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Sunday, September 4, 2022

From wound healing to regeneration

 The phenomenon of regeneration was discovered over 200 years ago in the freshwater polyp Hydra. Until now, however, it was largely unclear how the orderly regeneration of lost tissues or organs is activated after injury. In its investigations of Hydra, an interdisciplinary research team at Heidelberg University was able to show how wound healing signals released upon injury are converted into specific signals of pattern formation and cell differentiation. Essential components are the mitogen-activated protein kinases (MAPK) and the Wnt signalling pathway – molecular mechanisms that have remained relatively unchanged throughout evolution.

The ability to regenerate varies widely in animals. Most mammals and vertebrates have only limited regeneration capacity, while basal and simple animals that emerged early in evolution, like cnidarians and planarians, can regenerate their whole body. In all cases, the process of regeneration begins with wound healing. The cells at the site of injury proliferate and form an undifferentiated mass – a blastema – from which the missing structures are re-patterned. This activates genetic processes that also control embryonic development. To determine the molecular mechanisms involved, the research team led by Prof. Dr Thomas W. Holstein studied the freshwater polyp Hydra to understand the basic features of this activation of regeneration.

The core of their investigations is the doctoral thesis of Anja Tursch. She repeated the key experiment of Geneva naturalist Abraham Trembley (1710 to 1784) which led him to discover the regeneration phenomenon. The Hydra polyp is bisected, prompting the upper half to regenerate a new “head” and the lower half a new “foot” – hence totally different body parts can grow from the exact same tissue at the cut surface in the middle. Building on their previous work on Hydra regeneration, the researchers at the Centre for Organismal Studies (COS) of Heidelberg University have now shown how this is possible.

Regardless of where it occurs, any damage triggers nonspecific signals for an injury response, i.e. wound healing, via calcium ions and the production of reactive oxygen species. The signals are transmitted intracellularly by three mitogen-activated protein kinases – p38, JNKs, and ERK. Activation of these three molecules is required for both head and foot regeneration. Wnt signalling pathways are then activated that are important during embryonic development for the formation of rudimentary organs and the body axis. The generic signals of wound healing are thus transferred into position-specific signals of patterning and cell differentiation for regeneration.

“Our experiments show that the Wnt signalling pathway is a main component of the initially general injury response and, depending on signal strength, directs the tissue toward head or foot development,” explains Prof. Holstein. This is why, in the case of MAPK inhibition, the otherwise absent regeneration can be induced by artificially generated, recombinant Wnt proteins. “It was also surprising that in middle body parts that had both head and foot removed, heads can be induced at both ends in this way,” adds Dr Suat Özbek, a member of Prof. Holstein’s “Molecular Evolution and Genomics” research group at the COS.

Wnt/β-catenin, one piece of the Wnt signalling pathway, was already known to encode positional information for new head structure formation. In collaboration with mathematicians led by Prof. Dr Anna Marciniak-Czochra, the research team of Prof. Holstein and Dr Özbek developed a model that shows how basal positional information in the tissue transforms the initially undifferentiated injury response into a differential patterning process via the Wnt signalling pathway. “Because MAPKs and Wnts are highly evolutionarily conserved, this mechanism is likely deeply embedded in our genome, which is important for regenerative processes in vertebrates and mammals as well,” stresses Thomas Holstein.

The research was done under the auspices of the “Mechanisms and Functions of Wnt Signaling” Collaborative Research Centre (CRC 1324) funded by the German Research Foundation. The results were published in the “Proceedings of the National Academy of Sciences” (PNAS).

The Quiet Cost of Family Caregiving

 At first, Dana Guthrie thought she could help care for her parents, whose health had begun to decline, and still hold onto her job administering a busy dental practice in Plant City, Fla.

“It was a great-paying job and I didn’t want to lose it,” Ms. Guthrie, 59, recalled recently. So she tried shifting to a four-day schedule, working evenings to keep up with the office demands, and she began spending a few nights a week at her parents’ home instead of her own nearby.

Ultimately, though, her mother’s liver disease progressed and her father was diagnosed with dementia. The family learned that the cost of hiring home aides for two ailing 82-year-olds exceeded even a middle-class retirement income and savings. “They really needed me,” Ms. Guthrie said. In 2016, she left her job “and moved in full time.”


