Riviste scientifiche

World’s most northern island and climate change’s role in floods

Nature - Mer, 08/09/2021 - 00:00

Nature, Published online: 08 September 2021; doi:10.1038/d41586-021-02422-9

The latest science news, in brief.

Indonesia’s science super-agency must earn researchers’ trust

Nature - Mer, 08/09/2021 - 00:00

Nature, Published online: 08 September 2021; doi:10.1038/d41586-021-02419-4

The drastic shake-up of the country’s science system is intended to boost innovation, but there are concerns about political interference in the new centralized agency.

Watch a one-legged robot hop about as researchers try to knock it over

New Scientist - Mar, 07/09/2021 - 20:00
A one-legged robot that can stand, hop and keep its balance on sloping or unsteady surfaces could offer a cheaper route to bipedal bots and self-balancing exoskeletons

Gene responsible for cat fur patterns could lead to designer pets

New Scientist - Mar, 07/09/2021 - 18:00
Researchers have discovered the genetic basis for the different patterns of fur seen in domestic cats, but caution against the idea of using this to create pets with specific coats

Some animals are evolving new body shapes as the climate changes

New Scientist - Mar, 07/09/2021 - 18:00
Some endotherms, commonly called warm-blooded animals, have grown larger wings, beaks or tails to increase their surface area, which helps them stay cool as the world warms

The cardiovascular effects of amodiaquine and structurally related antimalarials: An individual patient data meta-analysis

PLoS Medicine - Mar, 07/09/2021 - 16:00

by Xin Hui S. Chan, Ilsa L. Haeusler, Yan Naung Win, James Pike, Borimas Hanboonkunupakarn, Maryam Hanafiah, Sue J. Lee, Abdoulaye Djimdé, Caterina I. Fanello, Jean-René Kiechel, Marcus VG Lacerda, Bernhards Ogutu, Marie A. Onyamboko, André M. Siqueira, Elizabeth A. Ashley, Walter RJ Taylor, Nicholas J. White

Background

Amodiaquine is a 4-aminoquinoline antimalarial similar to chloroquine that is used extensively for the treatment and prevention of malaria. Data on the cardiovascular effects of amodiaquine are scarce, although transient effects on cardiac electrophysiology (electrocardiographic QT interval prolongation and sinus bradycardia) have been observed. We conducted an individual patient data meta-analysis to characterise the cardiovascular effects of amodiaquine and thereby support development of risk minimisation measures to improve the safety of this important antimalarial.

Methods and findings

Studies of amodiaquine for the treatment or prevention of malaria were identified from a systematic review. Heart rates and QT intervals with study-specific heart rate correction (QTcS) were compared within studies and individual patient data pooled for multivariable linear mixed effects regression.The meta-analysis included 2,681 patients from 4 randomised controlled trials evaluating artemisinin-based combination therapies (ACTs) containing amodiaquine (n = 725), lumefantrine (n = 499), piperaquine (n = 716), and pyronaridine (n = 566), as well as monotherapy with chloroquine (n = 175) for uncomplicated malaria. Amodiaquine prolonged QTcS (mean = 16.9 ms, 95% CI: 15.0 to 18.8) less than chloroquine (21.9 ms, 18.3 to 25.6, p = 0.0069) and piperaquine (19.2 ms, 15.8 to 20.5, p = 0.0495), but more than lumefantrine (5.6 ms, 2.9 to 8.2, p < 0.001) and pyronaridine (−1.2 ms, −3.6 to +1.3, p < 0.001). In individuals aged ≥12 years, amodiaquine reduced heart rate (mean reduction = 15.2 beats per minute [bpm], 95% CI: 13.4 to 17.0) more than piperaquine (10.5 bpm, 7.7 to 13.3, p = 0.0013), lumefantrine (9.3 bpm, 6.4 to 12.2, p < 0.001), pyronaridine (6.6 bpm, 4.0 to 9.3, p < 0.001), and chloroquine (5.9 bpm, 3.2 to 8.5, p < 0.001) and was associated with a higher risk of potentially symptomatic sinus bradycardia (≤50 bpm) than lumefantrine (risk difference: 14.8%, 95% CI: 5.4 to 24.3, p = 0.0021) and chloroquine (risk difference: 8.0%, 95% CI: 4.0 to 12.0, p < 0.001). The effect of amodiaquine on the heart rate of children aged <12 years compared with other antimalarials was not clinically significant. Study limitations include the unavailability of individual patient-level adverse event data for most included participants, but no serious complications were documented.

