Culture

CLEVELAND - Cleveland Clinic researchers have developed and validated a risk prediction model (called a nomogram) that can help physicians predict which patients who have recently tested positive for SARS-CoV-2, the virus that causes COVID-19, are at greatest risk for hospitalization.

This new model, published in PLOS One, is the second COVID-19-related nomogram that the research team--led by Lara Jehi, M.D., chief research information officer at Cleveland Clinic, and Michael Kattan, Ph.D., chair of Lerner Research Institute's Department of Quantitative Health Sciences--has developed. Their earlier model forecasts an individual patient's likelihood of testing positive for the virus.

"Ultimately, we want to create a suite of tools that physicians can use to help inform personalized care and resource allocation at many time points throughout a patient's experience with COVID-19," said Dr. Jehi, corresponding author on the study.

The team's newest model was developed and validated using retrospective patient data from more than 4,500 patients who tested positive for COVID-19 at Cleveland Clinic locations in Northeast Ohio and Florida during a three-month time period (early March to early June). Data scientists used statistical algorithms to transform data from registry patients' electronic medical records into the risk prediction model.

Comparing characteristics between those patients who were and were not hospitalized due to COVID-19 revealed several previously undefined hospitalization risk factors, including:

Smoking. Former smokers were more likely to be hospitalized than current smokers.

Taking certain medications. Using univariable analysis, patients taking Angiotensin Converting Enzyme (ACE) inhibitors or angiotensin II type-I receptor blockers (ARBs) were more likely to be hospitalized than patients not taking those drugs.

Race. African American patients were more likely to be hospitalized than patients of other races.

Dr. Kattan, an expert in developing and validating prediction models for medical decision making, cautions that additional studies will be necessary to further explore the association between ACE inhibitors and ARBs. "In our study, taking these drugs was only found to confer increased risk for hospitalization when run through univariable analysis, which means the observed association could be the result of other, confounding variables, like a preexisting condition."

The team's findings also revealed that patients presenting with a symptom complex including fever, shortness of breath, vomiting and fatigue were more likely to be hospitalized than those who did not experience this quadrumvirate of symptoms.

The study confirmed other associations previously well-reported in the literature, including higher risk of hospitalization among older people; men; and those with co-morbidities, like diabetes and hypertension, or from lower socioeconomic backgrounds (as measured by zip code).

"Hospitalization can be used as an indicator of disease severity," said Dr. Jehi. "Understanding which patients are most likely to be admitted to the hospital for COVID-19-related symptoms and complications can help physicians decide not only how to best manage a patient's care from the time of testing, but also how to allocate beds and other resources, like ventilators."

The nomogram, which is freely available as an online risk calculator, was shown to be well calibrated and perform well, offering substantially better predictions than using no model at all. The model was also shown to perform well in different geographic regions as data from Ohio and Florida were used in its development.

In addition to further interrogating the association between taking ACE inhibitors and ARBs, it will be important to study on a pathogenic level how these risk factors confer increased hospitalization risk. It is also important to note that the team's findings only offer associations and do not suggest that these factors are causative.

Feeling green might not be a bad thing when it comes to friendships, especially during a pandemic.

Having friends is healthy. Not having friends is associated with a greater risk of dying from heart disease and with becoming sick from viruses.

A new study from Arizona State University, Oklahoma State University, and Hamilton College has found feelings of jealousy can be a useful tool in maintaining friendships. Feelings of jealousy were related to the value of the friendship and also motivated behaviors that maintain friendships. The work was published online in the Journal of Personality and Social Psychology on August 11.

"Friends aren't just fun. They are an important resource, especially in our current situation with ongoing COVID-19 outbreaks. Friends give support during conflict, buffer against loneliness, and can even provide life sustaining resources when we need them," said Jaimie Arona Krems, who earned her doctorate at Arizona State University and is now an assistant professor of psychology at Oklahoma State University. "We wanted to understand how we keep friendships, and we found feelings of jealousy can act like a tool for maintaining friendships."

The third wheel

Not all threats to friendships evoked jealousy. If a best friend moved away, people felt sadness and anger more than jealousy. But when friendships were threatened by another person - such as a new romantic partner or new friend at work - jealousy was the dominant feeling.

The intensity of jealous feelings varied by how likely the third-party threat was to replace someone in the friendship. A best friend gaining a romantic partner elicited less jealous feelings than them gaining a potential new friend.

"The third party threats to a friendship were not just related to a best friend spending time away from us: It mattered whether the person they were spending time with could replace us as a friend. We found people felt less jealous about their best friend spending the same amount of time with a new romantic partner than a new acquaintance, which means what makes us most jealous of is the possibility that we might be replaced," said Douglas Kenrick, who is a President's Professor of psychology at ASU and author on the paper.

Guarding friendships

Feelings of jealousy over being replaced were associated with behaviors that could overcome the third-party threats, like trying to monopolize a best friend's time and manipulate their emotions.

"Together, these behaviors are called 'friend guarding', and they occur across cultures and also in non-human animals. Female wild horses are known to bite and kick other female horses," said Keelah Williams, assistant professor of psychology at Hamilton College who earned her doctorate and law degree at ASU.

