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RIVERSIDE, Calif. -- People have different susceptibilities to SARS-CoV-2, the virus behind the COVID-19 pandemic, and develop varying degrees of fever, fatigue, and breathing problems -- common symptoms of the illness. What might explain this variation?

Scientists at the University of California, Riverside, and University of Southern California may have an answer to this mystery.

In a paper published in Informatics in Medicine Unlocked, the researchers show for the first time that the observed COVID-19 variability may have underlying molecular sources. The finding could help in the development of effective prophylactic and therapeutic strategies against the disease.

"Based on biomarkers and molecular profiles of individuals, one would hope to develop better medical tests to accommodate these variations in monitoring virus transmission and disease pathology, which helps guide mitigation and treatment options," said Sika Zheng, an associate professor of biomedical sciences at the UC Riverside School of Medicine, who led the study.

The SARS-CoV-2 virus hijacks human host molecules for fusion and virus replication, attacking human cellular functions. These human host molecules are collectively called SARS-CoV-2 host genes. The researchers systematically analyzed SARS-CoV-2 host gene expression, their variations, and age- and sex-dependency in the human population using large-scale genomics, transcriptomics, and proteomics.

They first found similarity of host gene expression is generally correlated with tissue vulnerability to SARS-CoV-2 infection. Among the six most variably expressed genes in the population they identified ACE2, CLEC4G, and CLEC4M, which are known to interact with the spike protein of SARS-CoV-2. Higher expression of these genes likely increases the possibility of being infected and of developing severe symptoms. Other variable genes include SLC27A2 and PKP2, both known to inhibit virus replication; and PTGS2, which mediates fever response. The authors also identified genetic variants linked to variable expression of these genes.

According to the Zheng, the expression profiles of these marker genes may help better categorize risk groups.

"More comprehensive risk assessment can better guide the early stage of vaccine distribution," he said. "Tests can also be developed to include these molecular markers to better monitor disease progression. They can also be used to stratify patients to assess and ultimately enhance treatment effectiveness."

In addition to identifying the most variable SARS-CoV-2 host genes, results from the study suggest genetic and multiple biological factors underlie the population variation in SARS-CoV-2 infection and symptom severity.

"Of course, these will need confirmation with more data. But the results indicate a potential value of a large scale eQTL project to profile genotypes and transcriptome of COVID-19 patients," Zheng said.

Next, the researchers plan to further analyze large scale genotypes and transcriptome data of COVID-19 patients when made available and to refine the results for higher association and accuracy.

In this Perspective, Marc Lipsitch and Natalie Dean consider what would happen if a COVID-19 vaccine offers little to no protection in high-risk groups, like the elderly and those with comorbidities, yet is able to reduce infection or infectiousness in younger adults. In such a case, they say, an indirect protection strategy - whereby those in contact with high-risk individuals are vaccinated to reduce transmission -could be preferred once vaccine supplies become large enough. This consideration mirrors the way influenza vaccine campaigns initially targeted the elderly, in an effort at direct protection, but more recently have focused on the general population, in part to enhance indirect protection. Measuring indirect effects of vaccines is harder than detecting direct effects, the authors note. "It is urgent, therefore, to obtain evidence on how each candidate vaccine affects infectiousness either before approval or soon after, when scarcity may justify randomized distribution of a vaccine," they say. "[H]aving reliable evidence on direct and indirect protection can help plan how to use these vaccines in a coordinated way." The evidence needed will depend in large part on results from Phase 3 trials; though, even after the trials are done, say the authors, questions that will require follow-up will remain, including about whether approved vaccines can prevent infection or reduce contagiousness, and also subgroup-specific efficacy. They point out that the clearest evidence of indirect protection from a vaccine is from a vaccine that prevents infection entirely, thereby reducing transmission. Ideally, write Lipsitch and Dean, the phase 3 trials in progress will identify more than one safe, effective vaccine for regulatory approval and deployment. Post-approval vaccine studies will then take on an important role for continued assessment of vaccine effectiveness, the authors say. In doing these, researchers can leverage ongoing surveillance, the authors say; these programs can simultaneously monitor more than one vaccine, enabling assessment of their relative merits.

BOSTON - The potential impact of the patient-clinician relationship on a patient's response to treatment is widely accepted. But until now, little was known about which parts of the brain may play a role in that interaction and which specific behaviors can influence clinical response, which is critically important to optimizing patient-clinician interactions for clinical benefit.

Now, researchers from Massachusetts General Hospital (MGH) have reported on an experiment using a novel magnetic resonance imaging (MRI)-based approach to study that interaction in real time and track the effects of different behaviors on the brain while patients and clinicians interact with one another. Their research, published in Science Advances, suggests that mirroring in both facial expressions and brain activity can affect the patient-clinician bond as well as the effects of treatment. In this case, the patients were receiving treatment for pain from an acupuncturist.

"We talk about medicine being an art as well as a science, but we know almost nothing about the neurobiology underlying the patient-clinician interaction," explains Vitaly Napadow, PhD, LAc, of MGH's Athinoula A. Martinos Center for Biomedical Imaging. Napadow is senior author of the paper and led this study with Ted J. Kaptchuk, director of the Program in Placebo Studies and Therapeutic Encounter (PiPS) at Harvard Medical School and Beth Israel Deaconess Medical Center.

