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July 12, 2021 - Transitions between healthcare sites - such as from the hospital to home or to a skilled nursing facility - carry known risks to patient safety. Many programs have attempted to improve continuity of care during transitions, but it remains difficult to establish and compare the benefits of these complex interventions. An update on patient-centered approaches to transitional care research and implementation is presented in a supplement to the August issue of Medical Care, sponsored by the Patient-Centered Outcomes Research Institute (PCORI). Medical Care is published in the Lippincott portfolio by Wolters Kluwer.

Titled Future Directions in Transitional Care Research, the special issue "focus[es] on opportunities and challenges involved in conducting patient-centered clinical comparative effectiveness research in transitional care," according to an introductory editorial by Carly Parry, PhD, MSW, of PCORI and co-authors. The supplement papers present an overview and update on early findings from PCORI's transitional care research portfolio.

Update on research 'toward a more holistic understanding of transitional care'

Recognizing the high risks and increased costs associated with care transitions has led to new research on interventions to enhance communication and continuity of care. However, new evidence has not always translated into meaningful improvement in the outcomes most important to patients. For this reason, in addition to important outcomes like hospital readmission rates, PCORI has supported research on patient-centered outcomes such as quality of life, caregiver burden, and healthcare decision-making.

A particular challenge is comparing results between studies, or identifying the most important aspects of these multi-component interventions. Providing evidence about the comparative effectiveness of interventions to improve decision making is a key goal of PCORI's investment in transitional care. The supplement presents findings from 11 of the 30 PCORI-funded transitional care studies, representing a wide range of health conditions, healthcare settings, patient characteristics, and patient outcomes.

A paper by Sabina B. Gesell, PhD, of Wake Forest School of Medicine and colleagues highlights the findings and implications of the PCORI transitional care portfolio so far. In discussions with researchers from nine studies, the authors identify three key themes:

Delineating the function versus form of transitional care interventions. While "function" refers to the core purposes of the intervention, "form" refers to the strategies and activities needed to carry out its function. It is critical to distinguish functions from forms. A pragmatic approach would allow for "flexible options for delivery while maintaining appropriate fidelity to the intervention."

Evaluating the process supporting implementation and the impact of interventions. Understanding the processes involved in program adaptations - planned and unplanned - is essential to assessing their actual effects, intended or unintended.

Engaging stakeholders in the design and delivery of interventions. A key aspect of the PCORI approach is engaging stakeholders - including patients, healthcare providers, and advocacy groups or policymakers - in the design and delivery of interventions. Partnering with stakeholders is critical for ensuring that appropriate interventions are designed and successfully disseminated, especially interventions that involve system change. Stakeholders can also play a key role in disseminating the research findings to broader audiences.

The introduction includes an overview of PCORI's Transitional Care Evidence to Action Network: a learning community designed to promote collaboration among researchers and stakeholders, and thus to enhance the collective impact of the new research PCORI has funded on patient-centered transitional care interventions.

"The papers in this Special Issue articulate challenges and lessons learned, and identify new directions for measurement, patient and stakeholder engagement, implementation, and methodological approaches that reflect the complexity of transitional care research," Dr. Parry and coauthors conclude. "They also move us toward a more holistic understanding of transitional care that integrates social needs and lifespan developmental transitions into our approaches to improving transitional care."

Click here to read "Implementation of Complex Interventions: Lessons Learned From the Patient-Centered Outcomes Research Institute Transitional Care Portfolio."

DOI: 10.1097/MLR.0000000000001591

Click here to read "Patient-Centered Approaches to Transitional Care Research and Implementation: Overview and Insights From Patient-Centered Outcomes Research Institute's Transitional Care Portfolio."

DOI: 10.1097/MLR.0000000000001593

Historically, shared resources such as forests, fishery stocks, and pasture lands have often been managed with an aim toward averting "tragedies of the commons," which are thought to result from selfish overuse. Writing in BioScience, Drs. Senay Yitbarek (University of North Carolina at Chapel Hill), Karen Bailey (University of Colorado Boulder), Nyeema Harris (Yale University), and colleagues critique this model, arguing that, all too often, such conservation has failed to acknowledge the complex socioecological interactions that undergird the health of resource pools.

The authors, who describe themselves as Blackologists ("'not simply scholars that are Black but, rather, are scholars who deliberately leverage and intersect Blackness into advancing knowledge production"), elucidate a model in which researchers' life experiences provide "unique perspectives to critically examine socioecological processes and the challenges and solutions that arise from them."

In this episode of BioScience Talks, Yitbarek, Bailey, and Harris join us to discuss this model of inclusive sustainability and the ways in which it can be brought to bear in service of ecosystems and the humans who inhabit them.

Snowmelt - the surface runoff from melting snow - is an essential water resource for communities and ecosystems. But extreme snow melt, which occurs when snow melts too rapidly over a short amount of time, can be destructive and deadly, causing floods, landslides and dam failures.