Not all friend guarding behaviors focus on trying to control a best friend; jealousy also led people to commit to being a better friend.

"Getting jealous can sometimes be a signal that a friendship is threatened, and this signal can help us jump into action to invest in a friendship that we might have been neglecting," said Athena Aktipis, assistant professor of psychology at ASU and author on the paper.

Making decisions in the face of uncertainty has never been easy. But the global pandemic has raised the stakes for many previously mundane choices: how to travel, where to get food, when to send kids back to school.

Understanding how humans have made high-stakes decisions over evolutionary time may help to explain our choices in the present day – including our tendency to veer from the preferences predicted by economic models, according to a new study from scholars at Stanford University and the Santa Fe Institute.

“Rather than starting with utility – the happiness or value I get out of making my decision now – let’s think about how the brain was constructed over evolutionary history,” said study co-author James Holland Jones, a biological anthropologist at Stanford’s School of Earth, Energy & Environmental Sciences (Stanford Earth). The research was published in the journal Evolutionary Human Sciences.

The pair’s proposal adds a new perspective to long-running scholarly debates over why practices designed to improve the standard of living among subsistence populations don’t take hold, such as the seemingly slow adoption of new farming technologies among poor, small-scale farmers, and more recently, the unwillingness of the poorest poor to adopt microfinance and other development schemes.

“There is an inclination to think of the poorest people as being ‘natural entrepreneurs’ because they have nothing to lose economically,” Jones explained. “However, the evolutionary logic we employ suggests that the poorest poor have everything to lose and are, in fact, closer to losing it than better-off people. Our model predicts that very poor people would be especially risk-averse.”

It also points to the weakness of lean systems in the face of uncommon but severe threats, such as the coronavirus. “One of the things we’re seeing right now is a world that has been optimized for efficiency and is extremely vulnerable to risk,” he said. “If you scale back organizations to keep them running at a mean level that’s high, and you don’t have a lot of slack, when a crisis hits you’re in trouble.”

Rational choices in evolutionary systems

According to the theory of expected utility, a staple of modern economics, people should always carefully weigh the likelihood of an event along with the prizes or consequences that would accrue from our decision – and then choose the option with the highest average payoff. Of course, we rarely calculate these averages in practice, as behavioral economists have long recognized. Yet an assumption that our brains will behave as if we made decisions this way – maximizing personal gain at every turn – is still baked into many public and economic policies.

“We might expect evolutionary systems to mirror markets, with organisms that act rationally out-competing those not behaving rationally,” said Jones, an associate professor of Earth system science at Stanford Earth and a senior fellow at the Stanford Woods Institute for the Environment. “The catch is that you can’t outcompete something if you’re extinct.”

In addition to influencing policy, business and financial markets, theories of how we make decisions have filtered into popular culture through books like Nudge and Thinking Fast and Slow. However, they tend to deal poorly with choices that humans have faced for the vast majority of their history on Earth – namely, those shaped not by market forces, but by environmental variables like temperature or rainfall. In this context, boom times can’t compensate for a single lethal bust. Just one bad heat wave, drought, cold snap or flood can leave a household hungry or worse. “Variance is what drives you to extinction,” Jones said.

As a result, when it comes to preferences that evolve by natural selection, he said, we should expect to see people undervalue long shots that could be profitable, play it safe when things look risky and generally overestimate the likelihood of rare bad outcomes.

Pessimism pays

On the timescale of evolution, the salient outcome of a decision is how it contributes to fitness, meaning the proportion of the population through time that carries your DNA. Unlike utility, fitness is a measure that multiplies over time. “If any generation in your lineage has zero offspring in it, it’s game over,” Jones said. “It is a general aversion to zeros that leads to pessimism.”

At the same time, fitness plays out over such long timescales that it can’t directly influence our behavior. The things that do shape our choices day to day are more like utility in that they can rise and fall without bringing catastrophe. “Psychological mechanisms, like satiety or sexual gratification, or something like love of your children, can motivate you in the immediate. They promote fitness in the long run, but they are not the thing actually being maximized over time,” he said.

Maximizing fitness leads us to be more pessimistic in our economic decisions than utility models predict. The optimal level of pessimism to promote survival depends “on the exact universe the organism occupies,” the authors write. For example, hunters targeting rare, big game may stand to bring home more calories if they succeed, but their household could go hungry if they fail. Herders have to weigh not only the productivity of their animals, but also their susceptibility to drought and disease.

“Any time where you have to avoid zero, pessimism will pay off, because you’d rather leave money on the table than run the risk of going extinct,” Jones said.

Theory into practice

When social distancing restrictions loosen enough to conduct group experiments, Jones and co-author Michael Price, PhD ’15, who studies complex systems as a fellow at the Santa Fe Institute, plan to test their theory with games challenging participants to maximize payoffs that multiply over time or that are hidden but associated with some tangible proxy. By formalizing and eventually testing the theory, the researchers write, they “hope to stimulate more work on the possible evolutionary foundations of key results from behavioral economics.”

