Culture

The surviving core of a gas giant has been discovered orbiting a distant star by University of Warwick astronomers, offering an unprecedented glimpse into the interior of a planet.

The core, which is the same size as Neptune in our own solar system, is believed to be a gas giant that was either stripped of its gaseous atmosphere or that failed to form one in its early life.

The team from the University of Warwick's Department of Physics reports the discovery today (1 July) in the journal Nature, and is thought to be the first time the exposed core of a planet has been observed.

It offers the unique opportunity to peer inside the interior of a planet and learn about its composition.

Located around a star much like our own approximately 730 light years away, the core, named TOI 849 b orbits so close to its host star that a year is a mere 18 hours and its surface temperature is around 1800K.

TOI 849 b was found in a survey of stars by NASA's Transiting Exoplanet Survey Satellite (TESS), using the transit method: observing stars for the tell-tale dip in brightness that indicates that a planet has passed in front of them. It was located in the 'Neptunian desert' - a term used by astronomers for a region close to stars where we rarely see planets of Neptune's mass or larger.

The object was then analysed using the HARPS instrument, on a program led by the University of Warwick, at the European Southern Observatory's La Silla Observatory in Chile. This utilises the Doppler effect to measure the mass of exoplanets by measuring their 'wobble' - small movements towards and away from us that register as tiny shifts in the star's spectrum of light.

The team determined that the object's mass is 2-3 times higher than Neptune but it is also incredibly dense, with all the material that makes up that mass squashed into an object the same size.

Lead author Dr David Armstrong from the University of Warwick Department of Physics said: "While this is an unusually massive planet, it's a long way from the most massive we know. But it is the most massive we know for its size, and extremely dense for something the size of Neptune, which tells us this planet has a very unusual history. The fact that it's in a strange location for its mass also helps - we don't see planets with this mass at these short orbital periods.

"TOI 849 b is the most massive terrestrial planet - that has an earth like density - discovered. We would expect a planet this massive to have accreted large quantities of hydrogen and helium when it formed, growing into something similar to Jupiter. The fact that we don't see those gases lets us know this is an exposed planetary core.

"This is the first time that we've discovered an intact exposed core of a gas giant around a star."

There are two theories as to why we are seeing the planet's core, rather than a typical gas giant. The first is that it was once similar to Jupiter but lost nearly all of its outer gas through a variety of methods. These could include tidal disruption, where the planet is ripped apart from orbiting too close to its star, or even a collision with another planet. Large-scale photoevaporation of the atmosphere could also play a role, but can't account for all the gas that has been lost.

Alternatively, it could be a 'failed' gas giant. The scientists believe that once the core of the gas giant formed then something could have gone wrong and it never formed an atmosphere. This could have occurred if there was a gap in the disc of dust that the planet formed from, or if it formed late and the disc ran out of material.

Dr Armstrong adds: "One way or another, TOI 849 b either used to be a gas giant or is a 'failed' gas giant.

"It's a first, telling us that planets like this exist and can be found. We have the opportunity to look at the core of a planet in a way that we can't do in our own solar system. There are still big open questions about the nature of Jupiter's core, for example, so strange and unusual exoplanets like this give us a window into planet formation that we have no other way to explore.

"Although we don't have any information on its chemical composition yet, we can follow it up with other telescopes. Because TOI 849 b is so close to the star, any remaining atmosphere around the planet has to be constantly replenished from the core. So if we can measure that atmosphere then we can get an insight into the composition of the core itself."

Northwestern University researchers have cracked one of the secrets of tooth decay. In a new study of human enamel, the materials scientists are the first to identify a small number of impurity atoms that may contribute to the enamel's strength but also make the material more soluble. They also are the first to determine the spatial distribution of the impurities with atomic-scale resolution.

Dental caries -- better known as tooth decay -- is the breakdown of teeth due to bacteria. ("Caries" is Latin for "rottenness.") It is one of the most common chronic diseases and a major public health problem, especially as the average life expectancy of humans increases.

The Northwestern discovery in the building blocks of enamel -- with detail down to the nanoscale -- could lead to a better understanding of human tooth decay as well as genetic conditions that affect enamel formation, which can lead to highly compromised or completely absent enamel.

Enamel, the human tooth's protective outer layer, covers the entire crown. Its hardness comes from its high mineral content.

"Enamel has evolved to be hard and wear-resistant enough to withstand the forces associated with chewing for decades," said Derk Joester, who led the research. "However, enamel has very limited potential to regenerate. Our fundamental research helps us understand how enamel may form, which should aid in the development of new interventions and materials to prevent and treat caries. The knowledge also might help prevent or ameliorate the suffering of patients with congenital enamel defects."

The study will be published on July 1 by the journal Nature.

Joester, the corresponding author, is an associate professor of materials science and engineering in the McCormick School of Engineering. Karen A. DeRocher and Paul J.M. Smeets, a Ph.D. student and a postdoctoral fellow, respectively, in Joester's lab, are co-first authors.

One major obstacle hindering enamel research is its complex structure, with features across multiple length scales. Enamel, which can reach a thickness of several millimeters, is a three-dimensional weave of rods. Each rod, approximately 5 microns wide, is made up of thousands of individual hydroxylapatite crystallites that are very long and thin. The width of a crystallite is on the order of tens of nanometers. These nanoscale crystallites are the fundamental building blocks of enamel.

