Many parents know the struggle of having to make children with pneumonia finish the usual 10-day course in antibiotics despite the child feeling better after a few days of medication.
New research from McMaster University has proven that a five-day course of high-dose amoxicillin will do just as well for children six months to 10 years old with common pneumonia.
“Several studies have proven that adults with pneumonia do fine with short courses of antibiotics, and now we have proved a short course of antibiotics also works for children,” said Dr. Jeffrey Pernica, lead study author, associate professor of pediatrics of McMaster’s Michael G. DeGroote School of Medicine and an infectious disease pediatrician for Hamilton Health Sciences.
The study, involving 281 Ontario children, found that 85.7% of those who received the short course of antibiotics and 84.1% of those who received the longer course of medication were cured two to three weeks later.
The paper was published online by the journal JAMA Pediatrics today.
“The dramatic increase in antimicrobial resistance in the world today is driven by overuse of antibiotics — which has only worsened during the COVID-19 pandemic,” Pernica said. “This is why we need these clinical studies — to figure out how short we can make antibiotic treatment courses for common infections.”
He said there are other reasons to use the least amount of antibiotics needed to effectively treat bacterial infections, including minimizing the costs of medicine.
As well, he noted, a number of conditions including obesity, asthma, and arthritis, have been associated with changes in the human microbiome that can be caused by the use of antibiotics.
The research team is recommending that clinical practice guidelines prepared for health professionals consider recommending five days of amoxicillin for pediatric pneumonia.
This study was supported by the PSI Foundation, Pediatric Emergency Research Canada and Hamilton Health Sciences.
The research is part of Canada’s Global Nexus for Pandemics and Biological Threats, an international network based at McMaster, with scientists, clinicians, engineers, social scientists and other experts working collaboratively to prevent future pandemics and mitigate global health threats.

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Mental health issues such as burnout and psychological distress are matters for concern among young adults, and are even more pertinent in today’s uncertain global climate. A recent paper by Yale-NUS College alumna Ms Joanna Chue (Class of 2019) and Assistant Professor of Social Sciences (Psychology) Cheung Hoi Shan identified five components of resilience that are applicable in Singapore’s cultural context, and demonstrated that college students possessing a higher degree of resilience were less susceptible to burnout and psychological distress. By identifying learnable components of resilience, the paper points to concrete, actionable ways that young adults can learn this vital characteristic, resulting in better mental health outcomes.
Published in Current Psychology in February 2021, the paper reported the results of two interrelated studies. The first established the validity of the Connor-Davidson Resilience Scale (CD-RISC), an internationally recognised measure of resilience, in the Singaporean context, and identified the five factors that constitute resilience among Singaporean students. While there are other measures of resilience, such as the local Singapore Youth Resilience Scale (SYRESS), the CD-RISC is more widely used internationally. Establishing the CD-RISC’s validity in the Singaporean context is a valuable result that enables its use by future researchers to make meaningful comparisons between resilience in Singapore and elsewhere.
“It was important to ascertain the validity of the CD-RISC to ensure that when administered to college students, it could accurately measure the construct of resilience in context,” said Ms Chue, first author of the study. “Validating the scale would then allow for its use, for example, in quantifying the impact of relevant programmes and interventions in strengthening mental resilience.”
The study also identified five factors that make up resilience in the Singaporean context: approach coping in adversity (a desire to actively seek ways to solve a problem, rather than avoiding it); self-belief and trust in one’s abilities; effort and purpose (being motivated by a sense of purpose and a desire to work hard to attain one’s goals); having good interpersonal and internal resources (including secure relationships, knowing where to find help in difficult times, and traits such as a sense of humour and a disposition to recognise one’s past successes and achievements); and spirituality (attributing happenings in life, including adversity, to a higher force such as God or fate).
“The five factors of resilience affirmed that mental resilience comprises both character traits and skills, the latter of which are learnt and honed over time. It’s heartening to know that we are all still works-in-progress, and can be equipped with skills to grow and adapt to the stressful situations we face,” Ms Chue added.
The second study linked resilience to lower levels of academic burnout in Singaporean college students, which was subsequently linked to lower psychological distress. By helping to regulate burnout, resilience contributed to better mental health overall. This insight points to an actionable way forward for professionals who work with young adults: instead of attempting to change the environment to lower the incidence of burnout — which, while important, is a daunting task — they can focus instead on cultivating resilience through training programmes and interventions. Not only is this a more practical way forward, it would also serve young adults well by equipping them with useful skills to deal with other stressful situations that they may face later on in life.
Asst Prof Cheung noted, “As resilience is a broad term, it was important for us to identify specific traits or skills that constitute resilience, so that we can develop in-house training programmes to enhance those skills among our students. After a discussion with colleagues from the Yale-NUS Wellness and Counselling Centres, we found that the skills related to resilience as identified in this study were indeed very trainable. These skills include increasing students’ confidence in harnessing their strengths to overcome challenges, teaching students active problem-solving skills, and the effective use of external support sources (such as peer support) that would enhance their resilience in the face of adversity.”
Ms Chue and Asst Prof Cheung pursued these new studies as a continuation of the findings in Ms Chue’s capstone project, where final-year Yale-NUS students embark on a year-long in-depth research study in their chosen major and field of study. At Yale-NUS, students have extraordinary opportunities to work closely with faculty to conduct original research, enabling them to increase their competitive edge as they consider graduate studies or other professional opportunities.