To better understand the processes that drive such rapid melting, researchers set out to map extreme snowmelt events over the last 30 years. Their findings are published in a new paper in the Bulletin of the American Meteorological Society.

"When we talk about snowmelt, people want to know the basic numbers, just like the weather, but no one has ever provided anything like that before. It's like if nobody told you the maximum and minimum temperature or record temperature in your city," said study co-author Xubin Zeng, director of the UArizona Climate Dynamics and Hydrometeorology Center and a professor of atmospheric sciences. "We are the first to create a map that characterizes snowmelt across the U.S. Now, people can talk about the record snowmelt events over each small area of 2.5 miles by 2.5 miles."

Zeng and lead study author Josh Welty, who received his doctoral degree under Zeng's advising, created a map that catalogs the top-10 extreme snowmelt events in terms of frequency, magnitude, temperature and precipitation over every 2.5-mile square of the U.S. between 1988 and 2017. They also used machine learning to understand how large-scale weather patterns affect extreme snow melt.

They found that in the western half of the country, winds transport water vapor from the Pacific Ocean eastward. However, in the eastern half of the country, weather patterns transport moisture primarily south to north from the Gulf of Mexico all the way to the Great Lakes and New England.

Their maps also reveal that in most cases, extreme snowmelt is caused by unusually warm temperatures. This conclusion is fairly intuitive, but a surprising finding revealed that in certain regions, particularly in the Pacific Northwest and the northeastern U.S., extreme snowmelt events are driven by rain - which is relatively warm - falling on snow. In these cases, extreme snowmelt events become immediately dangerous.

The paper outlines one such example in detail: The Oroville Dam in Butte County, California, holds the second-largest reservoir in the state. In 2017, a series of storms dropped huge amounts of warm rain on the snowcapped Sierra Nevada Mountains, resulting in rapid snowmelt that filled the dam past its brim. Spillways, which provide controlled water runoff, failed, and over 180,000 people were evacuated.

Such events might happen more often in the future, according to Zeng and Welty's findings. The researchers found only a slight increase in the frequency of such events over the 30-year period, and they didn't see a trend in terms of the magnitude of extreme snowmelt events. However, 30 years isn't long enough to establish a trend, said Zeng, who is also the Agnes N. Haury Endowed Chair in Environment in the UArizona Department of Hydrology and Atmospheric Sciences. That means future research will be especially important.

"This paper serves as foundation and a reference point to see if and how things will be changing in different regions over the next 10 to 15 years," Welty said.

INFORMS Journal Management Science Study Key Takeaways:

Lack of direct airline routes limit the flexibility of organ transplantation policies.

A new airline route can increase the number of kidneys shared between different regions by more than 7% while also decreasing the organ discard rate.

An increase in the quantity of kidneys does not come with a decrease in kidney quality.

CATONSVILLE, MD, July 12, 2021 - It's a supply and demand problem, it's a transportation problem, it's a donor problem - and that just scratches the surface. According to the Organ Procurement and Transplantation Network, every 9 minutes a new patient is added to the organ waiting list. Every day 17 people die waiting for a kidney transplant. New research in the INFORMS journal Management Science tackles the transportation part of this problem.

"Airline transportation limits the flexibility of organ transplantation, but new, more direct airline routes can increase the number of kidneys shared between regions connected by these routes by more than 7%," said Tinglong Dai of Johns Hopkins University. "Operations research and analytics is trying to save lives and allow kidneys to be more readily available to those who need them when they need them. Too often, viable kidneys are wasted because they can't reach a patient in time."

The study, "Does Transportation Mean Transplantation? Impact of New Airline Routes on Sharing of Cadaveric Kidneys," was conducted by Dai alongside Guihua Wang of the University of Texas at Dallas and Ronghuo Zheng of the University of Texas at Austin.

The research identifies how new airline routes can provide the necessary efficient airline transportation needed for the time-sensitive nature of kidney transplantation and reduce the number of viable kidneys being wasted because they didn't reach the patient in time.

The authors analyze U.S. airline transportation and kidney transplantation datasets. They use the data to track the evolution of airline routes connecting all U.S. airports. Then they look at kidney transplants between donors and recipients connected by these airports.

"Transportation plays a major role in providing patients with available donations, if new airline routes can increase the volume of shared kidneys by 7.3%, think of how many lives could be saved," continued Dai, a professor in the Carey Business School at Johns Hopkins. "We also find the post-transplant survival rate remains largely unchanged. It's a step forward in organ donations thanks to O.R. and analytics."

When we think about singularities, we tend to think of massive black holes in faraway galaxies or a distant future with runaway AI, but singularities are all around us. Singularities are simply a place where certain parameters are undefined. The North and South Pole, for example, are what's known as coordinate singularities because they don't have a defined longitude.

