Culture

Mice exposed to stress in the womb and soon after birth can expect a lifetime of immune system deficiencies that hinder the ability to ward off infections and cancer, Yale University researchers report March 5 in the journal Cell.

In a new study, they tracked a lifetime of physiological changes experienced by mice given a liquid solution containing the stress hormone glucocorticoid while in the womb or soon after birth. Glucocorticoids are naturally occurring hormones that reduce inflammation and are instrumental in helping infants and adults alike adapt quickly to environmental dangers, such as famine or violence. Physicians use them to treat asthma and autoimmune diseases caused by overactive immune systems, for example.

But, the researchers found, early-life exposure to the stress hormone can permanently alter many immune system responses, decreasing the body's ability to ward off bacterial infections and fight tumors.

"Mice for rest of their lives are rewired and reprogrammed in ways fundamentally different from those not exposed to glucocorticoids," said Yale immunobiologist Ruslan Medzhitov, senior author of the study and Howard Hughes Medical Institute investigator.

Medzhitov and first author Jun Young Hun, also of Yale, catalogued a host of physiological changes that occurred in mice given glucocorticoids and that had serious consequences for the rest of their lives. As adults, for instance, the exposed mice were more susceptible to bacterial infections and tumors than mice without exposure. One specific physiological change was decreased activity in a key T cell that responds to pathogens and other threats to the host.

The study helps explain why individuals vary so widely in their ability to ward off infections, the authors said. It also provides an explanation for a social phenomenon found throughout human history: an emphasis on shielding women from stress during pregnancy.

"In all cultures, there are efforts to shelter women from stress during pregnancy," he said. "The effects of early life stress don't just go away."

As more is learned about molecular changes caused by early exposure to stress, the more likely it is that medical science will find a way to minimize its damage, said the authors.

"We aren't there yet," Medzhitov said.

Energy-dense food, obesity and compulsive food intake bordering addiction: the scientific literature has been pointing to connections between these for years. Scientists at the CNRS and Université de Paris have just shown for the first time how fatty nutrients act on the brain in the reward circuit. Published in Cell Metabolism on 5 March 2020, these results shed new light on the connection between food and eating disorders.

This recent work, directed by scientists at the Unité de biologie fonctionnelle et adaptative (CNRS/Université de Paris)*, show that triglycerides, the nutrients that constitute animal fats, vegetable oils and dairy products, interact with certain neurons in the reward circuit and reduce their excitability in mice, both in vitro and in vivo. These neurons carry a specific type of dopamine-receptor, and their activity strengthens reward-seeking behaviour. The scientists also observed that the manipulation of triglyceride levels in the brain of mice changes many behaviours associated with dopamine, like pleasure and motivation to collect food.

The study is completed by observations of brain activity in humans in response to a food odour compared with their blood triglyceride level after a meal. The research team has shown that activity in the prefrontal cortex, one of the regions of the reward circuit that makes connections between a food's odour, its taste and the pleasure that it causes, is directly correlated with the quantity of triglycerides circulating in the blood. The higher it is, the lower the prefrontal cortex's response to a food odour. This suggests that the activity of important brain structures in the reward system can be directly modified by a lipid nutrient.

Usually, triglycerides only circulate in the blood after a meal. The exception is obese patients, for whom doctors often observe abnormally high triglyceride levels all day long. In this context, this study offers a new framework for potentially explaining why ever-wider access to rich foods may contribute to the establishment of compulsive dietary problems and increase obesity rates.

NEW YORK (March 5, 2020) -- Health systems can protect healthcare workers during the COVID-19 outbreak when best practices for infection control are diligently applied along with lessons learned from recent outbreaks, according to a study published today in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

Researchers from Queen Mary Hospital in Hong Kong reported that zero healthcare workers contracted COVID-19 and no hospital-acquired infections were identified after the first six weeks of the outbreak, even as the health system tested 1,275 suspected cases and treated 42 active confirmed cases of COVID-19. Eleven healthcare workers, out of 413 involved in treating confirmed cases, had unprotected exposure and were quarantined for 14 days. None became ill.

"Appropriate hospital infection control measures can prevent healthcare-associated transmission of the coronavirus," study authors said. "Vigilance in hand-hygiene practice, wearing of surgical masks in the hospital, and appropriate use of personal protective equipment in patient care, especially when performing aerosol-generating procedures, are the key infection control measures to prevent hospital transmission of the virus."

The researchers also conducted an experiment taking air samples from close to the mouth of a patient with a moderate level of viral load of coronavirus. The virus was not detected in any of the tests, whether the patient was breathing normally, breathing heavily, speaking or coughing, and tests of the objects around the room detected the virus in just one location, on a window bench.

"The descriptive study employed unique environmental and air samples with the results suggesting that environmental transmission may play less of a role than person to person transmission in disease propagation," said Gonzalo Bearman, MD, professor of medicine and chair of the Division of Infectious Disease at Virginia Commonwealth University, who reviewed but was not involved in the study.

