Publisher Health

The study says differences in children’s brains, which affect their sensitivity to pressure and rewards, and differences in the way they process information, make it more likely they will admit to crimes they didn’t commit when incentivized to do so.
These developmental vulnerabilities mean solicitors and barristers should get extra support to help them better support young people deciding whether to admit guilt.
Dr Rebecca Helm, from the University of Exeter, who led the research, published in the Journal of Law and Society, said: “The criminal justice system relies almost exclusively on the autonomy of defendants, rather than accuracy, when justifying convictions via guilty plea. But children don’t necessarily have the capacity to make truly autonomous decisions in this context, where they face a variety of really compelling pressures. Children are likely to misunderstand information, not admit they don’t understand and agree with statements, or succumb to pressure from others and the system. They may be unsure whether they have committed a legal offence, or whether there is a defence they can rely on.
“The incentives offered to encourage guilty pleas, and time pressures associated with them, are likely to interact with developmental vulnerabilities in children to create an environment in which innocent children are systematically pleading guilty.”
In England and Wales, the majority of defendants plead guilty rather than contest their guilt at trial. In 2019, 61 per cent of child defendants in the Crown Court pleaded guilty (with 58 per cent pleading guilty at their first hearing), and 47 per cent of child defendants in the Youth Court pleaded guilty at their first hearing.
Children who enter a guilty plea at the earliest possible opportunity to do so can get a reduction in their sentence of up to a third compared to what they would receive if convicted at trial, or receive a referral order or a youth rehabilitation order when they would face a custodial sentence at trial. The study says that these reductions are not appropriate in children and have the potential to create pressures to plead. It would be better to award tailored reductions to children based on less prescriptive guidelines and individual case circumstances, including defendant age.
Dr Helm said: “We now have a fairly good understanding of decision-making in children, and how it differs from decision-making in adults. It is therefore not appropriate to continue to put children accused of criminal offences in situations where it is predictable that they will ‘admit’ guilt even when innocent, and then punish them as if they are guilty. Ensuring children have appropriate and tailored protection when deciding whether to plead guilty is really important.”
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Early in human development, during the first trimester of gestation, a fetus may have XX or XY chromosomes that indicate its sex. Yet at this stage a mass of cells known as the bipotential gonad that ultimately develops into either ovaries or testes has yet to commit to its final destiny.
While researchers had studied the steps that go into the later stages of this process, little has been known about the precursors of the bipotential gonad. In a new study published in Cell Reports and co-led by Kotaro Sasaki of Penn’s School of Veterinary Medicine, an international team lays out the detailed development of this key facet of sexual determination in two mammalian models.
“Using single-cell transcriptome data, we can get a lot of information about gene expression at each developmental stage,” says Sasaki. “We can define what the default process is and how it might go awry in some cases. This has never been done in traditional developmental biology. Now we can understand development in molecular terms.”
Disorders of sex development (DSD) occur when internal and external reproductive structures develop differently from what would be expected based on an individuals’ genetics. For example someone with XY chromosomes might develop ovaries. These conditions often affect fertility and are associated with an increased risk of germ cell tumors.
“These disorders oftentimes create psychological and physical distress for patients,” Sasaki says. “That’s why understanding gonadal development is important.”
To understand atypical development, Sasaki and colleagues in the current study sought to layout the steps of typical development, working with a mouse model and a monkey model.

A team of researchers at the Center for Bioactive Delivery at the University of Massachusetts Amherst’s Institute for Applied Life Sciences has engineered a nanoparticle that has the potential to revolutionize disease treatment, including for cancer. This new research, which appears today in Angewandte Chemie, combines two different approaches to more precisely and effectively deliver treatment to the specific cells affected by cancer.
Two of the most promising new treatments involve delivery of cancer-fighting drugs via biologics or antibody-drug conjugates (ADCs). Each has its own advantages and limitations. Biologics, such as protein-based drugs, can directly substitute for a malfunctioning protein in cells. As a result, they have less serious side effects than those associated with traditional chemotherapy. But, because of their large size, they are unable to get into specific cells. ADCs, on the other hand, are able to target specific malignant cells with microdoses of therapeutic drugs, but the antibodies can only carry a limited drug cargo. Since the drugs are more toxic than biologics, increasing the dose of ADCs increases the risk of harmful side effects.