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A new substance could improve the treatment of persistent cancers. Researchers at Martin Luther University Halle-Wittenberg (MLU) and the University of Greifswald have developed a new inhibitor that makes drug-resistant tumour cells respond again to chemotherapy. The new substance blocks a protein in the cancer cells that normally transports the cancer drugs back out of the cells. The results were published in the scientific journal Molecules.
In addition to radiation therapy, cytotoxic agents, also known as chemotherapy, are frequently used to treat cancer. They prevent cells from dividing and thus cancer cells are unable to multiply unchecked. “Cytotoxic agents remain a very important form of treatment because they have a general effect, in other words, they work on different types of cancer,” explains Dr Andreas Hilgeroth, a professor of pharmacy at MLU. However, some tumours are resistant to chemotherapy. They possess certain proteins that transport the drugs back out of the cancer cell.
Hilgeroth’s research group has now developed a new class of substances that inhibits one of these transport proteins: the multi-drug resistant protein 4 (MRP4). “It plays a particular role in leukemia,” says Professor Christoph Ritter from the Institute of Pharmacy at the University of Greifswald. The protein transports chemical messengers that appear to contribute to the development of that type of cancer. Ritter supported the team in the efficacy studies on special, drug-resistant cancer cell lines. The researchers were able to show that the cells treated with the new inhibitor transported fewer of the dye-labelled messengers and that the cytotoxic agents began having an effect again. “One of the substances showed particularly promising results,” says Ritter, adding, it inhibited the protein much better than the best inhibitor known to date.
The new substances could have two simultaneously positive effects: “preventing the transport of cancer-promoting messengers and ensuring that the chemotherapy starts working again,” explains Hilgeroth. If they prove to be successful in further tests, however, they will only be administrable in patients who have tumours containing the MRP4 transport protein. However, a pre-screening that uses markers to identify the type and characteristics of a specific cancer is already part of standard treatment. “There is an increasing focus on individualised medicine, especially in cancer therapy,” says Hilgeroth. Drugs are used that are tailored to the type and characteristics of the cancer. A different inhibitor would then be used on a different transport protein.
The efficacy must now be confirmed in further preclinical trials. Researchers will try to establish how well the newly developed drugs specifically inhibit MRP4 in order to reduce side effects. If the substances are a success, several years of clinical trials will follow to confirm their efficacy in patients.

