'Water on the knee' could be early sign of Lyme disease

Spontaneous knee effusion, also known as "water on the knee," can be a primary symptom of Lyme disease, even when patients do not exhibit a "bull's eye" rash, another common Lyme disease symptom. According to a literature review appearing in the November issue of The Journal of the American Academy of Orthopaedic Surgeons (JAAOS), early diagnosis and antibiotic treatment can prevent the development of Lyme disease's more severe symptoms.

Lyme borreliosis, or Lyme disease--the most common vector-borne illness transmitted by insects--is prevalent in the Northeast and upper Midwest regions of the United States. Over 30,000 cases are reported to the Centers for Disease Control and Prevention (CDC) each year and likely over 300,000 new cases occur but go unreported.

"It is important to catch and treat Lyme disease early because the symptoms get progressively worse over time," said Elizabeth Matzkin, MD, lead study author and assistant professor of orthopaedic surgery at Harvard Medical School. "However, the lab tests used to diagnose Lyme disease can take time to process, and there are certain circumstances in which immediate antibiotic treatment may be recommended before the lab results are complete." If symptoms have been present for less than two weeks, the Lyme test may need to be repeated as the test can remain negative the first two weeks of an infection.

The current standard of care for the diagnosis of Lyme disease is a two-tier blood test. Antibiotic treatments are successful in 99 percent of patients who are diagnosed early and in 90 percent of patients who are diagnosed later. If left untreated, 60 percent of patients eventually develop Lyme arthritis, with the most severe cases having higher risks of permanent joint damage.

"Half of patients do not recall a tick bite or observe a rash, and early symptoms are not always detected when a physician diagnoses a knee effusion," said Dr. Matzkin. "One of the most notable differentiating factors is, while septic or arthritic knees usually come with significant pain, knee effusions caused by Lyme disease are often very large, not activity-related, and mostly pain-free."

Early symptoms of Lyme disease, which include fatigue, chills, fever, headache, muscle and joint aches, and swollen lymph nodes, occur three to 30 days after exposure and are not always present.

In areas where Lyme disease is common, physicians should always consider whether a spontaneous knee effusion might be caused by the disease and test accordingly. In areas of low prevalence, the clinician should ask if the patient has traveled to such an area before making a diagnosis.

Research shows Cuba's Internet issues

In December 2014, President Barack Obama made history by reestablishing diplomatic relations with Cuba, which included loosening its economic embargoes. Two months later, American companies like Netflix and Airbnb announced plans to expand into the once-banned island.

"Our first reaction was: 'Really?'" said Northwestern Engineering's Fabián E. Bustamante. "As a business model, Netflix and Airbnb rely on most people having Internet access. That's not quite the case in Cuba, so it really didn't seem to make much sense."

Wanting to see if these business ideas were feasible, Bustamante, professor of electrical engineering and computer science in Northwestern University's McCormick School of Engineering, and his graduate student Zachary Bischof decided to measure Cuba's Internet performance. They found that Cuba's Internet connection to the rest of the world was perhaps even worse than they expected.

Bischof presented their findings October 30 at the Association for Computing Machinery's 2015 Internet Measurement Conference in Tokyo.

Cuba's history with computing and Internet is a complicated one. Its citizens were not even allowed to own a personal computer until 2008. In February 2011, Cuba completed its first undersea fiber-optic cable with a landing in Venezuela, but the cable was not even activated until two years later. Today, about 25 percent of the population is able to get online and just five percent of the population has home Internet.

"If you're trying to connect anywhere, you either have to connect through these marine cables or up to the satellite," Bustamante said. "If you go up to the satellite, it would take significantly longer."

"For one, it's much farther to travel," Bischof added. "And the trip is on a very interference-rich environment, which include cosmic rays."

Since March 2015, Bustamante and Bischof have been conducting measurements from a server in Havana to observe Internet traffic going in and out of Cuba. They measure the amount of time it took for information to travel in both directions, taking note of the paths of travel. In early results, the team found that information returning to Cuba took a much longer route.

