San Diego zoo global biobanking advances wildlife conservation and human medicine worldwide

In a study that has unprecedented implications to advance both medicine and biodiversity conservation, researchers have sequenced 131 new placental mammal genomes, bringing the worldwide total to more than 250

SAN DIEGO ZOO GLOBAL

Research News

 

In a study that has unprecedented implications to advance both medicine and biodiversity conservation, researchers have sequenced 131 new placental mammal genomes, bringing the worldwide total to more than 250.

The results of the mammal genome project, published in the Nov. 12 issue of the journal Nature, catalog and characterize whole branches of Earth's biodiversity, spanning approximately 110 million years of mammal evolution--the largest and most diverse mammalian comparative genomics project to date. Oliver Ryder, Ph.D., Kleberg endowed director of Conservation Genetics at the San Diego Zoo Institute for Conservation Research, is one of the project's co-authors. He says that while the genetic material biobanked in San Diego Zoo Global's Frozen Zoo® has benefited his organization's conservation efforts, "Little did we know how broadly it would impact humankind."

While museum specimens were found to be mostly inadequate--because the most powerful sequencing technologies require large amounts of DNA and intact cells--San Diego Zoo Global's biobank contains 10,000 living cell cultures representing nearly 1,200 taxa, including more than 310 species classified as vulnerable, endangered, critically endangered or extinct.

Ryder compares the genome project to the invention of the microscope. "Before the microscope, we couldn't see what was going on inside of a cell. Now, we're viewing life from an entirely new perspective. DNA carries instructions, and now we're able to read those."

The study identifies genetic innovations that seem to protect certain animals from diseases like cancer and diabetes. It also pinpoints genomic elements that have remained unchanged across millions of years of evolution, which predict where mutations are likely to be associated with risk of disease, and could reveal new avenues of therapeutic development.

Important new findings for conservation have emerged for species conservation, too. "Genome sequences for endangered species can help identify a species' extinction risks and steer conservation efforts," says Megan Owen, Ph.D., corporate director of wildlife conservation science at San Diego Zoo Global. "They also give wildlife officials tools to apprehend poachers and wildlife traffickers." For this study, researchers prioritized endangered species like the Russian saiga, the black rhinoceros, the Pacific pocket mouse and the Peninsular bighorn sheep, among other species.

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The study, authored by 71 collaborating scientists across the United States and the European Union, was funded by the National Human Genome Research Institute and National Institutes of Health. Published in the Nov. 12 issue of Nature, the study catalogs and characterizes whole branches of Earth's biodiversity, spanning approximately 110 million years of mammal evolution--the largest and most diverse mammalian comparative genomics project to date. Other San Diego Zoo Global researchers who co-authored the project include Cynthia Steiner, Ph.D., associate director of Conservation Genetics; Marlys Houck, curator of the Frozen Zoo®, Biodiversity Banking; and researcher Leona G. Chemnick, retired. It is anticipated that the data from this project will be utilized in a variety of ways for years to come. Data are available for download at ncbi.nlm.nih.gov/assembly/, with no restrictions on their use in research or publications.

As a leader in conservation, the work of San Diego Zoo Global includes on-site wildlife conservation efforts (representing both plants and animals) at the San Diego Zoo, San Diego Zoo Safari Park, and San Diego Zoo Institute for Conservation Research, as well as international field programs on six continents. The work of these entities is made accessible to over 1 billion people annually, reaching 150 countries via social media, our websites and the San Diego Zoo Kids network, in children's hospitals in 12 countries. The work of San Diego Zoo Global is made possible with support from our incredible donors committed to saving species from the brink of extinction.

 

Landslide along Alaskan fjord could trigger tsunami

Glacier melt is exposing a slope that could crash into the water, study shows

OHIO STATE UNIVERSITY

Research News

 

A glacier that had held an Alaskan slope in place for centuries is melting, releasing the soil beneath in what can be described as a slow-motion landslide, researchers say. But there's also the possibility of a real landslide that could cause a devastating tsunami.

