Culture

A majority of police detectives in England and Wales investigating financial crime do not have sufficient knowledge to build a successful case.

That's the finding of new research from the Institute of Criminal Justice Studies at the University of Portsmouth, looking into why results of such investigations vary so widely, especially when the crimes account for half of all criminal activity in the UK.

The report, published today in Policing: A Journal of Policy and Practice, finds that only 40 per cent of investigators understood the process by which fraud is reported. A third of those questioned said they had not received proper training in how to investigate financial crime. There was also a poor perception of fraud and the impact on victims amongst those questioned.

Researchers found that in many cases investigators had a negative view of their work, and did not have the time, training or determination. Financial crime is perceived to be notoriously challenging to investigate. Investigations into less prolific, but higher profile and headline grabbing crimes are known to get better results. Their report builds a picture of why investigations into financial crimes are largely unsuccessful, and it makes a series of recommendations to improve outcomes.

Lead author Paul Gilmour, Lecturer of Criminal Justice and Policing, Institute of Criminal Justice Studies, University of Portsmouth, said: "The police service in England and Wales has been subject of much criticism in the past two decades over the response to financial crime. Many studies have reported failures in how the police investigate and prosecute financial crime, which have led to many victims being dissatisfied with the service provided by police. Despite this, there has been little research into the barriers facing police investigators entrusted with tackling financial crime."

A recent study by Her Majesty's Inspectorate of Constabulary and Fire & Rescue Services (HMICFRS) concluded that the policing response to fraud is ineffective, with victims of fraud often left dissatisfied with the quality of the police's investigation into fraud. Less than three per cent of fraud reported to police between 2017 and 2018 led to any type of positive outcome, such as a charge, summons, caution, or community service. These statistics are especially disappointing considering that fraud and related computer crimes accounted for almost half of all crime in England and Wales in the year ending December 2019 (Office for National Statistics, 2020).

Paul Gilmour said: "Our article reports on a study into such barriers, through surveys and interviews with investigators that aimed to better understand the challenges faced by police forces within England and Wales. It demonstrates several overriding practical and cultural issues that inhibit the success of investigations. The article concludes that police need a better appreciation of financial crime, to help improve the service delivered to victims and to prioritise this often undervalued field of policing."

The report found that financial crimes need to be prioritised, with all sectors of the police service needing to understand that they have an important role to play in the success of an investigation. Researchers also recognised that resources dedicated to fighting financial crime have struggled to compete with other policing priorities. It suggests improved training will allow investigators to better judge and, therefore, prioritise those cases that warrant further investigation.

A summary of the findings and recommendations can be
found below:

The findings showed a common theme -

The police's lack of knowledge around relevant legislation and investigative procedures emerged as a key theme in the research. Only 40 per cent of all respondents reported understanding the processes through which frauds are reported to the police, and half of all respondents did not understand the role of Action Fraud.

Many respondents reported a lack of training as a barrier. A total of 29 per cent of respondents reported having received no training related to investigating financial crime. Almost 40 per cent of all surveyed stated that the only training received relating to financial crime was during their initial police recruitment. In nearly 40 per cent of respondents, all investigative training delivered had been via online e-learning packages.

There was also a poor perception of fraud and also victims of fraud. Given the lack of training and knowledge around financial crimes, many respondents reported being fearful of conducting investigations into such crimes. The perception of fraud was overwhelmingly negative. Many respondents reported that fraud was not a priority.

One respondent said: "Fraud has never interested me, but that said, it does not seem to interest many people; and as a result, it is definitely a poor relation when it comes to criminal investigation."

The perceived lack of support from fraud victims was also reported as being a barrier. One said: "Many victims have a completely unrealistic attitude towards what we can achieve."

Many respondents also reported that inadequate available resources hinder their ability to respond to financial crimes.

Report recommendations:

Greater training is needed in this field to enhance investigators' ability to tackle financial crime. Further initial training and ongoing development will, not only, strengthen the police's competence in tackling financial crime, but also, improve the police workforce's resilience in meeting growing operational demands.

Better training will also improve how this area of policing is perceived. Victims of fraud and other financial crimes need the full support of the police, especially considering the increasing volume of frauds reported to police each year.

Researchers at the University of Maryland, Baltimore County (UMBC) have worked to create methods for improving the safety of technologically complex vehicles. Now that the majority of new cars operate using sophisticated computing technology, they are vulnerable to malicious attacks on their networks that could lead to disastrous safety issues. Riadul Islam, assistant professor of computer science and electrical engineering, has worked with collaborators at UMBC and the University of Michigan-Dearborn to create a simple, easily adapted method for detecting the breaches in security. The research is published in the Institution of Electrical and Electronic Engineers (IEEE) publication Transactions on Intelligent Transportation Systems.

Currently, the most widely used intra-vehicular communications network in the automobile industry is the controller area network (CAN). This network is very simple to use, which makes it appealing for consumers and manufacturers, but this simplicity also renders it vulnerable to potential security threats.

The CAN is essentially a broadcasting network, so any entity has the ability to "read" the messages coming from a car, and potentially send conflicting messages. It is possible to remotely control a car from another device using the CAN network. This is both a feature and a bug, enabling many new innovations, and also creating security concerns. An entity could take control of the network and send new commands to a vehicle, creating dangerous circumstances, such as disabling the breaks or causing engine failure.

The first step to completely eradicating these possible threats is detecting them. According to Islam, detecting these threats does not require extensive technology. Instead, his method involves the formulation of graph-based anomaly detection techniques that will "easily show the complex relationship between data."

Islam's team took the graphs that were made to demonstrate the data on the network and conducted a simple statistical analysis to detect intruders or threats. This method does not require costly machinery; instead, it relies on methods that are already well understood by statisticians and capable of functioning intuitively.

The main benefit of using a statistical method to detect potential threats in the CAN is that it is cost-effective by "an order of magnitude," according to Islam. "The statistical method requires less energy than machine learning or artificially intelligent methods would," he explains.

As the prospect of self-driving or heavily computerized cars becomes a reality, detecting and addressing network vulnerabilities becomes essential. Islam and his team have shown that this task does not need to be complex or expensive to be effective. Instead, car manufacturers can maintain simplicity by using data and statistical analysis to identify threats in real time. In the future, the statistical method developed by Islam will be available digitally to best assure accessibility as vehicles are created with more functions than ever before.

Magic squares belong to the imagination of humanity for a long time. The oldest known magic square comes from China and is over 2000 years old. One of the most famous magic squares can be found in Albrecht Dürer's copper engraving Melencolia I. Another one is on the facade of the Sagrada Família in Barcelona. A magic square is a square of numbers such that every column and every row sums to the same number. For example, in the magic square of the Sagrada Família every row and column sums to 33.

If the magic square can contain real numbers, and every row and column sums to 1, then it is called a doubly stochastic matrix. One particular example would be a matrix that has 0's everywhere except for one 1 in every column and every row. This is called a permutation matrix. A famous theorem says that every doubly stochastic matrix can be obtained as a convex combination of permutation matrices. In words, this means that permutation matrices "contain all the secrets" of doubly stochastic matrices--more precisely, that the latter can be fully characterized in terms of the former.

In a new paper in the Journal of Mathematical Physics, Tim Netzer and Tom Drescher from the Department of Mathematics and Gemma De las Cuevas from the Department of Theoretical Physics have introduced the notion of the quantum magic square, which is a magic square but instead of numbers one puts in matrices. This is a non-commutative, and thus quantum, generalization of a magic square. The authors show that quantum magic squares cannot be as easily characterized as their "classical" cousins. More precisely, quantum magic squares are not convex combinations of quantum permutation matrices. "They are richer and more complicated to understand", explains Tom Drescher. "This is the general theme when generalizations to the non-commutative case are studied."

