Unemployment associated with 50% higher risk of death in heart failure patients

Not being employed linked with greater likelihood of death than history of diabetes or stroke.

Unemployment is associated with a 50% higher risk of death in patients with heart failure, according to research presented today at Heart Failure 2017 and the 4th World Congress on Acute Heart Failure. The observational study in more than 20,000 heart failure patients found that not being employed was linked with a greater likelihood of death than history of diabetes or stroke.

"The ability to hold a job brings valuable information on wellbeing and performance status," said lead author Dr Rasmus Roerth, a physician at Copenhagen University Hospital, Denmark. "And workforce exclusion has been associated with increased risk of depression, mental health problems and even suicide."

"In younger patients with heart failure, employment status could be a potential predictor of morbidity and mortality," he continued. "If that was the case, employment status could help to risk stratify young heart failure patients and identify those needing more intensive rehabilitation."

This study compared the risks of all-cause death and recurrent heart failure hospitalisation in patients with heart failure, according to whether they were employed at baseline or not. Using the unique personal identification number assigned to all residents in Denmark, individual data was linked from nationwide registries on hospitalisation, prescribed medication, education level, public welfare payments, and death.

The study included all patients of working age (18 to 60 years) with a first hospitalisation for heart failure in Denmark between 1997 and 2012. Of the 21 455 patients with a first hospitalisation for heart failure, 11 880 (55%) were part of the workforce at baseline.

During an average follow-up of 1005 days, 16% of employed and 31% of unemployed patients died, while 40% of employed and 42% of unemployed patients were rehospitalised for heart failure.

After adjusting for age, sex, education level and comorbidities, heart failure patients unemployed at baseline had a 50% increased risk of death and 12% increased risk of rehospitalisation for heart failure compared to those who were employed. Not being part of the workforce was associated with a higher likelihood of death than history of diabetes or stroke.

Dr Roerth said: "We found that heart failure patients out of the workforce at baseline had a higher risk of death. Not being part of the workforce was associated with a risk of death comparable to that of having diabetes or stroke. Those without a job also had an increased risk of recurrent heart failure hospitalisation."

Dr Roerth said the exact mechanism on how employment status may affect mortality is complex and most likely multifactorial. "The ability to work can be seen as a measure of performance status and be interpreted as whether patients meet the physical requirements of a full time job or not," he said.

But he added: "Employment status is more than just a physical measurement as it also has an influence on quality of life, and has been shown to be important for mental health and wellbeing. Thus, both from a physical and psychological point of view it makes sense to include employment status in the evaluation of young heart failure patients' prognosis."

Dr Roerth said it was perhaps not surprising that employment status has importance for prognosis. "But the observation that employment status is associated with an increased risk of death comparable to that of many other comorbidities such as diabetes and stroke is notable," he said.

In terms of implications of the findings, Dr Roerth said workforce exclusion could be used to identify heart failure patients at risk of poor outcomes and that efforts to get patients back into work might be beneficial.

He said: "It could be highly valuable to assess employment status and actually think of workforce exclusion as a prognostic marker in line with suffering from serious chronic diseases. Knowledge on why workforce exclusion has happened for the individual patient might lead to ideas on how it can be prevented -- for example with more intensive rehabilitation, physical activity, psychological treatment, or a different job."

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Unemployment associated with 50% higher risk of death in heart failure patients

Non-O blood groups associated with higher risk of heart attack

Having a non-O blood group is associated with a higher risk of heart attack, according to research presented today at Heart Failure 2017 and the 4th World Congress on Acute Heart Failure.

Lead author Tessa Kole, a Master's degree student at the University Medical Centre Groningen, the Netherlands, said: "It has been suggested that people with non-O blood groups (A, B, AB) are at higher risk for heart attacks and overall cardiovascular mortality, but this suggestion comes from case-control studies which have a low level of evidence. If this was confirmed it could have important implications for personalised medicine."

The current study was a meta-analysis of prospective studies reporting on O and non-O blood groups, and incident cardiovascular events including myocardial infarction (heart attack), coronary artery disease, ischaemic heart disease, heart failure, cardiovascular events and cardiovascular mortality.

The study included 1 362 569 subjects from 11 prospective cohorts, described in nine articles. There were a total of 23 154 cardiovascular events. The researchers analysed the association between blood group and all coronary events, combined cardiovascular events, and fatal coronary events.

The analysis of all coronary events included 771 113 people with a non-O blood group and 519 743 people with an O blood group, of whom 11 437(1.5%) and 7 220 (1.4%) suffered a coronary event, respectively. The odds ratio (OR) for all coronary events was significantly higher in carriers of a non-O blood group, at 1.09 (95% confidence interval [CI] of 1.06-1.13).

The analysis of combined cardiovascular events included 708 276 people with a non-O blood group and 476 868 people with an O blood group, of whom 17 449 (2.5%) and 10 916 (2.3%) had an event, respectively. The OR for combined cardiovascular events was significantly higher in non-O blood group carriers, at 1.09 (95% CI 1.06-1.11).

The analysis of fatal coronary events did not show a significant difference between people with O and non-O blood groups.

"We demonstrate that having a non-O blood group is associated with a 9% increased risk of coronary events and a 9% increased risk of cardiovascular events, especially myocardial infarction," said Ms Kole.

The mechanisms that might explain this risk are under study. The higher risk for cardiovascular events in non-O blood group carriers may be due to having greater concentrations of von Willebrand factor, a blood clotting protein which has been associated with thrombotic events. Further, non-O blood group carriers, specifically those with an A blood group, are known to have higher cholesterol. And galectin-3, which is linked to inflammation and worse outcomes in heart failure patients, is also higher in those with a non-O blood group.

Ms Kole said: "More research is needed to identify the cause of the apparent increased cardiovascular risk in people with a non-O blood group. Obtaining more information about risk in each non-O blood group (A, B, and AB) might provide further explanations of the causes."

She concluded: "In future, blood group should be considered in risk assessment for cardiovascular prevention, together with cholesterol, age, sex and systolic blood pressure. It could be that people with an A blood group should have a lower treatment threshold for dyslipidaemia or hypertension, for example. We need further studies to validate if the excess cardiovascular risk in non-O blood group carriers may be amenable to treatment."

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Heart failure mortality is inversely related to wealth of country

Death in patients with heart failure is inversely related to the wealth of the country they live in, according to late breaking results from the INTERCHF study presented today at Heart Failure 2017 and the 4th World Congress on Acute Heart Failure. Death rates in India and Africa were three to four times higher than those documented in Western countries.

"Heart failure is a common condition that causes morbidity and mortality worldwide," said lead author Dr Hisham Dokainish, a principal investigator at the Population Health Research Institute (PHRI), McMaster University, Hamilton, Canada.

"Most data on heart failure have come from Western countries but the majority of the world's population lives elsewhere," he continued. "This study was conducted to fill large gaps in knowledge about congestive heart failure in non-Western countries."

The International Congestive Heart Failure (INTERCHF) study was an observational cohort study that enrolled 5 823 patients with heart failure in 16 countries grouped into six regions: Africa (Mozambique, Nigeria, South Africa, Sudan, Uganda), China, India, the Middle East (Egypt, Qatar, Saudi Arabia), Southeast Asia (Malaysia, the Philippines), and South America (Argentina, Chile, Colombia, and Ecuador).

Data on each patient was collected at baseline, six months and one year and entered into the electronic data management system at PHRI. Baseline data included demographics (age, sex), cardiac and non-cardiac factors (previous heart attack or stroke, duration of congestive heart failure, diabetes mellitus, renal failure, chronic obstructive pulmonary disease), medications, socioeconomic factors (education level, literacy, employment, urban/rural setting), and heart failure aetiology.

At six months and one year data was collected on the frequency and cause of any hospitalisations in the previous six months. Information was also recorded on death and cause of death. The investigators calculated death rates in each region and adjusted for 20 variables which included demographic, clinical, and socioeconomic factors, medications, and cause of heart failure.

The overall all-cause mortality rate for the entire study population was 17%. It was highest in Africa (34%) and India (23%), intermediate in Southeast Asia (15%), and lowest in the Middle East (9%), South America (9%) and China (7%).

Dr Dokainish said: "Mortality in patients with heart failure was inversely related to the wealth of the country. The poorer the country, the higher the mortality, and the richer the country, the lower the mortality."

"In Western countries the one-year mortality rate for patients with heart failure is 5-10%," added Dr Dokainish. "We're finding two to three times that death rate in African and Indian patients."

