Brain

If you're about to buy something online and its only customer review is negative, you'd probably reconsider the purchase, right? It turns out a product's first review can have an outsized effect on the item's future -- it can even cause the product to fail.

Shoppers, retailers and manufacturers alike feel the effects of customer reviews. Researchers at the University of Florida's Warrington College of Business looked at the influence of the first review after noticing the exact same products getting positive reviews on one retailer's website but negative reviews on others, said Sungsik Park, Ph.D., who studied the phenomenon as a doctoral student at UF.

"Why would a product receive a 4.7-star rating with 100 reviews on Amazon, but only four or five reviews with a two-star rating Walmart or BestBuy?" Park wondered.

To find out, Park -- now an assistant professor at the Darla Moore School of Business at the University of South Carolina -- teamed up with UF professors Jinhong Xie, Ph.D., and Woochoel Shin, Ph.D., to analyze what might cause the variation. By comparing identical vacuum cleaners, toasters and digital cameras on Amazon and Best Buy, they were able to isolate the first review as the variable in how the product fared. They showed that the first review can affect a product's overall reviews for up to three years, influencing both the amount and the tone of later reviews.

"The first review has the potential to sway the entire evolution path of online consumer reviews," Shin said.

How could one review have such a lasting impact? When the first review on a retailer's site was positive, the product went on to garner a larger number of reviews overall, and they were more likely to be positive. When a product got a negative first review, fewer people were willing to take a chance on buying it, so it had fewer opportunities to receive positive reviews, creating a lingering impact from the first unhappy customer.

"Once you think about how user reviews are generated, it makes sense," Park said.

The findings, published in the journal Marketing Science, suggest that retailers and manufacturers should take steps to detect negative first reviews and mitigate their impact.

Firms generally monitor their online reviews and evaluate their strategies accordingly, Xie explained. "However, they do so by focusing on average rating rather than a single rating, and after the product has sufficient time to be evaluated by consumers. Our research suggests that firms need to pay attention to a special single review (i.e., the first one) as soon as it is posted."

Consumers, on the other hand, might want to check multiple sites' reviews before they rule out a product. If you're looking at several sites to compare prices, Park suggests comparison shopping reviews, too. (For big ticket items, Park also checks third-party reviews like Consumer Reports.)

Because shoppers consider user reviews more trustworthy than information from advertising, it's important to understand the factors that could skew those ratings.

"We want consumers to know that this information can be easily distorted," Park said.

Narrowing of the trachea or the main bronchi due to injury or illness can end very badly. If patients get too little air,oxygen, they risk suffocating and often need medical help as quickly as possible.

Surgeons insert stents made of medically usable silicone or metal as a way of treating these patients. Although they quickly bring relief, the implants also have disadvantages: Metal stents have to be removed surgically with some effort, which is a burden for the patients, while silicone stents often migrate away from the insertion site. The reason for this is that the implants are not adapted to a patient's anatomy.

An ETH Zurich research team, composed of members of the Complex Materials and Drug Formulation and Delivery groups, has now developed an airway stent together with researchers from the University Hospital Zurich and the University of Zurich; it is tailored to patients and bioresorbable, (i.e., it gradually dissolves degrades after implantation). These stents are manufactured using a 3D printing process known as digital light processing (DLP) and light-sensitive resins specially adapted for this purpose.

First, the researchers create a computer tomography image of a specific section of the airways. Based on this, they develop a digital 3D model of the stent. The data is then transferred on to the DLP printer, which produces the customised stent layer by layer.

In the DLP process, a building platform is immersed in a reservoir full of resin. The platform is then exposed to UV light at the desired locations according to the digital model. Where light hits the resin, it hardens. The platform is lowered a little and the next layer is exposed to the light. In this way, the desired object is created layer by layer.

Special resin developed

Until now, DLP technology could only produce stiff and brittle objects using biodegradable materials. The ETH researchers, therefore, developed a special resin that becomes elastic after light exposure.

This resin is based on two different macromonomers. The material properties of the object produced with it can be controlled by the length (molecular weight) of the macromonomers used and by their mixing ratio, as the researchers show in their latest study in Science Advances.

As soon as UV light hits the resin, the monomers link together and form a polymer network. Since the newly developed resin is too viscous at room temperature, the researchers had to process it at temperatures of 70 to 90 degrees Celsius.

The researchers produced several resins with different monomers and tested the prototypes they made from them to see whether the material is cell-compatible and biodegradable. They also tested the prototypes for elasticity and for mechanical stress such as compression and tension.

Finally, the scientists used the material with the desired properties to make stents, which were tested on rabbits.

Inserting the stents also requiredd a special instrument, as the 3D-printed objects have to be delivered folded. This requires that the iThe implants cannot be kinked or squeezed in the wrong direction and that they have to unfold perfectly at their site of deployment.

The researchers included gold in the stent's structure in order to facilitate the use of medical imaging to track its location during insertion. This makes the stent more robust, but does not change its tolerability.

Successful tests, good prospects

The tests on the rabbits conducted by the research group of Daniel Franzen, Senior Physician at the Department of Pneumology at the University Hospital Zurich, and the Vetsuisse faculty were successful. The researchers were able to show that the implants are biocompatible and that they are absorbed by the body after six to seven weeks. Ten weeks after implantation, the stent was no longer visible on X-ray images. In addition, the inserted stents generally did not move from their insertion site.

"This promising development opens up prospects for the rapid production of customised medical implants and devices that need to be very precise, elastic and degradable in the body," says Jean-Christophe Leroux, Professor of Drug Formulation and Delivery at ETH Zurich. Further research will focus on making the insertion of the stents as gentle as possible.

Furthermore, the processes are to be designed in such a way that production is possible at the point of use, or at least would involves short supply chains. The process is still on a laboratory scale. "However, producing such stents on a large scale is a complex undertaking that we still need to study better," says André Studart, head of the Complex Materials Group at ETH. However, he says the technique can be transferred relatively easily to similar medical applications. "It is therefore hopefully only a matter of time before our solution finds its way into the clinic," says the professor.

