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BROOKLYN, New York, Tuesday, April 28, 2020 – The dissemination of fake news on social media is a pernicious trend with dire implications for the 2020 presidential election. Indeed, research shows that public engagement with spurious news is greater than with legitimate news from mainstream sources, making social media a powerful channel for propaganda.

A new study on the spread of disinformation reveals that pairing headlines with credibility alerts from fact-checkers, the public, news media and even AI, can reduce peoples’ intention to share. However, the effectiveness of these alerts varies with political orientation and gender. The good news for truth seekers? Official fact-checking sources are overwhelmingly trusted.

The study, led by Nasir Memon, professor of computer science and engineering at the New York University Tandon School of Engineering and Sameer Patil, visiting research professor at NYU Tandon and assistant professor in the Luddy School of Informatics, Computing, and Engineering at Indiana University Bloomington, goes further, examining the effectiveness of a specific set of inaccuracy notifications designed to alert readers to news headlines that are inaccurate or untrue.

The work, “Effects of Credibility Indicators on Social Media News Sharing Intent,” published in the Proceedings of the 2020 ACM CHI Conference on Human Factors in Computing Systems, involved an online study of around 1,500 individuals to measure the effectiveness among different groups of four so-called “credibility indicators” displayed beneath headlines:

Fact Checkers: “Multiple fact-checking journalists dispute the credibility of this news”

News Media: “Major news outlets dispute the credibility of this news”

Public: “A majority of Americans disputes the credibility of this news”

AI: “Computer algorithms using AI dispute the credibility of this news”

“We wanted to discover whether social media users were less apt to share fake news when it was accompanied by one of these indicators and whether different types of credibility indicators exhibit different levels of influence on people’s sharing intent,” says Memon. “But we also wanted to measure the extent to which demographic and contextual factors like age, gender, and political affiliation impact the effectiveness of these indicators.”

Participants — over 1,500 U.S. residents — saw a sequence of 12 true, false, or satirical news headlines. Only the false or satirical headlines included a credibility indicator below the headline in red font. For all of the headlines, respondents were asked if they would share the corresponding article with friends on social media, and why.

“Upon initial inspection, we found that political ideology and affiliation were highly correlated to responses and that the strength of individuals’ political alignments made no difference, whether Republican or Democrat,” says Memon. “The indicators impacted everyone regardless of political orientation, but the impact on Democrats was much larger compared to the other two groups.”

The most effective of the credibility indicators, by far, was Fact Checkers: Study respondents intended to share 43% fewer non-true headlines with this indicator versus 25%, 22%, and 22% for the “News Media,” “Public,” and “AI” indicators, respectively.

Effects of Political Affiliation

The team found a strong correlation between political affiliation and the propensity of each of the credibility indicators to influence intention to share. In fact, the AI credibility indicator actually induced Republicans to increase their intention to share non-true news:

Democrats intended to share 61% fewer non-true headlines with the Fact Checkers indicator (versus 40% for Independents and 19% for Republicans)

Democrats intended to share 36% fewer non-true headlines with the News Media indicator (versus 29% for Independents and 4.5% for Republicans)

Democrats intended to share 37% fewer non-true headlines with the Public indicator, (versus 17% for Independents and 6.7% for Republicans)

Democrats intended to share 40% fewer non-true headlines with the AI indicator (versus 16% for Independents)

Republicans intended to share 8.1% more non-true news with the AI indicator

Republicans are less likely to be influenced by credibility indicators, more inclined to share fake news on social media.

Patil says that while fact-checkers are the most effective kind of indicator, regardless of political affiliation and gender, fact-checking is a very labor-intensive. He says the team was surprised by the fact that Republicans were more inclined to share news that was flagged as not credible using the AI indicator.

“We were not expecting that, although conservatives may tend to trust more traditional means of flagging the veracity of news,” he says, adding that the team will next examine how to make the most effective credibility indicator — fact-checkers — efficient enough to handle the scale inherent in today’s news climate.

“This could include applying fact checks to only the most-needed content, which might involve applying natural language algorithms. So, it is a question, broadly speaking, of how humans and AI could co-exist,” he explains.

The team also found that males intended to share non-true headlines one and half times more than females, with the differences largest for the Public and News Media indicators.