Conclusions

While caution is advised in the use of amodiaquine in patients aged ≥12 years with concomitant use of heart rate–reducing medications, serious cardiac conduction disorders, or risk factors for torsade de pointes, there have been no serious cardiovascular events reported after amodiaquine in widespread use over 7 decades. Amodiaquine and structurally related antimalarials at the World Health Organization (WHO)-recommended doses alone or in ACTs are safe for the treatment and prevention of malaria.

Call for emergency action to limit global temperature increases, restore biodiversity, and protect health

PLoS Medicine - Mar, 07/09/2021 - 16:00

by Lukoye Atwoli, Abdullah H. Baqui, Thomas Benfield, Raffaella Bosurgi, Fiona Godlee, Stephen Hancocks, Richard Horton, Laurie Laybourn-Langton, Carlos Augusto Monteiro, Ian Norman, Kirsten Patrick, Nigel Praities, Marcel GM Olde Rikkert, Eric J. Rubin, Peush Sahni, Richard Smith, Nick Talley, Sue Turale, Damián Vázquez

Derivation and external validation of a risk score for predicting HIV-associated tuberculosis to support case finding and preventive therapy scale-up: A cohort study

PLoS Medicine - Mar, 07/09/2021 - 16:00

by Andrew F. Auld, Andrew D. Kerkhoff, Yasmeen Hanifa, Robin Wood, Salome Charalambous, Yuliang Liu, Tefera Agizew, Anikie Mathoma, Rosanna Boyd, Anand Date, Ray W. Shiraishi, George Bicego, Unami Mathebula-Modongo, Heather Alexander, Christopher Serumola, Goabaone Rankgoane-Pono, Pontsho Pono, Alyssa Finlay, James C. Shepherd, Tedd V. Ellerbrock, Alison D. Grant, Katherine Fielding

Background

Among people living with HIV (PLHIV), more flexible and sensitive tuberculosis (TB) screening tools capable of detecting both symptomatic and subclinical active TB are needed to (1) reduce morbidity and mortality from undiagnosed TB; (2) facilitate scale-up of tuberculosis preventive therapy (TPT) while reducing inappropriate prescription of TPT to PLHIV with subclinical active TB; and (3) allow for differentiated HIV–TB care.

Methods and findings

We used Botswana XPRES trial data for adult HIV clinic enrollees collected during 2012 to 2015 to develop a parsimonious multivariable prognostic model for active prevalent TB using both logistic regression and random forest machine learning approaches. A clinical score was derived by rescaling final model coefficients. The clinical score was developed using southern Botswana XPRES data and its accuracy validated internally, using northern Botswana data, and externally using 3 diverse cohorts of antiretroviral therapy (ART)-naive and ART-experienced PLHIV enrolled in XPHACTOR, TB Fast Track (TBFT), and Gugulethu studies from South Africa (SA). Predictive accuracy of the clinical score was compared with the World Health Organization (WHO) 4-symptom TB screen. Among 5,418 XPRES enrollees, 2,771 were included in the derivation dataset; 67% were female, median age was 34 years, median CD4 was 240 cells/μL, 189 (7%) had undiagnosed prevalent TB, and characteristics were similar between internal derivation and validation datasets. Among XPHACTOR, TBFT, and Gugulethu cohorts, median CD4 was 400, 73, and 167 cells/μL, and prevalence of TB was 5%, 10%, and 18%, respectively. Factors predictive of TB in the derivation dataset and selected for the clinical score included male sex (1 point), ≥1 WHO TB symptom (7 points), smoking history (1 point), temperature >37.5°C (6 points), body mass index (BMI) <18.5kg/m2 (2 points), and severe anemia (hemoglobin <8g/dL) (3 points). Sensitivity using WHO 4-symptom TB screen was 73%, 80%, 94%, and 94% in XPRES, XPHACTOR, TBFT, and Gugulethu cohorts, respectively, but increased to 88%, 87%, 97%, and 97%, when a clinical score of ≥2 was used. Negative predictive value (NPV) also increased 1%, 0.3%, 1.6%, and 1.7% in XPRES, XPHACTOR, TBFT, and Gugulethu cohorts, respectively, when the clinical score of ≥2 replaced WHO 4-symptom TB screen. Categorizing risk scores into low (<2), moderate (2 to 10), and high-risk categories (>10) yielded TB prevalence of 1%, 1%, 2%, and 6% in the lowest risk group and 33%, 22%, 26%, and 32% in the highest risk group for XPRES, XPHACTOR, TBFT, and Gugulethu cohorts, respectively. At clinical score ≥2, the number needed to screen (NNS) ranged from 5.0 in Gugulethu to 11.0 in XPHACTOR. Limitations include that the risk score has not been validated in resource-rich settings and needs further evaluation and validation in contemporary cohorts in Africa and other resource-constrained settings.

