Culture

Sophia Antipolis, 28 November 2019: Most patients do not understand or recall information given to them before heart procedures. For example, many patients mistakenly believe that opening blocked arteries will cure them of heart disease. That's one of the findings of a study about informed consent published today in the European Journal of Cardiovascular Nursing, a journal of the European Society of Cardiology (ESC).1

More than 40% of patients in the study acknowledged that they do not understand, or remember, the information they receive about percutaneous coronary intervention (PCI) that has become the most common intervention performed in high- and middle-income countries.

Providing details about a procedure, including the risks and benefits, is a legal and ethical requirement - called informed consent. Patients should receive enough information about their options to make a valid choice, without being coerced. Health professionals must also confirm that the patient has sufficient capacity to decide at that time.

The group of patients who were asked about the consent process were treated with either elective, or urgent PCI, but not emergency PCI when speed is of the essence. Some 60% of patients with coronary heart disease undergoing elective PCI to unblock an artery thought it would cure their coronary heart disease. Nearly all patients (95%) believed it would reduce their risk of a future heart attack and 91% thought it would increase their life span.

"These beliefs do not align with trial evidence, which shows that elective PCI is predominantly for relief of symptoms," said study author Professor Felicity Astin, University of Huddersfield, UK.

Professor Astin said health services should be reconfigured to allow sufficient time for patients and clinicians to discuss the proposed treatment and potential alternatives. She explained: "Patients often receive all of the information at once. They then feel overloaded, which contributes to forgetting or not comprehending what they hear."

Nearly half (47%) would have liked a family member with them when their treatment was explained during the informed consent process. Almost one-third (31%) of patients in the study needed some degree of help to understand health-related written information.

Professor Astin said: "Health literacy is a neglected issue. Leaflets should be in plain language. In addition, clinicians should ask patients if they need help reading or understanding health information. Patients will not volunteer that they can't read."

The paper identifies the need for patients and health professionals to work together to develop and evaluate new approaches to information sharing and decision-making. Professor Astin recommends that cardiologists and nurses receive training to use "teach back": giving small chunks of information then asking patients to explain it in their own words to see how much they have understood. Professor Astin said: "The emphasis is on being a good teacher, not testing the patient and making them feel ashamed. But staff can only do this if they have the time - which is why patient pathways need to be configured."

ESC guidelines on revascularisation state: "Active patient participation in the decision-making process should be encouraged. Use of terminology that the patient understands is essential. Risks and benefits...should be thoroughly discussed."2

Pharmacists based in GP practices can play an integral role in the prevention of cardiovascular disease, finds new research led by the University of Birmingham.

The study findings, published today (Nov 28 GMT) in the British Journal of Clinical Pharmacology, support the involvement of pharmacists as healthcare providers in managing patients with hypertension, diabetes and high cholesterol.

Pharmacist-led interventions such as patient education, medication review, and medication management can be pivotal in preventing heart-related illnesses, the researchers conclude.

Led by researchers at the University of Birmingham's School of Pharmacy and Institute of Applied Health Research, the team assessed medical literature for relevant randomised controlled clinical trials assessing the effectiveness of pharmacists-led interventions delivered in the general practice in reducing the medical risk factors of cardiovascular events.

They identified 21 trials involving a total 8,933 patients. Pharmacist-led interventions included patient education, medication review and counselling, physical assessment, assessing adherence, lifestyle modification, and medication management such as prescribing, adjusting, monitoring, and administering therapy, and identifying drug-related problems. The most frequently used pharmacist-led interventions were medication review and medication management.

Patients receiving pharmacist-led interventions experienced significant reductions in their systolic blood pressure (by an average of -9.33 mmHg); Hemoglobin A1c, a measure of blood sugar levels (by an average of -0.76%); and LDL-cholesterol (by an average of -15.19 mg/dl). Pharmacist-led interventions also helped patients correctly follow their prescribed medication regimens.

Abdullah Alshehri, of the University of Birmingham, said: "The evidence presented in this review provides an important message to health systems and policy makers regarding the effectiveness of general practice-based pharmacists' interventions.

"The significant reductions in blood pressure, blood glucose, and blood cholesterol reported in this meta-analysis, if sustained in clinical practice, could have significant implications for managing hypertension, diabetes and dyslipidaemia that could prevent cardiovascular morbidity and mortality."

Alshehri noted that the findings support a greater involvement of pharmacists in general practice.

"This will benefit health organisations by providing cost-effective care associated with greater control of patients' conditions and their medications," he said.

Computer scientists at the University of Waterloo have created a device for wearable computer input suitable for many situations, just by touching your fingertips together in different ways.

The device, called Tip-Tap, is inexpensive and battery-free through the use of radio frequency identification (RFID) tags to sense when fingertips touch. The device could, therefore, be added to disposable surgical gloves, allowing surgeons to access preoperative planning diagrams in an operating room.