In a study published last week, scientists noted that the slope on Barry Arm fjord on Prince William Sound in southeastern Alaska slid some 120 meters from 2010 to 2017. These are some of the first measurements to quantify how the slope is falling there.

"We are measuring this loss of land before the tsunami occurs," said Chunli Dai, lead author of the paper and a research scientist at The Ohio State University's Byrd Polar and Climate Research Center.

The study was published in Geophysical Research Letters.

Landslides on slopes near glaciers generally occur when glacial ice melts, a phenomenon occurring more rapidly around the world because of climate change. Landslides can prompt tsunamis by sending massive amounts of dirt and rocks into nearby bodies of water. Such a landslide happened in 2017 in western Greenland, prompting a tsunami that killed four people.

Scientists estimate that a landslide at Barry Arm fjord could be about eight times larger than that Greenland landslide.

If the entire slope collapsed at once, the researchers found, tsunami waves could reach communities throughout the sound, which are home to hundreds of people and visitors, including fishermen, tourists and members of an indigenous Alaskan group called the Chugach.

For this study, researchers used satellite data to measure and monitor the size of the glacier that had covered the Barry Arm slope, and to measure the amount of land that had already been displaced, which is found to be directly linked to Barry Arm glacier's melting. Then, they built models to identify the potential landslide risk.

The data showed that, from 1954 to 2006, Barry Glacier thinned by less than a meter per year. But after 2006, the melt rapidly increased, so that the glacier was thinning by about 40 meters per year. The glacier retreated rapidly from 2010 to 2017, the researchers found. The land's "toe" -- the bottom point of the falling slope -- had butted against the glacier in 2010. By 2017, that toe was exposed, and butted up against the water in Prince William Sound.

The researchers modeled potential tsunami scenarios, and found that, if the land along that slope collapsed at once, the resulting tsunami would send currents between 25 and 40 meters per second -- enough to cause significant damage to large cruise and cargo ships and fishing boats, as well as overwhelming kayakers, all of which frequent Prince William Sound.

Waves could reach 10 meters in the nearby town of Whittier. The tsunami could disrupt fiber optic service to parts of Alaska, the researchers noted -- two of the five submarine fiber optic lines to Alaska run below Prince William Sound. And oil from the 1989 Exxon Valdez oil spill still lingers in sediment in Prince William Sound, meaning it is possible that a tsunami could send that oil back into the environment.

"If the slope fails at once, it would be catastrophic," said Dr. Bretwood Higman, a geologist with Ground Truth Alaska and co-author of the study.

When and if that massive landslide occurs depends on geology, climate and luck. An earthquake, prolonged rains, thawing permafrost or snowmelt could trigger one, the researchers said. (A 2018 earthquake in Alaska did not trigger a landslide, the researchers noted.)

"People are working on early-detection warnings, so if a landslide happens, people in nearby communities might at least get a warning," said Anna Liljedahl, an Alaska-based hydrologist with Woodwell Climate Research Center, and another co-author. "This kind of research might help with building those early-warning systems."

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This research was supported by NASA and the National Science Foundation.

CONTACT: Chunli Dai, dai.56@osu.edu

Written by: Laura Arenschield, arenschield.2@osu.edu

 

Vaping may increase respiratory disease risk by more than 40%: BU study

BOSTON UNIVERSITY SCHOOL OF MEDICINE

Research News

 

A growing body of evidence points to the health risks of using e-cigarettes (or "vaping"). But because e-cigarettes are marketed as a less harmful alternative to traditional cigarettes, it has been difficult to tell whether the association between vaping and disease is just a matter of smokers switching to vaping when they start experiencing health issues.

Now, a study by researchers from the Boston University School of Public Health (BUSPH) and School of Medicine (BUSM) is one of the first to look at vaping in a large, healthy sample of the population over time, independently from other tobacco product use.

Published in JAMA Network Open, the study found that participants who had used e-cigarettes in the past were 21% more likely to develop a respiratory disease, and those who were current e-cigarette users had a 43% increased risk.

