Riviste scientifiche

Nations of the world agree to ban nuclear weapons – now what?

New Scientist - Me, 12/07/2017 - 16:14
Most of the world’s countries have agreed a treaty to ban nuclear weapons, but with the nuclear powers boycotting it, will it make a difference?

Why your favourite websites are protesting over the net’s future

New Scientist - Me, 12/07/2017 - 16:05
A campaign on 12 July opposes repeal of US net neutrality laws that ensure all web traffic is treated equally, but to succeed it must spark a wider discussion

Backstreet fried chicken shops must stop using killer trans fat

New Scientist - Me, 12/07/2017 - 14:47
Cheap fast food in deprived pockets of the UK has slipped through the net in the war on harmful trans fats. Time to dish up a solution, says Anthony Warner

Uninhabitable Earth? In fact, it’s really hard to fry the planet

New Scientist - Me, 12/07/2017 - 14:43
A controversial article says we’re heading for the worst-case warming scenarios. But while we can’t rule out extreme warming, it’s not our most likely future

Transformer robots can be printed on demand in just 13 minutes

New Scientist - Me, 12/07/2017 - 12:34
A reconfigurable robot made only from wire and motors can be printed to suit your needs. When the job is done, simply recycle it into a new robot

Whales sneak into shallow water to eat salmon from hatcheries

New Scientist - Me, 12/07/2017 - 02:01
Humpbacks have been spotted feeding on baby salmon bred for release into the wild to restock fisheries for the first time, competing with fishermen

Ants build living towers that flow like a fountain in reverse

New Scientist - Me, 12/07/2017 - 02:01
The rules that guide fire ants to make tall towers with their own bodies could be applied to miniature search-and-rescue robots

Spider waves its front legs like antennae to mimic warlike ants

New Scientist - Me, 12/07/2017 - 02:01
This sneaky jumping spider performs antics to fool predators in what is an unusual example of mimicry through behaviour, rather than appearance

Cellular therapies in trauma and critical care medicine: Looking towards the future

PLoS Medicine - Ma, 11/07/2017 - 23:00

by Shibani Pati, Todd E. Rasmussen

Shibani Pati and Todd Rasmussen summarize progress in preclinical research on cellular therapeutics for traumatic injury and its sequelae and discuss prospects for clinical translation.

Time for trauma immunology

PLoS Medicine - Ma, 11/07/2017 - 23:00

by Timothy R. Billiar, Yoram Vodovotz

Timothy Billiar summarizes the role of the innate immune response in the clinical course following severe injury and envisions a field of "trauma immunology."

Community and health system intervention to reduce disrespect and abuse during childbirth in Tanga Region, Tanzania: A comparative before-and-after study

PLoS Medicine - Ma, 11/07/2017 - 23:00

by Stephanie A. Kujawski, Lynn P. Freedman, Kate Ramsey, Godfrey Mbaruku, Selemani Mbuyita, Wema Moyo, Margaret E. Kruk

Background

Abusive treatment of women during childbirth has been documented in low-resource countries and is a deterrent to facility utilization for delivery. Evidence for interventions to address women’s poor experience is scant. We assessed a participatory community and health system intervention to reduce the prevalence of disrespect and abuse during childbirth in Tanzania.

Methods and findings

We used a comparative before-and-after evaluation design to test the combined intervention to reduce disrespect and abuse. Two hospitals in Tanga Region, Tanzania were included in the study, 1 randomly assigned to receive the intervention. Women who delivered at the study facilities were eligible to participate and were recruited upon discharge. Surveys were conducted at baseline (December 2011 through May 2012) and after the intervention (March through September 2015). The intervention consisted of a client service charter and a facility-based, quality-improvement process aimed to redefine norms and practices for respectful maternity care. The primary outcome was any self-reported experiences of disrespect and abuse during childbirth. We used multivariable logistic regression to estimate a difference-in-difference model. At baseline, 2,085 women at the 2 study hospitals who had been discharged from the maternity ward after delivery were invited to participate in the survey. Of these, 1,388 (66.57%) agreed to participate. At endline, 1,680 women participated in the survey (72.29% of those approached). The intervention was associated with a 66% reduced odds of a woman experiencing disrespect and abuse during childbirth (odds ratio [OR]: 0.34, 95% CI: 0.21–0.58, p < 0.0001). The biggest reductions were for physical abuse (OR: 0.22, 95% CI: 0.05–0.97, p = 0.045) and neglect (OR: 0.36, 95% CI: 0.19–0.71, p = 0.003). The study involved only 2 hospitals in Tanzania and is thus a proof-of-concept study. Future, larger-scale research should be undertaken to evaluate the applicability of this approach to other settings.