"One of the many possible applications of the device is in surgeries. What typically happens now with operation digital preplanning is that an assistant is responsible for navigating the computer and communicating with the surgeon, but this is slow and difficult", said Daniel Vogel, a professor in Waterloo's David R. Cheriton School of Computer Science. "If the surgeon tries to navigate it themselves using a touchscreen or a mouse, it's problematic because it would require constant sterilization, and current alternatives such as big gestures tracked by computer vision can get very tiring.

"The idea is if you mount Tip-Tap in surgical gloves, surgeons could navigate the computer themselves from where they are, and it won't affect their other actions like picking up the scalpel."

Researchers created the prototype of Tip-Tap as part of a new partnership with the National Research Council of Canada (NRC).

In developing the method, the researchers mapped the most comfortable areas on the index finger for people to touch with their thumb, and tested different designs for the input points, such as smooth, bumps, or magnets. Following user tests with an early "wired" prototype to benchmark performance, they tackled the problem of making it "battery-free."

The researchers were able to make Tip-Tap battery-free by splitting the antenna of an RFID tag in two, and equipping each side with three chips to enable two-dimensions of fingertip input, the first time this had ever been done.

The new RFID tag can be integrated into a glove or attached directly on the skin as a temporary tattoo.

"We used this design in two prototype Tip-Tap devices, a glove with a range of four meters, and an on-skin tattoo," said Vogel. "Such devices are useful for issuing simple commands when a user cannot easily hold an input device, and the usage context is a defined area -- for example, factory workers, surgeons, or people exercising in a gym.

"This is the only device of its kind that we're aware of that doesn't require a battery or cumbersome wires to make it work."

SINGAPORE, 28 November - Alzheimer's disease is the most common form of dementia in the elderly, which is increasingly important to the disease burden in ageing societies like Singapore. Despite this and the myriad investments into research on the disease, there is currently no effective treatment and an effective drug is yet to be discovered.

Researchers led by Duke-NUS Medical School, in collaboration with Monash University, have now published a comprehensive and detailed study of gene expression changes in specific human brain cell types that are associated with progression of Alzheimer's disease. Leveraging the latest single-cell sequencing technology, the findings yield insights that may aid in scientists' pursuit of potential druggable gene targets for drug development.

"Limited information has been available about how individual cell types in the brain contribute to Alzheimer's disease," said study co-senior author Assistant Professor Owen Rackham, from Duke-NUS' Cardiovascular and Metabolic Disorders (CVMD) Programme. "Although various genes have been implicated in Alzheimer's disease, we do not know which cell types harbour these differences in gene expression."

Focusing on the need to study cell types other than neurons, the main type of cell found in the brain, the researchers applied an innovative single-nucleus RNA sequencing technology called DroNCSeq to cells from the brain's entorhinal cortex, sampled from both control and Alzheimer's disease brains, yielding a total of over 13,000 high quality nuclei that they could analyse for gene expression differences. The entorhinal cortex, together with the hippocampus, are the regions of the brain that scientists understand to be involved in processing and storing memories, perceiving time, and predicting the future.

Associate Professor Enrico Petretto, co-senior author of the study, explained, "Our research sought to explore whether the answer to treating Alzheimer's lies in understanding how non-neuronal cells are affected during the disease. Using DroNCSeq, we were able to study differences in gene expressions at single-cell resolution, which is key to understanding how genes identified by genome-wide association studies in specific cell subpopulations are associated with Alzheimer's disease."

The study identified new subpopulations of cells present only in Alzheimer's disease patient brains as well as common and distinct networks of genes and functions that were coregulated across different types of cells. These results provide insights into the coordinated control of Alzheimer's disease risk genes and their cell type-specific contribution to disease susceptibility, and can ultimately help scientists identify potential gene targets for Alzheimer's disease drug development.

To facilitate access to these insights by other researchers, the research team published an interactive online tool to visualise and analyse their dataset, providing a unique resource for future studies seeking to understand cellular differences and define functional changes at single-cell level in the human Alzheimer's disease brain.

Professor Patrick Casey, Senior Vice Dean at Duke-NUS, commented, "Alzheimer's disease affects not only the patient, but also their caregivers. It is a global disease with biological, social, psychological, and economic impacts that will only grow in importance with increasingly ageing populations around the world. This study underscores the important role technological innovation and data science can play not only in helping us to better understand the disease, but also to identify potential drug targets."

A multidisciplinary team of scientists from Granada has warned for the first time of the presence of bisphenol A (BPA) and parabens (PBs) in a wide range of plastic medical devices, fabrics, personal care products (including topical creams), and nutritional supplements in hospital neonatal intensive care units (NICUs), coming into direct contact with new-born babies.

