Culture

Philadelphia, May 1, 2020-- Children in rural communities are 1.7 times more likely to undergo an amputation after a lawnmower injury than children in urban communities, according to a new study by researchers at Children's Hospital of Philadelphia (CHOP). The researchers also found that although lawnmower injuries are prevalent throughout the United States, children in Southern and Midwestern states account for more than 80% of pediatric lawnmower injuries.

The findings were published in the May issue of the Journal of the American Academy of Orthopaedic Surgeons.

"Lawnmower injuries affect thousands of children each year across the country," said Theodore J. Ganley, MD, an orthopaedic surgeon in CHOP's Pediatric Trauma Program and senior author of the study. "It is important for parents to understand that riding on or being near a lawnmower can have devastating consequences for children. These traumatic injuries have a huge impact on children, their families, and future generations."

Approximately 9,400 pediatric lawnmower injuries occur each year, with a hospitalization rate two times higher than any other consumer product-related injury. The injuries often require lengthy inpatient stays and multiple surgeries due to their severity and involvement of bone and soft tissues. These injuries also carry a high economic burden, costing the healthcare system about $90 million a year.

To assess the geographic distribution of these incidents, the research team used the Pediatric Health Information System, a unique, pediatric-specific database containing information from 49 not-for-profit hospitals across the United States. They analyzed data from children aged 0 to 18 between 2005 and 2017 and identified 1,302 patients who presented to a hospital with a lawnmower injury.

Of those patients, more than half were between the ages of 1 and 5. In rural areas, more than 60% of lawnmower injuries occurred in this youngest group, versus 43.7% in urban areas. The incidence, severity, and complications of lawnmower injuries were all greater in rural communities than in urban ones, with children in rural communities more likely to require an inpatient stay and 1.7 more likely to require an amputation.

The researchers also looked at injuries by geographic region and found that a combined 81.9% of all injuries occurred in the South and Midwest. The team attributes the high incidence in these regions to the warmer weather in the South, leading to more time spent mowing lawns, and the higher prevalence of ride-on mowers in the Midwest due to larger land areas.

Although many lawnmowers come with safety features, such as ride-on lawnmowers whose blades do not operate when the mower is reversing, the authors note many of these features can be overridden by operators.

"The safety features built into the lawnmower design can be improved by further scientific research, exploring risk stratification and design guidelines," Ganley said. "Regardless of the design, however, young children should be kept away from lawnmowers of any type, as the consequences of a lawnmower injury can be devastating and life-altering."

New Orleans, LA - A study conducted by a team of researchers at LSU Health New Orleans has shown for the first time that chronic exposure to inhaled nicotine alone increases blood pressure (hypertension), in both the body's general circulation and in the lungs that can lead to pulmonary hypertension. The study also found that nicotine-induced pulmonary hypertension is accompanied by changes in the size, shape and function (remodeling) of the blood vessels in the lung and the right lower chamber of the heart. Results are published in the May 2020 issue of Hypertension, available here.

Although cigarette smoking is the single most important risk factor for developing cardiovascular and lung diseases, the role of nicotine in the development of disease has not been well understood. The researchers used a novel nicotine inhalation model in mice that closely mimics human smokers/e-cigarette users to examine the effects of chronic nicotine inhalation on the development of cardiovascular and pulmonary disease with a focus on blood pressure and cardiac remodeling.

The researchers documented that nicotine inhalation increased systemic systolic and diastolic blood pressure as early as the first week of exposure.

"The increase was transient, but was sufficiently long to pose potential health risks in individuals with preexisting cardiopulmonary conditions," notes Eric Lazartigues, PhD, Professor of Pharmacology at LSU Health New Orleans School of Medicine.

Pulmonary hypertension is also often associated with remodeling of the blood vessels of the lung. The study findings suggest that chronic nicotine inhalation leads to muscularization of previously non-muscular pulmonary arterioles (small branches of arteries leading to capillaries) consistent with increased right ventricular systolic pressure and pulmonary vascular resistance.