DALLAS, August 11, 2020 -- Interstage Home Monitoring (IHM) programs for infants with single ventricle heart defects help families recognize potential complications early and improve infant survival rates and growth prior to the second of multiple surgeries, according to a new Scientific Statement from the American Heart Association, "Interstage Home Monitoring for Infants With Single Ventricle Heart Disease: Education and Management," published today in the Journal of the American Heart Association.

The National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC), a network of pediatric cardiology care centers across the U.S., reported an average 40% decrease (9.5% to 5.3%) in infant mortality and a 28% improvement in infant weight gain (18.6% to 13.1%) across 50 cardiac centers using IHM programs from 2008 to 2016.

Treatment for the single ventricle heart defect hypoplastic left heart syndrome - in which the heart's left side is underdeveloped - involves one surgery shortly after birth with a second surgery planned four to six months later, and a third procedure a year or so after that. IHM programs concentrate on the high-risk time between the first two surgeries, known as the interstage period. The primary focus of IHM programs is to help family caregivers carefully monitor several important health parameters including an infant's oxygen saturation levels, caloric intake and weight gain. Weight gain is an important marker for an infant to successfully undergo the second surgery.

IHM programs also train caregivers to recognize early "red flag" symptoms such as respiratory changes, sweating, fussiness, diarrhea, fever or changes in skin color that warrant immediate notification of the infant's health care team.

The AHA scientific statement outlines plans for health care professionals when training home caregivers while the infant is still hospitalized, and also addresses caregiver support and education, health care teams and resources, surveillance strategies and practices, national quality improvement efforts, interstage outcomes and future areas for research.

"This is a comprehensive resource for cardiology care professionals and family caregivers, and it also provides a framework and roadmap for cardiac centers looking to establish an IHM program or possibly expand or strengthen one already in place," said chair of the statement writing group Nancy Rudd, M.S., C.P.N.P.-P.C./A.C., FAHA, nurse coordinator for the Interstage Home Monitoring Program at Herma Heart Institute, Children's Wisconsin, and a nurse practitioner in the division of pediatric cardiology at the Medical College of Wisconsin, both in Milwaukee. "The statement is also a much-needed document validating the need for cost coverage for the various parts of IHM programs that lead to improved patient outcomes."

The first IHM program was initiated in 2000 at Children's Wisconsin due to trends indicating mortality rates were as high as 16% during the interstage period. The pediatric quality improvement cooperative was formed in 2008 and has advanced knowledge and best practice guidelines to improve the outcomes and quality of life for children with hypoplastic left heart syndrome during the interstage period.

"Prior to IHM programs, the outpatient management of interstage infants was the same as that of much less complex patients. Unfortunately, the tenuous nature of these infants means they can get very sick very quickly from even minor childhood illness like the common cold," said Rudd.

Statement authors noted other practice and program changes associated with caring for these pediatric patients also contributed to their improved survival and weight gain.

Sarah Robinson's daughter, now two years old, was born with hypoplastic left heart syndrome. As part of an IHM program, Robinson learned how to care for her infant through a rooming-in session during the baby's first post-surgery hospital stay. "Before discharge, we had to provide 24 hours of care, which meant doing everything for our daughter by ourselves with no machines on--all the feedings, administering medications and more--while having medical staff available if needed or if a problem arose," Robinson said in a perspective published with the statement. "Having a program like this in place gave us comfort, knowing we would not be completely alone during a very stressful and anxious time before the second surgery. Interstage home monitoring was our life preserver and safety net."

Many IHM programs have evolved to include telehealth platforms, and expanding technology enables optimized data collection and real-time video visual assessments of patients at home. The authors conclude that together with improved care coordination, discharge planning, and nutritional management bundles, IHM is a key component in optimizing outcomes in these high-risk infants.

The study, conducted by an international team and led by RMIT University's Professor Christian Doerig, outlines a strategy that could save years of drug discovery research and millions of dollars in drug development by repurposing existing treatments designed for other diseases such as cancer.

The approach shows so much promise it has received government funding for its potential application in the fight against COVID-19.

The study, published in Nature Communications, demonstrated that the parasites that cause malaria are heavily dependent on enzymes in red blood cells where the parasites hide and proliferate.

It also revealed that drugs developed for cancer, and which inactivate these human enzymes, known as protein kinases, are highly effective in killing the parasite and represent an alternative to drugs that target the parasite itself.

Lead author, RMIT's Dr Jack Adderley, said the analysis revealed which of the host cell enzymes were activated during infection, revealing novel points of reliance of the parasite on its human host.

"This approach has the potential to considerably reduce the cost and accelerate the deployment of new and urgently needed antimalarials," he said.

"These host enzymes are in many instances the same as those activated in cancer cells, so we can now jump on the back of existing cancer drug discovery and look to repurpose a drug that is already available or close to completion of the drug development process."

As well as enabling the repurposing of drugs, the approach is likely to reduce the emergence of drug resistance, as the pathogen cannot escape by simply mutating the target of the drug, as is the case for most currently available antimalarials.

Doerig, Associate Dean for the Biomedical Sciences Cluster at RMIT and senior author of the paper, said the findings were exciting, as drug resistance is one of the biggest challenges in modern healthcare, not only in the case of malaria, but with most infectious agents, including a large number of highly pathogenic bacterial species.