An estimated 22 to 26 million American adults currently provide care for family members or friends, most of them older people, who need help with daily activities; more than half of those caregivers have jobs. “There’s no doubt that juggling the two can be very difficult,” said Douglas Wolf, a demographer and gerontologist at Syracuse University.

Yulya Truskinovsky, an economist at Wayne State University, and her co-authors combined data from a Census Bureau survey with Social Security records to follow unusually long employment trajectories for nearly 13,000 people.

Among those who became caregivers, employment dropped almost 8 percent compared to demographically similar non-caregivers, the authors found. “It happens right away, in the first year,” Dr. Truskinovsky said. “We see little evidence that they either reduce hours or switch to self-employment. They leave the labor force and remain out of it for quite a long time.”

She added, “Younger caregivers are just as likely to leave the labor force as older ones.” Seven years later, the study found, those caregivers had not returned to the level of labor participation of demographically matched non-caregivers.

Moreover, there were significant gender differences among those exiting the work force.

Men started to reduce their workloads well before they became caregivers; then, “they leave the labor force and they don’t come back,” Dr. Truskinovsky said. The study could not provide an explanation; perhaps men take on caregiving when their work lives are already winding down.

In contrast, women caregivers leave the work force more abruptly and are more likely to return — after just two years, on average — “but at lower wages or fewer hours,” Dr. Truskinovsky said.

The pandemic amplified the conflict between employment and caregiving, Dr. Truskinovsky and colleagues found in another study. “Caregiving arrangements are very fragile,” she noted. While families often patch together paid and unpaid care, “it’s unstable, and if one thing falls through, your whole arrangement falls apart.”

In a national sample of adults over 55, half the family caregivers reported that Covid-19 had disrupted their care schedules, forcing them to provide more care (because paid help became unavailable) or less (because of quarantines and fear of transmission). Before the pandemic, more than one-third had been employed.

Caregivers facing disrupted arrangements were more likely to be furloughed or lose their jobs; they also showed far higher rates of depression, anxiety and loneliness than either non-caregivers or caregivers who did not experience disruptions.The toll on working caregivers takes many forms. Susan Larson, 59, an education services specialist for the U.S. Army, has forgone promotions, even when her superiors urged her to apply. “I’m not geographically mobile,” she said.

She cannot leave her home in St. Paul, Minn., where she and her husband built a handicapped-accessible addition for her mother, 83, who needs extensive assistance. The Army has been very supportive, Ms. Larson said. But she estimated that her salary would be nearly 25 percent higher if she had accepted promotions, in turn bolstering both her eventual pension and Social Security benefits.

Shawn French, 51, a video game writer in Limerick, Me., and his wife welcomed her widowed father into their home three years ago. Because Mr. French works remotely, he can help his father-in-law with meals, medications and mobility; his wife handles doctors visits and other tasks.

“I wouldn’t have it any other way,” Mr. French said. But the stress led him to relinquish weekend freelancing that had generated $200 to $300 a week. “We relied on it anytime things were a little tight,” he said. His wife reconfigured her work arrangement, too, which led to him being dropped from her health plan and becoming uninsured.

Even when caregivers keep their jobs, another recent study indicates, almost one-quarter report either missed work (absenteeism) or reduced productivity (known as presenteeism).

Presenteeism accounts for the most productivity loss, said senior author Jennifer Wolff, a gerontologist and health services researcher at Johns Hopkins University. “Absenteeism is visible, presenteeism is less so,” she said. “You show up, but you’re making doctor calls or managing insurance.”

Among affected employees, work productivity dropped by one-third, on average. Based on 2015 data, the most recent available on adults 65 and older, that translates to a $49 billion loss annually.

Paid family leave, although better configured for the more predictable needs of new parents, might help workers providing care for the elderly as well. When California adopted paid leave, which took effect in 2004, residency rates at nursing homes declined by about 11 percent, Dr. Wolf of Syracuse and his co-author Kanika Arora found.

Although the study could not establish the reason, Dr. Wolf speculated that “the change in the law induced people to stay on the job, but they took enough time off to keep their parents out of a nursing home.” The authors’ more recent work shows that paid sick leave also helps increase family caregiving.President Biden campaigned on an ambitious caregiving plan that would have provided 12 weeks of paid family leave annually, plus tax credits to offset caregiving expenses and Social Security credits for time family caregivers spend out of the labor force. Republican opposition in the Senate has prevented its passage.

