Riviste scientifiche

Brexit, exams, trying for a baby: How to cope when life is in limbo

New Scientist - Me, 16/10/2019 - 07:00
Living with uncertainty can be excruciating, whether it’s climate change, the next Brexit blow or wondering what’s making your partner late. Fortunately there are ways to build resilience

The agony of not knowing: How to cope with the world's uncertainty

New Scientist - Me, 16/10/2019 - 07:00
Living in limbo can be excruciating, whether it's waiting for a pregnancy test, the next Brexit blow or wondering what's making your partner late. Fortunately there are ways to build resilience

Humpback whales use their flippers to swat salmon into their mouths

New Scientist - Me, 16/10/2019 - 01:01
Humpback whales use their flippers to create a barrier that traps gathered prey, which they can then usher towards their mouths by swatting the water

The best of the 2019 Wildlife Photographer of the Year winning photos

New Scientist - Me, 16/10/2019 - 00:00
The winners of the 2019 Wildlife Photographer of the Year competition include pictures of a surprised marmot, a lichen-covered tree and sheep in a fierce embrace

Implementing a structured model for osteoarthritis care in primary healthcare: A stepped-wedge cluster-randomised trial

PLoS Medicine - Ma, 15/10/2019 - 23:00

by Nina Østerås, Tuva Moseng, Leti van Bodegom-Vos, Krysia Dziedzic, Ibrahim Mdala, Bård Natvig, Jan Harald Røtterud, Unni-Berit Schjervheim, Thea Vliet Vlieland, Øyvor Andreassen, Jorun Nystuen Hansen, Kåre Birger Hagen

Background

To improve quality of care for patients with hip and knee osteoarthritis (OA), a structured model for integrated OA care was developed based on international recommendations. The objective of this study was to assess the effectiveness of this model in primary care.

Methods and findings

We conducted a cluster-randomised controlled trial with stepped-wedge cohort design in 6 Norwegian municipalities (clusters) between January 2015 and October 2017. The randomised order was concealed to the clusters until the time of crossover from the control to the intervention phase. The intervention was implementation of the SAMBA model, facilitated by interactive workshops for general practitioners and physiotherapists with an update on OA treatment recommendations. Patients in the intervention group attended a physiotherapist-led OA education and individually tailored exercise programme for 8–12 weeks. The primary outcome was patient-reported quality of care (OsteoArthritis Quality Indicator questionnaire; 0–100, 100 = optimal quality) at 6 months. Secondary outcomes included patient-reported referrals to physiotherapy, magnetic resonance imaging (MRI), and orthopaedic surgeon consultation; patients’ satisfaction with care; physical activity level; and proportion of patients who were overweight or obese (body mass index ≥ 25 kg/m2). In all, 40 of 80 general practitioners (mean age [SD] 50 [12] years, 42% females) and 37 of 64 physiotherapists (mean age [SD] 42 [8] years, 65% females) participated. They identified 531 patients, of which 393 patients (mean age [SD] 64 [10] years, 71% females) with symptomatic hip or knee OA were included. Among these, 109 patients were recruited during the control periods (control group), and 284 patients were recruited during interventions periods (intervention group). The patients in the intervention group reported significantly higher quality of care (score of 60 versus 41, mean difference 18.9; 95% CI 12.7, 25.1; p < 0.001) and higher satisfaction with OA care (odds ratio [OR] 12.1; 95% CI 6.44, 22.72; p < 0.001) compared to patients in the control group. The increase in quality of care was close to, but below, the pre-specified minimal important change. In the intervention group, a higher proportion was referred to physiotherapy (OR 2.5; 95% CI 1.08, 5.73; p = 0.03), a higher proportion fulfilled physical activity recommendations (OR 9.3; 95% CI 2.87, 30.37; p < 0.001), and a lower proportion was referred to an orthopaedic surgeon (OR 0.3; 95% CI 0.08, 0.80; p = 0.02), as compared to the control group. There were no significant group differences regarding referral to MRI (OR 0.6; 95% CI 0.13, 2.38; p = 0.42) and proportion of patients who were overweight or obese (OR 1.3; 95% CI 0.70, 2.51; p = 0.34). Study limitations include the imbalance in patient group size, which may have been due to an increased attention to OA patients among the health professionals during the intervention phase, and a potential recruitment bias as the patient participants were identified by their health professionals.

Conclusions

In this study, a structured model in primary care resulted in higher quality of OA care as compared to usual care. Future studies should explore ways to implement the structured model for integrated OA care on a larger scale.

Trial registration

ClinicalTrials.gov NCT02333656.