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Professor Rosalind Gill, from City, University of London’s Gender and Sexualities Research Centre, has today published a new report to mark International Women’s Day.
The report — Changing the Perfect Picture: Smartphones, Social Media and Appearance Pressures — is based on research with 175 young women and nonbinary people in the UK.
Covering a range of issues — experiences of lockdown, feelings about ‘body positivity’, how to show support for Black Lives Matter — the research documents young people’s persistent anger with a mass media that they deem ‘too white’, ‘too heterosexual’ and too focused on very narrow definitions of beauty.
Professor Gill said: “A critique of perfection ran through the research like a bass track, with young people telling me that they feel overwhelmed by images that are ‘too perfect’.
“Women of colour, disabled women and gender nonconforming folk told me they rarely see anyone like them in the media.”
The report raises particular issues about how appearance standards are narrowing and how the affordances of smartphones (e.g., magnification and screenshotting), together with editing and filtering apps like Facetune, are contributing towards a society in which young people feel under constant forensic scrutiny by their peers.

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Ninety per cent of women report using a filter or editing their photos before posting to even out their skin tone, reshape their jaw or nose, shave off weight, brighten or bronze their skin or whiten their teeth.
Young women in the study also described regularly seeing advertisements or push notifications for cosmetic procedures — particularly for teeth whitening, lip fillers, and surgery to enhance bottom, breasts or nose.
Social media algorithms mean that, as one 21-year-old put it: “Once you look, you will never be allowed to forget.”
Professor Gill said: “With nearly 100 million photos posted every single day on Instagram alone, we have never been such a visually dominated society.
“Posting on social media can produce the intense pleasure of ‘getting likes’ and appreciative attention, but it is also a source of huge anxiety for most young women.

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“I was struck by young women saying to me again and again: ‘I feel judged’.”
Professor Gill noted that, while the research would have been important at any time, the unique context of the Covid-19 pandemic and lockdown gave it a particular urgency.
She said: “Day after day, reports were published highlighting the devastating mental health impacts of the pandemic on young people: their education suddenly halted, their freedoms curtailed, with many experiencing financial hardship, emotional difficulties or bereavement.
“This research helps to shed light on how a diverse sample of young people navigated this challenging time, as well as offering more general insights into their lives.
“In some ways, young people’s familiarity with online tools and platforms better prepared them (relative to older groups) for the lockdown period in which so many aspects of life moved online — including work, education, psychological and health services, and social lives.
“In other ways, as this report shows, they experienced heightened pressure and distress.”
The research was funded by City, University of London, and carried out at the Gender and Sexualities Research Centre (GSRC) during 2020.
The GSRC analyses how gender and sexuality intersect with other social divisions and identities in a rapidly changing world, fostering interdisciplinary dialogue, collaboration and research.
A summary report was submitted to the Government Equalities Office’s Inquiry into Body Image.

Research from the University of Kent predicts an end to deregulated competitive pubic transport in the UK as a consequence of Covid-19 social distancing measures leading to drastically reduced ridership, requiring a major rethinking of the provision of public transport.
This paper, published in Transport Policy, argues that the situation will require a fundamental approach to long-term policy for transport as a whole. This is an opportunity to reconstruct the system whilst addressing such problems as the environmental impact of transport, congestion and questions of transport justice such as accessibility to transport for disadvantaged groups in society.
Covid-19 has been a major disruptor on all aspects of the transport system, local, national and international. This has been significant for both the UK’s public sector and private sector operators and has thrown most business models into disarray, demonstrating the system’s fragility to crisis. Whilst the UK Government provides funding for services to continue amid the pandemic, the length of the emergency and the slow recovery threaten this ability to maintain support until demand returns to pre-pandemic levels.
In the UK central government borrowing in fiscal year 2020/21 is expected to reach almost £400 billion as the economy shrinks by an expected 11.3 per cent and unemployment rises to 7.5 per cent. Continued government funding for the public transport system is not sustainable for current pandemic levels of use, in which ridership is down across the system.
In addition to this, the increasing inequality in accessibility to transport according to income, age, disability and other individual and social characteristics was a pre-pandemic issue of major disparity, whilst the environmental crisis continues with transport accounting for a significant share of global emissions. These older issues continue and require immediate addressing.
The paper argues that returning to the old normal is unlikely and that public transport must adjust to increased home working and a fear of crowded spaces. This potentially spells the end of the prevailing model of a deregulated competitive public transport in the UK.
Roger Vickerman, Emeritus Professor of European Economics at Kent and author of the paper said: ‘Public transport’s flaws required urgent addressing prior to the pandemic and now much remains to be done in designing an inclusive transport system. In the light of the pandemic, we are presented with this opportunity now and may use it to establish a system that is efficient, environmentally considerate, and to the benefit of its users that currently suffer its disadvantages.’