Men are less likely to be influenced by credibility indicators, more inclined to share fake news on social media. But indicators, especially those from fact-checkers, reduce intention to share fake news across the board.

Socializing was the dominant reason respondents gave for intending to share a headline, with the top-reported reason for intending to share fake stories being that they were considered funny.

“Effects of Credibility Indicators on Social Media News Sharing Intent” is available at: ACM Digital Library

About the New York University Tandon School of Engineering

The NYU Tandon School of Engineering dates to 1854, the founding date for both the New York University School of Civil Engineering and Architecture and the Brooklyn Collegiate and Polytechnic Institute (widely known as Brooklyn Poly). A January 2014 merger created a comprehensive school of education and research in engineering and applied sciences, rooted in a tradition of invention and entrepreneurship and dedicated to furthering technology in service to society. In addition to its main location in Brooklyn, NYU Tandon collaborates with other schools within NYU, one of the country’s foremost private research universities, and is closely connected to engineering programs at NYU Abu Dhabi and NYU Shanghai. It operates Future Labs focused on start-up businesses in downtown Manhattan and Brooklyn and an award-winning online graduate program. For more information, visit engineering.nyu.edu.

DOI

10.1145/3313831.3376213

Researchers increasingly aim at utilising the manifold functions of lipids in our bodies, e.g. as blood fats or in blood coagulation, to better understand and predict diseases. An international team around Robert Ahrends at the Faculty of Chemistry of the University of Vienna now presented a groundbreaking tool for efficient lipid analysis in the journal Nature Communications. Their software LipidCreator highly accelerates the analysis of specific lipid groups and lipid signal molecules, and allows both, their qualitative and quantitative characterisation with mass spectrometry. The scientists applied the new method successfully in an analysis of blood components.

Lipids have a great potential as biomarkers. Life as we know it is wrapped in lipids, fats and waxes: they form cells and organelles, convey information, protect our organism from the harsh environmental conditions, and serve as energy building blocks. "It is not long ago that we gained an idea about the diversity of lipid functions," says biochemist Robert Ahrends, who started his tenure track professorship in lipidomics - i.e. the analysis of the total lipids of a cell, tissue or organism - at the University of Vienna at the beginning of this year.

The innovative software LipidCreator can take lipidomics to the next level. "The software enables scientists to come up with new targeted lipidomics assays, to make them easily available to other labs, and to retrieve and include comprehensive knowledge and data from other studies, as the software also serves as an online database for lipidomic research," study author Robert Ahrends from the Department of Analytical Chemistry explains.

Based on the software, scientists now can quantify about 60 lipid classes and their lipid signalling molecules in much bigger studies than previously; they can quickly set up workflows for the analysis of new target molecules, and easily check and validate the results.

Salvaging the treasure of Lipids

Lipids are chemically very diverse. They have a complex structure and consist of combinations of different building blocks, such as different sugars, fatty acyl groups, and different types of bonds. Mass spectrometry (MS) has become both, faster and more sensitive in recent years. Special further developments of MS today enable the identification of up to 500 lipids, the chemical components and structures of the lipids can be decoded via the masses of the individual lipid fragments. Despite the rapid growth of lipidomics, comprehensive software solutions for targeted mass spectrometric analyses of specific lipid groups have been lacking until now.

Clinical interest

Ahrends and his team already applied their software, proving their high potential for clinical applications: Lipids in different forms are important sources of energy, which are transported within the blood. As important factors in signal transmission between cells, they are also involved in the activation of blood platelets (thrombocytes), which in turn are important for blood clotting. Based on LipidCreator, the scientists successfully characterised lipids in blood plasma and analysed the role of lipids in platelet activation. According to the scientists, data gained from these kind of surveys might even help to identify relevant factors for blood coagulation and for the development of thrombosis.

African Americans with severe sleep apnea and other adverse sleep patterns are much more likely to have high blood glucose levels --a risk factor for diabetes--than those without these patterns, according to a new study funded in part by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.

The findings suggest that better sleep habits may lead to better blood glucose control and prove beneficial for type 2 diabetes prevention and diabetes management in African Americans, who are at higher risk for type 2 diabetes than other groups. They also point to the importance of screening for sleep apnea to help fight the potential for uncontrolled blood sugar in this high-risk group, the researchers said.

