Study reveals surprises about vaginal bacteria linked to preterm birth

Multiple species of Gardnerella, bacteria sometimes associated with bacterial vaginosis and preterm birth, can coexist in the same vaginal microbiome, researchers report.

The findings add to the emerging picture of Gardnerella‘s effects on human health.

Gardnerella is a group of anaerobic bacteria that are commonly found in the vaginal microbiome. Higher levels of the bacteria are a signature of bacterial vaginosis (BV) and associated with higher risk of preterm birth, but it is also found in women who have no sign of disease.

“We were trying to understand diversity within Gardnerella,” says Ben Callahan, associate professor of population health and pathobiology at North Carolina State University and corresponding author of the study in the journal mSystems.

“Scientists have only recently begun to look at individual Gardnerella species, so we don’t know yet whether different species might have different health effects. So our main aim was to explore the ecology of Gardnerella.”

The unique challenge in sequencing the vaginal microbiome is that any samples will be predominantly composed of the host’s DNA, which makes extracting microbial data more expensive and time consuming. The research team’s first job was to establish a methodology that allowed them to identify distinct species of Gardnerella from the microbiome data.

“The available tools to study the vaginal microbiome would consider all Gardnerella as the same species,” says Hanna Berman, a postdoctoral research scholar and the study’s lead author.

“To even be able to do this work, we had to create our own database of Gardnerella genomes and devise a method to identify the different Gardnerella species. Hopefully this will also allow more researchers to be able to study Gardnerella diversity.”

The research team looked at sequencing data from three cohorts: two random populations of pregnant women, and one population with a history of preterm birth. They analyzed the metagenomic sequences of Gardnerella from the samples to see if there was a relationship between a particular Gardnerella species and preterm birth.

While they didn’t find a “smoking gun,” they did make two surprising findings.

First, they identified a potential 14th species of Gardnerella among the samples—prior to this work only 13 species had been identified.

They also saw that in the majority of samples in which Gardnerella was present, multiple species of Gardnerella coexisted in the same microbiome: anywhere from two to as many as all 14 known Gardnerella species were found in single samples.

“Normally if a species of bacteria has colonized an environment, we expect it to exclude close relatives that would occupy the same environmental niche and consume the same resources,” Callahan says. “I often say that with bacteria all things are possible, but this is still unusual. We also saw that when the overall microbial load is higher, Gardnerella is a higher proportion of the microbial load.

“Evidence continues to build that Gardnerella has an association with preterm birth, but the details of that relationship are complicated. In this work, we didn’t find one bad species of Gardnerella—they may all be bad. This is far from the end of the story.”

The researchers hope to explore questions of species coexistence and microbiome composition further in future work.

“The vaginal microbiome has been understudied,” Callahan says. “For example, it is often dominated by one species of Lactobacillus, which creates an environment that excludes other bacteria. When it isn’t there, Gardnerella is. So how do the bacteria interact?

“Answering these questions may lead to more effective treatments for BV, and for ways to predict and avoid preterm birth. This work is an important step in that process.”

The Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institutes of Health, and the March of Dimes funded the work.

NC State student Megan Anderson and additional researchers from Metagenomi, Inc. and Stanford University contributed to the work.

Source: NC State


‘Whole fruit’ chocolate could be healthier and more sustainable

Making maximum use of the cocoa fruit in chocolate could increase the profitability of cocoa cultivation and make the sweet treat healthier.

Chocolate’s main components are cocoa mass and cocoa butter, which are extracted from the cocoa fruit. What is less known, however, is that the cocoa fruit contains additional valuable ingredients that have been underutilized until now.

As part of an Innosuisse project, a research team led by Erich Windhab, professor emeritus at ETH Zurich, worked together with start-up Koa, which is dedicated to sustainable cocoa fruit cultivation, and Swiss chocolate manufacturer Felchlin to develop a recipe for cocoa fruit chocolate.

The cocoa fruit is similar to the honeydew melon, says Kim Mishra, main author of the study in the journal Nature Food. “These fruits have similar structures. Both have a hard outer shell that reveals the flesh of the fruit when cut open, as well as the cocoa beans or melon seeds and pulp in the interior.”

