Culture

The pressure to send home more patients increases when hospital beds are in short supply.

For example, you have a greater chance of being discharged on a Friday or the day before a holiday. The chance of being discharged on days when the hospital is full due to high activity may also be greater, which can have very serious consequences for patients.

"Patients who are operated on for hip fractures have a higher risk of dying if they are discharged from the hospital early for space reasons," says Professor Johan Håkon Bjørngaard at the Norwegian University of Science and Technology's (NTNU) Department of Public Health and Nursing.

A recent study of 60000 of these patients over 70 years in Norway yielded this finding. The study was an interdisciplinary collaboration between researchers from St. Olavs Hospital and NTNU.

Each year, 8000 to 10000 patients undergo hip fracture surgery in Norway. Some newly operated patients are sent home quickly, while others need longer stays.

"The risk of death for these patients is high. Around 13 per cent of them died within the first 60 days following their surgery. During the first year, some 27 per cent died," says Dr. Lars Gunnar Johnsen at St. Olav's Hospital. He is also a researcher at NTNU's Department of Neuromedicine and Movement Science.

The difference in the 60-day mortality rate between patients discharged for space reasons and other patients is around four percentage points.

The recovery time in Norwegian hospitals for patients following hip surgery has been declining for several years. Reduced bed time due to better treatment is good, but reduced bed time due to pressure on bed capacity can be negative.

"The problem is that it's really difficult to separate these reasons from each other. We've tried to focus the effect of hasty discharges, but we have to account for several assumptions in the analysis," says Bjørngaard.

The average age of hip patients in Norway is 84 years old, and they often suffer from more than one chronic illness. This is a very vulnerable group.

"We had to figure out how to measure early discharges," says postdoc Sara Marie Nilsen of the Regional Center for Health Care Improvement (RSHU) at St. Olav's hospital.

Nilsen and researcher Andreas Asheim from RSHU and NTNU's Department of Mathematical Sciences helped to come up with the model for identifying situations where patients were sent home prematurely for space reasons.

"It's difficult to distinguish between patients who were too sick to be sent home and those who were actually ready to be discharged," Asheim says.

You can't just compare patients with short and long recovery times. The mortality rate won't increase for people who recover quickly, and so they can be discharged earlier for that reason.

"We used days when there was a high discharge probability to study whether early discharge led to higher mortality," says Nilsen.

The close association with professionals at St. Olav's hospital has been valuable for the research team in its efforts to create the best possible model.

Bjørngaard wonders whether hospitals should have a greater capacity to keep some patients longer.

"In 2016, half of the patients had bed rest of five days or less after hip fracture surgery. In 2010, only a quarter of the patients were discharged after five days," says Johnsen.

Patients now spend a much shorter time in the hospital. Much of this is due to the Norwegian Care Coordination Reform that was launched in 2012. This reform aimed to divide responsibility more effectively between specialists and municipal health services. A large part of the responsibility for pre-op patients was shifted to the municipalities.

Improved treatment may be part of the reason for quicker discharges, but the need to free up space in hospitals is still an important factor, not least because the coordination reform has led to many of the hospitals reducing the number of beds they have.

Now skilled professionals are employed in the primary health service system. For many patients, an early discharge with follow-up care in the municipality is the right decision.

But there is a lot of expertise at a hospital, where interdisciplinary groups can work together and advise each other to find out what is best for patients.

"At St. Olavs, we have teams that include pharmacists, orthopaedic surgeons, geriatric doctors and physiotherapists. This interdisciplinary treatment model is called orthogeriatrics and provides much better professional assessments," says Johnsen.

We can't expect local hospitals and rehabilitation centres to have access to groups like this. Local health care services simply don't have the resources to have specialists in so many different fields.

"We need to have a better idea about what the most comprehensive solution is," Bjørngaard says. He notes that it's not always a given that a hospital bed with a post-op patient is more expensive than a municipal bed.

Having greater expertise in hospitals to assess which patients are ready for discharge is another factor.

"With interdisciplinary treatment that includes geriatric expertise, we can provide better treatment and rehabilitation - and we can know who is ready for discharge with greater accuracy. Then more people can go home instead of to an institution," says Johnsen.

Australia has often been unfairly portrayed as an old and idle continent with little geological activity, but new research suggests that we remain geologically active and that some of our mountains are still growing.

The University of Melbourne study reveals that parts of the Eastern Highlands of Victoria, including popular skiing destinations such as Mt Baw Baw and Mt Buller, may be as young as five million years, not 90 million years as originally thought.

John Engel is one of four scientists from the Isotope Geochemistry Group in the School of Earth Sciences who studied the stalagmites, stalactites, and flowstones - technically called 'speleothems' - in the nearby Buchan Caves to produce the findings.

"At least 250 meters of additional height in the East Victorian Highlands appears to have been gained in the last few million years," Mr Engel said.

With the help of Parks Victoria Rangers, the team visited 10 caves, climbing down through the passages and crawling through tight squeezes to collect small fragments of speleothem 'rubble' to take back to the lab to determine their age, using radiometric U-Pb dating.

"Our research shows a clear trend between oldest speleothem (cave age) and height in the landscape," Mr Engel said. "The data suggests that the Buchan region has been steadily uplifting at a rate of 76 meters every million years, beginning at least 3.5 million years ago and continuing today. This means that some speleothems have been sitting in dark caves undisturbed for 3.5 million years."

Evidence suggests the Highlands originally rose up about 90 million years ago when the Tasman Sea between Australia and New Zealand opened up.

Researchers say the cause of the more recent uplift is debated but a leading theory points to the friendly rivalry with New Zealand.

"The Australian and Pacific plates share a common boundary and many of the forces involved at this boundary may be propagated into the Australian plate as tectonic stress. Some of this tectonically-induced stress is then released as uplift of the mountains in South East Australia," Mr Engel said.

"This is why East Gippsland may still feel effects related to these tectonic forces. This subtle modification of classical plate tectonic theory can help explain the frequent, small earthquakes observed along South East Australia."

Mr Engel said while mountains like the Himalaya and the Swiss Alps are admired for their aesthetic appeal, uncovering the secret stories surrounding when and how mountains form provides a layer of appreciation as well as an active field of research for geologists.

