It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Saturday, September 10, 2022
Enhancing our physical understanding of climactic processes using improved climate models
INSTITUTE OF ATMOSPHERIC PHYSICS, CHINESE ACADEMY OF SCIENCES
More frequent extreme climate events have become a major global challenge. To mitigate the human and economic costs of these events, climatologists consistently create future climate predictions. These projections help policy makers develop actionable climate policies to avoid the most dangerous climate change effects. Because of the high data volume required for accurate forecasts, scientists rely on supercomputer-run climate models to make predictions and to project changes in the climate system. However, an incomplete physical understanding of the Earth’s dynamic climatic processes remains a major limitation regarding climate model usability.
Chibuike Ibebuchi from the Institute of Physical Geography, University of Würzburg, conducted a recent study, published in Advances in Atmospheric Sciences, which applied a synoptic climatological statistical modelling approach called “circulation typing with fuzzy rotated principal component analysis.” This new technique is designed to enhance the physical understanding of the mechanisms through which teleconnections, such as the sub-tropical Indian Ocean Dipole, impacts seasonal rainfall variability in southern Africa, a region that is vulnerable to climate extremes. Circulation typing considers both space and time for rainfall anomalies.
Ibebuchi believes that climate modeling and projection improvements can advance with more research studies that aim towards gaining a better physical understanding of climate processes on the synoptic and global scales. Furthermore, research should analyze how the synoptic and large-scale climate processes interact with regional climates. Researchers can achieve this by enhancing techniques for effectively breaking down climate data sets through space and time to unravel the distinct (continuous) variability associated with the climate system.
More specifically, for these subsequent studies, Ibebuchi aims toward developing and optimizing existing statistical methods for decomposing, or breaking down data sets to unravel physically meaningful climate forecasting signals. This includes diagnosing misrepresentations in climate modeling processes.
Tuebingosaurus maierfritzorum lived about 203 to 211 million years ago in the region now known as Swabian Alb and was a herbivore. The new species displays similarities with the large long-necked dinosaurs known as sauropods, and was identified when already-known dinosaur bones were re-examined. The results have been published in the open-access, peer-reviewed scientific journal Vertebrate Zoology.
The fossils, which are part of Tübingen’s paleontological collection, were previously interpreted as belonging to the family Plateosauridae. Now, in a large-scale project, scientists Dr. Omar Rafael Regalado Fernandez and PD Dr. Ingmar Werneburg have re-examined all dinosaur bones stored in Tübingen. Most of the fossils originate from a quarry near Trossingen at the edge of Swabian Alb, where many dinosaur bones found since the 19th century have frequently been classified as Plateosaurus.
While it is undisputed that this group of dinosaurs was very common in parts of Europe about 200 million years ago, contemporary paleontologists are well aware that taxonomical classification in the past was often inaccurate, with some discoveries being too rapidly attributed to the Plateosaurus genus.
When they re-analyzed a skeleton that was discovered in Trossingen in 1922, consisting mainly of the rear of the body, Regalado Fernandez and Werneburg established that many of the bones were not the same as a typical Plateosaurus.
For instance, the partial skeleton displayed, among other derived characters, demonstrates broader and more strongly-built hips with fused sacral vertebrae, as well as unusually large and robust long bones. Both features imply locomotion on four legs. This is unlike the plateosaurid dinosaur, which - although resembling the long-necked sauropods from the Jura region - likely moved on only two legs.
Following in-depth comparison of all anatomical characteristics, the scientists re-categorized the partial skeleton from Trossingen in the dinosaur tree of life and established that they had discovered a previously unknown species and genus.
It is highly probable that the newly described Tuebingosaurus maierfritzorum was a quadruped, hence, far more closely related to more recently lived large sauropods, such as Brachiosaurus or Diplodocus.
The surrounding sedimentary rock and the preservation of the bones indicate that this Tuebingosaurus had sunk into a swamp and died. The bones on the left side of the body were probably on the surface and exposed to the elements for several years.
“Its genus name, Tuebingosaurus, is a homage to our beautiful university city and its inhabitants,” says Werneburg.
The species name (maierfritzorum) is a tribute to two German zoologists: Professor Wolfgang Maier from Tübingen and Professor Uwe Fritz from Senckenberg Natural History Collections Dresden.