Debate on how best to support family caregivers will continue, but there is little debate about their need for help. Although many workers can handle the more predictable needs of aging parents and spouses, some face intense pressures incompatible with contemporary workplaces.

After Ms. Guthrie’s parents died, she relocated to Radcliff, Ky., where her sister lives. She found positions at dental practices there but has never matched the compatibility or the salary of the job she left in Florida.

Currently unemployed, Ms. Guthrie has been interviewing for jobs and wondering whether she will ever be able to retire, although she doesn’t regret the sacrifices she made to care for her parents.

“We were a close-knit family and I would do it again,” she said. “But I took a beating, emotionally and financially, and I haven’t really been able to recover.”

https://www.nytimes.com/2022/09/04/science/elderly-work-caregiving.html

Primary Care Providers Are Best Place to Go for a Long COVID Diagnosis

 Many patients dealing with debilitating long COVID symptoms that interfere with their day-to-day lives might be tempted to go straight to a specialist – whether it’s a pulmonologist for breathing difficulties or a physiatrist for muscle fatigue – to see if they have long COVID. But medical experts – including many specialists who treat the most complex long COVID cases – recommend starting in a different place: primary care.

“Their primary care physicians are often most knowledgeable about the patients’ complete medical history, and that context is important in the process of diagnosing someone with long COVID,” says Benjamin Abramoff, MD, who leads the long COVID collaborative for the American Academy of Physical Medicine and Rehabilitation.

Primary care providers have been on the front lines of diagnosing long COVID since the early months of the pandemic, when it became clear that a large number of patients had lingering symptoms many weeks after their original COVID-19 infections cleared up.

One early guide for diagnosing long COVID in primary care, published in The BMJ in August 2020, estimated that 1 in 10 patients had a long illness after COVID infections. That estimate now looks low. A July 2022 report from the CDC found 1 in 5 people infected by the virus currently have long COVID symptoms.

Diagnosing long COVID has been a challenge because there’s no simple way to screen for the condition, and no single set of symptoms that definitively lead to the right diagnosis. Primary care providers, who often do detective work to sort out what conditions might explain patients’ health complaints, are well positioned to cast a wide net in exploring possible reasons for the complex mix of symptoms that is par for the course with long COVID.

Symptoms of long COVID Include fatigue, a cough that won’t go away, shortness of breath, lack of smell or taste, a hard time focusing, insomnia, sexual dysfunction, chest pain, and dizziness, among others, says Kristin Englund, MD, director of the Cleveland Clinic reCOVer Clinic, which treats long COVID patients.

Given how complex this is, there are many good reasons to seek a diagnosis in primary care, experts say.

Easier access to care is one big reason. Primary care providers tend to be closer to the patient’s home, and many set aside time to see sick patients quickly. Specialty clinics dedicated to long COVID care tend to be concentrated at academic medical centers in major cities and may have long waits for new patients. The sooner patients are seen, the sooner they may start getting care for symptoms that are interfering with their daily lives.

A primary care doctor who knows the patient well may be able to better distinguish symptoms unique to the COVID infection from old health problems that are resurfacing.

“Working with a primary care provider can avoid unwarranted and expensive diagnostic testing initially,” says Kathleen Bell, MD, a neuro-rehabilitation specialist at the University of Texas Southwestern O’Donnell Brain Institute who helped establish their COVID Recover program. “Patients should always start exploring questions of health care with their primary care physicians.”

Even if many experts agree that primary care is the best place to go for a long COVID diagnosis, they also agree that the process is imperfect and that not all of these doctors are up to the task. There aren’t yet evidence-based guidelines for diagnosing long COVID. And sometimes this diagnosis can get overlooked in primary care, especially when symptoms closely resemble those of other chronic health problems that have become more common during the pandemic – like depression, burnout, and chronic fatigue.

When patients show up with too many unexplained symptoms, primary care providers may also opt to refer patients to local specialists who can explore each issue separately, says Alba Miranda Azola, MD, co-director of the Post-Acute COVID-19 Team at Johns Hopkins University School of Medicine.