"Our research showcases a new - and rather unique - method for measuring the uplift of mountains. This technique of using speleothem is likely to also work in other caves across the world for regions with 'recent' tectonic activity, offering geologists great opportunities to share more stories about these impressive and unchanging features of our landscape."

Traditional stroke treatments like clot-dissolving tPA and surgical removal of big clots in the brain are good choices as well when the stroke results from SARS-CoV-2 infection, investigators report.

Excessive blood clotting and stroke -- even in young, previously healthy people -- are among the myriad of effects the virus is having on people across the globe. Another effect is keeping people away from hospitals even when they experience signs of stroke, like sudden and particularly one-sided weakness in the face, arm or leg, say stroke specialists at the Medical College of Georgia and Augusta University Health System.

"What we know about COVID-19 and stroke is people need to be treated urgently and they tend to do really well with tPA and mechanical thrombectomy (clot removal) if they come in within a short time window," says Dr. David Hess, stroke specialist and MCG dean, who encourages those with signs of stroke for any reason to get to the hospital as soon as possible.

Hess and Dr. Elizabeth Rutkowski, a neurologist whose expertise includes brain infections as well as stroke, are authors of a review paper in the journal Translational Stroke Research highlighting both established and emerging treatment options that may help improve stroke outcomes or reduce stroke risk in these unprecedented times when the extremely infectious SARS-CoV-2 has been added to the traditional risk factors for stroke like high blood pressure and diabetes.

They also have begun a five-year study to assess the overall neurological impact of SARS-CoV-2 infection long term in more than 500 Georgians.

Because signs of the virus' impact neurologically include not only stroke, but the loss of sense of smell, called anosmia; a reduced sense of taste, called hypogeusia; and brain involvement called encephalopathy that may impact consciousness and cause confusion and headaches, as well as seizures.

In fact, loss of smell can be an early or even lone indicator of SARS-CoV-2 infection. Whether it's a lasting loss is one of the many things the investigators want to learn. "The hypothesis may be that the people who have anosmia may be more at risk for developing cognitive and other neurological problems," Hess says.

The brain is a pretty direct target for the virus, which the Centers for Disease Control and Prevention says is mostly spread by human-to-human contact. When an infected individual coughs or sneezes in close proximity, a bystander's nasal passageway provides a pretty direct route for the virus to first make its way through the olfactory bulb in the front of the brain, which picks up and processes odors detected by cells in the nasal cavity, then to spread throughout the brain. The mouth affords a different route that can take the virus directly to the brain stem, and the neurologists say it's likely the virus could take both routes in one person.

The direct access to the brain enables a sort of double attack, with a direct hit by the virus to an organ, like the lungs, and to the organ's control centers in the brain. There are reports, Rutkowski notes, of patients seeming to do better but then they just stop breathing. While she and Hess agree that it's most often the lung failure that causes death with COVID-19, they suspect it's both this direct lung invasion and infection of breathing centers in the brain responsible.

While investigators are working in real time to determine what treatments are best for the still emerging array of problems caused by COVID-19, the MCG neurologists say the limited data out there on stroke indicate the standard therapies should work in this scenario as well.

"We think the pathogenesis behind the clots that form during this infection are a little different, but those clots people are describing with COVID-19 are very fresh and tPA seems to be really effective for those," says Rutkowski. "You see this in people with sepsis and with other viruses," Hess says of the clotting that can result in stroke and as well as damage to other organs. The neurologists suspect it is this propensity to clot coupled with the virus' attachment to ACE2 receptors, found throughout the body and considered protective, that leaves patients vulnerable to stroke.

Many viruses, including influenza and shingles, as well as other overwhelming infections such as sepsis, which is often driven by bacteria, result in excessive inflammation which can lead to increased coagulation that causes blood clots, including producing microscopic clots in the tiny air sacs of the lung, that can contribute to adult respiratory distress syndrome -- a major cause of severe illness and death in COVID-19 -- as well as the dysfunction and failure of other organs.

Patients' blood will have telltale high levels of D-dimer, a protein fragment produced when a clot is degraded, and their blood clots much faster than usual.

The now familiar spiky virus latches onto the angiotensin converting enzyme 2, or ACE2, an enzyme found on cells -- in the lungs, heart, kidneys, intestines and brain as well as the nasal mucosa - which explains its pervasive impact in the body. ACE2 is a part of the renin angiotensin system, which helps regulate blood pressure and is essentially a balance for angiotensin II, a powerful blood vessel constrictor and inflammation promoter. "It probably depletes ACE2 so you get this imbalance, you get too much angiotensin II, which is generally very bad," Hess says.

Rutkowski notes physicians at Mount Sinai Health System in New York, who have treated hundreds of patients, reporting how dialysis catheters are getting plugged with clots and how clots have even formed on the tip of a catheter during an interventional procedure to remove a clot from the brain.

Confusion is a common problem the neurologists also are seeing in patients with COVID-19, but it's hard to know in some patients whether that results from the fact that they are so sick and their oxygen levels are low or it's a direct result of brain infection, Rutkowski says. In others there are clear cases of a brain infection and of virus present in the spinal fluid. As part of their study, which is just getting started, the neurologists will be looking at what happens to cognition and the sense of smell in survivors over time, Rutkowski says, noting that in some pandemics, a viral or bacterial infection actually sets off a neurodegenerative condition that worsens with time. In the wake of the Spanish Flu Pandemic of 1918, for example, physicians were seeing immediate problems like delirium and encephalitis lethargica, which causes troubles like excessive sleepiness and movement problems, and -- sometimes years later -- a form of Parkinson's. "We could have the same thing happening here," Hess says of the current pandemic.

Their new study now underway at MCG and AU Health System likely will be expanded in coming months to MCG campuses statewide, starting with Albany which has one of the highest per capita COVID-19 death rates in the country.

With ongoing concern about COVID-19, those interested in the study can participate remotely or in person. Those enrolled in person will be examined by an MCG neurologist at AU Health System and those enrolled remotely will undergo a telehealth neurological evaluation. Both remote and onsite evaluations will include cognitive testing and a scent identification test where study participants will be asked to identify different smells like chocolate, bubble gum and root beer, queries that will provide more objective measure of changes in the smell sense, Rutkowski says.