Conventional chocolate only makes use of the beans, but the researchers were able to use the flesh and parts of the fruit shell—or the endocarp, to use the field-specific term—for their cocoa fruit chocolate recipe. They process it into powder and mix it with part of the pulp to form cocoa gel. This gel substance is extremely sweet and can replace the added powdered sugar that is normally part of the chocolate experience.

However, it was not easy for the scientists to find the perfect recipe for cocoa fruit chocolate. They systematically tested the texture of various compositions in the lab. Too much fruit juice extracted from the pulp made for a clumpy chocolate, but too little resulted in an insufficiently sweet product.

The research team therefore endeavored to find the perfect balance between sweetness and texture. The issue with clumping does not arise when using powdered sugar. The experiments showed that chocolate may contain up to 20% of gel, which equivalates to the sweetness of chocolate with 5 to 10% percent powdered sugar. In comparison, conventional dark chocolate can easily contain between 30 and 40% powdered sugar.

To test the sensory experience of the new recipes, trained panelists from the Bern University of Applied Sciences taste-tested pieces of chocolate weighing 5 grams each, with some containing various amounts of powdered sugar and others containing the new variety sweetened with cocoa gel.

“This allowed us to empirically determine the sweetness of our recipe as expressed in the equivalent amount of powdered sugar,” says Mishra.

By using cocoa gel as a sweetener, cocoa fruit chocolate boasts a higher fiber content than your average European dark chocolate (15 grams versus 12 grams per 100 grams). It also contains only 23 grams of saturated fat as opposed to the usual 33 grams.

This means that ETH researchers were able to increase the fiber content by around 20% while reducing the saturated fat percentage by around 30%.

“Fiber is valuable from a physiological perspective because it naturally regulates intestinal activity and prevents blood sugar levels from rising too rapidly when consuming chocolate. Saturated fat can also pose a health risk when too much is consumed. There’s a relationship between increased consumption of saturated fats and increased risk of cardiovascular diseases,” explains Mishra.

Small-scale farmers can diversify their product offerings and increase their income if other components of the cocoa fruit can be marketed for chocolate production instead of just the beans. And if most of the fruit can be used to produce cocoa fruit chocolate, only the shell remains, which is traditionally used as fuel or composting material.

“This means that farmers can not only sell the beans, but also dry out the juice from the pulp and the endocarp, grind it into powder and sell that as well,” Mishra says. “This would allow them to generate income from three value-creation streams. And more value creation for the cocoa fruit makes it more sustainable.”

This doesn’t mean that cocoa fruit chocolate will be hitting grocery store shelves anytime soon, however.

“Although we’ve shown that our chocolate is attractive and has a comparable sensory experience to normal chocolate, the entire value creation chain will need to be adapted, starting with the cocoa farmers, who will require drying facilities,” says Mishra. “Cocoa fruit chocolate can only be produced and sold on a large scale by chocolate producers once enough powder is produced by food processing companies.”

The first step has been taken: ETH has filed a patent for its cocoa fruit chocolate recipe. The development of cocoa fruit chocolate is a promising example of how technology, nutrition, eco-compatibility, and income diversification for small farmers can all work in tandem to improve the entire value-creation chain of the cocoa plant.

Source: Deborah Kyburz for ETH Zurich


Otters use tools to protect teeth when prey is extra crunchy

Individual sea otters that use tools—most of whom are female—are able to eat larger prey and reduce tooth damage when their preferred prey becomes depleted.

For the new study in the journal Science, the researchers and their enlisted volunteer “otter spotters” followed 196 radio-tagged southern sea otters off the coast of California to better understand how the threatened species uses tools in a rapidly changing environment.

The research team monitored how the marine mammals used tools—such as rocks, shells, and trash—to break open prey and identified links to the animals’ dietary patterns and dental health.

For the first time, researchers found that the use of tools among male and female otters led to a reduction in tooth injuries.

“Sea otters vary in how often they use tools,” says Chris Law, a postdoctoral researcher and an early career provost fellow at the University of Texas at Austin who led the study while a graduate student at the University of California, Santa Cruz.

“The females are likely using tools to overcome their smaller body size and weaker biting ability in order to meet their calorie demands. Raising pups takes a lot of energy, and the females need to be efficient in their foraging. The study shows that tool use is an important behavior for survival.”

In the southern sea otter’s range of coastal Central California, some of the preferred prey such as large abalone and sea urchins are not difficult to break open. However, these food resources dwindle or disappeared in many areas. This leads otters to prey more often on crabs, clams, mussels, and small marine snails whose hard shells can damage the otter’s teeth in the process of prying them open.