"We were very surprised by the much higher mortality rates," he continued. "You could say maybe the patients in Africa or India were sicker, or didn't take their medicines, or had poorer heart function, but we adjusted for all of those things and don't really understand why their death rates were so much higher."

The researchers hypothesised that variables not measured in the study contributed to the high death rates, such as access to and quality of healthcare, and cardiac biomarkers. These variables will be measured in the next phase of the research programme, the Global Congestive Heart Failure (G-CHF) study, which aims to recruit 25,000 heart failure patients from all inhabited continents and income levels. Genetic analyses will also be conducted in a G-CHF substudy.

Dr Dokainish said: "INTERCHF has shown that there are large differences in the risk of heart failure patients dying at one year depending on where they live. We hope to discover why these differences exist through the G-CHF study. If that identifies barriers to receiving care that are due to the way a healthcare system is structured, access to healthcare, or quality of healthcare, then that would need to be addressed."

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Compact fiber optic apparatus shines light on breath analysis in real-time

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An affordable gas sensor monitors trace levels of health-indicating chemicals, paving the way for future non-invasive studies, describe researchers in a new report. Compact fiber optic apparatus shines light on breath analysis in real-time

Purifying cells to treat disease

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Refining the purification process of therapeutic cells could improve their use for treating cancer and other diseases, report investigators. Purifying cells to treat disease

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PowerPoint, LED projector enable new technique for self-folding origami

Researchers at the Georgia Institute of Technology and Peking University have found a new use for the ubiquitous PowerPoint slide: Producing self-folding three-dimensional origami structures from photocurable liquid polymers.

The technique involves projecting a grayscale pattern of light and dark shapes onto a thin layer of liquid acrylate polymer placed in a plate or between two glass slides. A photoinitiator material mixed into the polymer initiates a crosslinking reaction when struck by light from an ordinary LED projector, causing a solid film to form. A light-absorbing dye in the polymer serves as a regulator for the light. Due to the complicated interaction between the evolution of the polymer network and volume shrinkage during photo curing, areas of the polymer that receive less light exhibit more apparent bending behavior.

When the newly-created polymer film is removed from the liquid polymer, the stress created in the film by the differential shrinkage causes the folding to begin. To make the most complex origami structures, the researchers shine light onto both sides of the structures. Origami structures produced so far include tiny tables, capsules, flowers, birds and the traditional miura-ori fold -- all about a half-inch in size.

The origami structures could have applications in soft robots, microelectronics, soft actuators, mechanical metamaterials and biomedical devices.

"The basic idea of our method is to utilize the volume shrinkage phenomenon during photo-polymerization," said Jerry Qi, a professor in the Woodruff School of Mechanical Engineering at Georgia Tech. "During a specific type of photopolymerization, frontal photopolymerization, the liquid resin is cured continuously from the side under light irradiation toward the inner side. This creates a non-uniform stress field that drives the film to bend along the direction of light path."

Details of the work are scheduled to be published April 28 in the journal Science Advances. The research was supported by the National Science Foundation, the Air Force Office of Scientific Research and the Chinese Scholarship Council. It is believed to be the first application to create self-folding origami structures through the control of volume shrinkage during patterned photopolymerization.

The process that creates the shrinkage phenomenon is considered harmful in other uses of the polymer.

"Volume shrinkage of polymer was always assumed to be detrimental in the fabrication of composites and in the conventional 3-D printing technology," said Daining Fang, a co-author of the paper and a professor at Peking University when the research was done. "Our work shows that with a change of perspective, this phenomenon can become quite useful." Fang is now at Beijing Institute of Technology.

To make the most complex shapes with bending in both directions, the researchers can flip the patterned film over to create crosslinking on the other side.

"We have developed two types of fabrication processes," said Zeang Zhao, a Ph.D. student at Georgia Tech and Peking University. "In the first one, you can just shine the light pattern towards a layer of liquid resin, and then you will get the origami structure. In the second one, you may need to flip the layer and shine a second pattern. This second process gives you much wider design freedom."

Light is shined onto the film for five to ten seconds, which produces a film about 200 microns thick. "The areas that receive light become solid; the other parts of the pattern remain liquid, and the structure can then be removed from the liquid polymer," said Qi. "The technique is very simple."

Frontal photopolymerization is a process in which a polymer film is continuously cured from one side in a thick layer of liquid resin. In the presence of strong light attenuation, the solidification front initiates at the surface upon illumination and propagates toward the liquid side as the irradiation time increases. The process can be delicately tuned by controlling the illumination time and the light intensity, and the method has been used to fabricate microfluidic devices and synthesize microparticles.

The researchers used poly(ethylene glycol) diacrylate in this demonstration, but the technique should work with a broad range of photocurable polymers. An orange dye was used in the demonstration, but other dyes could produce structures in a range of different colors.

For the proof-of-principle, Zhao created a PowerPoint pattern by hand. To scale the process up, the system could be connected to a computer-aided design (CAD) tool for generating more precise grayscale patterns.

Qi believes the technique could be used to produce structures as much as an inch in size. "The self-folding requires relatively thin films which might not be possible in larger structures," he said.

Added Qi, "We have developed a simple approach to fold a thin sheet of polymer into complicated three-dimensional origami structures. Our approach is not limited by specific materials, and the patterning is so simple that anybody with PowerPoint and a projector could do it."

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Researchers track impact of Brazil's 'Soy Moratorium' on an advancing agricultural frontier

The Brazilian state of Mato Grosso produces enough soybeans to be the equivalent of Iowa and Illinois put together. But it also plays home to lush Amazon rain forest, one of the richest, and most vulnerable, ecological treasures on our planet.

Using satellite imagery and unique ground-based information, the interface between highly mechanized agriculture and rainforest in Mato Grosso is shown with exceptionally granular detail in a new study led by Jude Kastens, research associate professor at the Kansas Applied Remote Sensing Program of the Kansas Biological Survey, and co-authored by J. Christopher Brown, professor of geography and atmospheric science and director of the Environmental Studies Program at the University of Kansas.

Their paper appears in PLOS ONE.

"Mato Grosso is a frontier in the sense that natural vegetation, both rainforest and savanna, known as cerrado, is being replaced with crop production and other agricultural uses," Kastens said. "Mechanized agriculture moved rapidly into the area in the 1990s, so there's a lot of opportunity for crop production and farm-related business development."

Indeed, the researchers said agriculture in the area has a boom-town energy, generating billions of dollars annually that contribute to the state's economy.

"There are cases of U.S. farmers selling everything in Iowa and moving to Mato Grosso in Brazil," Brown said. "That's a great indicator of being a frontier. There's opportunity. I've often boarded planes for Brazil in Houston and waited in line with lots of farmers headed on tours in Brazil to scope out moving operations there."

However, agricultural expansion has come at the expense of the Amazon rainforest. Concerns over widespread deforestation in the area led to a 2006 agreement between environmental groups and large agricultural corporations called the "Soy Moratorium." Under the moratorium, major soy purchasers agreed to not buy soy produced on land deforested after July of that year.

"This begs the question -- over such a large area, how are you going to know which deforested areas were replaced by soybeans after that date?" Brown said. "You need a really detailed land cover data set like we produced to know this."

Kastens and Brown, along with KU colleague Christopher Bishop and Alexandre Coutinho and Júlio Esquerdo of the Brazilian Agricultural Research Corporation (Embrapa), relied in part on satellite datasets from the Moderate Resolution Imaging Spectroradiometer, or MODIS. By looking at images taken over 14 growing seasons, the researchers could examine changes in cropland location and production intensity across Mato Grosso. Most soy production in the Amazon Forest Biome occurs in this large state.

"The satellite images capture reflectance values from the ground in various wavelengths -- the ones commonly used in vegetation studies are the red and near-infrared bands," Kastens said. "Red light reflectance goes down as photosynthesis increases, whereas near-infrared reflectance goes up with denser leaf canopies. These two bands are combined to form the Normalized Difference Vegetation Index. NDVI signals from healthy soy fields will look different from healthy cotton fields, which will look different from other cover types."

To interpret the satellite data, co-authors from Embrapa, the Brazilian equivalent of the USDA, collected an unprecedented amount of ground reference data in Mato Grosso by interviewing farmers. In 2006, the KU and Brazilian researchers began working under a memorandum of understanding to share methods in ground data collection and land cover classification. Since then, the researchers have visited each other's labs and carried out field work together.