During their study, Bustamante and Bischof found that when a person in Havana searched for a topic on Google, for example, the request traveled through the marine cable to Venezuela, then through another marine cable to the United States, and finally landed at a Google server in Dallas, Texas. When the search results traveled back, it went to Miami, Florida, up to the satellite, and then back to Cuba. While the information out of Cuba took 60-70 milliseconds, it took a whopping 270 milliseconds to travel back.

"It takes so long that it's almost useless," Bustamante said. "You can start loading a webpage, go have coffee, then come back and maybe you'll find it."

Bustamante and Bischof said this could be the result of a configuration problem or routing policy and are currently exploring this further. For now, they can only say -- with certainty -- that Cuba's Internet performance appears to be among the poorest in the Americas, and its infrastructure would struggle to support web services hosted off the island, particularly network-intensive applications like Netflix. Understanding the problems and diagnosing their causes will help Bustamante, Bischof, and other teams propose future solutions.

"Beyond Internet services like Netflix, to continue societal progress in Cuba depends on better connectivity," Bustamante said. "To better understand how to improve it, we first have to better understand what is available now."

In reversal, SXSW festival plans online harassment event

The SXSW Interactive technology festival said Friday that it will hold an "online harassment summit" after it was criticized for bowing to threats and canceling two panels related to video games and online harassment.

Canceling the panels "sent an unintended message that SXSW not only tolerates online harassment but condones it," SXSW Interactive Director Hugh Forrest said in a blog post.
The original inclusion of the panels triggered threats of violence against the festival. That led organizers to cancel them "in the interest of public safety," Forrest said.

But scrapping the sessions was "not an appropriate response" and the festival is now "working with the authorities and security experts," he said.

Both panels had been related to the online campaign dubbed "GamerGate" that began last fall, during which women were harassed for criticizing the lack of diversity in the video-game industry and women's portrayal in it. Neither of the panels mentions GamerGate specifically.

The tech festival, held every March in Austin, Texas, attracts 33,000-plus attendees and is part of the larger SXSW extravaganza for music and film. Online media companies BuzzFeed and Vox Media had threatened to pull their panelists and moderators from the festival if the panels weren't reinstated. Neither company responded to emails asking if they now planned to participate.

The festival said Friday that it would have a "day-long summit to examine" online harassment on Saturday, March 12. The event will be in-person and live-streamed, said Kelly Krause of SXSW's press team.
Forrest's post said the event would include speakers from both of the originally scheduled panels. One was called "Level Up: Overcoming Harassment in Games," the other "SavePoint: A Discussion on the Gaming Community." The "SavePoint" talk had been set to discuss the "current social/political landscape in the gaming community" and included speakers who shared some GamerGate concerns, such as ethics in gaming journalism. The "Level Up" panel included several women who have been subjected to harassment.

Not all the participants were comfortable with the new arrangement. Randi Harper, who had been scheduled to be on the "Level Up" panel, wrote in an emailed statement that the original panelists were "not confirmed to be speaking" at the summit after the two panels were combined into one event. Harper is the founder of the Online Abuse Prevention Initiative, a non-profit, according to its website.

"We were very surprised to find SXSW making GamerGate a part of the discussion about online harassment. While we fully support GamerGate being a part of SXSW Gaming, adding them to the summit creates a safety concern for many of the people who are currently scheduled to be participating," she wrote in the statement. "It is unfortunate that SXSW still lacks an understanding of online harassment, and I have no confidence in their ability to run this summit while keeping panelists safe and providing for a productive conversation."

Krause did not reply to an email asking for comment regarding Harper's statement.

"We're cautious. We want to play it by ear and see where it goes," said Perry Jones, who had been on the "SavePoint" panel and is founder of the Open Gaming Society. Jones said that was an advocacy group that is critical of both video game journalism and "pandering" in diversity efforts in video games.
"The last thing you want is for someone somewhere to take up arms and cause on-site violence of some sort," he said.