Tooth condition is important for survival because when an otter’s teeth become too worn or damaged, they could starve. Using tools helped individual otters to meet their calorie needs by branching out into different types of prey. The study found female otters had less tooth damage than male otters did.

Research shows that female otters are more likely to use tools, and in the new study, those that did were able to access harder or larger prey than otters that did not use tools. In fact, females were able to consume prey that were up to 35% harder compared with that of males that used tools.

Female dolphins, chimps, and bonobos are also known to use tools more than their male counterparts, probably for the same reasons. In these species, females tend to raise offspring, and they are often the ones that pass down tool-use behavior to offspring.

Listed as a threatened species under the US Endangered Species Act, southern sea otters number only about 3,000 in California, where they play a critical role in marine ecosystems preying on sea urchins that feed on kelp forests.

Additional coauthors are from UT Austin; the University of California, Santa Cruz; the Monterey Bay Aquarium; the US Geological Survey; and the California Department of Fish and Wildlife.

The US National Science Foundation, Packard Foundation, Coastal Conservancy, US Fish and Wildlife Service, Pacific Gas & Electric, and Bureau of Ocean Energy Management funded the work.

Source: UT Austin


System predicts who’s at risk of quitting opioid treatment

Researchers have developed a system designed to identify patients at high risk of discontinuing buprenorphine treatment for opioid use disorder.

An FDA-approved prescription drug, buprenorphine is one of three commercially available treatments for opioid use disorder proven to be effective in treating both pain and addiction.

In a study published in the journal Computers in Biology and Medicine, Md Mahmudul Hasan, and his research team found that roughly 15% of patients did not complete the clinically recommended yearlong buprenorphine treatment, while about 46% of patients stopped treatment within the first three months.

With the help of artificial intelligence (AI), the team also identified high-risk patients and several factors associated with treatment discontinuation.

Hasan, an assistant professor in the University of Florida College of Pharmacy department of pharmaceutical outcomes and policy, says the retrospective study, which included insured individuals aged 18 to 64 who were prescribed buprenorphine to treat opioid use disorder, offers new insights to use in the fight against the national public health epidemic that claimed more than 80,000 lives in the United States in 2021.

The study measured gaps of 30 days or more when buprenorphine prescriptions weren’t filled within the first year of treatment. By building predictive models focusing on distinct treatment stages—the time of treatment initiation, one month, and three months following the start of treatment—Hasan’s team found that nearly 15% of patients discontinued treatment prematurely. The team notes this is a conservative estimate, as several patient exclusion criteria might have resulted in a lower discontinuation rate.

“We know that sticking with a buprenorphine treatment plan is beneficial. Premature discontinuation could increase the risk of hospitalization, drug overdose, and most importantly, mortality,” Hasan says. “If we can use AI to predict which patients are at a higher risk of this behavior, clinical practitioners can get to the root cause, make more informed decisions and design more targeted interventions for those patients.”

The researchers used a framework for machine learning prediction and risk stratification to help identify high-risk patients and determine which factors contribute to a lack of buprenorphine treatment compliance.

Risk factors identified in this study include age, gender, early treatment adherence, use of stimulants or antipsychotics, and the number of days’ supply associated with the first buprenorphine prescription that a patient receives. The study also found that living in rural areas and other treatment access barriers contribute to a higher risk of discontinuation.

“Younger patients are at a higher risk of prematurely stopping treatment, along with those with a history of stimulant use, including nicotine,” Hasan says. “We also found patients with lower buprenorphine adherence at the early treatment stage are more at risk of premature treatment discontinuation.”

When the technology developed in the study is available to medical centers across the country, it will save frontline clinicians precious time while giving patients more access to buprenorphine treatment, Hasan says.

“Primary care physicians are already overburdened and overworked, and they have limited resources. A tool like this that can reliably predict which patient will be high-risk could be helpful,” Hasan says.

“Within a short time and without increasing their workload, health care providers can identify the interventions needed for each patient, allowing them to best allocate their limited resources.”

Source: University of Florida


Jelly sea creature ‘jet propulsion’ could give robots a boost

Scientists have discovered that colonies of gelatinous sea animals swim through the ocean in giant corkscrew shapes using coordinated jet propulsion.