They also are taking a more comprehensive look on what type of neurological effects the virus has, and if there are risk factors like preexisting medical problems or gender-- males seem preferentially impacted by COVID-19 -- that make people more susceptible to those effects, Rutkowski says.

Participants will provide details like medications they are taking, demographics and any COVID-19 related symptoms. Those opting for remote participation will receive similar remote examinations annually for five years. Those who opt for onsite participation will be asked to provide blood samples within a month of diagnosis or soon after a follow-up test shows they are disease free, then again at three and 12 months, then yearly. Blood will be examined for markers of inflammation like cytokines and chemokines and genetic factors like changes in the ACE2 gene that may predispose to neurological problems. Blood also will be examined for the presence and levels off antibodies against the virus and antibodies against sugars coating the virus, both signs of an attack by the immune system.

Blood samples will be studied and stored at the MCG Center for Biotechnology and Genomic Medicine where Dr. Jin-Xiong She, center director, also will be looking at variants in the ACE2 receptor that may make some more vulnerable to neurological problems, as well as antibodies people are making to the natural sugar coating on the virus. She says the antibodies may provide a disease history and help determine whether the severity of symptoms is associated with certain antibodies.

Other collaborators include Dr. John Morgan, director of the Parkinson's Foundation Center of Excellence and Movement and Memory Disorder Programs in the MCG Department of Neurology, who is conducting cognitive testing; and Dr. Lynnette McCluskey, neurobiologist in the MCG Department of Neuroscience and Regenerative Medicine, who is coordinating smell and taste testing.

Information collected during the study will be shared with the participants' primary care physician if desired. The investigators hope to add brain imaging to the examination if funding becomes available, Hess says.

In terms of addressing the disease's impact today, the blood thinner, low molecular weight heparin, used to prevent clots and treat deep vein thrombosis and pulmonary embolism and whose effect is considered to last longer and be more predictable than standard heparin, may be useful in reducing excessive clotting and potentially avoiding a stroke as well as other clot-related organ damage, they say. Rutkowski and Hess note that some physicians are already using it prophylactically and that it's essentially impossible in the midst of a pandemic to do standard clinical trials to more objectively measure if patients benefit from different therapies.

A more targeted therapy for these patients may be human recombinant soluble ACE2, which has been shown to help restore healthier ACE2 levels and interfere with SARS-CoV-2's ability to attach to cells, reducing the overall viral load, which decreases disease severity. The clinical grade ACE2 has already undergone early human studies for adult respiratory distress syndrome, the often deadly consequence of this virus, and other significant infections. An interventional study is now enrolling hospitalized adults in Austria, Denmark and Germany.

A clinical trial also is underway in patients with COVID-19 or suspected of having it who have bilateral viral pneumonia, infusing them with the blood vessel dilator angiotensin (1-7), which is significantly depleted in COVID-19 to hopefully improve lung function. Drugs that block the receptor for blood vessel constricting angiotensin II may work from another direction to help restore a healthier balance, the investigators say.

How we organize information plays an integral role in memory, reasoning and the ability to acquire new knowledge. In the absence of routine education programs, the pandemic is exacerbating the disparities in educational opportunities available for children to develop new skills. While children of higher socio-economic means often benefit from enrichment programs, these opportunities are unfortunately not available to every child.

New research at Carnegie Mellon University presents the first direct evidence that experiential programs increase a child's ability to lock away new information as well as generalize the knowledge to new situations. These findings suggest that enrichment programs folded into a normal academic curriculum could strengthen knowledge acquisition and increase academic success.

"It is well-documented that economic privilege is linked to better academic outcomes," said Catarina Vales, a post-doctoral researcher in CMU's Psychology Department and first author on the study. "Our research suggests that one possible reason may be access to enrichment opportunities where children acquire knowledge that will later become important in school."

The results of the study are available online May 17 in the journal Child Development.

Researchers believe that children acquire new knowledge by building bridges to pools of information from previous experiences. Prior research has focused on theoretical modeling with computer simulations to evaluate how learning creates those bridges. In this study, CMU researchers coordinated with educators at the Phipps Conservatory and Botanical Gardens in Pittsburgh to develop two programs -- one about bugs and one about plants ¬-- to understand how children generalize knowledge gained through summer programs to new situations.

In the study, 29 pre-school and kindergarten age children (19 girls, median age = 4.5 years) were enrolled in one of the programs, which included hands-on learning activities. The same programs were run over two consecutive summers and led by the same instructor.

Before and after each program, the children were challenged to use their knowledge to position cards with pictures of bugs and plants onto a grid based on similarity. The goal was to place cards with similar images closer together. For example, the cards for ladybug and a butterfly (both insects) are placed closer together than the cards for a ladybug and a spider (an arachnid). Whereas the card for a butterfly and a pumpkin are placed the farthest apart.

The researchers examined the pre- and post-test results. While the children could differentiate bugs and plants successfully even during the pre-test, their ability to differentiate within the domain that they studied, like bugs, was only evident at post-test. Importantly, children differentiated among items that were not part of the program activities, suggesting that they were able to generalize what they had learned at camp to new bugs or plants.

"This study demonstrates the importance of informal education, particularly in the summer, to prevent the 'summer slide,'" said Sarah L. States, director of Research and Science Education at Phipps Conservatory and Botanical Gardens. "We look forward to exploring other questions in children's' cognitive development in the future with the CMU team."

While the study size is small, the researchers believe the results are meaningful. They plan to continue to engage children in future studies to understand what learning activities might be particularly useful to help children succeed.

"It is possible that the variety of activities [during the enrichment program] are mutually redundant and reinforce each other," said Anna Fisher, associate professor of Psychology and senior author on the paper. "At this point no one knows the exact recipe, but giving kids opportunities to learn, for example, about biological classification in multiple ways, could better prepare children for future learning."

Vales and Fisher are collaborating with their partners at Phipps Conservatory and Botanical Gardens on implementing activities that can be delivered remotely and free of charge, so that all children can benefit from them.