PHILADELPHIA - Marginalized groups of people value professionalism more -- and are more likely to leave a job at an institution due to issues of professionalism -- compared to their white, male counterparts, according to a Penn Medicine study of staff, faculty, and students who were affiliated with a large, academic health system in 2015 and 2017. The findings, published today in JAMA Network Open, suggest that health care institutions must reevaluate and redefine professionalism standards in order to successfully make the culture of academic medicine more inclusive and to improve the retention of minorities and women.

This study is one of a series of research projects launched at Penn Medicine, under the leadership of Vice Dean Eve J. Higginbotham, MD, SM, as part of Office of Inclusion and Diversity's mission to chart Penn Medicine's course toward inclusivity for all groups.

"What does it actually mean to operationalize an anti-racist, inclusive workplace? It means understanding the factors in an environment that allow women and minorities to thrive in your organization," said Jaya Aysola, MD, MPH, assistant dean of Inclusion and Diversity at the Perelman School of Medicine and executive director at the Penn Medicine Center for Health Equity Advancement. "We wanted to look at the ways that marginalized groups perceive and experience professionalism, so that we could move toward standardizing policies in a way that is really inclusive for all. Recruiting female and minority students and employees is not enough if an organization cannot retain them."

Professionalism has been implemented as a core competency for medical education to govern how physicians conduct themselves in public, be it with patients or with each other. However, the medical field lacks a concise, unifying, and operational definition of professionalism, and the word is often misused or overused. Moreover, the historic definition of professionalism has largely centered around white, heterosexual male identity, and therefore the current understanding of what is deemed professional can often be non-inclusive or discriminatory. For instance, because of these cultural norms, the way that certain groups dress, speak, eat, or wear their hair might be deemed unprofessional.

The study authors wanted to examine perceptions and experiences of professionalism among faculty, trainees, staff, and students, in order to better understand, and then perhaps reevaluate, how professionalism standards are applied to different groups.

In the first part of the study, the researchers analyzed answers collected from the Diversity Engagement Survey, which is administered by Datastar, from February to April 2015. The dataset included 3,506 respondents -- faculty, trainees, staff, and students -- from two Philadelphia-area health systems and four medical/health professional schools.

On the survey, respondents were asked to rate their responses (from strongly agree to strongly disagree) to three statements related to professionalism: (1) "I have considered changing jobs due to inappropriate, disruptive, or unprofessional behavior by a coworker or supervisor." (2) "I value institutional initiatives, policies, and/or educational resources related to professional behavior in the workplace." (3) "My institution supports a culture of professionalism."

In response to the statement "I value institutional initiatives, policies, and/or educational resources related to professional behavior," 52 percent of women and 54 percent of

Black individuals agreed or strongly agreed, compared to 45 percent of male and 49 percent of white respondents.

Respondents who self-identified as female, LGBTQ, non-Hispanic Black individuals, when compared with white, heterosexual men, were also statistically significantly more likely to report considering changing jobs because of "unprofessional" behavior. No statistically significant adjusted differences were found among respondents who agreed with the statement "My institution supports a culture of professionalism."

Aysola said that she suspects the greater value women and underrepresented minority groups place on professionalism may stem from what they perceive to be lacking in their work environment, as well as gaps that they perceive between institutional values and their lived experiences.

To probe that hypothesis further, the research team also analyzed responses to the open-ended question: "Tell us a time that you felt valued or devalued, or welcomed or not welcomed by your organization." The researchers solicited narratives via email in 2017 from faculty, trainees, staff, and students across the organizations studied. They then analyzed 52 narratives pertaining to professionalism.

Many narrators who self-identified as members of marginalized populations expressed infringement on their professional boundaries during interactions at work or learning environments.

The infringements reported ranged from microaggressions to blatant racism, sexism, xenophobia, and homophobia. Other narratives stated that professional standards were applied differently to certain groups, and those groups perceived that they were subject to greater scrutiny. Experiences cited ranged from facing differential disciplinary practices and feeling unwelcomed, to experiencing pressure to conform and being asked questions about childbearing, living situations, and tattoos.

A consistent theme throughout the stories was that the respondents from underrepresented groups felt they were subjected to greater scrutiny, while simultaneously reporting greater infringements over their professionalism boundaries.

"The narratives that we collected reveal disparities in how we assess professionalism, with minorities and women reporting a microscope over their behaviors." Aysola said. "A common theme was that being different was not perceived as being a good 'fit,' forcing individuals to alter their authentic selves to feel included.'"

These findings, according to Aysola, underscore the need to revisit the professionalism standards, which govern the practice of medicine and the engagement between members of the medical profession. These standards, she said, must be informed by diverse perspectives, in order to be more inclusive. They also must be operationalized in a way that ensures behaviors are subject to equal scrutiny, irrespective of the culture or background of the individual, she added.

"We have to take every single policy and practice that governs culture, and we have to put it through an inclusion filter," she said. "Inclusion and diversity cannot exist in silos; they must be designed into the fabric of an institution."

CHAMPAIGN, Ill. -- Gut hormones play an important role in regulating fat production in the body. One key hormone, released a few hours after eating, turns off fat production by regulating gene expression in the liver, but this regulation is abnormal in obesity, researchers at the University of Illinois Urbana-Champaign found in a new study.

The study, led by molecular and integrative physiology professor Jongsook Kim Kemper and research scientist Young-Chae Kim, was published in the journal Nature Communications.

After eating, the pancreas produces insulin, which triggers the liver to convert digested foods into fat for storage in a process known as lipogenesis. A few hours later, when the body begins the transition to fasting mode, the liver slows fat production. While the insulin pathway has been thoroughly studied, the pathway by which lipogenesis is turned off has largely remained unknown, Kemper said.

In the new study, Kemper's team found that the gut hormone FGF15 in mice and its human counterpart FGF19 turn off fat-producing genes in the liver. The hormones are released a few hours after eating, when the body transitions from feeding to fasting. FGF15/19 activate regulatory molecules to enter the nucleus, the center of the cell where DNA is stored, and inhibit gene expression.

"This gut hormone actually acts as a breaker of insulin action, and specifically inhibits lipogenesis in the liver so that it's tightly regulated," Kemper said. "For example, with the holidays coming up, if you eat some cookies, the body will release insulin, which promotes lipogenesis. If lipogenesis is not reduced later when the body enters the fasting state, excess fat will accumulate in the liver, so the FGF19 hormone puts the brakes on fat production."

Furthermore, in experiments involving mice with obesity and human patients with nonalcoholic fatty liver disease, the researchers found that the pathway for turning off fat production was dysregulated. The genes that the gut hormone regulates were highly active, the FGF15/19-activated regulatory molecules did not even enter the cell's nucleus and the suppression markers were not added to the genes.

"This study could be very important for understanding this pathway and investigating how it is abnormal in obesity and nonalcoholic fatty liver disease," Kemper said. "It adds to our understanding of obesity, nonalcoholic fatty liver disease and other metabolic disorders. It also could have implications for other diseases such as diabetes or certain cancers, for which obesity is a risk factor.

"Based on this study, we potentially could search for therapeutic treatment options to target this pathway and increase regulatory function."

The study goals

Predi-COVID was launched with the goal of defining which patient profiles can be associated with a more severe prognosis. The study aims to identify the clinical, epidemiological and socio-demographic characteristics, as well as specific biomarkers from both the SARS CoV-2 virus and the patient, which can help predict the way the disease will evolve in a given individual, according notably to his immune profile.

Predi-COVID and Predi-COVID-H: patient recruitment and operational aspects

The research team has been establishing a cohort of people over the age of 18 positive for SARS CoV-2. All newly diagnosed individuals in Luxembourg can participate in Predi-COVID, upon agreeing to share their data for research purposes. In parallel to Predi-COVID, the ancillary study "Predi-COVID-H" was launched to include household members of COVID-19 positive participants to study the transmission of the virus in this high-risk population. The recruitment and data/sample collection phase started on May 5th and was initially planned to last until December 2020, although an extension period until late June 2021 is being requested.