It’s an unusual kind of locomotion that could inspire new designs for efficient underwater vehicles.

Salps are small creatures that look similar to jellyfish that take a nightly journey from the depths of the ocean to the surface. Observing that migration with special cameras helped researchers capture the macroplankton’s graceful, coordinated swimming behavior.

“Salps are really weird animals.”

“The largest migration on the planet happens every single night: the vertical migration of planktonic organisms from the deep sea to the surface,” says Kelly Sutherland, an associate professor in biology at the University of Oregon’s Oregon Institute of Marine Biology, who led the research.

“They’re running a marathon every day using novel fluid mechanics. These organisms can be platforms for inspiration on how to build robots that efficiently traverse the deep sea.”

Despite looking similar to jellyfish, salps are barrel-shaped, watery macroplankton that are more closely related to vertebrates like fish and humans, says Alejandro Damian-Serrano, an adjunct professor in biology. They live far from shore and can live either as solitary individuals or operate in colonies, he says. Colonies consist of hundreds of individuals linked in chains that can be up to several meters long.

“Salps are really weird animals,” Damian-Serrano says. “While their common ancestor with us probably looked like a little boneless fish, their lineage lost a lot of those features and magnified others. The solitary individuals behave like this mothership that asexually breeds a chain of individual clones, cojoined together to produce a colony.”

But the most unique thing about these ocean creatures was found during the researchers’ ocean expeditions: their swimming techniques.

Exploring off the coast of Kailua-Kona, Hawaii, Sutherland and her team developed specialized 3D camera systems to bring their lab underwater. They conducted daytime scuba dives, “immersed in infinite blue,” as Damian-Serrano described, for high visibility investigations.

They also performed nighttime dives, when the black backdrop allowed for high-contrast imaging of the transparent critters. They encountered an immense flurry of different salps that were doing their nightly migration to the surface—and many photobombing sharks, squids, and crustaceans, Sutherland says.

Through imaging and recordings, the researchers noticed two modes of swimming. Where shorter colonies spun around an axis, like a spiraling football, longer chains would buckle and coil like a corkscrew. That’s called helical swimming.

Helical swimming is nothing new in biology, Sutherland says. Many microorganisms also spin and corkscrew through water, but the mechanisms behind the salps’ motion are different.

Microbes beat water with hair-like projections or tail whips, but salps swim via jet propulsion, Sutherland says. They have contracting muscle bands, like those in the human throat, that pump water sucked from one side of the body and squirted out the other end to create thrust, Damian-Serrano says.

The researchers also noticed that individual jets contracted at different times, causing the whole colony to steadily travel without pause. The jets were also angled, contributing to the spinning and coil swimming, Sutherland says.

“My initial reaction was really one of wonder and awe,” she says. “I would describe their motion as snake-like and graceful. They have multiple units pulsing at different times, creating a whole chain that moves very smoothly. It’s a really beautiful way of moving.”

Microrobots inspired by microbial swimmers already exist, Sutherland says, but this discovery paves the way for engineers to construct larger underwater vehicles. It may be possible to create robots that are silent and less turbulent when modeled after these efficient swimmers, Damian-Serrano says. A multijet design also may be energetically advantageous for saving fuel, he says.

Beyond microbes, larger organisms like plankton have yet to be described in this way, Sutherland says. With Sutherland’s new and innovative methods of studying sea creatures, scientists might come to realize that helical swimming is more pervasive than previously thought.

“It’s a study that opens up more questions than provides answers,” Sutherland says. “There’s this new way of swimming that hadn’t been described before, and when we started the study we sought to explain how it works.

“But we found that there are a lot more open questions, like what are the advantages of swimming this way? How many different organisms spin or corkscrew?”

The study is published in Science Advances. Additional coauthors are from Louisiana Universities Marine Consortium, University of South Florida, Roger Williams University, Marine Biological Laboratory, and Providence College.

The Gordon and Betty Moore Foundation and the Office of Naval Research supported the work.

Source: Leila Okahata for University of Oregon


‘Robot-phobia’ takes a toll on food and hotel workers

Using more robots to close labor gaps in the hospitality industry may backfire and cause more human workers to quit, according to a new study.

