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NEW YORK (September 17, 2020) -- All healthcare personnel should be immunized against vaccine preventable diseases recommended by U.S. Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (CDC/ACIP) as a condition of employment, according to a new policy statement by the Society for Healthcare Epidemiology of America. The broad statement of support of the vaccination recommendations, published in the journal Infection Control and Hospital Epidemiology, suggests medical contraindications as the only exception to receiving recommended immunizations.

"Millions of lives have been saved and debilitating diseases have been prevented through vaccinations," said David J. Weber, MD, MPH, co-lead author of the statement and a member of the SHEA Board of Trustees. "It is critical that we continue to use immunizations to the fullest degree possible to keep vaccine-preventable illnesses in check in the U.S."

Because immunizations are safe and effective in reducing disease transmission, and as a result of recent declines in use, the writing panel of 14 infectious diseases experts outlined supporting rationale for recommended vaccinations, except for individuals with a medical condition/allergy that would make them unsafe.

The statement made three specific recommendations:

1. Healthcare providers should routinely assess their patients' immunization status and strongly recommend appropriate vaccinations, tapping messaging and resources to help reassure patients of the evidence supporting the safety and effectiveness of the vaccines.

2. Attendees and staff of childcare facilities and schools should be held to immunization requirements to reduce the risk of transmission, as well as illness or death from vaccine-preventable diseases in these group settings given that exclusion of sick participants alone will not prevent transmission of many diseases.

3. Healthcare personnel, including anyone who works or volunteers in healthcare settings, should be required as a condition of employment to demonstrate immunity to preventable diseases as recommended by CDC/ACIP.

Only about 54% of medical practitioners surveyed say they have prescribed pre-exposure prophylaxis, or PrEP, to HIV-vulnerable patients, according to a new study by a Vanderbilt University Medical Center investigator.

The study, led by Ashley Leech, PhD, assistant professor of Health Policy, surveyed 519 practitioners in five major U.S. cities who attended a continuing medical education course on HIV between March and May 2015. The study was published in PLOS ONE.

PrEP is a once-daily medication for people without HIV that is a widely accepted method of preventing HIV transmission, but less than 10% of the more than 1 million people vulnerable to HIV are taking PrEP, according to the study.

"With a U.S. policy goal to eradicate HIV by 2030, practitioners are central to ensuring the delivery of PrEP across care settings," Leech said. "Our findings, however, indicate that even among a subset of HIV-focused practitioners, PrEP prescribing is not routine."

The study found that internal medicine prescribers were 1.6 times more likely to prescribe PrEP than infectious disease practitioners, which researchers said was an indicator of how important internal and family medicine practitioners are in assessing and mitigating risk in their patients.

Longstanding confusion or disagreement between HIV and primary care practitioners over who should be responsible for prescribing this preventive medication may partly explain the slow adoption of PrEP among practitioners, Leech said.

Age, years of training, and sex of the independent prescribers were also significantly associated with prescribing experience.

The study also found that practitioners might be more willing to prescribe PrEP as a first clinical step for persons who inject drugs than previously indicated, with more work needed to effectively communicate with priority groups vulnerable to HIV and to reach individuals who could most benefit from PrEP, according to Leech.

"While a number of factors could impact PrEP prescribing, including patients' low familiarity with the drug or practitioners' lack of opportunity in offering PrEP, in order for the drug to be effective at eliminating HIV in the United States in the next 10 years, the proportion of prescribing needs to increase, with more effort placed on identifying risk across populations and clinical specialties."

PHILADELPHIA (September 17, 2020) - Opioid use disorder and overdose have reached unprecedented levels around the world. In the United States, remediation of pain is one of the most common reasons American adults seek healthcare. Therefore, it is vital that clinicians practicing in diverse roles and settings have a clinical understanding of pain and substance use disorders as well as knowledge about public health and opioid policy interventions.

Data show that future healthcare professionals have not been receiving the training needed to competently provide this care. Healthcare professional curricula at undergraduate and graduate levels currently lack the content needed to adequately prepare future clinicians to intervene at the clinical and policy levels with regard to opioid use disorder and pain.

To address this gap, Shoshana Aronowitz, PhD, CRNP; Health Schmidt, PhD; and Peggy Compton, PhD, RN, from the University of Pennsylvania School of Nursing (Penn Nursing), designed and taught a 14-week transdisciplinary elective course titled "Opioids: From Receptors to Epidemic." The course curriculum is presented in detail in an article published in the journal Pain Management Nursing.

"We believe that courses such as this one are a vital step in addressing the current opioid and overdose crises, and it is our hope that students leave this course with a basic understanding of pain and opioid use disorders and the complex ways in which both impact therapeutic approaches and society," the authors say. The course is open to students from nursing and other disciplines, and includes both undergraduate and graduate students.