"The wealth of ground reference data made this research possible," Brown said. "There hasn't been anything like this for such a large area outside the U.S. Our colleagues worked with farmers to trace field boundaries on printed satellite imagery and give cropping histories for various parcels of land."

A major finding of the research suggests the 2006 Soy Moratorium had a larger effect in reducing deforestation in the Amazon than has been previously understood.

"Based on our analysis, we found a much stronger deforestation decline coincident with the Soy Moratorium than other studies have reported," Kastens said. "The Soy Moratorium has been downplayed in some research as a factor in deforestation reduction. Our examination of essentially the same deforestation dataset used by others revealed a major decline in deforestation occurred immediately after the moratorium took effect.

"Deforestation is still happening, but it has slowed, and less of this land is being used for soy production," Kastens said.

The study incorporated deforestation data produced by the Brazilian Institute for Space Research (INPE).

The team also found a sharp rise in production on existing cropland after the moratorium, dubbed "vertical intensification," while deforestation-driven cropland expansion, or "horizontal intensification," slowed substantially.

"With vertical intensification, we see a dramatic increase in double cropping, where farmers plant a first crop of soybeans followed by a second commercial crop, typically corn, in the same growing season and field," Brown said.

The researchers are making their land cover data freely available. They hope it will help guide land managers and policymakers looking to strike a balance between farming and conservation.

"The rain forest helps regulate many climate-related factors in the Amazon basin and nearby regions, including temperatures and the hydrologic cycle," Kastens said. "It has obvious ecological value and is a biodiversity hotspot with many untapped natural resources."

The Amazon is also home to many native populations.

"Indigenous people in rain forest reserves are being completely surrounded by these soybean fields, many of which are upstream," Brown said.

Kastens added, "Researchers can utilize our map data, with its detailed spatial and class resolutions, to examine market accessibility impacts and other agricultural frontier-related questions, as well as issues related to climate, ecology and human geography."

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When bridges collapse: Researchers study whether we're underestimating risk

The United States is considering a $1 trillion budget proposal to update infrastructure, including its crumbling bridges. An obstacle to spending the money wisely is that the current means of assessing bridges may underestimate their vulnerability, according to a new study published in the Journal of Infrastructure Systems.

Case in point is a bridge along California's iconic Big Sur coast, which collapsed in March, isolating communities and costing local businesses millions of dollars. Although California's recent unprecedented rains were likely to damage infrastructure, standard risk assessments made it hard to identify which bridges were most vulnerable.

"This winter in California has highlighted the vulnerabilities of our nation's infrastructure," said Noah Diffenbaugh, a professor of Earth system science at Stanford and the Kimmelman Family Senior Fellow at the Stanford Woods Institute for the Environment. "Updating our infrastructure will require both making up for deferred maintenance, and preparing for the increasing risk of extreme events that comes along with global warming."

More frequent flooding

Big Sur's damaged Pfeiffer Canyon Bridge -- out until at least September -- is a harbinger of things to come. As climate and land-use change drive more frequent and intense flooding, collapses among the nation's more than 500,000 water-spanning bridges will likely increase, the authors state.

Complicated natural factors make accurate damage estimates hard to come by, but regional and national bridge studies have predicted up to $250 billion in direct climate impacts costs -- numbers that serve only as indicators of the true magnitude of costs related to climate change impacts on bridges, including lost business and ability to commute to work.

U.S. risk assessments generally assume that bridges may collapse when a 100-year flood -- a streamflow with 1 percent probability of being exceeded in any given year, or 63 percent over the course of a century -- occurs. This assumption underestimates risk, the paper's authors find, because it fails to capture the full range of stream flow conditions that can cause bridge collapse.

A new model

In their analysis, the researchers considered the full variability of floods that could cause collapse, as opposed to the 100-year approach taken previously. As a result, their findings identified a greater sensitivity to changes in the underlying frequency of flooding. This result appears to support the idea that analyses considering a range of flood scenarios, as opposed to a single 100-year threshold, could be more robust and accurate.

Indeed, of the 35 bridges analyzed, 23 were estimated to have collapsed during a water flow of lesser intensity than a 100-year flood level. The authors note that a primary reason for these lower flow collapses is the fact that most of those collapsed bridges were built before modern design standards. Because most U.S. bridges, along with most U.S. infrastructure, pre-date the modern design standards, the results highlight a more general risk that extreme climate events pose to U.S. infrastructure.

The American Society for Civil Engineering gives U.S. bridges a C+, estimating that $123 billion is needed to clear the maintenance backlog. An additional $140-$250 billion over the 21st century may be required to address the increasing risks posed by climate change, according to past research.

"To balance funding between the backlog and climate adaptation, bridge managers will need robust data on collapse risk," said lead author Madeleine M. Flint, an assistant professor of civil & environmental engineering at Virginia Polytechnic Institute and State University. "Our study is a step in that direction."

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Mapping the edge of reality

Australian and German researchers have collaborated to develop a genetic algorithm to confirm the rejection of classical notions of causality.

Dr Alberto Peruzzo from RMIT University in Melbourne said: "Bell's theorem excludes classical concepts of causality and is now a cornerstone of modern physics.

"But despite the fundamental importance of this theorem, only recently was the first 'loophole-free' experiment reported which convincingly verified that we must reject classical notions of causality.

"Given the importance of this data, an international collaboration between Australian and German institutions has developed a new method of analysis to robustly quantify such conclusions."

The team's approach was to use genetic programming, a powerful machine learning technique, to automatically find the closest classical models for the data.

Together, the team applied machine learning to find the closest classical explanations of experimental data, allowing them to map out many dimensions of the departure from classical that quantum correlations exhibit.

Dr Chris Ferrie, from the University of Technology Sydney, said: "We've light-heartedly called the region mapped out by the algorithm the 'edge of reality,' referring to the common terminology 'local realism' for a model of physics satisfying Einstein's relativity.

"The algorithm works by building causal models through simulated evolution imitating natural selection -- genetic programming.

"The algorithm generates a population of 'fit' individual causal models which trade off closeness to quantum theory with the minimisation of causal influences between relativistically disconnected variables."

The team used photons, single particles of light, to generate the quantum correlations that cannot be explained using classical mechanics.

Quantum photonics has enabled a wide range of new technologies from quantum computation to quantum key distribution.

The photons were prepared in various states possessing quantum entanglement, the phenomenon which fuels many of the advantages in quantum technology. The data collected was then used by the genetic algorithm to find a model that best matches the observed correlations.

These models then quantify the region of models which are ruled out by nature itself.

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Hybrid circuits can increase computational power of chaos-based systems

New research from North Carolina State University has found that combining digital and analog components in nonlinear, chaos-based integrated circuits can improve their computational power by enabling processing of a larger number of inputs. This "best of both worlds" approach could lead to circuits that can perform more computations without increasing their physical size.

Computer scientists and designers are struggling to keep up with Moore's law, which states that the number of transistors on an integrated circuit will double every two years in order to meet processing demands. They are rapidly reaching the limits of physics in terms of transistor size -- it isn't possible to continue shrinking the transistors to fit more on a chip.

Chaos-based, nonlinear circuits have been proposed as a solution to the problem, as one circuit can perform multiple computations instead of the current "one circuit, one task" design. However, the number of inputs that can be processed in chaos-based computing is limited by ambient noise, which decreases accuracy. Ambient noise refers to random signal fluctuations that can be caused by temperature variations, voltage fluctuations or semiconductor defects.

"Noise has always been a big problem in almost all engineering applications including computing devices and communications," says Vivek Kohar, postdoctoral research scholar at NC State and lead author of a paper describing the work. "Our system is nonlinear and so noise can be even more problematic."

To address the problem, the researchers created a hybrid system which uses a digital block of AND gates and an analog nonlinear circuit to distribute the computation between the digital and analog circuits. The result is an exponential reduction in computational time, which means that the output can be measured while the noise-based deviations are still small. In short, the computations are performed so quickly that noise doesn't have time to affect their accuracy.

To further improve the accuracy, Kohar and his colleagues' proposed solution couples multiple systems. This coupling provides a safety net that reduces the effect of noise-based deviations at the final stage.

"Think about mountaineering," says Kohar. "The climbers can climb individually but if one slips then he/she may have a dangerous fall. So they use ropes to connect them with each other. If one slips, the others will prevent their fall. Our system is somewhat like this, where all the systems are connected with each other all the time.

