Full evolutionary journey of hospital superbug mapped for the first time

WELLCOME TRUST SANGER INSTITUTE

Research News

 

Modern hospitals and antibiotic treatment alone did not create all the antibiotic resistant strains of bacteria we see today. Instead, selection pressures from before widespread use of antibiotics influenced some of them to develop, new research has discovered.

By using analytical and sequencing technology that has only been developed in recent years, scientists from Wellcome Sanger Institute, University of Oslo and University of Cambridge have created an evolutionary timeline of the bacterium, Enterococcus faecalis, which is a common bacterium that can cause antibiotic resistant infections in hospitals.

The results, published today (9th March 2021) in Nature Communications show that this bacterium has the ability to adapt very quickly to selection pressures, such as the use of chemicals in farming as well as the development of new medications, which have caused different strains of the same bacterium to be found in many places worldwide, from the majority of people's guts to many wild birds. As it is so widespread, the researchers suggest people should be screened for this type of bacteria when entering the hospital, in the same way they are for other superbugs, to help reduce the possibility of developing and spreading infection within healthcare.

Enterococcus faecalis is a common bacterium that, in most people, is found in the intestinal tract and doesn't cause harm to the host. However, if someone is immunocompromised and this bacterium gets into the bloodstream, it can cause a serious infection.

In hospitals, it is more common to find antibiotic resistant strains of E. faecalis and it was initially thought that the wide use of antibiotics and other antibacterial control measures in modern hospitals caused these strains to develop.

In a new study, scientists from Wellcome Sanger Institute, University of Oslo and University of Cambridge analysed around 2000 samples of E. faecalis from 1936 to present day using blood stream isolates from patients and stool samples from animals and healthy humans.

By sequencing the genome (including chromosomes and plasmids) using technology from Oxford Nanopore, the team mapped the evolutionary journey of the bacterium and created a timeline of when and where different strains developed, including those nowadays found to be resistant to antibiotics. They found that antibiotic resistant strains developed earlier than previously thought, before the widespread use of antibiotics, and therefore it was not antibiotic use alone that caused these to emerge.

Researchers found that agricultural and early medical practices, such as the use of arsenic and mercury, influenced the evolution of some of the strains we see now. In addition to this, strains similar to the antibiotic resistant variants we see in hospitals now were found in wild birds. This shows how adaptable and flexible this species of bacterium is at evolving into new strains in the face of different adversity.

Professor Jukka Corander, co-lead author and Associate Faculty member at the Wellcome Sanger Institute, said: "This is the first time we have been able to map out the full evolution of E. faecalis from samples up to 85 years old, which enables us to see the detailed effect of human lifestyles, agriculture and medicines on the development of different bacterial strains. Having the full timeline of evolutionary changes would not have been possible without analytical and sequencing techniques that can be found at the Sanger Institute."

Dr Anna Pöntinen, co-lead author and post-doctoral fellow at University of Oslo, said: "Currently, when patients are admitted to hospital, they are swabbed for some antibiotic resistant bacteria and fungi and are isolated to ensure that infection rates are kept as low as possible. Thanks to this study, it is possible to scrutinize the diversity of E. faecalis and identify those that are more prone to spread within hospitals and thus could cause harm in immunocompromised people. We believe that it could be beneficial to also screen for E. faecalis on admission to hospitals."

Professor Julian Parkhill, co-author and Professor in the Department of Veterinary Medicine at University of Cambridge, said: "This research has discovered that these hospital-associated strains of antibiotic resistant bacteria are much older than we previously thought, and has highlighted their incredible metabolic flexibility combined with numerous mechanisms enhancing their survival under harsh conditions that has allowed them to spread widely across the globe."

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Contact details:

Rachael Smith
Press Office
Wellcome Sanger Institute
Cambridge, CB10 1SA

Email: press.office@sanger.ac.uk

Notes to Editors:

Publication:

Anna K. Pöntinen, Janetta Top and Sergio Arredondo-Alonso, et al.(2021) Apparent nosocomial adaptation of Enterococcus faecalis predates the modern hospital era. Nature Communications. DOI: https://doi.org/10.1038/s41467-021-21749-5

Funding:

This research was funded by the Trond Mohn Foundation, the Joint Programming Initiative in Antimicrobial Resistance, the Applied Molecular Biosciences Unit, European Research Council, and Marie Sklodowska-Curie Actions.