Right ventricle failure is a major cause of death in pulmonary hypertension. The researchers found an eight-week exposure to nicotine resulted in significantly higher right ventricular systolic pressure, as well as thickening of the walls and enlargement of the right ventricle.

"Interestingly, the adverse effects of inhaled nicotine are largely isolated to the right heart, as we found no significant changes in left heart remodeling or protein expression," adds Xinping Yue, MD, PhD, Assistant Professor of Physiology at LSU Health New Orleans School of Medicine.

According to the Centers for Disease Control and Prevention, tobacco use is the leading cause of preventable disease, disability, and death in the United States. Based on 2018 data, about 34 million US adults smoke cigarettes. Every day, about 2,000 young people under age 18 years smoke their first cigarette, and more than 300 begin smoking cigarettes daily. Over 16 million people live with at least one disease caused by smoking, and 58 million nonsmoking Americans are exposed to secondhand smoke. In 2017, 25.2% of Louisiana high school youth reported currently using any tobacco product, including e-cigarettes. Among Louisiana high school youth, 12.3% reported currently smoking cigarettes.

"There is a frightening trend of increasing usage of e-cig and vape products in youths and young adults," says Jason Gardner, PhD, Associate Professor of Physiology at LSU Health New Orleans School of Medicine. "Recent high-profile cases of hospitalization and death following e-cig usage necessitate a greater understanding regarding the health impact of inhaled nicotine delivery systems. The current study clearly demonstrates the adverse effects of nicotine on both systemic and pulmonary blood pressure and cardiac remodeling. This study should help raise the awareness of the adverse effects of nicotine inhalation on the cardiopulmonary system and help formulate public health policies on e-cigarettes."

Native bees that boost food crops are in decline but changing fire management policies could help them.

Most flowering plant farms employ honeybees, a non-native species originally imported from Europe and managed by beekeepers. However, research shows that farms surrounded by natural bee habitat have higher crop yields.

UC Riverside entomologist Lauren Ponisio explains that native bees are increasingly important to food growers. They pollinate crops on the fringes of a farm and could potentially also be used for agricultural purposes.

"The non-native honeybees currently used for crops are having problems, and we're in trouble if native bees can't replace or supplement them on our farms," Ponisio said. "Relying on one species of bee to pollinate all our crops is unsustainable."

Ponisio led a study to be published this month in the journal Ecology and Evolution that examined environmental factors affecting the health of native bees. There are thousands of bee species that live in the wild, many of which are found in California.

Ponisio found that these native bees are better able to survive harsh climate events, like drought, in areas where naturally occurring fires are allowed to burn.

Small fires consume dry brush that would otherwise fuel megafires, like 2018's deadly Camp Fire, which occur with increasing frequency in California. In addition to eliminating fuel for megafires, smaller mixed-severity burns also trigger positive changes in the environment. They remove unhealthy and dead trees, allow sunlight to reach a forest floor, and create a better environment for native plants and their pollinators to thrive.

To compare bees from areas where fires are allowed to burn with bees from areas where they aren't, Ponisio and her team headed to Yosemite National Park. Near park buildings and tourist hotspots, fires are fought immediately. In other areas of the park, like the Illilouette Basin, fires are allowed to burn naturally as they have for centuries.

The team sampled bees in 2013 and 2014, a two-year period of severe drought in California. In 2014, there was no summer rainfall, there was little snowpack in the Sierra Nevada mountains, and flowers were not blooming.

A majority of the 164 bee and 71 flowering plant species Ponisio sampled during the study period declined. However, where natural fires had created a diversity of habitats, bees were able to find alternative flower species to visit, and therefore their populations did not decline as much as when the same species were in areas without a diversity of natural fires. There was only a single species of bee that not only survived but increased as a result of the drought -- the European honeybee.

"The honeybee is a hyper generalist," said Ponisio. "There's not a plant they won't try out, which is why they're great for agriculture, and are so successful when they invade wild ecosystems."