When the first reports of a cluster of pneumonia cases came from Wuhan, Hong Kong's 43 public hospitals stepped up infection control measures by widening screening criteria to include factors like visits to hospitals in mainland China. When the screening process identified a patient infected with the coronavirus, the patient was immediately isolated in an airborne infection isolation room or, in a few cases, in a ward with at least a meter of space between patients.

Enhanced infection control measures were put in place in each hospital, including training on the use of personal protective equipment, staff forums on infection control, face-to-face education sessions, and regular hand-hygiene compliance assessments. Hospitals also increased the use of personal protective equipment for healthcare workers performing aerosol generating procedures like endotracheal intubation or open suctioning for all patients, not just those with or at risk for COVID-19.

During the first six weeks of the outbreak, the number of locally acquired cases of COVID-19 in Hong Kong increased from 1 of 13 cases confirmed in the first 32 days of surveillance to 27 of 29 cases confirmed from day 33 to 42. Of the locally acquired cases, 28 came from eight family clusters with 11 cases likely transmitted during a gathering for "hot pot," where utensils contaminated with saliva were comingled in shared pots. This family included a 91-year-old woman and a child who both tested positive for the virus but did not display symptoms.

Overview:

Prof. Atsunori Matsuda, Prof. Hiroyuki Muto, Assistant Prof. Kazuhiro Hikima, Assistant Prof. Nguyen Huu Huy Phuc, Researcher Reiko Matsuda, and Mr. Takaki Maeda (Master Program) at the Department of Electrical and Electronic Information Engineering, Toyohashi University of Technology have made an active sulfur material and carbon nanofiber (CNF) composite using a low-cost and straightforward liquid phase process. All-solid-state lithium-sulfur batteries using a sulfur-CNF composite material obtained by liquid phase process show a higher discharge capacity and better cycle stability than those of lithium-ion secondary batteries. Thus, this all-solid-state lithium-sulfur batteries enable leading to applications in large scale batteries such as electric vehicles in the future.

Details:

Lithium-ion secondary batteries, which was awarded the Nobel Prize in chemistry last year, have been widely used as power sources for smartphones, electric vehicles, etc. All-solid-state batteries have also attracted attention as next-generation batteries in recent years because of the increase with hybrid and electric vehicles. In particular, all-solid-state lithium-sulfur batteries have attracted attention because of five times higher energy density than conventional lithium-ion secondary batteries. However, sulfur is an insulator, which thus limits their application in battery devices. In order to solve this issue, sulfur must be provided with an ionic and electron-conductive path.

Our research group suggested that cathode composites by combining a sulfur active material and carbon nanofiber (CNF) by an electrostatic assembly method, which can uniformly combine materials in a solution. All-solid-state lithium sulfur batteries using sulfur-CNF composites and electrochemically stable Li2S-P2S5-LiI solid electrolytes synthesized by liquid phase process showed high discharge capacity equivalent to the theoretical capacity of sulfur and maintained high capacity after repeated charge-discharge cycles.

The first author, Assistant Prof. Nguyen Huu Huy Phuc of Toyohashi University of Technology explained its features "It is required that a sulfur active material and a carbon material are appropriately combined for making high-performance all-solid-state lithium sulfur batteries. Conventionally, sulfur-carbon composites were synthesized by mechanical mixing, liquid mixing using a special organic solvent and complicated methods, in which sulfur is combined with a porous carbon material with a high specific surface area. However, there were few reports that all-solid-state lithium sulfur batteries showed high capacity almost equivalent to the theoretical capacity of sulfur and high cycle stability. Therefore, we focused on making a sulfur-carbon composite using a low-cost and simple electrostatic adsorption method which can uniformly combine nanomaterials. It was confirmed that sulfur at the sulfur-carbon composite synthesized by electrostatic adsorption method was accumulated on carbon nanofiber in the form of sheets. Besides, we constructed all-solid-state lithium sulfur batteries and found that sulfur was fully utilized as an active material. The other merit is that this sulfur-carbon composite can be produced by lower cost than conventional processes."

Development background:

The electrostatic adsorption method is that larger mother particles and smaller particles are electrostatically adsorbed by adjusting surface charges of the particles using polyelectrolytes in order to induce an electrostatic interaction. Although design of a variety of ceramic composites by the electrostatic adsorption were already reported, the adjustment of the surface charges of sulfur is difficult. However, our research group succeeded in the charge adjustment by using chemical reactions, in which Na2S and S reacted in ion-exchanged water to form aqueous soluble Na2S3. Therefore, this study achieved a new chemical process by applying the basic principle of electrostatic adsorption.

Future outlook:

This method is a low-cost and relatively simple method for preparing sulfur-carbon composites, so it is suitable for mass production. All-solid-state lithium-sulfur batteries using a sulfur active material will be put to practical use by this method. Besides, it is expected the exponential improvement in the energy density of electric vehicles, large-sized power source batteries for household and business use.