Conservative Protestant rural youth more violent than their urban counterparts

Conservative Protestant rural youth are more often involved in violent crimes than their counterparts in urban areas, who also use less violence than average. The relationship between alcohol use and violence is also stronger among rural youth and among conservative Protestant rural youth in particular. These are the conclusions of sociologist Don Weenink in his article entitled 'Taking the Conservative Protestant thesis across the Atlantic' that was published in the British Journal of Criminology. Weenink carried out his research with a Veni grant.

Weenink's research is the first large-scale study into violence, alcohol and religious background in Europe, in which rural and urban areas are compared. Weenink used data from 8000 Dutch young people in the age range 15 to 30 years.

Previous research has shown that in the southern, mainly rural, regions of the United States there was a close relationship between conservative Protestantism and violence. In the Netherlands, however, it transpired that conservative Protestant youth living in villages commit violent acts more often than their counterparts in urban areas – urban conservative Protestant youth stated that they use far less violence than average. The relationship between violence and this religion is therefore dependent on the social context. In general, rural youth and young people in urban areas differ little from each other with respect to the use of violence. Weenink: 'Contrary to what many people think, the Dutch countryside is not always that idyllic'.
Also the relationship between alcohol use and violence is dependent on the social environment. This relationship is stronger among young village residents especially those with a conservative Protestant background. Weenink also comments that alcohol consumption is often seen as harmless pleasure by both parents and young people in rural areas, whereas in urban areas they often associate alcohol use with antisocial behaviour.

Take matters into their own hands

Weenink does not rule out the possibility that in the relatively closed conservative Protestant villages in the Dutch Bible belt young people are more inclined to take matters into their own hands than to call the police for help in conflict situations. On the other hand the lower use of violence among conservative Protestant youth in urban areas is possibly correlated with their lower participation in the nightlife scene there.
Don Weenink previously investigated excessive violence committed by young people and the forms and meaning of youth violence. In this study one of his conclusions was that attackers could end up in an 'emotional tunnel' where the violence escalates if the victim ends up on the ground and if the supporting group of the attackers is larger than that of the victims.

More information: Don Weenink. Delinquent Behavior of Dutch Rural Adolescents, Journal of Youth and Adolescence (2011). DOI: 10.1007/s10964-011-9650-x

To Chinese, end of 1-child policy welcome, not game-changer

Everyone should have the chance to have more than one child, say Chinese parents who welcome the government's loosening of its population policy. But just because all couples can now have two children, that doesn't mean all want to take advantage.

Many already had that option because the one-child policy had been significantly relaxed in previous years. Some see a second child as too expensive, especially given the current level of government support for child care and medical care. Others say it's already too late, and reflect on the siblings they might have had if the policy had not been in place for the past three decades.

Parents in Beijing and Shanghai spoke to The Associated Press on Friday about the historic change:

LONELY GENERATION

Chinese born in the 1980s and 1990s, when the one-child policy was most strictly enforced, say they were lonely growing up without siblings. That increased perceptions that the policy was unjust, said Shanghai stay-at-home mother Shao Jiao.

"We lack brothers and sisters, accompaniment. That experience and that life, we do not have them," said Shao, 31, the mother of a 7-year-old boy and 6-week-old girl. "I think it is true that the only-child generation is lonely. So we have to turn to friends more for that. We are the lonely generation," Shao said.

SEEKING HEALTH-CARE HELP

China has changed its one-child policy to a two-child policy to help mitigate an expected shortage of workers that will be needed to support an aging population. But a Beijing resident said the government will need to increase child-care and health-care support to give families incentives to have more kids.

Like many Chinese interviewed by media, the man gave only give his surname, He. His 2-year-old needs substantial medical care, but government support varies widely, depending on where families live and their legal residency status. People who live in rural areas, or migrate from the country to big cities to find work, get less help than native urban-dwellers.

