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How schools can optimize support for children with ADHD

New research gives the clearest guidance yet on how schools can best support children with ADHD to improve symptoms and maximise their academic outcomes.

The study, led by the University of Exeter and involving researchers at the EPPI-Centre (University College London), undertook a systematic review which analysed all available research into non-medication measures to support children with ADHD in schools. Published in Review of Education, the paper found that interventions which include one-to-one support and a focus on self-regulation improved academic outcomes.

Around five per cent of children have ADHD, meaning most classrooms will include at least one child with the condition. They struggle to sit still, focus their attention and to control impulses much more than ordinary children of the same age. Schools can be a particularly challenging setting for these children, and their difficulty in waiting their turn or staying in their seat impacts peers and teachers. Research shows that medication is effective, but does not work for all children, and is not acceptable to some families.

The research was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula – or PenCLAHRC. The team found 28 randomised control trials on non-drug measures to support children with ADHD in schools. In a meta-analysis, they analysed the different components of the measures being carried out to assess the evidence for what was most effective.

The studies varied in quality, which limits the confidence the team can have in their results. They found that important aspects of successful interventions for improving the academic outcomes of children are when they focus on self-regulation and are delivered in one-to-one sessions.

Self- regulation is hard for children who are very impulsive and struggle to focus attention. Children need to learn to spot how they are feeling inside, to notice triggers and avoid them if possible, and to stop and think before responding. This is much harder for children with ADHD than most other children, but these are skills that can be taught and learned.

The team also found some promising evidence for daily report cards. Children are set daily targets which are reviewed via a card that the child carries between home and school and between lessons in school. Rewards are given for meeting targets. The number of studies looking at this was lower, and their findings did not always agree. But using a daily report card is relatively cheap and easy to implement. It can encourage home-school collaboration and offers the flexibility to respond to a child’s individual needs.

Tamsin Ford, Professor of Child Psychiatry at the University of Exeter Medical School, said: “Children with ADHD are of course all unique. It’s a complex issue and there is no one-size-fits-all approach. However, our research gives the strongest evidence to date that non-drug interventions in schools can support children to meet their potential in terms of academic and other outcomes. More and better quality research is needed but in the meantime, schools should try daily report cards and to increase children’s ability to regulate their emotions. These approaches may work best for children with ADHD by one-to-one delivery.”

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How to avoid raising a materialistic child

If you’re a parent, you may be concerned that materialism among children has been on the rise. According to research, materialism has been linked to a variety of mental health problems, such as anxiety and depression, as well as selfish attitudes and behaviors.

But there’s some good news. A new study published in the Journal of Positive Psychology suggests that some parenting tactics can curb kids’ materialistic tendencies.

“Our findings show that it is possible to reduce materialism among young consumers, as well as one of its most common negative consequences (nongenerosity) using a simple strategy — fostering gratitude for the things and people in their lives,” writes researcher Lan Nguyen Chaplin, associate professor of marketing at the University of Illinois at Chicago and coauthor of the study.

After studying a nationwide sample of more than 900 adolescents ages 11 to 17, Chaplin’s team found a link between fostering gratitude and its effects on materialism, suggesting that having and expressing gratitude may possibly decrease materialism and increase generosity among adolescents.

The team surveyed 870 adolescents and asked them to complete an online eight-item measure of materialism assessing the value placed on money and material goods, and a four-item measure of gratitude assessing how thankful they are for people and possessions in their lives.

The researchers then conducted an experiment among 61 adolescents and asked them to complete the same four-item gratitude measure from the first study and an eight-item materialism measure. The adolescents were randomly assigned to keep a daily journal for two weeks. One group was asked to record who and what they were thankful for each day by keeping a gratitude journal, and the control group was asked to record their daily activities.

After two weeks, the journals were collected and the participants completed the same gratitude and materialism measures as before. The kids were then given 10 $1 bills for participating and told they could keep all the money or donate some or all of it to charity.