Optical singularities typically occur when the phase of light with a specific wavelength, or color, is undefined. These regions appear completely dark. Today, some optical singularities, including optical vortices, are being explored for use in optical communications and particle manipulation but scientists are just beginning to understand the potential of these systems. The question remains -- can we harness darkness like we harnessed light to build powerful, new technologies?

Now, researchers from the Harvard John A. Paulson School of Engineering and Applied Sciences (SEAS) have developed a new way to control and shape optical singularities. The technique can be used to engineer singularities of many shapes, far beyond simple curved or straight lines. To demonstrate their technique, the researchers created a singularity sheet in the shape of a heart.

"Conventional holography techniques are good at shaping light, but struggle to shape the darkness," said Federico Capasso, the Robert L. Wallace Professor of Applied Physics and Vinton Hayes Senior Research Fellow in Electrical Engineering at SEAS and senior author of the paper. "We have demonstrated on-demand singularity engineering, which opens up a vast set of possibilities in wide-ranging fields, from super-resolution microscopy techniques to new atomic and particle traps."

The research is published in Nature Communications.

Capasso and his team used flat metasurfaces with precisely-shaped nanopillars to shape the singularities.

"The metasurface tilts the wavefront of light in a very precise manner over a surface so that the interference pattern of the transmitted light produces extended regions of darkness," said Daniel Lim, a graduate student at SEAS and first author of the paper. "This approach allows us to precisely engineer dark regions with remarkably high contrast."

Engineered singularities could be used to trap atoms in dark regions. These singularities could also improve super high-resolution imaging. While light can only be focused to regions about half a wavelength (the diffraction limit) in size, darkness has no diffraction limit, meaning it can be localized to any size. This allows darkness to interact with particles over length scales much smaller than the wavelengths of light. This could be used to provide information on not only the size and the shape of the particles but their orientation as well.

Engineered singularities could extend beyond waves of light to other types of waves.

"You can also engineer dead zones in radio waves or silent zones in acoustic waves," said Lim. "This research points to the possibility of designing complex topologies in wave physics beyond optics, from electron beams to acoustics," said Lim.

The Harvard Office of Technology Development has protected the intellectual property relating to this project and is exploring commercialization opportunities.

Los Alamos, N.M., July 12, 2021--For the first time, the long-theorized neutron-clustering effect in nuclear reactors has been demonstrated, which could improve reactor safety and create more accurate simulations, according to a new study recently published in the journal Nature Communications Physics.

"The neutron-clustering phenomenon had been theorized for years, but it had never been analyzed in a working reactor," said Nicholas Thompson, an engineer with the Los Alamos Advanced Nuclear Technology Group. "The findings indicate that, as neutrons fission and create more neutrons, some go on to form large lineages of clusters while others quickly die off, resulting in so-called 'power tilts,' or asymmetrical energy production."

Understanding these clustering fluctuations is especially important for safety and simulation accuracy, particularly as nuclear reactors first begin to power up. The study was a collaboration with the Institute for Radiological Protection and Nuclear Safety (IRSN) and the Atomic Energy Commission (CEA), both located in France.

"We were able to model the life of each neutron in the nuclear reactor, basically building a family tree for each," said Thompson. "What we saw is that even if the reactor is perfectly critical, so the number of fissions from one generation to the next is even, there can be bursts of clusters that form and others that quickly die off."

This clustering phenomenon became important to understand because of a statistical concept known as the gambler's ruin, believed to have been derived by Blaise Pascal. In a betting analogy, the concept says that even if the chances of a gambler winning or losing each individual bet are 50 percent, over the course of enough bets the statistical certainty that the gambler will go bankrupt is 100 percent.

In nuclear reactors, from generation to generation, each neutron can be said to have a similar 50 percent chance of dying or fissioning to create more neutrons. According to the gambler's ruin concept, the neutrons in a reactor might then have a statistical chance of dying off completely at some future generation, even though the system is at critical.

This concept had been studied widely in other scientific fields, such as biology and epidemiology, where this generational clustering phenomenon is also present. By drawing on this related statistical math, the research team was able to analyze whether the gambler's ruin concept would hold true for neutrons in nuclear reactors.

"You would expect this theory to hold true," says Jesson Hutchinson, who works with the Laboratory's Advanced Nuclear Technology Group. "You should have a critical system that, while the neutron population is varying between generations, runs some chance of becoming subcritical and losing all neutrons. But that's not what happens."

To understand why the gambler's ruin concept didn't hold true, researchers used a low-power nuclear reactor located at the Walthousen Reactor Critical Facility in New York. A low-power reactor was essential for tracking the lifespans of individual neutrons because large-scale reactors can have trillions of interactions at any moment. The team used three different neutron detectors, including the Los Alamos-developed Neutron Multiplicity 3He Array Detector (NoMAD), to trace every interaction inside the reactor.