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Over 10,000 people in Europe use an assistance dog; think of guide dogs for people with a visual impairment, hearing dogs for people with a hearing impairment, medical response service dogs and psychiatric service dogs.
According to a UN-agreement and the Dutch law, these dogs are welcome in stores, hospitals and other public places. However, in practice, many assistance dog users and their dogs are regularly refused entry. In the Netherlands, four out of five assistance dog users indicate that they regularly experience problems with this.
Often, hygiene reasons are given as the main argument for refusing entry to assistance dogs. Research by Utrecht University now shows that the paws of assistance dogs are cleaner than the shoe soles of their users, and thus, paw hygiene is no reason to ban assistance dogs from hospitals.
To investigate this, Jasmijn Vos, Joris Wijnker and Paul Overgaauw of Utrecht University’s Faculty of Veterinary Medicine took samples from the paws of 25 assistance dogs and the shoe soles of their users. For comparison, they also investigated an equally large group of pet dogs and their owners. Vos and her colleagues examined the samples for poop bacteria (Enterobacteriaceae), which are very common outdoors, and for an important diarrheal bacteria (Clostridium difficile).
“The dogs’ paws turned out to be cleaner than the soles of their shoes,” says Jasmijn Vos, Masters student at Utrecht University. “This makes the hygiene argument that is often used to ban assistance dogs from public locations invalid.” Moreover, the diarrheal bacteria did not occur on the dogs’ paws whatsoever, and only once on a shoe sole.
81% of assistance dogs are refused
Dutch assistance dog users were also surveyed about their experiences. 81% are still regularly refused entry to public places with their dog, even though this is prohibited by law. This is mainly down to lack of knowledge on the part of the person refusing entry: lack of knowledge on what an assistance dog is, how it can be recognised, and about the rules of law.
The study also shows that assistance dog users constitute only a small fraction of the total number of patients in Dutch hospitals. Should they decide to bring their assistance dog to the hospital, or elsewhere, this should be made possible; assistance dogs are usually well trained and are no more of a hygiene hazard than people!