Boosting native plants would provide ample food resources both for native and the non-native European honeybees that spread into wild environments. This way, all of them could feed and not compete for pollen resources. One of the best and most immediate ways to encourage this scenario would be to reconsider fire management policies.

"Smokey the Bear was wrong," Ponisio said. "We actually don't need to prevent forest fires when they are not endangering people."

Trauma patients are at risk of developing multiple infections while in the hospital, but it's difficult to identify those who are especially susceptible. Now a team at Massachusetts General Hospital (MGH) has found that certain scores already used to assess the severity of a trauma patient's condition can provide clues. The findings are published in PLOS ONE.

In the researchers' analysis of information on 1,665 trauma patients, five of such "disease-severity" scores--called the Denver score, the Marshall score, the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, the Injury Severity Score (ISS), and the New Injury Severity Score (NISS)--were examined as predictors of susceptibility to multiple independent infectious episodes. These scores differ in the way they assess a patient's condition by measuring physiologic responses or injury patterns.

The investigators found that the Denver and Marshall scores, which are used to assess the severity of organ failure in the setting of traumatic injury, can accurately predict susceptibility to multiple independent infections after trauma, even when the scores are determined much earlier than any clinical sign of infection.

"Our findings could potentially facilitate clinical decision-making by identifying patients who are at higher risk of suffering multiple infections during their hospital stay," said senior author Laurence G. Rahme, PhD, Director of the MGH Molecular Surgical Laboratory, Professor of Surgery and Microbiology at Harvard Medical School, and senior scientific staff at Shriners Hospital for Children.

"Early prognosis, before infections occur, could strategically guide the timing and duration of antibiotic administration to these patients," says Rahme, who is also an MGH Research Scholar 2020-2025. "It would also allow physicians to implement prophylactic measures, enhance patient nutrition, and formulate potent personalized treatment plans for this group of patients, thus protecting those at higher risk of repeated infections during their recovery period."

Dr. Rahme added that such personalized treatment plans could be cost-saving because they would limit interventions to only those patients most likely to develop infections, and they would help clinicians prevent hospital-acquired infections that can lead to prolonged hospital stays and the need for additional care.

Certain genetic changes, termed "pathogenic variants," substantially increase risk for cardiovascular disease and cancer--the leading causes of death--but testing to identify individual carriers is not part of current clinical practice.

Now a team led by investigators at Massachusetts General Hospital (MGH) determined that nearly 1% of the population carry such pathogenic variants. These individuals were at markedly increased risk and could not be reliably identified based on family history.

As reported in JAMA Network Open, the researchers studied 49,738 middle-aged adults in the UK Biobank, which recruited individuals across the United Kingdom. The study focused on three genetic conditions wherein, according to the U.S. Centers for Disease Control and Prevention, identifying individuals carrying pathogenic variants can be particularly useful: familial hypercholesterolemia, which predisposes to cardiovascular disease; hereditary breast and ovarian cancer; and Lynch syndrome, which predisposes to colorectal and uterine cancers.

Working with geneticists at Partners HealthCare Personalized Medicine, the scientists determined that 441 (0.9%) of the UK Biobank participants carried a pathogenic variant, including 0.3% for familial hypercholesterolemia, 0.5% for hereditary breast and ovarian cancer, and 0.2% for Lynch syndrome.

"We wondered how outcomes were affected for pathogenic variant carriers within the context of contemporary care," said lead author Aniruddh Patel, MD, a cardiology fellow at MGH and Harvard Medical School.

For all three conditions, risk of associated diseases was substantially higher: 21% for familial hypercholesterolemia variant carriers vs. 9% of noncarriers, 28% of hereditary breast and ovarian variant carriers of variants vs. 8% of noncarriers, and 22% of Lynch syndrome variant carriers vs. 2% of noncarriers.