The health evolution and symptoms of the enrolled patients are followed daily through different remote digital tools, depending on whether patients are at home or at the hospital, for 14 days from the time of confirmation of diagnosis. Short additional evaluations are also performed monthly for up to 12 months, to assess potential long-term consequences of COVID-19. Innovative digital data, specifically voice recordings, is also collected as part of the study. More detailed clinical and digital data and associated biological samples is gathered from a subset of at least 200 volunteers from the Predi-COVID cohort and from 100 Predi-COVID-H participants, in order to better characterise symptoms and clearly define the different outcomes. Upon inclusion in the study and after three weeks, several biological samples -- including blood, nasal and oral swabs, saliva and stool -- are collected from participants to identify human and viral predictive markers.

Preliminary results: participant recruitment, data collection, symptoms and vocal biomarkers

Since May 5th - the date of enrolment of the first participant - and as of November 10th, 1406 and 67 eligible subjects have been contacted by phone for inclusion in Predi-COVID and in Predi-COVID-H, respectively, 556 of which agreed to be included in the former and 48 in the latter. On average, participants are 39 years old. In terms of biological samples, the team has been establishing a unique biobank to study COVID-19, already boasting 627 specimens collected during the baseline and follow-up visits. This collection includes blood, sputum, swabs, stool and hair samples.

The preliminary findings also indicate that the majority of the enrolled population experienced few or mild symptoms. The most prevalent symptoms at admission included fever (26.2% of participants), cough (23.3%), runny nose (12.2%) and sore throat (10.8%), while the most common comorbidities and risk factors include smoking (18.1% of participants), asthma (5.4%), diabetes (4.7%), chronic heart disease (3.6%) and obesity (3.3%).

Furthermore, a total of 3,290 voice recordings has been made available by 245 participants using the CoLive LIH smartphone app, with multiple recordings per person to allow the study of the evolution of voice characteristics over time. These will enable the identification of "vocal biomarkers" of frequently observed symptoms in COVID-19 patients, such as respiratory syndromes, fatigue, anxiety or negative emotions related to COVID-19, which could subsequently be used for the easy remote monitoring of patients at home.

"We are delighted with the results obtained thus far. The greater the number of participants, the more accurate the final results. Besides, we are now collaborating with the Centre Hospitalier de Luxembourg to envisage the inclusion of up to 100 COVID-19 positive children in Predi-COVID and up to 30 children from affected households in Predi-COVID-H", states Prof Markus Ollert, Director of the LIH Department of Infection and Immunity and co-Principal Investigator of Predi-COVID.

"We are very grateful to the Health Inspection Department of the Ministry of Health for the unwavering support and excellent collaboration throughout, which are key to the success of the study. The protocol has recently been published in a renowned international journal and will serve as the core publication to cite for all future work based on Predi-COVID data. So far, nine ancillary projects funded by the National Research Fund or by the European Commission's Horizon 2020 programme are already using Predi-COVID data", concludes Dr Guy Fagherazzi of the LIH Department of Population Health, co-Principal Investigator of Predi-COVID and first author of the publication.

November 24, 2020 - Medical mistrust is one reason why African American patients are more likely to have regrets about their choice of treatment for prostate cancer, suggests a study in The Journal of Urology®, Official Journal of the American Urological Association (AUA). The journal is published in the Lippincott portfolio by Wolters Kluwer.

Concerns about masculinity also contribute to decision regret among African American men with localized prostate cancer, suggests the new research by Molly DeWitt-Foy, MD, and colleagues of the Cleveland Clinic. "Our findings may help to identify new approaches to reducing racial disparities in risk and treatment outcomes for African American men with prostate cancer," Dr. DeWitt-Foy comments.

Beliefs about prostate cancer help to explain racial disparities

The study included 1,112 men, average age 63 years, treated for localized prostate cancer between 2010 and 2016. Because their cancer hasn't spread beyond the prostate gland, patients with localized disease have a choice of treatment options, including active surveillance, hormone therapy, radiation, surgery, or watchful waiting.

About 40 percent of patients in the study were African American, while 60 percent were of other racial/ethnic groups. Most medical characteristics were similar for African American versus non-African American men. Initial treatment consisted of surgery (prostatectomy) in about 50 percent of patients and radiation (brachytherapy) in 42 percent.

The men completed a series of surveys, including a newly designed Prostate Cancer Beliefs Questionnaire (PCBQ). Based on previous studies of racial differences in cultural beliefs regarding medical care, the PCBQ aimed at a better understanding cancer-related beliefs and experience with prostate cancer diagnosis, treatment, recovery and survival.

The outcomes of prostate cancer treatment were generally similar between groups, including problems with urinary incontinence, bowel function, and hormonal symptoms. African American men had lower scores for sexual function compared to non-African American men. Yet despite similar outcomes, African American men had higher average scores for decision regret: about 45 versus 35 (on a 100-point scale).

There were also some racial differences in responses to the PCBQ. "African American men exhibited greater concern about masculinity and more medical mistrust than non-African American men," Dr. DeWitt-Foy and coauthors write.

African American patients were more likely to say their doctor treated them differently because of their race - although 80 percent of them disagreed with this statement. African American patients were also more likely to feel that screening and treatment for prostate cancer "made them feel like less of a man."

After adjusting for other factors, African American patients were more than twice as likely to have high decision regret regarding prostate cancer treatment. Medical mistrust and concerns about masculinity explained some of the effect of race on regret scores. Regardless of race, poorer sexual function and worse urinary incontinence - two major side effects of prostate cancer treatment - also predicted higher decision regret scores.

Despite progress over the past 20 years, African American men are still more likely to be diagnosed with, and die from, prostate cancer. The new study sought to better understand patients' beliefs about prostate cancer, and ultimately to reduce treatment-related decisional regret.

The findings confirm African American men have higher decision regret about their prostate cancer treatment, and suggest these regrets are related to medical mistrust and concerns about masculinity. Dr. DeWitt-Foy and colleagues conclude: "This information may help inform counseling of patients, and has the potential to reduce racial disparities in patients' experiences with prostate cancer by targeting opportunities for education and improved communication."

Click here to read "Race, Decisional Regret and Prostate Cancer Beliefs: Identifying Targets to Reduce Racial Disparities in Prostate Cancer."

DOI: 10.1097/JU.0000000000001385

A new paper from a UIC researcher shows evidence that suggests sex steroids may play a role in protecting against COVID-19 symptoms.

"Sex and Covid-19: A protective role for reproductive steroids," by Graziano Pinna, research associate professor in psychiatry, analyzes existing research to look at reasons why COVID-19 symptom severity and mortality are more frequent in men than in women and in older people. His paper suggests female reproductive steroids play a protective role.

Female reproductive steroids, estrogen and progesterone and its physiologically active metabolite, allopregnanolone, provide anti-inflammatory functions, reshape competence of immune cells, stimulate antibody production and promote respiratory epithelial cell repair, and inhibit the ACE2 receptor, the door of access for the novel coronavirus (SARS-CoV-2) to infect the organism, suggesting they may protect against COVID-19 symptoms, according to Pinna's report. The paper is published in Trends in Endocrinology and Metabolism.

Pinna became interested in the role of reproductive steroids in COVID-19 pathology in March when early case reports showed COVID-19 positive pregnant women who had no COVID-19 symptoms, had escalated symptoms -- severe enough to require intensive care -- immediately after giving birth. The severity of symptoms coincided with a rapid drop of estradiol, progesterone, and allopregnanolone.

"Hormones that help sustain the pregnancy - like progesterone -- are 100 times more concentrated in a pregnancy's third trimester. Estradiol, allopregnanolone, and progesterone all have important anti-inflammatory functions and are involved in resetting the immune system. This suggests that pregnant women became symptomatic, and some were even admitted to the ICU, after delivering their babies because of the rapid drop in these hormones," said Pinna. "The correlation was really striking."