An article published today in Environmental Health Perspectives (the most prestigious journal in the world in the environmental health field) explains how the researchers analysed over 50 items that routinely come into direct contact with babies born with a very low birth weight, during their stay in hospital. They warn that such babies are inadvertently exposed to BPA and PBs by various means--transdermal, digestive, respiratory, intravenous, or parenteral. Exposure to these two endocrine-disrupting compounds has been linked to a number of dysfunctions that lead to different diseases in both children and adults.

Among the items analysed in the study were plastic syringes and tubes for the intravenous administration of fluids or parenteral nutrition; plastic nasogastric and enteral feeding tubes; oxygen masks and endotracheal tubes; and a wide range of cardiopulmonary bypass circuits, dressings, bandages, and electrodes. Other specific baby products were also analysed, such as personal care products, certain fabrics, nappy-changing mats, and mattress protectors.

The study found that 60% of the objects or products sampled contained BPA, while PBs were found in 80% of the items. The highest BPA content was detected in the three-way stopcock (> 7,000ng/g), followed by the patterned transparent film dressing (surgical tape), the gastro-duodenal feeding tube, sterile gloves for professional use, the umbilical catheter, and the intravenous infusion extension kit (with BPA concentrations ranging between 100 and 700ng/g).

The researchers also observed high concentrations of PBs (greater than 100ng/g) in several items, such as the protective eye covers used when administering phototherapy to the baby, the aforementioned patterned transparent film dressings (surgical tape), intravenous catheters, and the intravenous infusion extension kit.

When they analysed the hormonal activity of the samples taken from the selected materials, based on oestrogenicity and anti-androgenicity assays, the items presenting the most hormonal activity were the dummy, the three-way stopcock, and the patterned transparent film dressing.

Analysis of the NICUs within hospitals in Granada

This study was conducted by a multidisciplinary group of clinical researchers from the "Virgen de las Nieves" university hospitals (whose NICU and new-born population were analysed) and from the "Clínico San Cecilio de Granada" hospital, together with researchers from the University of Granada (UGR), the Biomedical Research Centre (CIBM), ??and the Biohealth Research Institute in Granada (ibs.GRANADA). The research was funded by the Instituto de Salud Carlos III and the European Union.

Nicolás Olea, Professor of Radiology and Physical Medicine at the UGR and a doctor at the San Cecilio Hospital, is the main author of this study. "New-born babies with low birth weight," he explains, "require the complex care of the NICU setting, which endeavours to simulate uterine conditions until the baby's immature skin begins to develop correctly and their gastrointestinal, immune, nervous, and respiratory systems start to function properly."

In this hospital environment, such babies are subjected to multiple techniques and procedures that involve the use of medical instruments and devices that come into direct contact with their bodies, many of which are made of polycarbonate plastic, epoxy resins, or PVC. Substances such as BPA form part of the structure of these materials or have been added to improve the characteristics of the product.

"In addition, parabens are used as components of some plastics as preservatives or antimicrobial agents. They are also used in cosmetics and other consumer goods. Both BPA and PBs can be released when these materials are used, either due to wear of the plastic polymer or by being exposed to the very pH and temperature conditions that foster their release," warns the UGR Professor.

To date, only two other studies have addressed the exposure of new-born babies in the NICU environment to these chemical compounds, and both identified an increase in BPA concentrations in the urine of the babies that was linked to a higher frequency and intensity of the use of these medical devices. Values ??up to 30 times higher than those found among the general population were reached.

Higher levels of PBs were also described in hospitalised new-borns in relation to a greater use of medications, although no other possible sources of exposure were identified, in contrast to the study that is now being published.

The authors signal an urgent need to implement preventive measures to offset babies' exposure to these endocrine-disrupting compounds BPA and PBs, including both changes in clinical protocols and also the use of materials free of endocrine disruptors.

Not surprisingly, the authors of this study are now developing new work protocols and procedures designed to reduce the exposure of babies to these and other environmental factors in the first weeks of life during their stay in hospital that may interfere with their normal development.

How can the energy transition be organized in a globally just way? Will developing countries struggle to transition to clean energy because they lack the financial and technical means? A new Policy Brief by the Institute for Advanced Sustainability Studies (IASS) focuses on the risks of an uneven transition and makes concrete proposals to prevent such risks.

In their Policy Brief "Countering the risk of an uneven low-carbon energy transition", the authors Laima Eicke, Silvia Weko and Prof. Andreas Goldthau from the IASS write that meeting the technological and financial prerequisites for a global energy transition is crucial. Otherwise there is a danger that developing countries will not be able to make the change to more environmentally friendly energy systems and continue to lag behind in the energy transition - with far-reaching consequences for themselves and the rest of the world. On the one hand, a rise in global carbon emissions will have a negative global effect. On the other, late-transitioning countries would be more susceptible to political instability and economic crisis.

For example, countries that are unable to phase out fossil fuels quickly enough are at risk of being excluded from international trade and value chains. This is because in a decarbonising global economy, the carbon content of products will become an important factor for determining market access, and latecomers risk being left behind. The resulting damage to their economies could be sustained.