People receiving treatment for cancer are known to feel better with physical training. But does it make any difference how vigorously they exercise? A new study by researchers at Uppsala University shows that whether the training is intensive or rather less strenuous, its effect is roughly the same. The results are published in the journal Scandinavian Journal of Medicine and Science in Sports.

Physical activity and training during cancer therapy improve physical and mental health, and may also reduce the most common side effects of the treatment. This has been confirmed in several international studies. Many patients suffer from cancer-related fatigue, and both resistance and endurance training are known to lessen fatigue.

On the other hand, whether the intensity of the training is of any significance has yet to be clarified. Nor has it been ascertained whether extra support in the form of goal-setting, planning and self-monitoring of exercise brings improved results. To answer these questions, a randomised, controlled study known as Phys-Can (Physical training and Cancer) was implemented at the Universities of Uppsala, Linköping and Lund.

A total of 577 participants aged 30-84, recently diagnosed with breast, prostate or colorectal cancer, were randomised to undergo resistance and endurance training at either high or low-to-moderate intensity. In addition, half were randomly assigned to receive extra support in their training.

The resistance training was provided in instructor-led groups at Sweden's largest keep-fit club while the endurance training was home-based. The extra support given to half the participants was primarily a matter of assistance in planning their home-based endurance training and recording it in their diaries. The training period lasted six months.

After completion of the training, the two groups displayed differences. The group that had undergone high-intensity training suffered from somewhat less physical fatigue. They also had superior leg-muscle strength and slightly better fitness than the low-to-moderate intensity group. Regarding the extra support provided in the course of the training, no difference was found between the groups at follow-up. Accordingly, the additional support seems to have had no effect, given that the arrangements already entailed a great deal of support: thorough training instructions, a heart-rate monitor and instructor-led group training with other participants in a similar situation, for example.

"The conclusions we draw from the study are, first, that whether the training is of high or low-to-medium intensity doesn't seem to matter much. The groups' results didn't differ in a clinically relevant way - that is, there was no difference likely to make a difference in the patients' everyday life," says Ingrid Demmelmaier, Associate Professor of Physiotherapy at Uppsala University.

The researchers will return later with more results from the study concerning such aspects as the effects of the training on the participants' health in the longer term.

In the wake of repeated school shootings across the United States, today's youth have been called the mass shooting generation. A new study examined public support for arming school employees. The study found consensus for arming school resource officers, but division over whether to arm teachers and nonteaching staff. The research has clear implications for policy, including the possibility that support for arming school staff may diminish over time as young people (who are less supportive) make up a larger share of voters.

The study was conducted by researchers at Xavier University, the University of Cincinnati, the University at Albany, and the University of Arkansas at Little Rock. It appears in Criminology & Public Policy, a publication of the American Society of Criminology.

"As communities and school districts adapt to living in an age of school shootings, school safety will remain a salient issue," according to Cheryl Lero Jonson, associate professor of criminal justice at Xavier University, who led the study. "And with decisions often made at the local level and influenced by the prevailing will of the community, public opinion will continue to play a role in this debate."

Most states permit school security officers (typically officers on assignment to schools from local police departments) to carry firearms, and at least 466 school districts in 19 states allow teachers or staff members to be armed. To examine public support for arming those who work in U.S. schools, researchers commissioned YouGov (which conducts academic survey research) to launch a nationwide survey of 1,100 American adults in 2018. The demographic and political similarities between those who were surveyed and the U.S. population suggest that the study's findings are generalizable to American adults, the researchers say.

Respondents were asked to indicate how much they supported nine policies related to arming people in schools as a response to school shootings. Among the school personnel, the survey asked about teachers, nonteaching staff (e.g., janitors, coaches, administrators), and school resource officers. The survey also asked the respondents about their political views, moral and cultural values, and other factors such as firearm ownership, and demographics (e.g., race, gender, education, income, marital status, household composition, religion, and region of residence).

The study found consensus for school resource officers carrying weapons, with 70 percent of respondents in favor and only 10 percent opposed. But it found division for arming teachers and nonteaching staff, with 40 percent of respondents supporting arming these school employees and 40 percent opposing the policy.

Respondents who are older, believe in the effectiveness of guns as defensive weapons, lean right politically, are racially resentful, and have children were more likely to endorse arming school personnel who are not law enforcement officials. Membership in the National Rifle Association and concern about students, faculty, and staff were associated with support for arming teachers, while a belief in the moral wrongness of harming others predicted opposition to arming teachers.

"Our findings signal that support for arming school staff may wane in the coming years," suggests Alexander L. Burton, a PhD Candidate in the School of Criminal Justice at the University of Cincinnati, who coauthored the study. "Older individuals were more likely to support arming school employees, and with a younger, more liberal, more diverse generation becoming a larger voting bloc, support for arming school staff may dissipate in the near future."

Researchers have developed a computerized adaptive screener to identify youth at risk for attempting suicide. The screener, called the computerized adaptive screen for suicidal youth (CASSY), consists of 11 questions on average and correctly identified 82.4% of youth who went on to attempt suicide in the three months following screening. The results suggest this screener could serve as an easy-to-use way for providers to detect youth suicide risk in emergency department settings. The findings, funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health, appear in the journal JAMA Psychiatry.

"No young person should die by suicide, which is why we have made bending the curve in suicide rates a priority area of research for our institute," said Joshua A. Gordon, M.D., Ph.D., director of NIMH. "The CASSY screener represents an important advance in identifying those adolescents who are at risk for suicide, so they can be connected with the critical support services they need."

Suicide rates for adolescents have risen over the past two decades. In 2019, 1,580 adolescents between the ages of 12 and 17 died by suicide, which is a rate of 6.3 per 100,000, according to data from the Centers for Disease Control and Prevention. Since approximately 40% of adolescents who die by suicide have been treated for a mental health concern, it is important to screen broadly for suicide risk to help ensure at-risk youth are not missed.

Emergency departments are a common place where youth access emergency care, suggesting this environment is an optimal one in which to implement universal screening for suicide risk. Challenges to this type of implementation include the time and budgetary restrictions many emergency departments face. A suicide screener that can quickly and accurately identify suicide risk would help providers implement universal screening in these settings.