Conclusions

The simple and feasible clinical score allowed for prioritization of sensitivity and NPV, which could facilitate reductions in mortality from undiagnosed TB and safer administration of TPT during proposed global scale-up efforts. Differentiation of risk by clinical score cutoff allows flexibility in designing differentiated HIV–TB care to maximize impact of available resources.

Altering product placement to create a healthier layout in supermarkets: Outcomes on store sales, customer purchasing, and diet in a prospective matched controlled cluster study

PLoS Medicine - Mar, 07/09/2021 - 16:00

by Christina Vogel, Sarah Crozier, Daniel Penn-Newman, Kylie Ball, Graham Moon, Joanne Lord, Cyrus Cooper, Janis Baird

Background

Previous product placement trials in supermarkets are limited in scope and outcome data collected. This study assessed the effects on store-level sales, household-level purchasing, and dietary behaviours of a healthier supermarket layout.

Methods and findings

This is a prospective matched controlled cluster trial with 2 intervention components: (i) new fresh fruit and vegetable sections near store entrances (replacing smaller displays at the back) and frozen vegetables repositioned to the entrance aisle, plus (ii) the removal of confectionery from checkouts and aisle ends opposite. In this pilot study, the intervention was implemented for 6 months in 3 discount supermarkets in England. Three control stores were matched on store sales and customer profiles and neighbourhood deprivation. Women customers aged 18 to 45 years, with loyalty cards, were assigned to the intervention (n = 62) or control group (n = 88) of their primary store. The trial registration number is NCT03518151. Interrupted time series analysis showed that increases in store-level sales of fruits and vegetables were greater in intervention stores than predicted at 3 (1.71 standard deviations (SDs) (95% CI 0.45, 2.96), P = 0.01) and 6 months follow-up (2.42 SDs (0.22, 4.62), P = 0.03), equivalent to approximately 6,170 and approximately 9,820 extra portions per store, per week, respectively. The proportion of purchasing fruits and vegetables per week rose among intervention participants at 3 and 6 months compared to control participants (0.2% versus −3.0%, P = 0.22; 1.7% versus −3.5%, P = 0.05, respectively). Store sales of confectionery were lower in intervention stores than predicted at 3 (−1.05 SDs (−1.98, −0.12), P = 0.03) and 6 months (−1.37 SDs (−2.95, 0.22), P = 0.09), equivalent to approximately 1,359 and approximately 1,575 fewer portions per store, per week, respectively; no differences were observed for confectionery purchasing. Changes in dietary variables were predominantly in the expected direction for health benefit. Intervention implementation was not within control of the research team, and stores could not be randomised. It is a pilot study, and, therefore, not powered to detect an effect.

Conclusions

Healthier supermarket layouts can improve the nutrition profile of store sales and likely improve household purchasing and dietary quality. Placing fruits and vegetables near store entrances should be considered alongside policies to limit prominent placement of unhealthy foods.

Trial registration

ClinicalTrials.gov NCT03518151 (pre-results)

Assisted reproduction technology and long-term cardiometabolic health in the offspring

PLoS Medicine - Mar, 07/09/2021 - 16:00

by Ronald C. W. Ma, Noel Y. H. Ng, Lai Ping Cheung

Ronald Ma and co-authors discuss Emma Norrman and colleagues’ accompanying research study on the health of children born with assisted reproductive technology.

