Culture

According to an international study published in Frontiers in Psychology, people around the world have reported changes in their physical activity levels, wellbeing, and eating habits during the first stages of the COVID-19 pandemic. A decrease in physical activity during the pandemic was associated with poorer perceived physical and mental health. Reduced exercise was also associated with perceptions of weight gain and decreased sleep.

More than a thousand individuals from several countries with different containment measures participated in an online survey that explored changes in physical activity, eating, sleep, physical and mental health, and wellbeing during the first lockdown phases of the COVID-19 pandemic. The study was conducted in collaboration between the Faculty of Sport and Health Sciences at the University of Jyväskylä, the University of Wolverhampton and the University of Northampton in the United Kingdom.

Comparisons across countries revealed significant differences in physical health, with Finnish participants reporting higher values and participants residing in the UK indicating poorer health.

There was great variability in participants' physical activity. Some individuals reported a high increase in physical activity while others reported a great decrease.

"Increased physical activity was associated with better physical health as rated over the past week along with increased wellbeing and sleep," says Sport and Exercise Psychology Lecturer Montse Ruiz from the Faculty of Sport and Health Sciences at the University of Jyväskylä, Finland. "In contrast, reduced physical activity was related to lowest mental health, represented by more personal and emotional problems, and a signi?cant increase in eating and weight."

Participants living in Latin American countries perceived themselves to have poorer mental health, compared to South Koreans who indicated being significantly less affected by personal or emotional problems. Filipino participants reported higher sleep and eating scores compared to the other countries.

"Our findings indicate that irrespective of country of residence or age, participants reporting reduced physical activity typically experienced poorer physical and mental health along with diminished wellbeing," Ruiz says. "Reduced exercise was also associated with perceptions of weight gain and decreased sleep."

To minimize the spread of the SARS-CoV-2 virus, a range of containment measures, including the restriction of people's movement, were implemented in several countries. As a result, changes in peoples' behaviors were observed, such as the well-documented instances of panic buying and stockpiling of household items.

"As the containment measures related to COVID-19 continue, our findings highlight the importance of exercise in maintaining good physical and mental health," Ruiz says. "As such, we encourage individuals to find ways of incorporating physical activity into their day where possible."

A RAND Corporation report funded by The Rockefeller Foundation shows that COVID-19 testing can be effectively integrated into K-12 schools' pandemic response plans, helping families and staff feel more comfortable with in-person instruction.

The report found that even for well-resourced districts and schools, launching a COVID-19 testing program was a major undertaking that required access to rapid-turnaround tests, additional staffing or strong partners for logistical support, technical assistance for the design and execution of testing programs, and a strategy for successfully engaging the school community to participate in testing.

"Our interviews with K-12 schools show that COVID-19 testing is complex, but doable," said Laura Faherty, lead author and a physician policy researcher at nonprofit, nonpartisan RAND. "Many early adopters found it critical to partner with local public health departments, local health systems, their peers and testing vendors to launch feasible COVID-19 testing programs. But even with strong partnerships in place, school and district leaders described just how much effort it takes to make a testing program run smoothly. They described being 'hungry' for guidance and in need of a lot of technical assistance."

Researchers examined the experiences of schools and districts that were early adopters of COVID-19 testing in Fall 2020, including insights from a national scan of schools as well as more than 80 interviews with K-12 school and district leaders in December 2020.

According to the report, COVID-19 testing programs were more often implemented in public and independent schools with access to resources such as expert advice, sufficient funding and strong local partnerships.

Schools encountered varying degrees of hesitation around testing and used several strategies to encourage participation. Privacy concerns were common: Staff and parents worried their health information could be shared with others. Members of school communities expressed concern about how their test samples would be used. Another barrier to engaging their communities in testing was doubt about the actual risk posed by COVID-19.

"To give their communities peace of mind to return to in-person learning, schools often started small, using a pilot period to work out many of the details before fully launching," said Benjamin Master, co-leader of the project and a policy researcher at RAND. "The most scalable testing models that we identified involved districts that were able to access expert technical support and partners who could help manage the logistics of testing."

The report provides recommendations for how schools can develop, and policymakers can support, effective COVID-19 testing programs. Among them:

expand funding to ensure schools can access tests, hire additional staff and contract with vendors as needed to implement testing

continue to invest in research and development of testing solutions that are convenient for schools to use

provide incentives such as paid sick leave for teachers and families to participate in testing and isolate as needed

promote the use of standardized metrics and data platforms to support decisionmaking

provide resources to strengthen state and local health departments so they're fully equipped to help schools design testing programs and respond to positive tests.

The Rockefeller Foundation's funding for the report is part of its portfolio of work aimed at disseminating lessons learned so far about the use of COVID-19 testing to help facilitate school reopening.

According to the current BfR-Corona-Monitor of the German Federal Institute for Risk Assessment (BfR), 43 percent of the respondents have already had themselves tested for the virus. The survey, which has been conducted regularly for almost a year now, documents how the population is dealing with the situation, what they are doing to protect themselves and how they are informing themselves about the current events. "For 50 weeks now, our survey has provided insights into the current situation and its development," says BfR-President Professor Dr. Dr. Andreas Hensel. "Over time, we see that the vast majority of the population is implementing the key protective measures."

BfR-Corona-Monitor as to 2-3 March 2021:
https://www.bfr.bund.de/cm/349/210302-bfr-corona-monitor-en.pdf

Regarding the measures ordered to contain the coronavirus, the current mood is very mixed. For example, 84 percent of the respondents support the cancellation of events, 92 percent think the distance regulations are appropriate, and 91 percent think the same about the mandatory use of masks. For months, these regulations have been quite consistently accepted by the population. Other measures, however, have been losing support over the past few weeks. For example, approval for the closure of shops has dropped to 37 percent - at the beginning of January it was at 61 percent. In the current survey, about half of the respondents approve of the closure of restaurants, and 60 percent approve of the closure of cultural institutions. Similar values were last seen in the surveys at the beginning of December. After that, approval had initially risen.

Proximity to other people is still assumed to be the primary source of infection. Currently, around two-thirds of respondents rate the probability of contracting the disease through proximity to others as high. By comparison, at the beginning of the pandemic about a year ago, this figure was at 81 percent. Overall, it can be seen over time that the transmission of the coronavirus via objects such as door handles or toys is now considered less likely than a year ago. The perception of the possibility of an infection via pets, on the other hand, remains fairly constant. The values vary, with minor outliers, between 6 and 10 percent.

Researchers at Uppsala University have developed a digital self-test that trains users to assess news items, images and videos presented on social media. The self-test has also been evaluated in a scientific study, which confirmed the researchers' hypothesis that the tool genuinely improved the students' ability to apply critical thinking to digital sources.

The new tool and the scientific review of it are part of the News Evaluator project to investigate new methods of enhancing young people's capacity for critical awareness of digital sources, a key component of digital literacy.