The team found that while generations of neutrons would cluster in large family trees and others died out, a complete die-off was avoided in the small reactor because of spontaneous fission, or the non-induced nuclear splitting of radioactive material inside reactors, which creates more neutrons. That balance of fission and spontaneous fission prevented the neutron population from dying out completely, and it also tended to smooth out the energy bursts created by clustering neutrons.

"Commercial-sized nuclear reactors don't depend on the neutron population alone to reach criticality, because they have other interventions like temperature and control rod settings," Hutchinson said. "But this test was interested in answering fundamental questions about neutron behavior in reactors, and the results will have an impact on the math we use to simulate reactors and could even affect future design and safety procedures."

Scientists have discovered a novel way to classify magnetized plasmas that could possibly lead to advances in harvesting on Earth the fusion energy that powers the sun and stars. The discovery by theorists at the U.S. Department of Energy's (DOE) Princeton Plasma Physics Laboratory (PPPL) found that a magnetized plasma has 10 unique phases and the transitions between them might hold rich implications for practical development.

The spatial boundaries, or transitions, between different phases will support localized wave excitations, the researchers found. "These findings could lead to possible applications of these exotic excitations in space and laboratory plasmas," said Yichen Fu, a graduate student at PPPL and lead author of a paper in Nature Communications that outlines the research. "The next step is to explore what these excitations could do and how they might be utilized."

Possible applications

Possible applications include using the excitations to create current in magnetic fusion plasmas or facilitating plasma rotation in fusion experiments. However, "Our paper doesn't consider any practical applications," said physicist Hong Qin, co-author of the paper and Fu's advisor. "The paper is the basic theory and the technology will follow the theoretical understanding."

In fact, "the discovery of the 10 phases in plasma marks a primary development in plasma physics," Qin said. "The first and foremost step in any scientific endeavor is to classify the objects under investigation. Any new classification scheme will lead to improvement in our theoretical understanding and subsequent advances in technology," he said.

Qin cites discovery of the major types of diabetes as an example of the role classification plays in scientific progress. "When developing treatments for diabetes, scientists found that there were three major types," he said. "Now medical practitioners can effectively treat diabetic patients."

Fusion, which scientists around the world are seeking to produce on Earth, combines light elements in the form of plasma -- the hot, charged state of matter composed of free electrons and atomic nuclei that makes up 99 percent of the visible universe -- to release massive amounts of energy. Such energy could serve as a safe and clean source of power for generating electricity.

The plasma phases that PPPL has uncovered are technically known as "topological phases," indicating the shapes of the waves supported by plasma. This unique property of matter was first discovered in the discipline of condensed matter physics during the 1970s -- a discovery for which physicist Duncan Haldane of Princeton University shared the 2016 Nobel Prize for his pioneering work.

Robust and intrinsic

The localized plasma waves produced by phase transitions are robust and intrinsic because they are "topologically protected," Qin said. "The discovery that this topologically protected excitation exists in magnetized plasmas is a big step forward that can be explored for practical applications," he said.

For first author Fu, "The most important progress in the paper is looking at plasma based on its topological properties and identifying its topological phases. Based on these phases we identify the necessary and sufficient condition for the excitations of these localized waves. As for how this progress can be applied to facilitate fusion energy research, we have to find out."

Emotions towards and cultural importance of large carnivores are better predictors of the acceptance of management strategies by local communities than the extent of livestock depredation. This is the result of a new interdisciplinary investigation led by scientists from the Leibniz Institute for Zoo and Wildlife Research (Leibniz-IZW). They conducted 100 questionnaires with Maasai pastoralists in Ngorongoro Conservation Area, Tanzania, focusing on three large carnivore species (spotted hyenas, lions and leopards) and three management strategies (no action, relocation and lethal control). An emphasis on socio-cultural variables is key to understanding human-carnivore relationships and challenges the traditional focus on livestock depredation in human-carnivore conflict research, the scientists conclude. The findings are published in the open access scientific journal "Frontiers in Conservation Science".

Support from local communities is required to implement successful wildlife management strategies. A key challenge is that the relationship between local communities with large carnivores are complex: on the one hand, the animals are often considered charismatic, culturally important and emotionally evocative. Positive emotions such as joy have been suggested to predict the success of conservation-oriented management strategies. This is also true for the cultural importance of large carnivores. On the other hand, negative emotions such as fear and disgust as well as negative experiences such as livestock depredation - the traditional focus of human-carnivore conflict research - have been suggested to predict the acceptance of invasive measures such as relocation and lethal control. Past research looked at these factors separately, but did not compare them at the same time to see which is the best predictor - and which should therefore be prioritised by wildlife managers.