LOS ANGELES (May 20, 2020) - A study conducted by investigators at Cedars-Sinai suggests that universal testing of asymptomatic pregnant women in labor may not be necessary at every hospital. The investigation was prompted by reports from several large hospitals in New York City that nearly 14% of asymptomatic women admitted for childbirth had tested positive for COVID-19 during the early weeks of the pandemic. The women did not know they were infected.

In California, infections from the novel coronavirus and deaths from COVID-19 are strikingly lower than those in the state of New York. The reasons for the dramatic differences across regions of the country are not yet clear.

"That data from New York made us very concerned about the possibility of asymptomatic infections among our own pregnant patients. This would have implications for them, their babies, their households and for the health of our staff caring for them," said Mariam Naqvi, MD, maternal-fetal medicine specialist at Cedars-Sinai.

For one week in April, universal testing was employed to study the rates of asymptomatic infection in all admitted pregnant patients at Cedars-Sinai. Of the 82 patients tested, two had symptoms associated with the novel coronavirus, SARS-CoV-2, but 80 women were asymptomatic. The findings of the study were published this week in the journal Obstetrics & Gynecology: Severe Acute Respiratory Syndrome Coronavirus 2 Universal Testing Experience on a Los Angeles Labor and Delivery Unit.

"We had no positive tests for COVID-19 in any of the 80 asymptomatic women in our labor and delivery unit, and all remained symptom-free throughout their hospitalizations. Of the two patients who had symptoms when admitted, one tested positive," said Naqvi, the study's principal investigator.

Sarah Kilpatrick, MD, PhD, chair of the department of Obstetrics and Gynecology, emphasizes how important it is to have accurate data about the number of asymptomatic pregnant women who come to the hospital to give birth and are not infected with the virus.

"If a high number of the asymptomatic women had tested positive for COVID-19, then we would need to continue testing all pregnant women. But as we suspected, the positive tests for asymptomatic women were in fact very low-zero-so we do not need to institute universal testing at this moment," said Kilpatrick, one of the study investigators. "These results are reassuring for our patients, their families and for healthcare providers."

Importantly, sporadic outbreaks or hot spots may develop quickly as the pandemic works its way through cities and states. Kilpatrick says it is critical that hospitals and communities remain vigilant in protecting pregnant women.

"We would restart universal testing immediately if we noted an increase in the number of positive tests among asymptomatic pregnant women in Los Angeles or around the state," Kilpatrick said. "To keep this positive rate low, we all must continue with what is working: wearing face masks, frequent hand-washing and maintaining physical distancing."

A group of Hokkaido University researchers has developed a paper-based device that can easily and cheaply measure lithium ion concentration in blood, which could greatly help bipolar disorder patients.

Lithium carbonate is used for treating bipolar disorder, a mental health condition that causes extreme mood swings. But using this drug requires caution because the therapeutic concentration range of lithium ions in blood is narrow and close to the toxic range. Japan's Pharmaceuticals and Medical Devices Agency warns doctors to regularly examine lithium ion concentration levels in the blood of patients given the drug.

However, existing examination methods require a large amount of blood, special operations, and large, expensive devices. These methods can be performed only by certain testing laboratories.

The present study led by Takeshi Komatsu, a doctoral student at Hokkaido University's Graduate School of Chemical Sciences and Engineering, and Professor Manabu Tokeshi of the university's Faculty of Engineering was conducted to address this problem by developing a user-friendly, low-cost method. The study was published in ACS Sensors.

The researchers succeeded in making a colorimetric paper-based device that allows point-of-care testing in one step. The device consists of two paper-based elements linked to each other: a blood cell separation unit and a colorimetric detection unit. High-purity cotton blotting paper and blood cell separation membrane, which are both available on the market, are used as a substrate for each unit, respectively. Hydrophobic ink was coated on the device to allow easy liquid handling.

After a drop from a blood sample is placed on the end of the separation unit, plasma, or the liquid portion of the blood in the sample, is automatically separated and transported to the detection unit dry-coated with a reagent, which displays a diagnostic color. This process takes about a minute to complete. To measure the color, a digital camera obtains the image for analysis without any fixed light condition, a process that makes the conventional, special device for this task unnecessary. The researchers showed that the device's detection ability is comparable to that of conventional instruments using the same colorimetric reaction.

"The device provides an alternative method for regularly monitoring lithium ion concentrations when treating bipolar disorder patients," says Manabu Tokeshi. "In the future, we hope to develop a smartphone app for the image analysis so patients themselves or non-medical workers can check the lithium ion concentration in the blood." The researchers also say that by tuning detection reagents and other components, the device can be used for measuring the concentration of blood components other than lithium ions.

New research calls for more support for older adults in community settings with respiratory illnesses against COVID-19, and not just those in care homes, as around 7 million US adults fall into this category.

In a new article, published in the journal Aging and Social Policy, experts discuss how current methods in the US do not provide enough protection for this vulnerable group and outline specific steps to help fix the issue.

While there has been much attention on the impact of COVID-19 on the care home setting, there has been significantly less support for older adults in the community with respiratory illnesses, who are particularly vulnerable due to additional health risks and a higher mortality rate.

Additionally this group in the community is five times larger than those in nursing homes, suggesting this could become a significant issue if not dealt with correctly.

The paper suggests specific steps that can be taken to ensure the safety of this vulnerable sub-population, which are:

Increasing testing - especially prioritize older adults with known respiratory issues for coronavirus testing

Conducting assessments - defining who is most at risk and ensuring that appropriate precautions are taken

Social support - providing scheduled check-ins to ensure meaningful connection

Meet basic needs - providing essential necessities such as food and medicine

Protect home care workers - ensuring the correct PPE is available to those that support this group

Lead author Marc Cohen Clinical Professor at University of Massachusetts Boston emphasized, "It's really important we implement measures to protect all groups of people, especially those that are more vulnerable. Policymakers, providers and other stakeholders and advocates should take note of the concrete recommendations put forward to keep this category of the population healthy in order to help ensure their safety."

"The multi-prong approach that we are advocating here should help to ameliorate these concerns and mitigate further risk. It is incumbent on us to work together with urgency."

Further to the recommendations, the paper elaborates how the current social-distancing strategy could conversely be exacerbating other health problems because social isolation has been shown to have negative effects on health and in some cases, the impacts on be physical health are equivalent to smoking 15 cigarettes a day.