Cardiovascular disease, obesity, and type 2 diabetes in children born after assisted reproductive technology: A population-based cohort study

PLoS Medicine - Mar, 07/09/2021 - 16:00

by Emma Norrman, Max Petzold, Mika Gissler, Anne Lærke Spangmose, Signe Opdahl, Anna-Karina Henningsen, Anja Pinborg, Aila Tiitinen, Annika Rosengren, Liv Bente Romundstad, Ulla-Britt Wennerholm, Christina Bergh

Background

Some earlier studies have found indications of significant changes in cardiometabolic risk factors in children born after assisted reproductive technology (ART). Most of these studies are based on small cohorts with high risk of selection bias. In this study, we compared the risk of cardiovascular disease, obesity, and type 2 diabetes between singleton children born after ART and singleton children born after spontaneous conception (SC).

Methods and findings

This was a large population-based cohort study of individuals born in Norway, Sweden, Finland, and Denmark between 1984 and 2015. Data were obtained from national ART and medical birth registers and cross-linked with data from national patient registers and other population-based registers in the respective countries. In total, 122,429 children born after ART and 7,574,685 children born after SC were included. Mean (SD) maternal age was 33.9 (4.3) years for ART and 29.7 (5.2) for SC, 67.7% versus 41.8% were primiparous, and 45.2% versus 32.1% had more than 12 years of education. Preterm birth (<37 weeks 0 days) occurred in 7.9% of children born after ART and 4.8% in children born after SC, and 5.7% versus 3.3% had a low birth weight (<2,500 g). Mean (SD) follow-up time was 8.6 (6.2) years for children born after ART and 14.0 (8.6) years for children born after SC. In total, 135 (0.11%), 645 (0.65%), and 18 (0.01%) children born after ART were diagnosed with cardiovascular disease (ischemic heart disease, cardiomyopathy, heart failure, or cerebrovascular disease), obesity or type 2 diabetes, respectively. The corresponding values were 10,702 (0.14%), 30,308 (0.74%), and 2,919 (0.04%) for children born after SC. In the unadjusted analysis, children born after ART had a significantly higher risk of any cardiovascular disease (hazard ratio [HR] 1.24; 95% CI 1.04–1.48; p = 0.02), obesity (HR 1.13; 95% CI 1.05–1.23; p = 0.002), and type 2 diabetes (HR 1.71; 95% CI 1.08–2.73; p = 0.02). After adjustment, there was no significant difference between children born after ART and children born after SC for any cardiovascular disease (adjusted HR [aHR]1.02; 95% CI 0.86–1.22; p = 0.80) or type 2 diabetes (aHR 1.31; 95% CI 0.82–2.09; p = 0.25). For any cardiovascular disease, the 95% CI was reasonably narrow, excluding effects of a substantial magnitude, while the 95% CI for type 2 diabetes was wide, not excluding clinically meaningful effects. For obesity, there was a small but significant increased risk among children born after ART (aHR 1.14; 95% CI 1.06–1.23; p = 0.001). Important limitations of the study were the relatively short follow-up time, the limited number of events for some outcomes, and that the outcome obesity is often not considered as a disease and therefore not caught by registers, likely leading to an underestimation of obesity in both children born after ART and children born after SC.

Conclusions

In this study, we observed no difference in the risk of cardiovascular disease or type 2 diabetes between children born after ART and children born after SC. For obesity, there was a small but significant increased risk for children born after ART.

Trial registration number

ISRCTN11780826.

The latent tuberculosis cascade-of-care among people living with HIV: A systematic review and meta-analysis

PLoS Medicine - Mar, 07/09/2021 - 16:00

by Mayara Lisboa Bastos, Luca Melnychuk, Jonathon R. Campbell, Olivia Oxlade, Dick Menzies

Background

Tuberculosis preventive therapy (TPT) reduces TB-related morbidity and mortality in people living with HIV (PLHIV). Cascade-of-care analyses help identify gaps and barriers in care and develop targeted solutions. A previous latent tuberculosis infection (LTBI) cascade-of-care analysis showed only 18% of persons in at-risk populations complete TPT, but a similar analysis for TPT among PLHIV has not been completed. We conducted a meta-analysis to provide this evidence.