Gender differences in grant and personnel award funding rates at the Canadian Institutes of Health Research based on research content area: A retrospective analysis

PLoS Medicine - Ma, 15/10/2019 - 23:00

by Karen E. A. Burns, Sharon E. Straus, Kuan Liu, Leena Rizvi, Gordon Guyatt

Background

Although women at all career stages are more likely to leave academia than men, early-career women are a particularly high-risk group. Research supports that women are less likely than men to receive research funding; however, whether funding success rates vary based on research content is unknown. We addressed gender differences in funding success rates for applications directed to one or more of 13 institutes, representing research communities, over a 15-year period.

Methods and findings

We retrospectively reviewed 55,700 grant and 4,087 personnel award applications submitted to the Canadian Institutes of Health Research. We analyzed application success rates according to gender and the primary institute selected by applicants, pooled gender differences in success rates using random effects models, and fitted Poisson regression models to assess the effects of gender, time, and institute. We noted variable success rates among grant applications directed to selected institutes and declining success rates over time. Women submitted 31.1% and 44.7% of grant and personnel award applications, respectively. In the pooled estimate, women had significantly lower grant success (risk ratio [RR] 0.89, 95% confidence interval [CI] 0.84–0.94; p < 0.001; absolute difference 3.2%) compared with men, with substantial heterogeneity (I2 = 58%). Compared with men, women who directed grants to the Institutes of Cancer Research (RR 0.86, 95% CI 0.78–0.96), Circulatory and Respiratory Health (RR 0.74, 95% CI 0.66–0.84), Health Services and Policy Research (RR 0.78, 95% CI 0.68–0.90), and Musculoskeletal Health and Arthritis (RR 0.80, 95% CI 0.69–0.93) were significantly less likely to be funded, and those who directed grants to the Institute of Aboriginal People’s Health (RR 1.67, 95% CI 1.0–2.7) were more likely to be funded. Overall, women also had significantly lower personnel award success (RR 0.75, 95% CI 0.65–0.86; p < 0.001; absolute difference 6.6%). Regression modelling identified that the effect of gender on grant success rates differed by institute and not time. Study limitations include use of institutes as a surrogate identifier, variability in designation of primary institute, and lack of access to metrics reflecting applicants, coapplicants, peer reviewers, and the peer-review process.

Conclusions

Gender disparity existed overall in grant and personnel award success rates, especially for grants directed to selected research communities. Funding agencies should monitor for gender differences in grant success rates overall and by research content.

Mortality and recovery following moderate and severe acute malnutrition in children aged 6–18 months in rural Jharkhand and Odisha, eastern India: A cohort study

PLoS Medicine - Ma, 15/10/2019 - 23:00

by Audrey Prost, Nirmala Nair, Andrew Copas, Hemanta Pradhan, Naomi Saville, Prasanta Tripathy, Rajkumar Gope, Shibanand Rath, Suchitra Rath, Jolene Skordis, Sanghita Bhattacharyya, Anthony Costello, Harshpal S. Sachdev

Background

Recent data suggest that case fatality from severe acute malnutrition (SAM) in India may be lower than the 10%–20% estimated by the World Health Organization (WHO). A contemporary quantification of mortality and recovery from acute malnutrition in Indian community settings is essential to inform policy regarding the benefits of scaling up prevention and treatment programmes.

Methods and findings

We conducted a cohort study using data collected during a recently completed cluster-randomised controlled trial in 120 geographical clusters with a total population of 121,531 in rural Jharkhand and Odisha, eastern India. Children born between October 1, 2013, and February 10, 2015, and alive at 6 months of age were followed up at 9, 12, and 18 months. We measured the children’s anthropometry and asked caregivers whether children had been referred to services for malnutrition in the past 3 months. We determined the incidence and prevalence of moderate acute malnutrition (MAM) and SAM, as well as mortality and recovery at each follow-up. We then used Cox-proportional models to estimate mortality hazard ratios (HRs) for MAM and SAM. In total, 2,869 children were eligible for follow-up at 6 months of age. We knew the vital status of 93% of children (2,669/2,869) at 18 months. There were 2,704 children-years of follow-up time. The incidence of MAM by weight-for-length z score (WLZ) and/or mid-upper arm circumference (MUAC) was 406 (1,098/2,704) per 1,000 children-years. The incidence of SAM by WLZ, MUAC, or oedema was 190 (513/2,704) per 1,000 children-years. There were 36 deaths: 12 among children with MAM and six among children with SAM. Case fatality rates were 1.1% (12/1,098) for MAM and 1.2% (6/513) for SAM. In total, 99% of all children with SAM at 6 months of age (227/230) were alive 3 months later, 40% (92/230) were still SAM, and 18% (41/230) had recovered (WLZ ≥ −2 standard deviation [SD]; MUAC ≥ 12.5; no oedema). The adjusted HRs using all anthropometric indicators were 1.43 (95% CI 0.53–3.87, p = 0.480) for MAM and 2.56 (95% CI 0.99–6.70, p = 0.052) for SAM. Both WLZ < −3 and MUAC ≥ 11.5 and < 12.5 were associated with increased mortality risk (HR: 3.33, 95% CI 1.23–8.99, p = 0.018 and HR: 3.87, 95% CI 1.63–9.18, p = 0.002, respectively). A key limitation of our analysis was missing WLZ or MUAC data at all time points for 2.5% of children, including for two of the 36 children who died.