As the UK and most other countries went into lockdown, the need to save lives from the coronavirus rightly took priority over longer term health issues.

But experts writing in The BMJ today warn that "if we don't prepare for emerging from the pandemic, we will see the toll of increased alcohol harm for a generation."

In the week to 21 March, alcohol sales were up 67% as many people reacted to the closure of pubs and restaurants by stocking up to drink at home in isolation, write Sir Ian Gilmore, Chair of Alcohol Health Alliance UK, and Baroness Ilora Finlay, Chair of the Commission on Alcohol Harms. In comparison, overall supermarket sales only increased by 43%.

Just before the pandemic hit the UK, the Alcohol Health Alliance UK started a Commission on Alcohol Harm, aimed at highlighting the damage to individuals, families and communities.

The evidence so far suggests that those already struggling with alcohol dependence and those on the brink of dependence will be in particular need of urgent support.

Gilmore and Finlay also point out that alcohol is strongly associated with domestic violence and an early feature in lockdown was a rise in calls to domestic violence charities.

While the relationship between alcohol and domestic violence is complex they say, research finds that as many as 73% of perpetrators of domestic abuse have been drinking at the time of the assault.

"As in so many aspects of the coronavirus epidemic, it will be only in hindsight that we will be able to measure the impact of social isolation, job losses, and financial meltdown on the alcohol balance sheet," they say. Yet even at the best of times, alcohol costs the NHS in excess of £3.5bn (€4bn; $4.2bn) and the wider economy at least £21bn each year.

The report will come out later this year and will call for evidence-based population-level action on key drivers of harm, such as price, availability, and marketing, and for the implementation of innovative and cost-effective sobriety schemes to reduce alcohol fueled crime.

But Gilmore and Finlay fear that these calls will struggle to be heard amidst the avalanche of issues to be addressed once the pandemic is waning.

They predict a further rise in alcoholic liver disease, already increasing before the covid-19 crisis, and a similar surge in the need for alcohol treatment services, which are traditionally an easy target for cuts when finances are tight.

"We cannot claim to be a nation recovering from covid-19 if we do not adequately support the most vulnerable among us," they argue.

"We know that investing £1 in alcohol treatment services will save £3, as well as directly helping affected individuals, often the most vulnerable in society. This time, let's be ready. Tackling alcohol harms is an integral part of the nation's recovery."

A new Tel Aviv University-led study published on May 20 in Nature offers new evidence that the complexity of contemporary analytical methods in science contributes to the variability of research outcomes.

Previous studies in the fields of psychology, cancer biology and behavioral economics revealed many failures in the attempt to reproduce methodologies and mirror results. The TAU researchers used an approach known as "Many Analysts," in which many researchers analyzed the same dataset to test variability in the analysis outcomes, explains study co-lead author Dr. Tom Schonberg of the Department of Neurobiology at TAU's George S. Wise Faculty of Life Sciences and TAU's Sagol School of Neuroscience.

"The variability in outcomes demonstrated in this study is an inherent part of the complex process of obtaining scientific results, and we must understand it in order to know how to tackle it," he adds. "Science is conducted by humans, and there is no way to escape variability. But we must acknowledge this in order to self-correct and attain the most reliable answers."

The Neuroimaging Analysis, Replication and Prediction Study (NARPS) was also led by Dr. Schonberg's former PhD student Dr. Rotem Botvinik-Nezer, today a post-doctoral researcher at Dartmouth College, together with co-investigators Prof. Russel Poldrack of Stanford University and Prof. Thomas Nichols of Oxford University.

Overall, 180 researchers from 70 teams of scientists around the world analyzed the same brain imaging dataset of 108 subjects. These subjects participated in a task that tested their decision-making regarding gambles of potential gains and losses. Each group chose a distinct analysis method, and the different methods led to different conclusions.

"Science is being often criticized," adds Dr. Schonberg. "But it is not a belief like a religion, as some have argued. It has rules and a method -- the scientific method. We are constantly trying to improve this method in a process of constant self-questioning. We believe our study takes this process forward."

The research teams were presented with the same data -- fMRI scans of subjects performing a value-based decision-making task -- and told to test the same nine different set hypotheses.

The large neuroimaging dataset had been collected over the course of a year at the Alfredo Federico Strauss Center for Computational Neuroimaging at TAU by Roni Iwanir, a former Sagol School MSc student from Schonberg's lab. While the study participants engaged in the monetary decision-making task, fMRI scans were used to test whether the activity of specific brain regions involved in value processing changed in relation to the amount of money won or lost on a gamble. Some 70 international teams independently analyzed these datasets over the course of three months.

"The processing you have to go through from raw data to a result with fMRI is really complicated," adds Prof. Poldrack. "There are a lot of choices you have to make at each place in the analysis workflow."

Each team of researchers arrived at their own final conclusions regarding the data, with results varying significantly across the teams in five out of nine hypotheses.

"Our new study demonstrated high analytical flexibility as occurs 'in the wild'," says Dr. Schonberg. "The participating researchers modeled the hypotheses differently and used different software for the analysis. They also used different techniques and definitions in different aspects of the analysis."

Another part of the study involved experts from the field as well as researchers from the analysis teams trading with other researchers in what are called "prediction markets" on what they thought would be the outcomes of the research. This part of the study was run by economists and behavioral finance experts, who provided the initial idea for the the study, and revealed marked over-optimism about the ability to replicate previous findings, even by researchers who analyzed the data themselves.

"While the final reported outcomes varied substantially, earlier stage analysis results actually showed a consensus among most research teams," says Dr. Schonberg. "This is very encouraging and was in fact a somewhat surprising result. Despite the large variability in final reported results, the underlying analysis was similar, meaning we need to find methods to express this convergence.

"For example, the study suggests that researchers could perform and report multiple analyses with the same data, to find the results to which different reliable methods converge."

Dr. Schonberg believes the findings can help scientists advance their methodology and improve the quality of their analyses in the future.

"I would want our findings to be used to take science forward -- toward an even further sharing of all study related information, of transparency of methods, analysis codes and data," says Dr. Schonberg. That is the only way everyone can test and "play" with results to see what holds. We have seen the importance and great need in sharing data in the recent COVID-19 pandemic in order to understand the optimal course of action.

