Culture

What The Viewpoint Says: The importance of minimizing COVID-19 transmission in prisons and jails is described and policies and programs for doing so are detailed.

Authors: Laura Hawks, M.D., Cambridge Health Alliance in Cambridge, Massachusetts, 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/jamainternmed.2020.1856)

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

WASHINGTON, Tuesday, April 28, 2020 -- Biological robots, or biobots, draw inspiration from natural systems to mimic the motions of organisms, such as swimming or jumping. Improvements to biobots to better replicate complex motor behaviors can lead to exciting biorobotic engineering applications to help solve real world challenges. However, this requires the creation of biohybrid robots -- biobots made up of both organic and artificial materials -- which is a challenge.

Researchers from the University of Illinois at Urbana-Champaign combined an intact rat spinal cord with a tissue-engineered, 3D muscle system. They describe the novel biohybrid system in the journal APL Bioengineering, from AIP Publishing.

After culturing the system for seven days, the researchers found that the motor neurons from the spinal cord begin to produce electrical activity that causes contraction in the artificial muscles, mirroring the behavior of the peripheral nervous system.

"When we looked more deeply at how the neuron-muscle interface developed, we were very excited to observe many similarities between our tissue-engineered spinobot and in vivo development," said author Collin Kaufman, a neuroscience graduate student at UIUC.

Kaufman said this result indicates the explanted spinal cord is a viable mechanism for controlling muscular behaviors, even when removed from its natural environment.

They further tested this by varying the concentration of neurotransmitters in the system. When additional neurotransmitters are present, the contractions are more patterned and consistent, and when they are blocked, the twitching decreases.

Because studying the peripheral nervous system can be so difficult, the ability to observe it externally -- as demonstrated in the present study -- can lead to great strides in medicine.

One potential example is in Lou Gehrig's disease, also known as amyotrophic lateral sclerosis, in which the death of neurons results in the eventual loss of motor function. By developing an external peripheral nervous system, researchers can study ALS with ease of access to the impacted components in real time.

"The next steps to studying such a disease are surprisingly close," Kaufman said. "By replacing the muscle, the spinal cord, or any combination of the two tissues with an ALS mutant model, researchers would be able to study how diseased neurons interact with nearby muscles."

In addition, hybrid biobots can be used as surgical training tools, allowing medical students to perform practice surgery on real biological tissue.

"The future applications of this technology are only beginning to be understood, and we expect many great things from this area in the next few years," said Martha Gillette, professor of cell and developmental biology at UIUC.

What The Viewpoint Says: This Viewpoint describes the relevance of a palliative care approach to surgery during the coronavirus disease 2019 pandemic.

Authors: Zara Cooper, M.D., M.Sc., of Brigham and Women's Hospital in Boston, 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/jamasurg.2020.1698)

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

Australian researchers have revealed for the first time that males infected with the Toxoplasma parasite can impact their offspring's brain health and behaviour.

Studying mice infected with the common parasite Toxoplasma, the team discovered that sperm of infected fathers carried an altered 'epigenetic' signature which impacted the brains of resulting offspring. Molecules in the sperm called 'small RNA' appeared to influence the offspring's brain development and behaviour.

'Intergenerational inheritance' of similar epigenetic changes from men exposed to extreme trauma has been well documented. This latest research, published in Cell Reports, has raised the question of whether Toxoplasma infections - or even possibly other infections - in men before conception could impact the health of subsequent generations.

The research was led by Walter and Eliza Hall Institute researchers Dr Shiraz Tyebji and Associate Professor Chris Tonkin, in collaboration with Professor Anthony Hannan at the Florey Institute of Neuroscience and Mental Health.

At a glance

Melbourne researchers have revealed that mice conceived from sperm of males infected with the parasite Toxoplasma displayed changes in their brain function and behaviour.

The study showed Toxoplasma infection in male mice caused changes in levels of 'small RNA' molecules contained in their sperm, potentially altering gene expression in the resulting offspring.

As trauma in men can also cause epigenetic changes in sperm and has been associated with neuropsychiatric changes in their children and grandchildren, the research raises the possibility that men might also transmit changes associated with a Toxoplasma infection to their children.