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In the EU alone, 78,800 men died of prostate cancer last year. While tumors discovered at an early stage can often be completely removed by surgery and radiation therapy, the prospects of successful treatment are reduced if the cancer has further metastasized. At present, physicians cannot predict drug response or therapy resistance in patients.
Three-dimensional structures
The team led by PD Dr. Marianna Kruithof-de Julio at the Urology Research Laboratory at the Department for BioMedical Research (DBMR) of the University of Bern and Inselspital Bern, has developed a new strategy for the generation of prostate cancer organoids that can contribute to assess therapy response, their work is published in the latest issue of Nature Communications. Drs Sofia Karkampouna and Federico La Manna, the two lead co-authors of the paper, spent over one and a half year in optimizing and efficient protocol for the generation of the patient derived organoids and their detailed characterization. Moreover, in collaboration with the NEXUS Personalized Health Technologies, they have meticulously developed a medium-throughput screen for drug testing.
The researchers led by PD Dr. Kruithof-de Julio have demonstrated that patient-derived organoids retain relevant characteristics of the prostate carcinoma from which they have been originated: not only are they characterized by the same genetic mutations, but they also exhibit similar gene activity patterns.
Paving the way for personalized medicine
PD Dr. Kruithof-de Julio and her collaborators first generated a novel early stage, patient derived xenograft that is treatment naïve, then tested 74 different drugs on organoids from this and other experimental tumor models — identifying 13 compounds that reduced prostate cancer cell viability.
The researchers then tested the efficacy of these compounds on organoids from five prostate cancer patients — two with early-stage tumors and three with advanced metastatic tumors. Interestingly, among the hits ponatinib, so far approved for the treatment of leukemia, proved to be particularly effective in reduction of organoid viability and tumor growth in vivo.
However, for PD Dr. Kruithof-de Julio, the significance of these results lies not only in the drug repurposing but more importantly in promoting an approach that the medical community can undertake. “Our results pave the way for personalized medicine. In our study we only analyzed data from five patients retrospectively,” says Kruithof-de Julio. “But we clearly showed that the method would be in principle feasible. Growing the organoids and drug testing can be accomplished in two weeks, a time frame that is compatible with clinical decision making. In collaboration with the Urology Department of the Inselspital, led by Prof Thalmann, we have now already been able to prove this in several cases.”
“In my clinical activity, I am regularly confronted by tumors that do not respond to therapy or for which we do not know which therapy to use,” says Thalmann. “This is a further step in the direction of individualized medicine, where we might be able to tailor the treatment to the tumor during the course of the disease and better understand its biology.” With this approach, the researchers hope to treat patients more efficiently with less side effects and diminished costs.

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Concussion, a form of traumatic brain injury, is a common injury among children and teens. Concussions can have adverse effects on physical, cognitive, emotional and sleep health. Clinical guidelines for managing concussion in children and teens traditionally recommend complete physical and cognitive rest until symptom resolution, followed by a gradual return to activities like school and sports. These guidelines are often disputed and based on expert consensus as opposed to strong evidence. The challenge has been how to quantify the amount of physical and cognitive activity that children and teens should engage in during recovery. A new study by researchers at the Center for Injury Research and Policy, Sports Medicine, and Emergency Medicine at Nationwide Children’s Hospital investigated objectively measured, self-paced physical and cognitive activity across the first week post-concussion.
The study, published today in the Journal of Head Trauma Rehabilitation, found that self-paced physical and cognitive activity during the first week after sustaining a concussion alone neither hastened nor prolonged concussion recovery in children and teens. These findings indicate that children and teens with concussion may have some flexibility to determine their own activity levels during recovery. Physicians may encourage safe, non-contact, light physical activity if it does not make youths’ concussion symptoms worse, while also continuing to emphasize appropriate amounts of necessary rest.
Study participants were 11 to 17 years old, seen within 72 hours of injury in the emergency department or a concussion clinic through Nationwide Children’s Hospital and received a physician-confirmed diagnosis of concussion. They wore two devices — one to measure their physical activity and sleep around the clock, and one to measure their cognitive activity outside of school. Participants rated their daily concussion symptoms by completing the Postconcussion Symptom Scale during the first week post-injury.
Researchers found that while daily physical and cognitive activity increased across the first week post-injury, daily post-concussion symptoms decreased. Increased daily step count was associated with an increased likelihood of early symptom resolution. However, this association was not statistically significant after adjusting for acute post-concussion symptoms and other covariates.
“This study is the first to objectively measure self-paced cognitive activity during the first week post-injury,” said Ginger Yang, PhD, MPH, lead author of the study and principal investigator in the Center for Injury Research and Policy at Nationwide Children’s. “While increased physical and cognitive activity may help reduce post-concussion symptoms, reduced symptoms may also lead to increased physical and cognitive activity levels, highlighting the need for further research to better understand this bi-directional relationship.” Such research will provide evidence of when an individual is ready for physical and cognitive activity after concussion and what level of activity is most appropriate. This information could be used by clinicians to inform treatment decisions, including individualized physical and cognitive activity recommendations post-concussion.
“Concussions behave somewhat like snowflakes in that they are not all the same, and the specific effects of concussion on our young patients varies greatly — one size or treatment does not, necessarily, fit all,” said Thomas Pommering, DO, co-author of the study and division chief of sports medicine at Nationwide Children’s. “The strength of this study is that it appears that children and adolescents with concussions are generally pretty good at self-pacing their physical and cognitive activity so as to not prolong their recovery. With the guidance of physicians, there may be room for personalized treatment plans based on the symptom burden, while still following important guidelines protecting the patient from repeat head injury during the recovery time.”
Data for this study came from youth-parent dyads referred to the study team by their school athletic trainer or recruited at the Nationwide Children’s Hospital emergency department or concussion clinics. Following a physician-confirmed diagnosis of concussion, youth-parent dyads were contacted by research staff and enrolled within 72 hours post-injury after providing written assent and consent. Enrolled dyads were then followed until symptom resolution (defined as being symptom-free or symptoms returned to pre-injury level), or 45 days post-injury, whichever occurred first.