Previous studies have linked disturbed sleep patterns, including sleep apnea, to increased blood glucose levels in white and Asian populations. But this new study is one of the few to use objective measurements to link these disturbed sleep patterns to increased blood glucose levels in black men and women, the researchers said. Their findings appear online on April 28 in the Journal of the American Heart Association.

"The study underscores the importance of developing interventions to promote regular sleep schedules, particularly in those with diabetes," said Yuichiro Yano, M.D., Ph.D., the lead study author and a researcher in the Department of Family Medicine and Community Health at Duke University. "It also reaffirms the need to improve the screening and diagnosis of sleep apnea, both in African Americans and other groups."

Michael Twery, Ph.D., director of the NHLBI's National Center on Sleep Disorders Research, added that the study highlights important associations between untreated sleep apnea and poorly-regulated blood sugar. "It also adds to growing evidence that protecting our sleep, like diet and exercise, may help reduce the risk of diabetes and the related risk of cardiovascular disease."

For the study, the researchers evaluated sleep patterns while concurrently measuring blood glucose markers among 789 black men and women who were enrolled in the Jackson Heart Study, the largest study of cardiovascular disease in African-Americans. Most of the participants--74%--were women, 25% had type 2 diabetes, 20% were taking diabetes medication, and about 57% had a diagnosis of obstructive sleep apnea but were not receiving treatment for their condition, Yano said. Their mean age was 63 years.

Participants completed at-home sleep apnea tests, and each used a wrist actigraph watch, a tool that measures wakefulness and sleep, for seven days. The test calculated sleep duration (short vs long), sleep efficiency, night-to-night variability in sleep duration, and sleep fragmentation (multiple disruptions during sleep). The researchers obtained several measures of glucose metabolism, including fasting blood glucose concentration, HbA1c levels, and insulin resistance.

The researchers focused on four main groups: regular sleepers (no sleep apnea), those with mild sleep apnea, moderate sleep apnea, and severe sleep apnea. During the course of the study, they found that those with the severe sleep apnea had 14% higher fasting blood glucose levels compared to those without sleep apnea. Severe sleep apnea was also associated with higher HbA1c levels, Yano said.

In addition to studying sleep apnea, the researchers found that participants who experienced other types of disturbed sleep--including sleep fragmentation and sleep duration variability--were also more likely to have increased measures of blood glucose. The associations between disturbed sleep and high blood glucose levels were stronger in participants with diabetes compared to those without diabetes, the researchers said. In those without diabetes, disturbed sleep was also associated with increased insulin resistance.

Yano and his team also found that associations of sleep apnea and high blood glucose levels were stronger among black men than black women. Black men with severe sleep apnea had 10% higher fasting blood glucose levels than black women with severe sleep apnea in the study.

The researchers noted interventions that treat sleep apnea might help improve blood glucose management, including the use of continuous positive air pressure (CPAP) machines--devices that deliver air through a mask to keep the airway open when worn during sleep--and the encouragement of better sleep patterns in blacks, particularly in those with diabetes. But further studies will be needed to determine if such interventions will be effective, Yano said.

The new procedure will help to meet the high demand for testing in the mass coronavirus screening programmes needed in the early identification and isolation of asymptomatic individuals. The pooling of samples before testing is a well-established and safe procedure in blood banking. The team from the Institute of Virology has adapted and tested this method for use in coronavirus diagnostics.

Samples from several individuals are pooled and tested together in a single tube using sensitive molecular biological detection methods. Only if the pool result is positive do the samples need to be tested individually. When the infection rate is low and only a few people are infected, pool testing can significantly expand the testing capacity of the existing laboratory infrastructure. The team has been using the new procedure at Saarland University Hospital in Homburg since mid-March to successfully protect vulnerable patients from infection by asymptomatic SARS-CoV-2 carriers. The success of the pool testing procedure has now led to its use in screening residents and staff at nursing and residential care homes in Saarland.