"The systems are tuned in such a way that at the time of measurement, our system is at the maxima or minima -- the points where the effects of noise are low in general and much lower if the systems are coupled. Considering the mountaineering example again, this means that we take the averages of climbers when they are at resting locations like the peak or in a valley, where the distances between them are smallest."

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Long-term fate of tropical forests may not be as dire as believed, says study

Tropical rainforests are often described as the "lungs of the Earth," able to inhale carbon dioxide from the atmosphere and exhale oxygen in return. The faster they grow, the more they mitigate climate change by absorbing CO₂.

This role has made them a hot research topic, as scientists question what will happen to this vital carbon sink long-term as temperatures rise and rainfall increases.

Conventional wisdom has held that forest growth will dramatically slow with high levels of rainfall. But University of Colorado Boulder researchers this month turned that assumption on its head with an unprecedented review of data from 150 forests that concluded just the opposite.

"Our data suggest that as large-scale climate patterns shift in the tropics, and some places get wetter and warmer, forests will accelerate their growth, which is good for taking carbon out of the atmosphere," said Philip Taylor, a research associate with the Institute of Arctic and Alpine Research (INSTAAR). "In some ways, this is a good-news story, because we can expect greater CO₂ uptake in tropical regions where rainfall is expected to increase. But there are a lot of caveats."

Ecologists have long thought that forest growth follows a hump-shaped curve when it comes to precipitation: To a point, more rainfall leads to more growth. But after about 8 feet per year, it was assumed too much water can waterlog the ecosystem and slow the growth rate of forests. While working in the Osa Peninsula of Costa Rica, Taylor, who got his doctoral degree in ecology and evolutionary biology at CU Boulder, began to question this assumption.

"Here we were in a place that got 16 feet of rain per year, and it was one of the most productive and carbon-rich forests on Earth. It clearly broke from the traditional line of thinking," he said.

Intrigued, Taylor spent four years synthesizing data on temperature, rainfall, tree growth and soil composition from rainforests in 42 countries, compiling what he believes is the largest pan-tropical database to date.

The study, published April 17 in the journal Ecology Letters, found that cooler forests (below 68 degrees F on average), which make up only about 5 percent of the tropical forest biome, seemed to follow the expected hump-shaped curve. But warmer forests, which are in the majority, did not.

"The old model was formed with a lack of data from warm tropical forests," said Taylor. "It turns out that in the big tropical forests that do the vast majority of the 'breathing' the situation is flipped. Instead of water slowing growth down, it accelerates it."

Taylor cautioned this does not mean climate change won't negatively impact tropical forests at all. In the short term, research has shown, droughts in the Amazon Basin have already led to widespread plant death and a 30 percent decrease in carbon accumulation in the past decade.

"A lot of climate change is happening at a pace far quicker than what our study speaks to," he says. "Our study speaks to what we can expect forests to do over hundreds of years."

Because the carbon cycle is complex, with forests also releasing carbon into the atmosphere as plants die, it's still impossible to say what the net impact of a wetter climate might be on the forest's ability to sequester carbon, said senior author Alan Townsend, a professor of environmental studies.

"The implications of the change still need to be worked out, but what we can say is that the forest responds to changes in rainfall quite differently than what has been a common assumption for a long time," said Townsend.

Going forward, the authors hope the findings will set the record straight for educators and scientists.

"Our findings fundamentally change a view of the tropical forest carbon cycle that has been published in textbooks and incorporated into models of future climate change for years," said Taylor. "Given how much these forests matter to the climate, these new relationships need to be a part of future climate assessments."

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Long-term fate of tropical forests may not be as dire as believed, says study

Study examines state of social, personality psychology research

Is the quality and overall state of social and personality research "rotten to the core," as has been debated by psychologists in recent years?

The answer is no, according to University of Illinois at Chicago researchers who conducted two studies to examine how practices have changed, if at all.

In one study, the UIC researchers surveyed over 1,100 social and personality psychologists from the three largest professional organizations -- the Society for Personality and Social Psychology, the European Society for Social Psychology, and the Society for Australasian Social Psychologists -- about how the current debate has affected their perceptions of their own research practices and the field's.

"Scientists said they are less likely to use questionable research practices, and more likely to use best research practices, following the ongoing discussion of scientific reliability," said Matt Motyl, UIC assistant professor of psychology and lead author of the study. "Upon examining justifications for using questionable research practices, we found they tended to be quite justifiable and reasonable."

Journal editors requesting that scientists omit some analyses, or even whole experiments, and researchers remedying statistical problems, such as having too-small sample sizes to yield reliable results, are examples of the proactive field improvements noted in the report.

Despite the progress, the report indicates perceptions of the current state of the field are more pessimistic than optimistic. Most respondents think that improvement is needed in replicability, which is the ability to repeat an experiment and find the same result.

A second study involved a random selection of 30 percent of all articles published in the four leading journals -- the Journal of Personality and Social Psychology, the Personality and Social Psychology Bulletin, the Journal of Experimental Social Psychology, and Psychological Science -- in the 2003-2004 and 2013-2014 periods. The UIC investigators manually coded the research practices and important statistics contained in the studies.

"Journals did show a bias to publish significant results, but we did not find widespread evidence of researcher misconduct," Motyl said. "While there is always room for improvement, none of the findings suggest science was getting worse over this 10-year period."

Overall, the report suggests the field is evolving in a positive direction.

"Social and personality science seems to be improving, and we should have increased confidence in findings moving forward," he said. "Although, there is still a long way to go."

The researchers advise that more research should be pre-registered; data should be shared more widely; and data analysis should be more transparent.

"By increasing transparency, it will be easier to evaluate the truth-value of studies and estimate what findings are real and what findings are more likely to be flukes," Motyl said.

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Testosterone makes men less likely to question their impulses

Hotheaded, impulsive men who shoot first and ask questions later are a staple of Westerns and 1970s cop films, but new research shows there might be truth to the trope.

A study conducted by researchers from Caltech, the Wharton School, Western University, and ZRT Laboratory tested the hypothesis that higher levels of testosterone increase the tendency in men to rely on their intuitive judgments and reduce cognitive reflection -- a decision-making process by which a person stops to consider whether their gut reaction to something makes sense. The researchers found that men given doses of testosterone performed more poorly on a test designed to measure cognitive reflection than a group given a placebo.

The research will appear in an upcoming issue of the journal Psychological Science.

"What we found was the testosterone group was quicker to make snap judgments on brain teasers where your initial guess is usually wrong," says Caltech's Colin Camerer, the Robert Kirby Professor of Behavioral Economics and T&C Chen Center for Social and Decision Neuroscience Leadership Chair. "The testosterone is either inhibiting the process of mentally checking your work or increasing the intuitive feeling that 'I'm definitely right.'"

The study, which is one of the largest of its type ever conducted, included 243 males who were randomly selected to receive a dose of testosterone gel or placebo gel before taking a cognitive reflection test. A math task was also given to control for participant engagement, motivation level, and basic math skills.

The questions included on the cognitive reflection test are exemplified by the following:

A bat and a ball cost $1.10 in total. The bat costs $1 more than the ball.

How much does the ball cost?

For many people, the first answer that comes to mind is that the ball costs 10 cents, but that's incorrect because then the bat costs only 90 cents more than the ball. The correct answer is that the ball costs 5 cents and the bat costs $1.05. An individual prone to relying on their gut instincts would be more likely to accept their first answer of 10 cents. However, another person might realize their initial error through cognitive reflection and come up with the correct answer.

Participants were not limited on time while taking the test and were offered $1 for each correct answer and an additional $2 if they answered all the questions correctly.

The results show that the group that received testosterone scored significantly lower than the group that received the placebo, on average answering 20 percent fewer questions correctly. The testosterone group also "gave incorrect answers more quickly, and correct answers more slowly than the placebo group," the authors write. The same effect was not seen in the results of the basic math tests administered to both groups. The results "demonstrate a clear and robust causal effect of [testosterone] on human cognition and decision-making," they conclude.

The researchers believe that the phenomenon they've observed can be linked to testosterone's effect of increasing confidence in humans. Testosterone is thought to generally enhance the male drive for social status, and recent studies have shown that confidence enhances status.

"We think it works through confidence enhancement. If you're more confident, you'll feel like you're right and will not have enough self-doubt to correct mistakes," Camerer says.

Camerer says the results of the study raise questions about potential negative effects of the growing testosterone-replacement therapy industry, which is primarily aimed at reversing the decline in sex drive many middle-aged men experience.