"What was really striking was that simply taking a family history--as I currently do in my clinical practice--would have failed to identify most of the high-risk individuals," said senior author Amit V. Khera, MD, a medical director of the MGH Preventive Genomics Clinic and leader of a research group at MGH and the Broad Institute of MIT and Harvard.

Across the three conditions, only 40% of individuals who carried a pathogenic variant noted that a parent or sibling had been affected by the associated disease. "What's more is that the information was complementary--those who had both a family history and a pathogenic variant were at the highest risk," Khera said.

"Genetic testing is currently used predominantly in those already affected by disease, but these data really speak to the potential of doing it in much broader populations," Dr. Patel said. The cost of testing has decreased dramatically, and is now about $200.

If identified, risk can be reduced by interventions such as cholesterol-lowering medications, earlier screening with mammograms or colonoscopy, or surgical procedures such as a mastectomy and ovary removal.

As next steps, the researchers are performing genetic testing via an NIH research study on thousands of MGH patients who volunteered for the Partners HealthCare Biobank, aiming to identify the 1% of patients who harbor pathogenic variants and offer to work with patients and their health care teams to prevent disease before it starts.

After a sharp drop in out-of-pocket costs between 2010 and 2011, Medicare patients who use specialty biologic medications for rheumatoid arthritis have seen higher out-of-pocket spending for those same drugs because of gradual price increases, a new study in the Journal of the American Medical Association Open finds.

Led by Vanderbilt University School of Medicine student Alexandra Erath, BA, and Stacie B. Dusetzina, PhD, Ingram Associate Professor of Cancer Research in the Department of Health Policy at Vanderbilt University School of Medicine, the study finds that patients filling 12 months of biologic treatment under their Medicare Part D plans would have had their out-of-pocket costs drop by more than 34% between 2010 and 2011. However, between 2010 and 2019, that price reduction was only 21%.

On average, in 2010 -- before the Part D coverage gap or donut hole was closed -- the annual out-of-pocket spending for a patient on these drugs was $5,858. In 2019, the annual average out-of-pocket cost was $4,801.

"Although closing the donut hole was expected to greatly reduce out-of-pocket costs, we found that about a third of that savings has already been lost due to yearly increases in list prices," says Erath. "Going forward, seniors can expect higher annual cost increases since the donut hole is already closed."

For drugs that entered the market between 2011-2015, four of the five had higher out-of-pocket costs in 2019 than the year they entered the market. Rheumatoid arthritis (RA) patients often face high out-of-pocket expenses due to treatment with expensive specialty biologics. While it does not typically shorten life expectancy, RA often requires consistent biologic therapy to remain controlled, meaning patients can face high out-of-pocket costs for decades or longer.

"There are bills in Congress that would address both the increasing prices of biologics and that would help to lower out-of-pocket costs for Medicare beneficiaries who need these drugs," said Dusetzina. "We need real reforms that lower drug prices and out-of-pocket costs."

The researchers recommend policy makers consider capping out-of-pocket spending on Medicare Part D or limiting price increases to better manage the financial burden of these medications. Legislation has been introduced in both the U.S. House and Senate that include such changes to the Medicare Part D program.

"Closing the donut hole was an important step toward ensuring seniors had affordable and predictable drug expenses, but patients taking expensive specialty drugs still face significant cost exposure," says Erath. "An annual out-of-pocket maximum or a limit on yearly cost increases would help to ensure the ongoing affordability of crucial RA treatments."

Scientists have identified a key process in the way bacteria protect themselves from attack - and it heralds a new strategy in the hunt for antibiotics.

The researchers from the University of Leeds have pieced together how bacteria build their outer, defensive wall - in essence, the cell's armour plating.

The research has focused on the gram-negative bacteria Escherichia coli, but the process they have discovered is shared by many pathogenic gram-negative bacteria - so it could have importance for tackling other gram-negative pathogens, including the top three on the World Health Organisation's list of priority pathogens.

The findings are published today (01/05) in the journal Nature Communications.