'To protect those groups with a high mortality risk from the coronavirus, we need to prevent the introduction of the virus from asymptomatic individuals, including the medical and care staff that look after them. Groups most at risk include chronically ill hospital patients, such as those with cardiovascular disease or cancer, the elderly and, most especially, the residents of nursing homes and residential care homes. Prevention is only possible if we use large-scale testing to identify asymptomatic contact persons and thus avert infection of the most vulnerable,' says Sigrun Smola, Professor of Virology at the Saarland University and Director of the Institute of Virology at Saarland University Hospital. Up until now, it has not been possible to scale up mass screening programmes, as there was simply not enough testing capacity in the diagnostic labs.

'Early on in the pandemic, we started to explore whether the pool testing approach used in blood banking could be adapted to increase testing capacity in coronavirus diagnostics,' explains Professor Smola. In early March, the Homburg research team developed a testing protocol that involved pooling corona swabs from medical staff showing no clinical symptoms and then analysing the pooled sample. 'Our molecular biological test method (RT-PCR) was so sensitive that we were able to combine samples from up to 30 individuals in a single test tube. Even if only one person in that group of thirty was infected, we still obtained a positive result for the pooled test. If a pool had a positive result, we then conducted a second phase of testing on the individual samples to identify the infected person or persons. If the rate of infection is low and if many of the pools are negative, this can save significant numbers of test kits and increase the test capacity of the existing infrastructure' explains Sigrun Smola.

Viral infections are particularly challenging as infected individuals can be contagious before developing clinical symptoms such as a sore throat, cough or pneumonia. The literature shows that individuals can spread the coronavirus two days before the onset of clinical symptoms. Viral load is at its highest and the infected individuals are highly contagious almost a day before any symptoms become apparent. As some individuals do not develop further symptoms, but remain contagious for some time, it is crucial that these asymptomatic and presymptomatic patients are identified, as this allows us to detect infection 'hot spots' early on and to isolate infected individuals effectively so that we can break the infection chain.

In a concerted action with the Saarland Ministry of Health, the pool testing procedure developed in Homburg is now being used to screen residents and staff at 131 nursing and residential care homes in Saarland in order to protect the vulnerable elderly groups in these institutions who are most at risk from coronavirus infection. Around 22,000 people will be tested as part of the screening programme - an enormous logistical challenge requiring a huge collaborative effort involving numerous partners. 'Our mass screening campaign is a unique cooperation involving the Fraunhofer Institute for Biomedical Technology IBMT, the Helmholtz Institute for Pharmaceutical Research Saarland HIPS, the Saarland Consumer Protection Office (Landesamt für Verbraucherschutz ) and the Saarland Care Providers Association (Saarländische Pflegegesellschaft), with the Blood Donation Centre Saar-Pfalz gGmbH offering back-up lab,' explains Professor Smola.

'We have also received numerous urgent inquiries from hospitals in Germany and abroad, as testing capacity limitations are proving to be a critical issue at this moment,' says Smola.

The practical significance of the Homburg procedure in helping to combat the coronavirus pandemic is reflected in the paper 'Pooling of samples for testing for SARS-CoV-2 in asymptomatic people', which has been published in the highly respected medical journal 'The Lancet Infectious Diseases'. In addition to Professor Dr. med. Sigrun Smola and her team Dr. Stefan Lohse, Dr. Thorsten Pfuhl, Dr. med. Barbara Berkó-Göttel and Dr. med Jürgen Rissland, others involved in the work included Tobias Geißler from the Department of Anaesthesiology, and Professor Dr. med. Dr. phil. Sören Becker, Professor Dr. med. Barbara Gärtner and Dr. med. Sophie Schneitler from the Institute for Medical Microbiology and Hygiene at Saarland University Hospital.

An important goal of early-phase clinical trials is to discover a drug's possible side effects. But despite FDA guidelines seeking to standardize this reporting, a University of Colorado Cancer Center study finds significant variation in how drug side effects are reported, potentially making some drugs seem safer or less safe than they really are.

"Without standardizing how we present such data, there is the potential for misinformation about these side effects," says Emily Simons, MD, MPH, senior resident at University of Colorado School of Medicine and the first author of the study.

The group including senior author D. Ross Camidge, MD, PhD, got interested in the topic after seeing how differently the side effects of new drugs for treating lung cancer were being presented - and realizing that differences in reporting methods could over- or under-estimate the apparent safety of such drugs.