"If men want more testosterone to increase sex drive, are there other effects? Do these men become too mentally bold and thinking they know things they don't?"

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Rising costs, potential savings for generic, topical steroids

Although topical steroids are among the most commonly prescribed medications by dermatologists, there are limited data on spending and use for this class of drugs. In a new study led by investigators at Brigham and Women's Hospital, researchers have found that although most topical steroids prescribed to patients were generic, there was a sharp increase in Medicare Part D and out-of-pocket spending for elderly patients taking these drugs. The team found that potential savings could result from substituting cheaper, topical steroids from the same potency class of drugs. These findings build on recent literature that suggests pharmaceutical-led increases in costs of generic medications are leading to high increases in costs for systems and patients.

Their results are published online in JAMA Dermatology on April 28, 2017. The release of this article coincides with a presentation at the Society for Investigative Dermatology annual meeting.

The study was a retrospective, cost analysis of the Medicare Part D Prescriber Public Use File, which details annual drug use and spending on both generic and branded drugs from 2011 to 2015 by Medicare Part D patients who filled prescriptions for topical steroids. Medicare Part D is the Medicare prescription drug benefit program for patients over 65 years old. The team examined data from the total and potential Medicare and out-of-pocket patient spending. Their data show that Medicare Part D expenditures on topical steroids from 2011 to 2015 totaled approximately $2.3 billion, with $333.7 million out-of-pocket costs for patients. Despite an increase in the total number of prescriptions of 37 percent (an increase from 7.7 million in 2001 to 10.6 million in 2015), annual spending for Medicare increased 226.5 percent (from $237.6 million to $775.9 million) and out of pocket costs for patients increased 145.9 percent (from $41.4 million to $101.8 million) between 2011 and 2015. The potential health care savings and out-of-pocket patient savings from using alternative, cheaper topical steroids were $944.8 million and $66.6 million, respectively, over the study period.

"The increasing costs of generic steroids have led to massive increases in Medicare spending and increased out-of-pocket costs for our patients who are over 65," said Arash Mostaghimi, MD, MPA, MPH, senior author of the study and director of the dermatology inpatient service at BWH. "As physicians, we have prescription habits, but our research shows we need to identify cheaper options for patients, especially those who are older, on Medicare and have fixed incomes. We also need to work as a society to limit arbitrary increases in the costs of generic medications and give physicians the tools to identify and prescribe the cheapest drugs possible. This will improve patients' access to care while saving millions."

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Unravelling the mystery of DNA attacks in cells' powerhouse could pave way for new cancer treatments

New research has unravelled the mystery of how mitochondria -- the energy generators within cells -- can withstand attacks on their DNA from rogue molecules.

The findings could pave the way for new treatments to tackle neurodegenerative diseases and cancer. The research could also have important implications for clinical advances in 'mitochondrial donation' -- known as the 'three-parent baby' -- used to correct defects in faulty mitochondria.

The five-year study led by scientists at the University of Sheffield, published in Science Advances, reveals how the enzyme TDP1 -- which is already known to have a role in repairing damaged DNA in the cell's nucleus -- is also responsible for repairing damage to mitochondrial DNA (mtDNA).

Mitochondria are the powerhouses of cells, they generate the energy required for all cellular activity and have their own DNA -- the genetic material which they rely upon to produce important proteins for their function.

During the process of energy production and making proteins, a large amount of rogue reactive oxygen species are produced which constantly attack the DNA in the mitochondria. These attacks break their DNA, however the new findings show mitochondria have their very own repair toolkits which are constantly active to maintain their own DNA integrity.

Lead author of the study, Professor Sherif El-Khamisy, a Wellcome Trust Investigator and Chair of Molecular Medicine at the University of Sheffield, said: "Each mitochondria repair toolkit has unique components -- enzymes -- which can cut, hammer and seal the breaks. The presence of these enzymes is important for energy production.

"Defects in repairing DNA breaks in the mitochondria affect vital organs that rely heavily on energy such as the brain. It also has implications on mitochondria replacement therapies recently approved in the UK and known as 'three parent babies'."

Although much research has focused on how free radicals damage the DNA in the cell's nucleus, their effect on mitochondrial DNA is less well understood despite this damage to mtDNA being responsible for many different types of disease such as neurological disorders.

Having healthy mitochondria is also essential for tissue regeneration, making it particularly important for successful organ transplants.

The team further identified a mechanism through which mtDNA can be damaged and then fixed, via a protein called TOP1, which is responsible for untangling coils of mtDNA. When the long strands become tangled, TOP1 breaks and quickly repairs the strands to unravel the knots. If free radicals are also attacking the mitochondrial DNA, then TOP1 proteins can become trapped on the mitochondrial DNA strands, making repair even more difficult.

Professor El-Khamisy believes the findings could pave the way for the development of new therapies for mitochondrial disease that boost their DNA repair capacity, or for cancer treatments which could use TDP1 inhibitors to prevent mtDNA repair selectively in cancer cells.

"Cancer relies on cells dividing very quickly. That means they need a lot of energy, so will have really healthy mitochondria," said Professor El-Khamisy.

"If we can find a way to selectively damage the mitochondria in the cancer cells, by preventing or slowing its repair mechanism, this could be really promising."

The findings could also be important for new clinical advances such as the decision by the Human Fertilisation and Embryology Authority (HFEA) to allow 'mitochondrial donation' -- also known as 'three-parent babies' -- where mtDNA from a female donor is introduced to an embryo to correct mitochondrial defects.

"This research suggests that clinicians should assess the function of TDP1 and mitochondrial TOP1 before mitochondrial donation takes place, to ensure the success of this procedure," added Professor El-Khamisy.

"Even if the new embryo has healthy mitochondrial DNA from the donor, it could still have defective TDP1 or mitochondrial TOP1 from the recipient, since they are both produced by the DNA in the cell's nucleus, so mitochondrial DNA damage could still take place over time, and cause disease."

Professor Allan Pacey, a fertility expert at the University of Sheffield's Department of Oncology and Metabolism, said "Given that the first UK licence to perform mitochondrial donation procedures was awarded by the HFEA last month, the publication of this study is very timely.

"It is important that we know as much as possible about how to identify healthy and defective mitochondria, in order to help those people with debilitating mitochondrial disease."

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The ocean detectives

Marine microorganisms pose a research challenge for biologists, since many of these microorganisms cannot be grown in the laboratory. One way to study them is to collect water from the ocean and study the genetic material (DNA) the sample contains.

In a April 27 article published in Current Biology, researchers from the Technion-Israel institute of Technology present new findings obtained in this way about viruses that attack microorganisms from one of the archaeal marine groups (Euryarchaeota). This group is highly abundant in the oceans, and can produce energy from sunlight using a mechanism that is different from photosynthesis. But little is known about this group, and the team's findings shed light, for the first time, on the interaction between key groups in the marine ecosystem.

In the study conducted by Dr. Alon Philosof, under the supervision of Prof. Oded Béjà of the Technion Faculty of Biology, samples of dozens of liters were collected from the surface water layer in the Gulf of Eilat, from which DNA segments were sequenced. The team used the DNA segments to identify the microorganisms living in these waters. This was done by means of metagenomics -- a bioinformatics approach that combines computer science algorithms with biological knowledge.

The researchers assembled the DNA segments computationally -- a method similar to putting together a jigsaw puzzle from millions of pieces without a picture to serve as a guide. In doing so, they were able to reconstruct the genomes of viruses that attack the marine archaea. This complex reconstruction was made possible through the use of the ATLAS computing system (which is also used to analyze results from the CERN particle accelerator in Switzerland).

In all, 26 viruses that were previously unknown to science were detected in the study.

"On the basis of the similarity between segments of the genetic material of the viruses and those of the marine archaea, we began a detective work and concluded that these viruses attack those microorganisms," said Dr. Philosof. "This was accomplished without the possibility of growing the viruses or the archaea in the lab."

Environmental microbiology, especially in the oceans, is one of the last frontiers of ecology. The methods used in this study enable researchers to explore this terra incognita. The results of this study shed new light on the evolution of an important archaeal group and its viruses.