Have you taken an Uber ride and disagreed with the "fastest" route that the GPS app suggested because you - or the driver - know a "better" way?

For society to truly embrace self-driving cars, the experience of passengers must feel just as comfortable as any trip with a human driver - including choosing the "best," or more comfortable, way to get there.

It turns out that this is an extremely difficult computational challenge, but researchers are getting us a little bit closer to that ideal comfy ride.

They have devised a new optimization method for tracking the trajectory of self-driving cars that reduces errors, all the while keeping computation demands low. They published their results in IEEE/CAA Journal of Automatica Sinica.

While operating a vehicle, a human driver can be thinking about and responding to multiple phenomena from moment to moment: how fast to go, what to expect on the street, safety considerations, all the while also making decisions on -- and constantly re-assessing -- a trajectory that is above all comfortable for themselves and their passengers. This ability to prioritize comfort, and the attempt to replicate it in robots, has been the focus of a great deal of recent research.

An important aspect of this is the trajectory tracking problem--ensuring a vehicle follows a desired route as closely as possible in a given amount of time. It sounds simple because we humans do it all the time without paying much attention, but mathematically it really isn't simple at all. Popular ways of dealing with the problem have the major drawback of excessive computational requirements.

"With an autonomous vehicle, all this has to be performed in what we'd call the 'brain' of the autonomous vehicle," says paper author and engineer Kayvan Majd of Arizona State University. "We set ourselves a challenge that is simple to state but hard to achieve with respect to trajectory planning: A passenger in a self-driving car has to feel as if it were driven by a human."

A couple of attempts in recent years have been made to reduce this computational "overhead", but in doing so, they re-introduce large errors with respect to the trajectory.

What makes the new method such a leap forward is that it ticks all the boxes of stable trajectory tracking with minimal errors with respect to position, velocity and acceleration, while keeping computational overhead down.

The next step for these specialists is making their method more widely applicable, by taking into account additional and even more realistic variables such as taking into account tire forces and side slipping. This will allow the cars to operate at high speed and under harsh road conditions more accurately.

To help answer one of the great existential questions - how did life begin? - a new study combines biological and cosmological models. Professor Tomonori Totani from the Department of Astronomy looked at how life's building blocks could spontaneously form in the universe - a process known as abiogenesis.

If there's one thing in the universe that is certain, it's that life exists. It must have begun at some point in time, somewhere. But despite all we know from biology and physics, the exact details about how and when life began, and also whether it began elsewhere, are largely speculative. This enticing omission from our collective knowledge has set many curious scientists on a journey to uncover some new detail which might shed light on existence itself.

As the only life we know of is based on Earth, studies on life's origins are limited to the specific conditions we find here. Therefore, most research in this area looks at the most basic components common to all known living things: ribonucleic acid, or RNA. This is a far simpler and more essential molecule than the more famous deoxyribonucleic acid, or DNA, that defines how we are put together. But RNA is still orders of magnitude more complex than the kinds of chemicals one tends to find floating around in space or stuck to the face of a lifeless planet.

RNA is a polymer, meaning it is made of chemical chains, in this case known as nucleotides. Researchers in this field have reason to believe that RNA no less than 40 to 100 nucleotides long is necessary for the self-replicating behavior required for life to exist. Given sufficient time, nucleotides can spontaneously connect to form RNA given the right chemical conditions. But current estimates suggest that magic number of 40 to 100 nucleotides should not have been possible in the volume of space we consider the observable universe.

"However, there is more to the universe than the observable," said Totani. "In contemporary cosmology, it is agreed the universe underwent a period of rapid inflation producing a vast region of expansion beyond the horizon of what we can directly observe. Factoring this greater volume into models of abiogenesis hugely increases the chances of life occuring."

Indeed, the observable universe contains about 10 sextillion (10^22) stars. Statistically speaking, the matter in such a volume should only be able to produce RNA of about 20 nucleotides. But it's calculated that, thanks to rapid inflation, the universe may contain more than 1 googol (10^100) stars, and if this is the case then more complex, life-sustaining RNA structures are more than just probable, they're practically inevitable.

"Like many in this field of research, I am driven by curiosity and by big questions," said Totani. "Combining my recent investigation into RNA chemistry with my long history of cosmology leads me to realize there is a plausible way the universe must have gone from an abiotic (lifeless) state to a biotic one. It's an exciting thought and I hope research can build on this to uncover the origins of life."

On Thursday in the National Academy of Medicine's Perspectives, public health leaders including CUNY Graduate School of Public Health and Health Policy Distinguished Lecturer Scott Ratzan, MD called for informed and active public policy leadership to employ strategically coordinated health communication and outreach on COVID-19 and other emerging global health threats.