"As research leader in the project, I'm surprised how complicated it is to develop this type of tool against misleading information - one that's usable on a large scale. Obviously, critically assessing digital sources is complicated. We've been working on various designs and tests, with major experiments in school settings, for years. Now we've finally got a tool that evidently works. The effect is clearly positive and now we launch the self-test on our News Evaluator website http://www.newsevaluator.com, so that all anyone can test themselves for free," says Thomas Nygren, associate professor at Uppsala University.

The tool is structured in a way that allows students to work with it, online, on their own. They get to see news articles in a social-media format, with pictures or videos, and the task is to determine how credible they are. Is there really wood pulp in Parmesan cheese, for instance?

"The aim is for the students to get better at uncovering what isn't true, but also improve their understanding of what may be true even if it seems unlikely at first," Nygren says.

As user support, the tool contains guidance. Students can follow how a professional would have gone about investigating the authenticity of the statements or images - by opening a new window and doing a separate search alongside the test, or doing a reverse image search, for example. The students are encouraged to learn "lateral reading" (verifying what you read by double checking news). After solving the tasks, the students get feedback on their performance.

When the tool was tested with just over 200 students' help, it proved to have had a beneficial effect on their ability to assess sources critically. Students who had received guidance and feedback from the tool showed distinctly better results than those who had not been given this support. The tool also turned out to provide better results in terms of the above-mentioned ability than other, comparable initiatives that require teacher participation and more time.

Apart from practical tips such as opening a new search tab, doing reverse image searches and not always choosing the search result at the top of the hit page (but, rather, the one that comes from a source you recognise), Nygren has a general piece of advice that can help us all become more critically aware in the digital world:

"Make sure you keep up to date with information and news from trustworthy sources with credible practices of fact-checking, such as the national TV news programmes or an established daily newspaper. It's difficult and arduous being critical about sources all the time."

Philadelphia, March 9, 2021--Combining computational mining of big data with experimental testing in the lab, researchers at Children's Hospital of Philadelphia (CHOP) have identified RNA editing events that influence gene expression and, in turn, the phenotypic manifestation of that expression. In analyzing so-called A-to-I RNA editing, in which the adenosine of an RNA molecule is chemically modified into an inosine, the researchers describe how a single nucleotide change by RNA editing can have large downstream effects. The findings were published today in Genome Biology.

"Millions of A-to-I RNA editing sites have been identified across the human transcriptome, but the functions of most RNA editing events are unknown," said Yi Xing, PhD, director of the Center for Computational and Genomic Medicine at CHOP and senior author of the study. "Understanding how RNA editing affects gene expression and phenotype could help us unravel the genetic basis to many human conditions."

Dr. Xing and his team studied the functions of RNA editing through the lens of human genetic variation, or the differences that occur among people in approximately 1 in 1,000 DNA base pairs, affecting not only how genes are expressed but also how messenger RNAs (mRNAs) are processed. The researchers analyzed matched genetic and transcriptomic data of 49 tissues across 437 individuals, in a total of approximately 8,000 human samples from the NIH Genotype-Tissue Expression (GTEx) project, looking for A-to-I RNA editing events that are associated with genetic variation among individuals. They utilized an approach involving molecular quantitative trait loci (QTL) mapping, which maps molecular traits to genotypes to find genetic effects on gene regulation. Molecular QTL studies can provide clues to the genetic mechanisms that govern biological processes.

Using this approach, the researchers identified 3,117 unique RNA editing events associated with genetic variation. Surprisingly, 14% of these RNA editing QTLs were also associated with genetic variation in gene expression. In comparing their data with available genome-wide association study data, they found a subset of these RNA editing QTLs were also associated with complex traits or diseases in the human population.

To understand why RNA editing variation can be coupled with gene expression variation, the researchers focused on microRNAs, a class of small noncoding RNAs that can regulate gene expression by binding to complementary sequences in mRNAs and causing the bound mRNA molecules to be degraded. The research team found that certain microRNAs degrade or do not degrade their target mRNAs, depending on whether a given RNA editing site in the mRNA remains unedited as an adenosine (A) or is edited to an inosine (I). If such an RNA editing site is regulated by human genetic variation, this can trigger a cascade of downstream events by changing the stability and abundance of critical mRNA molecules and consequently the phenotypes influenced by these mRNA molecules.

"What is so useful about this approach is that it is disease agnostic," Dr. Xing said. "Future research can use this strategy to study specific diseases and look at the impact of RNA editing events from a disease perspective."

Flash sintering is a ceramic processing technique which uses electric current to intensively heat the ceramic sample internally rather than using only external furnace heating. The process can lower ceramic processing temperatures and durations significantly, enabling ceramics to be co-processed with metals or other materials, and reducing energy use.

However, the process can result in low quality ceramics due to weaknesses caused by inhomogeneities in the microstructure.

The origins of these inhomogeneities caused by thermal gradients in the material during flash sintering have been studied by researchers based at WMG, University of Warwick and academic and industrial collaborators, and routes to mitigate the effects of these gradients are outlined.

Adopting these modified flash sintering routes will enable the wider use of flash sintering in ceramic processing, enabling lower energy production of many useful ceramic products including solid-state batteries.

Densifying ceramics using flash sintering reduces energy use and may be used to improve the viability of manufacturing complex ceramic structures such as those required for solid state batteries by lowering the temperatures and shortening the duration of the heat treatment.

Caption: Causes and Effects of thermal and microstructural gradients in flash sintered ceramics. Credit: WMG, University of Warwick

Working in collaboration with academic and industrial partners, researchers from WMG, University of Warwick have published a review of the state of the art of flash sintering focusing on the formation of inhomogeneous regions within the ceramics which currently limit the scale-up potential of flash sintering. The review finds that thermal gradients are responsible for microstructural inhomogeneities and suggests of routes to eliminate or reduce these effects.

The reduction of energy use in the ceramic manufacturing industry is a key step in meeting global emissions reduction targets, as conventional processes require long firing treatments at very high temperatures. Several low-energy processes have been developed over the past decade, with flash sintering emerging as a particularly promising route for densification of materials for use in applications including solid state batteries, thermal barrier coatings, and ceramic joints.

In the paper, 'Promoting microstructural homogeneity during flash sintering of ceramics through thermal management' published as part of a special issue of the MRS Bulletin, Gareth Jones and Dr Claire Dancer from WMG, University of Warwick worked with collaborators from the University of Trento, Wuhan University of Technology, Normandie Université, and Lucideon Ltd to review the origins of microstructural variations in different regions of ceramic materials undergoing flash sintering.

Caption: Microstructural development changes with different sintering approaches. Flash sintering produces fine microstructures with very high density with lower energy use than conventional approaches. Credit: WMG, University of Warwick

Differences in microstructural development originate from thermal gradients within the material during processing, and these can be reduced by careful thermal management during the flash sintering process. These include:

Altering the method for applying electrodes

Improving thermal homogeneity through insulation

Tailoring the frequency of the AC current

Developing contactless methods for applying the electric current - which are currently limited to consolidation of thermal barrier coatings.Caption: Simulation of heat distribution during flash sintering. Credit: WMG, University of Warwick

The findings of this review provide a roadmap for further research on thermal management in flash sintering, which will accelerate the development of the process for industrial implementation.