“What our team has done,” explains Khushboo Singh, a graduate student in the chemistry department and one of the study’s lead authors, “is to combine the advantages of biologics and ADCs and address their weaknesses. It is a new platform for cancer therapy.”
The team’s approach depends on a nanoparticle the team engineered called a “protein-antibody conjugate,” or PAC. “Imagine that the antibodies in PACs are the address on an envelope,” adds Sankaran “Thai” Thayumanavan, distinguished professor in chemistry and interim head of biomedical engineering at UMass, “and that the cancer-fighting protein is the contents of that envelope. The PAC allows us to deliver the envelope with its protected treatment to the correct address. So, safer drugs are delivered to the right cell — the result would be a treatment with fewer side effects”
At the heart of the PAC is a “polymer brush,” a nanoparticle that the team engineered. This brush does two things. First, it is studded with antibodies that are capable of locating individual cancerous cells. Next, the brush has to both hold a sizable cargo of biologics but also keep that dose intact. The team found that their nanoparticle could carry four times the therapeutic dose of a typical ADC, and, through a variety of techniques, could be increased many times over.
While the UMass team’s research represents a major milestone in cancer research, their findings are also widely applicable, and “open many new opportunities in biomedicine, extending far beyond cancer to all sorts of genetic diseases, or really any abnormality that occurs inside a human cell,” says Bin Liu, one of the papers lead authors and a graduate student in the UMass chemistry department at the time of the research.
“Among the implications,” says Thayumanavan, “perhaps the most exciting part is that this opens the door to develop cures for certain cancers that have been long considered undruggable or incurable” The team’s research is currently being tested in models beyond a petri-dish.
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The Marburg virus, a relative of the Ebola virus, causes a serious, often-fatal hemorrhagic fever. Transmitted by the African fruit bat and by direct human-to-human contact, Marburg virus disease currently has no approved vaccine or antivirals to prevent or treat it.
A team of researchers is working to change that. In a new paper in the journal Antimicrobial Agents and Chemotherapy, investigators from Penn’s School of Veterinary Medicine, working together with scientists from the Fox Chase Chemical Diversity Center and the Texas Biomedical Research Institute, report encouraging results from tests of an experimental antiviral targeting Marburg virus. The compound blocks the virus from departing infected cells, thus putting the brakes on the spread of infection. Their findings are the first to show that this novel class of inhibitors can be effective against the infection in an animal model.
In addition, due to possible similarities in virus-host interactions between Marburg and SARS-CoV-2, the team has conducted experiments on the culprit behind the coronavirus pandemic. While preliminary and thus-far-unpublished, their initial tests show signs of promise.
“It really is exciting,” says Ronald Harty, a co-corresponding author of the research and a professor at Penn Vet. “These viruses are quite different but may be interacting with the same host proteins to control efficient egress and spread, so our inhibitors may be able to block them both.”
While many antivirals target the virus itself, the drug candidates that Harty and colleagues have been developing for years are known as “host-oriented.” They prevent virus-host interactions by blocking the proteins in host cells that viruses hijack during late stages of infection.
Not only does this approach help avoid the likelihood that a virus would evolve to resist such a therapy, but it also increases the chance that a drug could be used against multiple viruses, as many rely on the same host cell machinery to reproduce and spread.

Vaccination dramatically reduced COVID-19 symptomatic and asymptomatic infections in St. Jude Children’s Research Hospital employees compared with their unvaccinated peers, according to a research letter that appears today in the Journal of the American Medical Association.
The study is among the first to show an association between COVID-19 vaccination and fewer asymptomatic infections. When the Pfizer-BioNTech BNT162b2 vaccine was authorized for use in the U.S., the vaccine was reported to be highly effective at preventing laboratory-confirmed COVID-19. Clinical trial data suggested that the two-dose regimen reduced symptomatic disease, including hospitalization and death. But an association with reduced asymptomatic infection was unclear.