"Sometimes you only report an adverse event that happens in, say, 10 percent or more of patients on a trial. However, if you split related side-effects into lots of little sub-groups, perhaps no one event reaches this 10 percent threshold and nothing gets reported," Simons says. "In contrast, if you combine rationally grouped events - like confusion and memory issues - then this group passes 10 percent and you could clearly see the side effects as, for example, very broadly affecting higher functions of the brain."

These observations led Simons to look into all phase I and II clinical trials involving lung cancer patients reported at the American Society for Clinical Oncology (ASCO) annual meetings from 2017-2019, the major outlet for early-phase trial results, finding 209 trials in all.

What the group found was wide-ranging variation in the ways trial investigators report drug side effects.

For example, the study found six different thresholds used to decide when a side effect should be reported. Simons and colleagues also found that when patients were treated with multiple doses of a trial drug, side effects were sometimes reported only across all drug dosages. Combining side effect data across dosages could make a drug look more toxic due to the inclusion of side effects that occur only at very high doses. On the other hand, including side effects from especially low doses of a drug could make the drug seem more benign that it is at the recommended dose.

Additionally, patients are supposed to report all symptoms when they are on a clinical trial and then it's up to trial investigators to decide, in their opinion, whether a symptom is likely due to the drug or just happens to be another symptom the patient is experiencing at the time.

"Determining if a side effect is treatment-related or not is subjective. If you rely on this, you get rid of some of the background noise of coincidental symptoms. However, you can also miss more subtle side effects," Simons says.

Simon's study found that the reasons patients in some clinical trials stop taking study drugs or reduce the doses are also usually not documented. Similarly, some patients received blood tests to evaluate possible side effects, but it was often not documented whether everyone on a trial received these tests, or if only those patients already identified to be at risk were tested.

"If you don't know if everyone or only a fraction of people got a specific blood test, you don't know if the ten people with an abnormal result should be documented as 100 percent or 10 percent of the trial population. Some trials require patients to reduce the dose of a drug after an abnormal blood tests, even without other symptoms. Without knowing the details of why dose changes occurred leaves a lot open to speculation," Simons says.

Simons suggests there is a tremendous opportunity for conferences and academic journals to standardize their requirements for the reporting of side effects to help accurately communicate risk.

"Given the increased speed of drug licensing, early phase trial data is essential in helping us form accurate impressions of a new drug. Recognizing and addressing the variation in how side effects are reported would improve the accuracy of these impressions in the future," Simons says.

Diabetes is called an incurable disease because once it develops, it does not disappear regardless of treatment in modern medicine. Having diabetes means a life-long obligation of insulin shots and monitoring of blood glucose levels. But what if you could control the secretion of insulin just by wearing contact lenses?

Recently, a research team at POSTECH developed wirelessly driven 'smart contact lens' technology that can detect diabetes and further treat diabetic retinopathy just by wearing them.

Professor Sei Kwang Hahn and graduate students Do Hee Keum and Su-Kyoung Kim of POSTECH's Department of Materials Science and Engineering, and Professor Jae-Yoon Sim and graduate student Jahyun Koo of Department of Electronics and Electrical Engineering have developed a wireless powered smart contact lens that can diagnose and treat diabetes by controlling drug delivery with electrical signals. The findings were recently published in Science Advances, a world-renowned journal. The smart contact lenses developed by the research team are made of biocompatible polymers and integrate biosensors and drug delivery and data communication systems.

The research team verified that the glucose level in tears of diabetic rabbits analyzed by smart contact lenses matched their blood glucose level using a conventional glucose sensor that utilize drawn blood. The team additionally confirmed that the drugs encased in smart contact lenses could treat diabetic retinopathy.

Recently, by applying the platform technology of these smart contact lenses, a research has been conducted to expand the scope of electroceuticals that use electrical stimulations to treat brain disorders such as Alzheimer's and Parkinson's diseases, and mental illnesses including depression.

The research team expects this development of self-controlled therapeutic smart contact lenses with real-time biometric analysis to be quickly applied to wearable healthcare industries.

Professor Sei Kwang Han who led the research stated, "Despite the full-fledged research and development of wearable devices from global companies, the commercialization of wireless-powered medical devices for diagnosis and treatment of diabetes and retinopathy is insufficient." He added, "We expect that this research will greatly contribute to the advancement of related industries by being the first in developing wireless-powered smart contact lenses equipped with drug delivery system for diagnosis and treatment of diabetes, and treatment of retinopathy."