To study this complex question, Napadow and his colleagues first devised a specialized technological platform for "hyperscanning functional MRI," or recording functional magnetic resonance imaging to track the brain's response simultaneously in two individuals -- an acupuncturist and the patient undergoing treatment for pain. To their knowledge, this is the first study looking at synchronous brain activity in both clinicians and their patients during a treatment.

"Synching up with one another during interpersonal interactions may help optimize brain processing. And it has been suggested that such physiological concordance may support empathy and social bonding," says Dan-Mikael Ellingsen, PhD, the paper's lead author. Ellingsen, a post-doctoral fellow at the MGH Martinos Center when he contributed to the study, is now at the Department of Psychology of the University of Oslo.

To achieve this, the researchers connected two MRI scanners on the same floor. While the patient was being treated remotely with electroacupuncture and administered a moderate pressure pain, they and their clinician could communicate via video camera.

The researchers found that clinicians mirrored the facial expressions of patients expecting pain and treatment, while same regions of the brain were also activated in both parties. Those regions were parts of the neural circuitry already known to be associated with social mirroring (copying others' behavior) and the theory of mind, which describes the process of inferring another person's mental state. Both of those processes relate to empathy and have been strongly linked to activity in the temporoparietal junction, the region showing alignment in brain activity between patients and clinicians in this study.

"This study demonstrates that the clinical encounter has a demonstrable effect on the brain," says Napadow.

That realization may help answer questions such as why different patients respond differently to the same medications. In turn, it shows that the patient-clinician relationship has a measurable, quantifiable and relevant impact on the brain, emotions and clinical outcomes.

The researchers see this study as a first step towards a better understanding of the biological underpinnings of the clinician-patient relationship. "To optimize the effect of something, you have to first know how it works," says Napadow.

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

1. Down Syndrome associated with a 10-fold increased risk for COVID-19-related death

At the start of the COVID-19 pandemic, many national health organizations emphasized quarantining or physical distancing, especially for those deemed to be extremely vulnerable on the basis of certain medical conditions. Although Down syndrome was not specifically mentioned on official lists of conditions that put people at increased risk, the condition is associated with immune dysfunction, congenital heart disease, and pulmonary pathology. Therefore, it may be an unconfirmed risk factor for severe COVID-19.

Researchers from the University of Oxford, the University of Nottingham, the London School of Hygiene & Tropical Medicine, and the University College London studied a cohort of 8.26 million adults through a QResearch database to evaluate if Down syndrome is a risk factor for death from COVID-19. The authors found an estimated a 4-fold increased risk for COVID-19-related hospitalization and a 10-fold increased risk for COVID-19-related death in persons with Down syndrome. They stress this novel evidence should be used by public health organizations, policymakers, and health care workers to strategically protect vulnerable individuals. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-4986.

Media contacts: A PDF for this article is not yet available. Please click the link to read full text. The lead author, Julia Hippisley-Cox, MD, can be reached through Helen Jacques at helen.jaques@nihr.ac.uk or can be reached directly at julia.hippisley-cox@phc.ox.ac.uk.

2. Ensuring Safe Access to Mifepristone During the Pandemic and Beyond

Mifepristone, one of two drugs used together to induce a medication abortion, was approved 20 years ago by the U.S. Food and Drug Administration (FDA), yet it cannot be routinely prescribed and dispensed in the U.S. because it is covered by a risk evaluation and mitigation strategy, or REMS program. REMS programs are intended to minimize harms from special safety risks through such precautions as distribution controls, laboratory testing requirements, and a more robust process of informed consent.

Although many health care providers have long called for reconsideration of the mifepristone REMS program, the COVID-19 pandemic has brought new attention to the issue, in part because of the risk of in-person visits. Authors from Brigham and Women's Hospital and Harvard Medical School and George Washington University Milken Institute School of Public Health discuss the implications of the REMS on mifepristone and suggest that the FDA releasing the REMS on mifepristone would represent a meaningful step for women's health and the exercise of their constitutional rights. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-6671.

Media contacts: A PDF for this article is not yet available. Please click the link to read full text. The lead author, Ameet Sarpatwari, PhD, JD, can be reached directly at asarpatwari@bwh.harvard.edu.

DALLAS, October 21, 2020 --The recovery phase following cardiac arrest continues long after hospitalization and is now included as a key link in the Chain of Survival, a widely adopted series of critical actions that work to maximize the chance of someone surviving cardiac arrest, according to the "2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care," published today in the Association's flagship journal, Circulation.

Cardiac arrest - when the heart suddenly stops beating - results in death 90% of the time in the United States when it happens outside of the hospital setting (which is most of the time). The Association's 2020 Guidelines provide an extensive review of evidence-based new and updated recommendations for CPR and emergency cardiovascular care training and response.

The new, sixth link in the cardiac arrest chain of survival addresses recovery. It highlights the need for treatment, surveillance and rehabilitation for cardiac arrest survivors and their caregivers.