COP25 as a stepping stone to a global energy transition strategy

To limit global warming to 1.5 degrees Celsius, all countries should have equal opportunities to decarbonise their economies - and consistent strategies are needed for that to happen. As Laima Eicke, one of the study's authors, points out: "If the gap between early- and late-decarbonising countries widens, so too might the potential for disagreements, further slowing the transition." To prevent that scenario, many countries need commitments for financial and technical assistance to speed up their energy transition processes to the degree required by the Paris Agreement.

The Meetings of the Marrakech Partnership for Global Climate Action, which includes representatives of various government levels as well as the private sector and investors, might open further space for these discussions at COP25.

Other international platforms, bilateral programmes, and private actors can also play an important role. Initiatives like the NDC Partnership highlight the potential for aligning the activities of multiple actors in specific country contexts.

Steps must also be taken to coordinate the principles and practices of financial actors across all countries. COP25 in Madrid could serve as a stepping stone to consistent strategies, which will be crucial for developing countries as they update their NDCs in 2020 and for efforts to close the ambition gap.

The authors' three recommendations:

1. Policy debates on 'just transitions' focus on the implications of phasing out fossil fuels from national energy mixes. Yet there are distributional effects of a global energy transition especially for developing countries that lack financial and technological means to transition, creating structural risks. Acknowledging this global dimension of just transitions at the UNFCCC may help to create alliances for climate action.

2. Technology transfer initiatives can accelerate the diffusion of low-carbon energy technologies. Yet only a third of existing initiatives focus on transferring skills, expertise and technology simultaneously. To ensure the success of a global energy transition, tech transfer must be targeted and comprehensive.

3. COP25 should coordinate a consistent strategy among financial actors to shift financial flows for energy transitions in the Global South. Common guidelines for long-term risk assessments and an exchange of best practices for capacity development could leverage ambition in the 2020 NDC updating processes.

High-performance solid-state elastocaloric cooling materials with exceptional fatigue resistance are made possible by 3D printing a nickel-titanium based alloy, researchers report. According to the new study, the unique and intricate nanocomposite structures produced greatly enhance the efficiency and performance of the material for well over one million elastocaloric heat-pumping cycles, findings that indicate their potential use in contemporary refrigeration products and applications. Nearly one-fifth of the energy budget worldwide is spent on cooling and refrigeration, which is largely done using vapor compression, an inexpensive and mature technology; however, it is also limited in its efficiency and relies on refrigerants known to be greenhouse gasses. Solid-state cooling techniques suggest promising greener alternatives, particularly those that use mechanocaloric cooling materials, which could significantly surpass the energy efficiency of vapor compression. Elastocalorics, a type of mechanocaloric material, transfer latent heat when put under stress. However, repeated cycles of stress-induced heat pumping can lead to material fatigue or failure, limiting their long-term cooling performance and potential for widespread solid-state cooling applications. Huilong Hou and colleagues synthesized a nickel-titanium-based elastocaloric metal using laser directed-energy deposition (L-DED), a type of 3D printing that uses laser-melted metal powders to fabricate solid metal objects. Hou et al. discovered that the fusion of a nickel-rich blend of nickel and titanium powders resulted in a unique nanocomposite structure, which led to a considerable improvement in the resulting material's electrocaloric properties.

The coldest chemical reaction in the known universe took place in what appears to be a chaotic mess of lasers. The appearance deceives: Deep within that painstakingly organized chaos, in temperatures millions of times colder than interstellar space, Kang-Kuen Ni achieved a feat of precision. Forcing two ultracold molecules to meet and react, she broke and formed the coldest bonds in the history of molecular couplings.

"Probably in the next couple of years, we are the only lab that can do this," said Ming-Guang Hu, a postdoctoral scholar in the Ni lab and first author on their paper published today in Science. Five years ago, Ni, the Morris Kahn Associate Professor of Chemistry and Chemical Biology and a pioneer of ultracold chemistry, set out to build a new apparatus that could achieve the lowest temperature chemical reactions of any currently available technology. But they couldn't be sure their intricate engineering would work.

Now, they not only performed the coldest reaction yet, they discovered their new apparatus can do something even they did not predict. In such intense cold--500 nanokelvin or just a few millionths of a degree above absolute zero--their molecules slowed to such glacial speeds, Ni and her team could see something no one has been able to see before: the moment when two molecules meet to form two new molecules. In essence, they captured a chemical reaction in its most critical and elusive act.

Chemical reactions are responsible for literally everything: breathing, cooking, digesting, creating energy, pharmaceuticals, and household products like soap. So, understanding how they work at a fundamental level could help researchers design combinations the world has never seen. With an almost infinite number of new combinations possible, these new molecules could have endless applications from more efficient energy production to new materials like mold-proof walls and even better building blocks for quantum computers.