Selected websites:

About the University of Cambridge

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Citizen scientists help expose presence of invasive Asian bamboo longhorn beetle in Europe

PENSOFT PUBLISHERS

Research News

 

IMAGE: BAMBOO LONGHORN BEETLE (CHLOROPHORUS ANNULARIS) CAPTURED IN BRAINTREE, UNITED KINGDOM. view more 

CREDIT: STEPHEN ROLLS

A worryingly high number of Asian bamboo longhorn beetles (Chlorophorus annularis) turn out to have been emerging across Europe for about a century already, finds an international research team, headed by researchers from the Center of Natural History, University of Hamburg, Germany. Curiously, the recent records of the invasive, non-native to the Old Continent species are mostly sourced from citizen scientists and online platforms, which proves the power of involving the public in species monitoring. The study is published in the open-access, peer-reviewed scientific journal BioRisk.

In our globalised world, which has already become victim to climate change and biodiversity loss, non-native species present a further threat to our ecosystems. Thus, the rising accounts of newly recorded alien species are of serious concern to both scientists and (inter)national institutions. However, surveying non-native species remains limited to a small fraction of species: those known to be particularly invasive and harmful.

One of the multitude of non-native species that are currently lacking efficient and coordinated surveying efforts is the Asian bamboo longhorn beetle (Chlorophorus annularis). Naturally occurring in temperate and tropical Southeast Asia, the insect feeds on a variety of plants, but prefers bamboo. Thus, due to the international trade of bamboo and the insects 'travelling' with the wood, the species has continuously been expanding its distribution around the world. Its first appearance in Europe was recorded back in 1924, when it was identified in England.

Back to our days, during a fieldwork practice for students at the University of Hamburg, held within the city because of the COVID-19 travelling restrictions, the team stumbled across a longhorn beetle, later identified by scientists as the Asian bamboo borer. Furthermore, it became clear that there were even more recent records published across different citizen science platforms, such as iNaturalist, iRecord and Waarneming.nl. Having taken the contacts of the citizen scientists from there, the researchers approached them to ask for additional collection details and images, which were readily provided. As a result, the researchers formally confirmed the presence of the Asian bamboo borer in Belgium and the Netherlands. In total, they reported thirteen new introductions of the species in Europe, which translates to a 42% increase of the records of the species for the continent.

CAPTION

Bamboo longhorn beetle (Chlorophorus annulari) captured in Lincoln, United Kingdom

CREDIT

Sheena Cotter

"In light of the warming climate and a growing abundance of ornamental bamboo plants in Europe, the beetle might get permanently established. Not only could it become a garden pest, but it could also incur significant costs to the bamboo-processing industry," comments Dr Matthias Seidel, lead author of the study.

Having realised the potential of citizen science for bridging the gaps in invasive species monitoring, the researchers now propose for specialised platforms to be established with the aim to familiarise non-professional scientists with non-native species of interest and provide them with more sophisticated reporting tools. The aim is to speed up the identification of important alien species by collating records of specific species of interest, which are flagged and regularly exported from other citizen science databases and platforms.

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Original source:

Seidel M, Lüttke M, Cocquempot C, Potts K, Heeney WJ, Husemann M (2021) Citizen scientists significantly improve our knowledge on the non-native longhorn beetle Chlorophorus annularis (Fabricius, 1787) (Coleoptera, Cerambycidae) in Europe. BioRisk 16: 1-13. https://doi.org/10.3897/biorisk.

CAPTION

Emerging Asian bamboo longhorn beetle from bamboo in the Czech Republic.