New Orleans, LA - A team of researchers from LSU Health New Orleans Neuroscience Center of Excellence and the University of Copenhagen provides the first evidence that patients with ocular hypertension may exhibit superior antioxidant protection that promotes resistance to the elevated intraocular pressure associated with glaucoma. Their findings are published online in the Journal of Clinical Medicine, available here.

In general, glaucoma patients are vulnerable to increased intraocular pressure. However, a particular group of patients has no glaucomatous neurodegeneration despite high intraocular pressure -- patients with ocular hypertension.

The paper reports the discovery of a new mechanism to explain why patients with ocular hypertension do not have glaucoma. This is the first study evaluating oxidative stress and antioxidative agents in patients with normal-tension glaucoma and ocular hypertension during oxygen stress.

According to the American Academy of Ophthalmology, ocular hypertension is when the pressure inside the eye (intraocular pressure or IOP) is higher than normal.

The authors found that patients with ocular hypertension have increased antioxidant capacity and higher levels of anti-inflammatory, omega-3 derived chemical messengers involved in sustaining cell function in their plasma compared to patients with normal-tension glaucoma and age-matched controls. The abundance of these omega-3 fatty acid chemical messengers provides antioxidant defense, and as a consequence, potential resistance to elevated intraocular pressure and glaucomatous neurodegeneration by eliminating increases in systemic oxidative stress.

"The study opens avenues of therapeutic exploration highlighting the significance of the omega-3 fatty acid chemical messengers' antioxidant capacity as a potential diagnostic biomarker and as a novel treatment to prevent glaucomatous neurodegeneration," notes Dr. Nicolas G. Bazan, Boyd Professor, Ernest C. and Ivette C. Villere Chair of Retinal Degeneration, and Director of the Neuroscience Center of Excellence at LSU Health New Orleans School of Medicine.

Glaucoma is the most common cause of irreversible blindness. The sight-threatening disease is defined by a progressive loss of the innermost retinal neurons with corresponding visual field losses. Despite current treatments to lower the intraocular pressure, 15% of glaucoma patients go blind, and as many as 42% will lose sight in one eye.

The study is a result of a collaboration between Dr. Bazan and Professor in Translational Eye Research, Chief Physician, and Glaucoma Specialist at the Copenhagen University Hospital, Dr. Miriam Kolko. Their collaboration began many years ago when, as a medical student from Denmark, Dr. Kolko worked with Bazan at LSU Health New Orleans.

"I began developing my interests in neuroprotection and ophthalmology working under Nicolas Bazan, who mentored, motivated and guided me, as a medical school student from Denmark supported by a Fulbright Scholarship (1994-1996), and from 2000-2003," says Dr. Kolko." I was lucky to work with and be inspired by Dr. Nicolas Bazan. Later, he also became my PhD thesis director."

"Professor Kolko is a brilliant and innovative clinician-scientist who bridges a clinical career treating patients with glaucoma medically and surgically with basic and translational research to understand the pathophysiology behind it," concludes Bazan. "We are so proud that this international superstar's roots are here at LSU Health New Orleans."

PITTSBURGH, Sept. 17, 2020 - A blood protein test could detect the severity of head trauma in under 15 minutes, according to research published recently in the Journal of Neurotrauma.

By showing that glial fibrillary acidic protein (GFAP) can accurately determine the severity of a brain injury through a blood test, the research team working on this study, led by author David Okonkwo, M.D., Ph.D., director of the Neurotrauma Clinical Trials Center at UPMC and professor of neurological surgery at the University of Pittsburgh School of Medicine, advanced the development of a point-of-care testing device designed to help clinicians assess traumatic brain injury (TBI) in minutes.

For the rapid test, the vision included using a hand-held device with a cartridge that would measure GFAP in a patient's blood. Researchers at Abbott Laboratories, a global health care company, will need to finalize the test for the i-STAT device, which already is used by the military and health care providers around the world to perform several common blood tests within minutes. The blood test would reveal a patient's GFAP level.

"This would eliminate guesswork in diagnosing TBIs and learn whether a person needs further treatment," said Okonkwo. "Whether you're testing a soldier injured in combat or testing a patient in a small rural hospital with limited resources, health care providers could have critical information they need--in minutes--to treat each patient's brain injury."

For this study, which expanded upon previous GFAP findings, researchers enrolled 1,497 people who sought care at one of the 18 Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) level 1 trauma centers nationwide over four years. GFAP is a Food and Drug Administration-approved marker for ruling out whether a patient needs a head computed tomography (CT) scan within 12 hours after a mild TBI.

For years, scientists have studied blood tests involving GFAP. They also have studied a similar protein called S100B. Both proteins are released in the bloodstream in response to specific injuries, including TBI. But this study showed that GFAP substantially outperformed S100B as a TBI diagnostic marker.

"Knowing this protein can show the severity of a TBI through a simple blood test is promising when considering we can use a device that already is in widespread use in hospitals, doctors' offices and urgent care facilities. All we would need to do is add an extra cartridge to the device to analyze blood for the GFAP protein," said Okonkwo. He estimates this device could potentially decrease unnecessary CT scans by 20% or more, saving nearly $100 million in medical expenses annually.