This research was financially supported by Samsung Science and Technology Foundation, the Global Frontier Project (Director: Professor Kilwon Cho), the Mid-career Researcher Program from the National Research Foundation of Korea, and World Class 300 Project of the Ministry of SMEs and Startups. The research findings on smart contact lens-based technologies were introduced in the January issue of Nature Reviews Materials, which drew attention from the academic circles. The research team is preparing to carry out clinical trials for the safety and validity assessment for commercialization of smart contact lenses in collaboration with Interojo Inc.

Long before multiple myeloma becomes a malignant disease, the collection of immune system cells and signal carriers amid the tumor cells undergoes dramatic shifts, with alterations in both the number and type of immune cells, researchers at Dana-Farber Cancer Institute, the Broad Institute of MIT and Harvard, and Massachusetts General Hospital (MGH) report in a new study.

The findings, published online today by the journal Nature Cancer, are a step toward more personalized treatment of multiple myeloma. Future treatments may be geared to the immune microenvironment of each patient's disease - the specific constellation of immune cells in and around myeloma tissue - the study authors say.

"Our results provide a comprehensive map of the immune changes that take place in pre-malignant myeloma," said Irene Ghobrial, MD, of Dana-Farber, the Broad Institute, the co-senior author of the study with Gad Getz, PhD, of the Broad Institute and MGH. "The discovery that the immune microenvironment is abnormal even at very early stages of the disease may suggest strategies for targeting myeloma before it becomes malignant."

Multiple myeloma is a cancer of white blood cells known as plasma cells in the bone marrow. It is preceded by precursor conditions known as monoclonal gammopathy of unknown significance (MGUS) and smoldering multiple myeloma (SMM), in which people have abnormal plasma cells in their bone marrow but no physical symptoms or organ problems. Because not everyone with MGUS or SMM develops outright myeloma, treatment doesn't begin until symptoms of myeloma - such as bone pain, low blood counts, kidney problems, and nerve damage - appear. Researchers are working on ways to intercede in the disease process early on to identify individuals at risk and prevent the development of full-blown myeloma.

The new study represents the first time that single-cell RNA sequencing - in which scientists pluck individual cells from tissue and scan their RNA to determine which genes are active - has been used to identify features of the immune microenvironment in myeloma precursor conditions.

"We wanted to understand the changes that occur in the microenvironment as the disease progresses from MGUS to SMM to overt myeloma, as compared to the bone marrow of healthy tissue donors," said co-first author Oksana Zavidij, PhD, of Dana-Farber and the Broad Institute. "The approach could ultimately shed light on why some patients progress to myeloma while others don't and help us better target treatments to individual patients."

The analysis revealed major immune changes early in the course of myeloma development:

3 An increase in the number of natural killer (NK) cells - white blood cells that spring to attack foreign invaders and diseased cells - during MGUS. In patients with the highest volume of NK cells, the cells tended to be a type that is drawn into the bone marrow in response to signaling molecules.

The loss, in SMM, of memory T cells - white blood cells that respond to previously encountered bacteria, viruses, and one's own abnormal cells. (The finding suggests that treatments that replenish or activate these cells could be effective in some patients.)

A dysregulation of certain monocytes - large white blood cells that take on intruders. These monocytes normally display foreign or tumor proteins to T cells, which use that information to attack infected or cancerous cells. In myeloma precursor conditions, however, myeloma cells prevent these proteins from being presented, resulting in a tamped-down immune attack on the cancer.

"These changes didn't correspond to any particular precursor condition," said co-first author Nicholas Haradhvala, of the Broad Institute, MGH, and the Harvard Graduate Program in Biophysics. "They were found in different combinations in patients with MGUS and SMM, suggesting an axis upon which patients could be stratified for evaluation of individual-specific risk of progression and potential for early intervention."

"Our findings have described the landscape of dysregulated immune system that can be used to follow up in much larger studies and build robust associations with patient risk and progression," added Getz.

As the COVID-19 crisis continues to develop, researchers around the world are attempting to find the most effective treatment to combat the poorly understood virus behind this disease.