Methods and findings

We first screened potential articles from a LTBI cascade-of-care systematic review published in 2016. From this study, we included cohorts that reported a minimum of 25 PLHIV. To identify new cohorts, we used a similar search strategy restricted to PLHIV. The search was conducted in Medline, Embase, Health Star, and LILACS, from January 2014 to February 2021. Two authors independently screened titles and full text and assessed risk of bias using the Newcastle–Ottawa Scale for cohorts and Cochrane Risk of Bias for cluster randomized trials. We meta-analyzed the proportion of PLHIV completing each step of the LTBI cascade-of-care and estimated the cumulative proportion retained. These results were stratified based on cascades-of-care that used or did not use LTBI testing to determine eligibility for TPT. We also performed a narrative synthesis of enablers and barriers of the cascade-of-care identified at different steps of the cascade.A total of 71 cohorts were included, and 70 were meta-analyzed, comprising 94,011 PLHIV. Among the PLHIV included, 35.3% (33,139/94,011) were from the Americas and 29.2% (27,460/94,011) from Africa. Overall, 49.9% (46,903/94,011) from low- and middle-income countries, median age was 38.0 [interquartile range (IQR) 34.0;43.6], and 65.9% (46,328/70,297) were men, 43.6% (29,629/67,947) were treated with antiretroviral therapy (ART), and the median CD4 count was 390 cell/mm3 (IQR 312;458). Among the cohorts that did not use LTBI tests, the cumulative proportion of PLHIV starting and completing TPT were 40.9% (95% CI: 39.3% to 42.7%) and 33.2% (95% CI: 31.6% to 34.9%). Among cohorts that used LTBI tests, the cumulative proportions of PLHIV starting and completing TPT were 60.4% (95% CI: 58.1% to 62.6%) and 41.9% (95% CI:39.6% to 44.2%), respectively. Completion of TPT was not significantly different in high- compared to low- and middle-income countries. Regardless of LTBI test use, substantial losses in the cascade-of-care occurred before treatment initiation. The integration of HIV and TB care was considered an enabler of the cascade-of-care in multiple cohorts. Key limitations of this systematic review are the observational nature of the included studies, potential selection bias in the population selection, only 14 cohorts reported all steps of the cascade-of-care, and barriers/facilitators were not systematically reported in all cohorts.

Conclusions

Although substantial losses were seen in multiple stages of the cascade-of-care, the cumulative proportion of PLHIV completing TPT was higher than previously reported among other at-risk populations. The use of LTBI testing in PLHIV in low- and middle-income countries was associated with higher proportion of the cohorts initiating TPT and with similar rates of completion of TPT.

Covid-19 news: Antibodies are less effective against delta variant

New Scientist - Mar, 07/09/2021 - 13:47
The latest coronavirus news updated every day including coronavirus cases, the latest news, features and interviews from New Scientist and essential information about the covid-19 pandemic

High-res carbon emission maps reveal climate impact of commuting

New Scientist - Mar, 07/09/2021 - 12:50
High-resolution maps of carbon emissions have revealed how our day-to-day patterns of behaviour, such as commuting, affect the release of greenhouse gases, and could help governments quickly see the impact of green policies

First full survey of Peru and Chile’s threatened fog island ecosystems

New Scientist - Mar, 07/09/2021 - 02:01
So-called fog oases along the dry coast of Peru and Chile are home to medicinal plants – and a survey suggests they can grow in an area four times greater than previously thought

From the archive

Nature - Mar, 07/09/2021 - 00:00

Nature, Published online: 07 September 2021; doi:10.1038/d41586-021-02377-x

Nature’s pages feature a book review of Moby-Dick, and a look at the job market for PhDs in 1971.

License CRISPR patents for free to share gene editing globally

Nature - Mar, 07/09/2021 - 00:00

Nature, Published online: 07 September 2021; doi:10.1038/d41586-021-02420-x

Universities hold the majority of CRISPR patents. They are in a strong position to ensure that the technology is widely shared for education and research.

Kids and COVID: why young immune systems are still on top

Nature - Mar, 07/09/2021 - 00:00

Nature, Published online: 07 September 2021; doi:10.1038/d41586-021-02423-8

Innate immunity might be the key to why children have fared better with the virus. But the Delta variant poses fresh unknowns.

How misconduct helped psychological science to thrive

Nature - Mar, 07/09/2021 - 00:00

Nature, Published online: 07 September 2021; doi:10.1038/d41586-021-02421-w

Grass-roots action against bad behaviour has spurred reform — and should keep going.

Success! Mars rover finally collects its first rock core

Nature - Mar, 07/09/2021 - 00:00

Nature, Published online: 07 September 2021; doi:10.1038/d41586-021-02394-w

NASA’s Perseverance rover lives up to its name, drilling and storing Martian rock after a misstep in August.