"This provides some of the very first longitudinal evidence on the harms associated with e-cigarette products," says corresponding author Dr. Andrew Stokes, assistant professor of global health at BUSPH.

"In recent years we have seen dramatic increase in e-cigarette use among youth and young adults which threatens to reverse decades of hard-fought gains," Stokes says. "This new evidence also suggests that we may see an increase in respiratory disease as youth and young adults age into midlife, including asthma, COPD, and other respiratory conditions."

Most previous research on the respiratory health effects of vaping have used animal or cell models, or, in humans, only short-term clinical studies of acute conditions.

For this study, the researchers used data on 21,618 healthy adult participants from the first four waves (2013-2018) of the nationally-representative Population Assessment of Tobacco and Health (PATH), which is the most comprehensive national survey of tobacco and e-cigarette-related information to date.

To make sure they weren't simply seeing cigarette smokers switching to e-cigarettes specifically because of health issues (rather than vaping itself causing these issues), the researchers only included people with no reported respiratory issues when they entered PATH, and adjusted for a comprehensive set of health conditions. They also adjusted for having ever used other tobacco products (including cigarettes, cigars, hookah, snus, and dissolvable tobacco) and for marijuana use, as well as childhood and current secondhand smoking exposure. They repeated the analyses among subgroups of healthy respondents who had no self-reported chronic conditions, and whose self-rated overall health was good, great, or excellent.

Adjusting for all of these variables and for demographic factors, the researchers found that former e-cigarette use was associated with a 21% increase in the risk of respiratory disease, while current e-cigarette use was associated with a 43% increase. Current e-cigarette use was associated with a 33% increase in chronic bronchitis risk, 69% increase in emphysema risk, 57% increase in chronic obstructive pulmonary disease (COPD) risk, and 31% percent increase in asthma risk.

"With a longitudinal study design and extensive sensitivity analyses, the study adds to a growing body of evidence indicating long-term health risks of e-cigarette use to the respiratory system," says study lead author Wubin Xie, a postdoctoral associate in the Department of Global Health at BUSPH.

Evidence of the health effects of vaping, from this and other studies, also "highlight the importance of standardizing documentation of e-cigarette product use in electronic health records, and pushing the CDC to develop International Classification of Diseases codes for e-cigarette product use, so that providers can facilitate cessation discussions and identify adverse events related to e-cigarette use," says study co-author Dr. Hasmeena Kathuria, associate professor of pulmonary medicine and a member of the Pulmonary Center at BUSM.

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About the Boston University School of Public Health

Founded in 1976, the Boston University School of Public Health is one of the top five ranked private schools of public health in the world. It offers master's- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations--especially the disadvantaged, underserved, and vulnerable--locally and globally.

 

Age gates on alcohol websites are ineffective, Texas A&M research shows

Yes/no questions and indefinite attempts to enter a legal date of birth are "inconsequential barriers" to underage users, an alcohol researcher says

SAME GOES FOR OTHER ADULT SITES USING AGE GATES

TEXAS A&M UNIVERSITY

Research News

 

IMAGE: AGE GATES ON ALCOHOL WEBSITES OFTEN ASK USERS TO CLICK A YES/NO BOX OR ENTER A DATE OF BIRTH THAT IS OF LEGAL DRINKING AGE BEFORE ALLOWING ACCESS. view more 

CREDIT: COLLEGE OF EDUCATION & HUMAN DEVELOPMENT AT TEXAS A&M UNIVERSITY

"Age gates" that aim to keep underage users off alcohol websites are mostly ineffective, a Texas A&M University alcohol researcher found.

"Alcohol brand age gates are weak, at best, and likely an inconsequential barrier that someone with limited math abilities can easily overcome," said Adam Barry, a professor in the Department of Health and Kinesiology.

Age gates are virtual barriers intended to prevent people of ceratin age groups from accessing a website. Alcohol brand sites employ them to ensure the user attempting entry is of legal drinking age. Users are typically asked if they are 21 years of age or older, or asked to enter their birth date.