Conclusions

In rural eastern India, the incidence of acute malnutrition among children older than 6 months was high, but case fatality following SAM was 1.2%, much lower than the 10%–20% estimated by WHO. Case fatality rates below 6% have now been recorded in three other Indian studies. Community treatment using ready-to-use therapeutic food may not avert a substantial number of SAM-related deaths in children aged over 6 months, as mortality in this group is lower than expected. Our findings strengthen the case for prioritising prevention through known health, nutrition, and multisectoral interventions in the first 1,000 days of life, while ensuring access to treatment when prevention fails.

Nightjars time their epic migration flights using a lunar calendar

New Scientist - Ma, 15/10/2019 - 20:00
Nightjars are the first animal found to time migration by the moon, using its phases to know when to take flight on the journey from northern Europe to sub-Saharan Africa

Extreme snow stopped plants and animals breeding in parts of Greenland

New Scientist - Ma, 15/10/2019 - 20:00
Abnormally heavy snowfall in 2018 stopped almost all plants and animals breeding in parts of Greenland, and some migratory birds starved to death waiting for snow to melt

Extremely dexterous robot can solve a Rubik's cube one-handed

New Scientist - Ma, 15/10/2019 - 18:00
Artificial intelligence has learned to control a single robot hand with enough dexterity to solve a Rubik’s cube in around 3 minutes

How deadly disease outbreaks could worsen as the climate changes

New Scientist - Ma, 15/10/2019 - 17:00
Environmental destruction risks increasing the spread of deadly diseases including Ebola and malaria, with serious consequences for future public health

US green economy has 10 times more jobs than the fossil fuel industry

New Scientist - Ma, 15/10/2019 - 15:00
The green economy, covering renewable energy to environmental consultancy, is now so large in the US that it employs 10 times as many people as the fossil fuel industry

Extinction Rebellion protests should be embraced, not banned

New Scientist - Ma, 15/10/2019 - 13:24
The move to haul protesters off London’s streets reflects a scientifically and economically illiterate political and media elite in denial about the climate

Ancient jungle capital of the Khmer Empire mapped for the first time

New Scientist - Ma, 15/10/2019 - 13:00
The ancient city of Mahendraparvata has been hidden in the mountain forests of Cambodia for centuries, but thanks to airborne lasers we now have a detailed map of it

Huge fire blankets can protect houses from destructive wildfires

New Scientist - Ma, 15/10/2019 - 06:00
Wrapping a wooden house in a fire-resistant blanket can protect it from a wildfire for around 10 minutes - enough to let it survive fast-moving blazes

Astronomer Royal: We're destroying the book of life before reading it

New Scientist - Lu, 14/10/2019 - 18:06
In a talk on energy policy, artificial intelligence and space exploration Astronomer Royal Martin Rees called for urgent action at a crucial turning point for humanity

High levels of air pollution seem to be linked to early miscarriages

New Scientist - Lu, 14/10/2019 - 17:00
Pregnant women who live and work in places with a lot of air pollution appear to be more likely to experience missed miscarriages

Lee Berger: We have made another major discovery about early humans

New Scientist - Lu, 14/10/2019 - 16:19
Fossil skeletons found embedded in rock at a site near Johannesburg, South Africa, could shake up humanity's family tree

Eliud Kipchoge's sub-2 hour marathon may herald even faster times

New Scientist - Lu, 14/10/2019 - 15:44
Eliud Kipchoge has completed a marathon in under 2 hours, a feat that shows just how far sports science has come. Other elite runners may now go even faster

Joseph Plateau’s spinning disc illusions were the forerunner of cinema

New Scientist - Lu, 14/10/2019 - 14:33
Joseph Antoine Ferdinand Plateau was a Belgian physicist whose research on visual perception laid the foundations of film, television and animated gifs
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