In summary, with their project, the scientists demonstrate that the early European dinosaurs were far more diverse than previously thought.
After completing the study of the skeleton of the newly discovered species Tuebingosaurus maierfritzorum, the bones were put back together and can already be seen in two large display cabinets in the Tübingen’s paleontological collection.
There, amongst the thousands archaeological finds, the visitors can also find two complete Plateosaurus skeletons from Trossingen, partial skeletons of two sauropods and one stegosaur from Tanzania.
Reconstruction of how the death of the Tuebingosaurus maierfritzorum specimen may have occurred. Bones of the predatory dinosaur Teratosaurus were also found in Trossingen. However it has only been proven that Tuebingosaurus fell on its right side. Weathering indicates that the bones on the left side of the body probably lay for several years on the surface.
CREDIT
Marcus Burkhardt
Ingmar Werneburg (left) and Omar Rafael Regalado Fernandez (right) in the archive of the paleontological collection at Tübingen. The hips of Tuebingosaurus maierfritzorum can be seen in the foreground.
CREDIT
Valentin Marquardt and University of Tübingen
Research article:
Regalado Fernández OR, Werneburg I (2022) A new massopodan sauropodomorph from Trossingen Formation (Germany) hidden as 'Plateosaurus' for 100 years in the historical Tübingen collection. Vertebrate Zoology 72: 771–822. https://doi.org/10.3897/vz.72.e86348
A new massopodan sauropodomorph from Trossingen Formation (Germany) hidden as 'Plateosaurus' for 100 years in the historical Tübingen collection.
ARTICLE PUBLICATION DATE
8-Sep-2022
Eating behaviors of parents play a role in teens' emotional eating
New study published in the Journal of Nutrition Education and Behavior outlines what role parents can play in shaping emotional eating in their adolescent children
AUDIO: LEAD AUTHOR JOANNA KLOSOWSKA, MSC, DISCUSSES A NEW STUDY FOCUSING ON ADOLESCENT VULNERABILITY TO EMOTIONAL EATING AND HOW VARIOUS FEEDING PRACTICES USED BY PARENTS, SUCH AS RESTRICTION, FOOD AS REWARD, AND CHILD INVOLVEMENT, INFLUENCE EATING BEHAVIOR.view more
CREDIT: JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR
Philadelphia, September 7, 2022 – Emotional eating, or eating as a coping mechanism for negative, positive, or stress-driven emotions, is associated with unhealthy dietary patterns and weight gain. A research article featured in the Journal of Nutrition Education and Behavior, published by Elsevier, discusses adolescent vulnerability to emotional eating and how various feeding practices used by parents, such as restriction, food as reward, and child involvement, influence eating behavior.
"Emotional eating was previously found to be more learned than inherited. This study examined not only the interaction between parents when feeding their children, but also what children learned from watching their parents eat," said lead author Joanna Klosowska, MSc, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
The initial study was conducted in 2017 with 218 families. Additionally, longitudinal data collected in 2013 were also available. One parent from each family completed the Child Feeding Questionnaire, as well as the Child Feeding Practices Questionnaire, and both adolescent and parent completed the Dutch Eating Behavior Questionnaire. Emotion regulation was assessed with the Dutch version of the child-reported FEEL-KJ questionnaire. The adolescent's body weight and height were measured by researchers.
Over the four years between 2013 −2017, covering the time from late childhood to middle adolescence, changes occurred in some parental practices. Parents reported higher monitoring and healthy modeling feeding practices, while the reported levels of food restriction and the healthy environment remained unchanged. During the same time period, adolescents reported a considerable increase in emotional eating from below the average in 2013 to above the average in 2017, according to the norms for the Dutch population. Additionally, the maladaptive way in which they regulated their emotions was also associated with emotional eating.
Food as a reward and monitoring food increased emotional eating especially in instances where the adolescent employed maladaptive strategies in regulating their emotions. Child involvement in meals had an opposite effect since it was associated with higher levels of emotion regulation and lower levels of emotional eating. Interestingly, a parent's restrained eating behavior was linked to less emotional eating in adolescents.
"This study suggests that parents continue to play an important role in their child's eating behavior into their teen years," said Klosowska. "Additional research is needed to understand the impact restrained eating demonstrated by a parent impacts the emotional eating of a child."