According to recent CDC data, in the United States, 38,071 women who were pregnant contracted COVID-19, with 51 deaths -- 0.13%. For non-pregnant women, the death toll is 2%.

"Pregnant women are 15 times less likely to die from COVID than other women," said Pinna.

There is a difference between the severity of symptoms, and intensive care hospitalization between men and women with COVID-19, with women being more resistant. It was thought that female hormones protected women, but it was difficult to ascertain why, said Pinna.

"This observation in pregnant women provides significant scientific background, not only as to why women are more protected than men, but also why older people are less protected than younger people because we know the older you are, the more decreased your hormones are," said Pinna.

Pinna's paper also discusses the importance of reproductive hormones in stimulating the production of antibodies and promoting lung cell repair after virus infection and fighting against the 'cytokine storm' -- an immune response where the body starts to attack its own cells and tissues rather than just fighting off the virus.

"Progesterone and allopregnanolone can block the incredible overreaction of the inflammatory system, repressing it and avoiding the over-expression of pro-inflammatory cytokines," said Pinna.

Reproductive hormone protection from COVID symptoms may be warranted by oral combinations of hormonal contraceptives or by treatment with hormone replacement therapy against hypoestrogenism in postmenopausal women. Pinna said clinical trials to evaluate the efficacy of progesterone or estradiol to improve COVID-19 symptoms in men and post-menopausal women are underway.

Additionally, nutrition may also play a role when diets are enriched with phytoestrogens - plant-produced 'estrogen' -- (in foods such as soybeans, lentils, oats). Phytoestrogens have the ability to bind directly to human estrogen receptors, or can be converted to estradiol by the microbiome. The microbiome is the collective genomes of the microbes (composed of bacteria, bacteriophage, fungi, protozoa, and viruses) that live in the gut.

"Nutrition is very important and there hasn't been much talk about it," Pinna said. "It is important because it is something we can take care of each day to boost the immune system and make our bodies stronger against COVID."

What should we get for our kids this holiday? As children get older, giving them something they can experience (live through) instead of material things makes them happier, according to new research led by Lan Nguyen Chaplin, associate professor of marketing at the University of Illinois Chicago.

The research, published in the International Journal of Research in Marketing, compared the level of happiness children derive from material goods with the level of happiness they derive from experiences.

Across four studies with children and adolescents, Chaplin and her collaborators demonstrated that children ages 3-12 derive more happiness from material things than from experiences. However, older children derive more happiness from their experiences than from their possessions.

"What this means is, experiences are highly coveted by adolescents, not just expensive material things, like some might think," Chaplin says.

She goes on to explain, "Don't get me wrong. Young children do love experiences. Entire industries (e.g., theme parks such as Disneyland) are built around this premise. In fact, young children are ecstatic throughout the experience. However, for experiences to provide enduring happiness, children must be able to recall details of the event long after it is over."

Long after they have unwrapped their Legos and stuffed animals, there will still be a physical reminder to give them a "jolt" of happiness. However, young children can't see or touch experiences after they are over, making it harder for them to appreciate experiences long after the event is over. There's an easy and inexpensive fix though, according to Chaplin.

"Take pictures or videos of family walks, playing in the snow, and birthday parties," she said. "Children are likely going to appreciate those experiences more if there is something to remind them of the event. Additionally, they'll be able to learn the social value of shared experiences."

Children will remember and appreciate not only the birthday gifts they received, but also the time spent with family and friends as they relive the experience through concrete reminders such as photos and videos.

Since memory is developed over time, it's likely that children, especially young ones, may not derive as much happiness from past experiences as from possessions. But with age, creating new memories and exploring new interests may be far more valuable than acquiring new possessions.

Over the past decade, the climate change research community developed a scenario framework that combines alternative futures of climate and society to facilitate integrated research and consistent assessment to inform policy. An international team of researchers assessed how well this framework is working and what challenges it faces.

The scenario framework contains a set of scenarios about how society may evolve in the future - so-called Shared Socioeconomic Pathways (SSPs) - and defines different levels of climate change known as Representative Concentration Pathways (RCPs). Combining both aspects of the framework allows researchers to develop integrated analyses of how future societies can avoid climate change and cope with its impacts.

"The SSPs started with brief global narratives combined with projections of a few key variables like GDP, population, and urbanization. In the past few years, researchers extended the SSPs to individual countries, cities, and sectors. They've also added new indicators, such as governance, income distribution, access to basic services, and air pollution. The framework has been widely and successfully applied, and has shaped climate change research," explains Brian O'Neill, director of the Joint Global Change Research Institute (JGCRI) and main author of the assessment published in Nature Climate Change.

"The scenarios framework allows scientists to use similar scenarios across many different studies. Individual research projects don't need to develop their own scenario storylines and quantifications but can build on the work of others. Once many studies use comparable scenarios, it becomes more straightforward to assess the literature for insights that emerge across these studies. This means that large scientific assessments like the Intergovernmental Panel on Climate Change (IPCC) and the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) can use the framework to structure their analyses and reports," adds IIASA researcher Bas van Ruijven, one of the authors of the study and co-chair of the International Committee on New Integrated Climate Change Assessment Scenarios (ICONICS).

In their paper, the authors synthesize the insights from the first ever Scenarios Forum organized by the University of Denver and ICONICS in Denver, CO in March 2019, and present the first in-depth literature analysis of the SSP-RCP scenarios framework. They specifically looked into how useful the framework has been for researchers, which topics the SSPs have been used for, and what can be done to improve the framework and make it more useful for future studies.

The results show that the framework has been used in almost 1,400 studies over the past five years, of which about half are related to climate impacts, one-third to avoiding climate change, and the remainder to extensions or methodological improvements. Encouragingly, the findings indicate that the scenarios framework enables research that had not been possible before, such as estimating the combined impacts of socioeconomic and climate changes on exposure to climate risks. The insights from this new study will help researchers to improve the framework and make it even more useful over the next five years. The study also revealed that some studies use unlikely combinations of socioeconomic assumptions with the highest climate change outcomes (the so-called RCP8.5 pathway). They caution that researchers should be more careful using this high climate change scenario for their studies in combination with a development pathway aiming to sustainable development, as well as in communication about their findings.

The authors identified seven recommendations for future work:

Improving the integration of societal and climate conditions

Improving applicability to regional and local scales

Improving relevance beyond the climate research community

Producing a broader range of reference scenarios that include impacts and policy

Capturing relevant perspectives and uncertainties

Keeping scenarios up to date, and

Improving the relevance of climate change scenario applications for users.

"While the scenarios framework is mostly used by researchers, it has also been translated into accessible non-technical language for the public. It has had a significant impact on how we study and think about future climate change. By identifying the weaknesses of the existing framework, we improve the utility of the framework for future studies. Also, by combining socioeconomic and climate change scenarios with other societal objectives (e.g., biodiversity), we can paint a more concrete picture of what future societies might look like and systematically explore how to avoid climate change and how to cope with its impacts," notes IIASA Energy Program Director Keywan Riahi, who was also a study author.

Going forward, ICONICS and IIASA will support the research community in further improving the scenarios framework. To facilitate these developments, the two organizations will organize an online seminar and discussion series starting in January 2021. To foster and track progress, and revise goals as experience accumulates, the Scenarios Forum is intended to become a regular biennial event. To this end, IIASA and the ICONICS Steering Committee plan to host the second Scenarios Forum in Laxenburg, Austria in 2022.

CLEVELAND -- A new paper from the Department of Psychiatry and the Population Health program at University Hospitals (UH) Cleveland Medical Center, proposes a framework for eliminating defects in behavioral health treatment.

Entitled "Eliminating Defects in Behavioral Health Treatment," the paper was published online on Nov. 19 in the journal Psychiatric Services and was written by Patrick Runnels, M.D., M.B.A., Heather M. Wobbe, D.O., M.B.A., and Peter J. Pronovost, M.D., Ph.D.