CREDIT

Petr Jansa

The benefits of the Mediterranean diet pass on to the families of patients who follow it

Despite not participating in the programme, these people had lost an average of almost four kilos, two years after their family member started the programme

IMIM (HOSPITAL DEL MAR MEDICAL RESEARCH INSTITUTE)

Research News

 

People living with a patient undergoing an intensive weight loss treatment also benefit from this therapy. This has been demonstrated by a team of researchers from the Hospital del Mar Medical Research Institute (IMIM-Hospital del Mar) along with doctors from Hospital del Mar and the CIBER on the Physiopathology of Obesity and Nutrition (CIBERObn), in collaboration with IDIAPJGol, the Pere Virgili Health Research Institute (IISPV), IDIBELL, IDIBAPS and the Sant Joan de Reus University Hospital. The study has been published in the journal International Journal of Obesity.

The study analysed data from 148 family members of patients included in the weight loss and lifestyle programme PREDIMED-Plus (PREVencióDIetaMEDiterranea Plus) over a two-year period. The researchers analysed whether these people also indirectly benefited from the programme, as they were not enrolled in the study and did not receive any direct treatment. PREDIMED-Plus is a multicentre study in which a group of patients follow an intensive weight reduction programme based on the Mediterranean diet and a plan promoting physical activity.

Weight loss despite not being included in the programme

The relatives (three out of four were the patient's partner and the rest were children, parents, siblings or had some other degree of kinship), lost an average of 1.25 kg of weight during the first year of the programme, compared to the relatives of the patients in the control group (those who did not follow the intensive treatment proposed by PREDIMED-Plus). This rose to almost 4 kg in the second year. These figures were better in cases where the family member ate with the patient and, above all, when it was the patient themselves who cooked.

The treatment, aimed at achieving weight loss in people with obesity and high cardiovascular risk by following the Mediterranean diet, "Achieved effects beyond just weight loss in the patient, and this extended to their family environment", explains Dr. Albert Goday, the principal investigator on the project, head of section in the Department of Endocrinology and Nutrition at Hospital del Mar, researcher in the Cardiovascular Risk and Nutrition Research Group at the IMIM-Hospital del Mar and a CIBERobn researcher. "The effect was contagious, in this context it was, fortunately, a beneficial 'contagion', resulting in weight loss and improved dietary habits." Dr. Goday points out that "among the many possible dietary approaches to weight loss, the one based on the Mediterranean diet is the most easilt shared within a family environment."

According to Dr. Olga Castañer, the final author of the study and a researcher in the Cardiovascular Risk and Nutrition Research Group at the IMIM-Hospital del Mar and CIBERobn, the good results can be explained "By an improved diet, since the same contagious effect was not observed in terms of physical activity among the patients and their relatives."

Family members also showed increased commitment to the Mediterranean diet, according to a questionnaire assessing adherence to the dietary patterns of this regimen. But the same was not true in terms of physical activity. As Dr Castañer points out, "In addition to weight loss, there was greater adherence to the Mediterranean diet, which has intrinsic health benefits, such as protection against cardiovascular and neurodegenerative risks."

The results of the study "Demonstrate the contagion effect, the halo effect, of a treatment programme in the relatives of participants involved in an intensive weight loss procedure, as well as increased adherence to the Mediterranean diet", stresses Dr. Albert Goday. "The beneficial effect of the programme on one member of the family unit can be extended to its other members, which is extremely significant in terms of reducing the burden of obesity on the public health system", he explains. The family members not only lost weight but also improved the quality of their diet.

Effect of the programme on patients

The study also analysed the results of the PREDIMED-Plus programme in 117 patients. Compared to participants in the control group, they lost 5.10 kg in the first year of intervention rising to 6.79 kg in the second year. They also significantly increased their physical activity levels, as well as their adherence to the Mediterranean diet.

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Reference article:

Zomeño, M.D., Lassale, C., Perez-Vega, A. et al. Halo effect of a Mediterranean-lifestyle weight-loss intervention on untreated family members' weight and physical activity: a prospective study. Int J Obes (2021). https://doi.org/10.1038/s41366-021-00763-z

Majority of women can still give birth naturally if their water breaks early

UNIVERSITY OF MICHIGAN

Research News 

About 11% of women who carry to term will experience prelabor rupture of membrane--a condition where the amniotic sac breaks open early, but labor doesn't begin.

Typically, when a woman's water breaks but labor doesn't start, labor is induced. But a new University of Michigan study found that expectant management--waiting a period of time after the water breaks for labor to begin spontaneously--did not significantly increase risk to the fetus or the mother in healthy pregnancies.