As the COVID-19 outbreak in the United States rapidly expands, the authors say, the public needs reliable and actionable information to help them understand their risk of exposure as they go about their lives. They need clarity and transparency about travel bans, quarantines, personal protection efforts, and social distancing (e.g., closing mass transit, closing schools, or cancelling sporting events). Moreover, the public needs the assurance that as more is learned about this emerging infection, the information they get from trusted sources reflects both accurately and clearly what the health care establishment does and does not know.

"Currently, the public health community does not have all of the evidence needed to reliably predict the trajectory of this infection," Ratzan says. "Unfortunately, this uncertainty creates a ripe environment for both fear and misinformation."

The authors of the article urge a leading governmental medical spokesperson, such as the U.S. Surgeon General, to create and lead a credible, public-private, interdisciplinary new bureau to inform the United States and serve as an international resource in times of emerging global health threats. Such a bureau could forge long-term relationships with media sources to deliver sustained, up-to-date, evidence based, health-literate communication and serve as a central resource for compelling, scientifically-sound information, medical strategies, personal protection measures, electronic resources, and more.

"The public needs and wants to be able to believe and follow evidence-based guidance from trusted sources," the authors write. "Sound health communication will serve the public well as public health professionals manage the national response to COVID-19 and strengthen the health information infrastructure for when the next novel infection strikes."

A study by Carme Bach, a lecturer with the Department of Translation and Language Sciences at UPF, and Cristina Aliagas, a lecturer with the Faculty of Education at the UAB, both members of the GR@EL research group, analyses the view of families regarding the eduCAT1x1 programme, an education reform implemented in Catalonia by the Escola 2.0 programme, a state-wide project to introduce ICT into the education system through the 1x1 (one computer per student) model, which aimed to fit out classrooms with the necessary technological infrastructure and connectivity to thus orient the practices of teaching/learning.

The paper explores the tension between education reform and parental mediation, published in Revista Complutense de Educación under the title "El vaivén de los portátiles entre las aulas y el hogar: la perspectiva de las familias sobre la reforma educativa de la Escuela 2.0".

In a 1x1 class each student has a laptop connected to the Internet and actively uses it to carry out academic tasks both in and out of the classroom. "The laptop tos and fros between school and home and its function becomes defined in this coming and going between social spheres (school, home, group of friends) that are sustained by different value systems on the role of screens in the social and school life of children and young people", Bach and Aliagas claim.

"Parental mediation is a key factor in children's digital life as it is within the family that children and parents negotiate actively and on a daily basis such issues as access to and the use (purpose and time) of digital devices available within the home", the authors add.

The impact of education reform beyond the classroom

The view of families complements educational research conducted on classroom digitization, now from a new perspective, the impact of education reforms beyond the classroom. Analysis of 16 interviews conducted on families for this study shows that while parents believe technology to be beneficial for the academic and professional future of their children, they also feel unrest at having to manage the out-of-school uses they make of the laptop, where leisure and social communication compete with academic activities.

As Bach and Aliagas point out in their research: "Reforms like those of eduCAT1x1 where each student becomes a laptop 'owner', influence family decisions governing the use teenagers make of ICT".

Some families do not feel empowered regarding the education reform

From the analysis of the interviews, the authors point out that some families do not feel empowered regarding the 1x1 education reform and refer to several reasons: classroom digitization has been improvised and rapid; the introduction of the laptop to the lives of their children has caused changes in approaches to studies (and not everyone considers them as being positive) and digitization has involved a loss of control by parents over the lives of their teenage children.

The study suggests the need to coordinate education reforms with family dynamics, since family mediation is essential to ensure not only the success of educational innovations but also the deeper social transformations that are pursued.

OAKLAND, Calif. — Patients who followed more medical advice after a heart attack were more likely to survive years after their heart attack. Their prospects improved with every additional recommendation they followed, according to new research from Kaiser Permanente published in the Journal of the American Heart Association.

Mortality was reduced by as much as 43% among the most conscientious patients who were tracked.

The study was conducted in Kaiser Permanente Northern California, which has about 4.4 million members who are broadly representative of the area’s population. The study assessed how many recommendations patients were following at 30 and 90 days after their heart attacks and examined the association between adherence and survival in the years following the heart attack. The recommendations included taking 4 cardiovascular medications, not smoking, and achieving blood pressure and cholesterol control. The study followed patients for an average of 2.8 years after their heart attack.

Researchers found high compliance with individual components of post-heart attack medical advice among Kaiser Permanente patients ranging from 67% taking prescribed non-aspirin antiplatelet drugs to 88% taking high cholesterol medications at 30 days. Patterns were similar at the 90-day mark. At the 30-day mark, nearly 70% of the patients achieved either 5 or 6 of the 6 guideline recommendations examined. By 90 days, a little over half of patients achieved 6 or 7 of the 7 recommendations examined.

“Our findings support the value of comprehensive secondary prevention efforts such as cardiac rehabilitation programs and patients’ own commitment to their recovery and a healthy lifestyle,“ said lead author Matthew D. Solomon, MD, PhD, a cardiologist with Kaiser Permanente in Oakland, and adjunct investigator with the Kaiser Permanente Division of Research.