Infectious inheritance

Toxoplasma is one of the world's most common parasites, estimated to be carried by between 25 and 80 per cent of the global population. Toxoplasma infection can cause an initial mild illness in most people, however, pregnant women, babies and people with weakened immunity experience more severe infections.

Associate Professor Tonkin said people could carry the dormant Toxoplasma parasite for decades, and that this had been associated with the appearance of symptoms of mental disorders such as schizophrenia and bipolar disorder.

"Toxoplasma infections have been shown to cause long-term epigenetic changes in a range of cells around our body. These are changes that do not alter the genetic sequence of DNA, but influence gene expression - that is, which genes are switched on or off," he said.

"As other epigenetic changes in fathers - such as those caused by trauma or smoking - can influence their children, we decided to look at whether the effects of epigenetic changes caused by Toxoplasma infection could also be passed between generations."

By studying male mice infected with Toxoplasma, the researchers were able to narrow their investigations down to the transmission of epigenetic information through sperm, Dr Tyebji said.

"We discovered that Toxoplasma infection alters levels of DNA-like molecules, called small RNA, that are carried by sperm," he said. "These changes in small RNA levels affect gene expression, and so could potentially influence brain development and behaviour of offspring.

"We were stunned to see that even the next generation - the 'grandchildren' of the original infected male - displayed changes in their behaviour," Dr Tyebji said.

Impacts for public health

Professor Hannan said this was the first time it had been shown that an infection in a male can result in epigenetic changes being transmitted to subsequent generations. "While our studies were in mice, it raises an important question about whether infections in human fathers before conception also impact their children," he said.

"We normally think more about how infectious diseases in women affect the developing fetus, but perhaps certain infections in men could have long-term impacts on subsequent generations' health.

"This is certainly something we are following up, both looking at what is happening in humans, as well as investigating infections other than Toxoplasma, including animal models of infection with the SARS-CoV-2 virus which causes COVID-19," Professor Hannan said.

Associate Professor Tonkin said the study was an outstanding example of how collaboration enhanced medical research. "We have combined more than a decade of research in my laboratory into Toxoplasma infections and their impact on brain development with the expertise Professor Hannan's team has established in understanding the role of epigenetics in brain development and behaviour," Associate Professor Tonkin said.

New Rochelle, NY, April 27, 2020--A mobile telehealth system (MTS) has been used in a hospital in China where COVID-19 patients were treated in isolation wards set off from other healthcare providers. Click here to read the article free in the peer-reviewed journal Telemedicine and e-Health. This just-published paper provides a full description of the MTS, its components, and how it maintains the security of patient information.

The MTS was able to overcome the problem that patient information stored in the hospital intranet was not available to the staff working in isolated COVID-19 wards. The MTS enabled sharing of patient information among clinicians without compromising the security of patient information.

"Telemedicine innovations like this one are rapidly being developed worldwide," says Charles R. Doarn, MBA, Editor-in-Chief of the Journal and Research Professor and Director of the Master of Public Health Program, Department of Environmental and Public Health Sciences, University of Cincinnati, Ohio. "China has been able to contain COVID-19 in part by isolating individuals and using telehealth and telemedicine to support care between providers and patients using a mobile health application."

"Telemedicine applications are growing enormously" said Mary Ann Liebert, president of the publishing company that bears her name. "They will be a necessity as healthcare communities grapple with new challenges such as coronavirus. Telemedicine and e-Health has been the journal of record for 26 years."

A link has been discovered between a common gene defect and eczema, nasal blockage and wheeze among babies as young as six months, according to a new study at Brighton and Sussex Medical School (BSMS). The research raises new questions about how soon in life these defects could start affecting babies, resulting in serious health problems, and suggests treatment targeted towards children carrying these genetic defects started soon after birth could improve their lives.  

The protein filaggrin is present in the skin and nasal cavity, helping to maintain the skin barrier, and previous studies have shown defects in the gene synthesising filaggrin are strongly linked to the risk of developing eczema and how serious the eczema and asthma turned out to be over childhood.  

Professor Somnath Mukhopadhyay, Chair in Paediatrics at BSMS, said: "In the first study of this kind, we recruited mothers in the antenatal clinic and followed up the babies through infancy, in order to define the link between these gene defects, the resultant skin problem, and eczema, wheeze and nasal blockage, in early infancy. Our striking finding establishing this link could mean that some babies with these gene defects could be getting primed from birth or soon after, for a life of suffering from allergy-related disease."  