"People won't have a second child if the burden is too great, so there really needs to be more state help," He said as he strolled with his child outside Beijing's Capital Institute of Pediatrics.

COUNTING THE COSTS

Wang Huiying, who works for Chinese state broadcaster CCTV, said child care is a major concern when considering whether to have a second child. Wang, 34, employs a nanny to care for her 3-year-old daughter, Pipi, but said many families are forced to put their children in the care of grandparents who might not always be available.

Child care adds to the costs of clothing, food and outside tutoring, while housing costs in major cities such as Beijing and Shanghai are already major burdens.

Wang already had the option of having a second child. A major change to the policy in 2013 allowed people who were only children, including Wang's husband, to have a second child of their own. Still, the official end of the one-child policy has renewed her interest having another. "There are a lot of factors to consider, so we're going to think very hard about this," she said.

___

PAYING THE PRICE

Chen Xiaoling from Hebei province outside Beijing wasn't eligible for more than one child, but had a second, anyway. She had to pay a 40,000-yuan ($6,325) fine, which she and her husband were able to absorb. It helped that the couple are self-employed; had they worked for a state company or office, they could have been fired.

"Having another child isn't really a major issue if you can afford it, so I don't really think the change in rules will have a very big effect," Chan said while taking a walk in eastern Beijing's scenic Ritan Park.

___

AGING FUTURE

Boxing coach Chen Qiang in Shanghai says he's greatly concerned about the inverted-pyramid family structure the old policy has resulted in: four grandparents, two parents and just one child. The plunging birthrate stands to increase the burden on the working-age population and create a labor shortage, said Chen, 34.

"So nationwide, we will have very few young people decades later," he said. While Chen himself hopes for a daughter to accompany his 6-year-old son, he says Thursday's announcement was not a factor in his planning and questions whether it will motivate many couples to change their thinking. "Those who want two kids already have them," he said.

Extreme weather events in Chesapeake Bay give clues for future climate impacts

Fast food companies advertise children's meals on TV with ads that feature toy premiums, and it has been suggested that the use of these toy premiums may prompt children to request eating at fast food restaurants. In a new study scheduled for publication in The Journal of Pediatrics, researchers found that the more children watched television channels that aired ads for children's fast food meals, the more frequently their families visited those fast food restaurants.

Using a database they compiled of all fast food TV ads that aired nationally in 2009, Jennifer A. Emond, PhD, and colleagues from the Geisel School of Medicine at Dartmouth found that only two nationally-recognized fast food chains engaged in child-directed TV advertising at that time. According to Dr. Emond, "Seventy-nine percent of the child-directed ads from those two restaurants aired on just four children's networks."

The researchers enrolled 100 children (3-7 years of age) and one of their parents in the study. The parents completed a survey that included questions about how often their children watched each of the four children's networks, if their children requested visits to the two restaurants, if their children collected toys from those restaurants, and how often the family visited those restaurants. Researchers found that 37% of parents reported more frequent visits to the two fast food restaurants with child-directed TV ads.

Fifty-four percent of the children requested visits to at least one of the restaurants. Of the 29% of children who collected toys from the restaurants, almost 83% requested to visit one or both of the restaurants. Some factors associated with more frequent visits were more TVs in the home, a TV in the child's bedroom, more time spent watching TV during the day, and more time spent watching one of the four children's networks airing the majority of child-directed ads.

Despite the small numbers of enrolled families, this study shows that the more frequently a child views child-directed fast food TV ads, often involving a toy, the more likely the family visited the fast food restaurant that was featured in the advertising. These findings also show that children's food preferences may be partially shaped by a desire for the toys featured in TV ads. "For now," notes Dr. Emond, "our best advice to parents is to switch their child to commercial-free TV programming to help avoid pestering for foods seen in commercials."

How we use our smartphones twice as much as we think

The study in the journal PLOS ONE compared the amount of time participants estimated they spent on their smartphones with their actual usage.

It found that people were accessing their phones twice as often as they thought.