Therefore, both induction and expectant management should be considered, and the decision should be made in the context of the mother's wishes and health, said study co-author Ruth Zielinski, a nurse midwife and U-M clinical professor in nursing.

The American College of Obstetricians and Gynecologists recommends induction, but in healthy pregnancies carried to term the American College of Nurse Midwives recommends expectant management be offered as an option.

During pregnancy, the fetus is surrounded by a fluid-filled membrane called the amniotic sac. At some point at the beginning of or during labor, this sac ruptures and contractions typically begin soon after. The goal of the study was to examine rates of induction, maternal infection, neonatal outcomes and time to birth in women who carried to term, and were expectantly managed at home or in the hospital.

Zielinski and colleagues looked at 2,357 women cared for by a midwestern midwifery service between January 2016 and December 2018. The amniotic sac ruptured early in 281 women (12%). Among that group, 150 (53%) opted to wait for labor onset at home; 102 (36%) were expectantly managed in the hospital; 21 (7.5%) were admitted for immediate induction of labor; and 8 (3%) were admitted for immediate cesarean birth.

Of the women who opted to wait, the majority (65%) went into labor on their own and did not need to be induced. Rates of maternal and infant infection were no different between the groups of women with prelabor rupture of membranes.

Labor is typically induced when the water breaks early because the prevailing wisdom is that as the time between the amniotic sac rupturing and the beginning of labor grows, so does the risk of infection.

"The risk of infection does increase with prolonged ruptured membranes, which is why with prelabor rupture of membranes, when the mother is a Group B strep carrier, the recommendation is a shorter duration of expectant management," Zielinski said.

Group B strep is a common bacteria that does not cause maternal infections, and providing antibiotic prophylaxis during labor is recommended to decrease the risk of transmission to the newborn.

The majority of newborns will not get sick but if they do, they get quite sick, which is why antibiotics are recommended, Zielinski said.

"Twenty-six years ago when I graduated from midwifery school, I assumed everyone wanted to avoid induction, but this is definitely not the case," she said. "Often, patients want to get things going and are fine with induction. However, with healthy, term pregnancies, waiting for a period of time for labor to start is reasonable and should be offered."

It is important for women to discuss their options with their provider, she said.

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Study abstract: Outcomes of Expectant Management of Term Prelabor Rupture of Membranes

Ruth Zielinski

 

Robots can use eye contact to draw out reluctant participants in groups

KTH, ROYAL INSTITUTE OF TECHNOLOGY

Research News

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Volume 90

VIDEO: RESEARCHERS FROM KTH ROYAL INSTITUTE OF TECHNOLOGY DEMONSTRATE THE EXPERIMENTAL SET-UP THEY USED TO OBSERVE PARTICIPATION IN A WORD GAME LED BY A SOCIAL ROBOT. THE RESULTS INDICATE THAT, BY... view more 

CREDIT: SARAH GILLET AND RONALD CUMBAL

Eye contact is a key to establishing a connection, and teachers use it often to encourage participation. But can a robot do this too? Can it draw a response simply by making "eye" contact, even with people who are less inclined to speak up. A recent study suggests that it can.

Researchers at KTH Royal Institute of Technology published results of experiments in which robots led a Swedish word game with individuals whose proficiency in the Nordic language was varied. They found that by redirecting its gaze to less proficient players, a robot can elicit involvement from even the most reluctant participants.

Researchers Sarah Gillet and Ronald Cumbal say the results offer evidence that robots could play a productive role in educational settings.

Calling on someone by name isn't always the best way to elicit engagement, Gillet says. "Gaze can by nature influence very dynamically how much people are participating, especially if there is this natural tendency for imbalance - due to the differences in language proficiency," she says.

"If someone is not inclined to participate for some reason, we showed that gaze is able to overcome this difference and help everyone to participate."

Cumbal says that studies have shown that robots can support group discussion, but this is the first study to examine what happens when a robot uses gaze in a group interaction that isn't balanced - when it is dominated by one or more individuals.

The experiment involved pairs of players - one fluent in Swedish and one who is learning Swedish. The players were instructed to give the robot clues in Swedish so that it could guess the correct term. The face of the robot was an animated projection on a specially designed plastic mask.