“While further research is needed, by preventing infections, including in people who have no symptoms, there is a high possibility that vaccination will decrease transmission of SARS-CoV-2,” said Diego Hijano, M.D., of the St. Jude Department of Infectious Diseases. He and Li Tang, Ph.D., of St. Jude Biostatistics, are the first authors of the report. Tang is also the corresponding author.
The study involved 5,217 St. Jude employees who were eligible under Tennessee state guidelines for vaccination between Dec. 17, 2020, and March 20, 2021. More than 58% of employees were vaccinated during that period. Most workers received both doses.
Overall, vaccination reduced the risk of asymptomatic and symptomatic SARS-CoV-2 infection by 79% in vaccinated employees compared with their unvaccinated colleagues. An analysis of asymptomatic infections alone found vaccination reduced the risk by 72%.
Protection was even greater for employees who completed two doses. A week or more after receiving the second dose, vaccinated employees were 96% less likely than unvaccinated workers to become infected with SARS-CoV-2. When researchers looked just at asymptomatic infections, vaccination reduced the risk by 90%.

A study designed to enroll an equal number of Black and white men with advanced prostate cancer confirms key findings that have been evident in retrospective analyses and suggest potential new avenues for treating Black patients who disproportionately die of the disease.
Researchers at Duke Cancer Institute enrolled 50 Black and 50 white men with advanced prostate cancer to test whether there were outcome differences on treatment with the hormone therapy abiraterone acetate plus the steroid prednisone. In retrospective data reviews, the Duke researchers had previously found racial differences in PSA responses among advanced prostate cancer patients.
Publishing online in the journal Cancer, the researchers confirmed trends indicating that Black men’s PSA levels dropped further and more frequently than those of white men undergoing the therapy. These PSA changes, however, did not result in differences in disease progression or overall survival times.
But the survival finding has an important subtlety, said lead author Daniel George, M.D., professor in the departments of Medicine and Surgery at Duke University School of Medicine. George noted that most drug studies among prostate cancer patients include a small fraction of Black men that is far lower than their numbers in the larger population.
Exclusions typically result because Black men with prostate cancer are more likely to have other illnesses such as diabetes and high blood pressure, which study leaders often fear could put them at higher risk for complications. Additionally, there are deep historic and cultural reasons that Black men tend to decline participation in clinical studies.
For their study, however, the Duke team — including senior author Andrew Armstrong, M.D., professor in the departments of Medicine and Surgery — found that Black men were eager to join the clinical trial.
They were able to enroll a much larger proportion of Black men than what most studies include, in part because the study was addressing a question pertaining to race. And they did not exclude men with co-existing conditions, asserting that since the treatment is FDA approved for this population, they should be inclusive of the patients they see in practice.
“When you look at the overall survival data for our study, they’re equal between Black and white men,” George said. “But given the prevalence of coexisting conditions in the Black men we enrolled, mortality should have actually been higher for them.
“Our finding that it was not higher is telling — it suggests Black men with prostate cancer can fare just as well as whites, even with other health issues,” George said. “And it signals that future studies should consider enrolling Black men despite these often-disqualifying conditions.”
George said the researchers also identified a possible marker of ancestry-dependent treatment outcomes that could help explain why Black men respond more readily to hormone therapy, potentially pointing to new ways to address advanced prostate cancer in Black men.
“We need to understand how genetic ancestry might affect treatment outcomes — especially disease responsiveness in prostate cancer — because we are now using and studying these therapies earlier in the disease where we have the opportunity to cure patients,” George said.
“If there is a subgroup of patients with an ancestry-based predisposition for potential better response, we need to understand that. But to do so, we will need greater genetic diversity in our future study populations, especially among those with African ancestry. We aren’t going to fully understand this genetic complexity by solely enrolling men with European ancestry.”