Perhaps unique to human enamel, the center of the crystallite seems to be more soluble, Joester said, and his team wanted to understand why. The researchers set out to test if the composition of minor enamel constitutents varies in single crystallites.

Using cutting-edge quantitative atomic-scale techniques, the team discovered that human enamel crystallites have a core-shell structure. Each crystallite has a continuous crystal structure with calcium, phosphate and hydroxyl ions arranged periodically (the shell). However, at the crystallite's center, a greater number of these ions is replaced with magnesium, sodium, carbonate and fluoride (the core). Within the core, two magnesium-rich layers flank a mix of sodium, fluoride and carbonate ions.

"Surprisingly, the magnesium ions form two layers on either side of the core, like the world's tiniest sandwich, just 6 billionths of a meter across," DeRocher said.

Detecting and visualizing the sandwich structure required scanning transmission electron microscopy at cryogenic temperatures (cryo-STEM) and atom probe tomography (APT). Cryo-STEM analysis revealed the regular arrangement of atoms in the crystals. APT allowed the researchers to determine the chemical nature and position of small numbers of impurity atoms with sub-nanometer resolution.

The researchers found strong evidence that the core-shell architecture and resulting residual stresses impact the dissolution behavior of human enamel crystallites while also providing a plausible avenue for extrinsic toughening of enamel.

"The ability to visualize chemical gradients down to the nanoscale enhances our understanding of how enamel may form and could lead to new methods to improve the health of enamel," Smeets said.

This study builds on an earlier work, published in 2015, in which the researchers discovered that crystallites are glued together by an extremely thin amorphous film that differs in composition from the crystallites.

The opioid and addiction epidemic didn't go away when the coronavirus pandemic began. But rapid changes in regulations and guidance made during COVID-19 response could also help many more people get care for opioid use disorder and other addiction problems.

That's according to experts from the University of Michigan Addiction Center and VA Ann Arbor Healthcare System, writing in this week's issue of JAMA Psychiatry.

They document the recent policy changes that have made it possible for more addiction care to take place through telemedicine, specifically video chats and even telephone calls. They also note the requirements for in-person visits for key addiction treatments that have been waived - though only temporarily -- during COVID-19.

Yet despite the recent rapid progress, they say, it will take more changes to truly lower barriers that stand in the way of delivering evidence-based addiction care to more people via telemedicine.

If that happens, more people with substance use disorders could have access to care such as medications, psychotherapy and peer group support, they say -- even in rural areas and other places where addiction specialists are scarce.

Some of the authors already used telehealth as part of their work at the VA even before the COVID-19 pandemic began. Based on that experience, and on the intense shifts to virtual care in the past three months, they give specific recommendations for how to make telehealth for addiction a sustainable option for more providers and patients.

"Before COVID, treatment of substance use disorders was one of the least-used forms of telemedicine, because of a combination of regulatory issues, clinician comfort and patient comfort," says Allison Lewei Lin, M.D., M.Sc., the lead author and an addiction psychiatrist at the U-M and VA.

"Now, many addiction providers haven't seen their patients in the office, or have substantially decreased in-person visits, by using telemedicine in the past three months," she says. "And where we once relied on referring patients to inpatient and residential programs, many of those have not been available during this time, so outpatient clinicians have been trying to take care of sicker patients as well."

Policy shifts

Relaxation of rules such as the Ryan Haight Act, which previously didn't allow prescribers to prescribe buprenorphine and other controlled addiction treatment medications to patients they had only seen virtually, have made a big difference, says Lin.

So have changes in rules and guidance from the Substance Abuse and Mental Health Services Administration to make it easier for clinicians to communicate and care for patients with addiction via telemedicine.

Plus, the same changes to Medicare and Medicaid telemedicine reimbursement rules that have helped move non-addiction care online this spring are helping addiction providers, too.

More research needed

As the coronavirus pandemic continues, she says, many in the addiction field have a lot of questions - ones that researchers are now scrambling to study. For instance, how are patients doing, and are they improving with telemedicine-delivered treatment? Also of intense interest: Can telemedicine potentially help patients start and stay engaged in treatment longer than they would have with traditional care?

The rapid move to virtual care has been a big switch for a field that has focused for so long on building interpersonal rapport between patient and provider - and also on in-person checks such as urine tests to make sure patients are adhering to their treatment and spot relapses early.

"Patients are now used to telemedicine and some really like it, so we shouldn't take it away even when coronavirus wanes," Lin says. "But we have to evaluate the impacts, including if the treatments are actually effective, as we go on."

Last year, Lin led a team that published a review of the existing evidence surrounding telemedicine for substance use disorders. They concluded that much more research was needed - but that early evidence showed efficacy and high patient satisfaction.

Key recommendations

In the new piece, she and colleagues Anne Fernandez, Ph.D., M.A. and Erin Bonar, Ph.D. recommend three key changes going forward:

Development of treatment guidelines that include both in-person and telemedicine-based care for substance use disorders, and that provide guidance on urine toxicology practices and use of new ways to monitor treatment progress including self-monitoring apps and other practices.

More work to increase the availability of buprenorphine via telemedicine, including by increasing the number of physicians who are trained to prescribe it and monitor patients taking it. This could especially help rural areas hit hard by the opioid epidemic. Lin and her colleagues currently lead regular training sessions to get new providers started with such prescribing, and offer ongoing support for prescribers.

More help for people with substance use disorders who are also coping with other mental health conditions, and with the psychological and financial stress brought on by the COVID-19 pandemic. Online resources including group therapy online will be key, they say.