"Naturally, the novelty of discoveries matters a great deal to scientists. But just as important is the rigor of our methodology," concludes Dr. Schonberg. "Our study reflects the ambition of a vast community of scientists to spend thousands of hours to improve our methodologies in order to get the conclusions right and to reach reliable results."

Clinician burnout is a growing public health concern, with the National Academy of Sciences reporting that 35-54% of U.S. nurses and physicians exhibit substantial symptoms of burnout. New research led by the College of Health and Human Services at George Mason University found that health care professionals were more than twice as likely to report burnout with higher levels of anxiety and frustration than those who reported lower levels of anxiety and frustration. Additionally, primary care physicians reported burnout at twice the rate of other health care professionals in primary care practices.

Dr. Debora Goldberg, associate professor of health administration and policy, led the new study, published in the Journal of the American Board of Family Medicine, one of the few that have examined anxiety as a component of burnout and the rate of burnout among different professionals in a primary care practice.

"Burnout is a syndrome characterized by high emotional exhaustion, high depersonalization, and a low sense of personal accomplishment from work," explains Goldberg. "It is important to understand how health care professionals respond to these changes and if certain groups are more likely to experience burnout and why. This is critical due to the tremendous amount of change taking place in the health care industry, projected physician and nurse shortages, and most recently the extraordinary responsibilities placed on them during the COVID-19 pandemic."

The research team surveyed 1,273 healthcare professionals from 154 primary care practices in Virginia. They used the Change Diagnostic Index© (CDI) to assess the participants' feelings, emotions, and attitudes following organizational and technological change.

They found that rates of burnout varied by profession in primary care practices. Physicians reported the highest rates of burnout at 31.6%, nearly twice the rate of other staff in these practices: 17.2% of advanced practice clinicians, 18.9% of clinical support staff, and 17.5% of administrative staff.

Physicians who experienced increasing anxiety and withdrawal were more than three times as likely to report burnout compared to those who did not experience high levels of these domains. Anxiety was high across health care professionals and anxiety significantly raised the odds of burnout across health care professionals.

"This is not just a physician problem," explains Goldberg. "These findings tell us that we need to prioritize understanding and addressing clinician burnout at a system level and at a local level. The human cost as well as significant physician shortages expected in the future make this a critical public health concern."

The researchers suggest that a better understanding of how health care professionals respond to change and burnout can help guide programs and services to support individuals experiencing burnout and build strong work environments to prevent burnout among healthcare professionals in the future.

Shortly after the explosion in microcephaly cases caused by Zika virus in Brazil in 2015-16, several scientific studies were published with evidence that the pathogen is capable of crossing the human placenta, the organ that keeps the fetus connected to the mother's body during pregnancy. From then on, the states began following a protocol established by the National Ministry of Health requiring collection of placental samples to help diagnose the disease in women with symptoms during pregnancy.

However, according to a group of Brazilian researchers at the University of Campinas (UNICAMP) who have studied emerging viruses with São Paulo Research Foundation - FAPESP's support, the official protocol in place nationwide should be reformulated. As they recently reported in Frontiers in Microbiology, it is crucial to ensure that samples are representative and properly stored and transported to obtain trustworthy results in detecting the virus in the placenta.

The report concludes that Zika virus can indeed infect different regions of the placenta in pregnant women, such as the umbilical cord, amniotic membrane, chorionic plate, chorionic villi and basal plate.

This discovery suggests that diagnostic tests should take several placental regions into consideration to assure adequate representativeness and more accurate results. "The protocol currently in force says each sample should be 1 cubic centimeter in size but doesn't specify the placental regions to be analyzed," said molecular biologist José Luiz Proença Módena, who heads the Emerging Virus Research Laboratory (LEVE) at UNICAMP's Institute of Biology and is one of the authors of the report.

The study analyzed 17 placental samples from women who gave birth at the Women's Hospital (CAISM) run by UNICAMP. Fourteen tested positive for Zika virus using a real-time PCR kit developed by the researchers. The PCR method detects RNA from the virus in the samples tested.

"We collected four fragments from all placental regions for each patient, including the umbilical cord," Módena said. The women had symptoms of the disease during pregnancy, such as fever and rash, or delivered babies with microcephaly in 2016 or 2017. According to Módena, the collection of several placental fragments increases the chances of detecting Zika because some regions of the placenta contain more viruses than others.

The researchers were surprised to find that placental samples from the same patients tested negative when analyzed using the health ministry's protocol by the Adolfo Lutz Institute (IAL), the main reference laboratory for epidemiological surveillance in the state of São Paulo. "This problem highlights the urgency of changing the currently required method," Módena said.

In response to inquiries by Agência FAPESP, IAL's press office stated that placental samples continue to be tested in compliance with the official protocol, and there are no plans to change this procedure at the moment. For Módena, the urgent need to increase laboratory testing to detect the novel coronavirus SARS-CoV-2 will hinder efforts to change the protocol in the short run.

"The coronavirus pandemic will probably delay moves to reformulate the diagnostic test to detect Zika virus in placenta," he said. Módena has had to interrupt his normal research activities to join the efforts of the task force set up by UNICAMP to halt the spread of COVID-19 (read more at: agencia.fapesp.br/32998/).

Talks about adjustments to the placental test protocol with the Ministry of Health began at the end of 2019 but have also had to be suspended, he said.

For Maria Laura Costa do Nascimento, a professor in UNICAMP's School of Medical Sciences and a coauthor of the Frontiers in Microbiology article, while many research projects have been redirected in response to the emergency posed by the pandemic, a systematic protocol must be established as soon as possible to ensure that placental samples are collected in the appropriate manner. Evidence that SARS-CoV-2 can be transmitted from mother to fetus has not yet been found, but reliable studies of its behavior in the placenta are few and far between, she said.

The UNICAMP group planned to use the knowledge acquired from their research on Zika virus to study viral load in placental samples from women infected by SARS-CoV-2 during pregnancy.