Recommendations that are critically important to this concept include:

structured assessment for anxiety, depression, posttraumatic stress and fatigue for cardiac arrest survivors and their caregivers;

rehabilitation assessment and treatment for physical, neurologic, cardiopulmonary and cognitive impairments before discharge from the hospital; and

comprehensive, multidisciplinary discharge planning for cardiac arrest survivors and their caregivers, including medical and rehabilitative treatment recommendations and return to activity/work expectations.

"The 2020 Guidelines represent a synthesis of important science that guides how resuscitation is provided for critically ill patients," said Raina Merchant, M.D., M.S.H.P., FAHA, chair of the American Heart Association Emergency Cardiovascular Care Committee and associate professor of emergency medicine at the University of Pennsylvania. "As the science evolves over time, it's important that we review it and make recommendations about how providers can deliver high-quality care that reflects the most updated and state-of-the-art information."

The guidelines offer suggestions for increasing lay rescuer CPR rates, noting that currently less than 40% of non-hospitalized adults experiencing cardiac arrest receive layperson-initiated CPR before the arrival of emergency medical services. Some of the new or updated suggestions include the following:

Raise awareness of the need for lay persons to initiate CPR for presumed cardiac arrest, underscoring that the risk of harm to the patient is low.

Use mobile phone technology to increase the rate of bystander CPR and automated external defibrillator (AED) use. Emergency dispatch systems could alert willing bystanders via mobile phone technology apps to nearby events that may require CPR or an AED.

Bystander CPR training should target specific socioeconomic, racial, and ethnic populations who have historically exhibited lower rates of bystander CPR. CPR training should address gender-related barriers to improve bystander CPR rates for women.

Overall, the 2020 Guidelines outline 491 recommendations specific to adult, pediatric and neonatal life support, resuscitation education science and systems of care. In addition to the updated and new written guidance, all of the algorithms were updated to reflect the latest science and several major changes were also made to improve the visual training and performance aids. Some noteworthy updates incorporating updated or new algorithms and graphics include:

New data on respiratory rates during CPR in children are now available. The recommendation for pediatric CPR is one breath every 2 - 3 seconds (20 - 30 breaths per minute). Prior recommendations were based upon information extrapolated from adult data.

A new chain of survival created for in-hospital cardiac arrest in infants, children and adolescents.

A new algorithm and updated recommendations on resuscitation during pregnancy focuses on the best outcomes for both the mother and baby.

Addressing the increase in respiratory and cardiac arrests due to opioid overdoses, two new opioid-associated emergency algorithms for lay rescuers and for trained responders.

The guidelines were last updated in 2015, at which point the process of the five-year update transitioned to an online format using a continuous evidence evaluation process rather than periodic reviews to increase the potential for more immediate transitions and updates. The 2020 Guidelines document reflects alignment with the International Liaison Committee on Resuscitation (ILCOR) and associated ILCOR member councils. The writing group notes there is limited data in some areas of resuscitation research and a need for expanded study initiatives and funding opportunities. It also lists knowledge gaps within each section of the guidelines.

"High-quality CPR can make the difference between who lives and who dies from cardiac arrest and dedicated funding and efforts are needed to ensure that everyone who needs high-quality CPR receives it," said Merchant.

For the first time ever, the latest resuscitation science will be reflected in new high-quality CPR programs that release simultaneously, bringing science to life in the form of a new digital resuscitation portfolio. The programs are rooted in the True Adaptive™ learning design that delivers personalized instruction tailored to individual needs and knowledge levels. Developed in collaboration with Area9 Lyceum, a global leader in adaptive learning, the new digital solutions are delivered by RQI Partners, a partnership between and service provider for the Association and Laerdal Medical.

"In this time of physical distancing, resuscitation education and training delivery must evolve," said Clive Patrickson, Ph.D. and RQI Partners' chief executive officer. "The American Heart Association digital resuscitation portfolio uniquely and efficiently delivers safe and effective CPR quality improvement and leads healthcare organizations on an immediate journey to high-quality and verified CPR competence to maximize lifesaving outcomes. The time for digital is now."

The guidelines were developed by the writing group on behalf of the Adult Basic and Advanced Life Support Writing Group, The Pediatric Basic and Advanced Life Support Writing Group, the Neonatal Life Support Writing Group, the Resuscitation Education Science Writing Group and the Systems of Care Writing Group.

What The Viewpoint Says: The need for collaborative care among health care professionals to meet mental health demands in the COVID-19 pandemic is discussed in this Viewpoint.

Authors: Andrew D. Carlo, M.D., M.P.H., of the University of Washington School of Medicine in Seattle, 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/jamapsychiatry.2020.3216)

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

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ARLINGTON, Va., October 21, 2020 -- A new clinical guideline from the American Society for Radiation Oncology (ASTRO) provides guidance for physicians who use radiation therapy to treat patients with locally advanced rectal cancer. Recommendations outline indications and best practices for pelvic radiation treatments, as well as the integration of radiation with chemotherapy and surgery for stage II-III disease. The guideline, which replaces ASTRO's 2016 guidance for rectal cancer, is published in Practical Radiation Oncology.