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It turns out that not all build-ups of tau protein are bad, and a team of researchers from the Perelman School of Medicine at the University of Pennsylvania developed a method to show that. Using mammalian cell models, the researchers combined extremely high-resolution microscopy with machine learning to show that tau actually forms small aggregates when a part of the body’s normal physiology. Through this, they could distinguish between the aggregates occurring under healthy conditions from the ones associated with neurological diseases, potentially opening the door to screening for treatments that might break apart harmful aggregates. This research was published in the Proceedings of the National Academy of Sciences of the United States of America.
“There aren’t many tools that can visualize small, pathological protein aggregates within cells,” said the study’s senior author, Melike Lakadamyali, PhD, an associate professor of Physiology. “But through machine learning informed by super-resolution microscopy, we believe we’ve been able to show that tau forms both normal physiological aggregates and distinct pathological aggregates. In doing so, we created a useful method that could be the basis for new research into the appropriate treatments for tau-related pathologies.”
Tau is a protein that attaches to the microtubule structure of axons — which act much like highways in nerve cells. Previously, tau aggregates had been thought to only form once tau falls off the microtubules. These have been associated with some neurological diseases, including Alzheimer’s and other types of dementia. However, it turns out that small tau aggregates can also form outside disease conditions.
“Intrinsically, there is value in being able to tell which tau aggregates are a part of a healthy person’s nervous system, and which have formed harmful aggregates,” said the study’s lead author, Melina Theoni Gyparaki, a doctoral student in Lakadamyali’s lab. “Unfortunately, there has not been a process sensitive enough to make that distinction yet inside cells. So we set out to create one using mammalian cell models.”
First, the researchers used extremely high resolution microscopes capable of looking at single molecules to differentiate physiological and pathological oligomers (molecular formations). Monomers, dimers and trimers, which are oligomers made up of one, two, and three tau molecules, respectively, were most likely to end up associated with healthy physiological conditions because they were associated with microtubules and regular function.
When the team looked at tau structures associated with a mammalian cell model approximating frontotemporal dementia with Parkinsonism linked to chromosome 17 (FTDP-17) — a disease associated with tau aggregation — the structures were larger and more complex. These appeared to be the pathological tau aggregates that broke off.
With the differences in configuration established, the researchers created a machine learning algorithm to classify the pathological tau aggregates by shape alone. Additionally, they used antibodies that can detect and differentiate when the tau aggregates become “hyper-phosphorylated” — when they pick up a lot of phosphate groups and tend to harmfully break off. Combining these methods showed that tau containing phosphate groups on certain amino-acids was more likely to form linear fibrils, a thin structure, as opposed to other shapes of tau aggregates.
“The method we developed to identify tau aggregates is not yet a diagnostic tool, but we think it would be a useful research tool for anyone interested in studying the mechanisms that lead to pathological protein oligomerization in neurodegenerative disease,” Lakadamyali said.
Tau aggregates aren’t the only ones that this method could be used to classify, either. There’s an opportunity to use it on other potentially pathological protein build-ups, such as alpha-synuclein, which is associated with Parkinson’s disease, or huntingtin, related to Huntington’s disease. It could also be used to screen for potential treatments for these conditions that don’t harm the body’s regular protein complexes.
The team is now studying potential mechanisms for clearing tau aggregates and determining what other pathways could be helpful in this regard.
“We are also further using the method we devised to visualize tau aggregates in human postmortem brain tissue slices from Alzheimer’s disease to determine the role of tau’s post-translational modifications in aggregation,” Lakadamyali said.
Other authors on this study include Arian Arab, Elena Sorokina, Adriana Santiago-Ruiz, Christopher Bohrer, and Jie Xiao.

Misunderstanding food date labeling is common and educational communications are needed to improve consumer understanding, according to a new study in the Journal of Nutrition Education and Behavior, published by Elsevier.
Does it mean “spoiled — throw it out,” or “might not taste as good as it could anymore?” Food date labels (e.g., “USE By August 16”) can play an important role in helping consumers make informed decisions about food, and ultimately prevent unsafe consumption and waste of food. Researchers surveyed 2,607 adults in the United States to assess consumer understanding of the streamlined 2-date labeling system and explore the relative effectiveness of educational messages in increasing understanding.