While there are currently brief suicide questionnaires that detect suicide risk, these screeners often have only moderate sensitivity (the ability of a test to correctly identify people with the targeted condition) or specificity (the ability of a test to correctly identify people without the targeted condition). The new screener uses an adaptive approach which offers a chance to improve the sensitivity of screening tools, as it uses a person's initial responses to help vary and personalize the later questions--thus the screener "adapts" to try to best fit each person who takes it.

In the first phase of the study, led by Cheryl King, Ph.D., a professor of psychiatry at the University of Michigan, Ann Arbor, researchers recruited youth between the ages of 12 and 17 in collaboration with 13 emergency departments who are part of the U.S. Pediatric Emergency Care Applied Research Network (PECARN). Youth who were admitted to an emergency department at the study sites during randomly selected shifts completed self-report questionnaires assessing suicide ideation and rumination; history of suicide attempts; self-injury; depression; hopelessness; alcohol and drug misuse; family, school, and social connectedness; physical and sexual abuse; and other factors that have been found to be related to suicide risk. Youth and their parents then received follow-up calls three months after this initial screening to learn if the youth had tried to end their life in the intervening months.

The researchers used these data to create the CASSY. In the second phase of the study, the researchers tested the ability of CASSY to predict suicide risk in a new set of youth, aged 12 to17, who presented to 14 PECARN emergency departments and one Indian Health Service emergency department. Youth completed the CASSY as well as a subset of the questionnaires given to participants in the first phase of the study. Similarly, to phase 1 of the study, youth and their parents were contacted three months after completing the initial screeners to learn whether the youth had tried to end their life in the past three months.

When researchers looked at the data from the second phase of the study, they found 6% of participants had attempted suicide in the three months between initial screening and follow-up. CASSY correctly identified 82.4% of youth who had attempted suicide in the three months after screening and 72.5% of people who did not attempt suicide in the three months after screening.

"As we strive to prevent more youth suicides, identifying as many youths at risk as possible should be prioritized. Yet, emergency departments are often challenged by limited resources for mental health follow-up, such that universal screening becomes more feasible if the screen's false positive rate is relatively low," said King. "Because CASSY is dimensional, it offers the ability for hospitals to alter the sensitivity and specificity of the screen, balancing the false positive and negative rates to best fit each specific emergency department's resource needs."

The study had some limitations. For example, the data were collected in emergency departments connected to academic institutions and may not represent all emergency departments. In addition, a significant portion of adolescents who were approached to participate in initial screening declined. Of those who did participate in the initial screening, not all responded to contact attempts at the three-month follow-up timepoint.

Despite these limitations, the findings suggest that CASSY provides a valuable tool for identifying youth at risk for suicide in the months following screening and may help emergency personnel identify individuals who are at need of increased support and suicide prevention services.

The researchers note that moving forward, it will be important to develop triage recommendations for CASSY and collaborate with emergency departments to identify optimal screening implementation strategies.

Philadelphia, February 3, 2021 - New research and analysis appearing in the Journal of the Academy of Nutrition and Dietetics, published by Elsevier, highlights the barriers cancer survivors face in maintaining a healthy diet, as well as the role nutrition may play in cancer risk and treatment.

Cancer survivors at high risk for poor diet quality, particularly among the less-well educated and overweight

A new study finds poor diet is common in American adult cancer survivors with significant sociodemographic disparities. Researchers looked at the association of the Healthy Eating Index (HEI) score, a measure of diet quality and adherence to the USDA's Dietary Guidelines for Americans, with demographic, lifestyle, and health-related factors of 1,971 cancer survivors. Significant disparities were observed across sociodemographic and lifestyle factors, particularly education levels, body mass index, and smoking status. The study found that cancer survivors tended to underconsume whole grains and greens and beans and overconsume sodium and saturated fats. "These findings can inform the development of specific nutrition intervention strategies to improve diet quality in high-risk populations of cancer survivors," says lead investigator Eunkyung Lee, PhD, RDN, Assistant Professor, Department of Health Sciences, University of Central Florida College of Health Professions and Sciences, Orlando, FL, USA.

"Evaluation of Diet Quality Among American Adult Cancer Survivors: Results From 2005-2016 National Health and Nutrition Examination Survey," by Eunkyung Lee, PhD, RDN; Jianbin Zhu, PhD; Julia Velazquez, BS; Rachael Bernardo, BS; Jeanette Garcia, PhD; Michael Rovito, PhD; and Robert B. Hines, PhD, MPH (DOI: https://doi.org/10.1016/j.jand.2020.08.086)

Author contact: Eunkyung Lee at eunkyung.lee@ucf.edu

Impaired taste function consistently reported with radiotherapy treatment for cancer

Researchers reviewed 25 studies to understand whether changes in taste are associated with cancer diagnosis or method of treatment in adults. They found that cancer diagnosis alone did not appear to influence taste function. However, taste changes consistently appeared early after the start of radiotherapy treatment and had long-lasting effects. During chemotherapy, taste changes were less consistently reported. "Cancer-related malnutrition is associated with serious adverse health outcomes," notes lead investigator Sze-Yen Tan, PhD, AdvAPD, Senior Lecturer, School of Exercise and Nutrition Sciences and Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia. "Further research is needed to support dietitians in identifying taste alterations, understanding the contributing factors, and developing effective medical nutrition therapies."

"Taste Function in Adults Undergoing Cancer Radiotherapy or Chemotherapy, and Implications for Nutrition Management: A Systematic Review," by Nicole Kiss, PhD, AdvAPD; Kate Symons; Jessie Hewitt; Hannah Davis; Christy Ting; Angela Lee; Anna Boltong, PhD; Robin M. Tucker, PhD, RD, FAND; and Sze-Yen Tan, PhD, AdvAPD (DOI: https://doi.org/10.1016/j.jand.2020.08.014)

Author contact: Sze-Yen Tan at szeyen.tan@deakin.edu.au

Breast cancer survivors face barriers to eating a healthy diet and staying physically fit

A new study found that a high percentage of breast cancer survivors report that they've made positive changes to improve their diet and physical activity after cancer diagnosis or treatment. However, the proportion of those eating the recommended amount of whole grains and staying physically active remained low. Many patients experienced fatigue, stress, and treatment-related changes in eating habits, and pain or discomfort as a barrier to exercise. The study also found that the majority of patients searched the internet for nutrition advice, and fewer than half reported seeking nutrition advice from healthcare providers. Lead investigator Fang Fang Zhang, MD, PhD, Professor, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA, says, "This disconnection underscores the need for integrating nutrition into cancer care in outpatient oncology clinics."