"We are at risk of returning to the pre-antibiotic era if we don't solve this resistance problem, which constitutes a clear and present danger for global public health. We need innovative ways to address this issue," he said.

"By targeting the host and not the pathogen itself, we remove the possibility for the pathogen to rapidly become resistant by mutating the target of the drug, as the target is made by the human host, not the pathogen."

Doerig's team will now collaborate with the Peter Doherty Institute for Infection and Immunity (Doherty Institute) to investigate potential COVID-19 treatments using this approach, supported by funding from the Victorian Medical Research Acceleration Fund in partnership with the Bio Capital Impact Fund (BCIF).

Co-investigator on the grant, Royal Melbourne Hospital's Dr Julian Druce, from the Victorian Infectious Diseases Reference Laboratory (VIDRL) at the Doherty Institute, was part of the team that were first to grow and share the virus that causes COVID-19, and said the research was an important contribution to efforts to defeat the pandemic.

Royal Melbourne Hospital's Professor Peter Revill, Senior Medical Scientist at the Doherty Institute and a leader on Hepatitis B research, said the approach developed by the RMIT team was truly exciting.

"This has proven successful for other human pathogens including malaria and Hepatitis C virus, and there are now very real prospects to use it to discover novel drug targets for Hepatitis B and COVID-19," he said.

Enzymes used by bacteria to break down mucus in the gut could provide a useful biomarker for intestinal diseases, according to new research published in Nature Communications.

Researchers at the University of Birmingham and Newcastle University have successfully identified and characterised one of the key enzymes involved in this process. They demonstrated how the enzyme enables bacteria to break down and feed off sugars in the layers of mucus lining the gut.

The research offers a significant step forward in our understanding of the complex co-dependent relationships at work in the gut, about which little is currently known. Because the mechanism used by the enzyme is particularly distinctive, the researchers anticipate it can be used in the development of new diagnostics for intestinal diseases.

The molecules in mucus, called mucin, are constantly produced by the body to generate the layer of mucus in the gut that provides a barrier between the gut's complex populations of bacteria and the rest of the body. Mucin contain chains of sugar molecules called glycans, and these also provide an essential source of nutrients for bacteria.

The team investigated how this enzyme sits on the outside of the bacterial cell and clips away parts of the mucin molecule, taking them inside the bacterial cell to be consumed.

Because glycans are known to change when certain diseases are present in the body, the researchers anticipate it will be possible to use the enzymes to take a snapshot of the glycans within a biopsy and use that as a biomarker for early detection of the disease.

Lead researcher, Dr Lucy Crouch, of the University of Birmingham's School of Biosciences, explains: "Mucus is structured a bit like a tree, with lots of different branches and leaves. Lots of the enzymes discovered so far might clip away some of the leaves to eat, but the enzyme we studied will clip away a whole branch - that's quite a distinctive mechanism and it gives us a useful biomarker for studying disease."

The team have investigated this process in three different diseases. They examined tissue from adults suffering from ulcerative colitis and colorectal cancer, and from preterm infants with necrotising enterocolitis, a serious illness in which the gut becomes inflamed and can start to die. They found that by adding the enzyme to the samples and labelling the glycans with a fluorescent dye, they were able to get useful information about the glycan structure.

Dr Crouch adds: "Although we still don't fully understand what the glycan structures are made from and how these vary between different tissue types, we can see that the differences in structure between health and non-healthy tissue is quite distinctive. We hope to be able to use these enzymes to start producing better diagnostics for the very early stages of these diseases."

ITASCA, Illinois - A new study published in the Journal of Food Science suggests monosodium glutamate (MSG) can be used to significantly reduce sodium while also promoting the enjoyment of better-for-you foods like grains and vegetables. In the study, supported by Ajinomoto Co., Inc., participants evaluated four different recipes in which sodium was reduced by 31 to 61 percent through the addition of MSG, and described the dishes as "flavorful," "delicious," and "balanced."

Ninety percent of Americans consume too much sodium and often have misperceptions about the taste of nutritious foods creating a barrier to healthy eating. MSG (or umami seasoning) can be one tool to encourage healthier dietary patterns.

"Just as the substitution of butter with olive oil can help to reduce saturated fat intake, MSG can be used as a partial replacement for salt to reduce sodium intake," says Dr. Jean-Xavier Guinard, Professor of Sensory Science, Co-Director of the Coffee Center at the University of California, Davis, and a lead investigator in this study. "MSG has two-thirds less sodium than table salt and imparts umami - a savory taste. Taste is a key factor in what people decide to eat. Using MSG as a replacement for some salt in the diet and to increase the appeal of nutritious foods can help make healthy eating easier, likely leading to a positive impact on health."

Culinary scientists from Pilot R&D, a food innovation and development company, developed four dishes - roasted vegetables, a quinoa bowl, a savory yogurt dip, and cauliflower fried rice with pork. Study participants (163 total, aged 18-62 years) evaluated three different versions of each dish - a standard recipe with typical salt content, a reduced salt recipe with significant sodium reduction, and the same reduced salt recipe with significant sodium reduction plus MSG added. For each dish, participants rated overall liking, appearance, flavor, texture, saltiness, aftertaste, and how likely they would be to order the dish at a restaurant. The reduced salt recipes with added MSG were liked as much as or better than (in the case of the quinoa bowl and savory yogurt dip) the standard recipes, suggesting that MSG can be used as a way to reduce sodium without compromising taste. Whereas the reduced salt recipes were commonly described as "bland" and the standard recipes described as "salty" and "sour" in some cases, the MSG recipes were associated with "delicious," "flavorful," "balanced," and "savory" in some instances.