Barry's research, which was recently published in Alcohol or Alcoholism, assessed the effectiveness of the digital age gates of the top alcohol brands among American adolescents. The study found that for the vast majority of the sites, users could gain access after continuously entering dates of birth until eventually providing one indicating they were older than 21. Many sites also had no process for verifing the accuracy of the provided date of birth.

Barry is a health behavior social scientist with training and expertise in alcohol use, alcohol-induced impairment and intoxication. He said exposure to alcohol advertising can alter an adolescent's views, perceptions and expectations on alcohol consumption.

"Exposure to alcohol advertising has been linked to underage alcohol-related behaviors and intentions to consume alcohol," Barry said.

Barry's research examined alcohol webpages, but he also found that alcohol advertising on social media platforms is problematic. He said it's important to ensure that young people are not marketed to, don't interact with inappropriate content and don't fall prey to predators. However, this is often not the case.

"Unfortunately, the current strategies employed, such as asking for a birthdate, feel more like industry is concerned about their liability, as opposed to the welfare of users," Barry said.

He hopes to raise awareness of the lack of regulation in alcohol marketing. Brands themselves control the "safety measures" in place, rather than a larger entity.

"Currently, there is no formal legislation in the United States prohibiting alcohol advertisements that appeal to adolescents, the placement of alcohol advertising or how the age affirmation process and outcomes should be implemented," Barry said.

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Soccer players' head injury risk could be reduced with simple adjustments to the ball

PURDUE UNIVERSITY

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Volume 90%

 

VIDEO: THE AVERAGE SOCCER PLAYER HEADS THE BALL 12 TIMES IN A GAME, AND EACH HEADER CARRIES UP TO 100G ACCELERATION, ENOUGH TO CAUSE SERIOUS BRAIN DAMAGE. A PURDUE STUDY LED... view more 

CREDIT: PURDUE UNIVERSITY/JARED PIKE

WEST LAFAYETTE, Ind. -- Up to 22% of soccer injuries are concussions that can result from players using their heads to direct the ball during a game.

To reduce risk of injury, a new study recommends preventing how hard a ball hits the head by inflating balls to lower pressures and subbing them out when they get wet.

The study, conducted by Purdue University engineers, found that inflating balls to pressures on the lower end of ranges enforced by soccer governing bodies such as the NCAA and FIFA could reduce forces associated with potential head injury by about 20%.

But if the ball gets too wet, it can quickly surpass the NCAA weight limit for game play and still produce a nasty impact, the researchers said.

"If the ball has too high of a pressure, gets too waterlogged, or both, it actually turns into a weapon. Heading that ball is like heading a brick," said Eric Nauman, a Purdue professor of mechanical engineering and basic medical sciences with a courtesy appointment in biomedical engineering.

Soccer governing bodies already regulate ball pressure, size, mass and water absorption at the start of a game, but Nauman's lab is the first to conduct a study evaluating the effects of each of these ball parameters on producing an impact associated with potential neurophysiological changes.

The results are published in the journal PLOS One. The researchers discuss the work in a video on YouTube at https://youtu.be/3b_19wW7K6A.

The study also evaluated ball velocity, finding that this variable actually contributes the most to how hard a ball hits. But ball pressure and water absorption would be more realistic to control.

"You can't control how hard a player kicks a ball. There are other ways to decrease those forces and still have a playable game," Nauman said.

A professional soccer player heads the ball about 12 times over the course of a single game and 800 times in games over an entire season, past studies have shown.

The lower end of NCAA and FIFA pressure ranges, which the researchers discovered could help reduce the ball's peak impact force, already aligns with pressures specified by the manufacturer on the ball. These specifications would provide an easy way to know if a pressure is low enough to reduce risk of head injury.

"The study really sheds light on the issue of how the weight and impact of the ball can change under different conditions. Sports governing bodies and manufacturers can use this research to further reduce the risk of lasting brain functional or structural injury as a result of head impacts accrued through soccer game play," said Francis Shen, a professor of law at the University of Minnesota whose research focuses on the intersection of sports concussions and the legal system.