The authors cite that a large majority of defects are the result of system failures rather than due to the individual psychiatrist, and they propose that psychiatrists need to function as "systems engineers" to help eliminate these defects in healthcare organizations.

"The job of building and transforming behavioral health at the system level will require psychiatrists to adopt a new set of skills and a willingness to think differently about their identity as clinicians," said Dr. Runnels, Chief Medical Officer, Population Health - Behavioral Health at UH and Associate Professor of Psychiatry at Case Western Reserve University School of Medicine.

"Beyond assessment and treatment skills, psychiatrists who act as systems engineers must be experts in quality improvement, implementation science, resonant leadership, and design-based thinking," he said.

Dr. Pronovost, UH Chief Quality and Clinical Transformation Officer, said that they define "defect" as "anything clinically, operationally, or experientially that a provider would not want to happen, including in diagnosing, initiating treatment, adjusting treatment, nurturing therapeutic alliances at the individual provider and system level, and avoiding preventable service utilization."

"The ultimate goal is to provide "defect-free care" that we believe will empower clinicians to engage in quality improvement initiatives at whatever level is most accessible to them," said Dr. Pronovost.

"Despite our best intentions and efforts, defects happen every day in every field of medicine, said Dr. Pronovost, who is also Clinical Professor of Anesthesiology and Critical Care Medicine at CWRU School of Medicine. "Despite clear evidence-based screening tools and criteria for diagnosis, patients are rarely screened appropriately for common behavioral health issues, with barely half of identified individuals having received any care during the prior year and less than 15 percent having received appropriate evidence-based care. Even when prescribed a medication, only 23 percent of patients with depression received evidence-based psychopharmacology and appropriate symptom tracking."

The authors trace defects back to incentives that are poorly aligned with goals, within and across health care systems, often leading to inefficient, suboptimal behavioral health care delivery. To a large extent, this deficit occurs because clinicians and the systems in which they practice are incentivized almost entirely by volume and throughput rather than by quality and outcomes.

They write: "Traditional payment models, information systems, and treatment paradigms fail to incentivize keeping people healthy, managing chronic conditions, or coordinating care across the continuum of services. This is not an indictment of clinicians, who are clearly motivated to improve the lives of the patients they serve. Nor is it an indication that high-quality work is not happening. Pockets of excellence are all around. A discussion with almost any psychiatrist will yield multiple stories highlighting the positive impact they have had on those they serve, stories that motivate them to continue their work as healers. Yet, despite clinicians' best efforts, the constraints imposed by misaligned incentives negatively affect system design and lead to widespread defects in care."

"Our observation and experience are that we providers have become so accustomed to working in low-reliability environments that we accept defects in the system as the norm. Indeed, most defects are invisible or are accepted as the cost of caring for patients with complex issues," said Dr. Runnels.

In the paper, the authors provide scenarios to illustrate their points. In one such example, they describe a patient with major depressive disorder prescribed a starting dose of 20 mg of fluoxetine and scheduled for a follow-up appointment in four weeks. The patient picked up the medication but did not take the first pill for two weeks, then took two pills and stopped because of side effects. The patient called the office to report the trouble, but no one answered, and the phone call was never returned because no one checked the voicemail (no one had been assigned to check). When the patient arrived in the office four weeks later, the symptoms had not improved, and the patient ended up paying a second copayment of $50 to receive an alternative treatment. The patient described feeling angry with the system for not responding and for necessitating more time and money to receive the alternative treatment. The patient canceled the next appointment and did not return.

"If we instead made sure someone called patients one or two weeks after starting treatment and simply asked whether they had picked up the medication, tried it, and were still taking it, might we prevent this kind of outcome?" the authors ask.

They conclude with the belief that their framework to visualize and systematically eliminate defects in behavioral health care ultimately offers a hopeful approach to improving care--one that can drive large-scale success more effectively than trying to pick away at pieces of the system independently or berating clinicians about performance on individual quality metrics.

"This new narrative, which builds on much of the wisdom accumulated by our field over decades, can succeed only if clinicians see their core responsibility as focusing on eliminating defects and delivering the care that individuals with mental illness and addictions deserve, that clinicians are hungry for, and that payers increasingly demand," they write.

Young Brazilians are increasingly interested in biodiversity, conservation of the Amazon and science as they begin high school, but school students in the North region are more interested in learning about these subjects, and about local fauna and flora, than their peers in the Southeast.

These are some of the findings of a study reported in an article in Science Advances. Part of a Thematic Project supported by FAPESP (São Paulo Research Foundation), the study analyzed data from five PhD theses as well as an international survey called The Relevance of Science Education, or ROSE. The authors argue for the need to include more learning about local plants and animals in Brazil's National School Curriculum. The project was conducted under the aegis of the FAPESP Research Program on Biodiversity Characterization, Conservation, Restoration and Sustainable Use (BIOTA-FAPESP) and involved five institutions in the state of São Paulo: the University of São Paulo (USP), the Federal University of São Paulo (UNIFESP), the Federal University of the ABC (UFABC), the University of São Caetano do Sul (USCS), and Butantan Institute.

Fifteen-year-old school students have answered the ROSE questionnaire in more than 40 countries since 2004, detailing their interest in topics relating to conservation, science, technology, and biodiversity. "The Brazilian students were very interested in studying native plants and animals in more depth - far more so than youngsters in the UK, Norway or Sweden, for example. We conducted three runs of the survey in Brazil between 2007 and 2014, identifying several trends, one of which is that contrary to what may be considered common sense, young people's interest in these topics is increasing," said Nélio Bizzo, principal investigator for the project. Bizzo is Professor of Science Education at USP's School of Education and UNIFESP's Institute of Environmental, Chemical and Pharmaceutical Sciences.

The students were invited to express their views freely on topics relating to science, technology and biodiversity. The survey was conducted as a pilot in two cities in 2007, followed by nationwide samples in 2010 and 2014. In this latest run, 788 students (43.7% of the sample) in public and private high schools across the country said they were interested in learning about local wildlife, while 1,015 (56.3%) said they were not.

The comparison between regions showed that 50.4% of the students who lived in the North, which includes the Amazon Rainforest, were interested in learning more about local biodiversity, while the proportion in the Southeast was 33.1%.

The Northeast had the second-largest proportion of respondents who wanted to know more about biodiversity in their region (46.9%). "This a surprising result. One would expect interest in education to be higher in places with a higher HDI [Human Development Index] and more cultural or educational attractions such as museums, for example, but the survey showed exactly the opposite," Bizzo told Agência FAPESP. "The reasons for this inequality of interest will have to be investigated further. We want to understand why some are very interested and find ways of stimulating the others. The lowest HDIs in Brazil are in the North and Northeast. In the North, we suggest, indigenous culture may be a key reason for this interest in learning about forest conservation and biodiversity."

The researchers note in the article that Amazon biodiversity and the ancestral knowledge of the indigenous inhabitants of the region are all but absent from schools and textbooks, which tend to favor large exotic animals such as polar bears, elephants, giraffes, or lions over local diversity such as pink river dolphins, coatis, sloths, maned wolves, mosquitoes and ocelots.

"The need for Brazilian students to know more about the Amazon is evident, but schools and textbooks tell them about an impenetrable jungle only recently occupied by Indians," Bizzo said. "That's not really the case. As we know, the Amazon was very far from being empty of people when the Portuguese came over."

It is a well-established fact that in pre-Colombian times the Amazon was home to a large complex population and that these inhabitants changed the forest. "Local communities intervened in tree distribution and domesticated more than 80 plant species," he said. "This has been demonstrated by a very interesting study combining archeology and linguistics. Yet virtually nothing is said about all this traditional knowledge, even though students are eager to learn about it at school."

People know cassava has been domesticated, he added, but those more than 80 species also include the sweet potato, the pineapple, the papaya, and many other kinds of fruit and vegetable widely enjoyed around the world. "Even the active ingredient of chloroquine, the antimalarial drug that's often in the news these days, comes from the bark of a tree discovered by Amerindians," he said.