Emotion Regulation Moderates the Associations of Food Parenting and Adolescent Emotional Eating
ARTICLE PUBLICATION DATE
7-Sep-2022
Dedicated women’s heart centers can improve accurate diagnoses and outcomes
Important study in the Canadian Journal of Cardiology showcases improvement in outcomes for women with ischemic heart disease by attending a multidisciplinary women’s health center
IMAGE: THE OBJECTIVE OF THIS STUDY WAS TO INVESTIGATE WHETHER ATTENDING A WOMEN’S HEART CENTER IMPROVES DIAGNOSIS AND OUTCOMES IN WOMEN WITH INOCA AND MINOCA. INOCA: ISCHEMIA WITH NO OBSTRUCTIVE CORONARY ARTERY DISEASE; MINOCA: MYOCARDIAL INFARCTION WITH NO OBSTRUCTIVE CORONARY ARTERY DISEASE.view more
CREDIT: CANADIAN JOURNAL OF CARDIOLOGY
Philadelphia, September 7, 2022 – Cardiac conditions in women are underdiagnosed, undertreated, and under-researched compared to men. In an important prospective study in the Canadian Journal of Cardiology, published by Elsevier, investigators report that attending a multidisciplinary dedicated women’s heart center can increase the likelihood of an accurate diagnosis and significantly improve clinical and psychological outcomes of women reporting chest pain due to insufficient heart-muscle blood flow (myocardial ischemia) but not diagnosed with obstructive coronary artery disease.
Cardiovascular disease (CVD) continues to be a leading cause of hospitalization and death in women. Declines in CVD death rates have stalled in mid-life women compared to men, suggesting sex-specific approaches may be needed.
Many women with cardiac chest pain and ischemia or myocardial infarction do not have significant blockages in the arteries supplying the heart (obstructive coronary artery disease). Ischemia with no obstructive coronary artery disease (INOCA) may affect up to 62% of women undergoing coronary angiography for suspected angina, with a higher prevalence in mid-life women aged 45-65 years. Myocardial infarction with no obstructive coronary artery disease (MINOCA) accounts for 6% of myocardial infarctions and is more frequently diagnosed in women. Studies suggest that patients with INOCA and MINOCA have a decreased quality of life and are at increased risk of cardiovascular events like heart attacks and acute heart failure.
"Most studies of heart health consist primarily of male participants, and numerous clinical outcomes such as patient symptoms and treatments do not therefore necessarily apply to women with certain types of heart disease,” explained lead investigator Tara L. Sedlak, MD, Vancouver General Hospital Department of Cardiology, University of British Columbia Faculty of Medicine, and British Columbia Women’s Hospital, Vancouver, BC, Canada. “We conducted this research to gain a better understanding of the etiologies and treatment of women with ongoing signs and symptoms of INOCA, which is one of these understudied areas in heart health.”
Investigators prospectively followed 154 patients (112 INOCA and 42 MINOCA patients). attending the women’s heart center at Vancouver General Hospital, who completed baseline demographics questionnaires. Median age was 59, and the most common referral was for chest pain (94% in INOCA and 66% in MINOCA). After one year, chest pain frequency, quality of life, depression/anxiety symptoms, and cardiovascular outcomes were compared to baseline.
Many women with cardiac chest pain and ischemia or heart attack have no significant blockages of their larger coronary arteries but can have narrowing or dysfunction of their small coronary vessels or spasm of their blood vessels, which may be missed at initial diagnosis.
At baseline, 64% of INOCA and 43% of MINOCA patients did not have a specific diagnosis. Following investigations in the center, 71% of INOCA patients established a new or a changed diagnosis (the most common of which was coronary microvascular dysfunction at 68%), while 60% of MINOCA patients established a new or change in diagnosis (the most common of which was coronary vasospasm at 60%). At one year, participants had significantly decreased chest pain, improved quality of life and improved mental health.
“To our knowledge, this is the first prospective report of the outcomes in Canadian women with chest pain who have attended a women’s heart center,” noted Dr. Sedlak. “We hope our findings highlight the importance of having a dedicated women-specific heart center, which provides comprehensive care for women with heart disease by providing risk factor assessment, referral to psychiatrists, exercise classes, smoking cessation treatment, and consultation with a dietitian in addition to a focus on conditions such as INOCA that are more common in women.”