Results showed that participants who were encouraged to keep a gratitude journal showed a significant decrease in materialism and increase in gratitude. The control group, which kept the daily activity journal, retained their pre-journal levels of gratitude and materialism.

In addition, the group that kept a gratitude journal was more generous than the control group. Adolescents, who were in the experimental group, wrote about who and what they were thankful for and donated more than two-thirds of their earnings. Those who were in the control group and simply wrote about their daily activities donated less than half of their earnings.

“The results of this survey study indicate that higher levels of gratitude are associated with lower levels of materialism in adolescents across a wide range of demographic groups,” Chaplin noted.

The authors also suggest that materialism can be curbed and feelings of gratitude can be enhanced by a daily gratitude reflection around the dinner table, having children and adolescents make posters of what they are grateful for, or keeping a “gratitude jar” where children and teens write down something they are grateful for each week, while countering materialism.

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Eating leafy greens could help prevent macular degeneration

A new study has shown that eating vegetable nitrates, found mainly in green leafy vegetables and beetroot, could help reduce your risk of developing early-stage age-related macular degeneration (AMD).

Researchers at the Westmead Institute for Medical Research interviewed more than 2,000 Australian adults aged over 49 and followed them over a 15-year period.

The research showed that people who ate between 100 to 142 mgs of vegetable nitrates each day had a 35% lower risk of developing early AMD than people who ate less than 69mgs of vegetable nitrates each day.

Lead Researcher Associate Professor Bamini Gopinath from the Westmead Institute and the University of Sydney said the link between vegetable nitrates and macular degeneration could have important implications.

“This is the first time the effects of dietary nitrates on macular degeneration risk has been measured.

“Essentially we found that people who ate 100 to 142 mgs of vegetable nitrates every day had a reduced risk of developing early signs of macular degeneration compared with people who ate fewer nitrates.

“If our findings are confirmed, incorporating a range of foods rich in dietary nitrates — like green leafy vegetables and beetroot — could be a simple strategy to reduce the risk of early macular degeneration,” Associate Professor Gopinath said.

Spinach has approximately 20mg of nitrate per 100g, while beetroot has nearly 15mg of nitrate per 100g.

The research did not show any additional benefits for people who exceeded 142mgs of dietary nitrate each day. It also did not show any significant connections between vegetable nitrates and late stage AMD, or between non-vegetable nitrates and AMD risk.

One in seven Australians over 50 have some signs of macular degeneration.

Age is the strongest known risk factor and the disease is more likely to occur after the age of 50.

There is currently no cure for the disease.

The research compiled data from the Blue Mountains Eye Study, a benchmark population-based study that started in 1992.

It is one of the world’s largest epidemiology studies, measuring diet and lifestyle factors against health outcomes and a range of chronic diseases.

“Our research aims to understand why eye diseases occur, as well as the genetic and environmental conditions that may threaten vision,” Associate Professor Gopinath concluded.

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The stress-free way to listen to your unborn baby's heart

Checking the heartbeat of babies in the womb is set to become more accurate and less stressful for expectant mothers thanks to research by the University of Sussex.

Dr Elizabeth Rendon-Morales has a developed a much more effective sensor to measure a baby’s heartbeat without needing to visit a hospital.

It could help detect heart-related congenital disorders during pregnancy or highlight the need for medical interventions due to complications such as premature delivery or umbilical cord compression.

The new technology would also greatly benefit women experiencing high-risk pregnancy factors, such as high blood pressure, diabetes, preeclampsia and gestational high blood pressure, who require regular monitoring to ensure the wellbeing of their baby.

Dr Rendon-Morales, a Lecturer in Electrical and Electronic Engineering at the University of Sussex, said: “Currently expectant mothers with health concerns about their babies have to go through the stress of going to hospital to check on the heartbeat of their child. With this new technology, they will be able to do this from the comfort of their own home, which will be much better for the welfare of mother and baby.”

The research is the first significant update in the technology used to measure babies’ heart rates for 40 years and moves away from the existing use of silver chloride electrodes.