Dr Antonio Calabrese, University Academic Fellow in the Astbury Centre for Structural Molecular Biology, led the research. He said: "Our findings are changing the way we think about the way these cells constantly renew and replenish the proteins that make up the outer membrane.

"Understanding that process of how bacteria build their cell wall in greater detail may identify ways we could intervene and disrupt it.

"In doing so, we can either destroy the bacteria altogether or reduce the rate at which they divide and grow, making bacterial infections less severe.

"We are at the start of a quest that could result in new, drug-based therapies that work either alone or with existing antibiotics to target these disease-causing bacteria."

The research has focused on the role of a protein called SurA. Known as a chaperone, the job of SurA is to martial other proteins from where they are made, at the centre of the cell, to where they are needed, in this case to bolster the bacterium's outer wall.

Proteins are long chains of amino acids that must adopt a defined structural shape in order to function effectively. Without the chaperone SurA, the essential proteins needed to build the cell wall run the risk of losing their structural integrity on their journey to the outer membrane.

Using advanced analytical techniques, the scientists mapped how the chaperone SurA recognises proteins to transport them to the bacterial outer membrane.

Dr Calabrese said: "For the first time we have been able to see the mechanism by which the chaperone, SurA, helps to transport proteins to the bacterial outer membrane. In effect it does this by cradling the proteins, to ensure their safe passage. Without SurA, the delivery pipeline is broken and the wall cannot be built correctly."

Professor Sheena Radford, FRS, Director of the Astbury Centre for Structural Molecular Biology said "This is an exciting discovery in our quest to find weak spots in a bacteria's armoury that we can target to stop bacterial growth in its tracks and build much-needed new antibiotics.

"It's early days, but we now know how SurA works and how it binds its protein clients. The next step will be to develop molecules that interrupt this process, which can be used to destroy pathogenic bacteria."

Dr David Brockwell, Associate Professor in the Astbury Centre for Structural Molecular Biology, said: "It was only through the work of a great team from across the Astbury Centre that we were able to finally understand how SurA shuttles proteins to the bacterial outer membrane."

People with the genetic condition neurofibromatosis type 1 (NF1) are prone to developing tumors on nervous system tissue. A new study from Washington University School of Medicine in St. Louis has found that the development and growth of such tumors are driven by nearby noncancerous neurons and immune cells. The findings point to potential new therapeutic targets for people with NF1.

Children with the genetic condition neurofibromatosis type 1 (NF1) can develop brain and nerve tumors. If a tumor develops within the optic nerve, which connects the eye and the brain, the child may lose his or her vision.

New research at Washington University School of Medicine in St. Louis indicates that the growth of these brain tumors is driven by nearby noncancerous neurons and immune cells, and that targeting immune cells slows tumor growth in mice. The findings, published May 1 in Nature Communications, point to new potential treatments for low-grade brain tumors in people with NF1.

"The fact that nerve cells and immune cells interact to support a tumor is a new way of thinking about how tumors develop and thrive," said senior author David H. Gutmann, MD, PhD, the Donald O. Schnuck Family Professor of Neurology and director of the Washington University Neurofibromatosis Center. "These tumors are arising in the nervous system, but until recently, few people had considered that the nerve cells themselves could be playing a role in tumor development and growth. These findings show that we have to consider nerve cells as participants, if not essential drivers, of cancer development."

NF1 affects about one in every 3,000 people. It is caused by any one of a variety of mutations in the NF1 gene. While people with NF1 usually come to medical attention for birthmarks on their skin, nearly one in five children with NF1 will develop a brain tumor on the optic nerve, called an optic glioma.

To better understand what drives the development and growth of these brain tumors in people with NF1, first author Xiaofan Guo, MD, a graduate student in Gutmann's research laboratory, and colleagues studied mice with NF1 mutations and optic gliomas. The team previously had discovered that the tumor cells in optic gliomas are interspersed with immune cells that help drive tumor formation and growth. But there is also another cell type in the vicinity of the tumor: neurons.