Nauman and Shen met through the Big Ten-Ivy League Traumatic Brain Injury Collaboration, a multi-institutional research effort to better understand the causes and effects of sport-related concussion and head injuries.

In this study, Nauman's lab tested three soccer ball sizes - a 4, 4.5 and a 5 - by kicking them against a force plate in a lab. Even though only size 5 balls are played by professional adults, the researchers also observed the smaller 4 and 4.5 sizes played by kids under the age of 12 to evaluate how much the size of a ball contributes to peak impact force.

The study included 50 trials for each ball size at four different pressures, ranging from 4 psi to 16 psi. This range includes pressures below standard manufacturing specifications and near the limit of soccer governing body regulations.

Purdue graduate student Nicolas Leiva-Molano did 200 kicks per ball size for a total of 600 kicks.

To test water absorption, the researchers submerged each ball size for 90 minutes - the duration of a game regulated by soccer governing bodies. They weighed and rotated each ball every 15 minutes.

Within the first 15 minutes, a size 5 soccer ball had already exceeded the allowable weight gain cited in NCAA soccer rules.

Based on this study's findings, a size 4.5 soccer ball is the safest to play in terms of forces contributed by pressure, mass and water absorption. But reducing pressure and limiting water absorption made a difference for all three ball sizes.

"This was a very simple experiment. But there just hasn't been much data out there on these issues, and that's a huge problem," Nauman said.

The next step would be to replicate this experiment outside of the lab, ideally in partnership with a high school or college athletic conference, which would allow the researchers to study the effects of ball hits at different parameters before and after a season.

"There are lots of examples in sports where organizations have changed the rules to make the game safer. This new study suggests a simple way to further those efforts for safer equipment and game play," Shen said.

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ABSTRACT

Factors affecting peak impact force during soccer headers and implications for the mitigation of head injuries

Joshua Auger, Justin Markel, Dimitri D. Pecoski, Nicolas Leiva-Molano, Thomas M. Talavage, Larry Leverenz, Francis Shen, Eric A. Nauman

DOI: 10.1371/journal.pone.0240162

It has been documented that up to 22% of all soccer injuries are concussions. This is in part due to players purposely using their head to direct the ball during play. To provide a more complete understanding of head trauma in soccer athletes, this study characterized the effects of four soccer ball characteristics (size, inflation pressure, mass, velocity) on the resulting peak impact force as it relates to the potential for incurring neurophysiological changes. A total of six hundred trials were performed on size 4 and 5 soccer balls as well as a novel lightweight soccer ball. Impact force was measured with a force plate and ball velocity was determined using motion capture. These data were used, in conjunction with dimensional analysis to relate impact force to ball size, mass, velocity, and pressure. Reasonable reductions in allowable ball parameters resulted in a 19.7% decrease in peak impact force. Adjustments to ball parameters could reduce a high cumulative peak translational acceleration soccer athlete down into a previously defined safer low loading range. In addition, it was noted that water absorption by soccer balls can result in masses that substantially increase impact force and quickly surpass the NCAA weight limit for game play. Additional research is required to determine whether varying soccer ball characteristics will enable soccer players to avoid persistent neurophysiological deficits or what additional interventions may be necessary and the legal implications of these data are discussed.

Repeated small blasts put military, law enforcement at risk for brain injury

UVA-led study examined specialists who use explosives to enter buildings

UNIVERSITY OF VIRGINIA HEALTH SYSTEM

Research News

 

IMAGE: UVA SCHOOL OF MEDICINE RESEARCHER JAMES STONE, MD, PHD, IS HELPING DEVELOP A MODEL PREDICTING HOW REGULAR EXPOSURE TO ARTILLERY BLASTS AFFECTS THE BRAINS OF MILITARY PERSONNEL. view more 

CREDIT: UVA HEALTH

Military and law-enforcement personnel repeatedly exposed to low-level blasts have significant brain changes - including an increased level of brain injury and inflammation - compared with a control group, a new study has found.