Instead, the University of Sussex has developed an electrometer-based amplifier prototype using Electric Potential Sensing (EPS) technology, which allows for in utero fetal electrocardiogram monitoring by just placing the device on top of the skin of the pregnant mother’s abdomen in a non-invasive way.

Although there are some home-based fetal electrocardiograms available commercially, they are considered not suitable for daily or medical usage because of concerns around their accuracy and portability.

Dr Rodrigo Aviles-Espinosa, a research fellow at the University of Sussex and co-author of the study said: “This technology is a step forward for home-based medical devices, benefiting not only health service providers though resource optimization, but also expectant mothers who are experiencing a very exciting, but sometimes stressful, moment in their lives.

“This technology will give peace of mind in providing answers very quickly and ultimately ensuring the baby’s wellbeing.”

The technology developed at the University of Sussex is capable of recording information required to calculate fetal heart rate values and variability with high accuracy.

This can be used to clinically assess congenital cardiac diseases such as arrhythmia and to monitor processes associated with body auto regulation such as blood pressure and heart vascular tone.

The electrocardiogram can isolate the baby’s heartbeat from the mother’s with pinpoint accuracy, providing a simple reading without the need for any additional processing.

Devices currently in use require complex signal-conditioning algorithms to separate the maternal and fetal cardiac waveforms.

The new detector also removes the need for a special gel to be applied to the skin. This is necessary when using silver chloride electrodes, in order to establish a reading, but the process can produce inaccurate readings.

Dr Rendon-Morales said: “Although the ultrasound procedure is described as being non-invasive, having gel rubbed on your skin and then an electrode pressed against your womb is invasive and can be an uncomfortable experience for mothers. With this new heart monitor, expectant mothers can get reassurance that their baby is doing fine within a few seconds, removing the unnecessary stress and worry that waiting for a hospital scan currently involves.”

The new baby monitor has grown out of previous work Dr Rendon-Morales had published in 2015 in which she used highly sensitive sensors to map the electrical activity of the developing heart in the embryos of zebrafish, which are 2,500 times smaller than human hearts.

The potential of the technology to be adapted for human mothers and babies was recognised by Dr Heike Rabe, a consultant neonatologist at Brighton and Sussex Medical School.

Dr Rabe said: “At the moment it is sometimes difficult to distinguish between the heartbeat of the mother and that of the baby with the current ultrasound technique. Often there is signal loss as well. With the new technique we hope to recognize much earlier if a baby should be delivered quickly if their heart rate drops and does not recover.”

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The neurobiology of social aggression

Duke-NUS researchers have discovered that a growth factor protein, called brain-derived neurotrophic factor (BDNF), and its receptor, tropomyosin receptor kinase B (TrkB) affects social dominance in mice. The research has implications for understanding the neurobiology of aggression and bullying.

“Humans and rodents are social animals. Our every interaction follows rules according to a social hierarchy. Failure to navigate this hierarchy can be detrimental.” explained senior author A/Prof. Hyunsoo Shawn Je, from the Neuroscience and Behavioural Disorders Signature Research Programme at Duke-NUS Medical School. “Our paper may be the first to demonstrate that specific molecular signalling pathways in specialised nerve cells, in a particular location in the brain, are important for the balanced navigation of social hierarchies.”

Difficulties in navigating these hierarchies can lead to problems like aggression and bullying. “Given the heavy societal cost of bullying and aggression, understanding the biological causes is a step towards their effective prevention and treatment,” A/Prof. Je added.

Activity within the brain is mediated by circuits made up of excitatory neurons, which ramp up activity, and GABA-ergic interneurons, which inhibit and quiet the excitatory activity. Previous studies have shown that BDNF-TrkB signalling is important for the maturation of GABA-ergic interneurons and the development of nerve circuits in the brain. But researchers have not been able to pinpoint the behavioural consequences of disrupted BDNF-TrkB signalling.