Colorectal cancer is the second most common cause of cancer death in the U.S., and half of new colorectal cancer diagnoses are in people age 66 or younger. Rectal cancer diagnoses account for nearly one-third of colorectal cancers; an estimated 43,340 adults will be diagnosed with rectal cancer in 2020. While rectal cancer incidence and mortality rates have dropped among older adults in recent years, they have increased for those younger than age 55.

"As rectal cancer becomes more of a disease of younger adults, long-term survivorship and quality of life considerations become even more important. Part of our motivation was to create guidelines that provide options for different treatments that could potentially improve survival rates and also help preserve patients' quality of life," said Prajnan Das, MD, MPH, chair of the rectal guideline task force, and professor and chief of gastrointestinal radiation oncology at The University of Texas MD Anderson Cancer Center in Houston.

Standard treatment for locally advanced rectal cancer generally involves chemoradiation therapy or short-course radiation without chemotherapy, followed by tumor removal surgery and additional chemotherapy. More recently, several trials have shown potential for emerging paradigms, such as changing the sequencing of treatments or omitting portions of treatments for select patients.

"Different treatments are appropriate for different patients, and the oncology field at large is moving toward personalized care," explained Jennifer Y. Wo, MD, vice chair of the rectal guideline task force and associate professor of radiation oncology at Harvard Medical School and Massachusetts General Hospital in Boston. "Some patients may need less than what is considered a typical course of treatment, while some patients may need more. This guideline focuses on providing options that can be tailored to patients' characteristics and their wishes."

Recommendations in the guideline address patient selection for radiation therapy, delivery of pelvic radiation treatments, options for non-operative management of locally advanced rectal cancer and guidance for follow-up care. Key recommendations include:

Neoadjuvant radiation therapy is strongly recommended for patients with clinical stage II-III rectal cancer to reduce their risk of locoregional recurrence. Radiation therapy for locally advanced rectal cancer should be performed before rather than after surgery. Radiation may be omitted in favor of upfront surgery for some patients at low risk of recurrence, after discussion by a multidisciplinary care team. Clinical staging involving a physical exam and pelvic MRI is critical to determine which patients should receive neoadjuvant radiation therapy.

For patients who require neoadjuvant radiation therapy, both conventionally fractionated radiation and short-course radiation are recommended equally, given high-quality evidence for similar efficacy and patient-reported quality of life outcomes with each treatment. The guideline specifies optimal dosing, fractionation and delivery techniques for radiation therapy

Recommendations address how to incorporate chemotherapy into the pre-operative setting for patients who are at high risk of recurrence and who would likely benefit from the additional treatment using a total neoadjuvant therapy (TNT) approach. Recommendations also address other sequencing and timing issues for radiation, chemotherapy and surgery, with specific attention to treatment tolerability and potential downstaging.

Organ preservation approaches (i.e., non-operative management and local excision) may present an alternative to radical surgery for select patients, especially those who would have a permanent colostomy or inadequate bowel continence after surgery. The guideline outlines specific criteria for situations where surgery can be avoided, as well as long-term surveillance and care for these patients.

COVID-19 and Rectal Cancer

While the guideline was completed before the COVID-19 pandemic, recommendations can guide clinics as they continue to care for patients. To reduce how frequently patients needed to come into the clinic for treatment, many institutions across the country moved toward short-course radiation in the early months of the pandemic, which aligns with the guideline's recommendations.

"Patients usually complete short-course radiation therapy in one week, compared to five-and-a-half weeks for standard radiation treatment. That is particularly important in the COVID era, when you want to minimize patient time in the hospital and issues like financial toxicity are especially salient," said Dr. Das.

"We have yet to see the true impact of COVID-19, but we know that interruptions in screening likely will lead to fewer patients receiving treatment when their disease is more manageable," said Dr. Wo. "And if that does happen and we start seeing patients with more advanced disease, then the parts of the guidelines that specifically address treatment for high-risk patients will become even more important."

A peace sign from Martin Luther King, Jr, becomes a rude gesture; President Donald Trump's inauguration crowd scenes inflated; dolphins in Venice's Grand Canal; and crocodiles on the streets of flooded Townsville - all manipulated images posted as truth.

Image editing software is so ubiquitous and easy to use, according to researchers from QUT's Digital Media Research Centre, it has the power to re-imagine history.

And, they say, deadline-driven journalists lack the tools to tell the difference, especially when the images come through from social media.

Their study, Visual mis/disinformation in journalism and public communications, has been published in Journalism Practice. It was driven by the increased prevalence of fake news and how social media platforms and news organisations are struggling to identify and combat visual mis/disinformation presented to their audiences.

"When Donald Trump's staff posted an image to his official Facebook page in 2019, journalists were able to spot the photoshopped edits to the president's skin and physique because an unedited version exists on the White House's official Flickr feed," said lead author Dr T.J. Thomson.

"But what about when unedited versions aren't available online and journalists can't rely on simple reverse-image searches to verify whether an image is real or has been manipulated?

"When it is possible to alter past and present images, by methods like cloning, splicing, cropping, re-touching or re-sampling, we face the danger of a re-written history - a very Orwellian scenario."

Examples highlighted in the report include photos shared by news outlets last year of crocodiles on Townsville streets during a flood which were later shown to be images of alligators in Florida from 2014. It also quotes a Reuters employee on their discovery that a harrowing video shared during Cyclone Idai, which devastated parts of Africa in 2019, had been shot in Libya five years earlier.