"Self-Reported Changes and Perceived Barriers to Healthy Eating and Physical Activity among Global Breast Cancer Survivors: Results from an Exploratory Online Novel Survey," by Laura Keaver, MPH, RD; Aisling M. McGough, MSc; Mengxi Du, MS, MPH, RD; Winnie Chang; Virginia Chomitz, PhD, FACS; Jennifer D. Allen, ScD, MPH; Deanna J. Attai, MD, FACS; Lisa Gualtieri, PhD; and Fang Fang Zhang, MD, PhD (DOI: https://doi.org/10.1016/j.jand.2020.09.031)

Author contact: Fang Fang Zhang at fang_fang.zhang@tufts.edu

A Mediterranean style diet may reduce overall cancer risk for women, but not for men

A Mediterranean style diet, rich in vegetables and olive oil, and low to moderate consumption of meat and dairy, has been associated with a reduced rate of certain types of cancer. In a new study, researchers looked at the association of the diet with overall cancer risk in men and women. They found that woman who ate moderate amounts of food associated with the Mediterranean diet had a significantly reduced risk for cancer overall compared with women who consumed the least. The difference between women with the highest adherence to the diet and women with moderate adherence was not significantly significant. In men, there was no evidence of association between eating a Mediterranean diet and overall cancer risk. Lead investigator Piet A. van den Brandt, PhD, Professor, Department of Epidemiology, GROW--School for Oncology and Developmental Biology; and Professor, Department of Epidemiology, CAPHRI--School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands, observes that the study drew on the non-Mediterranean study population of the Netherlands Cohort Study, and results might be different in areas where the diet is more commonly followed.

"Adherence to the Mediterranean Diet and Overall Cancer Incidence: The Netherlands Cohort Study," by Maya Schulpen, PhD; and Piet A. van den Brandt, PhD (DOI: https://doi.org/10.1016/j.jand.2020.07.025).

Author contact: Piet A. van den Brandt at pa.vandenbrandt@maastrichtuniversity.nl

Women who consume chocolate frequently may have a moderately higher risk for colorectal cancer

A growing body of evidence suggests that flavonoids in chocolate have the potential to decrease the risk of cancer in humans, but most of the evidence is from laboratory and animal studies. Using data from the Women's Health Initiative Study, a large long-term study of disease in American women, researchers looked at empirical evidence on the association between chocolate consumption and the risk of cancer in postmenopausal women. They found no significant association between chocolate consumption for cancer overall, or for breast cancer specifically. However, women who consumed at least 1.5 ounces of chocolate per week had a moderate 18 percent higher risk of invasive colorectal cancer. Lead investigator James A. Greenberg, PhD, Emeritus Professor, Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York, Brooklyn, NY, USA, notes, "Given that obesity is an established risk factor for colorectal cancer, this result may be attributable to the excess adiposity associated with frequent chocolate candy consumption. Women who were more frequent consumers of chocolate also consumed more dietary energy and food of lower dietary quality." He says that more rigorous controlled prospective trials are needed to test the validity of the study.

"Chocolate Candy and Incident Invasive Cancer Risk in the Women's Health Initiative: An Observational Prospective Analysis," by James A. Greenberg, PhD; Marian L. Neuhouser, PhD, RD; Lesley F. Tinker, PhD, RD; Dorothy S. Lane, MD, PhD; Electra D. Paskett, MSPH, PHD; Linda V. Van Horn, PhD; Sylvia Wassertheil-Smoller, PhD; James M. Shikany, DrPH; Lihong Qi, PhD; Shawnita Sealy-Jefferson, PhD, MPH; and JoAnn E. Manson, MD, DrPH (DOI https://doi.org/10.1016/j.jand.2020.06.014)

Author contact: James A. Greenberg at jamesg@brooklyn.cuny.edu

Increased dietary fiber may improve gastrointestinal side effects in women undergoing radiotherapy for gynecological cancers

An analysis of evidence finds increased dietary fiber intake may have potential benefits to improve the gastrointestinal side effects of pelvic radiation in the treatment of gynecological cancers. While some evidence suggests improvement in the incidence and severity of diarrhea and bowel symptoms, it is insufficient to form specific recommendations for clinical practice. "Definitive recommendations regarding the type, amount, frequency of supplementation, or daily fiber target are not yet possible," explains lead investigator Judy Bauer, PhD, AdvAPD, Associate Professor, School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia. "Future research may further clarify the role of fiber in a therapeutic setting and the role of nutrition and dietetics practitioners in the delivery of specialized nutrition counseling."

"The Efficacy of Dietary Fiber in Managing Gastrointestinal Toxicity Symptoms in Patients with Gynecologic Cancers undergoing Pelvic Radiotherapy: A Systematic Review," by Emilie Croisier, MDietSt, APD; Teresa Brown, PhD, AdvAPD; and Judy Bauer, PhD, AdvAPD (DOI https://doi.org/10.1016/j.jand.2020.08.077)

Author contact: Emilie Croisier at emilie.croisier@uqconnect.edu.au

A new study published in Arthritis Care & Research has identified 10 readily available clinical factors that may predict which patients will persistently use high doses of opioids in the year following knee replacement surgery.

In the study of 142,089 Medicare patients with osteoarthritis who underwent total knee replacement surgery and had no history of high-dose opioid use, 10.6% became persistent users of high-dose opioids after surgery.

Certain preoperative characteristics including demographics (age, sex, and race), history of substance abuse (opioids, alcohol, and tobacco), and medication use (benzodiazepines, anxiolytics, antidepressants, anticonvulsants, and nonsteroidal anti-inflammatory drugs) were predictors of persistent use of high-dose opioids after surgery.