Conclusions

After implementation of the combined intervention, the likelihood of women’s reports of disrespectful treatment during childbirth was substantially reduced. These results were observed nearly 1 year after the end of the project’s facilitation of implementation, indicating the potential for sustainability. The results indicate that a participatory community and health system intervention designed to tackle disrespect and abuse by changing the norms and standards of care is a potential strategy to improve the treatment of women during childbirth at health facilities. The trial is registered on the ISRCTN Registry, ISRCTN 48258486.

Trial registration

ISRCTN Registry, ISRCTN 48258486

Trends in traumatic brain injury mortality in China, 2006–2013: A population-based longitudinal study

PLoS Medicine - Ma, 11/07/2017 - 23:00

by Peixia Cheng, Peng Yin, Peishan Ning, Lijun Wang, Xunjie Cheng, Yunning Liu, David C. Schwebel, Jiangmei Liu, Jinlei Qi, Guoqing Hu, Maigeng Zhou

Background

Traumatic brain injury (TBI) is a significant global public health problem, but has received minimal attention from researchers and policy-makers in low- and middle-income countries (LMICs). Epidemiological evidence of TBI morbidity and mortality is absent at the national level for most LMICs, including China. Using data from China’s Disease Surveillance Points (DSPs) system, we conducted a population-based longitudinal analysis to examine TBI mortality, and mortality differences by sex, age group, location (urban/rural), and external cause of injury, from 1 January 2006 to 31 December 2013 in China.

Method and findings

Mortality data came from the national DSPs system of China, which has coded deaths using the International Classification of Diseases–10th Revision (ICD-10) since 2004. Crude and age-standardized mortality with 95% CIs were estimated using the census population in 2010 as a reference population. The Cochran–Armitage trend test was used to examine the significance of trends in mortality from 2006 to 2013. Negative binomial models were used to examine the associations of TBI mortality with location, sex, and age group. Subgroup analysis was performed by external cause of TBI. We found the following: (1) Age-adjusted TBI mortality increased from 13.23 per 100,000 population in 2006 to 17.06 per 100,000 population in 2008 and then began to fall slightly. In 2013, age-adjusted TBI mortality was 12.99 per 100,000 population (SE = 0.13). (2) Compared to females and urban residents, males and rural residents had higher TBI mortality risk, with adjusted mortality rate ratios of 2.57 and 1.71, respectively. TBI mortality increased substantially with older age. (3) Motor vehicle crashes and falls were the 2 leading causes of TBI mortality between 2006 and 2013. TBI deaths from motor vehicle crashes in children aged 0–14 years and adults aged 65 years and older were most often in pedestrians, and motorcyclists were the first or second leading category of road user for the other age groups. (4) TBI mortality attributed to motor vehicle crashes increased for pedestrians and motorcyclists in all 7 age groups from 2006 to 2013. Our analysis was limited by the availability and quality of data in the DSPs dataset, including lack of injury-related socio-economic factors, policy factors, and individual and behavioral factors. The dataset also may be incomplete in TBI death recording or contain misclassification of mortality data.

Conclusions

TBI constitutes a serious public health threat in China. Further studies should explore the reasons for the particularly high risk of TBI mortality among particular populations, as well as the reasons for recent increases in certain subgroups, and should develop solutions to address these challenges. Interventions proven to work in other cultures should be introduced and implemented nationwide. Examples of these in the domain of motor vehicle crashes include policy change and enforcement of laws concerning helmet use for motorcyclists and bicyclists, car seat and booster seat use for child motor vehicle passengers, speed limit and drunk driving laws, and alcohol ignition interlock use. Examples to prevent falls, especially among elderly individuals, include exercise programs, home modification to reduce fall risk, and multifaceted interventions to prevent falls in all age groups.