Dr Claire Dancer, leader of the Ceramics Group within the Materials and Sustainability Directorate at WMG, University of Warwick comments:

"Lowering ceramic processing temperatures by using techniques such as flash sintering is an essential step for manufacturing complex multi-material structures such as those needed for solid-state batteries, and for lowering overall energy use in the ceramic industry.

"However, the process must produce robust homogenous ceramic materials to be of widespread use. Our paper explains why flash sintering can result in inhomogeneous properties in ceramics and suggests a number of routes to mitigate these effects."

As the fight against COVID-19 continues, scientists have turned to an unlikely source for a potentially effective treatment: tiny antibodies naturally generated by llamas.

While the world has welcomed the news of multiple vaccines against COVID-19, the search for effective treatments for those who contract the virus is ongoing. Now scientists are looking to what might seem to be an unlikely source: the South American llama.

Researchers are using the ultrabright X-rays of the Advanced Photon Source (APS), a U.S. Department of Energy (DOE) Office of Science User Facility at DOE’s Argonne National Laboratory, to help turn naturally generated llama antibodies into potentially effective therapies against SARS-CoV-2, the virus that causes COVID-19. Antibodies are the immune system’s natural defense against infection, and when extracted from blood, they can be used to design treatments and vaccines.

“Llamas generate these nanobodies naturally in high yields, and they fit into the pockets on the surface of proteins that larger-size antibodies can’t access.” — Jason McLellan, The University of Texas at Austin.

“We have received more than 50 llama antibodies with several proteins of SARS-CoV-2,” said Andrzej Joachimiak, director of the Structural Biology Center (SBC) at the APS and co-director of the Center for Structural Genomics of Infectious Diseases. (Researchers at the APS do not work with the live virus, but with crystals grown from simulated proteins.) These antibodies are part of ongoing collaborations with several partners, including researchers at the National Institutes of Health (NIH) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Joachimiak said, and will be analyzed using the APS to see if they combat the virus’s infectivity.

While it may seem surprising that scientists are turning to llamas, there’s a very good reason for it.

Llamas belong to a group of mammals called camelids, a group that also includes camels and alpacas. Thanks to a quirk of nature, camelids produce a unique type of antibody against disease. These antibodies, often referred to as nanobodies, are about half the size of the antibodies produced by humans. They’re also remarkably stable and easy for scientists to manipulate.

This genetic quirk, which causes camelids such as llamas to produce these smaller antibodies with single protein chains, was discovered by accident in the late 1980s by scientists in Belgium. Since then, scientists have worked with camelid nanobodies to create treatments against several diseases with great success. Their small size allows them to bind to areas of viral proteins that larger antibodies cannot fit into, blocking those proteins from connecting with cells.

“Llamas generate these nanobodies naturally in high yields, and they fit into the pockets on the surface of proteins that larger-size antibodies can’t access,” said Jason McLellan, an associate professor at The University of Texas at Austin.

McLellan has years of experience working with camelid nanobodies. He and his graduate student Daniel Wrapp, along with Xavier Saelens’ group in Belgium, have isolated nanobodies that have proven effective against respiratory syncytial virus (RSV) and two coronaviruses: severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).

When the genetic sequence of SARS-CoV-2 was released in January of 2020, McLellan, Wrapp and Saelens worked quickly to test whether any of the antibodies that they had previously isolated against the original SARS-CoV (taken from a Belgian llama named Winter) could also bind and neutralize SARS-CoV-2.  They discovered that one of these nanobodies, which they had characterized using the SBC beamlines at the APS, might be effective against SARS-CoV-2. McLellan said this nanobody — called VHH72 — is now under development as a treatment for COVID-19. He and Wrapp received a 2020 Golden Goose Award for this research.

McLellan will tell you that while his results were good, his hopes were a little higher.

“We were seeking one potent antibody that neutralized all coronaviruses,” he said. “We immunized Winter hoping to elicit that one nanobody. And maybe we elicited it, but we didn’t isolate it.”

Isolating these tiny nanobodies is tricky, since the body generates an enormous number of them and only a small fraction is intended to fight a particular virus. That’s exactly the problem that Yi Shi, professor of cell biology at the University of Pittsburgh, is trying to fix.

In a paper published in Science, Shi and his colleagues unveiled a new advanced mass spectroscopy method of analyzing those nanobodies from samples of llama blood. The result, according to Shi and research assistant Yufei Xiang (the paper’s lead author), is a large set of nanobodies that bind well to the SARS-CoV-2 virus.

“This is thousands of times better than the current technology, specifically in its selecting properties,” Shi said. “We want nanobodies that bind tightly to SARS-CoV-2, and with this method we can get a drug-quality nanobody that is up to 10,000 times more potent.”

As with McLellan’s research, Shi’s experiment began with a llama, this one named Wally because he resembles (and therefore shares a name with) his black Labrador. The team immunized Wally against SARS-CoV-2, waiting two months for nanobodies to be generated, and then Xiang used their new method to analyze the nanobodies, identify and quantify them. They ended up with 10 million nanobody sequences.

These nanobodies can sit at room temperature for six weeks, and are small enough that they can be aerosolized, meaning therapeutics designed from them can be inhaled directly to the lungs instead of moving through the bloodstream. To confirm the nanobodies’ effectiveness, Cheng Zhang, assistant professor at the University of Pittsburgh, determined structures of the nanobodies bound to the SARS-CoV-2 virus at the National Institute of General Medical Sciences and National Cancer Institute Structural Biology Facility (GM/CA) at the APS.

“With this method we can discover thousands of distinct, ultrahigh-affinity nanobodies for specific antigen binding,” Shi said. “These nanobodies may or may not provide a treatment for COVID-19, but the technology used to isolate them will be important in the future.”

Most recently, a team of scientists led by the University of Bonn in Germany reported newly discovered nanobodies that bind to SARS-CoV-2 and may prevent what is called “mutational escape.” That’s the ability of a virus to avoid immune responses by mutating, and a treatment that prevents the virus from doing so would guard against reinfection.

This research team combined several nanobodies into molecules that attack different parts of the virus simultaneously, helping to prevent virus mutations from reducing therapeutic effectiveness. These nanobodies were taken from a llama and an alpaca immunized against the SARS-CoV-2 virus, and out of several million candidates they ended up with four molecules that proved to be effective.

Ian Wilson, professor of structural biology at the Scripps Research Institute in California, led the team that conducted X-ray diffraction studies at GM/CA at the APS to determine structures of these molecules bound to the virus.

“From crystal structures determined from data collected at APS and the Stanford Synchrotron Radiation Lightsource (SSRL), we were able to identify the binding sites of the nanobodies on the SARS-CoV-2 receptor binding domain,” Wilson said. “The X-ray structural information, combined with cryo-electron microscopy data, was used to help design even more potent multivalent antibodies to prevent COVID-19 infection. The X-ray structural work was greatly facilitated by immediate access to the APS.”