Previous research has shown that MSG can be used to reduce sodium by 30 percent, and in some cases up to 50 percent, in packaged foods and snacks such as soups, broths, chips, and sausage, without compromising taste and consumer preference for the products. For the first time, this study shows promise for using MSG in better-for-you foods, or those with a desirable nutritional profile that consumers should be eating more of.

"Extensive scientific research confirms MSG's safety, and now we see a benefit of using it to improve the flavor of nutritious foods," says Guinard. "Survey results from our study show that many people are not aware of how to use MSG in their own cooking. The easiest place to start is to replace half of the salt in your salt shaker with MSG, or if a recipe calls for 1 teaspoon of salt, try ½ teaspoon of salt and ½ teaspoon of MSG, instead - and of course, savor the flavor."

As with any study, limitations should be considered. The study could have included many more versions of the recipes with varying levels of salt and MSG to optimize results. However, this is a promising starting point for using MSG in better-for-you foods.

Astronomers have applied artificial intelligence (AI) to ultra-wide field-of-view images of the distant Universe captured by the Subaru Telescope, and have achieved a very high accuracy for finding and classifying spiral galaxies in those images. This technique, in combination with citizen science, is expected to yield further discoveries in the future.

A research group, consisting of astronomers mainly from the National Astronomical Observatory of Japan (NAOJ), applied a deep-learning technique, a type of AI, to classify galaxies in a large dataset of images obtained with the Subaru Telescope. Thanks to its high sensitivity, as many as 560,000 galaxies have been detected in the images. It would be extremely difficult to visually process this large number of galaxies one by one with human eyes for morphological classification. The AI enabled the team to perform the processing without human intervention.

Automated processing techniques for extraction and judgment of features with deep-learning algorithms have been rapidly developed since 2012. Now they usually surpass humans in terms of accuracy and are used for autonomous vehicles, security cameras, and many other applications. Dr. Ken-ichi Tadaki, a Project Assistant Professor at NAOJ, came up with the idea that if AI can classify images of cats and dogs, it should be able to distinguish "galaxies with spiral patterns" from "galaxies without spiral patterns." Indeed, using training data prepared by humans, the AI successfully classified the galaxy morphologies with an accuracy of 97.5%. Then applying the trained AI to the full data set, it identified spirals in about 80,000 galaxies.

Now that this technique has been proven effective, it can be extended to classify galaxies into more detailed classes, by training the AI on the basis of a substantial number of galaxies classified by humans. NAOJ is now running a citizen-science project "GALAXY CRUISE," where citizens examine galaxy images taken with the Subaru Telescope to search for features suggesting that the galaxy is colliding or merging with another galaxy. The advisor of "GALAXY CRUISE," Associate Professor Masayuki Tanaka has high hopes for the study of galaxies using artificial intelligence and says, "The Subaru Strategic Program is serious Big Data containing an almost countless number of galaxies. Scientifically, it is very interesting to tackle such big data with a collaboration of citizen astronomers and machines. By employing deep-learning on top of the classifications made by citizen scientists in GALAXY CRUISE, chances are, we can find a great number of colliding and merging galaxies."

TAMPA, Fla. (Aug. 10, 2020) – In certain patients suffering a severe ischemic stroke, a mechanical device can be used to remove a clot blocking blood flow to the brain. The minimally invasive procedure either suctions the clot directly out of a large artery to the brain (known as aspiration thrombectomy), or by grabbing and extracting the blockage with a stent (stent-retrieval thrombectomy). Last year, a major trial known as COMPASS found both catheter-guided techniques to be equally safe and effective as first-line approaches for treating emergent large vessel occlusions (ELVO), the most destructive type of ischemic stroke.

Now, a multicenter study led by the University of South Florida Health (USF Health) Department of Neurosurgery and Tampa General Hospital, reports that clot perviousness, or permeability – the ability for contrast used during the initial imaging workup to seep through a clot, as estimated by CT imaging – is associated with “first-pass success” in ELVO patients initially treated with the aspiration thrombectomy approach.

Findings from this posthoc analysis of 165 eligible patients enrolled in the COMPASS trial were published July 17 in the Journal of Neurointerventional Surgery.

First-pass success means achieving complete reopening of a blocked artery in the first attempt with a thrombectomy device. The treatment success of the stent retriever-first approach for a large vessel occlusion stroke was less dependent on clot perviousness, the study found. Time-sensitive, successful removal of the clot restores blood flow (and therefore oxygen) to the brain, improving the likelihood of faster stroke recovery and reduced complications and disability.

The data is the first to indicate that highly pervious clots may result in better treatment success after first attempt clot removal using the aspiration thrombectomy technique. However, clots with low perviousness are more resistant to either thrombectomy approach, the researchers report, and more research is needed to determine the most effective way to treat ELVO in this population of patients.