ATLANTA - September 17, 2020 - A new report examining cancer in adolescents and young adults (AYAs), defined as diagnoses occurring during ages 15 to 39, provides updated estimates of the contemporary cancer burden in this age group, predicting that 89,500 cases and 9,270 deaths will occur in 2020 in the United States. The report appears in the American Cancer Society journal: CA: A Cancer Journal for Clinicians.

AYAs with cancer are frequently grouped with older or younger patient populations and/or presented in aggregate, masking the wide heterogeneity in cancer occurrence within this population. To address this issue, American Cancer Society investigators also examined cancer incidence, survival, and mortality among AYAs by race/ethnicity and for smaller age groups (15-19, 20-29, and 30-39).

Cancer incidence rates among AYAs are highest in those who are non-Hispanic white (83 per 100,000 population during 2012-2016) and lowest in those who are Asian/Pacific Islander (54 per 100,000 population) for both sexes. This reflects higher rates in non-Hispanic white AYAs for thyroid cancer, testicular tumors, and melanoma compared to other major racial/ethnic groups. Unlike adults ages 40 and older, however, female breast cancer incidence rates in non-Hispanic Black AYAs are 14% higher than those in non-Hispanic white AYAs (25.9 vs 22.3 per 100,000 population).

The authors also note that despite patterns in overall incidence, cancer mortality rates are highest in non-Hispanic Black AYAs, particularly females (12.6 per 100,000 vs 9.2 in non-Hispanic white persons), reflecting substantial survival disparities compared to those who are non-Hispanic white. The largest 5-year cancer-specific survival disparities occur among those who are non-Hispanic Black compared with non-Hispanic whites for acute lymphocytic leukemia (57% vs 71%, respectively) and female breast cancer (78% vs 89%, respectively).

By age group, the cancer incidence rate in AYAs increased during the most recent decade (2007-2016) overall but showed signs of stabilizing among men in their 20s. The rise is largely driven by thyroid cancer incidence rates, which rose by approximately 3% annually among those aged 20 to 39 and 4% among those aged 15 to 19 years. Incidence increased for several cancers linked to obesity, including kidney (3% across all age groups), uterine corpus (3% in group aged 20-39 years), and colorectum (0.9%-1.5% in the group aged 20-39 years).

In contrast to incidence, cancer mortality rates among AYAs for all cancers combined declined in the past decade (2008 through 2017) by 1% across sex and age groups except females aged 30 to 39, among whom rates remained stable due to a flattening of declines in breast cancer mortality. Mirroring incidence, mortality rates increased during the most recent 10 data years (2008-2017) for colorectal and uterine corpus cancers.

Other highlights from the report include:

Adolescents (aged 15-19 years) are more likely to be diagnosed with cancers associated with childhood, such as Hodgkin lymphoma, while those aged 20 to 39 years are more likely to be diagnosed with adult cancers, such as breast. Thyroid cancer is the only cancer predicted to rank among the three most commonly diagnosed cancers in each AYA age group in 2020.

Leukemia continues to be the leading cause of cancer death in ages 15 to 29 years. Among ages 30-39 years, breast (women) and colorectal (men) cancers are the leading cancer causes of death.

Melanoma incidence rates during 2007-2016 rapidly declined in ages 15 to 29 (4%-6% annually, on average). However, among ages 30-39 years, rates declined only slightly among men and remained flat among women.

Overall 5-year relative survival in AYAs for all cancers combined (83%-86% across age groups) is similar to that in children (84%), but masks lower survival for several cancer types, such as acute lymphocytic leukemia (ALL; 60% vs 91%, respectively).

The report notes an increasing body of evidence that tumors in AYAs are molecularly distinct from those in younger or older populations, suggesting differences in etiology and in treatment options. In addition, studies have shown that compared to childhood cancer survivors, AYAs have a higher risk of progression and death from their original cancer. Compared to older cancer patients, AYAs have a higher risk of long-term and late effects including infertility, sexual dysfunction, cardiovascular disease, and other future cancers. However, further research in these areas is needed.

The authors say that progress in reducing cancer morbidity and mortality among AYAs could be improved with more equitable access to health care, as AYAs are more likely than other age groups in the U.S. to be uninsured. Increased clinical trial enrollment, expanded research, and improved awareness among clinicians and patients of early symptoms and signs of cancer could also accelerate progress.

"Although there has been rapid progress in the scientific understanding of cancer in AYAs over the last decade, several research gaps in etiology, basic biology, treatment, and survivorship remain," write the authors. "AYAs diagnosed with cancer also continue to face challenges in health care access during early life transitions, which can negatively impact treatment."

A Rutgers-led team has created a smart drug delivery system that reduces inflammation in damaged nervous tissues and may help treat spinal cord injuries and other neurological disorders.