The GO-CHILD study recruited 2,312 pregnant women in England and Scotland, who gave a cord blood sample at birth or saliva in infancy for genotyping of the babies. Babies were followed up for symptoms related to allergic diseases such as dry skin, eczema, wheeze and nasal blockage, at the ages of 6, 12 and 24 months by postal questionnaires sent to the carers.  

The gene defects made eczema, wheeze and nasal blockage worse at six months. While the defects were affecting eczema at one year, they were no longer worsening wheeze and nasal blockage at this age. At two years, they were principally worsening eczema and nasal blockage, but not affecting wheeze. "The problems affecting the child change over time, filaggrin gene variation representing one major ensemble within the grand orchestra of allergic disease," said Professor Mukhopadhyay.   

He added: "The use of simple emollients from birth targeted towards those who have these gene defects may help correct this problem, thus alleviating suffering in infancy and also through life. This new approach for targeting treatment according to genetic information is known as precision or personalised medicine and a future trial could represent the first application of this exciting and novel approach in little babies otherwise primed to develop chronic disease from an early age. 

"This skin barrier defect leads to selective entry of allergens to increase the burden of disease. Whether such barrier defects could make us more vulnerable to agents causing infection, such as viruses, has not yet been addressed. We are in the midst of a pandemic where some people are affected but many are not. Could a defective outer barrier in skin and mouth be making some of us more vulnerable? If so, would identifying patients carrying these defects help us better protect those that are more vulnerable?" 

A large study in adolescents and children, some as young as 3 years of age, shows a link between obesity, high blood pressure, and later damage to blood vessels. The research is presented today on EAPC Essentials 4 You, a scientific platform of the European Society of Cardiology (ESC).

"The results of this study highlight the need to adopt healthy lifestyles from an early age," said study author Ms. Julia Bueschges, a PhD student at the Robert Koch Institute, Berlin, Germany.1

Until now, there has been little information on the connection between risk factors present in childhood - such as obesity and high blood pressure - and cardiovascular disease later in life.

The study used data from the nationally representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS cohort). Children from diverse backgrounds were enrolled from all over Germany irrespective of their health status; they were selected using a sophisticated sampling design to ensure they represented the German population.

Three study teams travelled over three years and set up temporary examination centres in 167 locations across the country. The baseline examination of 4,716 participants aged 3 to 17 included blood pressure, height and weight. The measurements were repeated 11 years later in the 14 to 29-year-olds, who also had an ultrasound of their arteries. The ultrasound assessed the thickness of the inner two layers of the carotid artery: thicker lining is an early indicator of clogged arteries.

High blood pressure (hypertension) at baseline was associated with a 33% increased risk of having a thicker lining of the artery 11 eleven years later, while baseline obesity was linked with a 38% elevated risk of thicker artery lining. Thicker lining was defined as the top 25% of measurements according to current guidelines. Being hypertensive at both examinations was linked with a 63% raised risk of thicker artery lining, while being obese at both examinations carried a 53% greater risk.

Ms. Bueschges said: "The study provides evidence from a large general population sample for a connection between cardiovascular risk factors in children and adolescents - namely high blood pressure and obesity - and subsequent deleterious changes in the blood vessels." She cautioned that individual risk prediction is only moderate, meaning that not all children and adolescents with high blood pressure or obesity will develop subclinical atherosclerosis.

She said: "These findings underline the importance of good cardiovascular health from an early age. Physical activity and a healthy diet can help prevent high blood pressure and obesity. Alcohol and tobacco should be avoided. Last but not least, it is important to manage stress."

She concluded: "Tackling these unhealthy behaviours does not depend on children and their families alone but also on the promotion of healthy environments and the reduction of social inequalities which are strongly associated with cardiovascular disease."

With the COVID-19 pandemic resulting in lockdowns in different parts of the world, from the US to many European nations, there have been intense debates on when and how we can safely reopen the economy.

New research led by Hong Kong Baptist University (HKBU) computer scientists has used a data-driven modelling approach to answer the time-critical question of when the stringent social distancing and quarantine measures against COVID-19 can be loosened so that normal life and economic activities can be restored in a safe manner.