The study, which included more than 620 lodging and food service employees, found that “robot-phobia”—specifically the fear that robots and technology will take human jobs—increased workers’ job insecurity and stress, leading to greater intentions to leave their jobs.

The impact was more pronounced with employees who had real experience working with robotic technology. It also affected managers in addition to frontline workers.

The findings are published in the International Journal of Contemporary Hospitality Management.

“The turnover rate in the hospitality industry ranks among the highest across all non-farm sectors, so this is an issue that companies need to take seriously,” says lead author Bamboo Chen, a hospitality researcher in the Carson College of Business at Washington State University.

“The findings seem to be consistent across sectors and across both frontline employees and managers. For everyone, regardless of their position or sector, robot-phobia has a real impact.”

Food service and lodging industries were hit particularly hard by the pandemic lockdowns, and many businesses are still struggling to find enough workers. For example, the accommodation workforce in April 2024 was still 9.2% below what it was in February 2020, according to US Bureau of Labor Statistics. The ongoing labor shortage has inspired some employers to turn to robotic technology to fill the gap.

While other studies have focused on customers’ comfort with robots, this study focuses on how the technology affected hospitality workers. Chen and colleague Ruying Cai surveyed 321 lodging and 308 food service employees from across the US, asking a range of questions about their jobs and attitudes toward robots.

The survey defined “robots” broadly to include a range of robotic and automation technologies, such as human-like robot servers and automated robotic arms as well as self-service kiosks and tabletop devices.

Analyzing the survey data, the researchers found that having a higher degree of robot-phobia was connected to greater feelings of job insecurity and stress—which were then correlated with “turnover intention” or workers’ plans to leave their jobs. Those fears did not decrease with familiarity: employees who had more actual engagement with robotic technology in their daily jobs had higher fears that it would make human workers obsolete.

Perception also played a role. The employees who viewed robots as being more capable and efficient also ranked higher in turnover intention.

Robots and automation can be good ways to help augment service, Chen says, as they can handle tedious tasks humans typically do not like doing such as washing dishes or handling loads of hotel laundry. But the danger comes if the robotic additions cause more human workers to quit. The authors point out this can create a “negative feedback loop” that can make the hospitality labor shortage worse.

Chen recommends that employers communicate not only the benefits but the limitations of the technology—and place a particular emphasis on the role human workers play.

“When you’re introducing a new technology, make sure not to focus just on how good or efficient it will be. Instead, focus on how people and the technology can work together,” he says.

Source: Washington State University


Copper mining could be a bottleneck in switch to green energy

Copper cannot be mined quickly enough to keep up with current US policy guidelines to transition the country’s electricity and vehicle infrastructure to renewable energy, according to a new study.

The Inflation Reduction Act, signed into law in 2022, calls for 100% of cars manufactured to be electric vehicles by 2035. But an electric vehicle requires three to five times as much copper as an internal combustion engine vehicle—not to mention the copper required for upgrades to the electric grid.

“A normal Honda Accord needs about 40 pounds of copper. The same battery electric Honda Accord needs almost 200 pounds of copper. Onshore wind turbines require about 10 tons of copper, and in offshore wind turbines, that amount can more than double,” says Adam Simon, professor of earth and environmental studies at the University of Michigan. “We show in the paper that the amount of copper needed is essentially impossible for mining companies to produce.”

For the study, Simon and Cornell University researcher Lawrence Cathles examined 120 years of global data from mining companies, and calculated how much copper the US electricity infrastructure and fleet of cars would need to upgrade to renewable energy. It found that renewable energy’s copper needs would outstrip what copper mines can produce at the current rate.

The shortfall is in part because of the permitting process for mining companies. The average time between discovering a new copper mineral deposit and getting a permit to build a mine is about 20 years, according to Simon.

Copper is mined by more than 100 companies operating mines on six continents. The researchers drew data for global copper production back to the year 1900, which told them the global amount of copper mining companies had produced over 120 years. They then modeled how much copper mining companies are likely to produce for the rest of the century.

The researchers found that between 2018 and 2050, the world will need to mine 115% more copper than has been mined in all of human history up until 2018 just to meet “business as usual.”

This would meet our current copper needs and support the developing world without considering the green energy transition.

To meet the copper needs of electrifying the global vehicle fleet, as many as six new large mines must be brought online annually over the next several decades. About 40% of the production from new mines will be required for electric vehicle-related grid upgrades.