Suspecting that neurons also might be contributing to tumor growth, the researchers examined human neurons with NF1 mutations that had been grown from stem cells. They discovered that the neurons release a protein that activates immune cells known as T cells, which then produce proteins that promote the growth of tumor cells. The findings jibe with data from people with low-grade gliomas. By analyzing two publicly available datasets, the researchers found that patients whose tumors had more of a kind of T cell known as CD8+ T cells had reduced overall survival.

Disrupting the communication between neurons, T cells and tumor cells potentially could slow the growth of tumors, the researchers said. In the new study, they removed T cells from mice with optic gliomas, or prevented T cells from getting into the brains of such mice. In both scenarios, the researchers found that the optic gliomas grew more slowly in the absence of T cells.

"What we have here is a new way of thinking about how neurons and immune cells interact to control tumor growth, adding important new insights to the emerging field of cancer neuroscience," Gutmann said. "We are excited about harnessing these critical interactions to develop new therapeutic strategies for childhood brain tumors."

DNA strand breaks can lead to cell death or to mutations and thus contribute in the long term to cancer development or the ageing process. Fortunately, cells possess molecular tools to repair such DNA strand breaks very efficiently. One of them is the enzyme poly(ADP-ribose) polymerase 1 (PARP1), which detects DNA strand breaks and thereby initiates downstream repair processes.

Scientists at the University of Konstanz (working groups of Professor Aswin Mangerich and Professor Alexander Bürkle, Department of Biology, and working group of Professor Karin Hauser, Department of Chemistry) have now been able to visualize in detail, by means of infrared spectroscopy, the biochemical processes that take place at DNA strand breaks involving PARP1, and could consequently provide important insight into the dynamic changes in the protein structure.

What The Study Did: This observational study examines the association of hydroxychloroquine or hydroxychloroquine and azithromycin with QT prolongation in adult patients hospitalized with coronavirus disease 2019 (COVID-19).

Authors: Howard S. Gold, M.D., of Beth Israel Deaconess Medical Center and Harvard Medical School 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/jamacardio.2020.1834)

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.

What The Study Did: Case series assesses QT intervals for French patients with coronavirus disease 2019 (COVID-19) treated with hydroxychloroquine alone or in combination with azithromycin.

Authors: Martin Cour, M.D., Ph.D., of the Hôpital Edouard Herriot in Lyon, France, 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/jamacardio.2020.1787)

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.

Researchers from City University of Hong Kong, Texas A&M, and University of North Texas published a new paper in the Journal of Marketing that examines the effects of contract ambiguity on interorganizational governance.

The study forthcoming in the Journal of Marketing is titled "Effects of Contract Ambiguity in Interorganizational Governance" and is authored by Xu (Vivian) Zheng, David Griffith, Ling Ge, and Uri Benoliel.

Being sued damages the brand. There was no positive development for 7-Eleven in February 2020 when Mitoshi Matsumoto, who owned a 7-Eleven outlet in Higashiosaka, Japan received international press coverage by filing suit against the chain. Nor was there any joy at Domino's Pizza Australia in January 2020 when Australian fast-food veteran Frederick Aloysius Mario White filed suit against the chain. Franchisors want to minimize litigation in business relationships. A new study in the Journal of Marketing explores which steps can be taken to do that.

While best practice suggests business contracts should be written to be clear so that there are no misunderstandings (which could lead to contract disputes and litigation), franchise contracts often contain ambiguous terms. For example, contracts frequently use terms such as "good faith effort" and "reasonable costs." The fact that a term such as "good faith effort" is open to multiple interpretations might be cause for concern. Zheng says, however, that "Contract terms that are ambiguous in relation to the franchisor's obligations enhance collaboration, minimize franchisee-initiated litigation, and enhance franchisor financial performance."