A/Prof. Je’s team generated transgenic mice in which the TrkB receptor was removed specifically in the GABAergic interneurons in the area of the brain regulating emotional and social behaviour, known as the corticolimbic system. The transgenic mice exhibited unusual aggressive behaviour when housed together with normal mice. To understand the origin of this behaviour, the team conducted behavioural tests. They found that the mice were not being aggressive to protect their territory. They were also not being aggressive because they were stronger; the transgenic mice were injured more than other mice during acts of aggression. Instead, their aggressive behaviour was a result of increased fighting for status and dominance over other mice in the group.

The researchers found that due to the loss of BDNF-TrkB, GABA-ergic interneurons in these transgenic mice supplied weaker inhibition to surrounding excitatory cells, which became overactive. They proceeded to shut down excitatory neurons in a specific area of the transgenic mice brains, which re-established the “excitatory/inhibitory” balance and which “instantaneously reversed the abnormal social dominance,” says Duke-NUS post-doctoral research fellow Dr. Shawn Pang Hao Tan, who was the first author of the paper.

A significant amount of research has focused on the roles of family and peer networks on aggressive behaviour. This study, together with other recently published findings, demonstrates that genetic and biological factors can play an unexpected role in social behaviours, said Je.

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Why some cancers affect only young women

Among several forms of pancreatic cancer, one of them affects specifically women, often young. How is this possible, even though the pancreas is an organ with little exposure to sex hormones? This pancreatic cancer, known as “mucinous cyst,” has strange similarities with another mucinous cancer, affecting the ovaries. By conducting large-scale analyses of genomic data, researchers at the University of Geneva (UNIGE) and at the University Hospitals of Geneva (HUG), Switzerland, in collaboration with colleagues from the United States have provided an answer: both tumours originate from embryonic germ cells. While still undifferentiated, these cells migrate to the reproductive organs. On their way, some can mistakenly stop in other organs, bringing a risk of tumour that may occur 30 years later. By allowing a better classification of these mucinous tumours, this study, to be read in the Journal of Pathology, paves the way for a more appropriate and personalized management aligned with the tumour’s origin.

Mucinous tumours of the ovary and pancreas affect young women — between 30 and 40 years of age. They take the form of a large cyst, a kind of ball filled with liquid. Rare — they account for about 3% of ovarian and pancreatic cancers — they are usually treated by surgery. Taken in time, the cancerous cyst is completely removed. However, in 15% of cases, the cyst breaks before surgery; the cancer cells spread into the peritoneum, giving rise to metastases that are highly resistant to chemotherapy. In such cases, the survival prognosis of patients does not exceed one year.

“Initially, this work was based on clinical observation,” says study leader Dr. Intidhar Labidi-Galy, a researcher at the Translational Research Centre in Onco-haematology at the UNIGE Faculty of Medicine and a physician at the HUG. “As a specialist in ovarian cancer, I came across an article detailing the genetic profile of mucinous tumours of the pancreas. To my great surprise, they had the same genetic alterations as mucinous tumours of the ovary, although these two organs have no direct relationship with each other. Dr. Kevin Elias, assistant professor of obstetrics and gynecology at Brigham’s and Women’s Hospital, Boston, USA and first author of the paper, identifies the close links between the two tumours: “We found the same genetic mutations, the same types of victims — young women, often smokers — and, even more surprisingly, ovarian tissue in pancreatic cysts.”

A common origin

Why is a non-gynaecological cancer almost exclusively female? What is the link between the ovary and the pancreas? “It is only during embryogenesis that these organs are really close. At the very beginning of pregnancy, the embryo possesses primordial germ cells — in a way, precursors of gametes, oocytes or spermatozoa — which, between 4 and 6 weeks of pregnancy, makes a long migration in the human body. They pass behind the future pancreas and arrive in the outline of the gonads, around the 7th week of pregnancy. Most likely, some of these germ cells stop on the way,” says Dr. Labidi-Galy.