“Our study showed that an overwhelming majority of consumers say that they use food date labels to make decisions about food and say they know what the labels mean,” said Catherine Turvey, MPH, Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA. “Despite confidently using date labels, many consumers misinterpreted the labels and continued to misunderstand even after reading educational messaging that explained the labels’ meaning.”
Less than half (46 percent) of study respondents knew that the “BEST If Used By” label specifically indicates that food quality may deteriorate after the date on the label. Less than one-quarter (24 percent) of study respondents knew that the “USE By” label means that food is not safe to eat after the date on the label.
Researchers explored if framing the messages with values like saving money or avoiding waste, would impact the effectiveness of messages at increasing consumer understanding. None of the seven value frames tested was significantly more effective at increasing understanding than another, but all messages significantly increased consumer’s general understanding of the labels.
After viewing educational messages, 37 percent of consumers still did not understand the specific meaning of the “BEST If Used By” label and 48 percent did not understand the specific meaning of the “USE By” label.
“Responses to the survey suggest that date labels are so familiar that some consumers believe they are boring, self-explanatory, or common sense despite misunderstanding the labels,” said Ms. Turvey. “Unwarranted confidence and the familiarity of date labels may make consumers less attentive to educational messaging that explains the food industry’s labeling system.”
Future communication campaigns will have to capture the attention of people who think they already know what date labels mean, find the information tedious, or are satisfied with a rough understanding of labels. Educating consumers about the meaning of the labels has growing implications for food waste and food safety as the 2-date labeling system becomes more widely adopted and gains support from non-profits and government institutions.
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Among younger adults visiting the emergency department for chest pain, women may be getting the short end of the stick. Compared with men of similar age, women were triaged less urgently, waited longer to be seen, and were less likely to undergo basic tests or be hospitalized or admitted for observation to diagnose a heart attack, according to new research being presented at the American College of Cardiology’s 70th Annual Scientific Session.
The study is the first to examine emergency room management of chest pain specifically among younger adults (age 18-55 years). Heart disease is the leading cause of death in women and is becoming more common in younger adults. About one-third of women who were hospitalized for a heart attack in the past two decades were under the age of 55, a proportion that has grown in recent years.
“Women should trust their instincts,” said Darcy Banco, MD, an internal medicine resident at NYU Langone Health and the study’s lead author. “Women should seek care right away if they experience new chest discomfort, difficulty breathing, nausea, vomiting, fatigue, sweating or back pain, as these could all be signs of a heart attack. The most important thing a woman can do is to seek medical care if she is worried and to ask specific questions of her doctor.”
Chest discomfort is the most common symptom of a heart attack in both men and women, but research shows that women can have a broader range of accompanying symptoms that may not initially be recognized as a sign of a heart attack. Chest discomfort caused by a heart attack can be perceived as pain, pressure, tightness or another uncomfortable sensation.
The study is based on data collected by the National Hospital Ambulatory Medical Care Survey between 2014-2018. Researchers extrapolated the data to represent an estimated 29 million emergency department visits for chest pain in the U.S. among adults aged 18-55; women comprised nearly 57% of those visits.
Researchers found that women reporting chest pain were equally likely to arrive at the hospital by ambulance but significantly less likely than men to be triaged as emergent. On average, women waited about 11 minutes longer to be evaluated by a clinician. Women were also significantly less likely to undergo an electrocardiogram (EKG), the standard initial test used to diagnose a heart attack, or to receive cardiac monitoring or be seen by a consultant, such as a cardiologist.
Medical guidelines recommend that all patients with possible heart attack symptoms receive an EKG within 10 minutes of arrival in the emergency department to minimize the time to treatment.
“Time is very important when you’re treating heart attacks,” Banco said. “The longer people wait, the worse their outcomes can be.”