The system, which uses extremely thin biomaterials implanted in the body, also protects nerve fibers (axons) that connect nerve cells in injured neural tissues, according to a study in the journal Advanced Materials.

Inflammation typically is a major factor during recovery from central nervous system diseases and injuries. Some regenerative medicine approaches have shown great potential for treating spinal cord injuries, traumatic brain injuries, Alzheimer's disease, Parkinson's disease, stroke and other neurological disorders. But suppressing the immune system during treatment can lead to side effects and boost the risk of infection.

"A major goal is to suppress neuroinflammation and restore a healthy micro-environment at sites of neurological disorders," said senior author KiBum Lee, a professor in the Department of Chemistry and Chemical Biology in the School of Arts and Sciences at Rutgers University-New Brunswick. "Our system took four years to develop and has shown enormous potential for smart drug delivery for better treatment of neurological disorders."

The team's unique drug delivery system consists of ultrathin nanomaterials, sugar polymers and neural proteins. The system, which releases an anti-inflammatory molecule (methylprednisolone), can create a favorable micro-environment to promote tissue repair and recovery after neurological injury.

By developing innovative, multifunctional and reliable drug delivery systems that use nano-biomaterials, Lee's research group aims to improve the treatment of neurological disorders. The team believes the new system may pave the way for treating not only central nervous system injuries, but also other diseases, since inflammation generally is associated with a variety of problems such as cardiovascular disease, osteoarthritis, diabetes and cancer.

PITTSBURGH, Sept. 16, 2020 - The slight decline in drug overdose deaths in 2018 coincided with changing Chinese regulations on a powerful type of opioid, rather than the result of U.S. efforts to curb the overdose epidemic, a University of Pittsburgh Graduate School of Public Health analysis revealed today in the journal Addiction.

What many--including President Donald Trump--perceived as a decline in overdose deaths in 2018 appears to be a return to the historic exponential curve. The finding is backed by preliminary federal data showing that the overdose death rate last year snapped back onto its long-term growth pattern, tallying more than 1 million deaths in the U.S. in the past four decades.

"The U.S. has not bent the curve on the drug overdose epidemic," said lead author Hawre Jalal, M.D., Ph.D., assistant professor of health policy and management at Pitt Public Health. "We are concerned that policymakers may have interpreted the one-year downturn in 2018 as evidence for an especially effective national response or the start of a long-term trend. Unfortunately, that isn't supported by the data."

Pitt Public Health scientists had previously demonstrated that overdose deaths have fit on an exponential curve since at least 1979, with the number of deaths doubling every 10.7 years. In 2016 and 2017, the death rate exceeded the curve's prediction by 22% and 11%, respectively. But in 2018, the rate declined by 4.1%, the first drop in overdose deaths since 1990.

Curious about what drove the drop, Jalal and Donald Burke, M.D., former dean of Pitt Public Health, crossed drug overdose data from the U.S. Centers for Disease Control and Prevention (CDC) with U.S. Drug Enforcement Administration (DEA) information on the types of drugs seized and submitted to state crime labs.

Carfentanil, an opioid that is 10,000 times more powerful than morphine and has no known medical use in humans, was rarely detected by these labs before 2016, when it began popping up in law enforcement drug seizures, peaking in 2017 and suddenly declining in 2018. The 2017 spike was concentrated in five states: Ohio, Florida, Pennsylvania, Kentucky and Michigan.

In 2017, China added carfentanil to its list of controlled substances, and, shortly thereafter, the U.S. supply dried up, coinciding with 2018's drop in overdose deaths.

When Jalal and Burke looked at the total decline in overdose deaths in just those five states with the largest decline in carfentanil drug seizures, they found that they accounted for nearly 100% of the total national drop in overdose deaths in 2018. Provisional 2019 data from the CDC shows a 5.6% rebound in overdose deaths since then.

"We all celebrated when the overdose death rate dropped, but it was premature," said Burke, Distinguished University Professor of Health Science and Policy in Pitt Public Health's Department of Epidemiology. "When policymakers believe a problem is solved, history has shown that funding is reprioritized to other efforts. The drug overdose epidemic is not solved. It continues to track along an ever-rising curve, with deaths doubling nearly every decade. We must address the root causes of this epidemic."

Jalal and Burke noted that the COVID-19 pandemic is likely to drive higher overdose deaths, especially since they tend to follow job losses, and social distancing means people may overdose alone, decreasing their chances of receiving life-saving care.

"This is a particularly critical time for the drug overdose epidemic, given the diversion of health care resources and the national attention to the COVID-19 pandemic," Jalal said. "The epidemic has continued brewing under the COVID-19 pandemic for half a year now. There is no indication that it's slowing."

A collaborative study led by Monash University's Biomedicine Discovery Institute and the Olivia Newton-John Cancer Research Institute (ONJCRI) has uncovered new markers (HLA-associated peptides) that are uniquely present on melanoma tumours and could pave the way for therapeutic vaccines to be developed in the fight against melanoma.