An image of Dr Martin Luther King Jr's reaction to the US Senate's passing of the civil rights bill in 1964, was manipulated to make it appear that he was flipping the bird to the camera. This edited version was shared widely on Twitter, Reddit, and white supremacist website The Daily Stormer.

Dr Thomson, Associate Professor Daniel Angus, Dr Paula Dootson, Dr Edward Hurcombe, and Adam Smith have mapped journalists' current social media verification techniques and suggest which tools are most effective for which circumstances.

"Detection of false images is made harder by the number of visuals created daily - in excess of 3.2 billion photos and 720,000 hours of video - along with the speed at which they are produced, published, and shared," said Dr Thomson.

"Other considerations include the digital and visual literacy of those who see them. Yet being able to detect fraudulent edits masquerading as reality is critically important.

"While journalists who create visual media are not immune to ethical breaches, the practice of incorporating more user-generated and crowd-sourced visual content into news reports is growing. Verification on social media will have to increase commensurately if we wish to improve trust in institutions and strengthen our democracy."

Dr Thomson said a recent quantitative study performed by the International Centre for Journalists (ICFJ) found a very low usage of social media verification tools in newsrooms.

"The ICFJ surveyed over 2,700 journalists and newsroom managers in more than 130 countries and found only 11% of those surveyed used social media verification tools," he said.

"The lack of user-friendly forensic tools available and low levels of digital media literacy, combined, are chief barriers to those seeking to stem the tide of visual mis/disinformation online."

Associate Professor Angus said the study demonstrated an urgent need for better tools, developed with journalists, to provide greater clarity around the provenance and authenticity of images and other media.

"Despite knowing little about the provenance and veracity of the visual content they encounter, journalists have to quickly determine whether to re-publish or amplify this content," he said.

"The many examples of misattributed, doctored, and faked imagery attest to the importance of accuracy, transparency, and trust in the arena of public discourse. People generally vote and make decisions based on information they receive via friends and family, politicians, organisations, and journalists."

The researchers cite current manual detection strategies - using a reverse image search, examining image metadata, examining light and shadows; and using image editing software - but say more tools need to be developed, including more advanced machine learning methods, to verify visuals on social media.

Distance studying and working is on the rise and, especially now with the constant threat of lockdown, learning how to master it more pressing than ever. A team of researchers from the Research Group in Education and ICT (EDUL@B) at the Universitat Oberta de Catalunya (UOC), led by Montse Guitert, has conducted a study to improve collaborative learning online and has redesigned an online course that overcomes the principal challenges.

The data gathered in the American Journal of Distance Education show the success of the app and validate the design using qualitative and quantitative methods. The researchers emphasize the key elements in fostering cooperation among students and conclude that the five factors can be extrapolated to other learning contexts in distance higher education.

Fears overcome

There are few who doubt the advantages of cooperative work on projects in on-site environments. However, when this type of learning is done online, obstacles appear. These include teachers' lack of confidence in the system, students' resistance to collaborative learning techniques, and plagiarism.

Educationalist Montse Guitert, who co-authored the paper together with Teresa Romeu and Marc Romero, also from EDUL@B, explained that "more than ever, students have to learn to work as a team online completely asynchronously, which are key elements for professionals in the digital society".

Guitert added: "As the first online university and with 25 years' experience in distance education, the UOC had already designed a course so that students could acquire digital skills in an integrated way as a team, and it has steadily evolved over the years. Taking into account that around 100,000 students have studied on it, we have now conducted research to especially improve the experience of collaborative learning in online environments".

The researchers have redesigned the compulsory course in ICT Skills, studied by an average of 3,500 students a year in one semester, divided over 22 very diverse programmes at the University, such as computer engineering, law and humanities.

The five key elements, improved

The course offers students the strategies to plan individual and group tasks and "successfully cooperate" in an online environment on the basis of a project that motivates them to learn while they acquire digital competence.
The key elements that they detect are:

1. STUDENT-FOCUSED AND ACTIVE. The course has to be student-focused and foster their active role in each of the phases. Students feel freer to experiment, research and learn for themselves, making this focus a suitable methodology for higher education.

2. STRUCTURED IN PHASES. The course is structured in phases, which include a series of task- and/or challenge-based activities and their link with cooperative work. It is a model that requires a high degree of cooperation between the students throughout almost the entire process.

3. MULTI-FORMAT. The learning resources, which support the progress of the activities through the different phases, are designed to be consistent with the course skills and evolve to meet the students' needs. The resources are in different formats (text, website, and video) to promote motivation and learning with different technological devices.

4. 360 ASSESSMENT. Assessment is continuous and linked to the group dynamic. It includes individual assessment, group reflection in every phase, self-assessment of the individual contribution to the group tasks, assessment of classmates' contributions with a peer assessment activity and global course assessment.
The study concludes that 85% of students are satisfied with the continuous assessment model. According to Guitert, "we see that it leads them to reflect and allows them to be aware of the impact of their own work within the group". The students also value the improvement of the group dynamic as one of the most important benefits. In the words of one student, "at first, I didn't want to rate my classmates, but I realized that it helped us improve our own participation in the group".
These assessments focus on the results and the processes and are carried out in the group spaces and the online classroom.