Culture also explains this strong interest to some extent, according to the researchers. Mythological creatures such as the river dolphin, curupira and mapinguari inhabit the imagination of local and indigenous populations in the Amazon, reflecting their proximity to nature. These fabulous beings and their sagas are part of the rural and urban culture of the Amazon. They contribute to the dissemination of knowledge about biodiversity, and because of them, young people living in the North, even in urban areas, have a different relationship to nature than those in the cities and countryside of the South and Southeast.

"It's very hard to find anything similar in Brazil's South region, even in western Santa Catarina, where there's a large indigenous population, mainly consisting of Guarani and Kaingang," Bizzo said, adding that a different approach to local biodiversity and conservation urgently needs to be offered to school students and the general public, especially in the Amazon.

The 2014 questionnaire included an item illustrating the disconnect between student interest and environmental policy. It asked respondents what they thought about compensation or reparation payments by rich countries to offset environmental problems. "Our objective data shows that most respondents in Brazil didn't support demands that rich countries pay reparations for environmental problems," Bizzo said. "Of course, these youngsters couldn't have foreseen that five years after this question was asked our environment minister would advocate making rich countries liable at the COP-25 UN climate conference in Madrid in December 2019."

November 24, 2020 - Orthopaedic surgery techniques for treatment of recurrent shoulder instability are effective, but prone to problems with nonunion of bone grafts held in place by screws alone. A new technique - borrowing a design used for centuries in Chinese architecture and woodworking - provides an effective approach to shoulder stabilization, suggests a study in The Journal of Bone & Joint Surgery. The journal is published in the Lippincott portfolio in partnership with Wolters Kluwer.

Inspired by the ancient woodworking technique of mortise-tenon joints, the "arthroscopic inlay Bristow procedure" provides a high success rate in patients with recurrent shoulder instability, according to the report by Guoqing Cui, MD, of Peking University Third Hospital and colleagues. Their technique "optimized the accuracy of graft positioning and resulted in a high rate of graft healing, excellent functional outcomes, and a high return to sports," the researchers write.

Initial experience shows good outcomes with 'inlay Bristow' technique
Recurrent anterior shoulder instability is a common problem among athletes, particularly those involved in collision or overhead sports. If shoulder dislocation becomes a recurrent problem, a surgical procedure may be necessary to stabilize the joint.

One popular surgical approach is the Bristow-Latarjet procedure, commonly performed arthroscopically. With this technique, a small "hook" of bone (i.e., the coracoid) is taken from the scapula and fixed with a screw to the glenoid bone, providing long-term anterior shoulder stability. This procedure has a good success rate in terms of preventing future shoulder dislocations.

However, problems can occur when the graft doesn't heal properly, resulting in nonunion. This can lead to bone deterioration and displacement or breakage of the screw, potentially resulting in recurrent instability.

Thinking about how to make the shoulder repair more stable, Dr. Cui and colleagues were inspired by an ancient technique from Chinese timber building: the mortise-tenon joint. Known to carpenters and woodworkers everywhere, this technique uses a projecting piece of wood (the tenon) that precisely fits into a gap (the mortise) in another piece of wood to join the two pieces together.

In the researchers' new "inlay Bristow" procedure, the coracoid graft is trimmed to form a tenon, which is fixed into a mortise created in the glenoid bone. Dr. Cui and colleagues report the results of 51 patients who underwent the arthroscopic inlay Bristow procedure for recurrent anterior shoulder instability.

One year after the procedure, the coracoid bone graft had healed in 96 percent of patients, with only two patients experiencing a nonunion of the bone graft. Follow-up CT scans showed good graft positioning with little or no sign of bone degeneration.

Patients also exhibited improved function with the inlay Bristow procedure, with significant improvements in shoulder stability (Rowe score) and overall joint function (American Shoulder and Elbow Surgeons score) at a minimum follow-up of three years. Eighty-seven percent of patients were able to return to sport.

Inspired by traditional Chinese architecture, the arthroscopic inlay Bristow procedure provides a promising reconstructive approach in patients with recurrent shoulder instability. The inherent strength of the mortise-tenon joint increases the contact area and proper positioning of the bone graft, with high rates of bone healing and union and good clinical outcomes. Dr. Cui and colleagues note that further studies will be needed to confirm the reliability of the procedure, and compare the outcomes of the procedure with other treatments for recurrent shoulder instability.

Click here to read "Cuistow: Chinese Unique Inlay Bristow: A Novel Arthroscopic Surgical Procedure for Treatment of Recurrent Anterior Shoulder Instability with a Minimum 3-Year Follow-Up."
DOI: 10.2106/JBJS.20.00382

Within the past two decades, Johns Hopkins Medicine researchers and others have shown that ketogenic diet therapies -- high-fat, low-carbohydrate and adequate protein diets that metabolize fat into chemicals called ketones that protect the brain and foster healthy neuron growth -- are safe and effective in treating both children and adults with drug-resistant forms of epilepsy. However, while established guidelines are available for using ketogenic diet therapy to reduce seizures in children, there aren't formal recommendations for adults.

Now, Mackenzie Cervenka, M.D., director of the Adult Epilepsy Diet Center and associate professor of neurology at the Johns Hopkins University School of Medicine, and her international collaborators have published the first set of recommendations based on current clinical practices and scientific evidence for managing ketogenic diet therapies in adult patients.

The new guidelines appear in the Oct. 30, 2020, issue of the journal Neurology: Clinical Practice.

"We wanted to guide medical professionals on how to manage adults who are using a ketogenic diet therapy," says Cervenka. "We focused on epilepsy, but we also touch on the diet's use in patients with other neurological disorders."

Emerging evidence supports using ketogenic diet therapies in other adult neurologic disorders and medical conditions, such as migraines, Parkinson's disease, dementia, brain tumors and multiple sclerosis.

"Ketogenic diets are called therapies for a reason," Cervenka says. "They should only be employed with the support of medical professionals who are familiar with them as a clinical tool. The concern is when people follow them unsupervised. Our new recommendations are designed to make it easier for health care providers to give proper guidance."

Ketogenic diets have been found effective in children with specific seizure types and epilepsy syndromes, which are often life-long conditions and require transition to adult providers for ongoing care.

"This goes back to Hippocrates, who wrote about fasting to suppress seizures," Cervenka says. "There are many studies and articles about the benefits of fasting; however, it's not a sustainable treatment. Ketogenic diet therapies create a metabolic state where you're breaking down fats like fasting, but with adequate nutrition."

To develop their recommendations, the researchers surveyed medical professionals at 20 institutions around the world on their results in treating an estimated 2,189 adults with ketogenic diet therapies for epilepsy and other neurologic diseases. Cervenka and her colleagues found that the therapy should be tailored to fit the needs of the individual patient, taking into consideration his or her: (1) physical and mental characteristics, (2) underlying medical conditions, (3) food preferences, (4) type and amount of support from family and others, (5) level of self-sufficiency, (6) feeding habits and (7) ease of following the diet.

"Most of the differences between the child and adult recommendations have to do with compliance," Cervenka says. "Often, it's more of a challenge for adults than for children."

The researchers advise medical professionals to provide their patients with recipe ideas, individualized training on the ketogenic diet lifestyle from a dietitian or nutritionist, and guidance for meal planning and preparation before initiating the therapy.

Proper preparation and training, says Cervenka, provide the greatest likelihood of success, as patients often report difficulties coping with carbohydrate restriction. She adds that patients on a ketogenic diet therapy should take multivitamin and mineral supplements, along with drinking plenty of fluids.

STUDY LOOKS AT BARRIERS KEEPING CHILDREN FROM ATTENDING DIABETES CAMPS, SUGGESTS REMEDIES

Media Contact: Michael E. Newman, mnewma25@jhmi.edu

According to the Diabetes Education and Camping Association, over 20,000 North American children with type 1 diabetes attend diabetes camps and related programs each year. These activities, says the organization, enable children to improve their management of the disease, provide motivation and support by being with others who share the condition, and foster acceptance and understanding while having fun.