In an accompanying editorial, C. Noel Bairey Merz, MD, Barbra Streisand Women’s Heart Center in the Smidt Heart Institute at Cedars-Sinai, Los Angeles, CA, USA. and colleagues congratulate Dr. Sedlak and coinvestigators on this important study as one of the first in Canada to showcase the improvement in outcomes for women with INOCA or MINOCA through a specialized women’s health center.
“These centers and programs continue to increase awareness, improve education for patients and healthcare providers, and facilitate accessibility to specific diagnosis, risk stratification, and management. Furthermore, as illustrated by this study, the multidisciplinary foundation of these centers fosters collaborations across the various disciplines that provide care for women, bridging the continuity between advocacy, research, and clinical expertise, Dr. Merz commented. “With the growing momentum from the last three decades, specialized women’s health centers are increasingly recognized as a long-term, sustainable model to address ongoing disparities facing women with cardiovascular risk factors and disease.”
IMAGE: ONCE IN A CENTURY FLOWERING AND SEEDING OF DWARF BAMBOO BOOSTS MICE POPULATIONSview more
CREDIT: REIKO MATSUSHITA
A research group from Nagoya University in Japan has found that an event that occurs only once every 120 years, the large-scale flowering, seeding, and dying of dwarf bamboo (Sasa borealis), provides ideal breeding conditions for Japanese field mice.
The large-scale flowering and seeding of dwarf bamboo is a rare event. This plant phenomenon is called masting, and the next one is not expected for more than 100 years. During such events, which occur in “mast years”, some plants will produce heavy seed crops. Plants that coordinate their flowering and fruiting in mast years do so simultaneously and over a wide area.
Rodent outbreaks are believed to be associated with feeding on bamboo seeds in these mast years. This has received a lot of attention because of the agricultural and forest damage that occurs, as well as the risk of diseases spread by these rodents. There have been previous reports of large-scale tree mortality during such events due to rodent outbreaks.
In the 2010s, the masting of dwarf bamboo, a Sasa species with a 120-year masting cycle, began to be observed on forest floors throughout Japan. A team of researchers from Nagoya University led by Associate Professor Hisashi Kajimura and doctoral student Hanami Suzuki, both from the Graduate School of Bioagricultural Sciences, investigated the effects of this simultaneous seeding of dwarf bamboo on local rodent populations in Aichi Prefecture, Japan. Comparing data from before and after the masting, the researchers found an increase in the populations of both the large and small Japanese field mouse, but no similar effect was seen on Smith’s voles in the same area. Their results were published in Ecological Processes.
“The interesting biological phenomenon that masting of bamboo and dwarf bamboo can cause an outbreak of forest rodents has long been something of a legend,” says Kajimura. “This research is important because it clarifies this long-suspected phenomenon by comparing rodent populations before and after masting.”
“What was interesting was that the increased populations of both species of rodent that we studied remained even two years after the masting, even though the dwarf bamboo itself had died.” explains Suzuki. “There was also a high proportion of female juveniles in the population, suggesting that the simultaneous fruiting resulted in good conditions for reproductive females. These findings clearly show for the first time how the field mouse population responds to the seeds of Sasa, such as dwarf bamboo, especially those that have a longer cycle and larger supply.”
The team is excited about the implications of their study. “This research is expected to provide important clues for understanding the realities of sudden environmental changes in forest ecosystems and the interactions among the organisms that live there,” they said.
This research was supported by the Nagoya University Fusion Frontier Fellowship Program, which began in FY2021.
IMAGE: PAROTOID GLAND SIZES OF URBAN POPULATIONS WERE SIGNIFICANTLY SMALLER THAN THOSE IN RURAL POPULATIONS, WHEREAS BODY MASS DID NOT DIFFER. LEG LENGTHS OF URBAN MALES WERE LONGER THAN THOSE OF RURAL MALES, BUT URBAN FEMALES HAD SHORTER LEGS THAN RURAL FEMALES. THESE RESULTS DEMONSTRATE THAT URBANIZATION CAUSES MORPHOLOGICAL CHANGES IN INVASIVE TOADS.view more
CREDIT: HIROTAKA KOMINE, YAMAGATA UNIVERSITY
Biodiversity is increasingly diminished by humanity’s many impacts, a major aspect of which is urbanization. Although there are a lot of studies reporting that urbanization influences wildlife population sizes and distributions, we are only beginning to study urbanization as an evolutionary force. Urban environments are also hotspots for invasive species, i.e., species that are not indigenous, or native, to an area, which can cause significant economic and ecological damage. In addition, invasive species provide an evolutionary laboratory in which we can study the effects of urbanization.