Led by University of Virginia School of Medicine researcher James Stone, MD, PhD, the study compared the brains of 20 "breachers" - specialists who use explosives to enter buildings and other structures - with a 14-person, age-matched control group. The breachers had been exposed to an average of 4,628 blasts, while the control group had been exposed to an average of three.

Blood measurements and neuropsychological assessments suggest that the breachers have increased levels of brain injury and inflammation, which the researchers wrote is "consistent with the theory that exposure to breaching-related blasts leads to system-wide effects in the brain."

The study also found that the breachers had statistically significant differences in blood flow, brain structure and brain activity.

"This study is the first to comprehensively assess military and law enforcement personnel to better understand whether repetitive blast exposure over a career can lead to changes within the brain," Stone said. "This is an area of high importance to military and law enforcement communities, as it is becoming increasingly clear there may be occupational health considerations related to repetitive low-level blast exposure in training and operations over the career of an exposed individual."

Investigating Brain Injury

The researchers wrote that further studies will be needed to determine more precisely what level and frequency of blast exposure may result in the observed brain changes.

Stone and his colleagues have two additional studies underway to further examine the effects of blasts on the brains of military personnel. The first - backed by a three-year, $2.1 million grant from the U.S. Department of Defense - is researching the effects of regular exposure to artillery blasts. The second is examining whether special operations forces are at risk for brain injury over their career.

"These additional studies will allow us to better understand whether the observations made in breachers are also seen in other blast-exposed populations, such as those that operate heavy weapons," Stone said. "We also hope to be able to shed light on how the brain responds to repetitive blasts on a molecular level."

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Findings Published

The researchers published their findings in the Journal of Neurotrauma. The UVA research team included Stone, Brian B. Avants, Nicholas J. Tustison, Meghan O'Brien and Natalie Domeisen. They were joined by colleagues from the National Institute of Neurological Disorders and Stroke, National Institute of Nursing Research, University of Florida, Pennsylvania State University, Oak Ridge Institute for Science and Education, Uniformed Services University, Walter Reed Army Institute of Research, the Department of Defense Joint Artificial Intelligence Center, University of Glasgow and the Naval Medical Research Center.

The work was supported by Joint Program Committee-5 Development of Exposure Standards to Repeated Blast Exposure program, work unit 603115HP-3730-001-A1118; Office of Naval Research (ONR) award N00014-18-1-2440, with supplemental funding to the ONR award provided by Cohen Veterans Bioscience; imaging resources from the Center for Neuroscience and Re-generative Medicine; the Clinical Neurosciences Program of the National Institute of Neurological Disorders and Stroke, project 1ZIANS002977-21; and the Research Participation Program at the Walter Reed Army Institute of Research.

 

On the way to lifelike robots

PAI: Physical Artificial Intelligence

SWISS FEDERAL LABORATORIES FOR MATERIALS SCIENCE AND TECHNOLOGY (EMPA)

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IMAGE: ROBOTICS RESEARCHER MIRKO KOVAC WANTS TO MERGE MACHINES WITH THE INTELLIGENCE OF LIFE. view more 

CREDIT: IMAGE: ROBERT STÜRMER / EMPA

Artificial intelligence is supposed to make machines perform at ever more amazing levels. A robot that can do little more than a remote-controlled model car has a limited range of applications. But from an automatic machine to an autonomous robot, it is a big, almost revolutionary step. Robotics researchers Mirko Kovac and Aslan Miriyev, who both work at Empa's "Materials and Technology Center of Robotics" in Dübendorf and at the "Aerial Robotics Lab" of Imperial College London, are convinced that one decisive component can make this evolutionary step possible: Physical artificial intelligence, PAI for short. Only when the artificial intelligence of a digital "brain" is merged with an intelligent body could new types of robots be created that have properties comparable to those of intelligent living organisms. They have now published their concept in the latest issue of the renowned scientific journal Nature Machine Intelligence.