Specifically, the researchers find that in a franchise setting, where the franchise agreement is written by the franchisor, contract ambiguity of franchisor obligations is used as a strategic tool to enhance joint problem solving and collaboration with franchisees as well as to deter franchisee-initiated litigation. The ultimate outcome for the franchisor is enhanced financial performance of the franchise system. For instance, the study's findings indicate that a one unit decrease in franchisee-initiated litigation leads to a 7% (i.e., $45,285.38) increase in franchisor net income. These findings extend beyond franchise systems because contracts predominate in interorganizational governance, often with similar power differences, where one party is the contract drafter and the other is the contract taker, such as a powerful manufacturer writing contracts offered to less powerful suppliers.

The written contract is only one aspect of interorganizational governance and the researchers point out two other significant aspects that managers should consider. As Griffith explains, "We find that franchisor training programs, when combined with contract ambiguity of franchisor obligations, serve as a buffer against franchisee-initiated litigation. Our results highlight the importance of franchisors not only viewing training programs as vehicles for increased franchisee efficiency, but also viewing investments in these efforts as important mechanisms that can aid in socializing franchisees, thereby facilitating the management of the franchise system." The study recommends that franchisors invest in building strong and expansive training programs that develop shared values with franchisees in order to enhance cohesion. This can be extended to the broader interorganizational governance context. For example, a powerful retailer should use supplier training programs to build esprit de corps and as a context for the clarification of misunderstandings that may arise from the contract, thus facilitating joint problem solving and collaboration.

Second, the study cautions franchisors about the potential negative consequences related to franchisee associations and the importance of carefully managing relations with an association. Consider the case of Denny's. In 1988 Denny's formed the Denny's Franchisee Council as a way for franchisees to communicate with the corporate office. However, in 1997 the Denny's Franchisee Council became independent from corporate sponsorship and reformed as the Denny's Franchisee Association. This may be an example wherein the franchisor-sponsored association stimulated bonding between franchisees (instead of bonding with the franchisor), thus creating a countervailing power to the detriment of the franchisor. Similar suggestions may extend to other network governance situations, cautioning that the increased connectivity and bonding among multiple business partners could work counter to a firm's governance efforts.

What The Study Did: This study delineates the transmission dynamics of coronavirus disease 2019 (COVID-19) and evaluates the transmission risk at different exposure window periods before and after symptom onset.

Authors: Hsien-Ho Lin, M.D., Sc.D., of the National Taiwan University in Taipei, 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.2020.2020)

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

Tokyo, Japan - Researchers at the Institute of Industrial Science, part of The University of Tokyo, and Yokohama City University have introduced novel color-changing organic crystals that spontaneously return to their original shape and hue after being stressed, a property they call superelastochromism. These materials can be used to make sensors for shear forces to monitor locations susceptible to damage.

The ability to visualize forces can be very useful in many industries, particularly heavy manufacturing and shipping. For example, a color-changing material that shows where beams are being stressed would be great for construction companies. However, such devices often work once and have to be replaced after being stretched. Materials that bounce back after being stretched or squeezed, like a rubber ball, are called elastic. But even these objects can suffer a permanent change of shape when stressed too much, in a process called plastic deformation.

Now, a team has introduced a new organic material that changes the color of its emitted fluorescence from green to red under mechanical stress, and bounces right back to its original configuration when this stress is removed.

"We called this property 'superelastochromism' because the color changes are due to completely reversible--that is, elastic--changes to the arrangements of molecules in the material," says first author Toshiki Mutai.

Based on 7-chloro-2-(2?-hydroxyphenyl)imidazo[1,2-a]pyridine (7Cl), the crystals consist of molecules that can exist in two distinct configurations. In both states, a hydrogen atom is covalently bonded to an oxygen atom, and only weakly attracted to a nearby nitrogen atom.

When the material is squeezed or bent, the molecular arrangement switches to the other configuration. This mechanically controlled phase transition alters the wavelengths of light the molecule will emit as fluorescence when excited by an external UV light source. The change is clearly apparent to the unaided eye as a shift in color from neon green to reddish orange.

"Chromatic changes in sensors are highly desirable, because they are easily seen and interpreted by people," says senior author Satoshi Takamizawa. "If more precise measurements are needed, spectroscopy can be used to quantify the amount of stress."