"We assessed for the first time several factors simultaneously for several carnivores to determine which factor best predicted the acceptance of commonly applied management strategies", explains first author Arjun Dheer (Leibniz-IZW). The investigation was conducted in the Ngorongoro Conservation Area (NCA) in Tanzania. "The NCA is a protected area which includes both wildlife conservation and human livelihoods in its management plan", adds Dheer. The investigation focused on three species: spotted hyena (Crocuta crocuta), lion (Panthera leo) and leopard (Panthera pardus). "The species we chose are the main predators of livestock in the region and past research in other areas showed that people view them in different ways", explains Dr Oliver Höner (Leibniz-IZW), co-senior author of the paper. The investigation focused on the acceptance of no action (continued protection of the carnivores), relocation and lethal control. Respondents rated the emotions of joy, disgust and fear and the cultural importance of each carnivore species. They were also asked to report on how many cattle, goats, sheep and donkeys they lost to the carnivores over the past three years.

The main result is that emotions and cultural importance were stronger predictors for the acceptance of specific management strategies than the extent of livestock depredation. "Amongst the emotions, joy was the strongest predictor; it was linked to a preference for no action and a negative assessment of relocation and lethal control. Cultural importance showed a trend similar to joy", explains Dheer. Overall, respondents favoured no action towards the carnivores and rejected relocation and lethal control. "It goes to show how scientists might be barking up the wrong tree by focusing on livestock depredation and negative emotions", explains co-senior author Dr Tanja Straka (Leibniz-IZW & TU Berlin).

"Our findings underpin the role of emotions and cognitions in human-wildlife relationships", concludes Dheer. The traditional emphasis on livestock depredation as the primary issue of concern when harnessing human tolerance of large carnivores is called into question, the authors summarise: it is apparent that emotions and cultural importance need to be considered, even across species that have different reputations. Multi-pronged approaches that combine emotions and cultural factors with the close involvement of local communities can help pave the way for continued human-carnivore coexistence.

One of the most significant challenges in the global R&D effort towards better energy technologies -- efficient and accurate material simulation -- may be one step closer to being solved, based on new techniques released by UK-based quantum software startup Phasecraft.

The new peer-reviewed study in the Physical Review B journal from the American Physical Society sets out a novel technique for modelling fermionic particles -- like electrons -- which significantly reduces the quantum hardware resources needed to perform simulations.

Phasecraft's Joel Klassen, who co-led the study, explained, "One of the most exciting potential applications for quantum computing is simulating physical systems like materials. Using new tools, like quantum computers, to develop a better understanding of how the natural world works has historically often led to dramatic technological breakthroughs. Our results reduce the resources required to perform these simulations, bringing this application closer to reality."

"Many important fields such as Chemistry and Materials Science are concerned with the dynamics of fermion particles in physical systems - in the form of electrons. Fermions are notoriously difficult to simulate on regular computers so being able to simulate them efficiently on a quantum device would provide a faster path to tackling hard problems in these areas of research such as understanding high temperature superconductivity or improving chemical reaction efficiency," commented Charles Derby, a Phasecraft team member and PhD candidate at UCL, who co-led the research.

"Our compact representation of fermions outperforms all previous representations improving memory use and algorithm size each by at least 25% - a significant step towards realising practical scientific applications on near-term quantum computers."

Although quantum hardware has seen significant improvements in recent years, existing devices remain limited and prone to a buildup of errors, and a gap exists between what hardware can do and the resources software needs. The new modelling technique not only helps close this gap, but has the added benefit of being able to detect errors in the computation. The lead authors, along with their collaborators, Toby Cubitt and Johannes Bausch at Phasecraft, lay out how this additional feature could be used to help address these errors.

Building on these findings, Phasecraft is conducting small-scale experiments to demonstrate these resource improvements and error mitigation methods on quantum hardware, as well as working with established industry partners to explore how they may be applied to battery material simulation.

"Another compelling part of this new approach is the error detection and mitigation integrated into the fermion encoding, which are particularly important on near-term, noisy quantum hardware,' explained Phasecraft consultant and research contributor Johannes Bausch.

Phasecraft co-founder and research contributor Toby Cubitt commented "At Phasecraft, we aim to speed up the timeline for quantum advantage. This new research continues our pioneering achievements for creating compact, resource-efficient, error-resilient software designed for the limited capacity of near-term quantum hardware. By developing these new techniques that are tuned to quantum hardware's limitations, Phasecraft may enable potential breakthroughs in energy efficiency and storage, chemistry, and far beyond."

A vaccine to protect against infection with hepatitis C could be in use within 5 years, says Professor Sir Michael Houghton, who won the Nobel Prize for Medicine and Physiology along with three other scientists for discovering the hepatitis C virus (HCV) in 1989. Sir Michael will discuss the development of a vaccine in a special presentation at this year's European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), held online this year.

Up to 2 million new HCV infections occur every year around the world, with an estimated 70 million carriers of the virus globally, most of whom are not diagnosed. The virus is estimated to cause some 400,000 deaths annually. Many infected with the virus go on to develop liver cirrhosis and liver cancer.