5. PROACTIVE ONLINE PROFESSOR. The role of the teacher is fundamental in the application of the methodology. Guitert claimed that "more than ever, teaching presence is key not only during the design of the activities, but also in the continuous monitoring of the groups' process and their assessment". A series of digital tools help to monitor the students (learning analytics using collaborative tools that leave a record), and detect plagiarism.

With the new design of online collaborative project-based learning, 77.4% of students passed the course, a figure that is notably higher than that of other first-year courses, which have an average pass rate of 66.8%.
In addition, 90% of students say that they have acquired a high level of skill in online teamwork. In the anonymous control survey, one of the course participants replied that "with the multi-format resources, the methodology by phases and the 360-degree assessment, I've learnt to cooperate very positively with my teammates. In fact, I've learnt to study online".

The five elements are transferable to other online training initiatives in higher education. Guitert concluded by saying "this research can enrich any training action based on projects or complex activities, where the students have to acquire different abilities in an integrated way, especially cross-disciplinary and instrumental skills".

Palliative care should extend across China and pay more attention to managing non-malignant disease - integrated within the country's healthcare system and available to everyone who needs it, according to a new study.

Researchers have found that, with rapidly aging populations, there is an increasing need for palliative care across Greater China - Hong Kong, Macao, mainland China and Taiwan - to help improve quality of life, as well as reducing pain, anxiety and depression.

Experts at the University of Birmingham also called for more research to understand the causes of poor pain control for patients at the end of their lives - noting that low use of opioids may stem from widespread use of traditional Chinese medicine for pain control.

The researchers analysed all relevant existing studies in the field and, publishing their findings in the Journal of Pain and Symptom Management, noted that, in traditional Chinese culture, relatives' views play an important role when making end-of-life care decisions. This created a major challenge for healthcare providers when patients' family members views were at odds with professional recommendations.

For patients with dementia, they also called for a suite of policy initiatives including advance care planning, home-based palliative care and institutional care.

Report co-author Dr. Ping Guo, from the University of Birmingham, commented: "Evaluation of palliative care intervention demonstrated positive effects on improving patients' quality-of-life, as well as reducing pain, anxiety and depression - cutting re-admission rates and cost. "

"There are still gaps in our understanding, however, and further research is needed into the lack of rigorous randomised control trials, palliative care for patients with non-malignant diseases and identifying partnerships between specialist palliative care and community services."

"Policy support will be vital in establishing culturally appropriate palliative care services in the region and ensuring that palliative care is well integrated into the existing health system and available for all individuals and communities in need in Greater China."

The researchers analysed studies relating to nine key themes:

Patients need for better pain control
69.9% of 2,185 patients with terminal cancer reported they usually had pain, with 47.4% of 1,370 terminal cancer patients reporting that they had unsatisfactory pain relief.

Patients' need for reduced aggressive end-of-life care
Patients reported that they wished a peaceful and natural death, avoiding excessive treatment and dying with dignity.

Identifying and meeting preferred place of care and death
Home is the preferred place of death, but barriers to uptake of home-based hospice care made this difficult.

Patients need for truth telling
Families often concealed a prognosis from patients, believing that disclosure was inappropriate, but patients report negative emotional effects from not knowing their prognosis and being unable to make informed choices.

Patients need for physical, emotional, and spiritual support
Poor symptom relief is associated with worsening well-being among patients, who as a result, often suffer disturbed sleep, fatigue, drowsiness, delirium, and dyspnea.

Healthcare professionals need for training
Health care professionals who worked with dying patients with cancer in mainland China said they need to develop skills for end-of-life communication, psychological care, and dispelling patients' myths and fears.

Informal caregivers need for end-of-life care education
Wives and husbands expressed a need for medical knowledge because they had to be active participants in cancer care.

Informal caregivers need for relieving care burden
Wives and husbands need help to alleviate their care burden as they balance between duties with care of their dying loved ones and other roles and duties to family and work.

Lack of national policy support

Oncology health care professionals acknowledge the needs of terminal patients and their families but find it difficult to implement measures because of the lack of relevant policy and legislation.

Palliative care is a human right, but a neglected dimension of global health. Projections suggest that serious health-related suffering in the last year of life is projected to increase by the year 2060 from 26 to 48 million people . Most of these people (83%) will live in low- and middle-income countries. In upper middle-income countries, such as mainland China, an 87% increase in serious health-related suffering at the end of life is expected .

A low dose of ketamine, administered intravenously, does not alter a healthy human's tolerance to blood loss. In other words, if someone was given ketamine to kill pain associated with a battlefield injury, they would be able to tolerate blood loss just as well as someone who did not received this pain killer.

That's according to new research published today in The Journal of Physiology.

Medics in the US Army give ketamine for pain relief associated with a battlefield injury. Such injuries are often accompanied with significant blood loss. Ketamine is also now being used by civilian medical personnel, such as emergency medical personnel, for pain control after a traumatic accident. However, little is known whether ketamine alters the ability of an individual to tolerate major blood loss following an injury.