Only time (and further tests) will tell whether the various nanobodies will translate into effective treatments against COVID-19. But if they do, we’ll have the lovable llama to thank for it. 

The Advanced Photon Source is a U.S. Department of Energy (DOE) Office of Science User Facility operated for the DOE Office of Science by Argonne National Laboratory. Additional funding for beamlines used for COVID-19 research at the APS is provided by the National Institutes of Health (NIH) and by DOE Office of Science Biological and Environmental Research. The APS operated for 10 percent more hours in 2020 than usual to support COVID-19 research, with the additional time supported by the DOE Office of Science through the National Virtual Biotechnology Laboratory, a consortium of DOE national laboratories focused on response to COVID-19 with funding provided by the Coronavirus CARES Act.

Study Reveals New Hope for Men With Common Urinary Issues

A new systematic review of evidence recommends the use of behavioral self-management treatments for common urinary issues experienced by upwards of 70 percent of older men. Common symptoms include trouble urinating, increased frequency and incontinence. These symptoms can have a substantial negative impact on sleep, social functioning and quality of life. Several guidelines recommend self-management techniques like health education, advice on fluid intake, and bladder retraining; however, in practice, self-management is often excluded from the menu of treatment options that include medication and surgery.

Researchers at Bond University's Institute for Evidence-Based Healthcare found that self-management interventions reduced the severity of lower urinary tract symptoms. The reduction in symptoms appeared similar in groups receiving medications versus self-management interventions. However, compared with drugs alone, individuals who had both drug and self-management intervention experienced a small but meaningful reduction in symptom severity after six weeks. The authors recommend further research to determine the optimal components and delivery methods for self-management interventions so that these strategies can become standard options for men with lower urinary tract symptoms.

Self-Management for Men With Lower Urinary Tract Symptoms: A Systematic Review and Meta-Analysis

Loai Albarqouni, MD, MSc, PhD, et al
Bond University, Queensland, Australia
https://www.annfammed.org/content/19/2/157

Treating Incontinence in Primary Care: A Doctor Versus Mobile App Trial

A mobile app designed to help women manage urinary incontinence was as effective as usual, in-person treatment of incontinence in primary care, according to new research from the Netherlands. The study included 262 women with frequent stress incontinence, overactive bladder or a mix of symptoms. Participants were randomly assigned to use a standalone mobile app called URinControl, which offered pelvic floor muscle and bladder training exercises. Those in a control group received standard care and were referred to their own primary care doctors who were broadly advised to follow the Dutch guidelines for primary care. After four months, women who used only the incontinence app and those who continued with standard care experienced similar results, with a decline in the severity of their symptoms, less frequent leakage and improved quality of life. Statistical analysis showed just over a one-half percentage point difference between the two groups' average decline in symptom severity. Therefore, the authors conclude that primary care physicians can offer care-as-usual and/or app-based treatment to women seeking help for urinary incontinence. Most importantly, the authors note, a mobile app will only be clinically relevant if it can demonstrate that it is either a less expensive option or offers an accessible and user-friendly alternative with significant long-term outcomes.

App-Based Treatment in Primary Care for Urinary Incontinence: A Pragmatic, Randomized Controlled Trial

Anne M. M. Loohuis, MD, et al
University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
https://www.annfammed.org/content/19/2/102

App-based and self-management tools have the potential to help individuals take control of their common urinary issues. In a corresponding editorial, Joel Heidelbaugh, MD, a clinical professor of family medicine and urology at the University of Michigan, discusses the significance of Loohuis et al's mobile app study and Albarqouni et al's review of self-management interventions, and highlights their value to both patients and primary care physicians. For patients, new e-health programs could help individuals manage their symptoms and improve their quality of life without medication, or they may experience additional benefits when combined with medication. For primary care physicians, apps and self-management tools might be a cost-effective and empowering strategy compared to usual care.

Self-Directed Technology to Improve Urinary Symptoms

Joel J. Heidelbaugh, MD
University of Michigan Medical School, Ann Arbor, Michigan
https://www.annfammed.org/content/19/2/100

Perspectives of US Youth During the Initial Month of the COVID-19 Pandemic

According to two national surveys by researchers at the University of Michigan Medical School, US teens and young adults are engaged in the ongoing COVID-19 pandemic with most being knowledgeable about the disease, concerned about its impacts on others, and practicing social distancing. On March 6, 2020, 70 percent reported knowledge of the pandemic, with 46 percent noting they got information from news sources. By March 20, 2020, nearly all respondents, 95 percent, reported impact. Worry about the pandemic increased from 25 to 51 percent. For some young people who weren't worried early on about the pandemic, staying at home and engaging in other preventive public health guidelines made them feel safer. Between the two surveys, pandemic preparation seemed to shift. Initially, respondents primarily reported doing nothing (36 percent), but by March 20th, 50 percent reported practicing social distancing. The authors recommend that, as public health planning evolves, it will be important to acknowledge young people's concern for others as a driver of their behavior and to create programs that are informed by their beliefs and perspectives.

Perspectives of US Youth During Initial Month of the COVID-19 Pandemic

Eric Waselewski, MD, et al
University of Michigan Medical School, Ann Arbor, Michigan
https://www.annfammed.org/content/19/2/141

Bonus: Visual Abstract

Primary Care Big Data Can Provide Opportunity for Rapid Research to Inform Patient Care, Policy During COVID-19 Pandemic

Members of the COVID-19 Primary Care Database Consortium explain how the use of big data containing millions of primary care medical records provides an opportunity for rapid research to help inform patient care and policy decisions during the COVID-19 pandemic. Established in April 2020, the Consortium brings together experts in big data, epidemiology, intensive care, primary care and statistics, as well as journal editors, patient and public representatives, and front-line clinical staff from the universities of Oxford, Cambridge, Southampton, Bristol and Nottingham

The consensus statement that the consortium has developed and described in the article aims to facilitate transparency and rigor in methodological approaches, as well as consistency in defining and reporting cases, exposures, confounders, stratification variables and outcomes in relation to the pharmacoepidemiology (i.e. the potential influence of old and new drug therapies on outcomes) of COVID-19. This is important, the authors write, because the vast majority of drugs for common conditions such as hypertension, diabetes or heart failure are prescribed in primary care practitioners in the U.K. For example, ACE-inhibitors widely prescribed by primary care doctors may impact COVID-19 outcomes. Using big data in collaborative databases may help answer questions about the interactions between medicines and COVID-19 outcomes.