Thinking outside the box

In order to develop fully autonomous, intelligent robot systems, researchers must recognize and utilize the synergies of different disciplines, such as materials science, biology, mechanical engineering, chemistry and computer science, according to the Empa scientists. "We imagine that PAI robots will only become reality through the use of a variety of unconventional materials and by combining research methods from various disciplines," says Mirko Kovac. To do this, researchers would need a much broader range of skills than is usually seen in conventional robotics. Interdisciplinary cooperation, partnerships and an adaptation of the curriculum for young researchers are therefore called for. "Working in a multidisciplinary environment requires courage and constant learning. Researchers must leave their comfort zones and think beyond the boundaries of their own field".

Symbiosis of man and machine

The Empa researchers want to promote the vision of a society in which people are "living" together seamlessly with machines. "This symbiosis can only be achieved if safe interaction is possible and if the machines have true, Physical AI, allowing them to live like benevolent animals together with nature and people," says Kovac. The researchers now hope that their work will encourage active discussion of the topic.

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Exoskeleton-assisted walking improves mobility in individuals with spinal cord injury

Multi-center U.S. trial shows exoskeleton training is safe, feasible, and effective across wide spectrum of individuals with mobility deficits caused by traumatic spinal cord injury

KESSLER FOUNDATION

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IMAGE: FOR THIS STUDY, TWO TYPES OF EXOSKELETONS WERE USED BY PARTICIPANTS WITH SPINAL CORD INJURY - EKSO GT, SHOWN HERE, AND REWALK. view more 

CREDIT: KESSLER FOUNDATION

East Hanover, NJ. November 12, 2020.
Exoskeletal-assisted walking is safe, feasible, and effective in individuals disabled by spinal cord injury, according to the results of a federally funded multi-site randomized clinical trial. The article, "Mobility skills with exoskeletal-assisted walking in persons with SCI: Results from a three-center randomized clinical trial" (doi: 10.3389/frobt.2020.00093), was published August 4, 2020 in Frontiers in Robotics and AI. It is available open access at https://www.frontiersin.org/articles/10.3389/frobt.2020.00093/full

The authors are Eun-Kyoung Hong, Pierre Asselin, MS, Steven Knezevic, Stephen Kornfeld, DO, and Ann M. Spungen, EdD, of the James J. Peters VA Medical Center, Gail Forrest, PhD, of Kessler Foundation, Peter Gorman, MD, and William Scott, PhD, of the University of Maryland School of Medicine, and Sandra Wojciehowski, PT, of Craig Hospital and Kessler Foundation. The study was conducted at three sites: James J. Peters VA Medical Center, Bronx, NY; Kessler Foundation, West Orange, NJ; and the University of Maryland.

Study investigators sought to establish guidelines for clinical exoskeletal-assisted walking programs for individuals with spinal cord injury. Their goal was to determine the number of exoskeleton training sessions needed by individuals with varied mobility deficits to gain adequate exoskeletal assisted walking skills and attain velocity milestones. Two powered exoskeletons were used in the study: the Ekso GT (Ekso Bionics), and ReWalk (ReWalk Robotics).

The 50 participants included individuals with tetraplegia and paraplegia, both motor complete and incomplete. In this randomized control trial, their performance was measured over a total of 36 sessions. Participants were randomized to Group 1 (exo-assisted walking) or Group 2 (usual activity) for 12 weeks; each group crossed over to the other study arm. After 12, 24, and 36 sessions, their progress was measured by the 10-meter walk test seconds (s) (10MWT), 6-min walk test meters (m) (6MWT), and the Timed-Up-and-Go (s) (TUG).

The majority of participants mastered the ability to ambulate effectively with the assistance of the exoskeleton, according to Dr. Forrest, director of the Tim and Caroline Reynolds Center for Spinal Stimulation, and associate director of the Center for Mobility and Rehabilitation Engineering Research at Kessler Foundation. After 12 sessions, 31 (62%), 35 (70%), and 36 (72%) participants achieved the milestones established for the 10MWT, 6MWT, and TUG, respectively. After 36 sessions, the results improved, with 40 (80%), 41 (82%), and 42 (84%) of participants meeting the criteria for the 10MWT, 6MWT, and TUG, respectively.