"While the advent of directly acting antivirals (DAAs) to cure hepatitis C has given us a huge weapon to turn the tide on this pandemic, there is no doubt that a vaccine is required to help the world reach its ambitious target of reducing new hepatitis C infections by 90% and mortality rates by 65% by 2030," explains Sir Michael, who is currently based at the Li Ka Shing Applied Virology Institute, University of Alberta, Canada.

He will discuss that, while countries like Egypt have managed to enact huge control programs for hepatitis C (50 million screened and 4 million treated and cured using DAAs since 2014), they have only been able to do so thanks to mass production of generic drugs ($US84 per patient). However, the cost per patient in high-income countries is some $US20,000 per patient.

He will explain how the scientific community has learnt what immune responses protect against HCV infection, and many technologies including the new RNA technology (used in Pfizer and Moderna COVID-19 vaccines) and adenovirus-based technologies (developed by Oxford University and AstraZeneca, and Johnson & Johnson) are able to reproduce these protective immune responses through vaccination.

Sir Michael and colleagues at the Li Ka Shing Applied Virology Institute are currently developing an adjuvanted recombinant vaccine, which is expected to induce production of antibodies to multiple cross-neutralising epitopes, making it harder for the virus to escape the humoral immune response. Put another way, there are many different antibodies likely to be produced by this vaccine that can prevent HCV infection, making it very hard for the virus to evade them by mutation and thus protecting the vaccine recipient from hepatitis C infection.

Sir Michael will discuss how the COVID-19 pandemic has pushed back many areas of medical research, including work on hepatitis C vaccines. But he anticipates phase 1 trials in 2022 using different adjuvants followed by phase 2 human efficacy trials from 2023-2026, either in an at-risk population such as people who inject drugs, or via human vaccine challenge trials.

He says: "If safety and efficacy are proven, roll-out of vaccine to the high-risk people-who-inject-drugs population could begin in 2026/2027. Following phase 3 trials, the hepatitis C vaccine could then be rolled out to other high-risk groups in or around 2029, such as men who have sex with men, healthcare workers, and babies born to mothers with hepatitis C, in all countries of the world."

Using Canada as an example, Sir Michael points out the huge cost savings that could be generated by a successful vaccine - it is estimated that treating people who inject drugs with DAAs over a decade would incur drug costs of around C$1 billion (US$0.8 billion), compared to $20 million (US$16 million) estimated for vaccine costs to protect the same population.

Nashville, Tenn. (3:24 p.m. EDT--July 10, 2021)--Approximately 12 percent of patients who underwent shoulder stabilization surgery experience arthritis in the shoulder joint within a seven-year period, according to research presented today at the American Orthopedic Society for Sports Medicine-Arthroscopy Association of North America Combined 2021 Annual Meeting.

"While arthroscopic stabilization for posterior glenohumeral instability has shown excellent success preventing recurrent instability and allowing return to sport, eventual progression to glenohumeral arthritis remains a concern in these patients," said Bobby Yow, MD, of Walter Reed National Military Medical Center, Bethesda, Md. Yow and colleagues sought to evaluate the rate of progression to glenohumeral arthritis and identify potential risk factors after arthroscopic posterior stabilization in a young and high demand population.

Yow and fellow researchers enrolled 110 patients who were active duty servicemembers identified in the Military Heath System (MHS) with posterior shoulder instability who underwent primary arthroscopic surgical stabilization and had postoperative imaging or medical records available over a twelve-year period between January 2004 and September 2016.

Among the 110 patients with posterior shoulder instability that underwent arthroscopic stabilization, 12.7% (14/110) developed glenohumeral arthritis. The mean age of all patients was 23.9 years (SD 6.71). The median time to diagnosis of arthritis was seven years and the median follow-up time was 8.1 years (IQR 5.8). Among all diagnosed with posterior shoulder instability requiring surgical fixation, 12.7% (14/110) developed glenohumeral arthritis during the study period. The overall incidence of GH arthritis was 1.7 per 100 person-years (95% CI 0.92, 2.81). Ten-year GHOA-free survival was 84.0% (95% CI 75.3, 93.8). Hazard ratios (95% CIs) estimated from separate Cox regression models of the development of glenohumeral arthritis were 1.45 (0.76, 2.74) or age in years (per SD) and 0.87 (0.74 to 1.03) for glenoid bone loss.

"No previous study has reported the incidence and risk factors for glenohumeral arthritis after arthroscopic surgical stabilization for posterior shoulder instability," Yow reported. "Though no risk factors were found amongst the cohort, the hypothesized higher risk with increasing age at index procedure and near significant confidence interval for glenoid bone loss warrants further evaluation in larger cohorts not limited to active-duty service members."

Yow said that their findings may help guide clinical decision making and chronicity of treatment for patients presenting with posterior shoulder instability.

A new class of drug successfully targets treatment-resistant prostate cancers and prolongs the life of patients. The treatment delivers beta radiation directly to tumour cells, is well tolerated by patients and keeps them alive for longer than standard care, found a phase 3 trial to be presented at the European Association of Urology congress, EAU21, today.