In her previous work, Ni used colder and colder temperatures to work this chemical magic: forging molecules from atoms that would otherwise never react. Cooled to such extremes, atoms and molecules slow to a quantum crawl, their lowest possible energy state. There, Ni can manipulate molecular interactions with utmost precision. But even she could only see the start of her reactions: two molecules go in, but then what? What happened in the middle and the end was a black hole only theories could try to explain.

Chemical reactions occur in just millionths of a billionth of a second, better known in the scientific world as femtoseconds. Even today's most sophisticated technology can't capture something so short-lived, though some come close. In the last twenty years, scientists have used ultra-fast lasers like fast-action cameras, snapping rapid images of reactions as they occur. But they can't capture the whole picture. "Most of the time," Ni said, "you just see that the reactants disappear and the products appear in a time that you can measure. There was no direct measurement of what actually happened in these chemical reactions." Until now.

Ni's ultracold temperatures force reactions to a comparatively numbed speed. "Because [the molecules] are so cold," Ni said, "now we kind of have a bottleneck effect." When she and her team reacted two potassium rubidium molecules--chosen for their pliability--the ultracold temperatures forced the molecules to linger in the intermediate stage for microseconds. Microseconds--mere millionths of a second--may seem short, but that's millions of times longer than usual and long enough for Ni and her team to investigate the phase when bonds break and form, in essence, how one molecule turns into another.

With this intimate vision, Ni said she and her team can test theories that predict what happens in a reaction's black hole to confirm if they got it right. Then, her team can craft new theories, using actual data to more precisely predict what happens during other chemical reactions, even those that take place in the mysterious quantum realm.

Already, the team is exploring what else they can learn in their ultracold test bed. Next, for example, they could manipulate the reactants, exciting them before they react to see how their heightened energy impacts the outcome. Or, they could even influence the reaction as it occurs, nudging one molecule or the other. "With our controllability, this time window is long enough, we can probe," Hu said. "Now, with this apparatus, we can think about this. Without this technique, without this paper, we cannot even think about this."

HRL Laboratories, LLC, has published test results showing shock-absorbing pads made from HRL's microlattice--an architected elastomeric material--had up to 27% more energy absorption efficiency than the current best-performing expanded polystyrene (EPS) foam when sustaining a single impact and up to 48% improved absorption efficiency over the state-of-the-art vinyl nitrile foam when impacted repeatedly. The microlattice material could replace currently used foams in applications such as protective packaging, shock isolators for electronics, vehicle interiors, and padding in football, military, or bicycle helmets. The paper entitled Elastomeric microlattice impact attenuators is the featured cover article in the journal Matter for December 2019.

"The best competing architected pads to date have maximum energy absorption efficiencies up to 44% for a single impact," said Eric Clough, HRL researcher and the paper's lead author. "Our best performing microlattice pads had maximum energy absorption efficiencies of nearly 58%. Also, the competitor lattice-based pads are irreversibly smashed after sustaining a single impact. Whereas, our elastomeric microlattice pads continue to efficiently absorb the shock of multiple repeated impacts."

The sports technologies company VICIS has licensed HRL's microlattice technology portfolio. They intend to further develop microlattice impact attenuators and commercialize them in new products to minimize sports-related head injuries.

HRL's material is manufactured by a process called light casting by which a UV light is cast through a patterned template onto a tray of specially formulated liquid resin. The areas of resin exposed to the light cure and quickly grow into solid polymer struts that then grow together to form the lattice pad. The formulation of the liquid resin can be adjusted to make microlattice that is stiffer, softer, or more compliant, as desired.

Current helmets typically combine a hard shell with closed-cell foam padding that traps heat and holds sweat against an athelete's head. The open-celled architected structure of the microlattice, resembling the Eiffel Tower, allows air to flow freely through the entire pad. This unique feature improves air flow for a much cooler wearing experience.

"Microlattice is composed of solid polymer struts and air. Unlike foam it has an ordered architecture that enables improved performance in airflow, energy absorption, stiffness, and strength. Under high impact, microlattice stiffens to absorb energy and significantly reduces acceleration and force transmitted to the wearer. With light casting we can make a set of pads for a helmet in under a couple minutes. Methods such as stereolithography 3D printing would take a much longer," Clough said.

CHICAGO - Researchers are trying to identify injury patterns and predict future outcomes for victims of gun violence who are seen in the emergency room and later readmitted to the hospital, according to research being presented next week at the annual meeting of the Radiological Society of North America (RSNA). They found that patients who had gunshot injuries to the chest or abdomen were more likely to be readmitted to the hospital.

"Gun violence is a national health emergency and yet there is a profound lack of research on the long-term consequences of gunshot-related injuries," said lead researcher and radiology resident Corbin L. Pomeranz, M.D., from the Department of Radiology at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pa. "As a level-one trauma center, we have an opportunity to study the outcomes for this patient population and to look for ways to provide better care to gunshot victims."