CAPTION

Two participants play a word game led by a robot, which uses its gaze to prompt less proficient players to speak up. Researchers Sarah Gillet and Ronald Cumbal say the results offer evidence that robots could play a productive role in educational settings.

CREDIT

Sarah Gillet

While it would be natural for a fluent speaker to dominate such a scenario, Cumbal says, the robot was able to prompt the participation of the less fluent player by redirecting its gaze naturally toward them and silently waiting for them to hazard an attempt.

"Robot gaze can modify group dynamics - what role people take in a situation," he says. "Our work builds on that and shows further that even when there is an imbalance in skills required for the activity, the gaze of a robot can still influence how the participants contribute."

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The study was published at the ACM/IEEE International Conference on Human-Robot Interaction '21.

Catching energy-exploration caused earthquakes before they happen

Sandia scientists use 3D-printed rocks, machine learning to detect unexpected earthquakes

DOE/SANDIA NATIONAL LABORATORIES

Research News

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CREDIT: VIDEO BY REBECCA GUSTAF/SANDIA NATIONAL LABORATORIES. ALL VIDEO FOOTAGE WAS TAKEN PRIOR TO THE COVID-19 PANDEMIC.

ALBUQUERQUE, N.M. -- Geoscientists at Sandia National Laboratories used 3D-printed rocks and an advanced, large-scale computer model of past earthquakes to understand and prevent earthquakes triggered by energy exploration.

Injecting water underground after unconventional oil and gas extraction, commonly known as fracking, geothermal energy stimulation and carbon dioxide sequestration all can trigger earthquakes. Of course, energy companies do their due diligence to check for faults -- breaks in the earth's upper crust that are prone to earthquakes -- but sometimes earthquakes, even swarms of earthquakes, strike unexpectedly.

Sandia geoscientists studied how pressure and stress from injecting water can transfer through pores in rocks down to fault lines, including previously hidden ones. They also crushed rocks with specially engineered weak points to hear the sound of different types of fault failures, which will aid in early detection of an induced earthquake.

3D-printing variability provides fundamental structural information

To study different types of fault failures, and their warning signs, Sandia geoscientist Hongkyu Yoon needed a bunch of rocks that would fracture the same way each time he applied pressure -- pressure not unlike the pressure caused by injecting water underground.

Natural rocks collected from the same location can have vastly different mineral orientation and layering, causing different weak points and fracture types.

Several years ago, Yoon started using additive manufacturing, commonly known as 3D printing, to make rocks from a gypsum-based mineral under controlled conditions, believing that these rocks would be more uniform. To print the rocks, Yoon and his team sprayed gypsum in thin layers, forming 1-by-3-by-0.5 inch rectangular blocks and cylinders.

However, as he studied the 3D-printed rocks, Yoon realized that the printing process also generated minute structural differences that affected how the rocks fractured. This piqued his interest, leading him to study how the mineral texture in 3D-printed rocks influences how they fracture.

"It turns out we can use that variability of mechanical and seismic responses of a 3D-printed fracture to our advantage to help us understand the fundamental processes of fracturing and its impact on fluid flow in rocks," Yoon said. This fluid flow and pore pressure can trigger earthquakes.

For these experiments, Yoon and collaborators at Purdue University, a university with which Sandia has a strong partnership, made a mineral ink using calcium sulfate powder and water. The researchers, including Purdue professors Antonio Bobet and Laura Pyrak-Nolte, printed a layer of hydrated calcium sulfate, about half as thick as a sheet of paper, and then applied a water-based binder to glue the next layer to the first. The binder recrystallized some of the calcium sulfate into gypsum, the same mineral used in construction drywall.

The researchers printed the same rectangular and cylindrical gypsum-based rocks. Some rocks had the gypsum mineral layers running horizontally, while others had vertical mineral layers. The researchers also varied the direction in which they sprayed the binder, to create more variation in mineral layering.

The research team squeezed the samples until they broke. The team examined the fracture surfaces using lasers and an X-ray microscope. They noticed the fracture path depended on the direction of the mineral layers. Yoon and colleagues described this fundamental study in a paper published in the journal Scientific Reports.