The research team developed a novel computational model that explicitly characterises and quantifies the underlying transmission patterns among different populations throughout the various phases of the COVID-19 outbreak. Based on the model, the research team carried out a prospective analysis of the different work resumption plans, revealing the respective economic implications and the levels of disease transmission risk associated with each plan.

The original research was titled "What are the Underlying Transmission Patterns of COVID-19 Outbreak? An Age-specific Social Contact Characterization", and it was published in The Lancet's EClinicalMedicine journal.

Novel data science approach to public health issues

The model was developed by a research team from HKBU's Department of Computer Science, and the study was led by Professor Liu Jiming, Chair Professor of the Department, in collaboration with the National Institute of Parasitic Diseases of the Chinese Center for Disease Control and Prevention (China CDC) and the Chinese Academy of Sciences.

"For over a decade, our research team at HKBU has been dedicated to adopting an interdisciplinary approach while leveraging novel data analytics and artificial intelligence methodologies to address global public health challenges such as malaria and influenza. Our current work, published in an international medical journal, represents a unique scientific attempt in response to the COVID-19 pandemic," said Professor Liu.

An age-specific social contact characterisation model

The researchers were able to characterise the disease transmission patterns by examining the interactions between people. The computational model divided the population into seven age groups with their own specific social circles, gathering places and activity patterns. Four representative social contact settings, namely households, schools, workplaces, and public places, were considered as they are examples of dense populations in which the spread of COVID-19 may occur.

Six cities in mainland China, including Wuhan and five cities from three key economic zones, namely Beijing, Tianjin, Hangzhou, Suzhou, and Shenzhen, were analysed. In each case, a contact matrix was inferred to describe the contact intensity between different age-groups for each of the four settings, and this enabled the dynamics of disease transmission to be computed. Confirmed cases, population sizes, and the cities' respective intervention measures were taken into account when building the model.

Prospective analysis of work resumption plans

With this age-specific social contact-based transmission model, the team proceeded to project the prospective development of the COVID-19 outbreak, with a focus on work resumption plans.

Disease transmission risks and the estimated impact on local GDP growth were examined for the different work resumption plans. These plans vary from more lenient ones, in which work resumes earlier and completes within a shorter time frame, to stricter ones where work resumes later within a longer overall time frame. Results of the analysis on Beijing, Tianjin, Hangzhou, Suzhou, and Shenzhen are summarised in Appendix. Wuhan was also analysed and the researchers suggest that the city should take longer to complete work resumption in order to reduce the potential transmission risk.

Projections that help policymaking

The data-driven computational model developed by the research team provides a science-based analytical solution which enables policymakers to design plans that can achieve both the containment of disease transmission risk and the gradual reopening of affected cities in a safe manner. By conducting a data-driven prospective analysis, policymakers can calculate the best time to reopen the economy. For instance, they can work out whether they should reopen their cities as late as possible and hence have no disease transmission risk, or alternatively, resume work and life gradually and systematically while keeping all the necessary control measures in place to eliminate any potential disease transmission.

The research team will openly share their data-driven computational modelling and analytical tools with public health policymakers and researchers around the world, and this will enable them to capitalise on these tools for decision making using their domestic epidemiological data.

Scientists are one step closer to understanding how the cancer-fighting drug Taxol is produced by trees.

In a recent paper published in the Journal of Biological Chemistry, a group of researchers led by Washington State University's Mark Lange, has found candidate genes that could eventually be used to manufacture Taxol more quickly and efficiently.

"Our goal is to find enzymes that activate precursors contributing to the complex structure of Taxol," said Lange, a professor in WSU's Institute of Biological Chemistry. "That will enable engineers to know which genes to throw into the mix to develop organisms that can produce the drug."

Also known as paclitaxel, Taxol is a natural compound discovered in the bark of Pacific Yew trees.

It is used to treat a variety of cancers, from breast to ovarian to bladder to prostate and more.

It used to be harvested directly from trees by stripping their bark, but harvests weren't done sustainably and many of the trees died. Currently, most of the drug sold in the United States is made by extracting the substance from Yew tree cell cultures grown in a laboratory.

This process is time consuming and expensive.

"We've been working on this for many years because the structure of Taxol is so complex," Lange said. "There are over 500 known taxane natural products, of which Taxol is only one. We're trying to find enzymes that activate precursors to make Taxol, but not other taxanes."