Despite all improvements in melanoma treatment, every five hours one Australian dies because of the lack of effective treatment. A promising new approach harnesses the body's own immune system to detect and kill tumour cells, through recognition of small tumour specific protein fragments (peptides) that decorate the surface of the tumour cells. The study, published in Cancer Immunology Research, a journal of the American Association for Cancer Research, has successfully identified thousands of peptides uniquely present on melanoma tumours that can be recognised by the immune system.

These observations have had an immediate clinical application, with the first clinical study on vaccination of melanoma patients using spliced peptides underway with collaborators at the Parker Institute for Cancer Immunotherapy, USA.

The study was co-led by Monash Biomedicine Discovery Institute's Dr Pouya Faridi, Professor Anthony Purcell and Associate Professor Ralf Schittenhelm, and Drs Katherine Woods and Andreas Behren from the Olivia Newton John Cancer Institute.

"We considered how a melanoma tumour might 'look' to the human immune system, under different growth conditions. The sheer scope of melanoma peptides that we identified in this study, many of which have never been reported before, was both surprising and inspiring," said Dr Woods.

Findings have shown that some of these melanoma peptide markers are generated from a process called splicing. In splicing, a protein is first cut into small pieces (peptides) and then two of these pieces are pasted together to make a "spliced peptide". By identifying the exact spliced peptides, they can be synthesised outside of the body, then administered to patients to trigger the immune system into recognising and targeting tumours.

"The general goal of our study was to find new targets for melanoma treatment. We were unaware of the existence, prevalence and importance of these unique spliced peptides or if they could be recognised by the immune system. Now that we know they can, these peptides can be used as bait for the immune system to take action," Dr Faridi said.

Dr Andreas Behren, Head Tumour Immunology Laboratory at ONJCRI said: "Our finding, that we can successfully identify spliced melanoma peptides that are immunogenic across different patients, is very exciting."

Professor Purcell notes: "Based on these studies, spliced peptide antigens have moved from an immunological curiosity to a whole new class of actionable targets not just in melanoma but other cancers as well. Using Dr Faridi's new workflow we have been able to shine a spotlight on this previously ignored class of peptides opening up a previously untapped resource for immunotherapy and cancer vaccination. Indeed, the ubiquitous nature of this splicing process point towards this class of antigens playing roles in infectious disease, autoimmunity and allergy.

Patients with a first-time depression diagnosis have an increased risk of the disease worsening and requiring hospitalisation, if they have previously been treated for a physical disease at a hospital. This is shown by research from iPSYCH.

The risk of being hospitalised with depression is increased if the patient has multiple physical diseases. Research findings from the national psychiatry project iPSYCH show that the risk was increased by up to 69 per cent in patients who had previously been treated at a hospital for physical diseases. Age is also a factor. The more physical diseases patients under 65 years have, the greater the risk of hospitalisation with depression.

"This may possibly be explained by a large number of physical diseases at a relatively young age being psychologically stressful, whereas having several diseases is 'to be expected' when you're older," says Ole Köhler-Forsberg, who is behind the study.

Reduced risk

The researchers also found that patients who were treated for a physical disease or who rededemed a prescription for medicine for physical diseases in the year before their depression, had a reduced risk of being hospitalised with depression.

"This may mean that the treatment of physical diseases can also have a better effect on the course of a depression, but it may also be explained by the fact that the patient is better at following their antidepressant treatment or that their own doctor is already more aware of the patient," explains Christiane Gasse, who also contributed to the study.

The study is the first to examine the correlation in a whole population between all physical diseases and the prognosis after a depression diagnosis. And it emphasises how much mental and physical health are interrelated, and that treatment of a physical disease also affects the mental health and vice versa.

"The study expands our knowledge by not only focusing on a specific disease, for example cardiovascular disease or cancer, but by including all physical diseases. Our findings show how important it is to thoroughly examine and treat people with depression for possible physical diseases," says Ole Köhler-Forsberg.

Positive effect on depression

The results are published in the Journal of Affective Disorders.

Almost 118,000 people who were diagnosed with a depression for the first time at a Danish psychiatric hospital during the period 1996-2015 were included in the study. The researchers had information about hospital-based diagnoses of physical diseases before the depression diagnosis since 1977, as well as information about the patients use of medicine prescribed by their GP for physical diseases in the year prior to the depression diagnosis.

The study confirms previous findings and experiences from clinical practice. For this reason, the researchers believe that future studies should look into whether better treatment of physical diseases also has a positive effect on depression.

The importance of the correlation between physical diseases and depression, and of better focus on this, is further emphasised in another article which Ole Köhler-Forsberg just published in collaboration with several international partners, particularly from the Charite Hospital in Berlin, Germany. In the article in Nature Reviews Disease Primers, the authors describe current knowledge about the frequency, diagnosis and treatment of depression in people with chronic physical diseases.