Despite progress in medicine in recent years, metastatic castration-resistant prostate cancer remains untreatable and fatal. The new treatment, known as Lu-PSMA-617, takes a new approach, targeting a molecule called PSMA, which is known to be increased on the surfaces of the tumour cells, destroying them and their surrounding microenvironment.

Professor Johann de Bono, Professor of Experimental Cancer Medicine at The Institute of Cancer Research, London, and Consultant Medical Oncologist at The Royal Marsden NHS Foundation Trust, and Professor Ken Herrmann, Director of the Clinic for Nuclear Medicine at University Hospital Essen, Germany, and an international team of researchers set out to see whether Lu-PSMA-617 was more effective than standard care and recruited 831 patients with metastatic castration-resistant prostate cancer between June 2018 and October 2019. Patients were randomly assigned to receive the treatment plus standard care or standard care alone.

They report that the treatment significantly improved survival of patients by an average of four months, compared with standard treatment. Median survival time was 15.3 for the treatment group and 11.3 months for those receiving standard care. Progression-free survival, or the time before a patient's tumour became worse, was also longer with the treatment: a median of 8.7 months compared with 3.4 months for those with standard care.

The trial also compared side effects, finding that health-related quality of life was not negatively affected, and the team concludes that it is an effective and safe medicine that can improve standard of care for patients with this advanced prostate cancer.

Professor Ken Herrmann says: "This is a completely new therapeutic concept; a precision medicine that delivers radiation directly to a high incidence tumour. The treatment was well tolerated by patients and they had an average of four months' longer survival with good quality of life. Lu-PSMA-617 can improve the lives of many men with advanced prostate cancer and their families."

Professor Johann de Bono says: "Our findings show that this potent radioactive medicine can deliver radiation precisely to cancer cells and destroy them, extending patients' lives. I hope men whose tumours have high levels of PSMA can soon benefit from this highly innovative treatment. Currently, the treatment is being appraised by the National Institute for Health and Care Excellence (NICE) for use in the NHS in England and Wales."

"Using the PSMA molecule to directly target prostate cancer cells is the beginning of a new era of precision medicine in urology diagnostics as well as therapy", says Professor Peter Albers, Head of the Department of Urology, Dusseldorf University, and Chair of the Scientific Office of the EAU. "LU-PSMA-617 was tested in so-called end-stage disease and still showed superiority and this paves the way for studies to treat patients in earlier stages. We have seen similar success in the diagnostic setting, using this molecule to improve the way we stage tumours. This targeted approach will revolutionise the way we approach the treatment of men with prostate cancer in the future."

The dangerous mcr-1 gene, which provides resistance to the last-resort antibiotic colistin, has been found in four healthy humans and two pet dogs. In two cases, both dog and owner were harbouring the gene, according to new research being presented at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) held online this year.

Since first being reported in China in 2015, the mcr-1 gene has been found in various people and animals around the world. It confers resistance to colistin, an antibiotic of last resort used to treat infections from some bacteria resistant to all other antibiotics. The nightmare scenario that could emerge is mcr-1 combining with already drug-resistant bacteria to create a truly untreatable infection.

Dr Juliana Menezes and colleagues at the Centre of Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Portugal are interested in whether household pets may be acting as a reservoir of the gene and so aiding its spread in the community.

To find out, the authors looked for resistance to colistin in bacteria in faecal samples from people and pets. Samples were taken from 126 healthy people living with 102 cats and dogs in 80 households in Lisbon between February 2018 and February 2020. All of the humans and 61 of the pets were healthy. A total of 23 pets had skin and soft tissue infections (SSTI) and 18 had urinary tract infections (UTI).

Eight dogs out of the 102 pets (7.8%) and four humans out of 126 (3.2%) harboured bacteria with the mcr-1 gene. Three of the dogs were healthy, four had SSTIs and one had a UTI. None of the cats were carrying the gene.

Further analysis showed that the bacteria isolated from all 12 samples that were mcr-1 positive were resistant to multiple antibiotics.

In two households with dogs with SSTIs, the mcr-1 gene was found in both dog and owner. Genetic analysis of the samples suggested that in one of these two cases, the gene had been transmitted between pet and owner.

While transmission in both directions is possible, it is thought that in this case the gene passed from dog to human, says Dr Menezes.

The owners did not have infections and so did not need treatment. The sick dogs were successfully treated.

The researchers say their results show that the mcr-1 gene can be transmitted between dogs and their owners. This raises concerns that pets can act as reservoirs of the gene and so aid the spread of resistance to precious last-line antibiotics.

Dr Menezes adds: "Colistin is used when all other antibiotics have failed - it is a crucial treatment of last resort. If bacteria resistant to all drugs acquire this resistance gene, they would become untreatable, and that's a scenario we must avoid at all costs.

"We know that the overuse of antibiotics drives resistance and it is vital that they are used responsibly, not just in medicine but also in veterinary medicine and in farming."