Those who followed all of the recommendations had significantly greater long-term survival, and survival increased with each additional guideline followed. Adherence to one additional guideline recommendation was associated with 8% to 11% lower risk of death, while patients who met all guideline recommendations had 39% to 43% lower mortality compared with those who followed the fewest recommendations.

The study included 25,000 patients who had heart attacks between 2008 and 2014. Patients were followed using data from the electronic health record for a median of about 3 years and up to a maximum of 7 years.

Those results are a positive reflection on Kaiser Permanente Northern California’s cardiac rehabilitation program, said senior author Alan S. Go, MD, an internist and research scientist with the Division of Research in Oakland. “The high percentage of people achieving all or nearly all of the recommended guidelines highlights the benefits of our integrated health care delivery system’s ability to ensure high-quality follow-up care in recovery after a heart attack,” Go said.

Kaiser Permanente’s cardiac rehabilitation program in Northern California is comprehensive and home-based. Patients receive an exercise prescription and a care plan that targets smoking cessation, medication adherence, cholesterol management, blood pressure control, dietary advice, stress reduction, and weight management. Enrollment is 77%, compared with typical nationwide participation in cardiac rehabilitation programs of around 30%. Kaiser Permanente has been a national leader in successful secondary prevention and an innovator in home-based cardiac rehabilitation.

While modern-day cardiac care may seem quick and simple — such as receiving medications and stents to clear a blockage — it’s still vital that patients take follow-up care seriously, Solomon said. “People often think they are ‘fixed’ after they are treated for a heart attack,” he said. “But our findings show that following all the recommended treatments after a heart attack is critical to long-term health and wellness. Doctors and patients must work to ensure every single evidence-based recommendation is followed. Following ‘most’ of the recommended treatments is not enough.”

Philadelphia, March 5, 2020 - A report in the Journal of Molecular Diagnostics, published by Elsevier, describes a new technique that uses real-time next-generation sequencing (NGS) to analyze tiny amounts of microbial cell-free DNA in the plasma of patients with sepsis, offering the possibility of accurate diagnosis of sepsis-causing agents within a few hours of drawing blood. Current diagnostic tests are neither fast nor specific enough to provide timely, critically important information.

"With up to 50 million incident sepsis cases and 11 million sepsis-related deaths per year, sepsis represents a major cause of health loss," explained co-lead-investigator Thorsten Brenner, MD, vice head of the Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany. "Reliable and early identification of the pathogen enables rapid and the most appropriate antibiotic intervention, thereby increasing the chance of better outcomes and patient survival. Currently, standard-of-care diagnostics still rely on microbiological culturing of the respective pathogens, which in most cases (70 to 90 percent) do not provide timely positive results."

NGS encompasses several advanced processes used to sequence the nucleotides in DNA. In previous work, the investigators described a system that utilized NGS of microbial cell-free DNA to detect blood pathogens that was highly sensitive and faster than standard blood cultures (within 28 hours). However, their ultimate goal was to develop an even faster test to expedite treatment.

To overcome this limitation the investigators established a diagnostic workflow based on 3rd generation high-throughput (nanopore) sequencing of microbial DNA. Normally, nanopore sequencing is used to analyze long fragments in sufficient amounts. However, microbial cell-free DNA occurs in small fragments and low quantities in plasma. Nanopore sequencing offers the possibility of real-time analyses during sequencing, which dramatically reduces the time needed to obtain results. "We also had to create validated, specifically adapted bioinformatic procedures to reliably identify pathogens," noted principal investigator Kai Sohn, PhD, Fraunhofer Institute for Interfacial Engineering and Biotechnology, Stuttgart, Germany.

This new technique relies on the use of a handheld nanopore sequencer known as the MinION. This device is portable, can read out ultra-long reads, and immediately processes reads in real time.

In this proof-of-concept study, the investigators analyzed plasma from four septic patients and three healthy controls who were hospitalized in the ICU. Each sample's DNA underwent sequencing using both technologies: the standard NGS (Illumina) and the new nanopore NGS technology. With nanopore sequencing, all septic patient samples were found to be positive for relevant pathogens, whether bacterial, viral, or fungal.

After additional refinements, the new technique was able to achieve a 3.5-fold increase in sequencing throughput, allowing pathogen identification within minutes after sequencing began. In fact, the highest quality results were generated within 2 or 3 hours of the beginning of sequencing. In contrast, with Illumina the final results are available only after the sequencing is finished. "This new system might facilitate same-shift adaption of antibiotic intervention at the ICU, which might, in turn, improve patient outcomes significantly," commented Dr. Sohn.