"Depression occurs two to four times more frequently in people with a chronic physical disease than in those who are physically healthy - and both psychological and medical treatment can have an effect on the depression," says Ole Köhler-Forsberg.

However, diagnosis and treatment can be complex because of the competing physical disorders and overlapping symptoms.

"Both biological, genetic, psychological and lifestyle factors play a role and increase the risk of suffering from both a physical disease and a depression, which is why it's also important to focus on the mental health of people with chronic physical diseases," explains the researcher.

The Government of India's use of nudge theory in the first three months of the pandemic helped to tackle the virus on numerous fronts, a new study suggests.

India has reported nearly five million COVID-19 cases and well over 80,000 deaths (as of 16 September 2020), making the country one of the worst hit in the world. But an even greater tragedy may have unfolded had India's government not used nudge theory to maintain one of the world's strictest and longest lockdowns in the first quarter of the year. This is the view of a new study by Ramit Debnath and Dr Ronita Bardhan from Cambridge's Behaviour and Building Performance Group, Department of Architecture.

Using machine learning and AI-based algorithms to analyse almost 400 government press releases, they show how India nudged across 14 key policy areas to influence the behaviour of 1.3 billion people, including government employees, scientists, health professionals, manufacturers, food suppliers and students to help fight COVID-19. The researchers argue that nudges from India's Prime Minister, Narendra Modi, were particularly important in creating herd effect on lockdown and social distancing norms across the nation.

The study, published in PLoS ONE, found that the government deployed nudge techniques to tackle a wide range of urgent challenges between 15 January and 14 April 2020. Nudging is a design-based public policy approach which uses positive and negative reinforcements to modify the behaviour of a population.

In January and February, policy nudges were focused on evaluating the risk of incoming travellers from China and extending surveillance at international airports. But the narrative soon shifted to address other pressing concerns. By March, nudges sought to impose new restrictions on travel, discouraging people from visiting crowded and public spaces, and strict social distancing. On 24 March, Modi told the nation that "21 days is critical to breaking the infection cycle... or else the country and your family could be set back 21 years". The next day, the country entered phase 1 of lockdown.

The government nudged to tackle fake news about the virus and to convince the population to strictly adhere to the rules, use masks and wash hand frequently. At the same time, it conducted surveillance in urban areas using smart technologies that included drones, spatial analysis, low-power Bluetooth mobile phone applications and humanoid robots.

Ramit Debnath said: "Nudge-based policy approaches are crucial in a democratic country like India which has a vast population and geo-spatial divide, high levels of illiteracy and an extremely vulnerable health system."

Ronita Bardhan added: "The government urgently needed to buy time and it had to bring a deeply divided population together to fight a common struggle - this was a huge challenge. Our findings show that the government needed much more than scientific data to convince people, they appealed to powerful values including patriotism, family, religion and community."

The study highlights the role played by the 'Prime Minister's Citizen Assistance and Relief in Emergency Situations Fund' (PM CARES Fund) which was created to nudge the public to make micro-donations and encourage public participation to help tackle the crisis. On 5 April, the Prime Minister nudged people to voluntarily switch off their lights for 10 minutes in solidarity with frontline workers. Most of these nudges were made with social media advertisements, SMS forwards and broadcast media.

The study found that government ministries nudged India's manufacturing firms to produce PPE, hand sanitiser and masks to meet the national demand, while also seeking to protect the country's food security and supply chains at a critical time - India's farmers harvest their winter crops from February to April.

Meanwhile, the government spurred on India's scientific community to fight the pandemic, releasing funding through the Department of Science and Technology. Research institutions were encouraged to submit proposals to focus on the development of affordable diagnostics, vaccines, antivirals, disease models, and other R&D to study COVID-19.

Scientific innovation during this period included robots for encouraging social distancing in public spaces and healthcare centres; and a contact tracing app (AarogyaSetu) using GPS and Bluetooth. Frequent SMS reminders were used to nudge people to use the app. The Ministry of Human Resource Development also nudged the start-up and innovation community in India to participate in the fight for COVID-19 by launching programs like 'Fight Corona IDEAthon'.

To support education, the government encouraged home-schooling by aggressively advertising the use of the National Digital Library of India. The government even harnessed nostalgia to help keep people at home during lockdown by broadcasting popular '80s and '90s TV shows on the national channel, Doordarshan.

The study demonstrates how nudge strategies evolved as the crisis unfolded. Between January and the first week of March, for instance, one government ministry (AYUSH) was aggressively nudging people to follow the traditional medicinal practice of Ayurveda and to maintain good health through yoga to increase immunity, while also insisting on disciplined personal hygiene. However, in mid-March, as infection rates increased, the nudges shifted away from traditional treatments to promoting a healthy lifestyle using hashtags like #YOGAathome.

The researchers used topic modelling, a computational social science method that has its basis in text mining and natural language processing. It automatically analyses text data to determine cluster words for a set of documents.