Dr David Ellis, a psychologist at Lancaster University, said: "Psychologists typically rely on self-report data when quantifying mobile phone usage in studies, but our work suggests that estimated smartphone use should be interpreted with caution."

The researchers argue that 'rapid mobile phone interactions' are becoming habitual for smartphone users. They asked 23 participants, aged 18-33, asked to estimate how much time they had spent on their phone.

An app was also installed on their smartphones which recorded all their actual usage over a two week period. This included activities like checking the time, looking atmessage notifications or social media alerts, phone calls and playing music.

Researchers found that smartphone use was typically confined to short bursts – more than half of uses lasted less than 30 seconds.

The study was led by Lancaster University with Nottingham Trent, the University of Lincoln and University of the West of England.

More information: Sally Andrews et al. Beyond Self-Report: Tools to Compare Estimated and Real-World Smartphone Use, PLOS ONE (2015). DOI: 10.1371/journal.pone.0139004 

Read more at: http://phys.org/news/2015-10-smartphones.html#jCp

Email, text or web portal? Study probes patients' preferences for receiving test results

The results of common medical tests are sometimes delivered to patients by email, letters or voice mail, but are these the most preferred methods? According to one of the first studies to look at this question, the answer is no.

The Georgetown University Medical Center (GUMC) survey, published today in the Journal of the American Board of Family Medicine, finds that the largest portion of participants was comfortable receiving test results through password-protected websites or portals. (The survey did not include in-person communications.)

The survey of 409 participants suggests that while password-protected web portals are highly preferred, participants don't mind a variety of non in-person communication methods including email, texts or voicemail for receiving results of common tests such as blood cholesterol levels.

However, that is not the case for two very sensitive tests -- non-HIV sexually transmitted infections (STIs) and genetic test results. In those cases, receiving the results via a password-protected patient portal/website was highly preferred.

"Communication with patients may need to be on a case-by-case basis -- every individual may have a personal preference, and there may be a way to indicate those preferences in the patient's record. The goal of this study was to try to better understand these preferences, so we can improve doctor-patient communication," says the study's lead researcher, Jeannine LaRocque, PhD, assistant professor of human science in the School of Nursing & Health Studies at GUMC.

It is not uncommon for a physician to call or email a patient with results to common tests without any idea of which is preferred in different contexts, but "this study makes clear that the majority of people prefer something different than what we've been doing," says the study's senior researcher, Daniel Merenstein, MD, director of research programs in the department of family medicine at GUMC.

The survey tested the desirability of seven different methods of non-in-person communication in receiving three different kinds of tests: common tests such as blood cholesterol and colonoscopy results; non-HIV STIs; and genetic testing (predisposition to a disorder, carrier of an inherited gene linked to a disease and a carrier of a genetic disorder).

The seven methods of communications surveyed were a password-protected patient portal website, phone voicemail, personal email, letter, home voicemail, fax and mobile phone text.

Researchers found that in all categories, patients were least comfortable receiving information via fax.

Half or more preferred receiving cholesterol or colonoscopy results in four methods: password protected patient portal websites, personal voicemail, personal email or letter. The majority did not want to receive a home voicemail, mobile text message or a fax.

For receiving results of STIs, only one method was preferred by the majority (51 percent) of participants -- password-protected websites. No single method was preferred for genetic test results; the closest, at 46 percent, was also password-protected websites.

LaRocque, a researcher focused on genetics and molecular biology, is interested in how sensitive information is transmitted to patients. "With these highly sensitive medical results such as genetic test results, patients may not trust the privacy of methods such as personal voicemail or email, whereas password-protected websites provide an added level of security, which may be necessary as these tests become more prevalent in primary care practices," she says.

But other studies have found that a minority of patients has signed up for available patient portals, and only half have actually activated their sites, the researchers say.

The researchers point out one potential bias in the study: since the majority of completed surveys were administered online, those who participated may be innately more comfortable with electronic communication.