Enzymes are substances in living organisms that act as catalysts to start a chemical reaction.

"Ideally, you want an enzyme that activates a specific reaction, as opposed to multiple reactions," Lange said.

These results will be used by other scientists to add genes to yeast or other microbes, allowing them to produce the drug in large quantities.

"It's very challenging," Lange said. "It could involve 30 to 50 genes. But the genes we characterized here can be part of that."

Lange and his team are part of a much larger group working on the project, including a Stanford University engineer and biologists from the University of California system and the John Innes Centre in the UK.

They received a $4 million grant from the National Center for Complementary and Integrative Health, part of the National Institutes of Health, last fall in support of the project.

Since MIT (Massachusetts Institute of Technology) started the OpenCourseWare movement, by publishing its course materials as open educational resources, many types of initiatives have been developed to open access to education via the use of digital technologies. Among other resources, the MOOCs have proliferated. These offer specialised online courses (frequently free) to an unlimited number of students. However, the drop-out rate of students that starts a MOOC (Massive Open Online Courses) are very high, which makes it useful to analyse the student profiles, establishing typologies and individual profiles. As the study by the LRPC (Personal Network and Community Laboratory) and the JRC shows, the initial diagnosis of learning intention can be very useful for improving educational performance.

Researchers from the University of Seville have carried out a study within the Moocknowledge project, a European initiative which collects data on a large scale on participant in MOOCs between 2014 and 2018. The project gathered information from more than 23,000 users from a total of 84 different MOOCs.

The study analysed the psychological factors that influence the learning of the participants in the massive online courses. Its results show that initial intention is related to individual differences in drop-out probability.

The research was carried out by means of a survey of 1768 participants from 6 different MOOCs. The students were classified in function of their motivational profile and learning intentions at the start of the course. The results show that initial motivation is clearly associated with the satisfaction and the quality perceived on the quality of the learning experience. "A good initial diagnosis of the learning intention and motivational profile of each student can therefore help to design personalised learning plans, as well as improve the degree to which students benefit from the course", explains the University of Seville teacher Isidro Maya.

The Laboratorio de Redes Personales y Comunidades de la Universidad de Sevilla (Personal Network and Community Laboratory) collaborated in the preparation of the databases generated in this European Commission project. Currently, the data is being used in various research projects, and have been especially useful for exploring the impact of the MOOCs on learning, employability and the development of professional careers.

Although the article was available online in June 2019, the printed version was issued in February 2020.

A drug that has life-extending effects on mice also reverses age-related dental problems in the animals, according to a new study published today in eLife.

Periodontal disease, also known as gum disease, is a common problem in older adults that causes painful inflammation, bone loss and changes in the good bacteria that live in the mouth. Yet there are no treatments available beyond tooth removal and/or having good oral hygiene. The findings suggest that treatments targeting the aging process in the mouth might help.

Rapamycin is an immune-suppressing drug currently used to prevent organ rejection in transplant recipients. Previous studies in mice have also suggested that it may have life-extending effects, which has led to interest in studying the drug's effects in many age-related diseases.

"We hypothesised that biological aging contributes to periodontal disease, and that interventions that delay aging should also delay the progress of this disease," says lead author Jonathan An, Acting Assistant Professor at the Department of Oral Health Sciences, University of Washington, Seattle, US.

To find out if rapamycin might slow periodontal disease, An and his colleagues added the drug to the food of middle-aged mice for eight weeks and compared their oral health with untreated mice of the same age. Similar to humans, mice also experience bone loss, inflammation and shifts in oral bacteria as they age.

Using a 3D-imaging technique called micro-computed tomography, the team measured the periodontal bone, or bone around the tooth, of the rapamycin-treated and untreated mice. They showed that the treated mice had more bone than the untreated mice, and had actually grown new bone during the period they were receiving rapamycin.

The work also showed that rapamycin-treated mice had less gum inflammation. Genetic sequencing of the bacteria in their mouths also revealed that the animals had fewer bacteria associated with gum disease and a mix of oral bacteria more similar to that found in healthy young mice.

"By targeting this aging process through rapamycin treatment, our work suggests that we can delay the progress of gum disease and actually reverse its clinical features," explains senior author Matt Kaeberlein, Professor of Pathology and Adjunct Professor of Oral Health Sciences at the University of Washington.