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Fast, non-destructive test for two-dimensional materials

By now it is well understood that thinning a material down to a single atom thickness can dramatically change that material's physical properties. Graphene, the best known 2D material, has unparalleled strength and electrical conductivity, unlike its bulk form as graphite. Researchers have begun to study hundreds of other 2D materials for the purposes of electronics, sensing, early cancer diagnosis, water desalination and a host of other applications. Now, a team of Penn State researchers in the Department of Physics and the Center for Two-Dimensional and Layered Materials (2DLM) has developed a fast, nondestructive optical method for analyzing defects in two-dimensional materials.

"In the semiconductor industry, for example, defects are important because you can control properties through defects," said Mauricio Terrones, professor of physics, materials science and engineering and chemistry, Penn State. "This is known as defect engineering. Industry knows how to control defects and which types are good for devices."

To really understand what is going on in a 2D material like tungsten disulfide, which has a single atom-thick layer of tungsten sandwiched between two atomic layers of sulfur, would require a high-power electron microscope capable of seeing individual atoms and the holes, called vacancies, where the atoms are missing.

"The benefit of transmission electron microscopy (TEM) is that you get an image and you can see directly what is going on -- you get direct evidence," said Bernd Kabius, staff scientist at Penn State's Materials Research Institute, an expert in TEM and a coauthor on the paper appearing April 28 in the online journal Science Advances.

The downsides, according to Kabius, are an increased possibility of damage to the delicate 2D material, the complex preparation required of the sample and the time involved -- an entire day of instrument time to image a single sample and a week or more to interpret the results. For those reasons, and others, researchers would like to combine TEM with another method of looking at the sample that is simpler and faster.

The technique developed by Terrones and his team uses an optical method, fluorescent microscopy, in which a laser of a specific wavelength is shone on a sample and the excited electrons, pushed to a higher energy level, each emit a photon of a longer wavelength when the electron drops down to a lower energy level. The wavelength, or color of light, can be measured by spectroscopy and gives information about the defect type and location on the sample. This data shows up as peaks on a graph, which the team then correlated to visual confirmation under the TEM. Theoretical calculations also helped to validate the optical results. A necessary step in the process requires placing the sample in a temperature-controlled specimen holder, or stage, and lowering the temperature to 77 kelvin, almost 200 degrees C below zero. At this temperature, the electron-hole pairs that produce the fluorescence are bound to the defect -- in the case of this work a group of sulfur vacancies in the top layer of the sandwich -- and emit a signal stronger than the pristine areas of the material.

"For the first time, we have established a direct relationship between the optical response and the amount of atomic defects in two-dimensional materials," said Victor Carozo, former postdoctoral scholar in Terrones' lab and first author of the work.

Terrones added, "For the semiconductor industry, this is a quick measurement, an optical nondestructive method to evaluate defects in 2D systems. The important thing is that we were able to correlate our optical method with TEM and also with atomistic simulations. I think this method can be very helpful in establishing a protocol for characterization of 2D crystalline materials."

In this context, co-author Yuanxi Wang, a postdoctoral researcher in the 2DLM and a theorist, added, "Our calculations show that electrons trapped by vacancies emit light at wavelengths different than the emission from defect-free regions. Regions emitting light at these wavelengths can easily identify vacancies within samples."

And Vincent Crespi, Distinguished Professor of Physics, Materials Science and Engineering and Chemistry, Penn State, said "We can establish not just an empirical correlation between the presence of certain defects and modified light emission, but also identify the reason for that correlation through first-principles calculations."

Device applications that could be enhanced by this work include membranes with selective pore sizes for removing salt from water or for DNA sequencing, gas sensing when gas molecules bind to specific vacancies and the doping of 2D materials, which is the addition of foreign atoms to enhance properties.

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Plague bacteria take refuge in amoebae

Yersinia pestis, the bacterium that causes bubonic plague, can survive within the ubiquitous soil protozoan, the amoeba, by producing proteins that protect against the latter microbe's digestion. The research is published April 28th in Applied and Environmental Microbiology, a journal of the American Society for Microbiology.

The research is important because plague is a re-emerging disease, according to the Centers for Disease Control and Prevention, with 95 percent of cases occurring in sub-Saharan Africa and Madagascar. Modern antibiotics are effective, but without prompt treatment, plague can cause serious illness, or death.

Y. pestis spreads from rodent to rodent, and sometimes to human, often via fleas It uses the protective niche of the amoeba to abide when conditions are unfavorable to its spread, that is, when rodents are scarce, said Viveka Vadyvaloo, PhD, Assistant Professor, Paul G. Allen School for Global Animal Health, Washington State University, Pullman.

Amoebae are similar to certain human immune cells, the macrophages, in their ability to engulf bacteria, or other nourishing items of similar size.These are taken up within special compartments called vacuoles, which in both amoebae and humans are capable of digestion. (image: scanning electron micrograph of a mass of Yersinia pestis.)

"With this in mind, graduate student Javier Benavides-Montaño separately cultured three distinct Y. pestis strains that have been associated with human epidemics, with a common laboratory strain of the free-living soil amoeba, Acanthamoeba castellanii, in a medium that supports the latter's growth," said Vadyvaloo.

Benavides-Montaño then tested Y. pestis' ability to enter and survive within the amoeba. To do so, he killed any bacteria that were outside of the amoebae, and then gently lysed the latter, and then placed the lysed content on a medium that encourages Y. pestis to grow. They were able to culture Y. pestis only after the amoebae had been lysed.

The investigators also used electron microscopy to peer inside intact amoebae, and found Y. pestis within the vacuoles.

"To understand more about how Y. pestis might be surviving within amoebae we considered how Y. pestis survive in human macrophages," said Vadyvaloo. "Macrophages usually engulf bacterial pathogens and destroy them, but some bacterial pathogens are able to avoid being killed therein by producing proteins that block the digestion." Indeed, that is the key strategy for a number of human pathogens. Some such proteins are known. So the investigators used mutant Y. pestis that doesn't produce one of these proteins. Those mutants failed to survive within the amoebae.

Vadyvaloo said that amoebae's longstanding reputation as Trojan horses for human pathogens led her to investigate the possibility that plague bacteria could abide within their vacuoles. The best known example of this phenomenon had been Legionnaires' Disease, a respiratory disease that was discovered in 1976 after an outbreak among attendees at a convention of the American Legion in Philadelphia.

"This study serves as a proof of principle that amoebae can support prolonged survival of Y. pestis in the environment," said Vadyvaloo. It may encourage a search for this interaction within areas of Colorado and New Mexico where plague is endemic. And that, she said, could enable prediction of potential disease re-emergence, thereby reducing spread to humans.

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Helpful tool allows physicians to more accurately predict parathyroid cancer recurrence

A newly-created prognostic tool reliably predicts the recurrence of parathyroid cancer, enabling physicians to identify patients at the highest risk. Consequently, the tool also helps to determine the optimum postoperative strategy, including aggressive surveillance and additional treatments, according to study results published online as an "article in press" on the Journal of the American College of Surgeons website ahead of print publication.

Parathyroid cancer is rare, and it is often difficult to diagnose. There is no definitive and effective medical management. The best chance of curing this devastating form of cancer is to make the diagnosis early and then surgically remove all tumor cells, avoiding spillage or spread of those tumor cells into surrounding tissue.

However, more than half of patients will develop a recurrence after the first surgical procedure, said study author Angelica Silva-Figueroa, MD, who recently completed a research fellowship at the University of Texas MD Anderson Cancer Center and is now an oncological surgeon, and head and neck surgeon at RedSalud Avansalud Clinic, Chile. "Currently there has been no reliable system to predict who will recur. What is needed is a prognostic staging system for parathyroid cancer. We do not know which group of patients has an increased risk of relapse at the time of diagnosis," Dr. Silva-Figueroa said.

For the study, researchers examined data on patients treated for parathyroid cancer between 1980 and 2016 at the University of Texas MD Anderson Cancer Center, Houston, Texas. From a sample size of 68 patient records, 26 patients developed recurrent disease after a median follow up of 4.6 years.

Rather than using the traditional parameter called disease-free survival, which evaluates the effectiveness of a therapy over time, the investigators assessed recurrence-free survival. After the initial operation to remove the tumor, the recurrence-free survival rates were 85 percent at one year, 67 percent at two years, and 51 percent at 10 years.

"The data points used to determine recurrence-free survival are quantitative and can predict disease recurrence in the first two to three years after disease resection," said study senior author Nancy D. Perrier, MD, FACS, chief of endocrine surgery, department of surgical oncology, the University of Texas MD Anderson Cancer Center. "This [approach] offers a means to stratify patients and consider more aggressive adjuvant treatment for those at higher risk of recurrence."