"We believe that our prediction model may help identify patients at high risk of future adverse outcomes from persistent opioid use and dependence after total knee replacement surgery," said senior author Seoyoung C. Kim, MD, ScD, MSCE, of Brigham and Women's Hospital and Harvard Medical School.

The genus Ficus (figs) and their agaonid pollinating fig wasps are a classic example of coevolution. It represents perhaps the most extreme and ancient (about 75 million years) obligate pollination mutualism known.

Previous studies have suggested that pollinator host-switching and hybridization existed in some fig taxa with genetic evidence based on relatively few genes. However, those cases were mainly treated as rare exceptions, and strict-sense coevolution was still treated as the dominate coevolution model for the codiversification of this "extreme" obligate pollination system with high species richness.

Together with colleagues from 11 institutions from home and abroad, researchers from the Xishuangbanna Tropical Botanical Garden (XTBG) of the Chinese Academy of Sciences have recently shown that the fig hybridization mediated by pollinator host-switching in the obligate fig-wasp pollination system is more common than previously thought. The study was published in Nature Communications.

The researchers collected complete sequences for nuclear, chloroplast, and mitochondrial genomes from 15 fig species representing all major recognized Ficus clades.

By assembling and analyzing genomes from across the Ficus clades, the researchers, employing multiple commonly used hybridization detection analyses, found that hybridization events have occurred throughout Ficus evolutionary history.

"We conducted cophylogenetic reconciliation analyses and detected significant incongruence among all nuclear, chloroplast, and mitochondrial-based phylogenies, none of which correspond with any published phylogenies of the associated pollinator wasps," said Dr. WANG Gang from XTBG.

Significantly, most hybridization events detected among the main Ficus clades exhibit associated pollinator host-switching events. Therefore, the evolutionary history of figs and wasps has likely been characterized by frequent host-switches among the pollinators.

"These pollinator host-switches and fig hybridization events are a dominant feature of fig-wasp coevolutionary history," said Prof. CHEN Jin, one of the corresponding authors of the study.

The results also offered insights into the temporal and biogeographical reconstructions of fig-wasp mutualism.

"We suggest that future studies attempting to reconstruct the phylogenetic relationships or any coevolution stories between figs and their pollinators should not be constrained by the idea that species or even lineages of pollinators have strictly coradiated with the currently corresponding species or lineages of figs," said Dr. WANG Gang.

A collaboration between the Pericàs group with Prof. Timothy Noël and Dr. Paola Riente at the Eindhoven University of Technology (TU/e, The Netherlands), has crystallised in a Nature Communications paper where they provide key insight into the chemical nature of the true photocatalyst involved in the Bi2O3-driven atom-transfer radical addition (ATRA) reaction.

Back in 2014, ICREA professors Miquel Pericàs and Emilio Palomares together with former postdoctoral researcher Dr. Riente published a paper on Angewandte Chemie International Edition pioneering the research on organic transformations in mild reactions conditions by using Bi2O3 and visible light as a sustainable alternative to other transition metals. On the rise of new green approaches for efficient catalysis, Bi2O3 has become popular as a photocatalyst to drive light-induced organic transformations due to its low price, non-toxicity, solid nature, high availability and visible light response. Moreover, in some cases, it can replace the use of metal complexes based on expensive and non-abundant ruthenium and iridium transition metal photocatalysts.

The researchers set out to unravel the atom transfer radical addition (ATRA) reaction between diethyl bromomalonate (DEBM) and 5-hexen-1-ol as a reaction model. As the reaction progresses, the mixture evolves from a suspension to a yellowish transparent solution. This quickly caught the researcher's attention, as Bi2O3 isn't soluble in organic solvents. Therefore, "we envisaged that the interaction of Bi2O3 with some component of the reaction was forming, under irradiation, a homogeneous bismuth-based intermediate species that worked as the true photocatalyst of the reaction," explains Dr. Riente, first author of the paper.

Reaching out to Dr. Mauro Fianchini, a theoretical postdoc working in the Pericàs group, the team devised a theoretical model that has helped elucidate that the catalytically active species involved in photocatalytic processes where Bi2O3 is used are actually closely related to pure BiBr3 or BiBr3- based complexes. In the presence of dimethyl sulfoxide (DMSO) or dimethylformamide (DMF), Bi2O3 transforms into BiBr3- based complexes, photocatalytic species able to absorb light, ultimately triggering the formation of the required alkyl radical in ATRA and alkylation reactions.

Pushing this idea forward, the researchers performed calculations of few solvate complexes where DMSO was coordinating with BiBr3 to find the ideal candidate. Combining these computational insights with the structural information provided by X-ray diffraction the team has cracked the puzzle, finding that the active photocatalytic species is a complex salt of bismuth hexabromide. In fact, a mixture composed of [(BiBr6)]3? octahedral anions balanced by [(CH3)3S]+ cations and [(CH3)3S]Br.

Using the words of Dr. Fianchini "this is a good foundation. This research is the basement of the "house" and, looking forward, we will start growing up the walls and put a roof on by proposing the mechanisms behind the solvation of the precatalyst and the ATRA activation of organic substrates of interest."

February 1, 2021 - Extracorporeal cardiopulmonary resuscitation (ECPR) is a potentially lifesaving treatment for patients in cardiac arrest when the circulation can't be restored by conventional CPR. New guidelines for ECPR in adults and children, developed by the Extracorporeal Life Support Organization (ELSO), are presented by the ASAIO Journal, official journal of the American Society for Artificial Internal Organs. The journal is published in the Lippincott portfolio by Wolters Kluwer.

A specialized application of extracorporeal membrane oxygenation (ECMO), ECPR is increasingly being used to provide a chance for survival in patients with a broadening range of conditions. "This ELSO guideline is intended to be a practical guide to implementing ECPR and the early management following establishment of ECMO support," according to the interim guideline statement for ECPR in adults. Alexander (Sacha) C. Richardson, BMBCh, MA, MRCP, FCICM, of The Alfred Hospital, Melbourne, Australia, is lead author of the adult guideline. Anne-Marie Guerguerian, MD, PhD, of the Hospital for Sick Children, Toronto, is lead author of the pediatric ECPR guideline.