"The placenta is a very important organ for diagnosing several diseases, including Zika," Nascimento said. "About 70% of those infected are symptomatic or exhibit mild symptoms, so that they take longer to go to a doctor." The probability of a positive test result after the acute stage of infection is negligible, she added. The virus can be detected for up to five days in blood and eight days in urine, counting from the date of infection. In the placenta, however, traces of the virus can be detected months after the start of infection.

According to the Ministry of Health, 2,054 cases of Zika were reported in Brazil in the first three months of this year.

The researchers acknowledge that changing the protocol is no easy task. Collecting a larger number of samples from specific placental regions will make testing more expensive, for example.

"It's one thing to extract a placental fragment at random and store it in a freezer at -20 °C, as the protocol requires now. Collecting four or five specific fragments and storing them at -80 °C is quite another," Módena said.

According to Nascimento, the challenge will be guaranteeing that Brazil's maternity hospitals have the requisite technical staff trained to perform a more complex procedure and the equipment to store samples properly until they arrive at the reference laboratory responsible for diagnostic testing.

"It's complicated to work with samples collected during or just after childbirth, especially when the procedure hasn't been scheduled in advance and is performed by rosters of hospital duty personnel," Nascimento said. "These professionals would have to be trained to collect specific placental fragments, ensuring sample quality and representativeness, as soon as possible after the baby is delivered."

As is the case with most fatal diseases, coronavirus disease (COVID-19) is already taking a disproportionate toll on black Americans and other disadvantaged minorities. As of April 14 in the United States, 32 percent of deaths from COVID-19 occurred among black Americans who comprise of only 13 percent of the population. These numbers indicate that they have a 2.3-fold excess risk of dying from COVID-19 compared to white Americans.

Researchers from Florida Atlantic University's Schmidt College of Medicine and collaborators from Baylor College of Medicine and the University of Wisconsin School of Medicine and Public Health provide ominous forebodings in a commentary just published in The American Journal of Medicine, aptly quoting the philosopher George Santayana, who in 1905 said, "Those who cannot remember the past are condemned to repeat it."

Charles H. Hennekens, M.D., Dr.PH, senior author, the first Sir Richard Doll professor and senior academic advisor in FAU's Schmidt College of Medicine, and co-authors, emphasize that most major clinical and public health challenges of COVID-19 will be long term and will inevitably result from the development of lifesaving drugs in treatment as well as a vaccine that will be preventive. The authors document that the introduction of such lifesaving innovation will only markedly increase the already existing racial inequalities, if public health initiatives for equitable dissemination throughout all communities are not immediately developed.

In the commentary, the authors document increases in racial inequalities following lifesaving drugs for HIV, respiratory distress syndrome, and hepatitis C as well as the experiences before and after the development of the Salk vaccine for polio. Before the introduction of the vaccine in 1952, initially, black Americans experienced significantly lower rates of paralytic polio than white Americans. By 1959, after the widespread dissemination of the Salk polio vaccine, the reverse was true.

"We must certainly try to overcome all of the barriers facing black Americans and other minorities in the United States but, realistically this is a long-term goal," said Hennekens. "Now is the time to address short-term clinical and public health challenges to ensure equal access to any lifesaving innovation."

The authors also highlight that mistrust is one of the major factors influencing inequalities. Even today many black Americans, particularly older black men, mistrust the efforts of the U.S. Public Health Service due to the lingering perceptions derived from the late disclosure of their study results of syphilis at Tuskegee, which withheld treatment from black men in favor of depicting the natural course of the disease.

"As a black physician committed to addressing racial inequalities in morbidity and mortality, if we do not act now, then those in greatest need will once again be condemned to even greater racial inequalities," said Heather M. Johnson, M.D., FACC, co-author and a preventive cardiologist/cardiologist at the Lynn Women's Health and Wellness Institute at Boca Raton Regional Hospital/Baptist Health South Florida.

The urgency of the issues raised by the authors are only enhanced by the recent public pronouncements concerning remdesivir as a promising but unproven treatment for COVID-19 as well as very recent encouraging news about an accelerated timetable for the development of an effective and safe vaccine.

"Death is inevitable but premature death is not. Unfortunately, black Americans and other disadvantaged minorities have unacceptably high mortality rates from COVID-19 and most other chronic diseases that confer their markedly reduced life expectancies," said Hennekens.

Hennekens, Johnson and co-authors Robert S. Levine, M.D., first author and professor of family and community medicine at Baylor College of Medicine and an affiliate professor in FAU's Schmidt College of Medicine; and Dennis G. Maki, M.D., professor emeritus in the Department of Medicine at the University of Wisconsin, where Johnson is an adjunct associate professor, conclude that, at present, individual behavior change is an important and necessary strategy. However, they also state that major societal changes amenable to responsible government but beyond individual control, also are needed to combat current and increasing future racial inequalities in mortality from COVID-19.

Hennekens and Maki have been collaborators since 1969, when they served as lieutenant commanders in the U.S. Public Health Service as epidemic intelligence service officers with the U.S. Centers for Disease Control and Prevention. Hennekens and Levine have collaborated since 1976, including on racial inequalities for more than 20 years.

Coincidentally, Hennekens has been listed by Science Heroes as No. 81 in the history of the world for having saved more than 1.1 million lives and Salk is listed as No. 83.

Results from a study led by investigators at Massachusetts General Hospital may help to improve the diagnosis and treatment of allergies, pointing to a potential marker of these conditions and a new therapeutic strategy. The research is published in Nature.

Nearly one third of the world's population suffers from allergies. These conditions are caused by certain antibodies--called IgE antibodies--that bind to allergens such as peanuts and trigger a reaction that releases an array of molecules that cause allergic symptoms, and in extreme cases, potentially life-threatening anaphylaxis.

Scientists have been perplexed by the fact that many individuals have circulating allergen-specific IgE antibodies without ever developing allergy symptoms. For example, about half of the people who have peanut-specific IgE antibodies (or test positive to a peanut skin prick test) do not have peanut allergies. In addition, some allergic individuals outgrow their symptoms yet still retain detectable levels of circulating allergen-specific IgE.

To look into these mysteries, Robert Anthony, PhD, of the Center for Immunology and Inflammatory Diseases, and his colleagues compared IgE from individuals with peanut allergies with IgE from individuals without any allergies. The analyses revealed an increase in a particular sugar residue called sialic acid on IgE from peanut allergic individuals.