Years of life lost due to traumatic brain injury in Europe: A cross-sectional analysis of 16 countries

PLoS Medicine - Ma, 11/07/2017 - 23:00

by Marek Majdan, Dominika Plancikova, Andrew Maas, Suzanne Polinder, Valery Feigin, Alice Theadom, Martin Rusnak, Alexandra Brazinova, Juanita Haagsma

Introduction

Traumatic brain injuries (TBIs) are a major public health, medical, and societal challenge globally. They present a substantial burden to victims, their families, and the society as a whole. Although indicators such as incidence or death rates provide insight into the occurrence and outcome of TBIs in various populations, they fail to quantify the full extent of their public health and societal impact. Measures such as years of life lost (YLLs), which quantifies the number of years of life lost because the person dies prematurely due to a disease or injury, should be employed to better quantify the population impact. The aim of this study was to provide an in-depth analysis of the burden of deaths due to TBI by calculating TBI-specific YLLs in 16 European countries, analyzing their main causes and demographic patterns, using data extracted from death certificates under unified guidelines and collected in a standardized manner.

Methods and findings

A population-wide, cross-sectional epidemiological study was conducted in 16 European countries to estimate TBI YLLs for the year 2013. The data used for all analyses in this study were acquired from the statistical office of the European Union (Eurostat). A specifically tailored dataset of micro-level data was provided that listed the external cause of death (International Classification of Diseases–10th Revision [ICD-10] codes V01–Y98), the specific nature of injury (ICD-10 codes S00–T98), the age at death, and sex for each death. Overall number of TBI YLLs, crude and age-standardized TBI YLL rates, and TBI YLLs per case were calculated stratified for country, sex, and age. Pooled analyses were performed in order to estimate summary age-standardized rates of TBI YLLs. In order to evaluate the relative importance of TBI in the context of all injuries, proportions of TBI YLLs out of overall injury YLLs were calculated. The total number of TBI YLLs was estimated by extrapolating the pooled crude rate of TBI YLLs in the 16 analyzed countries to the total population of the 28 member states of the EU (EU-28). We found that a total of 17,049 TBI deaths occurred in 2013 in the 16 analyzed countries. These translated into a total of 374,636 YLLs. The pooled age-standardized rate of YLLs per 100,000 people per year was 259.1 (95% CI: 205.8 to 312.3) overall, 427.5 (95% CI: 290.0 to 564.9) in males, and 105.4 (95% CI: 89.1 to 121.6) in females. Males contributed substantially more to TBI YLLs than females (282,870 YLLs, 76% of all TBI YLLs), which translated into a rate ratio of 3.24 (95% CI: 3.22 to 3.27). Each TBI death was on average associated with 24.3 (95% CI: 22.0 to 26.6) YLLs overall, 25.6 (95% CI: 23.4 to 27.8) in males and 20.9 (17.9 to 24.0) in females. Falls and traffic crashes were the most common external causes of TBI YLLs. TBI contributed on average 41% (44% in males and 34% in females) to overall injury YLLs. Extrapolating our findings, about 1.3 million YLLs were attributable to TBI in the EU-28 in 2013 overall, 1.1 million in males and 271,000 in females. This study is based on administratively collected data from 16 countries, and despite the efforts to harmonize them to the greatest possible extent, there may be differences in coding practices or reporting between countries. If present, these would be inherited into our findings without our ability to control for them. The extrapolation of the pooled rates from the 16 countries to the EU-28 should be interpreted with caution.

Conclusions

Our study showed that TBI-related deaths and YLLs have a substantial impact at the individual and population level in Europe and present an important societal and economic burden that must not be overlooked. We provide information valuable for policy-makers, enabling them to evaluate and plan preventive activities and resource allocation, and to formulate and implement strategic decisions. In addition, our results can serve as a basis for analyzing the overall burden of TBI in the population.

Validation of the sensitivity of the National Emergency X-Radiography Utilization Study (NEXUS) Head computed tomographic (CT) decision instrument for selective imaging of blunt head injury patients: An observational study

PLoS Medicine - Ma, 11/07/2017 - 23:00

by William R. Mower, Malkeet Gupta, Robert Rodriguez, Gregory W. Hendey

Background

Clinicians, afraid of missing intracranial injuries, liberally obtain computed tomographic (CT) head imaging in blunt trauma patients. Prior work suggests that clinical criteria (National Emergency X-Radiography Utilization Study [NEXUS] Head CT decision instrument [DI]) can reliably identify patients with important injuries, while excluding injury, and the need for imaging in many patients. Validating this DI requires confirmation of the hypothesis that the lower 95% confidence limit for its sensitivity in detecting serious injury exceeds 99.0%.A secondary goal of the study was to complete an independent validation and comparison of the Canadian and NEXUS Head CT rules among the subgroup of patients meeting the inclusion and exclusion criteria.