The Use of Primary Care Big Data in Understanding the Pharmacoepidemiology of COVID-19: A Consensus Statement From the Covid-19 Primary Care Database Consortium

Hajira Dambha-Miller, MRCGP, PhD, et al
University of Southampton, Southampton, United Kingdom
https://www.annfammed.org/content/19/2/135

New Collaborative Care Model Offers Insight into Providing Help for Patients With Mental Health Needs

Members of the Perelman School of Medicine at the University of Pennsylvania and its health system developed and implemented a new model of collaborative care called The Penn Integrated Care (PIC) program. PIC includes a resource center to support intake, triage and referral management and collaborative care services in primary care practices. PIC was created to increase access to and engagement with mental health professionals to improve mental and physical health outcomes. Primary care physicians were able to refer patients with any mental health symptom or condition to PIC. In 12 months, 6,124 unique patients were referred from eight primary care clinics to either the PIC Resource Center or were connected with a mental health professional. Most were triaged to collaborative care or specialty health care with active referral management.

Among patients enrolled in collaborative care, the mean length of treatment was 7.2 encounters over 78 days. Remission of symptoms was achieved by almost 33 percent of patients with depression and almost 40 percent of patients with anxiety. Stakeholders viewed the program favorably. Primary care physicians perceived they were providing patients with higher quality care, and patients appreciated having someone to talk to in addition to, or instead of, receiving a medication prescription. Results provide insight into a model for launching and implementing collaborative care to meet the needs of a diverse group of patients who have a full range of mental health conditions often seen in primary care.

Addressing Common Challenges in the Implementation of Collaborative Care for Mental Health: The Penn Integrated Care Program

Courtney Benjamin Wolk, PhD, et al
University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
https://www.annfammed.org/content/19/2/148

Use of Patient Data Guides Outreach to Treat and Monitor People With Diabetes

Researchers from the HealthPartners Institute and University of Minnesota in Minneapolis conducted an observational analysis of interviews and characteristics of primary care clinics, comparing the strategies, facilitators and barriers to high performance in treating patients with diabetes. The purpose of the study was to learn what strategies and factors seem most important to leaders of primary care clinics to ensure high performance. The percentage of Minnesota diabetes patients who achieved optimal diabetes care measures increased from 12 to 45 percent between 2004 and 2017, while national measures of diabetes care outcomes did not improve significantly around the same time span.

The main difference among the strategies and factors was the degree to which top performing clinics used patient data to guide proactive and outreach methods to intensify treatment and monitor impact. The authors state that while confirmatory studies are needed, clinic leaders should consider the value of this paradigm shift in approach to care.

Strategies and Factors Associated With Top Performance in Primary Care for Diabetes: Insights From a Mixed Methods Study

Leif I. Solberg, MD, et al
HealthPartners Institute, Minneapolis, Minnesota
https://www.annfammed.org/content/19/2/110

Standardized vs. Customized Patient Care: Finding the Right Balance

Authors from the American Medical Association and the University of Wisconsin write a commentary about finding the right balance between standardization and customization of patient care processes. They write that, in most situations, patients receive better care when physicians and their teams have the ability to exercise professional judgment about workflow and task distribution, supported by best practices of systems engineering, rather than when they are expected to perform a rigid sequence of transactions mandated by well-intentioned but distant health care designers. The authors present four principles to guide decisions between standardization and customization: develop processes and policies in collaboration with end users; share decision authority with the clinicians closest to the patients; seek measures of customization; and not all variation is bad. Finding the balance between standardization and customization is important for patient care and should be considered by organizational leadership, those who determine patient treatment standards, and health care regulators, according to the authors.

Standardization vs Customization: Finding the Right Balance

Christine A. Sinsky, MD, et al
American Medical Association, Chicago, Illinois
https://www.annfammed.org/content/19/2/171

Increased Collaboration between Primary Care Doctors, Oncologists May Improve Fragmented Cancer Care

Cancer patients often experience fragmented care, particularly as they undergo cancer treatments. Although family physicians seek to provide continuous and comprehensive care, they often lose touch with their cancer patients during the treatment phase. Researchers conducted a randomized intervention that aimed to improve continuity of care and interprofessional collaboration as perceived by lung cancer patients and their family physicians.

The components of the intervention included the bidirectional exchange of patient information and care summaries between oncology teams and family physicians. Oncology teams recommended that patients see their family physicians after their cancer diagnosis. At the same time, cancer patients received priority access to their family physicians when needed.

The authors conclude that the intervention improved patient and family physician perceptions of interprofessional collaboration. Patients reported improved care continuity. In its objective to address fragmented cancer care, the study implemented pragmatic strategies to improve information exchange between family practitioners and the oncology team that could be integrated into routine practice. These findings provide valuable insight into potential strategies to bridge the gap between primary care and oncology care.

Continuity of Cancer Care and Collaboration Between Family Physicians and Oncologists: Results of a Randomized Clinical Trial

Michele Aubin, MD, PhD, et al
Laval University, Quebec City, Québec, Canada
https://www.annfammed.org/content/19/2/117

Using Health Behavior Outcomes Can Help Determine Efficacy of Patient-Centered Intervention for People With Multiple Morbidities

Intervention research focusing on patients with multiple, simultaneous chronic illnesses is a priority for health organizations such as the National Institutes of Health and Canadian Institutes of Health Research. This is important as physicians seek to better understand how one disease may influence the course of another coexisting one, and how to best care for patients who are battling multiple health issues. Researchers conducted a controlled trial in patients 18 to 80 years with three or more chronic conditions. They collected quantitative data and conducted in-depth interviews with patients, family members and health care providers, then measured the effectiveness of a four-month intervention based on changes in care delivery. For the study, health care professionals were trained to coach patients on adopting healthy lifestyle changes and managing their own health.

After four months, the intervention showed no effect on quantitative measures of self-management or self-efficacy. However, patients reported in qualitative interviews that the intervention improved their self-management and self-efficacy. The authors warn that complex interventions can be difficult to evaluate and important effects may be missed in evaluations that only include quantitative assessments.

Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial

Martin Fortin, MD, MSc, et al
Universite de Sherbrooke, Sherbrooke, Québec, Canada
https://www.annfammed.org/content/19/2/126

It's Time to Expand Chlamydia Treatment for Gay and Bisexual Men

In most US states, many gay and bisexual men are excluded from one effective approach to treating the sexually transmitted infection chlamydia. Because of nearly decade-old CDC guidelines that have been adopted in most states, health care practitioners are discouraged from offering an extra dose of antibiotic treatment for chlamydia for a patient's partner, without requiring that partner to be tested or examined, a practice that is called expedited partner therapy (EPT). Although EPT remains a highly effective way to break the cycle of reinfection, the CDC recommends against offering EPT to men who have sex with men, citing the lack of clinical trial evidence in this population and the risk of undetected coinfections like HIV. The authors of this essay note that changes in the HIV prevention landscape over the past ten years should prompt policy makers and public health officials to reevaluate the risks and benefits of expedited partner therapy for gay and bisexual men and their sexual networks. PrEP, or pre-exposure prophylaxis, was introduced to US markets in 2012. The popularity of PrEP among certain gay and bisexual men, the authors argue, connects patients who might not otherwise engage in preventive care to more frequent and comprehensive infection screenings and services. Additionally, they argue that limiting EPT to heterosexual people may discourage open and accurate conversations between doctor and gay and bisexual patients and point to an urgent need for data to understand the effectiveness and downstream effects of expedited partner therapy in this population.