The investigators also compared the probability of pathogen detection with the MinION system to the highly accurate and clinically validated Illumina NGS technique in a retrospective analysis of 239 samples taken from sepsis patients. Although the accuracy of nanopore sequencing was lower than with Illumina (approximately 85 percent vs. 99 percent), they found a strong correlation between the findings generated by MinION vs. Illumina.

"Time consuming, error- and contamination-prone blood cultures are still considered as the standard of care for sepsis diagnostics, frequently leading to an inappropriate and delayed targeted therapy," said Prof. Dr. Brenner. "The nanopore sequencing platform sequences in real time and has the potential to reduce time to diagnosis to only a few hours."

In the first large, observational study with a control group in England and Wales, research funded by the NIHR Maudsley Biomedical Research Centre has found that Community Treatment Orders (CTOs) are associated with an increased risk of readmission as well as increased time spent in psychiatric hospitals, contrary to results from previous uncontrolled studies. Researchers suggest that these findings should be considered in future reforms to the UK Mental Health Act.

CTOs were introduced in England and Wales under the 2007 amendment to the Mental Health Act (1983). They are a legal order for compulsory monitoring and treatment of people discharged from psychiatric hospitals with serious mental disorders within a community care setting. They also allow quicker readmission to hospital, if necessary, following suspected relapse. Their use has exceeded initial expectation and 5,000 are now used in England each year on average.

Researchers compared 830 patients who were discharged on a CTO with 3,659 patients discharged to voluntary community mental healthcare. Results showed that in the two years following discharge from psychiatric hospital, patients on CTOs spent, on average, 17.3 additional days in hospital and had a 60% greater rate of readmission compared to patients receiving voluntary care. The study also found that the average CTO lasted three years, more than four times longer than initial government projections of nine months.

These findings are contrary to previous uncontrolled observational studies carried out in the UK and Wales, some of which reported a reduction in readmission rates in patients on CTOs. However, the addition of a control group of patients discharged without a CTO in this study allowed researchers to compare outcomes more robustly than in previous studies.

These results could be due to the tendency for patients with CTOs to have historic relapses and severe symptoms, or due to the ease of readmission through the CTO pathway.

Lead author Dr Rashmi Patel, MRC UKRI Health Data Research UK Fellow at the Institute of Psychiatry, Psychology & Neuroscience at King's College London, said: "Community Treatment Orders were designed to prevent relapse and readmission to hospital for people with serious mental illnesses. In fact, our study suggests that they have the opposite effect, with people on CTOs being more likely to be readmitted and spending longer in hospital. In light of these findings, we need to think carefully about what role (if any) CTOs should play in providing care to people with serious mental illnesses".

Co-author Dr Alexis Cullen, Research Fellow at the Institute of Psychiatry, Psychology & Neuroscience at King's College London added "While we cannot establish a causal effect of CTOs on readmission rates, our findings concur with smaller randomised controlled trials from the UK in showing that readmission rates are not reduced. Importantly, our inclusion of patients treated in forensic psychiatric settings (who have been excluded from previous studies) means that our sample is more reflective of the patients who typically receive these treatments."

Researchers used the Clinical Record Interactive Search (CRIS) system which has access to over 400,000 anonymised electronic health records from the South London and Maudsley NHS Foundation Trust. Records available from patients who were discharged between 2008 and 2014 under the Mental Health Act were analysed.

The bacterium Lactococcus lactis, which plays an important role in the dairy industry, is unable to produce the amino acid methionine and has to rely on uptake from the environment. To do this, the bacteria have two systems, with high and low affinity. University of Groningen microbiologists discovered that cells growing in a clonal population can differ in the uptake system they use. Furthermore, the choice for either system is maintained over many generations. It is the first time that such stable heterogeneity is observed in an amino acid uptake pathway. The results were published in the journal Nature Communications on 5 March.

It has long been known that bacteria grown in a clonal population (where all cells share the same genes) can nevertheless behave differently. Under harsh conditions, some cells may go into survival mode by sporulation while other cells do not. 'It is a kind of bet-hedging', explains University of Groningen Professor of Molecular Genetics Oscar Kuipers. 'Sporulation is costly for a cell, and conditions may improve. Or they may not. Taking both routes ensures that part of the population will always survive.'

Hesitant

However, this strategy had never before been observed in amino acid transport. Under Kuipers' supervision, Ph.D. student Jhonatan Hernandez-Valdes grew Lactococcus bacteria in medium with different methionine concentrations. He added a reporter gene to the cells that made them light up fluorescent green when the high-affinity methionine transporter was expressed. However, under low methionine conditions, he noticed that some cells did not light up.

At first, Hernandez-Valdes thought his cell culture was contaminated. But after several checks, it turned out that all cells carried the green fluorescence gene - though not all of them expressed the high-affinity methionine uptake system. Kuipers: 'We discovered that the switch to the high-affinity system is very slow. You could say that the cells are hesitant to switch.'