However, Kaeberlein adds that while rapamycin is already used to treat certain conditions, it can make people more susceptible to infections and may increase their risk of developing diabetes, at least at the higher chronic doses typically taken by organ transplant patients. "Clinical trials in humans are needed to test whether rapamycin's potential oral health and other benefits outweigh its risks," he concludes.

Food wrapping, fishing gear and plastic waste continue to reach the Antarctic. Two new studies into how plastic debris is reaching sub-Antarctic islands are published this month (April 2020) in the journal Environment International.

New findings include analyses of some of the longest continuous datasets in the world on plastics ingested by seabirds and washed up on beaches, and insights into where this plastic originates. They also highlight the ongoing prevalence of plastic in the Polar Regions, its impact on the environment and the animals that inhabit these remote areas.

Scientists from British Antarctic Survey (BAS) have systematically collected marine debris washed up on the beaches of Bird Island (South Georgia) and Signy Island (South Orkneys) over three decades. Their findings reveal an increase in the amount of debris collected. Over 10,000 items were recovered, the majority of which was plastic.

Lead author Dr Claire Waluda, a marine ecologist at BAS says:

"While we found an increase in the quantity of beached plastic debris, recent surveys have shown increasing numbers of smaller pieces. This might be due to the breakdown of larger pieces of plastic which have been in the Southern Ocean for a long time."

"It's not all bad news. With the amount of plastic recovered on beaches peaking in the 1990s, our study suggests that the measures to restrict the amount of debris entering the Southern Ocean have been successful, at least in part. But more still needs to be done. By putting our data into oceanographic models we will learn more about the sources and sinks of plastic waste and how it is transported into and around the Southern Ocean."

A second BAS-led study used seabirds as sentinels of plastic pollution, due to their natural tendency to consume indigestible items - such as plastic - which they mistake for natural prey. Over 30 years, researchers looked at the variation in plastic ingestion by three species of albatrosses, including the wandering albatross, and giant petrels on Bird Island.

Researchers categorised debris - including type, size, colour and origin. They found substantial differences in the characteristics of the marine debris associated with South Georgia's seabirds.

For example, items ingested by wandering albatrosses and giant petrels were primarily food-related wrapping that had been packaged in South America. These species typically scavenge behind vessels so the debris is highly likely to be waste items that have been discarded or lost overboard.

Lead author and seabird ecologist at BAS, Professor Richard Phillips, says:

"Our study adds to a growing body of evidence that fishing and other vessels make a major contribution to plastic pollution. It's clear that marine plastics are a threat to seabirds and other wildlife and more needs to be done to improve waste-management practices and compliance monitoring both on land and on vessels in the South Atlantic."

"There is some good news, we found that black-browed albatrosses typically ingested relatively low levels of debris, suggesting that plastic pollution in the Antarctic waters where they feed remains relatively low."

Long-term monitoring on the islands continues whilst the rest of the world is in lockdown.

We learned it as children: to cross the street in exemplary fashion, we must first look to the left, then to the right, and finally once more to the left. If we see a car and a cyclist approaching when we first look to the left, this information is stored in our short-term memory. During the second glance to the left, our short-term memory reports: bicycle and car were there before, they are the same ones, they are still far enough away. We cross the street safely.

This is, however, not at all true. Our short-term memory deceives us. When looking to the left the second time, our eyes see something completely different: the bicycle and the car do not have the same colour anymore because they are just now passing through the shadow of a tree, they are no longer in the same location, and the car is perhaps moving more slowly. The fact that we nonetheless immediately recognise the bicycle and the car is due to the fact that the memory of the first leftward look biases the second one.

Scientists at Goethe University, led by psychologist Christoph Bledowski and doctoral student Cora Fischer reconstructed the traffic situation - very abstractly - in the laboratory: student participants were told to remember the motion direction of green or red dots moving across a monitor. During each trial, the test person saw two moving dot fields in short succession and had to subsequently report the motion direction of one of these dot fields. In additional tests, both dot fields were shown simultaneously next to each other. The test persons all completed numerous successive trials.