It's Time to Expand Chlamydia Treatment for Gay and Bisexual Men

Hannan M. Braun, MD and Jessica L. Taylor, MD
Boston Medical Center, and Boston University, Boston, Massachusetts
https://www.annfammed.org/content/19/2/168

Innovations in Primary Care

Innovations in Primary Care are brief one-page articles that describe novel innovations from health care's front lines. In this issue:

Combination of Home-Based Hormonal and Mobile Technology for Virtual Monitoring of Menstrual Cycles--Smartphone applications combined with home-based hormonal tests can be effectively used for virtual physician monitoring of patients/ menstrual cycles.

https://www.annfammed.org/content/19/2/180

The Impact of COVID-19 Proactive Outreach With Somali Seniors--The COVID-19 positivity rate for Somalis in Minneapolis is disproportionately high. A targeted health outreach program paired bilingual volunteers with high-risk patients to provide education on COVID-19 and general health support over the phone.

https://www.annfammed.org/content/19/2/179
Medical School Affiliation Accelerates the Development of Community Health Centers in China--A program to build a bridge between China's community health centers and academic institutions has resulted in a relationship that has the potential to improve how family medicine is delivered.

https://www.annfammed.org/content/19/2/178

Since 1983, the bacteria Pantoea ananatis has been known to infect several important crops including onions, rice, and corn. It was unclear, however, what molecules were involved. A new study, published in mBio, has identified one of the culprits: pantaphos. Intriguingly, the researchers have discovered that pantaphos can also act as an herbicide and it is toxic to glioblastoma cells, making it an exciting candidate for agricultural and biomedical applications.

"Herbicide resistant weeds are an issue in agriculture," said William Metcalf (MMG leader), a professor of microbiology. "Unfortunately, there hasn't been a new class of herbicide for over 30 years. If we can understand how pantaphos causes onion rot, we can solve a big problem."

Scientists at Cornell University had previously compared the disease-causing strains of P. ananatis to other innocuous strains. They identified a group of genes, designated as hvr, that were responsible for causing onion rot. The researchers in the current paper were inspired by these studies, and they subsequently identified which molecules were produced by these genes and found pantaphos.

"We can inject onions with purified pantaphos and cause onion rot. The injected onions start rotting, and become gross and mushy. It was exciting to see," said Alexander Polidore, a PhD student in the Metcalf lab. "Additionally, bacteria that cannot synthesize this molecule cannot cause onion rot, which means that it is necessary to cause the infection."

"If we can fully understand how pantaphos is made by the bacteria, we can identify multiple steps of intervention. If we can stop any one of those processes, we can get rid of onion rot," Metcalf said.

Intriguingly, pantaphos has also shown promise as an effective herbicide. "I compared pentaphos to Liberty and Roundup, which are common herbicides, and it was just as good--or even better--against typical weeds such as mustard seedlings," Polidore said.

An important requirement for an herbicide is that it kills weeds, but remains non-toxic to other animals, including humans. Therefore, the researchers tested the toxicity of pantaphos against other organisms. "Although it does not affect other bacteria and fungi, we found that it is moderately toxic to normal human cell lines, but strikingly toxic to glioblastoma cell lines. We were excited because those cancer cells are notoriously hard to kill," Polidore said.

Although pantaphos is somewhat toxic to human cell lines, it is possible that it will not be toxic to whole animals. "If you feed pantaphos to a mouse and it doesn't get taken up in the intestine, it will be much less toxic," Metcalf said. "Thus, our cell line studies are preliminary and will require follow-up experiments to define the level of toxicity in humans."

The researchers are currently trying to understand how pantaphos kills weeds and glioblastoma cells. The results of those studies may help them design modified versions of the molecule that affect only the desirable targets. Using bioinformatic analysis, they have also found similar hvr genes in other bacteria, indicating that there may be several pantaphos-like molecules that could be used as potential herbicides or therapeutic drugs.

CHAPEL HILL, NC -- A comprehensive review by University of North Carolina researchers and colleagues of hundreds of publications, incorporating more than two dozen articles on prevention screening for lung cancer with low-dose spiral computed tomography (LDCT), shows there are both benefits and harms from screening. The review is published in JAMA on March 9, 2021.

The results of the decadelong National Lung Screening Trial (NLST) showed that LDCT could detect lung cancer better than conventional X-rays in current or previous heavy smokers. Based on those results, the United States Preventive Services Task Force (USPSTF) initially recommended low-dose CT screening for people ages 55 to 80 with a 30 pack-year smoking history. Subsequently, other screening trial results have been published, including a European trial called NELSON, the next-largest study to the NLST. NELSON also found a reduction in deaths due to lung cancer because of screening.

It has been nearly a decade since the initial recommendations were formulated, so the USPSTF initiated an updated review of the evidence. UNC scientists and their collaborators evaluated and synthesized data from the seven trials to arrive at a comprehensive, current assessment of harms and benefits of screening.

New recommendations, based on this evidence review, broaden the criteria for screening eligibility by lowering the screening age from 55 to 50 and reducing the pack-year requirement from 30 to 20 pack-years. There were several reasons for this change in eligibility according to the reviewers; one was to promote health equity, in part because African Americans have higher lung cancer risk even with lower levels of smoking exposure.

"Two large studies have now confirmed that screening can lower the chance of dying of lung cancer in high-risk people. However, people considering screening should know that a relatively small number of people who are screened benefit, and that screening can also lead to real harms," said Daniel Reuland, MD, MPH, one of the review authors, a member of the UNC Lineberger Comprehensive Cancer Center, and a professor in the division of General Medicine and Clinical Epidemiology at UNC School of Medicine.

In screening with CT scans, doctors are looking for lung spots or nodules that might represent early lung cancer. Harms from screening can come from the fact that the large majority of the nodules found on screening are not cancer. These findings are known as false positives, and patients with these results usually require additional scans to see if the spots are growing over time. In some cases, these false positives lead to unnecessary surgery and procedures. Throughout the process, patients may experience the mental distress of a possible cancer diagnosis.

"Applying screening tests to a population without symptoms of disease can certainly benefit some people but also has the potential for some harms," said lead author Daniel Jonas, MD, MPH, who conducted most of this research while he was a professor at the UNC School of Medicine and now is director of the division of general internal medicine at Ohio State University. "In the case of lung cancer screening, we now have more certainty that some individuals will benefit, with some lung cancer deaths prevented, and we also know others will be harmed. The USPSTF has weighed the overall benefits and harms, and on balance, based on our review and from modeling studies, has determined that screening with LDCT has an overall net benefit for high-risk people ages 50 to 80."

Reuland and Jonas note that, encouragingly, lung cancer rates are declining, reflecting changing smoking patterns in recent decades. Therefore, the population eligible for screening is also projected to decline. At this point, however, they don't foresee these trends changing screening recommendations during the next decade or so.