In this study, funded by the US Army, the research found that the dose of ketamine administered on the battlefield does not alter a person's ability to tolerate a simulation of major blood loss. This finding was identified in both healthy men and women that possess similar physical characteristics of US Army personnel.

This study, conducted on conscious humans, provides experimental evidence that giving a low dose of ketamine (20 mg intravenous) does not alter the tolerance to progressive blood loss. These findings will assist medical personnel in choosing the ideal pain medication for a serious injury with accompanying blood loss, particularly on the battlefield.

The study involved 30 healthy volunteers, 15 male and 15 female adults, having physical characteristics of US Soldiers completed the study. Each volunteer participated in two experimental trials, in random order, where they received either saline (placebo) or ketamine (pain medication) immediately before the onset of a simulated blood loss procedure called lower-body negative pressure.

While lying on their back, each volunteer was sealed in a box-like chamber from the waist down and progressively increased levels of suction were applied to the lower body. This suction transfers blood from the upper body (chest and head areas) to the lower limbs simulating gradual blood loss.

Tolerance capacity of this simulation of blood loss was determined by the time it takes to reach well-recognized physiological symptoms of impending fainting (pre-syncope).

The participants, regardless of body size, received the identical amount of ketamine i.e, 20 mg intravenous racemic ketamine hydrochloride. This fixed dose of ketamine is consistent with the guidelines from the US Army's Committee on Tactical Combat Casualty Care.

The obtained findings may be dissimilar if body-mass specific dosage of ketamine was given. Also, the participants were healthy, relatively young, weighed a minimum of 143 lbs, and were not obese. Thus, the obtained findings should not be applied to other populations, especially to people with underlying diseases.

Craig Crandall, an author on the study, commented:

"Ketamine is one of four pain medications recommended for use in the battlefield after a serious injury. Further studies are needed to investigate if the use of these other medications - fentanyl, morphine, and sufentanil - alters tolerance to simulated blood loss. Further research is also warranted to investigate the effects of different dosages of ketamine in these experimental conditions and in a more varied population."

Using a new mathematical approach to screen large groups for Covid-19 could be around 20 times cheaper than individual testing, a study suggests.

Applying a recently created algorithm to test multiple samples in one go reduces the total number of tests needed, lowering the cost of screening large populations for Covid-19, researchers say.

This novel approach will make it easier to spot outbreaks early on. Initial research shows it is highly effective at identifying positive cases when most of the population is negative.

A team of researchers, including a theoretical physicist from the University of Edinburgh, developed the method - called the hypercube algorithm - and conducted the first field trials in Africa.

Tiny quantities taken from individual swabs were mixed to create combined samples and then tested. The team showed that a single positive case could still be detected even when mixed with 99 negative swab results.

If this initial test highlighted that the mixed sample contained positive cases, then researchers used the algorithm to design a further series of tests. This enabled them to pinpoint individual positive swab results within the combined sample, making it easy to identify people who are infected.

If the initial test results indicated that there were no positive cases in the mixed sample, then no follow-up action was needed.

The new method is best suited to regular screening of a population - rather than testing individual patients - and may help to significantly lower testing costs, the team says.

So far, the method has been trialled in Rwanda, where it is being used to screen air passengers, and in South Africa, where it is being used to test a leading rugby team regularly.

The study, published in the journal Nature, also involved researchers from the African Institute for Mathematical Sciences (AIMS) and the University of Rwanda.

Professor Neil Turok, who recently joined the University of Edinburgh's School of Physics and Astronomy as the inaugural Higgs Chair of Theoretical Physics, said: "We hope our method will enable regular, cost-effective screening in multiple contexts. By doing so, it could be a game changer in helping us to overcome the Covid-19 pandemic."

Chameleons can famously change their colors to camouflage themselves, communicate and regulate their temperature. Scientists have tried to replicate these color-changing properties for stealth technologies, anti-counterfeiting measures and electronic displays, but the materials have limitations. Now, researchers have developed a flexible film that changes color in response to stretching, pressure or humidity. They report their results in ACS Applied Materials & Interfaces. Watch a video of the chameleon-inspired material here.

By tensing or relaxing their skin, chameleons can change the way light reflects from guanine crystals under the surface, producing what's known as structural coloration. These structural colors are different from the pigments that give many other creatures their hues. Scientists have mimicked the crystalline nanostructures of chameleon skin in various color-changing materials, but they're typically difficult to produce, or they rely on non-renewable petroleum resources. In contrast, cellulose nanocrystals are a renewable material that can self-assemble into a film with iridescent structural colors. However, the films are typically fragile and, unlike chameleon skin, can't be stretched without breaking. Fei Song, Yu-Zhong Wang and colleagues wanted to develop a highly flexible film made of cellulose nanocrystals that changes color when stretched.

To increase the flexibility of cellulose nanocrystals, the researchers added a polymer called PEGDA and used UV light to crosslink it to the rod-shaped nanocrystals, producing films with bright iridescent colors ranging from blue to red, depending on the PEGDA amount. The films were both strong and flexible, stretching up to 39% of their original length before breaking. During stretching, the color of one film gradually changed from red to green, and then changed back when relaxed. According to the researchers, this is the first time that stretching- and relaxing-induced, reversible structural color changes that are brilliant and visible to the naked eye have been realized for cellulose nanocrystal materials. The film also changed color with pressure and humidity, allowing the team to show or hide writing made by an inkless pen. The new bio-based smart skin could find applications in strain sensing, encryption and anti-counterfeiting measures, the researchers say.