Traditionally, when dangerous new bacterial and viral infections emerge, the response is to develop a treatment that combines several different drugs. However, this process is laborious and time-consuming, with drug combinations chosen sub-optimally, and selection of doses is a matter of trial and error. This costly and inefficient way of developing a treatment is problematic when a rapid response is crucial to tackle a global pandemic and resources need to be conserved.

With this in mind, Professor Dean Ho from the National University of Singapore (NUS) led a multidisciplinary team of researchers to come up with a pioneering artificial intelligence (AI) platform known as 'IDentif.AI' (Identifying Infectious Disease Combination Therapy with Artificial Intelligence) to dramatically increase the efficiency of this development.

Their results were published in Advanced Therapeutics on 16 April 2020.

Drawbacks of traditional drug screening

Conventional selection of drugs for treatment involves examining virus or bacteria growth in response to different potential candidates. The drugs are given to the bacteria or viruses at increasing dosages until maximal prevention of their growth is observed. Additional drugs are then added together to amplify the effect. However, these methods become ineffective when several drugs are simultaneously studied as candidates. Also, these approaches often result in positive outcomes for in vitro studies, but are not observed in human studies.

"If 10 or more drugs are examined, it is virtually impossible to study the effects of all the possible drug combinations and dosages needed to identify the best possible combination using traditional methods," explained Prof Ho, Director of The N.1 Institute for Health and Institute for Digital Medicine (WisDM) at NUS.

Furthermore, in traditional screening, if a drug from a pool of candidate therapies is shown to have no apparent effect on the pathogen, this drug will generally no longer be considered. "However, if this drug is systematically combined with more drugs, each at the correct doses, this could very well result in the best possible combination. Unfortunately, this remarkable level of required precision cannot be arbitrarily derived," added Prof Ho, who is also the Head of the NUS Department of Biomedical Engineering.

Using artificial intelligence to optimise drug therapies

To avoid the drawbacks of traditional drug combination therapy development, Prof Ho and his team, together with collaborators from Shanghai Jiao Tong University harnessed the processing power of AI.

The research team carefully selected 12 drugs which are viable candidates for treating an infection in lung cells caused by the vesicular stomatitis virus (VSV). They then used IDentif.AI to markedly reduce the number of experiments needed to interrogate the full range of combinations and optimal dosages of these 12 drugs.

"Using IDentif.AI, we took three days to identify multiple optimal drug regimens out of billions of possible combinations that reduced the VSV infection to 1.5 per cent with no apparent adverse impact. This speed and accuracy in discovering new drug combination therapies is completely unprecedented," said Prof Ho.

Importantly, the team saw that when the top-ranked drug combination was optimally dosed, it was seven times more effective compared to sub-optimal doses. This shows the critical importance of ideal drug and dose identification.

Similarly, when a single drug was substituted out from the top-ranked drug combination, and this new combination was administered at sub-optimal doses, the combination was 14 times less effective.

"There is a notion in drug discovery that if you discover the right molecule, the work is done. Our results with IDentif.AI prove that it is critically important to think about how the drug is developed into a combination and subsequently administered. How do you combine it with the right drugs? How do you dose this drug properly? Answering these questions can dramatically increase efficacy at the clinical stage of drug development," shared Prof Ho.

In addition to validating IDentif.AI, this study also included insights by a team of experts in operations research and healthcare economics from NUS Business School and KPMG Global Health and Life Sciences Centre of Excellence, as well as global health security and surveillance experts from EpiPointe LLC and MRIGlobal. They concluded that strategies such as IDentif.AI, which can rapidly optimise drug repurposing under austere economic conditions amidst pandemics, could play a key role in improving patient outcomes compared to standard approaches.

Using IDentif.AI against COVID-19 and more

Having proved the effectiveness of IDentif.AI to rapidly provide treatments for infectious diseases, the team is currently setting their sights on COVID-19.

Prof Ho said, "As the development of vaccines and antibody therapies for COVID-19 are ongoing, we will need a rapid therapeutic strategy that addresses the virus which may evolve over time. Our strength is that we can perform one experiment and come out with a list of drug combinations for treatment within days. And in time, if patients do not respond well to the first combinations of drugs, we can derive new combinations within days to re-optimise their care. Our platform is useful to address the possibility that patients will need different drug combinations depending on when treatment was initiated, and if downstream infection with a different strain occurs."