"Different trials have used different screening approaches, and we still do not know how often screening should be done or which approach to categorizing lesions is best for reducing the harms, costs and burdens of screening while retaining the benefits," said Reuland, who is also a research fellow at UNC's Cecil G. Sheps Center for Health Services Research. "I would prioritize this as an important area of future research, as it could likely be addressed by implementing less expensive studies or using approaches other than those used in the large trials we just reviewed."

Researchers have come up with a better way to test which fabrics work best for masks that are meant to slow the spread of COVID-19. By testing those fabrics under conditions that mimic the humidity of a person's breath, the researchers have obtained measurements that more accurately reflect how the fabrics perform when worn by a living, breathing person.

The new measurements show that under humid conditions, the filtration efficiency -- a measure of how well a material captures particles -- increased by an average of 33% in cotton fabrics. Synthetic fabrics performed poorly relative to cotton, and their performance did not improve with humidity. The material from medical-procedure masks also did not improve with humidity, though it performed in roughly the same range as cottons.

This study, conducted by scientists at the National Institute of Standards and Technology (NIST) and the Smithsonian's Museum Conservation Institute, was published in ACS Applied Nano Materials.

An earlier study by the same research team showed that dual-layer masks made of tightly woven cotton fabrics with a raised nap, such as flannels, are particularly effective at filtering breath. That study was conducted under relatively dry conditions in the lab, and its main finding still stands.

"Cotton fabrics are still a great choice," said NIST research scientist Christopher Zangmeister. "But this new study shows that cotton fabrics actually perform better in masks than we thought."

The researchers also tested whether humidity makes the fabrics harder to breathe through and found no change in breathability.

The Centers for Disease Control and Prevention (CDC) recommends that people wear masks to slow the spread of COVID-19. When worn correctly, those masks filter out some of the virus-filled droplets that an infected person exhales and also offer some protection to the wearer by filtering incoming air.

This study is one of several, conducted by NIST and other organizations, that contributed to the first standards for fabric masks meant to slow the spread of COVID-19. Those standards were recently released by the standards-developing organization ASTM International.

The filtration efficiency of cotton fabrics increases in humid conditions because cotton is hydrophilic, meaning it likes water. By absorbing small amounts of the water in a person's breath, cotton fibers create a moist environment inside the fabric. As microscopic particles pass through, they absorb some of this moisture and grow larger, which makes them more likely to get trapped.

[See more images of what's happening on a microscopic level inside your mask]

Most synthetic fabrics, on the other hand, are hydrophobic, meaning they dislike water. These fabrics do not absorb moisture, and their filtration efficiency does not change in humid conditions.

For this study, the team tested fabric swatches, not actual masks. First, they prepared dual-layer fabric swatches by placing them inside a small box where the air was maintained at 99% humidity -- roughly the same as a person's exhaled breath. For comparison, a second set of swatches were prepared at 55% humidity. After the fabrics reached an equilibrium with the humidified air, the researchers placed them in front of a pipe that emitted air at about the same velocity as exhaled breath. That air carried salt particles in a range of sizes typical of the droplets that a person exhales when breathing, speaking and coughing. This salt particle method is recommended by the CDC's National Institute for Occupational Safety and Health (NIOSH) for measuring the filtration performance of mask-making materials.

The researchers calculated filtration efficiency by measuring the number of particles in the air before and after it passed through the fabric. They measured breathability by measuring the air pressure on both sides of the fabric as the air passed through it.

The researchers tested nine different types of cotton flannel, which under humid conditions increased their filtration efficiencies from 12% to 45%, with an average increase of 33%. They tested six types of synthetic fabric, including nylon, polyester and rayon. All performed poorly in comparison to cotton flannel regardless of humidity. Medical-procedure masks and N95 respirator masks provided the same filtration efficiency under both high and low humidity conditions.

While the change in performance for cotton flannels is large, they don't actually absorb very much water. Under humid conditions, a two-layer cotton flannel mask absorbs about 150 milligrams of water from human breath, the equivalent of just one or two drops. If fabric masks actually get wet in other ways, they may become difficult to breathe through, and the CDC advises that people not wear them for activities such as swimming. If masks become wet due to weather, they should be changed.

While this research provides useful information for people who wear face masks, it also holds lessons for scientists who are working to improve masks and measure their performance.

"To understand how these materials perform in the real world," Zangmeister said, "we need to study them under realistic conditions."

Astronomers have discovered evidence for an extraordinarily long jet of particles coming from a supermassive black hole in the early universe, using NASA's Chandra X-ray Observatory.

If confirmed, it would be the most distant supermassive black hole with a jet detected in X-rays. Coming from a galaxy about 12.7 billion light-years from Earth, the jet may help explain how the biggest black holes formed at a very early time in the universe's history.

The source of the jet is a quasar - a rapidly growing supermassive black hole - named PSO J352.4034-15.3373 (PJ352-15 for short), which sits at the center of a young galaxy. It is one of the two most powerful quasars detected in radio waves in the first billion years after the big bang, and is about a billion times more massive than the Sun.

How were supermassive black holes able to grow so quickly to reach such an enormous mass in this early epoch of the universe? This is one of the key questions in astronomy today.
 

Despite their powerful gravity and fearsome reputation, black holes do not inevitably pull in everything that approaches close to them. Material orbiting around a black hole in a disk needs to lose speed and energy before it can fall farther inwards to cross the so-called event horizon, the point of no return. Magnetic fields can cause a braking effect on the disk as they power a jet, which is one key way for material in the disk to lose energy and, therefore, enhance the rate of growth of black holes.  

"If a playground merry-go-round is moving too fast, it's hard for a child to move towards the center, so someone or something needs to slow the ride down," said Thomas Connor of NASA's Jet Propulsion Laboratory (JPL) in Pasadena, California, who led the study. "Around supermassive black holes, we think jets can take enough energy away so material can fall inward and the black hole can grow."
 

Astronomers needed to observe PJ352-15 for a total of three days using the sharp vision of Chandra to detect evidence for the X-ray jet. X-ray emission was detected about 160,000 light-years away from the quasar along the same direction as much shorter jets previously seen in radio waves by the Very Long Baseline Array. By comparison, the entire Milky Way spans about 100,000 light-years.

PJ352-15 breaks a couple of different astronomical records. First, the longest jet previously observed from the first billion years after the big bang was only about 5,000 light-years in length, corresponding to the radio observations of PJ352-15. Second, PJ352-15 is about 300 million light-years farther away than the most distant X-ray jet recorded before it.. 

"The length of this jet is significant because it means that the supermassive black hole powering it has been growing for a considerable period of time," said co-author Eduardo Bañados of the Max Planck Institute for Astronomy (MPIA) in Heidelberg, Germany. "This result underscores how X-ray studies of distant quasars provide a critical way to study the growth of the most distant supermassive black holes."

The light detected from this jet was emitted when the universe was only 0.98 billion years old, less than a tenth of its present age. At this point, the intensity of the cosmic microwave background radiation left over from the big bang was much greater than it is today. 
 