Although the benefits of diabetes camp programs are well established, minority youth are underrepresented in camp attendance. In a recent study -- believed to be the first of its kind -- Johns Hopkins Medicine researchers tried to define why this occurs, identify barriers to making it happen and find potential disparities in those barriers.

The findings were reported online Oct. 8, 2020, in the Journal of Pediatric Endocrinology and Metabolism.

In the study, 39 children, ages 5 to 15 with type 1 diabetes, and their primary caregiver were surveyed. The majority of the children were between ages 10 and 15 (59%), male (54%) and had an average time with diabetes of 2.9 years. Ethnically and racially, the participants were 67% white, 28% Black, 2.5% Hispanic or Latino, and 2.5% other groups. Only 18% of the children had previously attended a diabetes camp, although most (79%) had heard about them from their diabetes medical team. Less than half (46%) of the children and their caregivers were aware that financial assistance was available to help pay for attendance.

The most frequently reported barriers to attending diabetes camp -- for all racial/ethnic groups, socioeconomic levels, and for children who had or had not previously attended camp -- were "There are no camps close to me" (59%), "Camp is too much money" (46%) and "I don't want my child to attend sleep-away camp" (44%). Families of youths ages 10 to 15 were more likely to report "My child doesn't want to attend sleep-away camp" (40%) than "I don't want my child to attend sleep-away camp" (33%).

The average number of barriers reported per family was 2.3, with no significant difference in majority compared to minority children.

Most families were able to identify benefits of diabetes camps, including meeting other friends with diabetes (100%), improved independence in diabetes control (97%), improved diabetes control (94%) and learning about diabetes (94%).

Participants stated that diabetes clinics, online and social media groups, and the Juvenile Diabetes Research Foundation were the sources they most often sought for support and information about diabetes. However, minority families reported engaging with fewer sources and networks compared with white families.

"Our findings indicate that if barriers are mitigated, parents and caregivers would be more likely to send their children to diabetes camps," says Risa Wolf, M.D., assistant professor of pediatrics at the Johns Hopkins University School of Medicine and senior author of the study.

The researchers suggest a number of strategies to improve access to diabetes camps, especially for minority and underserved populations. These include:

Operating more day camps in urban settings to provide easier access for young children -- and perhaps, serve as a springboard to overnight camps.

Increasing diversity of camp staff to appeal to more minority youth.

Inclusion of developmentally appropriate programs -- such as counselor-in-training opportunities -- to engage more adolescents.

Increasing awareness of financial assistance and scholarships for camps, thereby encouraging families to seek more support.

Increasing availability of camp information on social support networks and in diabetes clinics since most study participants cited them as primary knowledge resources.

"Although the sample size was small, our study findings clearly suggest that further research is needed -- with more Black and Hispanic/Latino families participating -- to gain greater insight into the barriers to attending diabetes camps, and then develop ways to overcome them," says study lead author Gina Ferrari, M.S.N., M.P.H., F.N.P.-C, a recent graduate of the nurse practitioner program at the Johns Hopkins University School of Nursing.

POOR ENERGY METABOLISM MAY DRIVE HEART FAILURE AFTER ATTACK

Media Contact: Vanessa McMains, Ph.D., vmcmain1@jhmi.edu

After a heart attack, a patient can go on to develop cardiac failure, but not always. Previous research looking at the molecular mechanism behind this process in heart muscle cells showed that the heart enzyme calmodulin kinase II (CaMKII) relocates to the power factories of the cell -- the mitochondria -- shortly after a heart attack to drive the organ's shutdown.

Now, Johns Hopkins Medicine researchers have shown in mice that CaMKII drains energy molecules from the mitochondria of heart muscle cells, causing the heart to work harder because it doesn't pump as efficiently. They also revealed that it was possible to direct an enzyme to move energy out of the mitochondria, enabling it to fuel the heart muscle cells. In turn, they say, this prevents the physical signs of failure in mouse hearts.

The findings, published on Sept. 4, 2020, in Nature Communications, suggest that by targeting energy transfer in the heart's muscle cells, it may be possible to prevent the progression to cardiac failure following a heart attack.

"It's really not clear clinically why certain people who have heart disease will progress to heart failure while others won't," says Elizabeth "Betsy" Luczak, Ph.D., assistant professor of medicine at the Johns Hopkins University School of Medicine, and lead author of the study. "Our findings suggest this could be a clue as to the ways to develop a therapy for people with dilated heart failure or even arrhythmias [irregular heartbeats] by enhancing transfer of ATP, the energy molecules in the cell."

Following a heart attack, one of the classic signs of heart failure is when the left ventricle -- the chamber of the heart responsible for pumping oxygenated blood throughout the body -- increases in size from working too hard. This is because the tissue of the ventricle thins and doesn't pump as well. In their study using a mouse model of a heart attack, Luczak and her colleagues turned on the enzyme creatine kinase to high levels in the heart muscle, which prevented CaMKII from draining ATP and resulted in the left ventricle no longer dilating and thinning.

According to the U.S. Centers for Disease Control and Prevention, heart failure eventually leads to death, with more than half of patients dying within five years of developing the condition.

GLOBAL STUDY SHOWS FOUR-MONTH TREATMENT FOR TUBERCULOSIS AS EFFECTIVE AS SIX-MONTH REGIMEN

Media Contact: Michael E. Newman, mnewma25@jhmi.edu

With everyone focused on the ongoing COVID-19 pandemic, it's easy to overlook the fact that there are other health threats still plaguing the world. Number one on the list is tuberculosis (TB), the disease that the World Health Organization calls the leading cause of death worldwide -- some 1.5 million fatalities annually -- from a single infectious agent (the microbe Mycobacterium tuberculosis). Now, the recently released results of an international clinical trial have shown that a four-month daily treatment plan using a high-dose, or "optimized," course of the drugs rifapentine and moxifloxacin is as safe and effective as the existing standard six-month daily therapy.

The new regimen is the first successful short-course treatment option for drug-susceptible TB disease in 40 years. The findings from the clinical trial that led to its development -- with significant involvement from Johns Hopkins Medicine researchers -- were announced Oct. 21, 2020, by the research team funded by the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH).

In the past 40 years, physicians have put their patients with TB on a six-month treatment regimen, which includes daily doses of the drugs rifampin, isoniazid, pyrazinamide and ethambutol for eight weeks, followed by 18 weeks of daily therapy with just rifampin and isoniazid. Looking for a way to shorten the regimen without sacrificing safety or efficacy, the CDC's Tuberculosis Trials Consortium and the AIDS Clinical Trial Group (funded by the NIH's National Institute of Allergy and Infectious Diseases) conducted one of the largest TB clinical trials in history. It involved more than 2,500 participants, ages 12 and older with newly diagnosed TB, who were enrolled at 34 clinical sites in 13 countries. The trial included 214 people with HIV infection.

Participants in the trial, known as Study 31/A5349, were given standard treatment or one of two four-month drug regimens for their TB -- the first featuring high-dose rifapentine, instead of rifampin, and the second using high-dose rifapentine and moxifloxacin.

"We found that four months of treatment -- with rifapentine and moxifloxacin -- cured TB as well as the six-month standard treatment, had a comparable level of safety, and was well tolerated by patients," says Richard Chaisson, M.D., director of the Johns Hopkins Center for Tuberculosis Research, professor of medicine at the Johns Hopkins University School of Medicine and one of four co-chairs of Study 31/A5349.

However, the regimen of high-dose rifapentine without moxifloxacin was found to be inadequate.

Along with their leadership role in the trial, the Johns Hopkins Medicine researchers followed 100 participants at a Johns Hopkins Medicine-funded center in South Africa and previously had conducted a number of animal studies that helped lay the groundwork for the latest investigation.