“I’m a huge fan of the Inflation Reduction Act. I think it’s fantastic. I’ve got solar panels, batteries, and an electric vehicle,” Simon says. “I’m fully on board with the energy transition. However, it needs to be done in a way that’s achievable.”

Instead of fully electrifying the US fleet of vehicles, the researchers suggest focusing on manufacturing hybrid vehicles.

“We are hoping the study gets picked up by policymakers who should consider copper as the limiting factor for the energy transition, and to think about how copper is allocated,” Simon says.

“We know, for example, that a Toyota Prius actually has a slightly better impact on climate than a Tesla. Instead of producing 20 million electric vehicles in the United States and globally, 100 million battery electric vehicles each year, would it be more feasible to focus on building 20 million hybrid vehicles?”

The researchers also point out that copper will be needed for developing countries to build infrastructure, such as building an electric grid for the approximately 1 billion people who don’t yet have access to electricity; to provide clean water drinking facilities for the approximately 2 billion people who don’t have access to clean water; and wastewater treatment for the 4 billion people who don’t have access to sanitation facilities.

“Renewable energy technologies, clean water, wastewater, electricity—it cannot exist without copper. So we then end up with tension between how much copper we need to build infrastructure in less developed countries versus how much copper we need for the energy transition,” Simon says.

“We think our study highlights that significant progress can be made to reduce emissions in the United States. However, the current—almost singular—emphasis on downstream manufacture of renewable energy technologies cannot be met by upstream mine production of copper and other metals without a complete mindset change about mining among environmental groups and policymakers.”

Source: University of Michigan


Why docs shouldn’t do telehealth visits in the kitchen

What a doctor has behind them during a telehealth video visit can make a difference in how a patient feels about them and their care, a new study finds.

Even if the doctor is miles away from their usual in-person clinic or exam room, they should make it look like they’re there, the study suggests.

Even better: sitting in an office with their diplomas hanging behind them—or perhaps having a virtual background that’s a photo of such an office. This is especially true if they haven’t seen the patient before, the study shows.

A home office with a bookshelf or a plain solid-color background are both acceptable to patients, too.

But providers should use blurred or virtual backgrounds if they carry out the visit in a home environment with a kitchen or a bed in the background, the study shows.

The findings come from a survey that asked patients to react to seven different backgrounds behind a model physician, and to rate how knowledgeable, trustworthy, caring, approachable, and professional the physician appeared in each, and how comfortable the patient would feel with that provider.

It also asked them to consider each background for a first or returning appointment with a primary care or specialty provider.

For the study, published in JAMA Network Open, more than 1,200 patients who had seen providers at one of the two health systems completed the study surveys, and the researchers compiled their responses.

Lead researcher Nathan Houchens is an associate professor of internal medicine at the University of Michigan and associate chief of medicine at the VA Ann Arbor Healthcare System (VAAAHS). His past work on how interpersonal communications affects the patient-provider relationship—including non-verbal factors like attire and posture—led to the new telehealth study.

“The transition to virtual care was rapid and came without specific guidance during the start of the COVID-19 pandemic, but telehealth appears to be here to stay so it’s important to understand what patients prefer when it comes to the setting their provider is in,” says Houchens, a hospitalist who worked with Jennifer Meddings, a general internist, and others for the study.

He notes that during the first year of the pandemic, providers were urged to conduct telehealth visits outside of clinics if they didn’t need to go in, to reduce the chance of COVID-19 transmission.

But now, some clinics have created dedicated spaces for providers to sit in if they have telehealth appointments on days when they’re also seeing patients in person. Some of those might be spaces shared with other clinicians, so a virtual background would also serve to reduce visual distractions.

Houchens notes that as telehealth increased in use and became a standard way to receive care, some guidance on “webside manner” has been suggested to guide providers in the ways in which they interact verbally over a virtual connection. But very little guidance is available about the background for their video visits.

Houchens and his colleagues were surprised at the level of dislike that patients had for kitchen and bedroom settings, with only 2% and 3.5% saying they preferred these backgrounds respectively, compared with 35% for an office with displayed diplomas, 18% for a physician office, 14% for a plain color background, and around the same for a home office with bookshelf or an exam room.

There were also significant differences in the composite scores for how patients rated the way each background would make them feel about receiving care from the provider. The bedroom and kitchen backgrounds received far lower composite scores than any of the other five backgrounds.