"Topological defects" are formed when the symmetry of a magnetic material is disrupted. Domain walls (DWs) are a type of topological defect that separates regions of different magnetic orientations. A widely studied phenomenon, the manipulation of these defects has potential applications in high-performance memory storage devices, energy processing devices, and quantum computing.

Recently, the possibility of other topological defects embedded in or combined with DWs has gained attention for their potential applications in different fields of physics. Some examples of these "defects within defects" called DW skyrmions and DW bimerons. While theoretical models have supported the existence of these defects, they have not been experimentally observed--not before now.

In a new study published in Nature Communications, Associate Professor Masahiro Nagao from Nagoya University, Japan, and his colleagues used Lorentz transmission electron microscopy (LTEM) to visualize these defects. They were able to do so by passing electrons and observing their deflections through a thin magnetic film. The topological defects were observed as contrasting pairs of bright and dark areas. Using this technique, the team imaged topological defects in a chiral magnetic thin film made of cobalt, zinc, and manganese.

Initially, the researchers observed a single DW defect when the film was not magnetized. On magnetizing the film by passing a magnetic field perpendicular to the film, they could observe the development of two types of DWs. The conventional DWs were seen as black lines, while chains of DW bimerons were seen as bright elliptical dots on the LTEM images. These two types of DWs appeared alternatively and in pairs. The researchers noted that these DWs increased as the strength of the magnetic field was increased and finally disappeared after a certain threshold was reached. To confirm their discovery, the researchers used the transport of intensity equation to obtain the magnetic distributions which revealed opposite magnetizations on both sides of the chain of DWs, confirming them to be DW bimerons.

The researchers could finally propose an explanation of these defects and their mechanism of formation. As Prof Nagao explains: "In our chiral magnet thin films, we show chained and isolated bimerons playing the role of and bound to DWs respectively, which are realized by not only in-plane magnetic anisotropy component but also the combination of Dzyaloshinskii-Moriya interaction, out-of-plane magnetic anisotropy, dipolar interaction, and Zeeman effect."

The team's findings shed light on topological defects in chiral magnets and have implications in fields of physics related to topology, ranging from cosmological length scales to condensed matter.

Recess quality, not just the amount of time spent away from the classroom, plays a major role in whether children experience the full physical, mental and social-emotional benefits of recess, a new study from Oregon State University found.

"Not all recess is created equal," said William Massey, study author and an assistant professor in OSU's College of Public Health and Human Sciences. With schools returning to full-time in-person classes this fall, he said, "Now is a good time to rethink, 'How do we create schools that are more child-friendly?' I think ensuring quality access to play time and space during the school day is a way we can do that."

Massey's study, published this week in the Journal of School Health, involved in-person observation of third- and fifth-grade students at 25 schools across five states during the 2018-19 school year. The schools covered a wide range of socioeconomic status and racial and ethnic diversity.

Researchers measured recess quality on a number of factors, including whether the schoolyard offered physical and environmental safety; whether kids had opportunities to play and had the requisite space and equipment; whether there were opportunities for inclusion; and if they had diverse options for play.

A safe space with basic playground equipment might seem like a given, but that's not always the case, Massey said.

"I've been on playgrounds where the kids go outside, and it's a parking lot with high fences, no play structure, no balls, no jump-ropes, no chalk -- they're literally outside, and there's nothing to do," he said. He has also seen large holes from construction, broken glass, used condoms and needles in play spaces.

Researchers also looked at student behavior and the occurrence of verbal and physical conflict, as well as conflict resolution; and watched what adults on the playground were doing.

"A lot of my previous research shows that adults are one of the most important entities on the playground," Massey said. "One of the most important things is: Do adults model and encourage positive interactions with the students, and do they actually engage with the students themselves? The more adults engage with and play with students at recess, the more kids play, the more physical activity there is and the less conflict there is."

Schools that ranked highly on these measures saw associated positive outcomes in classroom behavior and socio-emotional markers. There was significant correlation between high-quality recess and higher scores in student resilience, self-control, adaptive classroom behaviors and executive function, Massey said.

Based on these findings and his previous research on recess, Massey argues that schools should look at recess as a critical part of the school day -- which means investing adequate time and resources into it.

Schools don't need expensive play structures to accomplish that, he said. Simple, low-cost measures like having an adult do a safety sweep of the playground every morning, or making sure the soccer field is already set up so kids can maximize even 10- or 15-minute recess breaks, would make a big difference.

As schools emerge from the pandemic, Massey said there's a chance for teachers to recognize the importance of kids' social and emotional development and need for play, but some may also think they need to cram all the missed content from the last year into as short a time as possible.

"I would argue that's a huge mistake. Kids don't have the capacity to come in stressed and traumatized and out of the rhythm of school, and have all that dumped on them," he said. "These findings show that recess is not detrimental to what we want to see in the classroom, but rather, it's complementary."