Methods and findings

We conducted a prospective observational study of the NEXUS Head CT DI in 4 hospital emergency departments between April 2006 and December 2015. Implementation of the rule requires that patients satisfy 8 criteria to achieve “low-risk” classification. Patients are excluded from “low-risk” classification and assigned “high-risk” status if they fail to meet 1 or more criteria. We examined the instrument’s performance in assigning “high-risk” status to patients requiring neurosurgical intervention among a cohort of 11,770 blunt head injury patients.The NEXUS Head CT DI assigned high-risk status to 420 of 420 patients requiring neurosurgical intervention (sensitivity, 100.0% [95% confidence interval [CI]: 99.1%–100.0%]). The instrument assigned low-risk status to 2,823 of 11,350 patients who did not require neurosurgical intervention (specificity, 24.9% [95% CI: 24.1%–25.7%]). None of the 2,823 low-risk patients required neurosurgical intervention (negative predictive value [NPV], 100.0% [95% CI: 99.9%–100.0%]).The DI assigned high-risk status to 759 of 767 patients with significant intracranial injuries (sensitivity, 99.0% [95% CI: 98.0%–99.6%]). The instrument assigned low-risk status to 2,815 of 11,003 patients who did not have significant injuries (specificity, 25.6% [95% CI: 24.8%–26.4%]). Significant injuries were absent in 2,815 of the 2,823 patients assigned low-risk status (NPV, 99.7% [95% CI: 99.4%–99.9%]).Of our patients, 7,759 (65.9%) met the inclusion and exclusion criteria of the Canadian Head CT rule, including 111 patients (1.43%) who required neurosurgical intervention and 306 (3.94%) who had significant intracranial injuries. In our study, the Canadian criteria for neurosurgical intervention identified 108 of 111 patients requiring neurosurgical intervention to yield a sensitivity of 97.3% (95% CI: 92.3%–99.4%) and exhibited a specificity of 58.8% (95% CI: 57.7%–59.9%). The NEXUS rule, when applied to this same cohort, identified all 111 patients requiring neurosurgical intervention, yielding a sensitivity of 100% (95% CI: 96.7%–100.0%) with a specificity of 32.6% (95% CI: 31.5%–33.6%). Our study found that the Canadian medium-risk factors identified 301 of 306 patients with significant injuries (sensitivity = 98.4%; 95% CI: 96.2%–99.5%), while the NEXUS rule identified 299 of these patients (sensitivity = 97.7%; 95% CI: 95.3%–99.1%). In our study, the Canadian medium-risk rule exhibited a specificity of 12.3% (95% CI: 11.6%–13.1%), while the NEXUS rule exhibited a specificity of 33.3% (95% CI: 32.3%–34.4%).Limitations of the study may arise from application of the rule by different clinicians in different environments. Clinicians may vary in their interpretation and application of the instrument’s criteria and risk assignment and may also vary in deciding which patients require intervention. The instrument’s specificity is also subject to spectrum bias and may change with variations in the proportion of “low-risk” patients seen in other centers.

Conclusions

The NEXUS Head CT DI reliably identifies blunt trauma patients who require head CT imaging and could significantly reduce the use of CT imaging.

Boy finds ‘extinct’ frog in Ecuador and helps revive species

New Scientist - Ma, 11/07/2017 - 18:00
A citizen science prize of $1000 got one family looking for a once-common amphibian. Their rediscovery of it has led to tadpoles hatching in captivity

Online harassment on the rise – but no one can agree what it is

New Scientist - Ma, 11/07/2017 - 17:00
People in the US want more policing of online harassment, but the varying ways it affects different groups make it difficult to agree on a definition

Child tooth is fourth fossil clue to mysterious Denisovan humans

New Scientist - Ma, 11/07/2017 - 16:30
Genetic analysis shows a tooth from the Denisova cave in Siberia is only the fourth specimen from elusive early humans who lived alongside Neanderthals

San Francisco is first US city to ban flavoured tobacco products

New Scientist - Ma, 11/07/2017 - 16:30
Menthol cigarettes are disproportionately smoked by black and gay smokers in California, and some hope banning flavoured tobacco will protect these groups

Invisibility cloak makes solar panels work more efficiently

New Scientist - Ma, 11/07/2017 - 14:50
A new material that hides the metal grid on top of solar panels make them 9 per cent more efficient in lab tests

Melting ice may be making mountains collapse in Greenland

New Scientist - Ma, 11/07/2017 - 13:56
The collapse of the mountain which triggered a tsunami that destroyed an Arctic village last month may have been caused by climate change – and more may follow
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