New ELSO guidelines set standards for ECPR support

In ECPR, the patient's circulation and gas exchange are restored using ECMO in the context of cardiopulmonary resuscitation measures. ECPR is performed as an emergency measure in selected patients with potentially treatable causes of cardiac arrest, but who don't achieve return of spontaneous circulation with conventional CPR.

"By providing organ perfusion, [ECPR] provides time for the delivery of interventions necessary to regain an adequate native circulation," Dr. Richardson and colleagues write. "ECPR is a time-sensitive, complex intervention that requires teamwork, clearly defined roles, and well-trained health care providers."

While the availability and use of ECPR have been increasing, evidence to guide practice in key areas is still limited. Topics addressed in the new ELSO guidelines include:

Selection of patients who may benefit from ECPR, as well as the timing and location of this advanced life support technology
Approaches to cannulation: placement of the lines through which the patient's blood will be routed out of the body through a vein, oxygenated outside the body, and returned through an artery (V-A ECMO)
Connection and establishment of ECPR support, including steps for care management after cardiac arrest
Initial care while the patient is on ECMO, including imaging studies to monitor the patient's condition and prepare for any necessary tests and treatment
Weaning off ECMO: steps for removing the patient from extracorporeal life support and restoring natural circulation, if possible

The guidelines also address the process of developing an ECPR program, including resources, staff training and competency, and quality assurance. Use of ECPR also raises unique issues related to ethics and patient consent, as well as special considerations in patients with out-of-hospital cardiac arrest.

Children undergoing ECPR differ from adults in several ways: because many children who need ECPR are already hospitalized for congenital heart disease surgery, ECPR access and restoration of circulation can often be achieved more rapidly. Children generally have better survival and short-term outcomes after ECPR. However, in children as in adults, there are limited data on long-term outcomes.

The two new ELSO statements were created by international, interdisciplinary teams. Recommendations are based on the best available research and on expert consensus where evidence is lacking, and will be updated as further evidence becomes available.

MIT researchers have developed a type of neural network that learns on the job, not just during its training phase. These flexible algorithms, dubbed "liquid" networks, change their underlying equations to continuously adapt to new data inputs. The advance could aid decision making based on data streams that change over time, including those involved in medical diagnosis and autonomous driving.

"This is a way forward for the future of robot control, natural language processing, video processing -- any form of time series data processing," says Ramin Hasani, the study's lead author. "The potential is really significant."

The research will be presented at February's AAAI Conference on Artificial Intelligence. In addition to Hasani, a postdoc in the MIT Computer Science and Artificial Intelligence Laboratory (CSAIL), MIT co-authors include Daniela Rus, CSAIL director and the Andrew and Erna Viterbi Professor of Electrical Engineering and Computer Science, and PhD student Alexander Amini. Other co-authors include Mathias Lechner of the Institute of Science and Technology Austria and Radu Grosu of the Vienna University of Technology.

Time series data are both ubiquitous and vital to our understanding the world, according to Hasani. "The real world is all about sequences. Even our perception -- you're not perceiving images, you're perceiving sequences of images," he says. "So, time series data actually create our reality."

He points to video processing, financial data, and medical diagnostic applications as examples of time series that are central to society. The vicissitudes of these ever-changing data streams can be unpredictable. Yet analyzing these data in real time, and using them to anticipate future behavior, can boost the development of emerging technologies like self-driving cars. So Hasani built an algorithm fit for the task.

Hasani designed a neural network that can adapt to the variability of real-world systems. Neural networks are algorithms that recognize patterns by analyzing a set of "training" examples. They're often said to mimic the processing pathways of the brain -- Hasani drew inspiration directly from the microscopic nematode, C. elegans. "It only has 302 neurons in its nervous system," he says, "yet it can generate unexpectedly complex dynamics."

Hasani coded his neural network with careful attention to how C. elegans neurons activate and communicate with each other via electrical impulses. In the equations he used to structure his neural network, he allowed the parameters to change over time based on the results of a nested set of differential equations.

This flexibility is key. Most neural networks' behavior is fixed after the training phase, which means they're bad at adjusting to changes in the incoming data stream. Hasani says the fluidity of his "liquid" network makes it more resilient to unexpected or noisy data, like if heavy rain obscures the view of a camera on a self-driving car. "So, it's more robust," he says.

There's another advantage of the network's flexibility, he adds: "It's more interpretable."

Hasani says his liquid network skirts the inscrutability common to other neural networks. "Just changing the representation of a neuron," which Hasani did with the differential equations, "you can really explore some degrees of complexity you couldn't explore otherwise." Thanks to Hasani's small number of highly expressive neurons, it's easier to peer into the "black box" of the network's decision making and diagnose why the network made a certain characterization.

"The model itself is richer in terms of expressivity," says Hasani. That could help engineers understand and improve the liquid network's performance.

Hasani's network excelled in a battery of tests. It edged out other state-of-the-art time series algorithms by a few percentage points in accurately predicting future values in datasets, ranging from atmospheric chemistry to traffic patterns. "In many applications, we see the performance is reliably high," he says. Plus, the network's small size meant it completed the tests without a steep computing cost. "Everyone talks about scaling up their network," says Hasani. "We want to scale down, to have fewer but richer nodes."

Hasani plans to keep improving the system and ready it for industrial application. "We have a provably more expressive neural network that is inspired by nature. But this is just the beginning of the process," he says. "The obvious question is how do you extend this? We think this kind of network could be a key element of future intelligence systems."

The multidisciplinary research group Lactiker - Quality and Safety of Foods from Animal Origin, which is attached to the University of the Basque Country (UPV/EHU), is working on (among other things) characterising the biochemical, microbiological and technological processes involved in cheese manufacturing that have a direct impact on its technological, nutritional and sensory quality, as well as on its food safety status. The aim is to provide the cheesemaking industry with the information it requires to ensure safe, high-quality products.