The researchers also found that adding sialic acid to IgE enhanced allergic reactions triggered by IgE in animal models, while removing sialic acid from IgE dampened these reactions and reduced anaphylaxis.

"Our results indicate that quantifying sialic acid on IgE may serve as a marker for more accurate diagnoses of allergic disease, and that removal of sialic acid from IgE is a novel strategy for treating affected patients," said Dr. Anthony.

Additional research on the mechanisms behind sialic acid's effects on IgE activity could provide additional insights into allergies and their causes. The team is currently planning studies to determine how removing sialic acid from IgE attenuates allergy, and develop strategies to exploit this therapeutically.

The automatic operation and maintenance of optical network is important for ensuring information communication and network operation. The growing variety of services has forced operation and maintenance personnel to face tremendous operational pressure. A recent study has constructed a control architecture called intent defined optical networks (IDON) to cope with the issue.

The research related paper "Intent Defined Optical Network with Artificial Intelligence-based Automated Operation and Maintenance" is recently published in a special focus on artificial intelligence for optical communications in SCIENCE CHINA Information Sciences. The paper is achieved by Hui Yang as the corresponding author and associate professor of Beijing University of Posts and Telecommunications. Researchers have adopted a self-adapted generation and optimization policy (SAGO) to perform control research on intent defined optical network architectures, revealing two key closed-loop operations, namely closed-loop strategies generation and closed-loop intent guarantee.

Traditionally, the operation and maintenance of optical networks rely on the experience of engineers to configure network parameters, including command line interfaces, middleware scripts, and troubleshooting. With the rapid development of Internet of Things and high bitrate applications beyond 5G and 6G, a large number of applications are presented on the network in the form of intentions, such as the Internet of Vehicles which closely interact with the environment. As an important support of the policy of "network power", the optical network faces the challenges of accurate match of the intent application and the complex control of highly dynamic applications, resulting in unsatisfactory levels of manual operation and maintenance. In such case, operators urgently need to consider the upgrade of their optical network architecture to achieve automatic intelligent operation and maintenance.

Research of intent defined optical network (IDON) introduces an adaptive generation and optimization (SAGO) strategy in a self-optimizing way. The IDON architecture can achieve intent-oriented configuration conversion, realize adaptive generation and optimization strategies, and perform closed-loop intent-guaranteed operations. IDON specifically addresses communication intent and uses natural language processing to construct semantic graphs to understand, interact, and operate the required network configuration. Then, deep reinforcement learning (DRL) is utilized to dynamically integrate fine-grained strategies to find a synthesis strategy which meets the requirements of the intent. Finally, a deep neural evolution network (DNEN) was introduced to respond to failures to achieve intent guarantee at the millisecond level. The researchers have validated feasibility and efficiency on an enhanced SDN test platform

The research result has enriched the research on intelligent operation and automation of optical networks based on artificial intelligence. IDON with SAGO is not only of great significance to the research of operation automation of optical networks, but also has very important scientific significance and reference value for the application of zero-touch operation and artificial intelligence in networks.

"To the best of our knowledge," the researchers wrote, "We have investigated and presented the functional entities of the architecture and interworking procedure in optical network automatic operation. The performances are demonstrated on the testbed for intent-based control. Our experiments verify that IDON with SAGO can effectively perform the intent translation and zero-touch configuration."

Oxidation of primary alcohols to carboxylic acids is of importance in both organic chemistry and chemical industry because the oxidation products can be used to prepare various pharmaceuticals and useful chemicals. Photocatalytic oxidation process has been considered as a sustainable technology to achieve the selective oxidation under ambient conditions with irradiation from solar light. To develop superior photocatalysts with a broad-range of light absorption and efficient electron-hole separation, surface modification with metal nanoparticles such as Au and Pt allow for the fast transfer of photoexcited electrons to the surface active sites. Therefore, bimetallic Au and Pt catalysts would be desirable by combining the advantages of both surface plasmonic resonance effect on Au and activation effect on Pt to further enhance the efficiency for catalytic oxidation under visible light irradiation.

Hollow structured materials have shown great potential in a variety of applications, including catalysis, drug release and delivery, and energy storage and conversion. High specific surface area and discrete voids afford abundant accessible surface sites and immobilization of reactive centers for catalytic reactions. More reactant molecules can be adsorbed and enriched within the hollow structure to accelerate reactions. However, it remains challenge to develop a facile and mild synthetic method to simultaneously create efficient hollow photocatalytic nanoreactor with ordered porous channels on the shell, well-controlled metal location, broad-spectrum utilization and well-controlled mass transfer and diffusion.

In a new research article published in the Beijing-based National Science Review, scientists at Dalian Institute of Chemical Physics, Chinese Academy of Sciences, University of Surrey,University of Technology Sydney and The University of Sydney demonstrated a facile synthesis of hollow-structured photocatalysts with controllable spatial location of active metals, chemical compositions and tunable shell thickness. Hollow structures can be achieved through coating SiO2 on the surface of ZIF-8 and a subsequent hydrothermal treatment. The formation mechanism of hollow structure is systematically investigated and a "adhesive-contraction" model is proposed. AuPt@HMZS nanoreactors exhibited broader absorbance region under visible light and excellent catalytic activity in cinnamyl alcohol oxidation to cinnamic acid with 99% selectivity.

AuPt@HMZS nanoreactors has the following advantages: i) Broader absorbance region under visible light; ii) Multiple light scattering can be generated within a hollow void to enhance light-harvesting process and heat generated by the photo-thermal effect is collected; iii) The uniform channels are excellent to facilitate the reactant diffusion and mass transfer; iv) A synergetic effect among plasmonic hot electron injection and electron trapping improves solar energy utilization and electron-hole separation of photocatalysts; v) The strong metal-metal interactions at the alloy interface tune the reaction performance. "The proposed strategy to build hollow structures as multifunctional micro/nanoreactors is promising for the design of high-performance and sustainable catalysts for chemical synthesis." Prof. Jian Liu said. "It is an amazing technology for construction of micro/nanoreactors with precise spatial location of active sites" Prof. Jun Huang added.