Using public databases, Kevin Elias and Petros Tsantoulis from UNIGE, together with Intidhar Labidi-Galy and co-leader Ronny Drapkin from University of Pennsylvania have developed a transcriptomic profile — which identifies gene expression levels in a tissue — of primordial germ cells at 6, 7, 11, 16 and 17 weeks of pregnancy, as well as of tumoral and healthy ovarian and pancreatic cells.

The researchers then compared these data, on one hand with the pancreas and on the other hand with the ovary, by studying for each of these two organs the profile of healthy tissues, mucinous tumours and other types of tumours. Their results are clear: in both cases, the transcriptomic profile of the mucinous tumour is far away from the supposed tissue of origin (ovary or pancreas), but very close to the primordial germ cells. This proves that these tumours are closer to the primordial germ cells than to the organ in which they developed.

Unexpected stops during migration

These results indicate that a stop in cell migration that occurred accidentally during the embryonic life of these women may, decades later, be expressed as cancer, depending on their other risk factors (e.g. smoking) and where in the body these primordial germ cells have settled. Indeed, while the scientists have examined the pancreas and ovary, similar cases have been reported everywhere on the migration line of germ cells, particularly in the liver or peritoneum.

“Our results will not change the surgical management of these patients, but may lead us to reflect on chemotherapy protocols. These rare tumours are a bit like the orphan diseases of cancers, for which there are no standard treatments. By linking them to other cancers, we hope to identify treatments that would be effective. For each mutation, what is the best treatment? We are here at the heart of personalized oncology: knowing your enemy in every detail makes it easier to fight him,” concludes Dr. Labidi-Galy.

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Scientists find brain signal that might help us judge the holiday buffet

At holiday buffets and potlucks, people make quick calculations about which dishes to try and how much to take of each. Johns Hopkins University neuroscientists have found a brain region that appears to be strongly connected to such food preference decisions.

Researchers, working with rats, found robust neural activity related to food choice in a previously overlooked part of the brain. The finding suggests this brain area could be key to developing therapies and treatments to encourage healthy eating. The findings are set for publication in the journal Nature Communications.

“We found a region in the brain that reflects our perception of food in a strikingly dominant way,” said lead author David Ottenheimer, a Johns Hopkins University graduate student studying neuroscience. “The level of brain activity we saw exceeded our expectations by far.”

The research team wanted to know how the brain determines what and how much to eat when someone has several good food options. It’s a situation people face daily, if not at buffets or potlucks, then when looking over restaurant menus or at what’s in the refrigerator.

This might seem automatic as you move down a buffet line, but when someone is considering either mac and cheese or mashed potatoes, the brain must quickly determine which of those quite similar choices — both tasty, both treats, both carbs — would be most rewarding. Even if we can have both, Ottenheimer says, the dish that’s the favorite will likely be eaten faster and with bigger bites.

To study this question, researchers gave rats two similar sugary drinks. The rats preferred the one made with sucrose over the one with maltodextrin, and when they received sucrose, they’d lick it faster.

Over several days, the rats were given either one drink or the other. Meanwhile, the team mapped the rats’ brain activity precisely at the moment the animals realized which drink they’d gotten, pinpointing the neurons that registered the excitement for sucrose, and the disappointment for maltodextrin.

The activated neurons were in an area called the ventral pallidum, a spot long associated with reward and pleasure perception, but thought to be in more of a secondary role.

Next, the team presented rats with a different set of options — either the maltodextrin drink or plain water. In this scenario, when rats got maltodextrin, ventral pallidum neurons fired liked they had for sucrose. This suggests the brain area is making context-dependent decisions, zeroing in on the best food option at any given time.

“Because the signaling by ventral pallidum neurons changes immediately when the rat changes his ranking of which flavor is his favorite, we see this response as providing a real-time readout of what you like best from currently available options,” said senior author Patricia Janak, a Bloomberg Distinguished Professor of Psychological and Brain Sciences and Neuroscience.