"Participants showed improvement regardless of level of injury, completeness, or duration of injury," noted Dr. Forrest, "indicating that exoskeletons can be used to improve mobility across a broad spectrum of individuals with neurological deficits caused by spinal cord injury. Our results can be used to guide the application of exoskeletons to spinal cord injury rehabilitation, and the timely acquisition of skills for the safe use of these devices for rehabilitation and community use."

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Funding sources:
US Department of Defense CDMRP SCI Award 30234 (W81XWH-14-2-0170); National Center for the Medical Consequences of SCI (B9212-C, B2020-C); James Lawrence Kernan Endowment Fund; Bronx Veterans Medical Research Foundation

About Kessler Foundation

Kessler Foundation, a major nonprofit organization in the field of disability, is a global leader in rehabilitation research that seeks to improve cognition, mobility and long-term outcomes, including employment, for people with neurological disabilities caused by diseases and injuries of the brain and spinal cord. Kessler Foundation leads the nation in funding innovative programs that expand opportunities for employment for people with disabilities. For more information, visit KesslerFoundation.org.

 

Racial disparities in pediatric diabetes treatment

UNIVERSITY OF PENNSYLVANIA SCHOOL OF NURSING

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IMAGE: TERRI H. LIPMAN, PHD, CRNP, FAAN, MIRIAM STIRL ENDOWED TERM PROFESSOR OF NUTRITION, PROFESSOR OF NURSING OF CHILDREN AND ASSISTANT DEAN FOR COMMUNITY ENGAGEMENT AT PENN NURSING. view more 

CREDIT: PENN NURSING

PHILADELPHIA (November 12, 2020) - Type 1 diabetes (T1D) is the third most common pediatric chronic disease in the United States, and the risk of the disease has risen sharply in non-Hispanic Black (NHB) children in the last 20 years, data show. Ironically, the significant advances in T1D therapeutics over recent years, especially new technologies, may have exacerbated racial disparities in diabetes treatment and outcomes.

In an article in the journal Pediatric Diabetes, researchers from the University of Pennsylvania School of Nursing (Penn Nursing) and the Children's Hospital of Philadelphia detail their retrospective study of more than 2,800 children with T1D. Their findings have helped quantify racial and ethnic disparities in health care use, technology application, and outcomes in pediatric diabetes treatment.

"Disparities in these treatments are of clinical significance, as both intensive insulin therapy and the incorporation of technology have been associated with improved glycemic control and, consequently, reduced long-term complications," writes Terri H. Lipman, PhD, CRNP, FAAN, Miriam Stirl Endowed Term Professor of Nutrition, Professor of Nursing of Children and Assistant Dean for Community Engagement at Penn Nursing.

The article, "Racial Disparities in Treatment and Outcomes of Children With Type 1 Diabetes," details how treatment modalities, clinical outcomes, and appointment attendance in NHB versus non-Hispanic white and Hispanic children with T1D were examined while including the contribution of insurance status (as a proxy for socioeconomic status) to these disparities. Despite similar outpatient appointment attendance rates, significant disparities in continuous glucose monitoring and insulin pump use were observed.

"Disparities in health care cannot be eliminated without a societal effort to address structural racism. The underlying etiologies of health care disparities, including the impact of patient and provider bias, should be fully investigated and strategies developed to mitigate these contributing factors," concludes Lipman.

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The article is available online. Co-authors of the article include Jennifer A. Smith, Oona Patil, Steven M. Willi, and Colin P. Hawkins, all of the Children's Hospital of Philadelphia.

About the University of Pennsylvania School of Nursing

The University of Pennsylvania School of Nursing is one of the world's leading schools of nursing. For the fifth year in a row, it is ranked the #1 nursing school in the world by QS University and is consistently ranked highly in the U.S. News & World Report annual list of best graduate schools. Penn Nursing is currently ranked # 1 in funding from the National Institutes of Health, among other schools of nursing, for the third consecutive year. Penn Nursing prepares nurse scientists and nurse leaders to meet the health needs of a global society through innovation in research, education, and practice. Follow Penn Nursing on: Facebook, Twitter, LinkedIn, & Instagram.