"In this moment when clinical care has been transformed because of real-world necessity, rather than evidence produced by research, it makes research on the effects of that transformation all the more urgent," says Lin. "We need to understand to what extent we should be offering telemedicine even after COVID-19 has subsided."

Another urgent issue: making sure that patients in rural areas without broadband Internet access aren't left behind.

Lin has been seeing addiction patients for years using telehealth, but they had to travel to a clinic in a nearby city in order to connect with her. Now she is having visits with those patients in their homes instead.

"These past few months have been a natural experiment for substance use disorder treatment, much of which has traditionally been largely outside the realm of other types of medicine," she says. "It will be important to see how things change, for better or worse. When we have the option for in-person care again, we will also need to determine which is better - telemedicine or the traditional approach - and for which patients to keep them engaged and make care more accessible, especially for vulnerable populations."

CLEVELAND--A team led by Case Western Reserve University medical researchers has developed a potential treatment method for Pelizaeus-Merzbacher disease (PMD), a fatal neurological disorder that produces severe movement, motor and cognitive dysfunction in children. It results from genetic mutations that prevent the body from properly making myelin, the protective insulation around nerve cells.

Using mouse models, the researchers identified and validated a new treatment target--a toxic protein resulting from the genetic mutation. Next, they successfully used a family of drugs known as ASOs (antisense oligonucleotides) to target the ribonucleic acid (RNA) strands that created the abnormal protein to stop its production. This treatment reduced PMD's hallmark symptoms and extended lifespan, establishing the clinical potential of this approach.

By demonstrating effective delivery of the ASOs to myelin-producing cells in the nervous system, researchers raised the prospect for using this method to treat other myelin disorders that result from dysfunction within these cells, including multiple sclerosis (MS).

Their research was published online July 1 in the journal Nature.

"The pre-clinical results were profound. PMD mouse models that typically die within a few weeks of birth were able to live a full lifespan after treatment," said Paul Tesar, principal investigator on the research, a professor in the Department of Genetics and Genome Sciences at the School of Medicine and the Dr. Donald and Ruth Weber Goodman Professor of Innovative Therapeutics. "Our results open the door for the development of the first treatment for PMD as well as a new therapeutic approach for other myelin disorders."

Study co-authors include an interdisciplinary team of researchers from the medical school, Ionis Pharmaceuticals Inc., a Carlsbad, California-based pioneer developer of RNA-targeted therapies, and Cleveland Clinic. First author Matthew Elitt worked in Tesar's lab as a Case Western Reserve medical and graduate student.

PMD attacks the young

PMD is a rare, genetic condition involving the brain and spinal cord that primarily affects boys. Symptoms can appear in early infancy and begin with jerky eye movements and abnormal head movements. Over time, children develop severe muscle weakness and stiffness, cognitive dysfunction, difficulty walking and fail to reach developmental milestones such as speaking. The disease cuts short life-expectancy, and people with the most severe cases die in childhood.

The disease results from errors in a gene called proteolipid protein 1 (PLP1). Normally, this gene produces proteolipid protein (PLP) a major component of myelin, which wraps and insulates nerve fibers to allow proper transmission of electrical signals in the nervous system. But a faulty PLP1 gene produces toxic proteins that kill myelin producing cells and prevent myelin from developing and functioning properly--resulting in the severe neurological dysfunction in PMD patients.

PMD impacts a few thousand people around the world. So far, no therapy has lessened symptoms or extended lifespans.

For nearly a decade, Tesar and his team have worked to better understand and develop new therapies for myelin disorders. They have had a series of successes, and their myelin-regenerating drugs for MS are now in commercial development.

Latest research

In the current laboratory work, the researchers found that suppressing mutant PLP1 and its toxic protein restored myelin-producing cells, produced functioning myelin, reduced disease symptoms and extended lifespans.

After validating that PLP1 was their therapeutic target, the researchers pursued pre-clinical treatment options. They knew mutations in the PLP1 gene produced faulty RNA strands that, in turn, created the toxic PLP protein.

So they teamed with Ionis Pharmaceuticals, a leader in RNA-targeted therapeutics and pioneer of ASOs. These short strings of chemically modified DNA can be designed to bind to a specific RNA target and block production of its protein product.

And that's exactly what happened in their studies. The result was improved myelin and locomotion, and substantial extension of lifespan. "ASOs provided an opportunity to cut the disease-causing protein off at its source," Elitt said.

The successful clinical use of ASOs is relatively new, yet recent developments seem promising. In 2016, the U.S. Food and Drug Administration approved the first ASO drug for a neurological disorder, spinal muscular atrophy. The drug, Spinraza, was developed by Ionis and commercialized by Biogen Inc. More ASO therapies are in development, and clinical trials and hold promise for addressing many neurological diseases that as of now have no effective treatment options.

Tesar said that ongoing and planned experiments in his laboratory will help guide future clinical development of ASO therapy for PMD. For example, researchers want to understand more about how well the treatment works after the onset of symptoms, how long it lasts, how often treatment needs to be given and whether it might be effective for all PMD patients, regardless of their specific form of the disease.

"While important research questions remain, I'm cautiously optimistic about the prospect for this method to move into clinical development and trials for PMD patients," Tesar said. "I truly hope our work can make a difference for PMD patients and families."