Houchens and colleagues including coauthor Sanjay Saint, have previously published work on patients’ preferences for what physicians wear during clinical encounters. Just like with video visit background, these seemingly superficial factors can actually make a difference in the patient experience, he says.

“Patients have expectations of what physicians’ attire and workspaces should look like. This study showed that patients prefer what have been previously termed traditional or professional attire and settings,” he says.

“Diplomas and credentials remind patients of the expertise they expect a physician to have, and conversely, something is lost when the background conveys a relaxed, informal home environment.”

The team is currently analyzing more data from the same study, to assess other factors that affect patients’ telehealth experiences—including their access to high-speed internet and their ability to use necessary technologies.

But for now, they suggest that providers can take immediate steps to conduct virtual visits from an office or exam room. Clinics may want to make unused clinical rooms available for use by providers conducting virtual visits during in-person clinic days.

Another option is to create virtual backgrounds that will evoke these types of professional settings.

Houchens also notes that while they haven’t yet studied what physicians think of the backgrounds behind patients during video visits, these may provide helpful information.

The rise of “Hospital at Home” and home-based primary care means that patients with more acute conditions may be able to see their providers virtually, and that their setting can give clues to the way physical and social factors play a role in their health.

Discussing visible elements from both a provider’s and a patient’s virtual background—art and other hobby-related items, for example—can also help build rapport, Houchens notes.

“This is a reminder that patients often do care about some of the details that providers and health systems may not have emphasized,” he says. “It’s important to remember that our words and our nonverbal behaviors are taken to heart by those we care for, and it behooves us to care about them as well.”

Source: University of Michigan


How to protect your dog from dangerous bacterial infection

Leptospirosis is a dangerous infection that can lead to kidney failure and even death in dogs. An expert has tips for keeping your four-legged friends safe and healthy.

“It’s heartbreaking when we see these cases,” says Emmanuelle Butty, assistant clinical professor at Cummings School of Veterinary Medicine at Tufts University, because an efficient vaccine for leptospirosis has been available for the past 20 years.

Leptospirosis is an illness caused by a bacteria called leptospira that can be present in soil and stagnant water. Rodents and other wildlife carry the bacteria and spread it through their urine.

Both humans and dogs can become sick with leptospirosis, while cats are considered disease-resistant. For both people and dogs, the result of infection can range from mild to deadly serious.

How is leptospirosis transmitted?

Most dogs become infected by drinking water from puddles or lakes, or by entering stagnant water when they have an open wound.

People, on the other hand, are more likely to become infected after a natural disaster such as a hurricane or flooding that disperses contaminated soil and water far and wide.

Dogs with an active infection can also transmit the disease to other dogs in the household, so Butty recommends that pet owners ask their vet about treating other pets with preventative antibiotics if their pet is diagnosed with leptospirosis.

Owners of infected pets should also reach out to their primary care physicians. “It’s a zoonotic disease,” Butty says. “It can be transmitted from animals to humans.”

Is your dog at risk?

“Every dog that has access to the outdoors is at risk of getting leptospirosis,” Butty says.

Leptospirosis is prevalent in New England, with the infection being most common in spring and fall.

A dog with leptospirosis will seem unwell and lethargic. They may vomit, have a decreased appetite, or refuse to eat. They may seem very thirsty, or their eyes and skin may appear yellow (a sign of jaundice).

But because the symptoms are nonspecific, Butty says a trip to the vet is in order to get an official diagnosis.

What if your dog gets leptospirosis?

Many dogs recover with antibiotics, but a subset will develop serious complications. Many organs can be affected, with the kidneys and liver topping the list.

Dogs that experience complete kidney failure can sometimes be saved by undergoing several sessions of dialysis. Taking over the function of the kidneys can keep the dog alive until they are able to recover from the infection.

“If we buy time,” Butty says, “we have a chance that the body will recover.”

The strategy works for some dogs, but not all. Butty recently published a study in the Journal of Veterinary Internal Medicine that she and her colleagues conducted to gain a deeper understanding of how often dialysis saves these dogs, with the goal of helping owners and vets make informed decisions about treatment

The researchers found that among 22 dogs with leptospirosis who experienced kidney failure and underwent dialysis, 16 survived.