As the electrons in the jet fly away from the black hole at close to the speed of light, they move through and collide with photons making up the cosmic microwave background radiation, boosting the energy of the photons up into the X-ray range to be detected by Chandra. In this scenario, the X-rays are significantly boosted in brightness compared to radio waves. This agrees with the observation that the large X-ray jet feature has no associated radio emission.

"Our result shows that X-ray observations can be one of the best ways to study quasars with jets in the early Universe," said co-author Daniel Stern, also of JPL. "Or to put it another way, X-ray observations in the future may be the key to unlocking the secrets of our cosmic past."
 

Most teenagers don't remember life before the internet. They have grown up in a connected world, and being online has become one of their main sources of learning, entertaining and socializing.

As many previous studies have pointed out, and as many parents worry, this reality does not come risk-free. Whereas time on the internet can be informative, instructive and even pleasant, there is already significant literature on the potential harm caused by young children's problematic internet use (PIU).

However, a new study led by István Tóth-Király, a Horizon Postdoctoral Fellow at the Substantive-Methodological Synergy Research Laboratory in Concordia's Department of Psychology, is one of only a few that examines PIU's effects on older adolescents. The paper was co-written by professor of psychology Alexandre Morin and Lauri Hietajärvi and Katariina Salmela-Aro of the University of Helsinki.

The paper, published in the journal Child Development, looks at data gathered by a longitudinal study of 1,750 high school students in Helsinki over three years.

It begins by asking three big questions: what were some of the predictors or determinants of PIU? How did PIU change over the course of late adolescence, in this case, ages 16-19? And what are the consequences of PIU among the age group?

At-risk signals

The researchers identified three principal determinants of PIU among adolescents. The first was loneliness, defined as a lack of satisfying interpersonal relationships or the perceived inadequacy of social networks. Other studies on PIU also identified loneliness as a predictor.

Parenting practices, as perceived by the teen, also predicted PIU. The researchers looked at both parental caring, such as the expressions of warmth, empathy, interest and closeness towards the child, and parental neglect, defined as the uneven availability or unresponsiveness to the child's needs.

Not surprisingly, better parenting is linked to lower PIU, while neglectful parenting is linked to higher PIU. The researchers noted the differences in how maternal and paternal behaviour affected usage.

Maternal caring especially was associated with lower PIU, suggesting that high-quality mother-child relationships might have led to a decrease in the need to use the internet excessively. Paternal neglect, on the other hand, had a stronger relationship with higher PIU, as a lack of guidance and limits hindered a teen's ability to set personal boundaries.

Finally, the researchers considered gender. They found boys more likely to engage in PIU than girls, as they tend to be prone to more addictive-like behaviour, are more impulsive and, as suggested by other studies, may have more online options such as gaming or watching YouTube videos or pornography. Girls may be more likely to be online for socializing purposes.

Circular and harmful effects

The researchers then looked at outcomes associated with PIU, again identifying three broad categories.

The first is depressive symptoms. If left unchecked, PIU appears to come with higher levels of depression. The two have been linked in previous studies, but Tóth-Király says their findings suggest a new interpretation.

"Our study tries to understand this relationship in a bi-directional or reciprocal way," he says. "We think that PIU and depressive symptoms are likely to be co-occurring instead of one determining the other. They likely reinforce one another over time."

The other outcomes linked to PIU are higher levels of substance abuse and lower levels of academic achievement. These were to be expected, and were also believed to be co-occurring.

Tóth-Király says some teens go through a phase of heavy internet use, usually around mid-adolescence. Time spent online tends to decrease as the children mature, develop their own goals and boundaries and form their first romantic relationships. He adds that being online for hours is not necessarily damaging, even if it does seem excessive to parents.

"If adolescents spend a lot of time on the internet but it doesn't really impact their mental health or their grades or doesn't seem to have any substantial negative consequences, then we cannot really say this is problematic behaviour," he says.

Cancer patients often experience fragmented care, particularly as they undergo cancer treatments. Although family physicians seek to provide continuous and comprehensive care, they often lose touch with their cancer patients during the treatment phase. Researchers conducted a randomized intervention that aimed to improve continuity of care and interprofessional collaboration as perceived by lung cancer patients and their family physicians.

The components of the intervention included the bidirectional exchange of patient information and care summaries between oncology teams and family physicians. Oncology teams recommended that patients see their family physicians after their cancer diagnosis. At the same time, cancer patients received priority access to their family physicians when needed.

The authors conclude that the intervention improved patient and family physician perceptions of interprofessional collaboration. Patients reported improved care continuity. In its objective to address fragmented cancer care, the study implemented pragmatic strategies to improve information exchange between family practitioners and the oncology team that could be integrated into routine practice. These findings provide valuable insight into potential strategies to bridge the gap between primary care and oncology care.

While many celebrate apple blossoms as classic signs of spring, they are also welcoming entry gates for pathogens. Full of nutrients to lure pollinators and promote pollen germination, flowers also attract bacteria like Erwinia amylavora, a pathogen that causes a damaging disease called fire blight. However, recent work by scientists at the Connecticut Agricultural Experiment Station suggests that these flowery infection sites might also be perfect targets for applying microbial fire blight biocontrol measures.

In a paper recently published in Phytobiomes Journal, researchers Zhouqi Cui, Regan Huntley, Neil Schultes, Blaire Steven, and Quan Zeng found that treating apple flowers with a probiotic spray reduced incidence of fire blight. They sprayed blooming trees with different strains of bacteria isolated from apple flowers and then exposed the same blooms to the fire blight pathogen. After this inoculation, they sampled the floral microbiomes and observed the development of fire blight symptoms.

They found flowers treated with Pantoea spp. bacteria developed distinct microbiomes and exhibited fire blight symptoms 35 to 45 percent less frequently than flowers treated with just water. These results suggest that Pantoea spp. structure floral microbiomes in a way that reduces infection and could be an effective probiotic biocontrol for fire blight. Flowers may be a particularly promising system in which growers can actively influence microbiomes--compared to roots and leaves, flowers are short-lived, which could make reshaping their microbiomes both more technically feasible and biologically impactful.

This research underscores the importance of studying apple flower ecology in the field. While many researchers simply screen bacterial isolates in the laboratory, Cui and colleagues studied how these natural strains altered flower microbiomes and disease rates in the field. This step was crucial as the bacterial strain that suppressed the fire blight pathogen most strongly in the lab failed to substantially reduce infections in the field while Pantoea spp., the strain with the promising fire blight reduction in the field, did not directly suppress pathogen growth in the lab.

The authors suggest that the ineffectiveness of biocontrol agents in field settings may be due to the products' incompatibility with natural plant microbiomes. "Typical studies...often fail to even test if the applied strain effectively colonizes the flower" the authors note. As evidenced in their study, laboratory results can sometimes show false promise, but in some incidences--as with the case of Pantoea, may allow promising biocontrol agents to be overlooked.