CAPTION

Sandia National Laboratories geoscientist Hongkyu Yoon holds a fractured 3D-printed rock. Hongkyu squeezed 3D-printed rocks until they cracked and listened to the sound of the rocks breaking to be able to identify early signs of earthquakes.

CREDIT

Photo by Rebecca Gustaf/Sandia National Laboratories

Sound signals and machine learning to classify seismic events

Also, working with his collaborators at Purdue University, ?Yoon monitored acoustic waves coming from the printed samples as they fractured. These sound waves are signs of rapid microcracks. Then the team combined the sound data with machine-learning techniques, a type of advanced data analysis that can identify patterns in seemingly unrelated data, to detect signals of minute seismic events.

First, Yoon and his colleagues used a machine-learning technique known as a random forest algorithm to cluster the microseismic events into groups that were caused by the same types of microstructures and identify about 25 important features in the microcrack sound data. They ranked these features by significance.

Using the significant features as a guide, they created a multilayered "deep" learning algorithm -- like the algorithms that allow digital assistants to function -- and applied it to archived data collected from real-world events. The deep-learning algorithm was able to identify signals of seismic events faster and more accurately than conventional monitoring systems.

Yoon said that within five years they hope to apply many different machine-learning algorithms, like these and those with imbedded geoscience principles, to detect induced earthquakes related to fossil fuel activities in oil or gas fields. The algorithms can also be applied to detect hidden faults that might become unstable due to carbon sequestration or geothermal energy stimulation?, he said.

"One of the nice things about machine learning is the scalability," Yoon said. "We always try to apply certain concepts that were developed under laboratory conditions to large-scale problems -- that's why we do laboratory work. Once we proved those machine-learning concepts developed at the laboratory scale on archived data, it's very easy to scale it up to large-scale problems, compared to traditional methods."

Stress transfers through rock to deep faults

A hidden fault was the cause of a surprise earthquake at a geothermal stimulation site in Pohang, South Korea. In 2017, two months after the final geothermal stimulation experiment ended, a magnitude 5.5 earthquake shook the area, the second strongest quake in South Korea's recent history.

After the earthquake, geoscientists discovered a fault hidden deep between two injection wells. To understand how stresses from water injection traveled to the fault and caused the quake, Kyung Won Chang, a geoscientist at Sandia, realized he needed to consider more than the stress of water pressing on the rocks. In addition to that deformation stress, he also needed to account for how that stress transferred to the rock as the water flowed through pores in the rock itself in his complex large-scale computational model.

Chang and his colleagues described the stress transfer in a paper published in the journal Scientific Reports.

However, understanding deformation stress and transfer of stress through rock pores is not enough to understand and predict some earthquakes induced by energy-exploration activities. The architecture of different faults also needs to be considered.

Using his model, Chang analyzed a cube 6 miles long, 6 miles wide and 6 miles deep where a swarm of more than 500 earthquakes took place in Azle, Texas, from November 2013 to May 2014. The earthquakes occurred along two intersecting faults, one less than 2 miles beneath the surface and another longer and deeper. While the shallow fault was closer to the sites of wastewater injection, the first earthquakes occurred along the longer, deeper fault.

In his model, Chang found that the water injections increased the pressure on the shallow fault. At the same time, injection-induced stress transferred through the rock down to the deep fault. Because the deep fault was under more stress initially, the earthquake swarm began there. He and Yoon shared the advanced computational model and their description of the Azle earthquakes in a paper recently published in the Journal of Geophysical Research: Solid Earth.

"In general, we need multiphysics models that couple different forms of stress beyond just pore pressure and the deformation of rocks, to understand induced earthquakes and correlate them with energy activities, such as hydraulic stimulation and wastewater injection," Chang said.

Chang said he and Yoon are working together to apply and scale up machine-learning algorithms to detect previously hidden faults and identify signatures of geologic stress that could predict the magnitude of a triggered earthquake.

In the future, Chang hopes to use those stress signatures to create a map of potential hazards for induced earthquakes around the United States.

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His research effort, as well as Yoon's initial work, were funded by Sandia's Laboratory Directed Research and Development program. Yoon received funding from the Department of Energy's Office of Fossil Energy to continue his research.