According to Dr. Pomeranz, the bulk of the cost of treating victims of gun violence is spent on ongoing care, including treating the complications associated with gunshot wounds.

"The vast majority of research on gun violence focuses on emergency care, but in reality only a tiny fraction of the billions spent on medical care from gun violence in the U.S is spent on direct expenses for emergency medical care," he said.

Dr. Pomeranz and a team of researchers performed a retrospective analysis of patients with a history of prior gunshot wounds who were seen in the emergency room at Thomas Jefferson University Hospital between January and April of 2018. During that time, 110 patients with a history of a gunshot injury returned to the hospital and underwent a total of 174 imaging exams. The majority of gunshot-wound patients in the study were men (91.8%), and the average age was 49.7 years.

"Radiology is pivotal in the treatment of these patients because every trauma patient will receive some type of imaging," he said. "Creating a regional patient database can provide a wealth of knowledge for improving both gun violence research and patient care."

Using the imaging database, the team collected information on the patients, including age, gender, admitting hospital unit, the number of readmissions and surgeries, imaging data and gunshot wound history.

Of the 110 patients, 36 patients with a history of gunshot wounds were readmitted to the hospital with neurologic, visceral (thorax [chest] plus abdomen) or extremity injuries. Of those, 18 were readmitted due to complications associated with their prior gunshot wounds.

Neurologic injuries were the most common injury in the study group (24 patients), followed by abdominal and chest wounds (9 patients). Three patients had major blood vessel injuries. Eighteen of the patients were readmitted to the hospital with complications associated with their initial gunshot wound injuries. Three surgeries were performed after readmission, two of which were chest surgeries.

A statistical analysis demonstrated that the type of gunshot injury was the strongest predictor of hospital readmission. Patients who had a gunshot wound to the thorax or abdomen were more likely to be readmitted to the hospital.

"Where you are shot has an effect on your long-term health," Dr. Pomeranz said.

Dr. Pomeranz said the preliminary study is small but warrants additional multi-hospital and regional studies of outcomes for gunshot patients. He hopes future studies collect additional information on gunshot victims, such as whether bullets or bullet fragments remain in the body, and treatment outcomes.

"The outcomes of gun violence can only be assessed once we have a firm understanding of injury patterns," he said. "A location and injury severity scale based on imaging findings could be used to predict long-term consequences as well as the costs of gunshot wounds."

The goal of the researchers is to show hospitals how they can build their own database to identify patients at risk for readmission. This information will tell the researchers which patients will need more aggressive home care, Dr. Pomeranz noted.

"We want to help these patients stay of out of the hospital, but we also want to help improve their quality of life," he said. "That's the physician's job."

Research Highlights:

The fear of deportation was associated with double the risk of developing high blood pressure over a four-year period, in a study of Mexican-born women who reside in an agricultural area of California.

Worries associated with immigration policies and enforcement may have negative impacts on the long-term cardiovascular health of immigrants, their families and community.

DALLAS, Nov. 27, 2019 -- In a four-year study of Mexican-born women who reside in an agricultural area of California, the worry of deportation appears to double their risk of developing high blood pressure, according to new research published today in the Journal of the American Heart Association, the open access journal of the American Heart Association.

The researchers followed 572 women (average age of 39 years; 99% were born in Mexico) participating in a long-term study of Mexican women and their children in farmworker families in the Salinas Valley region of California.

"Our findings suggest that concerns around immigration policies and enforcement may have potentially negative impacts on the long-term cardiovascular health of immigrants and their families and community," said Jacqueline M. Torres, Ph.D., M.P.H., lead author of the study and assistant professor of epidemiology and biostatistics at the University of California, San Francisco.

As part of a baseline assessment in 2012-2014, the women in the study were asked to rate their concern about deportation for themselves or others as not too much (28%), a moderate amount of worry (24%) or a lot of worry (48%). At the baseline assessment, worry about deportation was associated with steeper increases in systolic (top number) blood pressure. However, there was no significant difference in the proportion of women diagnosed with high blood pressure.

"Given what we learned in this first study, we are concerned about the long-term effects of deportation worry and its impact on both mental and physical health," Torres said.

In the four-year, follow-up with evaluations conducted between 2014-2016 and 2016-2018, the researchers found:

A steeper initial increase in systolic blood pressure and mean arterial pressure in women who reported higher deportation worry at their baseline assessment;

No change in the association between deportation worry and higher body mass index (BMI) and waist circumference over four-years; and

Among the 408 women who did not have high blood pressure at the initial assessment, women with moderate or high deportation worry were twice as likely to be diagnosed with high blood pressure, compared to those expressing little worry during the four-year follow-up period (either self-reported, a formal diagnosis or a blood pressure greater than 130mm Hg systolic or 80 mmHg diastolic at the evaluation).