The group, which has been working in this field for 25 years, has conducted studies focusing on all aspects of the production of cheeses under the Idiazabal Protected Designation of Origin label: 'For years we have researched how fermentation occurs; how to enable clotting using natural or commercial rennets; how cheese matures; why raw milk is used and what difference using pasteurised milk would make,' explains Luis Javier R. Barron, lead researcher from the Lactiker group. Another of the group's principal scientific contributions is 'the determination, characterisation and parametrisation of the sensory properties of Idiazabal cheese, so that it can be identified as such,' he continues. To this end, the team works in collaboration with the UPV/EHU's Sensory Laboratory (LASEHU), which is authorised to carry out sensory quality controls for Idiazabal cheese. At the laboratory they analyse 'whether cheeses comply with the sensory requirements of Idiazabal. There are sensory differences between cheeses, which is indicative of the fact that producers make cheeses with a variety of different nuances in terms of aroma, taste and texture; these nuances are highly valued by consumers,' he adds.

The importance of transferring knowledge

The group works shoulder to shoulder with small artisan dairies producing Idiazabal cheese, 'in which the role of the cheesemaker is crucial, because while the parameters of the production process are regulated, they are not automated. The cheeses produced in these small dairies are almost signature products. For example, we have observed the way in which they induce clotting, studying clotting times, the amount of rennet used, the type of cutting applied, the whey draining process, etc. All these are essential processes in cheesemaking, but they depend greatly on the cheesemakers,' explains the professor from the UPV/EHU.

In a recent study, they analysed the relationships between cheese-processing conditions and curd and cheese properties, with the aim of improving yield while maintaining the high quality of the product. According to Prof. Barron, the results obtained 'may help establish specific guidelines for clotting and whey draining processes, which in turn may help improve the production process of artisanal Idiazabal cheese'. Another recent study carried out by Lactiker aimed to analyse the extent to which environmental or technological conditions affect the sensory differentiation of raw ewe milk cheeses produced in valley or mountain farms.

In addition to working with small artisan dairies, the Lactiker group also collaborates with the official Protected Designation of Origin, as well as with producers' associations such as Artzai-Gazta. As a result of the doctoral thesis carried out by Ane Aldalur, the group has published and distributed a short leaflet targeted at small dairies and containing a series of recommendations for small-scale producers: 'We aim to help dairies control their production processes better. We learn from the cheesemakers, and they from us. They have experience making cheese and we analyse the reasons behind certain things, identify possible improvements and come up with solutions to certain problems,' explains the group's lead researcher.

For some years now, the Lactiker group has been pursuing an avenue of research which aims to assess the sustainability of food production systems, particularly those based on grazing. This project, which is carried out in collaboration with other research groups, aims to 'find ways of assessing the sustainability of systems based on grazing, which itself depends on economic and environmental factors, food quality and safety and social and cultural issues, among others. We need to determine whether, in the medium and long term, these systems are sustainable in the globalised world in which we now live. Providing they are sustainable, these small dairies can and should defend their livelihoods. We need to send this message out to the general public.

We are eager to see how we can support small-scale producers who keep their own flocks of grazing animals, such as Latxa sheep. There are many problems and difficulties to be overcome, but one of the most significant, which can be found in many different areas of Europe and other Mediterranean countries, is the gradual decline of grazing systems. If we start to use milk that does not come from grazing sheep, then Idiazabal cheese will no longer have the characteristics and properties it has at the moment, and we will gradually lose the benefits provided by the grazing system in terms of the environment, biodiversity, culture and rural development,' he concludes.

Global circulating winds can carry bacteria, fungal spores, viruses and pollen over long distances and across national borders, but the United States is ill-prepared to confront future disease outbreaks or food-supply threats caused by airborne organisms, says a new paper published in the Ecological Society of America's journal Ecological Applications.

Claire Williams, the paper's primary author and a research professor at American University, has spent decades studying long-range transport of tree pollen. Her early findings led to collaborations with German and Russian scientists who conducted a wide range of research - on forest genetics, atmospheric chemistry and climate change - all under the unifying theme of atmospheric biology.

"The more I learned about pollen aloft, the more I came to understand that pollen is part of a large airborne milieu of what I call 'aerial plankton' - bacteria, fungi, lichen soredia [reproductive structures], insect parts, viruses and more," said Williams.

Zotino Tall Tower Observation Facility (ZOTTO) and its surrounding forests in central Siberia. Photo courtesy of Anastasia Makhnykina, Sukachev Institute of Forest, Krasnoyarsk, Russia.

Now, having seen the highly integrated and well-funded atmospheric biology research underway in Germany and Russia, Williams wants U.S. leaders to understand the value of atmospheric biology to national security - and recognize that the United States is coming up short.

The persistent threat of Valley Fever is one example of how well-coordinated research is critical when responding to threats. Valley Fever is caused by the inhalation of Coccidioides fungus, which lurks in hot, dry soils of the southern United States. Monitoring and mitigating outbreaks requires an understanding of land use, meteorology and human risk factors. And because fungus spores, bacteria and pollen do not obey borders or boundaries, responding to diseases like Valley Fever can also require international collaboration and diplomacy.

An aerial view from the Aircraft Bioaerosol Collector 2 (ABC-2) science flight in the lower troposphere over the Sierra Nevada mountain range in June 2018. Photo courtesy of NASA.

In the United States, research and monitoring of airborne organisms is split between an array of federal agencies. The Department of Agriculture monitors airborne pathogens that threaten food supply, the Department of Defense oversees biological warfare agents such as anthrax, the Center for Disease Control studies human-health impacts of airborne pathogens, and additional contributions to atmospheric biology research are spread across the National Institutes of Health, United States Geological Survey, National Aeronautics and Space Administration, National Science Foundation, Department of Energy and National Oceanic and Atmospheric Administration.

While it makes sense for each department or agency to carry out research relevant to its responsibilities and interests, the lack of coordination and information-sharing can effectively cripple the U.S. response to national security threats, such as pandemics, that require cooperation and input from multiple agencies.

"The time has come - after all, pandemics are caused by airborne viruses and a host of airborne pathogens, pests and parasites," said Williams. "If we pieced together the expertise that we do have in a host of U.S. science agencies, we would be better prepared for the next pandemic or disease outbreak."