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Several processes in the human body are regulated by biochemical reactions involving hydrogen peroxide (H2O2). Although it can act as a ‘secondary messenger’, relaying or amplifying certain signals between cells, H2O2 is generally toxic because of its oxidant character. The latter means that it converts (oxidizes) biochemical molecules like proteins and DNA. The oxidizing property of H2O2 is of potential therapeutic relevance for cancer, though: deliberately causing tumor cells to increase their H2O2 concentration would be a way to destroy them. In light of this, but also for monitoring pathologies associated with H2O2 overproduction, it is crucial to have a means to reliably quantify hydrogen peroxide concentrations in the extracellular environment. Now, Leonardo Puppulin from Nano Life Science Institute (WPI-NanoLSI), Kanazawa University and colleagues have developed a sensor for measuring concentrations of H2O2 in the vicinity of cell membranes, with nanometer-resolution.
The biosensor consists of a gold nanoparticle with organic molecules attached to it. The whole cluster is designed so that it anchors easily to the outside of a cell’s membrane, which is exactly where the hydrogen peroxide molecules to be detected are. As attachment molecules, the scientists used a compound called 4MPBE, known to have a strong Raman scattering response: when irradiated by a laser, the molecules consume some of the laser light’s energy. By measuring the frequency change of the laser light, and plotting the signal strength as a function of this change, a unique spectrum is obtained — a signature of the 4MPBE molecules. When a 4MPBE molecule reacts with a H2O2 molecule, its Raman spectrum changes. Based on this principle, by comparing Raman spectra, Puppulin and colleagues were able to obtain an estimate of the H2O2 concentration near the biosensor.
After developing a calibration procedure for their nanosensor — relating the H2O2 concentration to a change in Raman spectrum in a quantitative way is not straightforward — the scientists were able to produce a concentration map with a resolution of about 700 nm for lung cancer cell samples. Finally, they also succeeded in extending their technique to obtain measurements of the H2O2 concentration variation across cell membranes.
Puppulin and colleagues conclude that their “novel approach may be useful for the study of actual H2O2 concentrations involved in cell proliferation or death, which are fundamental to fully elucidate physiological processes and to design new therapeutic strategies.”
Surface-enhance Raman spectroscopy
The biosensor developed by Leonardo Puppulin from Kanazawa University and colleagues is based on a method called surface-enhanced Raman spectroscopy (SERS). The principle derives from Raman spectroscopy, in which differences between the incoming and the outcoming frequencies of laser light irradiated onto a sample are analyzed. The spectrum obtained by plotting the signal strength as a function of frequency difference is characteristic for the sample, which can in principle be a single molecule. Typically, however, the signal coming from one molecule is too weak to detect, but the effect can be enhanced when the molecule is absorbed on a rough metal surface. Puppulin and colleagues applied the technique to (indirectly) detect hydrogen peroxide; their Raman-responsive molecule is a compound called 4MPBE, which is modified when exposed to hydrogen peroxide.

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