Sandia National Laboratories is a multimission laboratory operated by National Technology and Engineering Solutions of Sandia LLC, a wholly owned subsidiary of Honeywell International Inc., for the U.S. Department of Energy's National Nuclear Security Administration. Sandia Labs has major research and development responsibilities in nuclear deterrence, global security, defense, energy technologies and economic competitiveness, with main facilities in Albuquerque, New Mexico, and Livermore, California.

 

Daily e-cigarette use shows 'clear benefit' in helping smokers to quit

A new study published today from King's College London highlights the 'clear benefit' of using e-cigarettes daily in order to quit smoking

KING'S COLLEGE LONDON

Research News

 

A new study published Tuesday 10 March, No Smoking Day, from King's College London highlights the 'clear benefit' of using e-cigarettes daily in order to quit smoking, and supports their effectiveness when compared to other methods of quitting, including nicotine replacement therapy or medication.

Although the number of people in England who smoke has continued to fall in recent years, tobacco smoking is still the leading preventable cause of premature death and disease - killing nearly 75,000 people in England in 2019.

While e-cigarettes have been around for more than a decade, evidence on their effectiveness for helping people to quit smoking is still limited. Recent studies have produced inconsistent findings or failed to measure important factors such as frequency of use or the effect of different types of e-cigarette on attempts to quit.

In their Cancer Research UK-funded study, the researchers analysed data from an online survey of more than 1,155 people, which included smokers, ex-smokers who had quit within one year prior to completing the survey, and e-cigarette users.

Five waves of data were collected between 2012 and 2017. The researchers analysed the effectiveness of e-cigarettes in aiding abstinence from smoking for at least one month at follow-up, and at least one month of abstinence between the first survey and subsequent follow-up waves.

Published today in the journal Addiction, the study found that people who used a refillable e-cigarette daily to quit smoking were over five times more likely to achieve abstinence from tobacco smoking for one month, compared to those using no quitting aids at all.

Similarly, people who used a disposable or cartridge e-cigarette daily were three times more likely to quit for one month, compared to those using no help.

Daily use of e-cigarettes was also more effective for quitting than other evidence-based methods of quitting - including nicotine replacement therapy, medication such as bupropion or varenicline, or any combination of these aids. None of these methods were associated with abstinence from smoking at follow-up, compared to using no help at all. However, in a secondary analysis, prescription medicine was associated with achieving at least one month of abstinence from smoking.

Dr Máirtín McDermott, Research Fellow at King's College London's National Addiction Centre and lead author of the study, said: "Our results show that when used daily, e-cigarettes help people to quit smoking, compared to no help at all. These findings are in line with previous research, showing that e-cigarettes are a more effective aid for quitting than nicotine replacement therapy and prescribed medication.

"It's important that we routinely measure how often people use e-cigarettes, as we've seen that more sporadic use at follow up - specifically of refillable types - was not associated with abstinence."

Dr Leonie Brose, Reader at King's College London's national Addiction Centre added: "Despite the World Health Organization's (WHO) cautious stance on e-cigarettes, studies like ours show they are still one of the most effective quitting aids available.

"The WHO is especially concerned about refillable e-cigarettes, as these could allow the user to add harmful substances or higher levels of nicotine. However, we've shown that refillable types in particular are a very effective quitting aid when used daily, and this evidence should be factored into any future guidance around their use."

King's College London is one of the top 10 UK universities in the world (QS World University Rankings, 2018/19) and among the oldest in England. King's has more than 31,000 students (including more than 12,800 postgraduates) from some 150 countries worldwide, and some 8,500 staff.

The Institute of Psychiatry, Psychology & Neuroscience (IoPPN) which is the premier centre for mental health and related neurosciences research in Europe. It produces more highly cited outputs (top 1% citations) on mental health than any other centre (SciVal 2019) and on this metric we have risen from 16th (2014) to 4th (2019) in the world for highly cited neuroscience outputs. World-leading research from the IoPPN has made, and continues to make, an impact on how we understand, prevent and treat mental illness and other conditions that affect the brain. https://www.kcl.ac.uk/ioppn @KingsIoPPN