People who take opioid medications for chronic pain may have a hard time finding a new primary care clinic that will take them on as a patient if they need one, according to a new "secret shopper" study of hundreds of clinics in states across the country.

Stigma against long-term users of prescription opioids, likely related to the prospect of taking on a patient who might have an opioid use disorder or addiction, appears to play a role, the University of Michigan research suggests.

Simulated patients who said their doctor or other primary care provider had retired were more likely to be told they could be accepted as new patients, compared with those who said their provider had stopped prescribing opioids to them for an unknown reason.

The U-M primary care provider and health care researcher who led the new study, Pooja Lagisetty, M.D., M.Sc., hopes that her team's new findings published in the journal Pain could help primary care clinics look at their practices regarding existing or prospective new patients.

"We need to make sure we're training prescribers and their teams in addressing the systemic biases that this research highlights," says Lagisetty, a general internal medicine physician at Michigan Medicine, U-M's academic medical center. "We shouldn't even be thinking about the reason that patients are giving when they seek to access care.

"Even if you think that someone is using opioids for a reason other than pain, or that long-term opioids are not an effective pain care strategy, those are exactly the patients we in primary are should be seeing," she adds. "Restricting their primary care access limits their ability to engage in pain-focused care and potentially addiction-focused care."

It also worsens stigma, she says, by suggesting that people using opioids for pain are more worthy of receiving care than those who may have addiction.

She and her colleagues had seen signs of stigma against patients on long-term opioids for non-cancer pain in a previous study that used the "secret shopper" technique to call clinics in Michigan. But the new study takes that to a new level, with data from 452 clinics in nine states.

Each clinic responded to two calls, separated by time, from a female caller who asked if the clinic was taking new patients, said she was covered by a major insurer in the area, and said she had been taking opioids for years for pain. Depending on the call, she then either said that her last provider had retired or stopped prescribing opioids, leading her to seek a new primary care clinic and asking if their providers would potentially continue to prescribe opioids after a visit.

All of the clinics included in the study said they were taking new patients, but when the patient mentioned wanting to receive opioids, 43% of the clinics said they were no longer willing to schedule the appointment.

"This suggests that many clinics are likely just shutting their door to any patient needing an opioid prescription despite the reason for needing a new provider," says Lagisetty, who is also a member of the U-M Institute for Healthcare Policy and Innovation. "Clinics often stated to the patient that this was due to new policies, fear of legal ramifications, or administrative burdens."

She adds that barriers to treating opioid addiction in a primary care setting, including the special training needed to prescribe buprenorphine and the added support needed to help patients receiving medications for opioid use disorder, may have contributed to this. Recent signs that the federal requirements may be relaxed could help change this, but only if primary care providers receive help and training in providing this kind of care.

Nearly one-third (32%) of the clinics said they would schedule the patient for an appointment and the primary care provider would potentially continue to prescribe opioids, no matter which scenario the patient gave.

But the remaining 25% of clinics gave mixed signals when called twice. In those clinics, patients had nearly 2 times the likelihood of getting scheduled if their prior physician had retired as compared to those who said their last doctor had stopped prescribing for unknown reasons.

"In these cases, where clinics gave different answers depending on the scenario presented, it is harder to argue that stigma around opioid use, pain, and addiction is not playing a role in clinic decision-making," says Lagisetty.

INDIANAPOLIS--Researchers at the Indiana University Melvin and Bren Simon Comprehensive Cancer Center have identified how breast cancer cells hide from immune cells to stay alive. The discovery could lead to better immunotherapy treatment for patients.

Xinna Zhang, PhD, and colleagues found that when breast cancer cells have an increased level of a protein called MAL2 on the cell surface, the cancer cells can evade immune attacks and continue to grow. The findings are published this month in The Journal of Clinical Investigation and featured on the journal's cover.

The lead author of the study, Zhang is a member of the IU Simon Comprehensive Cancer Center and assistant professor of medical and molecular genetics at IU School of Medicine.

Considered the future of cancer treatment, immunotherapy harnesses the body's immune system to target and destroy cancer cells. Understanding how cancer cells avoid immune attacks could offer new ways to improve immunotherapy for patients, explained Xiongbin Lu, PhD, Vera Bradley Foundation Professor of Breast Cancer Innovation and cancer center researcher.

"Current cancer immunotherapy has wonderful results in some patients, but more than 70% of breast cancer patients do not respond to cancer immunotherapy," Lu said. "One of the biggest reasons is that tumors develop a mechanism to evade the immune attacks."

The collaborative research team set out to answer key questions: How do breast cancer cells develop this immune evasion mechanism, and could targeting that action lead to improved immunotherapies?

Zhang and Lu, members of the Vera Bradley Foundation Center for Breast Cancer Research, turned to biomedical data researcher Chi Zhang, PhD, assistant professor of medical and molecular genetics at IU School of Medicine. Chi Zhang developed a computational method to analyze data sets from more than 1,000 breast cancer patients through The Cancer Genome Atlas. That analysis led researchers to MAL2; it showed that higher levels of MAL2 in breast cancer, and especially in triple-negative breast cancer (TNBC), was linked to poorer patient survival.

"Dr. Chi Zhang used his advanced computational tool to build a bridge that connects cancer genetics and cancer genomics with a clinical outcome," Lu said. "We can analyze molecular features from thousands of breast tumor samples to identify potential targets for cancer immunotherapy. From that data, MAL2 was the top-ranked gene that we wanted to study."

Xinna Zhang took that data to her lab to determine MAL2's purpose in the cells, how it affects breast cancer cell growth and how it interacts with immune cells. Using breast cancer tissue samples from IU patients, cell models and animal models, she found that breast cancer cells express more MAL2 than normal cells. She also discovered that high levels of MAL2 significantly enhanced tumor growth, while inhibiting the protein can almost completely stop tumor growth.

In Lu's lab, he used a three-dimensional, patient-derived model called an organoid to better understand how reducing MAL2 could improve patient outcomes.

"Tumor cells can evade immune attacks; with less MAL2, the cancer cells can be recognized and killed by the immune system," Lu said. "MAL2 is a novel target. By identifying its function in cancer cells and cancer immunology, we now know its potential as a cancer immunology target."