A new, ultra-rapid formulation of insulin reached peak activity in pigs with diabetes about twice as fast as a commercially available option, according to new research. The formulation, which peaked in as little as 9 minutes, could improve quality-of-life for patients with diabetes by allowing them to more quickly manage their blood sugar levels during mealtimes. Type 1 diabetes is one of the most common chronic conditions, affecting about 40 million people around the world. Patients with diabetes usually receive routine injections of insulin to control their blood sugar levels, but current insulin formulations suffer from various drawbacks. For example, even fast-acting insulin treatments can take as long as 90 minutes to peak in activity, making them less than ideal for patients who need quick and effective blood sugar control during mealtimes. Here, Joseph Mann and colleagues designed a faster-acting insulin formulation based on polymer excipients, compounds that maintain the insulin in a less aggregated form that more closely mimics how the hormone is naturally released in the body. The scientists used a high-throughput screen to evaluate various excipients, and integrated the top-performing candidate into an insulin formulation named UFAL. When injected into pigs with diabetes, the new formulation reached peak activity in 9 minutes - twice as fast as the commercially available insulin formulation Humalog, which peaked in 25 minutes. Furthermore, UFAL was safe in rats and outperformed Humalog and similar rapid-acting insulin analogs in a model that simulates drug activity in humans. The authors caution that more work is needed to pin down their formulation's activity and safety in people, as pigs show different insulin dynamics compared with humans.

What The Study Did: The clinical findings of four children who experienced neurological symptoms associated with COVID-19 are presented in this case series.

Authors: Yael Hacohen, M.D., Ph.D., of University College London, 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/jamaneurol.2020.2687)

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

#  #  #

Media advisory: The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jamaneurology/fullarticle/10.1001/jamaneurol.2020.2687?guestAccessKey=814c2fa0-6c23-4d4e-85df-928b66ab0034&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=070120

What The Viewpoint Says: The need for and implementation of telemedicine for patients with substance use disorder in the era of COVID-19 is discussed in this Viewpoint.

Authors: Lewei (Allison) Lin, M.D., M.S., of the University of Michigan in Ann Arbor, 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.2020.1698)

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

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Media advisory: The full article is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jamapsychiatry/fullarticle/10.1001/jamapsychiatry.2020.1698?guestAccessKey=2ee5e96a-66ee-4445-b892-16005d7ca2b9&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=070120

Adults who meet recommended weekly physical activity levels have a lower risk of death, finds a US study published by The BMJ today.

The survival benefits are similar regardless of intensity of activity, although they are slightly higher for vigorous than light to moderate activity, the findings show.

Inadequate physical activity is a worldwide public health issue. It has been estimated that physical inactivity was responsible for 6-10% of the global burden of major chronic non-communicable diseases and 9% of early deaths in 2008 at a cost of $53.8 billion to healthcare systems worldwide in 2013.

Growing evidence that physical activity may prevent many chronic diseases and reduce mortality has led to governments setting out recommended activity levels.

The 2018 US guidelines recommend at least 150 minutes of moderate intensity, or at least 75 minutes of vigorous intensity aerobic activity per week. They also suggest adults should engage in muscle strengthening activity of moderate or greater intensity on at least two days per week.

But evidence that meeting these recommendations is linked to reduced mortality is unclear.

So an international team of researchers set out to determine the association between sufficient physical activity according to the 2018 US guidelines and death from any cause as well as eight specific causes including cardiovascular disease (CVD), cancer, chronic lower respiratory tract diseases, accidents and injuries, Alzheimer's disease, and diabetes.

Their findings are based on 479,856 US adults aged 18-85 years who reported the amount of leisure time spent in aerobic physical activity and muscle strengthening activity per week as part of the National Health Interview Surveys from 1997 to 2014.

This data was then linked to national death records over an average of nearly nine years.

During the study period, only 16% (76,384) participants fully met the recommended activity levels and 59,819 participants died.

Compared with participants who did not meet the recommended activity levels, those who engaged in sufficient muscle strengthening activity had an 11% lower risk of death from any cause, while those who engaged in sufficient aerobic activity had a 29% lower risk of death from any cause.

Those who fully met the recommended activity levels - both sufficient muscle strengthening and aerobic activities - achieved even larger survival benefits (40% lower risk of death from any cause).

In addition, adults who engaged in sufficient aerobic activity were at reduced risk of death from all eight specific causes, while those who engaged in sufficient strengthening activity were at reduced risk of death from three causes (CVD, cancer, and chronic lower respiratory tract disease).

This is an observational study, so can't establish cause, and relied on participants self-reporting activity levels. But the authors also point out some strengths, including the large sample size representative of the US population, and their ability to adjust for potentially influential factors, such as lifestyle and underlying conditions.

"Our findings support that the physical activity levels recommended in the 2018 physical activity guidelines for Americans provide important survival benefits," they write. "Additionally, in accordance with the guidelines, more physical activity than the minimum recommendation could provide greater health benefits."

What The Study Did: This online survey study investigated how common were symptoms of depression, anxiety, insomnia and acute stress and potential risk factors in the general population in China during the COVID-19 pandemic.

Authors: Yan-Ping Bao, Ph.D., and Lin Lu, M.D., Ph.D., of Peking University in Beijing, are the corresponding authors.