Bet-hedging

Further exploration revealed that something known as a T-box riboswitch was responsible for heterogeneity in the expression of the high-affinity transporter. Apparently, using low or high-affinity transporters makes no difference in terms of methionine uptake. 'It appears to be a matter of chance which route a cell will take. But once the choice is made, it remains fixed for over ten generations.'

Cells with either uptake system grow equally well under low-methionine conditions. So why the heterogeneity? Kuipers and his colleagues suggest two potential explanations. The first is bet-hedging, a well-known phenomenon in both bacteria and higher organisms. 'Not investing in the high-affinity transport system may offer some advantage under natural conditions.' Some cells within the population gamble on an increase in methionine availability, while others take the safe route and switch on the high-affinity system that provides them with the methionine they need even when there is very little around.

'The other possibility is that there is a division of labor: the two sub-populations cooperate, for example, cells may start to excrete methionine, or die and fall apart, thus making their amino acids available for other cells', Kuipers explains. But this scenario is very speculative.

'We do know that heterogeneity is a good thing for bacteria', he continues. There may be hundreds of different strains in a gram of soil, all battling for their niche. 'By splitting into two populations, you can better anticipate changes in the environment. That is always a smart strategy.'

A coronavirus app coupled with machine intelligence will soon enable an individual to get an at-home risk assessment based on how they feel and where they've been in about a minute, and direct those deemed at risk to the nearest definitive testing facility, investigators say.

It will also help provide local and public health officials with real time information on emerging demographics of those most at risk for coronavirus so they can better target prevention and treatment initiatives, the Medical College of Georgia investigators report in the journal Infection Control & Hospital Epidemiology.

"We wanted to help identify people who are at high risk for coronavirus, help expedite their access to screening and to medical care and reduce spread of this infectious disease," says Dr. Arni S.R. Srinivasa Rao, director of the Laboratory for Theory and Mathematical Modeling in the MCG Division of Infectious Diseases at Augusta University and the study's corresponding author.

Rao and co-author Dr. Jose Vazquez, chief of the MCG Division of Infectious Diseases, are working with developers to finalize the app which should be available within a few weeks and will be free because it addresses a public health concern.

The app will ask individuals where they live; other demographics like gender, age and race; and about recent contact with an individual known to have coronavirus or who has traveled to areas, like Italy and China, with a relatively high incidence of the viral infection in the last 14 days.

It will also ask about common symptoms of infection and their duration including fever, cough, shortness of breath, fatigue, sputum production, headache, diarrhea and pneumonia. It will also enable collection of similar information for those who live with the individual but who cannot fill out their own survey.

Artificial intelligence will then use an algorithm Rao developed to rapidly assess the individual's information, send them a risk assessment -- no risk, minimal risk, moderate or high risk -- and alert the nearest facility with testing ability that a health check is likely needed. If the patient is unable to travel, the nearest facility will be notified of the need for a mobile health check and possible remote testing.

The collective information of many individuals will aid rapid and accurate identification of geographic regions, including cities, counties, towns and villages, where the virus is circulating, and the relative risk in that region so health care facilities and providers can better prepare resources that may be needed, Rao says. It also will help investigators learn more about how the virus is spreading, the investigators say.

Once the app is ready, it will live on the augusta.edu domain and likely in app stores on the iOS and Android platforms.

It is imperative that we evaluate novel models in an attempt to control the rapidly spreading virus, Rao and Vazquez write.

Technology can assist faster identification of possible cases and aid timely intervention, they say, noting the coronavirus app could be easily adapted for other infectious diseases. The accessibility and rapidity of the app coupled with machine intelligence means it also could be utilized for screening wherever large crowds gather, such as major sporting events.

While symptoms like fever and cough are a wide net, they are needed in order to not miss patients, Vazquez notes.

"We are trying to decrease the exposure of people who are sick to people who are not sick," says Vazquez. We also want to ensure that people who are infected get a definitive diagnosis and get the supportive care they may need, he says.

While stressing that the infection with coronavirus is not a pandemic-- defined by the World Health Organization, as the worldwide spread of a new disease, including numerous flu pandemics like HINI, or swine flu, in which people find themselves exposed to a virus for which they have no immunity -- "This is what you have to do with pandemics," says Vazquez. "You don't want to expose an infected person to an uninfected person." If problems with infections persist and grow, drive-thru testing sites may be another need, he says.

The investigators hope this readily available method to assess an individual's risk will actually help quell any developing panic or undue concern over coronavirus, or COVID-19.

"People will not have to wait for hospitals to screen them directly," says Rao. "We want to simplify people's lives and calm their concerns by getting information directly to them."

If concern about coronavirus prompted a lot of people to show up at hospitals, many of which already are at capacity with flu cases, it would further overwhelm those facilities and increase potential exposure for those who come, says Vazquez.

Tests for the coronavirus, which include a nostril and mouth swab and sputum analysis, are now being more widely distributed by the CDC, and the Food and Drug Administration also has given permission to some of the more sophisticated labs, particularly those at academic medical centers like Augusta University Medical Center, to use their own methods to look for signs of the viral infection, which the hospital will be pursuing.