Americans strongly reduced their visits to grocery stores, pharmacies, and transit stations following stay-at-home orders from mayors and governors earlier this year, but did not reduce their visits to parks and beaches, according to a study co-authored by a researcher at the Johns Hopkins Bloomberg School of Public Health.

In the study, which appeared online September 30 in the journal Landscape and Urban Planning, the researchers examined publicly available Google data based on anonymized mobility information from millions of Android, iPhone, and Google Maps users in the United States to destinations including grocery stores, rail stations, and parks. The researchers analyzed how total movements changed, at the county level, following local shelter-in-place orders. They found relatively large reductions in visits to "essential" destinations such as grocery stores--but effectively no reduction in "non-essential" visits to parks and other outdoor recreational spots such as parks and beaches.

The analysis, which included all 771 metropolitan counties in Google's dataset from the first day of stay-at-home order in each county until May 11, 2020, showed that in counties classified as densely populated, reductions to essential trips were even more pronounced.

"The main challenge of compliance with stay-at-home orders in dense and compact areas doesn't seem to relate to 'essential' trips to grocery stores, pharmacies, and transit stations--trips that people in these areas seemed quite willing to reduce," says study senior author Shima Hamidi, PhD, Bloomberg Assistant Professor of American Health in the Department of Environmental Health and Engineering at the Bloomberg School. "This could be due to access to better services such as home-delivery grocery shopping in dense areas. Also, recent evidence shows that residents of dense places are more likely to adhere to the stay-at-home order, being more cognizant of the threat."

Mandatory social distancing and lockdown measures imposed by states and municipalities have been the most widely used public health tools against COVID-19 so far. But the degree to which people comply with these mandates has been unclear and relatively unstudied.

Hamidi and her co-author Ahoura Zandiatashbar, PhD, an assistant professor of Urban and Regional Planning at San Jose State University, found that for all 771 counties covered by the Google dataset, lockdowns appeared to have a sizeable impact on the three major categories of travel they examined. Trips to grocery stores and pharmacies following lockdowns and up to May 11 stayed, on average, 13.3 percent below the local baseline averages established in January and February. Trips to transit stations stayed 37.4 percent below baseline. By contrast, trips to parks, beaches, and other outdoor recreational spots were only 0.4 percent lower on average--effectively unchanged.

Hamidi suggests that park and beach visits may not have declined because they were allowable under many stay-at-home mandates, may have been important in reducing stress amid the pandemic, and may also have been widely perceived as low risk. However, she also notes that there is some evidence from epidemiological studies suggesting that parks and other outdoor spaces can present a significant chance of virus transmission, especially if relatively crowded.

Hamidi and Zandiatashbar analyzed how trip trends varied according to different factors, and found that trips to grocery stores/pharmacies and transit stations--often categorized as "essential" trips--dropped more significantly in denser ("compact") counties, while trips to parks and beaches in these counties slightly increased.

"This is not surprising but could be concerning, since visiting parks during the pandemic has its own risks," says Hamidi. "Parks could be a potential hotspot for the transmission of the virus, especially if people don't physically distance. In addition, the risk of exposure to COVID-19 in parks is potentially even greater among the homeless who use parks frequently, which could eventually elevate the risk of COVID-19 exposure to the general population."

The researchers also analyzed trip changes during lockdown periods and counties' electoral results, and found slightly lower compliance overall, especially related to essential trips, in metropolitan counties where Donald Trump won a higher percent of the vote in the 2016 presidential election.

The researchers observed as well that reductions in the three types of trips tended to deepen in the days just after the announcement of lockdowns, but then lessen as lockdowns wore on.

"We urge decision-makers, planners, and public health officials to design and implement social distancing guidelines specifically for parks and similar areas," Hamidi says, "and to closely monitor people's social distancing behaviors in and travel patterns to parks in relatively dense urban spaces with higher per capita COVID-19 mortality rates."

Among U.S. patients diagnosed with breast, prostate, lung, or colorectal cancer from 2004 to 2016, those who were uninsured or had Medicare or Medicaid were less likely than privately insured patients to receive surgical care at high-volume hospitals. The findings are published in CANCER, a peer-reviewed journal of the American Cancer Society (ACS).

The study also showed that for uninsured and Medicaid patients with colorectal cancer, the likelihood of receiving care at high-volume hospitals improved after implementation of the Affordable Care Act.

The authors noted that volume of a hospital and clinical outcomes are closely related--with evidence of significantly lower death rates at high-volume hospitals.

"Ultimately, if patients with private insurance get care at better hospitals, then they will have better outcomes. Policy needs to address these issues urgently, otherwise insurance-based disparities will persist or get worse," said senior author Quoc-Dien Trinh, MD, of Brigham and Women's Hospital.

An accompanying editorial notes that additional studies should look into patient preferences and social determinants of health that may affect decisions and the ability to obtain high-quality surgical care.