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

(doi:10.1001/jamanetworkopen.2020.14053)

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

The immune system protects our body from constant attack by viruses, bacteria, and other pathogens. Much of this protection is provided by hematopoietic immune cells, which are derived from the bone marrow and specialize in fighting pathogens. They include macrophages, which remove pathogens; T cells, which kill infected virus-producing cells; and B cells producing antibodies that neutralize pathogens. However, immune functions are not restricted to these "specialists", and many more cell types are able to sense when they are infected and contribute to the immune response against pathogens.

Structural cells provide essential building blocks of the body and play an important role in shaping the structure of tissue and organs. Most notably, epithelial cells constitute the surface of the skin, while also separating tissues and organs from each other; endothelial cells coat the inside of all blood vessels; and fibroblast provide the connective tissue that keeps tissues and organs in shape. Structural cells are often regarded as simple and rather uninteresting components of the body, despite their well-established roles in autoimmune diseases (such as rheumatoid arthritis and inflammatory bowel disease) and in cancer. In their new study, Thomas Krausgruber, Nikolaus Fortelny and colleagues in Christoph Bock's laboratory at CeMM focused on elucidating the role of structural cells in immune regulation by pursuing a systematic, genome-wide analysis of epigenetic and transcriptional regulation of structural cells in the body.

To that end, the CeMM researchers established a comprehensive catalog of immune gene activity in structural cells, applying high-throughput sequencing technology (RNA-seq, ATAC-seq, ChIPmentation) to three types of structural cells (epithelium, endothelium, fibroblasts) from twelve different organs of healthy mice. This dataset uncovered widespread expression of immune genes in structural cells as well as highly cell-type-specific and organ-specific patterns of gene regulation. Bioinformatic analysis detected genes that control a complex network of interactions between structural cells and hematopoietic immune cells, indicating potential mechanisms by which structural cells contribute to the response to pathogens.

Interestingly, many immune genes showed epigenetic signatures that are normally associated with high gene expression, while the observed expression in structural cells obtained from healthy mice was lower than expected based on their epigenetic signatures. CeMM researchers therefore hypothesized that these genes are epigenetically pre-programmed for rapid upregulation when their activity is needed - for example in response to a pathogen. To test this hypothesis, they joined forces with Andreas Bergthaler's laboratory at CeMM, capitalizing on their expertise in viral immunology and infection biology.

When the mice were infected with a virus (LCMV) that triggers a broad immune response, many of those genes that were epigenetically poised for activation became upregulated and contributed to the transcriptional changes that structural cells showed in response to viral infection. These results suggest that structural cells implement an "epigenetic potential" that pre-programs them to engage in rapid immune responses. As an additional validation, the researchers triggered an artificial immune response by injecting cytokines into mice, and they indeed found that many of the same genes were upregulated.

The new study has uncovered a striking complexity of immune gene regulation in structural cells. These results highlight that structural cells are not only essential building blocks of the body, but also contribute extensively to its defense against pathogens. Moreover, the presented data constitute an important first step toward understanding what "structural immunity" might mean for the immune system, and it may help develop innovative therapies for some of the many diseases that involve the immune system.

According to the researchers, the study shows that spending cuts to alcohol services represent a false economy since decreases in expenditure are linked to increased hospital admissions which inevitably are costly to society and the economy.

In March 2012 the Health and Social Care Act (HSCA) transferred the responsibilities of commissioning specialist drug and alcohol services from the NHS to local authorities. In 2018 there were nearly 25,000 deaths related to alcohol in England, and data collected during the COVID-19 pandemic has shown that nearly one in five daily drinkers have further increased the amount they drink since lockdown (Alcohol Change UK, 2020).

Published in The British Journal of Psychiatry, the study showed an association between the level of spending on treatments for alcohol misuse at the local authority level and the number of alcohol related hospital admissions since the HSCA has come into force.

According to the analysis, if the average local authority reduced its net annual spending by 5 per cent on treatment for those with alcohol misuse problems there would be an expected associated average increase of 60 alcohol related hospital admissions for that local authority per 100,000 people per year. To put this reduction in spending into context 5 per cent of annual expenditure per local authority is on average 18p per person.

This is the first study known to assess the relationships between alcohol-related hospitalisations, the provision of specialist alcohol treatment and money spent on alcohol services at the local authority level in England. This in turn has been affected by reductions in the government's public health grant to local authorities.

Lead author Dr Emmert Roberts from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) King's College London said: 'Our results show that the rate of alcohol related hospital admissions is associated with a reduction in net spending for treatment of alcohol misuse, suggesting that local authority funding cuts to specialist alcohol treatment services may be displacing costs onto the NHS hospital system. The drug and alcohol budget may be seen as easier to cut than other local authority budgets especially as they are now not protected by ringfencing. An average reduction in spend of 18p per person appears to have large consequences on the number of people needing hospital treatment for problems relating to alcohol.'

The study analysed data from 2012 to 2019 on the expenditure on alcohol services, the provision of specialist alcohol treatment and the level of alcohol related hospitalisation from 152 local authorities in England. The study showed that, since the HSCA was passed, on average local authorities have decreased annual net spending on treatment for alcohol misuse treatment by £147 per 1000 people and the net spending for prevention and reducing alcohol misuse by £88 per 1000 people.

On average the number of hospitalisations where either the main reason for admission or one of the secondary diagnoses is an alcohol-related condition has increased by about 60 per 100,000 population per year, according to the study.