“What ends up happening in reality sometimes is patients see their primary care provider, they come in, they have 15 minutes, and they are ranting about all of these symptoms that are multisystemic,” she says. “The primary care provider doesn’t have time to deal with all of these symptoms – it’s gastroenterology and cardiology and neurology – and they refer to all of these different specialists.”

While referrals often help get patients diagnosed properly, it doesn’t always work because not all of these specialists are experienced with diagnosing long COVID, Azola says. “They see the cardiologist who says all of the tests are fine and I can’t help you, then it’s the same with all the different specialists.”

Patients who suspect long COVID, but don’t get this diagnosis despite persistent symptoms, may want to go to a specialized long COVID clinic for a second opinion, says Monica Verduzco-Gutierrez, MD, chair of rehabilitation medicine and director of the COVID-19 Recovery Clinic at the University of Texas Health Science Center at San Antonio.

“If the primary care provider has limited knowledge on the topic or limited options for treatments, or in the case where patients may become more chronic and have multiple conditions and symptoms to manage, this is where a multi-disciplinary long COVID clinic would be an excellent option,” she says.

Long COVID can be diagnosed when patients have persistent symptoms at 4 four weeks after infections start, according to the CDC. Many specialized long COVID clinics focus on more severe, complex cases and won’t see patients unless their symptoms don’t clear up for at least 3 months.

This makes sense, since many long COVID patients can be effectively diagnosed and treated in primary care, says, Tochi Iroku-Malize, MD, founding chair and professor of family medicine for the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. And primary care remains the best place for patients to go whenever they have concerning, unexplained symptoms – whether it’s long COVID or not.

“As the health care community continues to learn more about long COVID, it’s important to start with a health care professional you know and trust – your primary care physician,” she says.

https://www.medscape.com/viewarticle/980198

CVS takes lead in talks to acquire Signify Health

 CVS Health Corp. has reportedly taken the lead in the battle among heavyweights for the home-healthcare company Signify Health Inc.CVS is said to be in advanced talks with a bid of around $8 billion, according to Bloomberg.

Signify is a provider of technology and services for home health.

The companies could announce a deal next week with a value of more than $30 a share.

Amazon.com and UnitedHealth Group have also been interested in making a deal.

There is still no guarantee that CVS will reach a deal for Signify, which has been exploring strategic alternatives since earlier this summer.

Amazon announced in July that it will acquire U.S. primary health care provider One Medical for $18 per share, in an all-cash deal valued at about $3.9 billion.

That deal is under investigation as the Federal Trade Commission has asked for more information on the acquisition.

TickerSecurityLastChangeChange %
CVSCVS HEALTH CORP.99.47-0.43-0.43%
SGFYSIGNIFY HEALTH INC28.77+0.38+1.34%
UNHUNITEDHEALTH GROUP INC.516.35-7.65-1.46%
AMZNAMAZON.COM INC.127.51-0.31-0.24%

The Wall Street Journal reported earlier that CVS was in advanced talks to buy Signify. 

Signify rose 1.3% to close at $28.77 in New York trading Friday, giving it a market value of about $6.7 billion. 

https://www.foxbusiness.com/markets/cvs-takes-lead-talks-acquire-signify-health-report

Saturday, September 3, 2022

'Social media experiment reveals potential to inoculate millions against misinfo'

 Short animations giving viewers a taste of the tactics behind misinformation can help to "inoculate" people against harmful content on social media when deployed in YouTube's advert slot, according to a major online experiment led by the University of Cambridge.

Working with Jigsaw (https://jigsaw.google.com/), a unit within Google dedicated to tackling threats to open societies, a team of psychologists from the universities of Cambridge and Bristol created 90-second clips designed to familiarise users with manipulation techniques such as scapegoating and deliberate incoherence.

This "pre-bunking" strategy pre-emptively exposes people to tropes at the root of malicious propaganda, so they can better identify online falsehoods regardless of subject matter.

Researchers behind the Inoculation Science project (https://inoculation.science/) compare it to a vaccine: by giving people a "micro-dose" of misinformation in advance, it helps prevent them falling for it in future -- an idea based on what social psychologist's call "inoculation theory."

The findings, published in Science Advances, come from seven experiments involving a total of almost 30,000 participants -- including the first "real world field study" of inoculation theory on a social media platform -- and show a single viewing of a film clip increases awareness of misinformation.