“Currently, physicians who treat strokes with thrombectomy are ‘in the dark.’ We have a variety of tools available but, frankly, we often don’t know which particular device will be most effective in a particular patient,” said the paper’s lead author Max Mokin, MD, PhD, associate professor of neurosurgery and neurology at the USF Health Morsani College of Medicine and Tampa General Hospital. “This study provides the first set of clues to guide us in selecting the devices (aspiration and/or stent retrievers) that may provide the most advantage, making the thrombectomy procedure safer, faster and ultimately more effective.”

Dr. Mokin specializes in neurointerventional surgery for the USF Health and Tampa General Hospital, one of the largest academic medical centers in Florida. He leads a three-year National Institutes of Health grant investigating how patient brain vessel anatomy interacts with clot removal devices. The goal is to optimize endovascular approaches for treating acute ischemic stroke, a leading cause of death and long-term disability worldwide.

Journal

Journal of NeuroInterventional Surgery

DOI

10.1136/neurintsurg-2020-016434

Aurora, Colo. (Aug. 11, 2020) - Greater rates of Colorado's children are going to the pediatric emergency department as a result of dog bites during the COVID-19 pandemic, according to a recently published commentary article in the Journal of Pediatrics. The article's authors, Cinnamon Dixon, DO, MPH/MSPH and Rakesh Mistry, MD/MS, who are attending physicians at Children's Hospital Colorado (Children's Colorado) and University of Colorado School of Medicine faculty, share data revealing significant increases in dog bite rates presenting to Children's Colorado since the initiation of statewide stay-at-home orders in March. Moreover, high rates of dog bite injuries have continued even as these orders have relaxed over time.

"It is well known that the number of dog bites tends to increase during the spring and summer months," said Dr. Dixon. "However this year's rates of emergency department visits due to dog bites have been startling." The incidence of visits for dog bites to Children's Colorado's emergency department in spring 2020 was nearly triple that of last year's rates at the same time.

"These findings are likely not unique to Colorado nor this institution," said Dr. Dixon. "There are approximately 82 million children and 77 million pet dogs in the U.S. who are all living in some variation of restriction. Families across the country are living under extreme stress and angst during the pandemic, and our canine friends are not immune to their human caregivers' increased anxiety. Not to mention, parents have competing priorities now more than ever, which may make them less focused on supervising their child when they are near a dog."

Factors that could be contributing to the increased rates of dog bites during the pandemic include:

Increased child-dog exposure earlier in the year because of shelter-in-place regulations

Heightened stress for dogs as they intuitively pick up on amplified household stress

Decreased adult supervision around dogs and children as adults juggle increased responsibilities at home

According to the CDC's National Center for Injury Prevention and Control, more than 40% of dog bite injuries resulting in emergency department visits are to children and adolescents. Children ages five to nine have the highest risk of dog bites, with infants and children at greater risk of bites to the head and neck. Most dog bites are by the family dog or another known dog.

"Dogs can be amazing companions and enrich our lives in so many ways; however it's important to remember that any dog can bite given the right circumstance," continued Dr. Dixon. "Recognizing the intense pressures and responsibilities that families are under, it is critical that parents and caregivers of children prioritize the best way to prevent dog bites - which is to always, always supervise infants and children whenever they are near a dog."

A number of additional strategies can help prevent dog bites as well, including:

Teaching children to:

o Never disturb a dog who is caring for puppies, eating or sleeping

o Never reach through a fence to pet a dog

o Never run from a dog

Encouraging dog owners to:

o Keep their dog healthy and ensure routine veterinary care

o Properly train and socialize their dog

The Republic of Korea, like other countries with a rapidly ageing population, is facing increasing numbers of patients with dementia, of which Alzheimer's disease (AD) is the most representative type. Unfortunately, AD has no complete cure yet; but, some treatments have been proven to delay its progression. Of course, this means that timely diagnosis while the symptoms are still mild is essential to maximize a patient's quality of life.

However, currently available technologies for diagnosing AD are limited because they involve expensive machinery and invasive or inconvenient procedures. Now, in a recent study published in Scientific Reports, scientists from Daegu Gyeongbuk Institute of Science and Technology, Korea, hint at a novel way of diagnosing AD in a much simpler way --collecting and analyzing specific proteins in nasal discharge samples.

Professor Cheil Moon, who led the study, explains how they came up with the idea: "In 2017, we found that olfactory dysfunction occurred in the early stages of AD in mice and suggested that the cause of the symptoms was induced by soluble species of amyloid-β (Aβ) oligomer accumulations in the peripheral olfactory system. We hypothesized that soluble Aβ oligomers could be detectable in nasal discharge and that they may be a useful parameter to monitor disease progression." To test their hypothesis, they gathered and compared nasal discharge samples from 39 patients with AD and 21 people from an age-matched control group.

They found that the levels of two particular Aβ oligomers (the aggregated forms of Aβ implicated as characteristic of Alzheimer's) were consistently higher in patients from the AD group. What's more, the levels of the "soluble" form of this protein could be used to not only separate healthy subjects from patients with AD, but also predict the onset and progression of AD over a three-year period.