The Government started lifting lockdown restrictions on 7 June 2020, and the spread of the virus has since accelerated. But the benefits of the government's nudge campaign are still being felt, the researchers believe. Ronita Bardhan says:

"Behaviour changes encouraged by nudges earlier in the year, including the wearing of masks and social distancing, are still widely maintained across India. These nudges are still helping to save lives."

The study does not attempt to assess the success or failure of the Government of India's policy interventions, rather to understand how context-specific latent nudges were created through policy interventions.

Debates over whether hydroxychloroquine should be taken to help lessen the duration and impact of COVID-19 have revolved around the drug's reputation for causing cardiac events such as abnormal heart rhythms or beats and cardiac arrest. Because of this, the U.S. Food and Drug Administration has revoked emergency use authorization for the drug in treating COVID-19.

Another drug, azithromycin -- a commonly-prescribed antibiotic -- also is being investigated as a potential treatment for COVID-19. Azithromycin's association with cardiac events also has been debated. In 2012, the FDA issued a warning for azithromycin stating that it had been linked to cardiac events, but subsequent studies have yielded mixed results.

Now, researchers from the University of Illinois Chicago have found that azithromycin by itself is not associated with an increase in cardiac events; however, if the drug is taken with certain other drugs that affect the electrical functioning of the heart, then cardiac events increased.

"Our findings should give researchers and clinicians looking at azithromycin as a potential treatment for COVID-19 pause," said Haridarshan Patel, a researcher in the department of pharmacy systems, outcomes and policy at the UIC College of Pharmacy and corresponding author on the paper. "We found that if taken together with drugs that affect the electrical impulses of the heart, the combination is linked with a 40% increase in cardiac events, including fainting, heart palpitations and even cardiac arrest."

Their findings are published JAMA Network Open.

Drugs that affect the electrical impulses of the heart, specifically the interval in the electrical rhythm called the QT interval, are called QT-prolonging drugs. These drugs include blood pressure medications such as ACE inhibitors and beta-blockers, some antidepressants, anti-malaria drugs such as hydroxychloroquine and chloroquine, opioid medications and even muscle relaxers.

"Because QT-prolonging drugs are used so commonly, our findings suggest that doctors prescribing azithromycin should be sure that patients are not also taking a QT-prolonging drug," Patel said.

In a previous study, Patel and colleagues found that one in five people prescribed azithromycin also were taking a QT-prolonging drug.

Previous studies looking at azithromycin and cardiac events examined specific populations that tend to be older and have more health issues, including Medicaid patients and veterans. But in this study, Patel and colleagues used a large database containing medical data on millions of patients in the United States with a mean age of 36 years old.

The risk of cardiac events with azithromycin was evaluated against amoxicillin, another antibiotic that has never been linked to cardiac events and which has no impact on the QT-interval. The researchers looked at data from more than 4 million patients enrolled in private health insurance plans who were hospitalized or visited an emergency department for a cardiac event between 2009 and 2015 who started taking either amoxicillin or azithromycin within five days of their hospital visit. There were approximately 2 million episodes in each group. Cardiac events included ventricular arrhythmias, fainting, palpitations and cardiac arrest, and death.

"Drugs often prolong QT-interval but may not necessarily result in cardiac events that self-resolve over time," Patel said. "We looked at events that led to emergency department visits or hospitalizations in this study."

The researchers found that the likelihood of cardiac events with azithromycin compared with amoxicillin were not significantly higher, and these events actually were quite low or rare in both groups, with the most common cardiac events being fainting and palpitations. However, among patients taking both a QT-prolonging medication and azithromycin together, the risk of cardiac events was 40% higher compared with the amoxicillin group.

"Because both QT-prolonging drugs and azithromycin are so commonly prescribed, the risk for cardiac events due to the combination, while still rare, is serious," Patel said. "Studies looking at using azithromycin to treat COVID-19 or other diseases should very carefully consider its use among patients who are also taking QT-prolonging medications."

University of Guelph researchers are the first to discover that adolescents react differently to e-cigarette vapour than adults.

Led by Prof. Jibran Khokhar, Department of Biomedical Science in U of G's Ontario Veterinary College, the rodent-based research measured behavioural responses related to vaping.

"This is the first study to show that rodents find e-cigarette vapour rewarding in a conditioned place preference experiment," Khokhar said,?referring to animals' preference for a chamber in which experimenters previously exposed them to a drug.

"It also shows that adolescents find the nicotine vapour more rewarding compared to adults, and do so even at shorter exposures, which are not rewarding for the adults."

Published recently in eNeuro, the research?is the first to use a U of G-developed technology called OpenVape, which makes the study of vaping more accessible. The apparatus can be used with various vapourizers, is easy to build and costs less than existing technologies.

"The OpenVape device opens a lot of new doors for researchers trying to test the effects of exposures in a manner akin to the route used by humans," Khokhar said.

The research findings are important, he added, because they may help explain why e-cigarettes are so popular with adolescents and why there is a steady rise in their use.