As of this week, about 90,000 cases of coronavirus have been reported in 62 countries, with China having the most cases.

The CDC and WHO say that health care providers should obtain a detailed travel history of individuals being evaluated with fever and acute respiratory illness. They also have recommendations in place for how to prevent spread of the disease while treating patients.

Currently when people do present, for example, at the Emergency Department at AU Medical Center, with concerns about the virus, they are brought in by a separate entrance and escorted to a negative pressure room by employees dressed in hazmat suits per CDC protocols, Vazquez says. As of today, all those who have presented at AU Medical Center have tested negative, he says.

The cause of back pain can be linked to humanity's evolutionary past, according to new research from a team of bioarchaeologists at Simon Fraser University, the University of Liverpool, and the University of Sydney.

The study, published in Evolution, Medicine, and Public Health, examines why some people are more susceptible to a particular stress fracture known as spondylolysis - a condition that often affects athletes.

"Because spondylolysis only occurs in humans and does not affect our great ape cousins, it has long been assumed to be the result of increased stress placed on our spine by our unique ability to walk upright on two legs," says SFU postdoctoral researcher Kimberly Plomp. "However, there have been few attempts to test this hypothesis."

The researchers used advanced 3D shape analysis techniques to compare the final lumbar vertebrae of humans with and without spondylolysis to the same bones in our closest living relatives, the great apes.

The team found that the differences between human vertebrae with spondylolysis and great ape vertebrae were greater than those between healthy human vertebrae and great ape vertebrae. People who developed spondylolysis have vertebrae that are more wedge-shaped, where the front is taller than the back, in addition to other subtle shape differences. The differences are consistent with the vertebrae having "overshot" the optimum for walking on two legs, leaving the individual prone to developing spondylolysis.

The latest research is the third study that the researchers have conducted linking vertebral shape and back pain to the evolutionary history of our lineage. Previously, they have demonstrated that humans with intervertebral disc hernias have vertebrae that are more similar in shape to those of modern chimpanzees and those of our fossil ancestors than are humans with healthy spines.

"We can picture vertebral shape variation in humans as a spectrum with one end having vertebrae with an ancestral shape and the other end having vertebrae with exaggerated bipedal adaptations. Where an individual's vertebrae lie within this distribution has a bearing on their spinal health," says Mark Collard, SFU archaeology professor and Canada Research Chair in Human Evolutionary Studies.

"For decades, scholars have assumed that the reason humans are so commonly afflicted with back problems is because we walk on two legs," says Plomp." Our studies are the first to show a clear link between the shape of your vertebrae, bipedalism, and the health of your spine."

Keith Dobney, professor of human palaeoecology at the University of Sydney and the University of Liverpool, adds: "This is an area requiring further study, but our data show that studying the past can have a direct bearing on current societal issues - in this case the prevention and management of back pain."

For years, curry lovers have sworn by the anti-inflammatory properties of turmeric, but its active compound, curcumin, has long frustrated scientists hoping to validate these claims with clinical studies.

The failure of the body to easily absorb curcumin has been a thorn in the side of medical researchers seeking scientific proof that curcumin can successfully treat cancer, heart disease, Alzheimer's and many other chronic health conditions.

Now, researchers from the University of South Australia (UniSA), McMaster University in Canada and Texas A&M University have shown that curcumin can be delivered effectively into human cells via tiny nanoparticles.

Sanjay Garg, a professor of pharmaceutical science at UniSA, and his colleague Dr Ankit Parikh are part of an international team that has developed a nano formulation which changes curcumin's behaviour to increase its oral bioavailability by 117 per cent.

The researchers have shown in animal experiments that nanoparticles containing curcumin not only prevents cognitive deterioration but also reverses the damage. This finding paves the way for clinical development trials for Alzheimer's.

Co-author Professor Xin-Fu Zhou, a UniSA neuroscientist, says the new formulation offers a potential solution for Alzheimer's disease.

"Curcumin is a compound that suppresses oxidative stress and inflammation, both key pathological factors for Alzheimer's, and it also helps remove amyloid plaques, small fragments of protein that clump together in the brains of Alzheimer disease patients," Prof Zhou says.

The same delivery method is now being tested to show that curcumin can also prevent the spread of genital herpes.

"To treat genital herpes (HSV-2) you need a form of curcumin that is better absorbed, which is why it needs to be encapsulated in a nano formulation," Prof Garg says.

"Curcumin can stop the genital herpes virus, it helps in reducing the inflammation and makes it less susceptible to HIV and other STIs," Prof Garg says.

Women are biologically more vulnerable to genital herpes as bacterial and viral infections in the female genital tract (FGT) impair the mucosal barrier. Curcumin, however, can minimize genital inflammation and control against HSV-2 infection, which would assist in the prevention of HIV infection in the FGT.