Although further research will be required to better understand the link between Aβ oligomers in nasal discharge and the cognitive impairments related to AD, the results are certainly promising. Prof Moon remarks, "Routine nasal discharge screenings would be a better option to screen for AD because of its various advantages, such as its relatively low cost and non-invasive nature. The results of our study introduce a novel and simple approach to assess AD progression."

This new diagnostic technique will hopefully help in simpler and faster detection of Alzheimer's and improving the disease outcome, thus bringing much needed relief to millions suffering from the Alzheimer's worldwide.

In 2009, the Israeli government unanimously selected Bar-Ilan University to open Israel's 5th medical school and first in 34 years, in the northern Galilee city of Safed. The socioeconomic and health disparities of the north, and the need to enhance the physician workforce and health system to serve a diverse Arab and Jewish community contributed to this historic decision.

From the outset family medicine and population health have been key components of Bar-Ilan's Azrieli Faculty of Medicine, with a mission to embrace the community, upgrade health care, and effect positive change in the region.

Project Raphael, a novel social incubator for improving health in disadvantaged regions, was the Faculty's flagship community initiative, aiming to create academic-community partnerships to define and address the region's most pressing health needs. Established by Prof. Mary Rudolf, a former head of the Faculty's Department of Population Health, Raphael offers local community and health organizations an opportunity to define the most pressing problems in their communities, and to develop creative solutions. When the Project was first announced, ninety organizations submitted proposals. Thirteen were accepted. Personalized academic consultation and support was provided by Prof. Rudolf and team, along with modest seed funding by generous benefactors.

Prof. Rudolf and her research team, including Dr. Jumanah Essa-Hadad and Dr. Sivan Spitzer-Shohat, closely tracked the progress of the 13 organizations in achieving their goals and recently published their findings in the journal BMC Public Health. Twelve of the projects were completed, and all were successful to differing extents. Tangible improvements in health for disadvantaged populations in the Galilee resulted. Three of the most successful projects subsequently received grants from external competitive funding sources and have extended their projects locally and even nationally. The nine others continued their projects locally over time. The goal of reaching vulnerable populations across the Galilee was reached, and a constellation of health promoting activities was implemented.

One such success story is Al-Manal, an NGO which works to empower physically disabled Arab women. In Arab communities, disabled women are often socially isolated and lack self-confidence. Al-Manal's project was to train physically disabled Arab women to raise awareness regarding their health needs and advocate for equal health care and services. Prof. Rudolf and team found that Raphael gave the 12 women who participated the skills and confidence to speak out and address health care managers and professionals, local community leaders and decision makers, high school staff and students, among others. The project also had a significant impact on their social lives, resulting in the formation of strong social relationships, a sense of group belonging, and a decrease in feelings of isolation. In fact, following participation in the project, a number of participants made life-changing decisions, even applying for university. The organization went on to approach larger funding bodies and secured sustainability by receiving a $25,000 grant from the U.S. Embassy Middle East Partnership Initiative program.

"The Raphael Project has demonstrated that the concept of a 'social incubator' can be successful in bringing about health benefits to disadvantaged communities. It is also a way for medical schools to engage with the community and create productive academia-community partnerships with minimal resources," says Prof. Rudolf. "Medical schools have an important potential to impact upon the lives of people and upon the surrounding community."

Reducing the viscosity of heavy oils for extraction is one of the most important research foci in contemporary petroleum science. KFU has long been concentrated on exactly this topic, more specifically, thermal treatment methods. The latest publication tackles the use of Fe, Co, Ni-based catalysts for this purpose.

"The catalysts showed good results under 300 degrees C in reducing viscosity, decreasing the ratio tars and asphaltenes, eliminating sulfur and nitrogen, reducing polyaromatic compounds, etc.," says Junior Research Associate Suweid Munir Abdo Mohammed.

"The catalysts are oil-soluble transition metal reagents with different ligands. Oil-soluble organic ligands can improve the lipophilicity of catalysts, which contributes to the fact that metal ions change their catalytic activity," adds Senior Research Associate, co-author of the paper Chengdong Yuan. "In this study, we looked at stearic acid in terms of its long alkyl chain, which can be useful for interacting with the long side chains of heavy oil components."

The results of the study showed that the good catalytic properties of the new transition metal catalysts, as well as their low cost and easy accessibility, make them a potential solution in the aquathermolysis reaction and heavy oil recovery.

The publication is currently available online and is scheduled to see light in print on 1st December 2020.

Scientists have made a key discovery thanks to stardust found in meteorites, shedding light on the origin of crucial chemical elements.

Meteorites are critical to understanding the beginning of our solar system and how it has evolved over time. However, some meteorites contain grains of stardust that predate the formation of our solar system and are now providing important information about how the elements in the universe formed.

In a study published by Physical Review Letters, researchers from the University of Surrey detail how they made a key discovery connected to the "pre-solar grains" found in primitive meteorites. This discovery has provided new insights into the nature of stellar explosions and the origin of the chemical elements. It has also provided a new method for astronomical research.