The next step is to figure what the signaling in this part of the brain means. Is it used to reinforce prior food-seeking actions and make them more likely to occur again? Or is it used to inform future decisions and bias them towards one food reward over the other next time someone is presented with a food choice?

“Our data suggest that further investigation of ventral pallidum will be critical for understanding how we make decisions about eating,” Ottenheimer said. “If we want to figure out why a food can be exciting in one scenario and disappointing in another, ventral pallidum could be the key.”

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Securing access to optimal cancer care through innovation, integration and sustainability

Securing access to optimal cancer care for all patients can only be achieved through integrated, sustainable translation of today’s scientific advances into tomorrow’s treatments, reinforced by a clear understanding of the magnitude of clinical effects and accurate identification of patients most likely to benefit.

At the opening press conference of ESMO 2018 Congress, Scientific Chair, Professor Solange Peters stressed the importance of ensuring that the innovations reported at the meeting reach the right patients at the right time.

“ESMO 2018 is first and foremost about innovation, and compelling clinical trial data will be presented about potential new treatments for breast, prostate, ovarian and other cancers. But the conference is also about integration and sustainability, and we are encouraging a more integrated approach to cancer care as well as supporting essential policy-informing discussions about affordable, sustainable models of care,” she said.

Over the next few days, data will be presented from over 2000 submitted abstracts, representing nearly 116,000 patients who have taken part in clinical trials. Amongst studies focused on access to care will be important research demonstrating large variations between countries in time for reimbursement decisions on new cancer drugs. This shows that some European countries take more than twice as long as others to reach health technology assessment (HTA) decisions to reimburse new cancer drugs following their approval by the European Medicines Agency (EMA). The average decision time is longer than one year in some countries (1).

“Without timely reimbursement decisions, based on appropriate evaluation of a new medicine’s benefits and cost-effectiveness, patients may miss out on potentially life-changing cancer medicines,” explained study co-author Dr Kerstin Vokinger, senior research scientist at the University Hospital of Zurich, Switzerland, and affiliated researcher at Harvard Medical School, Boston, USA.

The study found that health authorities generally made decisions much more quickly for drugs ranked as being of “highest benefit” on the ESMO Magnitude of Clinical Benefit Scale (ESMO-MCBS) which uses a rational, structured and consistent approach to grade the magnitude of clinical benefit that can be expected from anti-cancer treatments (2,3) Together with the recently published ESMO Scale for Clinical Actionability of molecular Targets (ESCAT) (4) which simplifies and standardises choices for targeted cancer treatment, ESMO-MCBS is helping to ensure that treatment decisions are based on the highest standards of evidence.

“ESMO is a driver of change affecting the entire field of oncology. ESMO-MCBS and ESCAT are grounding treatment choices in the best available evidence, helping to enhance decision making for both clinicians and healthcare providers, and making a major contribution to securing access to optimal cancer care for all patients, wherever they live,” concluded ESMO President, Josep Taberno.

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Social media for medical journals operates in 'wild west,' needs more support to succeed

Much of the published medical research goes unread by the general public and medical community, despite being largely funded by the federal government and private foundations. To reach more people, medical journals have begun using social media to promote new research.

A new Northwestern Medicine study has found social media editors lack established best practices and support from their journals and home institutions, making it difficult for them to successfully promote new research.

In general, the median citation rate for journal articles — when one paper refers to another paper — is zero, meaning a lot of new research isn’t being read even in the medical community. If utilized correctly, social media could help journals increase awareness of new research, according to the study. But first, social media editors need more resources and support.

“American tax dollars are paying for research the public never hears about,” said senior author Dr. Seth Trueger, assistant professor of emergency medicine at Northwestern University Feinberg School of Medicine and a practicing physician at Northwestern Medicine. “I’m optimistic we can get the word out through social media, but we first need to explore and develop tried-and-true methods to distribute this information to the public.”

Study authors urge medical journals to define social media editor roles and responsibilities more clearly and provide more resources to social media editors.