"Just as clinicians may think about the role of other stressors impacting the lives and health of their patients, this study suggests they may also need to consider the impact of policies such as immigration on stress levels and the subsequent effect on outcomes related to blood pressure," said Torres.

The researchers cautioned that the study contained only women from one part of the country, and the results may not be generalizable to other groups. However, they noted there is also reason to believe they may have underestimated the effect that living in fear of deportation has on cardiovascular risks like high blood pressure.

"The women in this study are living in a welcoming, largely Latino community, and they're also in California, where they may have less fear of being deported because it's a sanctuary state," said senior author Brenda Eskenazi, Ph.D., M.A., who directs the Center for Environmental Research and Children's Health at the University of California, Berkeley. "These results may be magnified in other regions in the United States."

The investigators are currently expanding the list of questions about the impact of immigration policies for participants at their six-year follow-up visit, to measure the impact of deportation worries on outcomes related to the women's cognitive and physical functioning as they enter middle age.

As computers continue to infiltrate almost every aspect of modern life, their negative impact on the environment grows. According to recent estimates, the electricity required to power today's computers releases a total of more than 1 gigatonne of carbon emissions to the atmosphere each year. Now, researchers reporting in ACS Nano have developed a new manufacturing process that could enable ultra-efficient atomic computers that store more data and consume 100 times less power.

Scientists have previously manipulated single atoms to make ultra-dense memory arrays for computers, which store more data in a much smaller space than conventional hard drives and consume much less power. In a technique known as hydrogen lithography, researchers use the tip of a scanning tunneling microscope (STM) to remove single atoms of hydrogen bonded to a silicon surface. The pattern of silicon atoms bound to or lacking a hydrogen atom forms a binary code that stores the data. However, there is a bottleneck when rewriting the data because the STM tip must pick up and deposit hydrogen atoms at precise locations. Roshan Achal, Robert Wolkow and colleagues wanted to develop a more efficient method to rewrite atomic memory arrays.

The researchers prepared silicon surfaces covered with hydrogen atoms. With hydrogen lithography, they removed certain atoms to write data. The scientists found that by taking away an extra hydrogen atom next to a bit they wanted to rewrite, they could create a reactive site that attracted hydrogen gas that was infused into the chamber. Binding of a single hydrogen gas (H2) molecule to the two adjacent sites erased the sites so that a new binary code could be written. Using hydrogen gas as a molecular eraser to rewrite the data was much faster and easier than bringing in individual hydrogen atoms on an STM tip. The researchers demonstrated the technique's ability to rewrite a small 24-bit memory array. The new method allows 1,000-times-faster fabrication of atomic-scale computers, making them ready for real-world manufacture, the researchers say.

Scientists have added a crucial tool to the atomic-scale manufacturing toolkit with major implications for today's data driven--carbon intensive--world, according to new research from the University of Alberta in Canada.

"Computers today are contributing one gigatonne of carbon emissions to the atmosphere, and we can eliminate that by enhancing the most power-hungry parts of conventional computers with our atomic-scale circuitry," said Robert Wolkow, professor in the University of Alberta's Department of Physics a Principal Research Officer at the National Research Council of Canada's Nanotechnology Research Centre, and chief technical officer of Quantum Silicon Inc, a spinoff company taking the technology to market. "This new tool better enables an ultra-efficient kind of hybrid computer for the training of neural networks for artificial intelligence."

The latest finding speeds up the atomic-scale manufacturing process, taking advantage of a natural physical phenomenon. Hydrogen molecules seek out and automatically repair errors in atomic-scale circuitry and can be used to significantly improve the rewriting speeds of atomic data storage. This work builds on the decades-long dedication by Wolkow's research group to realizing the potential for atomic-scale manufacturing, something that has shifted from an idealistic dream to an ever more likely reality in the next few years.

"It will take a couple of years, but there's an actual path to atomic-scale devices that will be very impactful for our world," said Roshan Achal, lead author on the new discovery, currently completing his PhD with Wolkow. "And we now have this faster and better application of atomic memory, which will only continue to improve with time."

Achal explained the technical process of moving hydrogen molecules at the atomic level scales up in efficiency as electronic circuits and memories increase in size, translating to easier mass production of low-power electronics with more memory and faster functioning.

Considerations for carbon

The findings present potential applications from smaller hard drives to more efficient data centres, a need and a new reality for our data-driven climate-concerned world.

Wolkow and Achal are two of the minds behind the groups' recent groundbreaking discoveries, which include creating the highest demonstrated memory storage and the first silicon atomic circuitry. The group has quickly and quietly been perfecting their techniques, which used to be slow but sufficient for applications in scientific labs. These recent developments have sped up the process by 1000 times, thereby making it more practical for scalable applications in the real world.

An unanticipated offshoot of their hydrogen-related discovery is the ability to detect other molecules, presenting the potential for chemical sensing within their atomic-scale circuits, useful for example in the detection of alcohol, THC, and molecules found in explosives.