Dr Gavin Lotay, Nuclear Astrophysicist and Director of Learning and Teaching at the University of Surrey, said: "Tiny pre-solar grains, about one micron in size, are the residuals of stellar explosions that occurred in the distant past, long before our solar system existed. Stellar debris eventually became wedged into meteorites that, in turn, crashed into the Earth."

One of the most frequent stellar explosions to occur in our galaxy is called a nova, which involves a binary star system consisting of a main sequence star orbiting a white dwarf star - an extremely dense star that can be the size of Earth but has the mass of our Sun. Matter from the main star is continually pulled away by the white dwarf because of its intense gravitational field. This deposited material initiates a thermonuclear explosion every 1,000 to 100,000 years and the white dwarf ejects the equivalent of the mass of more than thirty Earths into interstellar space. In contrast, a supernova involves a single collapsing star and, when it explodes, it ejects almost all of its mass.

As novae continually enrich our galaxy with chemical elements, they have been the subject of intense astronomical investigations for decades. Much has been learned from them about the origin of the heavier elements, for example. However, a number of key puzzles remain.

Dr Lotay continues: "A new way of studying these phenomena is by analysing the chemical and isotopic composition of the pre-solar grains in meteorites. Of particular importance to our research is a specific nuclear reaction that occurs in novae and supernovae -- proton capture on an isotope of chlorine -- which we can only indirectly study in the laboratory."

In conducting their experiment, the team, led by Dr Lotay and Surrey PhD student Adam Kennington (also a former Surrey undergraduate), pioneered a new research approach. It involves the use of the Gamma-Ray Energy Tracking In-beam Array (GRETINA) coupled to the Fragment Mass Analyzer at the Argonne Tandem Linac Accelerator System (ATLAS), USA. GRETINA is a state-of-the-art detection system able to trace the path of gamma rays (g-ray) emitted from nuclear reactions. It is one of only two such systems in the world that utilise this novel technology.

Using GRETINA, the team completed the first detailed g-ray spectroscopy study of an astronomically important nucleus, argon-34, and were able to calculate the expected abundance of sulfur isotopes produced in nova explosions.

Adam Kennington said: "It's extremely exciting to think that, by studying the microscopic nuclear properties of argon-34, it may now be possible to determine whether a particular grain of stardust comes from a nova or a supernova."

Some people get really sick from COVID-19, and others don't. Nobody knows why.

Now, a study by investigators at the Stanford University of Medicine and other institutions has turned up immunological deviations and lapses that appear to spell the difference between severe and mild cases of COVID-19.

That difference may stem from how our evolutionarily ancient innate immune system responds to SARS-CoV-2, the virus that causes the disease. Found in all creatures from fruit flies to humans, the innate immune system rapidly senses viruses and other pathogens. As soon as it does, it launches an immediate though somewhat indiscriminate attack on them and mobilizes more precisely targeted, but slower-to-get-moving, "sharpshooter" cells belonging to a different branch of the body's pathogen-defense forces, the adaptive immune system.

"These findings reveal how the immune system goes awry during coronavirus infections, leading to severe disease, and point to potential therapeutic targets," said Bali Pulendran, PhD, professor of pathology and of microbiology and immunology and the senior author of the study, which will be published Aug. 11 in Science. Lead authorship is shared by Stanford postdoctoral scholars Prabhu Arnunachalam, PhD, and Florian Wimmers, PhD; and Chris Ka Pun Mok, PhD, and Mahen Perera, PhD, both assistant professors of public health laboratory sciences at the University of Hong Kong.

Three molecular suspects

The researchers analyzed the immune response in 76 people with COVID-19 and in 69 healthy people. They found enhanced levels of molecules that promote inflammation in the blood of severely ill COVID-19 patients. Three of the molecules they identified have been shown to be associated with lung inflammation in other diseases but had not been shown previously in COVID-19 infections.

"These three molecules and their receptors could represent attractive therapeutic targets in combating COVID-19," said Pulendran, who is the Violetta L. Horton Professor. His lab is now testing the therapeutic potential of blocking these molecules in animal models of COVID-19.

Bacterial debris and immune paralysis

The scientists also found elevated levels of bacterial debris, such as bacterial DNA and cell-wall materials, in the blood of those COVID-19 patients with severe cases. The more debris, the sicker the patient -- and the more pro-inflammatory substances circulating in his or her blood.

The findings suggest that in cases of severe COVID-19, bacterial products ordinarily present only in places such as the gut, lungs and throat may make their way into the bloodstream, kick-starting enhanced inflammation that is conveyed to all points via the circulatory system.

But the study also revealed that, paradoxically, key cells of the innate immune system in the blood of COVID-19 patients became increasingly paralyzed as the disease got worse. Instead of being aroused by the presence of viruses or bacteria, these normally vigilant cells remained functionally sluggish.

If high blood levels of inflammation-promoting molecules set COVID-19 patients apart from those with milder cases, but blood cells are not producing these molecules, where do they come from? Pulendran believes they originate in tissues somewhere in the body -- most likely patients' lungs, the site of infection.

"One of the great mysteries of COVID-19 infections has been that some people develop severe disease, while others seem to recover quickly," Pulendran said. "Now we have some insights into why that happens."

Pulendran is a member of Stanford Bio-X and a faculty fellow of Stanford ChEM-H.