Researchers found a large variation in the figures between local authorities, and several authorities with the largest average number of alcohol related hospital admissions also showed the largest net spending cuts for alcohol misuse treatment. For example, one local authority had one of the highest average increases in alcohol related hospital admissions at 107 per 100,000 people per year, but also one of the largest decreases in expenditure for alcohol misuse treatment at £1,820 per 1000 people per year.

Dr Roberts commented: 'Our study indicates that local authority areas in England most in need of adequately funded specialist alcohol treatment due to high levels of alcohol dependence and deprivation are not receiving targeted increases in funding, and that the national rise that we are seeing in alcohol-related hospitalisations may be fuelled by cuts to specialist alcohol treatment services.'

Senior author, Professor Colin Drummond from the IoPPN said: 'Our study shows a relationship between the spending cuts for alcohol services and alcohol-related hospital admissions and, as 1 in 10 people in hospital have alcohol dependence, we believe these cuts represent a false economy.

'Alongside this the COVID-19 pandemic has implications for alcohol services since research shows a general increase in alcohol consumption and that those already drinking heavily have increased their alcohol intake. This combined with significant reduction in support from specialist alcohol treatment services due to social distancing, is likely to produce an increase in demand for services as the pandemic progresses. With alcohol treatment services already depleted due to cuts to the local authority's public health grants, they will be ill equipped to respond to a surge in demand.'

This research was supported by the Medical Research Council (MRC) and part funded by the National Institute of Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, and the NIHR Applied Research Collaboration South London at King's College Hospital NHS Foundation Trust.

Real-world mobile phone data suggests a decline in the number of trips people made per day began before state-level stay-at-home policies were implemented, and the decline was strongly correlated with a reduction of COVID-19 case growth in the 25 most affected counties across the USA, according to a modelling study published in The Lancet Infectious Diseases journal.

The authors say their analysis supports the role of social distancing as an effective way to control the spread of COVID-19 in the USA until a vaccine is available. However, they note the study does not account for other infection control measures (eg, wearing face masks and handwashing), which are also likely to have contributed to the decline in the case growth rate during March.

Dr Lauren M Gardner, Johns Hopkins University, USA, says, "Our results strongly support the conclusion that social distancing played a crucial role in the reduction of case growth rates in multiple US counties during March and April, and is therefore an effective mitigation policy for COVID-19 in the USA . Critically, we also found that behavioural changes were already underway in many US counties days to weeks before state-level or local-level stay-at-home policies were implemented." [2]

She continues: "If individual-level actions were not taken and social distancing behaviour was delayed until the state-level directives were implemented, COVID-19 would have been able to circulate unmitigated for additional weeks in some locations, inevitably resulting in more infections and deaths. This demonstrates that it is within the power of each US resident to help slow the spread of COVID-19." [2]

Within the first four months of COVID-19 being reported in the USA, the virus spread to every state and to more than 90% of counties. The policy response was highly decentralised during this period - when and how county and state-level stay-at-home policies were implemented varied significantly, making the effectiveness of social distancing difficult to assess.

This study uses real-world mobile phone movement data as an indicator of social distancing. It compares local case growth with how individuals actually modified their movement patterns, rather than relying on assumed compliance with local stay-at-home policies.

Daily mobility data was taken from mobile network records between Jan 1 to April 20, 2020, to capture trends in movement patterns for each US county, and compared to baseline patterns before COVID-19 (Jan 8 to Jan 31, 2020) to generate a social distancing metric. [3] Additionally, a COVID-19 daily growth rate ratio was calculated for each county, using local epidemiological data on recorded cases (starting from Mar 16 after more widespread testing was underway).

Using these metrics, the authors created statistical models that evaluated how social distancing (measured by relative change in movement patterns) affected the rate of new infections in each of the 25 counties in the USA with the highest number of confirmed COVID-19 cases on April 16, 2020.

For all 25 most affected counties, the correlation between movement patterns and case growth was significant, with the correlation considered strong for 20 of the 25 counties.

From Jan 24 to April 17, 2020, mobility dropped to 35-63% of the normal patterns in the 25 most affected counties - ranging from 35% of normal levels of movement in New York City to 63% in Harris County.

There was a lag of 9-12 days before the effects of decreases in movement were observed on COVID-19 transmission, which is in line with expectations after accounting for the time for symptoms to manifest after infection, worsen, and be reported.

Individuals began to reduce their movement in early March, indicating social distancing began well before the first US state-level stay-at-home directive (implemented by California on March 21). While this could partly be explained by some county-level policies that were put in place before state-level ones, the initial decline in movement began in 21 out of 25 counties before any formal regulation (including county-level) was put in place.

Although social distancing has consistently been shown to have positive effects on COVID-19 transmission in China, the authors say that their work extends these results to the USA.

Moving forward, they note that practices such as handwashing, face mask use, and self-isolation when people get sick, may become more widespread and help in controlling the virus, but stress that social distancing will remain one of the most important ways to control the spread infections until a vaccine is available.

Co-author Dr Hamada Badr, Johns Hopkins University, USA, says, "Individuals seem to have anticipated public health directives in March and April, despite a mixed political message. As stay-at-home policies begin to relax, we urge individuals and governments to make safe and data-driven decisions, to respond to the potential risk of increased infections. More timely, consistent and decisive policy implementation of social distancing and other known effective mitigation measures is urgently needed." [2]

The authors note some additional limitations of their study. They were unable to differentiate between low-risk and high-risk trips involved in the movement patterns, so they acknowledge that their social distancing metric does not account for this. For example, multiple trips alone to a park are probably lower risk than a single trip to a grocery store (without using other physical distancing strategies, such as wearing a face mask). They also note that there may be errors in the case data due to reporting issues and limited COVID-19 testing capacity.