The study did not examine the reasons why women with chest pain were treated differently than men. Banco suggested that pre-conceived notions of risk–rather than overt discrimination–likely play a role. Historically, heart attacks have been most common in older men, and clinicians may be less likely to suspect a heart attack among patients outside of that demographic. Banco suggested clinicians should appreciate that younger women represent a growing portion of heart attack patients.
“We, as health care providers, should continue to learn about how best to triage and diagnose patients with heart attacks, particularly among those who have historically been under-diagnosed or under-treated,” Banco said. “We are learning that heart attacks take many forms. We need to continue to raise awareness and make sure all patients are diagnosed and treated properly, even if they’re not the ‘classic’ demographic for a heart attack. [This knowledge] will help us improve care for all.”
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Young and middle-aged adults who reported severe psychological distress — such as depression or anxiety — after suffering a heart attack were more than twice as likely to suffer a second cardiac event within five years compared with those experiencing only mild distress, according to a study presented at the American College of Cardiology’s 70th Annual Scientific Session.
The study is the first to comprehensively assess how mental health influences the outlook for younger heart attack survivors, according to the researchers. The researchers also tracked inflammatory markers that appear to have a role in increasing cardiovascular risk among people experiencing distress. The findings align with previous studies focusing on older adults, bolstering the evidence for mental health as an integral part of a person’s recovery after a heart attack.
“Our findings suggest that cardiologists should consider the value of regular psychological assessments, especially among younger patients,” said Mariana Garcia, MD, a cardiology fellow at Emory University in Atlanta and the study’s lead author. “Equally importantly, they should explore treatment modalities for ameliorating psychological distress in young patients after a heart attack, such as meditation, relaxation techniques and holistic approaches, in addition to traditional medical therapy and cardiac rehabilitation.”
The researchers analyzed health outcomes in 283 heart attack survivors between the ages of 18 and 61, with an average age of 51 years. Study participants completed a series of validated questionnaires measuring depression, anxiety, anger, perceived stress and posttraumatic stress disorder within six months of their heart attack. Based on these questionnaires, the researchers established a composite score of psychological distress for each participant and grouped patients based on experiences of mild, moderate and high distress.
Within five years after their heart attack, 80 of the 283 patients suffered a subsequent heart attack or stroke, were hospitalized for heart failure or died from cardiovascular causes. These outcomes occurred in nearly half (47%) of patients experiencing high distress compared to 22% of those experiencing mild distress.
Previous studies suggest inflammation is one mechanism through which psychological distress may lead to heart problems. In the new study, patients who experienced high distress were also found to have higher levels of two inflammatory markers — interleukin-6 and monocyte chemoattract protein-1 — in their blood during rest and after mental stress. These markers, which increase during times of mental stress, are known to be associated with plaque buildup in the arteries and adverse cardiac events.
“It is thought that those who have had a heart attack may be particularly vulnerable to plaque rupture as a result of these inflammatory mechanisms at play,” Garcia said. “The association we found was independent of known cardiovascular risk factors and suggests mechanisms involving systemic inflammation in response to stress may be implicated in the likelihood of a subsequent cardiac event.”
The researchers also found that patients with high distress were more often Black, female and from a disadvantaged socioeconomic background and were more likely to smoke or have diabetes or high blood pressure.
“This finding highlights the importance of socioeconomic status in regard to higher distress and raises important questions about the role of race, sex and other factors,” Garcia said.
The researchers plan to further investigate how socioeconomic and demographic factors may influence mental health among people who suffer a heart attack at a young age. Recent studies have suggested younger adults, especially women, account for an increasing proportion of the heart attacks occurring each year in the U.S., Garcia said, underscoring the importance of improving outcomes in this population.
“Outreach to the community has led to increased awareness of traditional heart disease risk factors and focus on things like diet and exercise, but many people, particularly younger people, may not be aware of the importance of mental health,” Garcia said. “Our study offers a strong message to people recovering from a heart attack that ameliorating psychological distress is equally important.”
Garcia cautioned that causation cannot be proven with an observational study and noted the possibility of recall bias among people with more severe disease, since psychological distress was self-reported in this study. While the study’s sample size was relatively small, it did demonstrate a robust association using a prospective design.