“All of them would have died without dialysis because their kidneys were completely shut down,” she says, “but almost 75% of them were able to get out of the hospital. Even if things look really bad, there is a decent chance we will be able to save this animal.”

The study shows that survival was less likely if multiple organ systems were affected by the infection.

Dialysis for dogs is not cheap, though, so Butty recommends that dog owners consider pet insurance. “It can definitely save a life,” she says.

Even dogs that don’t require dialysis can have chronic health problems after a leptospirosis infection.

“It’s sad when dogs have chronic kidney disease at one or two years old,” Butty says. “Their lifespan is going to be reduced significantly.”

How can you protect your dog?

The leptospirosis vaccine is the easiest way to protect dogs from infection, but many dogs don’t receive it. Butty would like to change that.

“We have a good way to prevent the disease and to prevent the most severe cases of the disease, and that is the vaccine,” Butty says.

The leptospirosis vaccine consists of an initial two-shot series spaced four weeks apart, which can be started in puppies at 12 weeks of age, followed by yearly booster shots. The timing of the yearly boosters is important.

“If the booster is not on time, they are not considered vaccinated anymore and have to be restarted with the first two doses,” Butty says.

“Owners absolutely have to be on top of this and get an appointment with the vet before the due date.” These guidelines are part of the updated consensus statement on leptospirosis in dogs published in 2023.

Dogs may feel a little under the weather for a day or two after the vaccine, but serious reactions are extremely rare.

“I’ll take the vaccine reaction any day over ending up on dialysis because of complete kidney failure,” Butty says. “Dogs need to be vaccinated.”

Source: Mary-Russell Roberson for Tufts University


Firefighters may have higher prostate cancer risk

Firefighters may have an increased risk of prostate cancer due to on-the-job chemical exposures, according to new research.

Prostate cancer is the leading incident cancer among US males. Firefighters are diagnosed with prostate cancer at a rate 1.21 times higher than the general population, possibly because of chemical exposures including smoke and firefighting foam during firefighting.

Some of those chemicals can affect how genes are expressed through a process called epigenetic modification, and certain epigenetic modifications, including DNA methylation, contribute to cancer development.

Researchers found evidence that experienced firefighters have different epigenetic modifications than new firefighters in regions linked to prostate cancer.

“With these published findings, we have clear evidence of the health risks that firefighters face due to cumulative exposure on the job,” says Jeff Burgess, director of the Center for Firefighter Health Collaborative Research and professor at the University of Arizona Mel and Enid Zuckerman College of Public Health.

The study appears in the journal Environmental and Molecular Mutagenesis.

Burgess, also a member of the BIO5 Institute, has investigated firefighter health for decades. He collaborated with lead author Margaret Quaid and researcher Jackie Goodrich, from the University of Michigan, who led the analysis on the methylation of genes. The team also collaborated with fire service partners and researchers around the country through the Fire Fighter Cancer Cohort Study.

The researchers found that experienced firefighters had different epigenetic modifications at chromosome 8q24—a particular area of the genome where epigenetic modifications have been linked to prostate cancer risk—compared with new firefighters.

One class of chemicals that is linked with epigenetic modifications is per- and polyfluoroalkyl substances, or PFAS, which are used in firefighting foam as well as in many household items, including nonstick pans and water-resistant clothing. The researchers also investigated whether there was a link between exposure to PFAS and epigenetic modification.

The results showed that, in many fire departments, new and experienced firefighters had similar exposure to PFAS. However, exposure to a specific PFAS chemical—branched perfluorooctanoic acid, or PFOA—was linked to epigenetic modifications.

“This study demonstrates the power of the Fire Fighter Cancer Cohort Study to combine data across grants—in this case awards from the Federal Emergency Management Agency in 2014, 2015, and 2018—to more powerfully evaluate questions from the fire service, this time around exposures and increased prostate cancer risk,” Burgess says.

Additional coauthors are from the University of Arizona, the University of Miami, Rutgers University, the National Institute for Occupational Safety and Health at the Centers for Disease Control and Prevention, the Tucson Fire Department, the Los Angeles County Fire Department, the Orange County Fire Authority, and the Fire Protection Research Foundation.

The National Institute of Environmental Health Sciences, a division of the National Institutes of Health; the Federal Emergency Management Agency; and the Centers for Disease Control and Prevention funded the work.

Source: University of Arizona