Light pollution is increasingly being recognized as yet another of humanity's many impacts on the rest of the natural world. Artificial light at night, or "ALAN" to use the researchers' name for the phenomenon, can alter foraging behavior, migration patterns, mortality rates and even the very physical structure of animals.

But there has been little research into the effect of ALAN on invasive species--species that are not indigenous, or native, to an area--which can sometimes cause significant economic and ecological damage.

However, as anyone who has a porch light can see, nocturnal insects such as moths, flies and beetles are attracted to this artificial light. These invertebrates are food sources for nocturnal predators such as bats, birds and frogs--including what is perhaps the most iconic invasive species of all time, the cane toad.

Cane toads feed on nocturnal insects, and Assistant Professor Hirotaka Komine with Tokyo University of Agriculture and Technology (TUAT) along with their colleagues from Australia's James Cook University wanted to find out whether the artificially large food source that ALAN makes available in a particular location had any impact on the cane toad.

They published their findings on April 16 in Scientific Reports.

They set up six outdoor enclosures, each with an artificial light attached, in different rural areas around Townsville, Queensland. They then placed cane toads that they had locally captured in the enclosures just before sunset. After the toads had feasted overnight on whatever invertebrate delectable treats had been attracted to the ALAN, the toads were euthanized and dissected to measure the contents of their bellies.

The researchers varied the amount of light, and controlled for the affects of rainfall, wind speed, and temperature, which also have an impact on the availability of sources of food. They found that when the lights were on, the percentage of flying insects that the toads consumed increased significantly.

But the toads did not eat as many flying bugs when the moon was bright. The same reduction in bug consumption happened in those areas that were closer to urban areas that already suffered from ample ambient ALAN. In both cases, the extra light diluted the impact of the lamps the researchers had set up.

"This tells us that in order to control the growth of this invasive species," said conservation biologist Hirotaka Komine. "More careful management of artificial light in rural areas such as that from highway lampposts or scattered buildings, could go a long way in reducing the food resources available."

The researchers added that light management approaches should also consider the lunar cycle, such as reducing light use where possible during dark lunar phases.

Stamp-sized device comprises a suite of clinical-grade sensors, including temperature and pulse oximetry

Device sits at the base of the throat to pick up vibratory signatures of breathing, coughing, swallowing

Since developing the device, researchers have tested it on more than 50 physicians, rehabilitation specialists and patients at Shirley Ryan AbilityLab and Northwestern Memorial Hospital

Researcher: 'We are already seeing clear vital sign differences collected by the sensor between patients with COVID-19 and healthy-matched controls'

Research group has partnered with BARDA to continue developing and deploying the device to help fight the pandemic

EVANSTON, Ill. -- Although it might be tempting to rely on your fitness tracker to catch early signs of COVID-19, Northwestern University researchers caution that consumer wearables are not sophisticated enough to monitor the complicated illness.

The Northwestern team, led by bioelectronics pioneer John A. Rogers, published a perspective today (July 1) in the journal Science Advances, in which they differentiate between popular consumer electronics and clinical-grade monitoring systems.

Rogers co-authored the perspective with Dr. Shuai Xu, a Northwestern Medicine dermatologist, and Hyoyoung Jeong, a postdoctoral fellow in the Rogers lab.

"According to the Journal of the American Medical Association, the three most important early symptoms for COVID-19 are fever, shortness of breath and coughing," Rogers said. "For a wearable technology, you want to track those key symptoms. A conventional wearable device, such as a fitness tracker, sits on the wrist or finger -- not the anatomical location that is most relevant to COVID-19."

This past spring, the Rogers group and researchers at Shirley Ryan AbilityLab introduced a novel wearable device and set of data algorithms specifically tailored to catch early signs and symptoms associated with COVID-19 and to monitor patients as the illness progresses. About the size of a postage stamp, the soft, flexible, wireless device sits just below the suprasternal notch, the visible dip at the base of the throat -- an ideal location for monitoring respiratory health.

More recently, Rogers' team added a wearable, flexible pulse oximeter to pair with the suprasternal-mounted device. This allows physicians to continuously monitor for silent hypoxia, an often asymptomatic feature marked by alarmingly low blood oxygen levels. Adding this feature will help the device, and accompanying algorithms, give a fuller picture of the disease's onset, progression and response to treatment.

"The device measures very tiny vibrations on the skin and has an embedded temperature sensor for fever," Rogers said. "As you cough and breathe, it counts coughs, monitors the intensity of cough and senses labored breathing. The location on the throat also is close enough to the carotid artery that it can measure mechanical signatures of blood flow, monitoring heart rate."

"This sensor system targets key symptoms for COVID-19, with the goal to identify the infection earlier in patients," Xu said. "It's a suite of clinical-grade sensors wrapped into one small device. And once it's placed on the throat, people don't even realize that it's there."

Rogers is the Louis Simpson and Kimberly Querrey Professor of Materials Science and Biomedical Engineering in Northwestern's McCormick School of Engineering, professor of neurological surgery at Northwestern University Feinberg School of Medicine and director of the Querrey Simpson Institute for Bioelectronics (QSIB).

Xu is an assistant professor of dermatology at Feinberg and of biomedical engineering at McCormick. He also is the medical director of QSIB.