Recent years have seen a sharp increase in adolescent vaping. E-cigarette use more than doubled between 2017 and 2019 in Ontario among Grade 7-12 students. Between 2017 and 2019, vaping rates doubled among Ontario teens, from 11 per cent to 23 per cent.

"The adolescent brain may be especially vulnerable to the rewarding effects of nicotine vapour," Khokhar said. "The shorter exposures may also suggest that it might take very limited exposure to the vapour for adolescents to experience the rewarding effects, and this may contribute to their continued use."

A growing body of literature suggests adolescents are especially vulnerable to the addictive effects of nicotine, he added. Longitudinal studies associate adolescent e-cigarette use with a greater risk of cigarette smoking in future.

"The findings from our study will help uncover the mechanisms underlying the vulnerability of the adolescent brain to the rewarding effects of e-cigarette vapour as well as the long-term consequences of adolescent vapour exposure," Khokhar said.

Next, he plans to look at the long-term consequences of adolescent exposure to e-cigarette vapour on behaviours related to tobacco consumption.

"Studies in humans suggest that adolescent vaping increases the risk for switching to combustible tobacco, so we would be able to answer whether that association is causal," he said. "We will also explore the brain mechanisms that make adolescents more vulnerable, as well as the long-term changes in brain activity and function after adolescent exposure."

When viruses, parasites and other pathogens spread, humans and other animals tend to hunker down with immediate family and peer groups to avoid outsiders as much as possible. But could these instincts, developed to protect us from illnesses, generalize into avoidance of healthy individuals who simply look, speak or live differently?

Jessica Stephenson, an assistant professor in the University of Pittsburgh Department of Biological Sciences, coauthored a paper exploring the answer, which was recently published in the Proceedings of the Royal Society of London, Series B.

"During epidemics, humans tend to become overly sensitive, so any sort of physical abnormality that somebody has suddenly becomes a potential indicator of infection. We become much more bigoted, we pay way more attention to things that differentiate people from what we perceive as our own phenotype. People who look different from us and sound different from us, which, of course, leads to a lot more xenophobia," said Stephenson, who runs Stephenson Lab of Disease Ecology and Evolutionary Parasitology at Pitt.

One example noted in the study showed that black garden ants exposed to a fungus clustered together in groups much smaller than researchers could predict by chance, which effectively limited the spread of disease. Similar behaviors seen among 19 non-human primate species were also credited for lowering direct spread of parasites.

Human beings share these same biological impulses to separate into modular social groups. However, when pathogens are spreading, humans tend to also adopt a set of behaviors that are "hyper vigilant and particularly error prone," the researchers wrote.

"It's interesting and really disappointing," Stephenson said.

As COVID-19 continues its spread, humans are even more susceptible to the impulse.

"We shouldn't discriminate against different groups in our social distancing, or in our efforts to work together to beat the virus," she said. "But I think our natural, evolved tendencies would be to associate only within our ingroups. We have to fight that natural antipathy towards people who differ from ourselves, and not shut down."

In the first week of the coronavirus pandemic, people living in the United States underestimated their chances of catching the virus, or of getting seriously ill from the virus, according to a recently published Caltech-led study. But as the days progressed, those same people became more worried about their personal risk, and, as a result, began to increase protective behaviors such as washing hands and social distancing.

"A little bit of anxiety is good in this case," says Toby Wise, a visiting postdoctoral scholar at Caltech and lead author of the new study appearing in the journal Royal Society Open Science. "It means that people will be more prudent. We found that an individual's assessment of personal risk affected their behavior more than concerns about the safety of other people. Knowing this helps in the development of public health strategies." Wise, who is based at the University College London, works with Dean Mobbs, assistant professor of cognitive neuroscience at Caltech and a Chen Scholar.

The idea that people underestimate their risk of catching diseases has been documented before. For example, in previous studies, researchers have shown that smokers believe that they personally have less of a risk of developing lung cancer than other people who also smoke. In the new study, this same "optimism bias" is demonstrated for the case of COVID-19, the disease caused by the novel coronavirus. Wise, Mobbs, and their colleagues monitored almost 400 people via online questionnaires for a period of five days, beginning March 11, the official start of the pandemic according to the World Health Organization.

"We found that people's perceptions changed dramatically during the first few days of the pandemic in the U.S.," says Wise. "And the more people became aware of the risk to themselves, the more engaged they became in activities like hand washing and social distancing. In the context of a global pandemic, risk perception is highly susceptible to change."

The study also identified a subset of participants who continued to feel that they were at a low risk of harm from COVID-19 even as the pandemic unfolded, and consequently did not engage in any protective behaviors. Although not demographically different from other people, this group was shown to be less personally affected by the pandemic.

"We can target these disengaged individuals with information campaigns, such as using emergency alerts on phones, for example. Educating people on the beneficial effects to others may also improve engagement," says Wise.

Adds Mobbs: "Our study shows that in many cases, it doesn't take long for people's views and behavior to change rapidly when needed."