The Frankfurt scientists were very interested in the mistakes made by the test persons and how these mistakes were systematically connected in successive trials. If for example the observed dots moved in the direction of 10 degrees and in the following trial in the direction of 20 degrees, most people reported 16 to 18 degrees for the second trial. However, if 0 degrees were correct for the following trial, they reported 2 to 4 degrees for the second trial. The direction of the previous trial therefore distorted the perception of the following one - "not very much, but systematically," says Christoph Bledowski. He and his team extended previous studies by investigating the influence of contextual information of the dot fields like colour, spatial position (right or left) and sequence (shown first or second). "In this way we more closely approximate real situations, in which we acquire different types of visual information from objects," Bledowski explains. This contextual information, especially space and sequence, contribute significantly to the distortion of successive perception in short-term memory. First author Cora Fischer says: "The contextual information helps us to differentiate among different objects and consequently to integrate information of the same object through time."

What does this mean for our traffic situation? "Initially, it doesn't sound good if our short-term memory reflects something different from what we physically see," says Bledowski. "But if our short-term memory were unable to do this, we would see a completely new traffic situation when we looked to the left a second time. That would be quite confusing, because a different car and a different cyclist would have suddenly appeared out of nowhere. The slight 'blurring' of our perception by memory ultimately leads us to perceive our environment, whose appearance is constantly changing due to motion and light changes, as stable. In this process, the current perception of the car, for example, is only affected by the previous perception of the car, but not by the perception of the cyclist."

CHICAGO (April 28, 2020): Amid shortages of personal protective equipment due to the Coronavirus Disease 2019 (COVID-19) pandemic, a St. Louis health care system has implemented a process to disinfect disposable N95 respirator masks that allows health care workers to reuse their own mask for up to 20 cycles. The novel disinfection process, developed in collaboration with Washington University School of Medicine, uses vaporized hydrogen peroxide and is described in an "article in press" on the Journal of the American College of Surgeons website in advance of print.

Test results from a pilot program at Barnes-Jewish Hospital and two other hospitals that are also part of BJC HealthCare, showed that the disinfection process kills germs from N95 masks while ensuring that the only person who touches the mask is the original mask wearer, study authors reported.

"Our primary outcome is safety for the health care worker," said project leader and study coauthor Andrew Pierce, MHSA, director of supply plus at Barnes-Jewish. "We want to make it safer for team members who are at risk while taking care of patients with a known or possible COVID-19 diagnosis."

Their program uses a disinfecting procedure first tested by Duke University researchers in 2016.1 However, the Barnes-Jewish process has a unique modification--an identification system that enables the hospital to return the sanitized mask to the same individual each time, said senior author Shaina Eckhouse, MD, FACS, assistant professor of surgery at Washington University School of Medicine, St. Louis. Dr. Eckhouse is part of the multidisciplinary team of university and hospital staff who developed the disinfection program.

This approach, according to the authors, increased employee acceptance of reusing what is normally a single-use N95 mask and helped ensure proper fit of the returned mask.

During the COVID-19 pandemic, the Centers for Disease Control and Prevention has recommended strategies for conserving personal protective equipment, including decontamination and reuse of N95 masks.2 Almost half of U.S. health care facilities reported being nearly or completely out of N95 respirator masks, according to a March 27 survey conducted by the Association for Professionals in Infection Control and Epidemiology.3

In late March, before the program began, Barnes-Jewish had a low inventory of N95 masks--about a week's worth--and no expectations for replenishment because of international shortages in hospital supply chains, according to Mr. Pierce.

How the process works

The disinfection process that has since been put into place begins at the end of a shift. A health care provider removes his or her N95 mask in that unit's soiled utility room and places it in a sterilization pouch (Crosstex) made of breathable polyethylene fiber (Tyvek by DuPont) on one side. On the other side of the sealed pouch, the worker writes his or her name or employee ID number, hospital, department, and unit location and puts the pouch in the soiled collection bin.

A designated worker wearing proper protection collects the bins twice a day and takes them to a specially designed and sealed disinfection room--built in four days, according to Dr. Eckhouse. There the pouches are arranged, breathable side up, by clinical unit on wire racks. A hydrogen peroxide vapor generator (Bioquell Z-2), which Washington University already owned to decontaminate equipment, fills the room with the chemical.