The videos introduce concepts from the "misinformation playbook," illustrated with relatable examples from film and TV such as Family Guy or, in the case of false dichotomies, Star Wars ("Only a Sith deals in absolutes").

"YouTube has well over 2 billion active users worldwide. Our videos could easily be embedded within the ad space on YouTube to prebunk misinformation," said study co-author Prof Sander van der Linden, Head of the Social Decision-Making Lab (SDML) at Cambridge, which led the work.

"Our research provides the necessary proof of concept that the principle of psychological inoculation can readily be scaled across hundreds of millions of users worldwide."

Lead author Dr Jon Roozenbeek from Cambridge's SDML describes the team's videos as "source agnostic," avoiding biases people have about where information is from, and how it chimes -- or not -- with what they already believe.

"Our interventions make no claims about what is true or a fact, which is often disputed. They are effective for anyone who does not appreciate being manipulated," he said.

"The inoculation effect was consistent across liberals and conservatives. It worked for people with different levels of education, and different personality types. This is the basis of a general inoculation against misinformation."

Google -- YouTube's parent company -- is already harnessing the findings. At the end of August, Jigsaw will roll out a prebunking campaign across several platforms in Poland, Slovakia, and the Czech Republic to get ahead of emerging disinformation relating to Ukrainian refugees. The campaign is designed to build resilience to harmful anti-refugee narratives, in partnership with local NGOs, fact checkers, academics, and disinformation experts.

"Harmful misinformation takes many forms, but the manipulative tactics and narratives are often repeated and can therefore be predicted," said Beth Goldberg, co-author and Head of Research and Development for Google's Jigsaw unit.

"Teaching people about techniques like ad-hominem attacks that set out to manipulate them can help build resilience to believing and spreading misinformation in the future.

"We've shown that video ads as a delivery method of prebunking messages can be used to reach millions of people, potentially before harmful narratives take hold," Goldberg said.

The team argue that pre-bunking may be more effective at fighting the misinformation deluge than fact-checking each untruth after it spreads -- the classic 'debunk' -- which is impossible to do at scale, and can entrench conspiracy theories by feeling like personal attacks to those who believe them.

"Propaganda, lies and misdirections are nearly always created from the same playbook," said co-author Prof Stephan Lewandowsky from the University of Bristol. "We developed the videos by analysing the rhetoric of demagogues, who deal in scapegoating and false dichotomies."

"Fact-checkers can only rebut a fraction of the falsehoods circulating online. We need to teach people to recognise the misinformation playbook, so they understand when they are being misled."

Six initial controlled experiments featured 6,464 participants, with the sixth experiment conducted a year after the first five to ensure earlier findings could be replicated.

Data collection for each participant was comprehensive, from basic information -- gender, age, education, political leanings -- to levels of numeracy, conspiratorial thinking, news and social media checking, "bullshit receptivity," and a personality inventory, among other "variables."

Factoring all this in, the team found that inoculation videos improved people's ability to spot misinformation, and boosted their confidence in being able to do so again. The clips also improve the quality of "sharing decisions": whether or not to spread damaging content.

Two of the animations were then tested "in the wild" as part of a vast experiment on YouTube, with clips positioned in the pre-video advert slot that provides an option to skip after five seconds.

Google Jigsaw exposed around 5.4 million US YouTubers to an inoculation video, with almost a million watching for at least 30 seconds. The platform then gave a random 30% of users that watched a voluntary test question within 24 hours of their initial viewing.

The clips aimed to inoculate against misinformation tactics of hyper-emotive language and use of false dichotomies, and the questions -- based on fictional posts -- tested for detection of these tropes. YouTube also gave a "control" group of users who had not viewed a video the same test question. In total, 22,632 users answered a question.

Despite the intense "noise" and distractions on YouTube, ability to recognise manipulation techniques at the heart of misinformation increased by 5% on average.

Google say the unprecedented nature of the experiment means there is no direct data comparison available. However, increases in brand awareness from advertising on YouTube -- known as "brand lift" -- are typically limited to 1% in surveys of under 45,000 users.

"Users participated in tests around 18 hours on average after watching the videos, so the inoculation appears to have stuck," said van der Linden.

Researchers say that such a recognition increase could be game changing if dramatically scaled up across social platforms -- something that would be cheap to do. The average cost for each view of significant length was the tiny sum of US$0.05.