Differences between COVID-19 patients and healthy controls

Since launching the device in April, the team has tested it on 52 COVID-19-positive physicians, nurses, rehabilitation specialists and patients at Shirley Ryan AbilityLab and Northwestern Memorial Hospital. The device was tested both in the hospital and in the home.

From these tests, Rogers and his team have collected 3,000 hours of data, which will continue to strengthen the device's algorithms. Eventually, the machine-learning algorithms will become smart enough to distinguish between a COVID-like cough and more benign coughs from allergies, colds or dryness. The team expects to test 500 subjects by the end of the year.

"We are already seeing clear vital sign differences collected by the sensor between patients with COVID-19 and healthy-matched controls," said Arun Jayaraman, a researcher assistant scientist at Shirley Ryan AbilityLab, who leads the algorithm development. "We're working together to develop predictive algorithms for detecting the disease earlier."

Thoracic surgeon remotely monitors patients

Dr. Ankit Bharat, chief of thoracic surgery at Northwestern Medicine who performed the first double-lung transplant on a COVID-19 patient in the United States, is actively testing the device on his pulmonary patients. The device wirelessly transmits data to a HIPAA-protected cloud, where automated algorithms produce graphical summaries tailored to facilitate rapid, remote monitoring. This allows Bharat to continue monitoring his patients well after they have been dismissed from the hospital.

"It has provided valuable information about each patient's respiratory status," Bharat said. "We hope that as we gain experience with this device, it will greatly enhance our ability to monitor patients remotely. Under the circumstances of the pandemic, remote monitoring capabilities improve efficiency in medical care while increasing protection to health care workers against the virus."

Continued research and deployment

To accelerate manufacturing and deployment, Rogers and Xu launched technology startup Sonica Health, based on intellectual property (IP) jointly developed by Northwestern and the Shirley Ryan AbilityLab. The IP related to this project has been optioned through Northwestern's Innovation and New Ventures Office. The effort is supported by the Biomedical Advanced Research Deployment Authority (BARDA), part of the Office of the Assistant Secretary for Preparedness and Response at the U.S. Department of Health and Human Services.

Sonica Health previously partnered with BARDA for technology focused on chronic obstructive pulmonary disease (COPD). Now the partnership has expanded to focus on early detection of COVID-19 and other respiratory infections in high-risk clinical populations and, in collaboration with another spinout from QSIB, Sibel Health, to provide the pulse oximetry sensor.

With BARDA's support, Sonica Health and Sibel Health will jointly submit the device and associated algorithms for Food and Drug Administration (FDA) approval later this month. The overall goal is an FDA-cleared platform that gives an early warning of COVID-19 contraction, helping reduce the transmission of the virus.

The study states that failing to encourage tourists to do more on behalf of wildlife represents a missed opportunity for conservation. "We argue that the combination of emotional engagement and knowledge-driven action provided by wildlife-based tours will pave the way for a new area of conservation-oriented tourism" says Dr. Alvaro Fernández-Llamazares, the lead-author of the study from the University of Helsinki.

"Some years ago I took a whale-watching tour in Iceland, and it surprised me to see that while the guide provided very detailed information about the ecology, life cycle and foraging habits of whales, she did not mention any single time the huge conservation threats that these animals are facing. My colleagues had noticed similar patterns in other corners of the world. Concerned about this, we decided to thoroughly review the academic literature on wildlife-based tourism and examine to which extent was conservation messaging lacking in wildlife-based tours," explains Dr. Fernández-Llamazares.

The authors carried out a comprehensive review of the academic literature on wildlife-based tourism, finding out that indeed conservation messaging is virtually absent from many mainstream wildlife-based tourism operations. Operators often fail to give information on wildlife conservation and opportunities for tourists to engage in conservation action.

Whale-watching tour in Húsavík (Iceland). Information on cetacean conservation and threats to the marine environment is argued to be limited in many whale-watching tours. Credit: Á. Fernández-Llamazares.

"There is increasing research evidence that wildlife-based tourism could help to transform the environmental knowledge, attitudes and behaviours of tourists through first-hand encounters with wildlife, complemented by effective conservation messaging," says Dr. Fernández-Llamazares. "However, such conservation messaging is not always a priority for many wildlife-based tourism operators, who often fail to provide a well-designed environmental interpretation".

Tools to engage tourists in wild-life conservation

The study documents new avenues that are broadening the potential of wildlife-based tourism, using alternative forms of communicating conservation-related messages. For example, empirical research shows that combining the emotional response of viewing wildlife with the educational benefits of a tailored interpretative programme provides tourism operators with numerous opportunities to cultivate the conservation potential of a tourism experience.

"I have experienced it myself: when you have the opportunity to see wildlife in situ, it creates a deep emotional connection between you and wildlife. However, as tourists we do not always have the tools to act beyond that experience, to transform the emotional bonds towards environmental stewardship," says Aina Brias-Guinart, co-author of the study from the University of Helsinki. "For this reason, in this study, we thought of a set of principles that wildlife-based tourism operators could use to maximize the conservation potential of the tourist experience".

The study introduces a toolbox of ideas for improving the conservation messaging of wildlife-based tourism operations, based on five principles: promote positive messaging, provide actionable information, engage tourists in research and practice, link experience with consumption choices and foster long-term interactions. These ideas focus on amplifying the emotional engagement among tourists participating in wildlife-based tours, and on empowering them to take purposeful conservation action.