The study was published this week in the journal Academic Medicine. It is the first study to examine this specific role of social media editor at medical journals.

Journals may be able to help social media editors to more effectively get the word out and determine which strategies are most effective, study authors said. Doing so will help journals and social media editors better focus their limited resources.

“Many journals have been building social media editor positions, which is great, but as a relatively new niche, our study found journals didn’t really know what these people should be doing,” Trueger said. “They would tell new editors to ‘take this job and do what you can with it.’ It’s the wild west.”

The study also found: (1) monetary support for these roles is lacking; (2) journals use different metrics to measure engagement and success; and (3) there is no consistency in editor responsibilities among journals.

In addition to his role at Northwestern, Trueger previously was the social media editor for the Annals of Emergency Medicine. He is now the digital media editor at JAMA Network Open and said his goal is to “get eyeballs on the science.”

Something Trueger has learned in these positions is how impactful social media can be for medical research, if done properly.

“If you have a paper on a Medicare program, you don’t just have physicians looking at that research; there are health economists, patient groups and the general public who have an interest in it,” Trueger said. “If we can determine which strategies work for online dissemination, a social media editor’s success rate for sharing new information to a wide audience can skyrocket.”

Medical schools and universities should better incorporate social media engagement with more tangible support, such as academic credit toward promotion and tenure, according to the study.

Given the overall lack of tangible support reported by social media editors in the study, medical journals should consider providing non-physician staff to help manage social media accounts to support editors in their positions, the study suggested.

Twenty-four social media editors from 19 medical journals participated in the study. The study was funded by the Summer Research Program at the Pritzker School of Medicine at the University of Chicago, which is in part funded by the National Institutes of Health.

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New cell movement process key to understanding and repairing facial malformations

The embryonic stem cells that form facial features, called neural crest cells, use an unexpected mechanism of moving from the back of the head to the front to populate the face, finds a new UCL-led study.

The researchers say their findings could help understand how facial defects form, bringing scientists one step closer to repairing craniofacial malformations in the embryo.

The new study, published in Science, reports a new and surprising mechanism that is likely to be important for other processes involving cell movement, such as cancer invasion during metastasis or wound healing, which may pave the way to develop new forms of therapies for each.

“Our findings solve a long-standing question in the scientific community about how cells move. The traditional explanation likens the process to how a train moves: there is an engine at the front of the train that generates the force, pulling the rest of the train forward. Our surprising discovery shows that the engine moving the cells is at the back and not at the front,” said the study’s lead author, Professor Roberto Mayor (UCL Cell & Developmental Biology).

This has important consequences as any new therapies based on modifying cell movement to repair facial malformation, improve wound healing or inhibit cancer metastasis should target the back cells, and not the front cells as traditionally done.

“In the womb, neural crest cells need to migrate from the back to the front of the head in order to form the face. For the first time, we’ve identified how that migration happens, and it appears to be similar to how you would squeeze toothpaste from the back of a tube to move the contents at the front,” said Professor Mayor.

The discovery has important implications for understanding the causes of facial defects, such as cleft palate and facial palsy, which account for a third of all birth defects globally (3.2 million each year) and are the primary cause of infant mortality*.

For the study, the researchers investigated embryos of both frogs and fish, because their neural crest cells behave in a similar way to those of humans and their movement is often used to study the spread of cancer. In addition, the embryo development of frogs and fish can be studied without inflicting harm.

The team used light to control the behaviour of the neural crest cell cluster using a technique called optogenetics. After identifying a protein cable surrounding the cluster that contracts to move the cluster, they found that when neural crest cells at the back of the embryo were illuminated with a laser beam, they contracted and led to movement towards the face.

“By clarifying how faces develop, we can begin to investigate how that process can occur incompletely or differently to cause facial defects, and hopefully identify ways to prevent such harmful defects,” said PhD researcher Adam Shellard (UCL Cell & Developmental Biology), a co-author of the paper.

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