Added Roozenbeek: "If anyone wants to pay for a YouTube campaign that measurably reduces susceptibility to misinformation across millions of users, they can do so, and at a miniscule cost per view."


Story Source:

Materials provided by University of Cambridge. Original written by Fred Lewsey. Note: Content may be edited for style and length.


Journal Reference:

  1. Jon Roozenbeek, Sander van der Linden, Beth Goldberg, Steve Rathje, Stephan Lewandowsky. Psychological inoculation improves resilience against misinformation on social mediaScience Advances, 2022; 8 (34) DOI: 10.1126/sciadv.abo6254

Bacteria powered biofilm could produce long-term, continuous electricity from sweat

 Researchers at the University of Massachusetts Amherst recently announced that they have figured out how to engineer a biofilm that harvests the energy in evaporation and converts it to electricity. This biofilm, which was announced in Nature Communications, has the potential to revolutionize the world of wearable electronics, powering everything from personal medical sensors to personal electronics.

"This is a very exciting technology," says Xiaomeng Liu, graduate student in electrical and computer engineering in UMass Amherst's College of Engineering and the paper's lead author. "It is real green energy, and unlike other so-called 'green-energy' sources, its production is totally green."

That's because this biofilm -- a thin sheet of bacterial cells about the thickness of a sheet of paper -- is produced naturally by an engineered version of the bacteria Geobacter sulfurreducensG. sulfurreducens is known to produce electricity and has been used previously in "microbial batteries" to power electrical devices. But such batteries require that G. sulfurreducens is properly cared for and fed a constant diet. By contrast, this new biofilm, which can supply as much, if not more, energy than a comparably sized battery, works, and works continuously, because it is dead. And because it's dead, it doesn't need to be fed.

"It's much more efficient," says Derek Lovley, Distinguished Professor of Microbiology at UMass Amherst and one of the paper's senior authors. "We've simplified the process of generating electricity by radically cutting back on the amount of processing needed. We sustainably grow the cells in a biofilm, and then use that agglomeration of cells. This cuts the energy inputs, makes everything simpler and widens the potential applications."

The secret behind this new biofilm is that it makes energy from the moisture on your skin. Though we daily read stories about solar power, at least 50% of the solar energy reaching the earth goes toward evaporating water. "This is a huge, untapped source of energy," says Jun Yao, professor of electrical and computer engineering at UMass, and the paper's other senior author. Since the surface of our skin is constantly moist with sweat, the biofilm can "plug-in" and convert the energy locked in evaporation into enough energy to power small devices.

"The limiting factor of wearable electronics," says Yao, "has always been the power supply. Batteries run down and have to be changed or charged. They are also bulky, heavy, and uncomfortable." But a clear, small, thin flexible biofilm that produces a continuous and steady supply of electricity and which can be worn, like a Band-Aid, as a patch applied directly to the skin, solves all these problems.

What makes this all work is that G. sulfurreducens grows in colonies that look like thin mats, and each of the individual microbes connects to its neighbors through a series of natural nanowires. The team then harvests these mats and uses a laser to etch small circuits into the films. Once the films are etched, they're sandwiched between electrodes and finally sealed in a soft, sticky, breathable polymer that you can apply directly to your skin. Once this tiny battery is "plugged in" by applying it to your body, it can power small devices.

"Our next step is to increase the size of our films to power more sophisticated skin-wearable electronics," says Yao, and Liu points out that one of the goals is to power entire electronic systems, rather than single devices.

This research was nurtured by the Institute for Applied Life Sciences (IALS) at UMass Amherst, which combines deep and interdisciplinary expertise from 29 departments to translate fundamental research into innovations that benefit human health and well-being.


Story Source:

Materials provided by University of Massachusetts AmherstNote: Content may be edited for style and length.


Journal Reference:

  1. Xiaomeng Liu, Toshiyuki Ueki, Hongyan Gao, Trevor L. Woodard, Kelly P. Nevin, Tianda Fu, Shuai Fu, Lu Sun, Derek R. Lovley, Jun Yao. Microbial biofilms for electricity generation from water evaporation and power to wearablesNature Communications, 2022; 13 (1) DOI: 10.1038/s41467-022-32105-6