"A single molecule landing on a surface can now be electrically detected," said Wolkow. "It's like a lightbulb goes on when this happens. You're detecting the tiniest most delicate event. It's beautiful and so useful. It's amenable to sensor incorporation in everything from your phone to diagnostic devices in the doctor's office."

For Achal, this latest publication serves as the perfect cap on his thesis, which he is finishing up next month. "This new paper is the culmination of what I see as the last piece of what our atomic scale fabrication toolkit needed. Now we can really start working on making these circuits and moving to a large-scale demonstration."

BOSTON - The cause of amyotrophic lateral sclerosis (ALS)--a disabling neurodegenerative disease that affects nerve cells in the brain and spinal cord and leads to weakened muscles and early death--is not fully understood, but accumulating evidence suggests that inflammatory processes may play a role in the initiation and progression of the condition. In research led by investigators at Massachusetts General Hospital (MGH) and published in Scientific Reports, treatment with an anti-inflammatory drug delayed the onset of disease in a mouse model of ALS.

Only two treatments are approved by the U.S. Food and Drug Administration (FDA) to treat ALS, and they are only modestly effective. Recent studies from MGH demonstrated that cromolyn sodium, an FDA-approved compound used to treat asthma and other conditions, exerts neuroprotective effects in cellular and animal models of Alzheimer's disease. To test the therapeutic potential of the drug against ALS, a team led by Ghazaleh Sadri-Vakili, PhD, director of the NeuroEpigenetics Laboratory at the Sean M. Healey & AMG Center for ALS and the MassGeneral Institute for Neurodegenerative Disease, in collaboration with Healey Center and MGH colleagues, injected cromolyn sodium into male and female mice with and without a genetic mutation that causes ALS.

In addition to observing that the treatment delayed the development of disease symptoms in the mice carrying the ALS mutation, the researchers demonstrated that it protected neurons from degenerating and helped to maintain the connections between nerves and muscles. Also, cromolyn sodium reduced inflammation surrounding muscles by targeting specific immune cells, called mast cells, and decreased pro-inflammatory markers both in the spinal cord and the blood.

"Our study supports the notion that inflammation has a significant role in the progression of ALS and therefore exploring anti-inflammatory treatments may be of great value for developing an effective treatment," said Sadri-Vakili. "Our findings demonstrate that cromolyn treatment provides neuroprotection in a mouse model of ALS. It remains to be seen whether these effects will translate to people living with the disease. Therefore, we will continue to explore inflammation's role in disease development and progression in hopes of translating this research into potential ALS treatments."

A new technique in chemistry could pave the way for producing uniform nanoparticles for use in drug delivery systems.

Scientists have been investigating how to make better use of nanoparticles in medicine for several decades. Significantly smaller than an average cell, nanoparticles are more similar in size to proteins. This makes them good at interacting with biomolecules and transporting drug molecules attached to their surface across cell membranes.

To date, however, only a handful of nanoparticle-based drugs have succeeded in reaching the clinic. This is because of the challenges in controlling the size and shape of nanoparticles - and understanding fully how these variables affect the way the particles behave in the body.

In a new study, published in Nature Communications, researchers from the University of Birmingham and the University of Bath have demonstrated a technique that will allow chemists to more closely control the size and shape of nanoparticles.

Dr Tom Wilks, in the University of Birmingham's School of Chemistry, is one of the lead authors of the study. He explains: "If you change the shape of a nanoparticle from, for example, a spherical to a cylindrical shape, others have shown that this can have a dramatic effect on how it interacts with cells in the body, and how it is distributed through the body. By being able to control the size and shape, we can start to design and test nanoparticles that are exactly suited to an intended function."

Currently, to produce differently shaped nanoparticles for drug delivery scientists have to develop a bespoke chemical synthesis for each, which can be a laborious, time-consuming and expensive process.

The technique developed by the Birmingham researchers offers a deceptively simple way of streamlining this process. The team started with a base nanoparticle, made of a polymer, and added a second polymer in solution. The polymers are designed so they want to bond to each other, so the second polymer is driven into the core of the nanoparticle, forcing it to expand. The exact size and shape of the nanoparticle is then determined simply by how much of the second polymer is added.

"The precise way that these polymers were designed and the control we have over how much of the second polymer is added means we can accurately predict the shape of the nanoparticle, and have a high degree of control over its size," explains Dr Wilks.

The team believe the process could also be reproduced with other polymers, meaning the process could be adapted for any number of applications involving nanoparticles, from photonics to fuel cells.

"This is an important first step in being able to effectively harness nanoparticles for a whole host of applications, but there are a lot of questions still to answer," says Dr Wilks. "For example, in the field of drug delivery, we need to know much more about what would happen once drug molecules are introduced to our nanoparticles, as well as how the sizes and shapes of the nanoparticles can be optimised for different uses."