatment including inherited and somatic mutations, methylation alterations (epigenetic changes) and genomic scars (mutational patterns created by defective DNA repair).

The authors defined which mutation and methylation events correlated with response to rucaparib.

But in patients who had received previous chemotherapy, cancers had developed a resistance to  rucaparib.