Cane toads are invasive in Australia, and Assistant Professor Hirotaka Komine with the Tokyo University of Agriculture and Technology (Current affiliation: Yamagata University) along with colleagues from Australia’s James Cook University, wanted to find out whether the urban environment had impacts on the morphology of these toads. They hypothesized that toads may have fewer predators in urban environments compared to ‘country’ or peri-urban environments, and that this may mean that urban toad antipredator defences were less well developed.
They published their findings on 2 September 2022 in Biological Journal of the Linnean Society.
They captured 419 adult toads in 3 Queensland Australian towns: Townsville, Cairns and Mackay, within city limits, and then ventured to surrounding rural areas of each city. They measured these toads’ parotoid glands, which contain strong toxins for anti-predator defense, as well as leg length and mass.
The researchers found parotoid gland sizes were significantly smaller in urban toads compared to those in rural populations, although body mass was not different. Interestingly, leg lengths of urban males were longer than those of rural males, but the legs of urban females were shorter than rural females. Thus, urbanization caused reduced anti-predator defenses in invasive toads, and also increased sexual dimorphism in leg length. Invasive toads were introduced to Australia in 1935, so these morphological changes may have occurred rapidly. Without genetic work, we do not know if these changes are a phenotypically plastic response, or genetically encoded, but in either case they seem adaptive.
“This invasive species could apparently adapt rapidly to the urban environment,” said conservation biologist Hirotaka Komine. “Phenotypic changes in invasive species could enhance their invasiveness, so these findings are not only interesting for evolutionary biologists, but could also be valuable for conservation of native ecosystems.”
The researchers added that further studies are needed to reveal the underlying mechanism driving these morphological changes and to clarify whether these changes were evolutionary or phenotypic changes.
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Original publication:
Komine, H. *, Yasumiba, K. & Schwarzkopf L. The country toad and the city toad: comparing morphology of invasive cane toads (Rhinella marina) from rural and urban environments. Biological Journal of the Linnean Society, blac100 https://doi.org/10.1093/biolinnean/blac100 *: corresponding author
IMAGE: SATELLITE PHOTO OF THE KAMCHATKA PENINSULA (PHOTO: SHIN SUGIYAMA).view more
CREDIT: SHIN SUGIYAMA
Scientists have quantified the glacier mass loss on the Kamchatka Peninsula; the accelerated loss in the region since the turn of the millennium is likely to increase in the short term.
One of the many effects of global warming and climate change is the reduction in the size of glaciers due to accelerated melting. The most severe of these losses has been seen in mountain glaciers, which have contributed to 80% of the global reduction in glacier volume. The Kamchatka Peninsula in Russia is one such region; however, their loss is less understood—despite the influence and importance of these glaciers in water circulation in the North Pacific Ocean.
A team of researchers led by Professor Shin Sugiyama at the Institute of Low Temperature Science, Hokkaido University, has used satellite data to reveal glacier mass changes on the Kamchatka Peninsula. Their discoveries, which show that 4.9 gigatons of ice was lost across the peninsula in the last 20 years, were published in the Journal of Glaciology.
The Kamchatka Peninsula in Far Eastern Russia is a cold region with heavy snowfall of up to 1200 mm per year. The peninsula has a long mountain range and many active volcanoes, and there are a total of 405 glaciers in the peninsula. Freshwater flowing into the Sea of Okhotsk from the Kamchatka Peninsula plays an important role in the seawater circulation in the North Pacific Ocean. Hence, it is vital to understand the glacier dynamics in the region; however, the analysis of glacier fluctuations in the Kamchatka Peninsula was scarce.
The researchers reconstructed and analysed glacier elevation data from satellite images recorded between 2000 and 2016. They combined these data with local meteorological data; they also included on-site measurements of snow depth for part of their analysis. They used the combined data to track mass loss in glaciers across the 16 years covered by their analysis.