Patients with parathyroid cancer typically have significantly elevated levels of calcium in their blood as well as other abnormal parathyroid hormone levels. In the multivariate analysis, the research team identified three key prognostic indicators of parathyroid cancer recurrence: serum calcium level greater than 15 mg/dL, age over 65, and invasion of the tumor into blood vessels.

From there, the research team developed a simple predictive tool by combining these three variables. Patients were stratified into three risk groups -- low, moderate, and high -- based on the number of adverse characteristics each one had, which ranged from zero to three.

The study found that the two-year recurrence-free survival rate after parathyroidectomy was 93 percent in those with zero adverse characteristics (low risk), 72 percent in those with one adverse characteristic (moderate risk), and 27 percent in those with two adverse characteristics (high risk).

The investigators also showed that, although the risk of recurrence is greater within two years after the initial surgical procedure, this risk continues to increase over the next 10 years and beyond in the moderate risk group, Dr. Silva-Figueroa said.

With this combination of measurable and available information, a patient's risks can be assessed. For individuals at elevated risk, additional surgery or other adjuvant therapies could be used early on to control cancer recurrence.

"We believe that this scoring system is the first step in personalized cancer care," Dr. Silva-Figueroa said. "The system may help physicians predict the clinical progression of this disease, reliably aid immediate postoperative treatment decisions, and guide clinical monitoring for progression."

This prognostic scoring system is currently being validated at four centers across the country. Once these prospective studies have been completed and results are published, the tool will be made available for public use.

"This article is an important contribution to the medical literature and should be employed for other rare tumors where data are insufficient to generate prognostic stages," said David Winchester, MD, FACS, Medical Director of Cancer Programs at the American College of Surgeons. "It's a good model to pave the way for future studies."

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Zika virus persists in the central nervous system and lymph nodes of rhesus monkeys

Unexpected damage found rippling through promising exotic nanomaterials

Some of the most promising and puzzling phenomena in physics play out on the nanoscale, where a billionth-of-a-meter shift can make or break perfect electrical conductivity.

Now, scientists have developed a new method to probe three-dimensional, atomic-scale intricacies and chemical compositions with unprecedented precision. The breakthrough technique -- described February 6 in the journal Nano Letters -- combines atomic-force microscopy with near-field spectroscopy to expose the surprising damage wreaked by even the most subtle forces.

"This is like granting sight to the blind," said lead author Adrian Gozar of Yale University. "We can finally see the all-important variations that dictate functionality at this scale and better explore both cutting-edge electronics and fundamental questions that have persisted for decades."

Scientists from Yale University, Harvard University, and the U.S. Department of Energy's Brookhaven National Laboratory developed the technique to determine why a particular device fabrication technique -- helium-ion beam lithography -- failed to create the scalable, high-performing superconducting nanowires predicted by both theory and simulation.

In previous work, heavy ion beams were used to carve 10-nm-wide channels -- some 10,000 times thinner than a human hair -- through custom-made materials. However, the new study revealed beam-induced damage rippling out over 50 times that distance. At this scale, that difference was both imperceptible and functionally catastrophic.

"This directly addresses the challenge of quantum computing, for example, where companies including IBM and Google are exploring superconducting nanowires but need reliable synthesis and characterization," said study coauthor and Brookhaven Lab physicist Ivan Bozovic.

Writing with ions

One promising design for high-temperature superconducting devices is alternating superconductor-insulator-superconductor (SIS) interfaces -- or so-called Josephson junctions. These are theoretically easy to fabricate by direct beam writing, assuming sufficient precision can be achieved.

Helium-ion beam lithography (HIB) was a perfect candidate, proven recently in similar materials and well suited for swift and scalable production of superconducting nanowires and Josephson junctions.

"HIB lets us focus the particle beam to less than a single nanometer and effectively 'write' patterns to create superconducting interfaces," said Nicholas Litombe, who led the HIB work under the guidance of Professor Jenny Hoffman of Harvard, a coauthor of this study. "We set out to shift that technique to another class of materials: LSCO thin films."

The collaboration started with the painstaking assembly of perfect LSCO thin films -- so named for their use of lanthanum, strontium, copper, and oxygen. Bozovic's group at Brookhaven used a technique called atomic layer-by-layer molecular beam epitaxy, which can create atomically perfect superconducting films and heterostructures.

"I have a long-standing interest and specialization in using interphase physics to induce and understand high-temperature superconductivity," Bozovic said. "HIB gives us an entirely new way to explore these materials on the nanoscale."

Litombe carved the ultra-precise interface channels in Bozovic's thin films. But the immediate results were discouraging: the anticipated superconductivity was entirely suppressed when current ran through wires narrower than a couple hundred nanometers.

"Our computer models and experimental results all looked excellent, but we knew there were hidden forces at work," Litombe said. "We needed deeper insight into the material structure."

Cryogenic lightning rod

Material composition and electronic properties can be pinpointed through the way they absorb and emit light -- a longstanding field called spectroscopy. In the instance of superconductivity, this can distinguish between the "shiny" surface of a conductive metal versus the dullness of a current-breaking insulator.

The scientists turned to scanning near-field optical microscopy (SNOM) to examine the spectroscopic sheen on the HIB pathways. But this technique, which funnels light through a gilded glass capillary, has a resolution limit of about 100 nanometers -- much too large to examine the nanoscale superconducting interfaces.

Fortunately, Gozar built a specialized instrument to radically increase the spectroscopic resolution. The machine, built entirely at Brookhaven Lab and now housed at Yale, combines SNOM with atomic force microscopy (AFM). Like a record player's needle extracting sound from the texture of vinyl, an AFM needle travels over a material and reads the atomic topography.

"Here, the AFM needle acts like a lightning rod, channeling the SNOM light down to just tens of nanometers," Gozar said. "We have simultaneous AFM topography and spectroscopic data on the deep chemical structures."

Crucially, Gozar's AFM-SNOM system also operates at the cryogenic temperatures required to test these materials -- a capability only offered at a few laboratories in the world.

Widespread ruin

The novel technique revealed the unexpected and widespread damage left in the wake of the helium ions. Despite the 0.5-nanometer focus of the beam, its effects rattled atoms across a 500-nanometer spread and altered the structure enough to prevent superconductivity. For nanomaterial construction, this so-called lateral straggle is utterly untenable.

"Even the slightest nudge at this scale shatters the powerful phenomena we mean to exploit," Litombe said. "High-temperature superconductivity can have a coherence distance of just a few atoms, so this lateral effect is devastating. We are, of course, still thrilled to explore the never-before-seen details."

Added Bozovic, "In one sense, the whole result was negative. Our initial goal of creating nanometer-thick superconducting wires was not fully accomplished. But figuring out why has opened some truly exciting doors."

The SNOM-AFM technique is readily applicable to fields such as plasmonics for display technology and the study of the mechanism behind high-temperature superconductivity.

"The nanoscale resolution and the tomographic capabilities of the instrument, put us on the cusp of uncovering new truths about nanoscale phenomena and the technology it empowers," Gozar said.

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Unexpected damage found rippling through promising exotic nanomaterials

First endoscopic stricturotomy with needle knife study for intestinal strictures in IBD

Cleveland Clinic doctors have published the first study illustrating the safety and efficacy of endoscopic needle knife therapy for intestinal strictures in patients with inflammatory bowel disorder (IBD).

"We pioneered this procedure," said Bo Shen, MD, Medical Director of Cleveland Clinic's IBD Center. "And our research shows that it is effective and can have advantages over other conventionally used treatments, such as medical therapy, balloon dilation and surgery."

Shen's study, which was co-authored with research fellow Nan Lan, MD, was featured as the cover story in the April 2017 issue of the journal Inflammatory Bowel Diseases. Dr. Lan will present their findings in May at Digestive Disease Week 2017.

In their study, Drs. Shen and Lan reviewed the records of 85 patients with strictures treated by needle knife stricturotomy (NKSt) between 2008 and 2016 at Cleveland Clinic's Center for Inflammatory Bowel Disease.

Because many patients had multiple strictures, there were a total of 231 NKSts performed on the 85 subjects. Passage of the scope through each stricture was achieved in 100 percent of the patients.

Developing nonsurgical treatments for IBD patients such as NKSt results in better quality of life, according to Dr. Shen. "Multiple bowel resection surgeries can shorten patients' intestinal tracts while noninvasive procedures preserve them."