After 4.5 hours of disinfection, a worker moves the racks of masks to another area that has a fan to offgas the hydrogen peroxide, where the masks stay until sensors record a zero reading. The pouches are returned to their respective units in a decontaminated bin, finishing a process that takes about seven hours, Mr. Pierce said.

Workers can wear their mask up to three weeks because past studies show that disinfection more than 20 times could alter the fit of the mask, he noted.

Since the program began April 1 in the Barnes-Jewish emergency department, it expanded in just two weeks to additional clinical departments and other hospitals in the system, which Mr. Pierce called "an immense achievement."

"A welcome improvement"

Currently, Mr. Pierce said they are disinfecting 240 N95 masks a day and have the capability of disinfecting 1,500 masks daily.

Without the disinfection program, he said the health care system would need to discard a substantial amount of its respirator masks. Because of the disinfection, the hospitals now have enough masks to last for weeks.

"This program is a welcome improvement for extended usage of N95s during the shortage that we are facing," Mr. Pierce said.

Dr. Eckhouse said other hospitals facing mask shortages can reproduce the disinfection program if they bring together experts in environmental health and safety, medicine, and facility management. "Having the infrastructure already in place would improve the ease of deploying an N95 disinfection process," she stated.

CINCINNATI - By leveraging the basics of artificial intelligence technology now used to predict risk for suicide or other mental health issues, researchers developed an AI system that analyzes linguistic patterns to predict a youth's risk for committing acts of school violence.

Study data published in the International Journal of Medical Informatics by physicians and clinical informaticians at Cincinnati Children's Hospital Medical Center show the system can detect the risk of aggression for individual subjects.

The AI system uses pattern-recognizing machine learning and natural language processing (NLP) technologies. It combines the analytical scope and speed of information technology with clinical risk-assessment data and practitioner expertise, thereby automating a complex and time-consuming process, according to Yizhao Ni, PhD, co-principal investigator and a clinical informatician in the Division of Biomedical Informatics.

The technology uncovered multiple warning signs that could deliver useful clinical insights to assist personalized interventions, Ni explained. When fully developed, the system's built-in risk assessment scales and automated risk prediction algorithms should produce an accurate and scalable computerized screening service to prevent school violence.

"Students are physically or verbally bullied on school property, electronically through texting or social media, and youth violence costs society billions of dollars in health care expenses or lost productivity," Ni said, citing data from the U.S. Centers for Disease Control and Prevention.

"Our study demonstrates that overall, our AI system matches the clinical judgements and accuracy of psychiatrists 94 percent of the time. It has tremendous potential to help address youth violence at school and eventually other mental health conditions."

Empowering a Solution

Earlier research shows that using NLP and machine learning technologies pioneered at Cincinnati Children's and elsewhere improve risk prediction for mental health problems like suicide. Current study authors note that so far there are no automated solutions developed to predict the risk for violent behaviors at school.

Recent advancements in school-based crime prevention programs demonstrate the best results occur when at-risk youth receive timely and individualized intervention, according to Drew Barzman, MD, co-principal investigator and director of the Child and Adolescent Forensic Psychiatry Service at Cincinnati Children's.

But high patient need and busy clinical schedules can constrain the ability to complete the complex, labor intensive tasks needed for timely clinical evaluation of mental health patients. An effective automated system could help overcome this challenge and help mental health caregivers deliver timely interventions based on a youth's individual needs, he said.

Study Design

The study was tested by embedding it as a clinical service in the Division of Child and Adolescent Psychiatry at Cincinnati Children's. The division's inpatient units receive about 30,000 psychiatric admissions annually. Its outpatient clinic has over 52,000 patient visits every year.

Conducted between May 2015 and April 2018, the study prospectively recruited 131 students between ages 10 and 18 years from middle and high schools in Ohio, Kentucky, Indiana, and Tennessee.

Clinical assessments by psychiatrists indicated that 68 students (52 percent) were considered high risk towards others. For analysis with the AI assessment tool, the patients were segmented into smaller groups to compare the system's predictive reliability when compared physician-generated patient clinical assessments. These comparisons yielded the AI system's overall risk assessment match rate of 94 percent.

Future development plans for the tool include seeking research collaborations with other medical institutions and school systems to test live implementation in educational and medical settings, according to the researchers. Researchers said that based on funding capabilities, this will be the next phase of their work.