Their analysis revealed that, overall, the glacier cover on Kamchatka has lost a total of 4.9 billion tons of ice between 2000 and 2016, which corresponds to a sea level rise of 0.013 mm. The loss has been greatest in the eastern and northern parts of the region; in particular, the rate of mass loss has increased in the second part of the study period.
They were able to determine that rising temperatures were the primary driver of these changes. Most concerning, a recurring climate variability in the Pacific Basin, the Pacific Decadal Oscillation, is expected to reduce snowfall in Kamchatka, leading to further acceleration in the glacier mass loss.
This study is the first to quantify glacier mass changes on the Kamchatka Peninsula, Russia. This study also clarified the distribution and regional characteristics of glacier fluctuations within the peninsula. “Our findings are important to accurately understand sea-level rise, and are also valuable data for the understanding of mountain glacier fluctuations,” said Shin Sugiyama.
(Left) Glacier area (circle size) and rate of change of area (color of circles) from 2000/2002 to 2014/15/16 in each region of Kamchatka; (Right) rates of glacier mass change (circle size) and mean specific mass change (color of circles) from 2000 to 2014/15/16 in each region (Shungo Fukumoto, et al. Journal of Glaciology. July 4, 2022).
CREDIT
Shungo Fukumoto, et al. Journal of Glaciology. July 4, 2022
Shungo Fukumoto (blue parka), lead author of the paper, with members of student climbing club Academic Alpine Club of Hokkaido, Hokkaido University, during their expedition to the study site in Kamchatka in 2016 (Photo: Shungo Fukumoto).
A new study published in The Lancet shows that medical abortion can be carried out both safely and effectively via telemedicine, without a routine ultrasound examination. The study, which is a collaboration between researchers at Karolinska Institutet in Sweden and the University of Cape Town in South Africa, highlights the opportunities to provide safe and effective abortion services in low-resource settings.
“As far as we know, our study is the first randomised clinical trial to evaluate telemedicine, meaning care at a distance, in abortion. This method can potentially reduce the number of unsafe abortions, something that is particularly important and relevant in times when the right to abortion is under threat”, says Margit Endler, researcher at the Department of Women’s and Children’s Health at Karolinska Institutet and consultant at the Department of Obstetrics and Gynecology at Södersjukhuset (Stockholm South General Hospital).
Significant threat to women’s health
According to the World Health Organization (WHO), 25 million unsafe abortions are performed every year and up to 47,000 women and girls die as a result. The reasons women seek unsafe abortions include a lack of resources, stigma surrounding abortion and restrictive abortion laws. In South Africa, it is estimated that approximately half of all abortions are performed outside of the general healthcare system, thus risking the safety of women in need of care.
The present study included 900 women from four clinics in Cape Town, South Africa, who were at or before 9 weeks gestation and who were seeking care for an abortion. Half received standard care with in-person consultation, ultrasound, and had an abortion that was initiated with oral medication at the clinic. The other half received treatment through telemedicine, where the women filled out an online consultation form, received information and instructions for the abortion procedure via text messages, and took both abortion medications at home. The only in-person component the telemedicine group received was a simple uterine examination (palpation), which was performed in the clinic as a safety precaution.
Equal to standard care
The researchers then compared the rate of successful abortion, continuing pregnancy, adverse events, and satisfaction with the treatment. They found that the women who completed an abortion through telemedicine adhered well to the instructions and achieved treatment results that were as good as the women who received standard care while maintaining similar levels of safety.
“What was interesting was that the majority of women in both groups expressed that they preferred the telemedicine option. This care model can be particularly important in resource-poor areas where there is a lack of healthcare infrastructure or restrictive abortion laws. For example, women can be examined at a clinic that does not have access to ultrasound and then receive guidance for the abortion remotely”, says Margit Endler.
The researchers are now planning another study in Africa where they will evaluate whether women who are deemed to have a low risk of complications can forego the physical visit to the clinic completely.
The research was funded by Grand Challenges Canada OPTIONS initiative, and the Swedish Research Council. One of the co-authors, Rebecca Gomperts, is the founder and director of Women on Web, the telemedicine platform used in the study. No other conflicts of interest are declared.