Strictures, the narrowing of the intestines due to inflammation and scarring, are a common side effect of IBD. Patients with Crohn's disease or, to a lesser degree, ulcerative colitis after surgery, often develop them as their conditions progress. Strictures also may occur after a bowel resection. They can cause abdominal pain, diarrhea, nausea, vomiting, weight loss and malnutrition.

To treat strictures, physicians typically have turned to surgery or a procedure called endoscopic balloon dilation (EBD) that stretches out the constricted area, however, this therapy carries a risk of perforation and intestinal bleeding, and usually the therapeutic effect typically lasts only three to six months before the stricture returns.

The interval between endoscopic and surgical interventions and the interval from the treatment to the return of the stricture was longer, Drs. Shen and Lan found, if patients first had NKSt. "For example, if you need EBD every three months, you need it every six months after NKSt," said Dr. Shen.

Dr. Shen was already experienced in using endoscopic needle-knife technology to treat strictures in the upper GI tract when he decided it might be a good alternative therapy for IBD patients with strictures in the lower GI track.

He says the technology allows physicians to be much more precise when opening up strictures. "You have more control over how deep you cut and where you cut," he said. "This is a major advantage."

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Thin layers of water hold promise for the energy storage of the future

Researchers at North Carolina State University have found that a material which incorporates atomically thin layers of water is able to store and deliver energy much more quickly than the same material that doesn't include the water layers. The finding raises some interesting questions about the behavior of liquids when confined at this scale and holds promise for shaping future energy-storage technologies.

"This is a proof of concept, but the idea of using water or other solvents to 'tune' the transport of ions in a layered material is very exciting," says Veronica Augustyn, an assistant professor of materials science and engineering at NC State and corresponding author of a paper describing the work. "The fundamental idea is that this could allow an increased amount of energy to be stored per unit of volume, faster diffusion of ions through the material, and faster charge transfer.

"Again, this is only a first step, but this line of investigation could ultimately lead to things like thinner batteries, faster storage for renewable-based power grids, or faster acceleration in electric vehicles," Augustyn says.

"The goal for many energy-storage researchers is to create technologies that have the high energy density of batteries and the high power of capacitors," says James Mitchell, a Ph.D. student at NC State and lead author of the paper. "Pseudocapacitors like the one we discuss in the paper may allow us to develop technologies that bridge that gap."

For this work, the researchers compared two materials: a crystalline tungsten oxide and a layered, crystalline tungsten oxide hydrate -- which consists of crystalline tungsten oxide layers separated by atomically thin layers of water.

When charging the two materials for 10 minutes, the researchers found that the regular tungsten oxide stored more energy than the hydrate. But when the charging period was only 12 seconds, the hydrate stored more energy than the regular material. One thing that's intriguing, the researchers say, is that the hydrate stored energy more efficiently -- wasting less energy as heat.

"Incorporating these solvent layers could be a new strategy for high-powered energy-storage devices that make use of layered materials," Augustyn says. "We think the water layer acts as a pathway that facilitates the transfer of ions through the material.

"We are now moving forward with National Science Foundation-funded work on how to fine-tune this so-called 'interlayer,' which will hopefully advance our understanding of these materials and get us closer to next-generation energy-storage devices."

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Fast, low energy, and continuous biofuel extraction from microalgae

As an alternative to liquid fossil fuels, biodiesel extracted from microalgae is an increasingly important part of the bioenergy field. While it releases a similar amount of CO₂ as petroleum when burned, the CO₂ released from biodiesel is that which has recently been removed from the atmosphere via photosynthesis meaning that it does not contribute to an increase of the greenhouse gas. Furthermore, research has shown that microalgae produces a much higher percentage of their biomass to usable oil in a significantly smaller land mass than terrestrial crops. Currently, one of the largest obstacles in replacing diesel with biodiesel is the cost of production. Fossil fuels are still cheaper than biofuels so improvements in production efficiency are highly sought-after.

Recently, efforts have been made by researchers in Japan to reduce the cost of biodiesel production by using pulsed electric fields (PEF) to extract hydrocarbons from microalgae. A milli- or microsecond PEF is typically used to weaken cell walls and increase permeability allowing for extraction of elements inside the cell. Kumamoto University researchers, on the other hand, used a nanosecond PEF (nsPEF) to focus on the microalgae matrix instead of the cells. A nsPEF generally uses less energy than the ?s/msPEFs even at high voltages, and is not as destructive or costly as the traditional drying method of oil extraction.

The researchers performed several tests with the nsPEF on the microalgae Botryococcus braunii (Bb) to determine the optimal electric field, energy, and pulse repetition frequency for hydrocarbon extraction. Interestingly, it was found that doubling the energy only resulted in a 10% increase in hydrocarbon extraction. At 10 Hz, the optimal field and energy conditions were determined to be approximately 50 kV/cm and 55.6 J/ml respectively per volume of algae. Further, the researchers found that pulse frequency had little to no effect on extraction percentage, meaning that a large amount of hydrocarbons may be extracted quickly for large/industrial systems.

"The advantage with this extraction mechanism is that it separates hydrocarbons from a matrix, rather than extracts them from cells. Other microalgae do not secrete a matrix so the cell membranes must be damaged or destroyed to get at the hydrocarbons, which both takes more energy and is less efficient than our method," said lead researcher, Professor Hamid Hosseini of the Institute of Pulsed Power Science at Kumamoto University. "On top of that, many extraction processes practiced today use a drying method to extract oil which ends in the destruction of the algae. Our method is relatively non-destructive and the microalgae are able to rebuild their colonies after extraction has finished."

One minor drawback is the impurity of the matrix; polysaccharides must be purified from the extracted hydrocarbon solution. Fortunately, these molecules may be used in the creation of bioethanol but their concentration is low.

It is hoped that this technology will improve biofuel production as an appropriate green energy source.

This work may be found in the online BioMed Central journal, Biotechnology for Biofuels.

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Mining: Bacteria with Midas touch for efficient gold processing

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Weather extremes and trade policies were main drivers of wheat price peaks

Price peaks of wheat on the world market are mainly caused by production shocks such as induced for example by droughts, researchers found. These shocks get exacerbated by low storage levels as well as protective trade policies, the analysis of global data deriving from the US Department of Agriculture shows. In contrast to widespread assumptions, neither speculation across stock or commodity markets nor land-use for biofuel production were decisive for annual wheat price changes in the past four decades. This finding allows for better risk assessment. Soaring global crop prices in some years can contribute to local food crises, and climate change from burning fossil fuels and emitting greenhouse gases is increasing weather variability.

"Food security to a large extent is a matter of prices, hence our interest in understanding what drives variations from one year to another," says lead-author Jacob Schewe from the Potsdam Institute for Climate Impact Research (PIK).

When global wheat prices, along with those of other staple crops, skyrocketed in 2007/08 and again in 2010/11, poor people in many developing countries suffered from that -- these temporary price rises have even been linked to food riots in several countries. "These recent peaks, as others, have been preceded by severe droughts that reduced crop production. Now we can show that such weather-induced shocks have the potential to induce strong price increases," says Schewe "Moreover, they can trigger protective trade policy responses, including hoarding or export bans, which further exacerbate the global effects of production shortfalls even though they may seem rational from a country's point of view. This happened during the recent price peaks."

Commodity speculation turns out to be just a minor factor for annual prices

"While cross-market speculation might further exacerbate the problem on monthly or shorter time-scales, the data indicate that in the end it was a minor factor for annual prices," adds co-author Christian Otto. This is despite the fact that the sudden price increase in 2007/08 coincides with speculation by index funds driven out of the collapsing US housing and stock markets.

The researchers developed and applied a rather simple computer simulation of wheat markets. By comparing the results to observation data from past years, the scientists checked that the computer simulations fit reality. Importantly, the factor of supply and demand from storage -- also based on existing data from markets -- is integrated in these calculations. The simulation model could be applied for assessments of future wheat price fluctuations under climate and land use changes.

"This informs us what can be done to limit food price peaks in the future"

"The good news: Our study helps to understand what can be done if we want to limit food price peaks in the future," says Katja Frieler, co-author of the study and vice-chair of PIK's research domain Climate Impacts and Vulnerabilities. "First, besides improving productivity experts can seek to carefully adjust trade policies as well as storage capacities. Second, stabilizing the climate by reducing greenhouse gas emissions is key if we want to limit the risks of weather extremes across the globe."

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Weather extremes and trade policies were main drivers of wheat price peaks