This work can help led to a wide range of "smart" material sensors. For example, one could be used to determine the time when mechanical stress is applied or removed.

New research led by University of South Australia has found that smokers who receive the medication varenicline tartrate combined with Quitline counselling following a period of hospitalisation due to a tobacco-related illness are six times more likely to quit smoking than those who attempt to stop without support.

The world-first study led by UniSA's Associate Professor Kristin Carson-Chahhoud found that after two years, nearly 30 per cent of study participants were still smoke-free after the treatment, while 18 per cent of participants who had only received Quitline counselling during the same trial also sustained their abstinence.

According to Assoc Prof Carson-Chahhoud, the results prove that both treatment options are highly viable - compared to quitting without support which has a success rate of only three-to-five per cent - and should be implemented in hospitals immediately.

"Not only did we confirm that the combination of varenicline tartrate and counselling offers smokers a very real chance of successfully quitting for good, it also demonstrates the safety and effectiveness of varenicline tartrate over a long period of time," she says.

"This is the first trial of varenicline tartrate worldwide that evaluates long-term effectiveness of the medication with two-year follow-up, and the first study to evaluate the use of varenicline tartrate in a hospital setting among people with many co-morbidities, compared to other studies of the drug that have used primarily 'healthy' community volunteers.

"Given the success of the trial and the relative ease in which the treatment could be implemented, we hope our findings influence how smokers who are hospitalised are supported to quit."

Varenicline works by blocking receptors in the brain that nicotine goes into meaning that people who smoke while using the medication don't get the rush and enjoyment they normally would from smoking. Because the receptors in the brain aren't getting that hit of nicotine from each cigarette smoked, the drug also decreases cravings or eliminates them entirely.

Based at the Australian Centre for Precision Health at UniSA, Assoc Prof Carson-Chahhoud says supporting people to quit smoking during hospital admissions is a massive and underutilised opportunity.

"Providing the right treatment and support for those hospitalised with tobacco-related illnesses would lead to long-term success in reducing smoking rates in our community," she says.

"Even minimal intervention like Quitline counselling - that starts with a simple phone call to get support - can make such a huge difference in helping a smoker successfully quit long-term.

"The health benefits of quitting are widely known - people who stop smoking have fewer hospital admissions, emergency department visits and GP visits, as well as improved quality of life.

"Ultimately we hope that this evidence will be enough to convince policy makers that having a dedicated quit smoking support officer based in hospitals is a very worthwhile investment that will pay long-term dividends."

Dr Carson-Chahhoud also hopes that varenicline tartrate combined with Quitline counselling will become standard practice among hospitalised smokers.
"The hospital setting is a powerful time to help people in their quitting journeys for a number of reasons. Among people admitted because of a tobacco-related disease, it's usually something serious and can act as a wakeup call for people to put their health first," she says.

"It also takes them out of their usual routine and natural environment, where they are a captive audience and more willing to consider quitting smoking as part of their new post-illness routine. In addition, many patients have already had to stop 'cold turkey' for a few days while in hospital.

"Our study proves that with the right intervention, nearly a third of those admitted to hospital with smoking-related illness could be discharged and walk away already well on their way to never smoking again."

While the study was conducted with patients admitted to hospital, Assoc Prof Carson-Chahhoud notes that varenicline tartrate plus Quitline counselling is also a viable treatment option for outpatients.

"In the current pandemic of COVID-19, there has never been a better time to quit since the latest data coming out of China is showing that smokers are significantly more likely to get COVID-19, have a more severe case, need to be admitted to intensive care unit and die from the disease, compared to non-smokers," she says.

Assoc Prof Carson-Chahhoud first commenced work on the study during her PhD at the University of Adelaide.

The paper 'Two-year efficacy of varenicline tartrate and counselling for inpatient smoking cessation (STOP study): A randomized controlled clinical trial' was published in PLOS ONE this week.