"This will certainly change how TB is treated in the United States [which still documents just under 10,000 cases annually] and likely, the world," Chaisson says.

MOLECULAR 'SWITCH' CONTROLS ABILITY TO REPAIR HEARING LOSS IN MICE

Media Contact: Rachel Butch, rbutch1@jhmi.edu

In a study in mice, Johns Hopkins Medicine researchers have found a molecular "switch" that turns off the animal's ability to repair damaged cells in the inner ear. The findings shed light on regenerative abilities that are present in many species of birds and fish, but get turned off in mammals, including humans.

The study was published Sept. 8, 2020, in The Proceedings of the National Academy of Sciences.

"We might have for the first time identified something that explains why humans lost the ability to repair cells related to hearing loss," says Angelika Doetzlhofer, Ph.D., associate professor of neuroscience at the Johns Hopkins University School of Medicine, and co-author of the study.

More than 37 million adults in the United States report hearing loss. In the majority of cases, it results from damage to sound receptor cells deep within the human ear known as hair cells. These cells line the spiral-shaped walls of the cochlea, a bony structure in the inner ear, and capture sound waves reverberating in the area. Then, they convert the vibrations into electrical impulses that are carried to the brain by nerves.

Hair cells are kept healthy by a layer of cells called supporting cells. In birds and fish, supporting cells can function as progenitors to replace lost hair cells. Recent studies of mammals have shown that supporting cells have some regenerative potential early in life, before the animals start hearing. For example, supporting cells in mouse pups are able to create new hair cells at birth. However, the ability to repair or replace them stops within a week. At that point, any damage done to the hair cells is irreversible.

Based on these data from previous mouse studies, Doetzlhofer and study co-author Xiaojun Li, Ph.D., a postdoctoral fellow in her laboratory, looked to the rodents as a way to better understand what controls the decline in regenerative ability in mammals.

The researchers achieved this by following the levels of a protein and micro RNA in mice, called LIN28B and let-7, respectively. LIN28B and let-7 are what scientists call "mutual agonists,"' meaning they control each other's function within the cell.

They found that when let-7 levels ramp up, LIN28B levels drop at the same time, turning off the mouse's regenerative ability.

The two researchers found that without LIN28B, hair cell regeneration does not occur. They tested this by using cochlear tissue and cells from genetically engineered mice that enabled the protein and its agonistic RNA to be turned on and off as needed.

The researchers say that their findings suggest LIN28B is the deciding factor as to whether or not the hair cells retain their regenerative abilities. LIN28B, they believe, promotes the regenerative process by turning on progenitor-specific genes in supporting cells, which then reprograms supporting cells into hair cell progenitor-like bodies.

"The most exciting part was seeing the dramatic effects of manipulating these factors. We began the experiment hoping to get any type of response, and to see a restoration regeneration capability was really thrilling," says Doetzlhofer.

The researchers say that a better understanding of the biology behind hair cell regeneration may lead to the development of future treatments for hearing loss.

This research was supported by the National Institute on Deafness and Other Communication Disorders and the David M. Rubenstein Fund for Hearing Research.

The number of young people with anxiety doubled from 13 per cent to 24 per cent, during the early stages of the COVID-19 pandemic and lockdown 1, according to new research from the University of Bristol. The study, using Bristol's Children of the 90s questionnaire data, showed that young people (27-29 years) reported higher levels of anxiety during the early phases of the pandemic in the first national lockdown and this was higher than their parents.

Researchers also found that anxiety levels continued to remain high even when lockdown restrictions were eased in June and thus a similar situation may be expected this winter. The findings also suggest that this could be worse for individuals with a history of mental health problems, women and those who had experienced pre-pandemic financial problems. These findings have been highlighted by Public Health England to help influence policy and the government's understanding of the impact of COVID-19 on mental health.

There was no evidence that depression was higher overall, however, specific groups of individuals were more likely to experience greater levels of depression and anxiety during the pandemic.

Bristol's Children of the 90s health study recruited 14,500 pregnant mothers in 1991-2 and has collected almost three decades of detailed health and lifestyle data about the mothers and their babies, who will soon be turning 30. For this study, researchers compared participants' previous years' of data with findings from two 2020 COVID-19 questionnaires to understand the impact of the pandemic on mental health.

Who is at risk of poorer mental health during COVID-19?

Certain groups within the study were at greater risk of increased anxiety and/or depression during COVID-19, even after accounting for their previous history of depression and anxiety. These were women, those with pre-existing mental and physical health conditions, those living alone during the pandemic, those self-isolating as a result of COVID-19 and those who had experienced recent financial problems. Interestingly, some factors, such as living alone, were only linked to greater depression and others, such being a parent, only linked to anxiety. Researchers did not find evidence of an elevated risk of anxiety in key workers or healthcare workers. These findings were observed in both the younger and older generations and replicated in an additional group of over 4000 Scottish individuals - implying these effects may not just be specific to individuals in the South-West.

Researchers are now looking at why some groups of people may have poorer mental health during the pandemic and the role of worries and health behaviours such as sleep and exercise levels. A further questionnaire examining the impact of the England's second lockdown is planned for December. Alongside the data from Children of the 90s, the research also looked at data from another longitudinal study - Generation Scotland.

Co-lead researcher Dr Alex Kwong, Senior Research Associate in Psychiatric Genetic Epidemiology at University of Bristol, commented: "The highly detailed Children of the 90s questionnaire data reveals a worrying rise in young people's anxiety - this looks like it is due to the pandemic itself and potentially the societal and economic fallout caused by the lockdown measures used to control the spread of the virus. Evidence suggests this is not going to be a short-term issue and that mental health support and interventions are urgently required to reduce some of the mental health inequalities that have emerged."

COVID-19 in Children of the 90s

The Children of the 90s' first two COVID-19 questionnaires uncovered details about participants' COVID-19 symptoms, plus their work, finances, lifestyle and diet - helping to understand more about their own, their parents' and their children's physical and mental health.

As might be expected in a study heavily based in the south west of England, only a small percentage had tested positive for COVID-19, but a larger and more representative number of participants have experienced at least one of the primary COVID-19 symptoms - loss of smell/taste (13 per cent), new persistent cough (21 per cent) or fever (23 per cent). A subsequent antibody testing study by Children of the 90s found that 4.3 per cent of those who took part tested positive for antibodies, suggesting they had previously had an infection with COVID-19.

Professor Nic Timpson, principal investigator of Children of the 90s comments: "Longitudinal health studies like Children of the 90s are so important as they repeatedly measure an individual's mental health (as well as lifestyle and general health) over different time points throughout their life. With this study, it enabled us to compare pre- and post-pandemic data to fully understand the impact of COVID-19 on mental health. Such detailed, contextualised health data is unique, providing valuable evidence for policymakers and Public Health England."

Co-lead researcher Dr Rebecca Pearson, Senior Lecturer in Psychiatric Epidemiology and the University of Bristol said: "The findings suggest that there is a need to protect mental health at this time (especially managing anxiety) and support mental health services. It is especially important to learn lessons from the first lockdown now that we are in a second lockdown. The findings also provide evidence for supporting specific groups at greater mental health risk, such as those living alone. Support bubbles for single adults and single parents (which have been allowed from the outset this lockdown) could be beneficial to mental health, but we need to understand the role of social isolation better".

Professor David Porteous, Principle Investigator for Generation Scotland said: "This study shows beyond doubt how COVID-19 is affecting mental health, particularly in younger people. The strength of the study is really three-fold. First, both Children of the 90s and Generation Scotland had mental health measures from before and repeat measures during the pandemic. Second, each cohorts findings echo the other. Third, the findings are not a quirk of locality - young adults in both Scotland and around Bristol were similarly affected. The study shows that indirect effects of COVID-19 are profound and widespread and felt most acutely by young adults. They as much as any group will bear the long-term brunt of the COVID experience and post-pandemic recovery."