Furthermore, IDentif.AI could be immediately deployed to address any other infectious diseases in the future. Prof Ho concluded, "When an aggressive pathogen hits, a rapid response is needed, and this response may need to evolve quickly as the pathogen evolves. Now, with IDentif.AI, we will be ready."

A team of researchers and patient advocates have addressed the challenges related to traveling after receiving 177Lu-DOTATATE radiation therapy in a study published in the April issue of The Journal of Nuclear Medicine. Due to the residual radiation activity of 177Lu-DOTATATE, neuroendocrine tumor patients have experienced travel delays at U.S. ports of entry. It is recommended that patients carry a travel card containing treatment information after each therapy cycle and for an additional three months after therapy has concluded to avoid travel delays.

"Disruption in travel, especially if not anticipated, can be extremely distressing for patients who have enough to deal with already. For many such patients, this travel is meant to take the mind off of their disease. Being stopped at borders of entry is, without a doubt, potentially traumatic," said Thorvardur R. Halfdanarson, MD, professor of oncology at the Mayo Clinic Cancer Center in Rochester, Minnesota.

Approved by the U.S. Food and Drug Administration (FDA) in 2018, 177Lu-DOTATATE has been used for the treatment of advanced somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors by over 150 hospitals and medical centers throughout the United States. The radiation activity from the treatment is not harmful to others, but it can be detected by sensitive radiation detectors at international airports and border crossings by boat, car or foot and can lead to travel delays. Furthermore, the metastable isotope 177mLu, which is present after treatment with 177Lu-DOTATATE, can be mistaken for plutonium at ports of entry as plutonium and 177mLu have some coincidental similarities in their radiation signatures. This can contribute to additional wait times.

To alleviate potential delays while traveling, the study authors recommend that patients be given a travel card containing the patient's personal information, type of radiation received, dose of radiation administered and date of administration. The card should also include information about the treating institution and contact information with 24-hour access if further information is required. In addition, patients should carry a copy of their most recent clinical notes in a single envelope that is easily accessible when going through U.S. ports of entry and high-security areas.

According to Halfdanarson, providing education for patients and treating physicians is key. Physicians should advise patients that they may be delayed at various points of travel and that they should allow extra time when traveling, especially when transferring between international and domestic flights. Frequent communication between the FDA, Nuclear Regulatory Commission, Customs and Border Protection (CBP) and researchers should continue in order to keep the staff up to date on the current use of medical isotopes and to help CBP make appropriate radiation-detection equipment choices. Training and improvements in detection technology can help mitigate the travel delays.

"All of the new and exciting developments in nuclear medicine therapies are changing how we practice nuclear medicine and molecular imaging. As more therapies using different radionuclides are brought into clinical practice, this change will become more significant," noted Ay?e Tuba Kendi, MD, associate professor in the division of nuclear medicine, department of radiology, at the Mayo Clinic in Rochester, Minnesota. "This unique article is a great example of teamwork, connection and communication with patients, colleagues and experts, which are key elements for success of nuclear therapies."

The researchers published their findings in the prestigious journal The Lancet on World Malaria Day on 25 April even as countries the world over battle to contain transmission of the COVID-19.

The malaria trial conducted in northern Namibia demonstrates how malaria incidence can be reduced by up to 75% in settings where malaria transmission is mostly low but persistent, and plagued by sporadic outbreaks of higher numbers of malaria cases.

This scenario in Namibia is in many ways typical in neighbouring South Africa's malaria endemic districts.

In a Global South and Global North collaboration, scientists at the WRIM at the University of the Witwatersrand in South Africa; the University of Namibia with the Namibia Ministry of Health and Social Services; the London School of Hygiene and Tropical Medicine; the University of California, San Francisco; and the University of Texas, Southwestern conducted this first ever randomized controlled trial of its kind.

"The reduction in cases was achieved using existing tools, namely anti-malarial drugs and insecticides, but deploying these in a 'smart' way, i.e., in close proximity of newly reported cases," says Professor Immo Kleinschmidt, one of the Principal Investigators in the project, Honorary Professor in the Wits School of Pathology and Professor of Epidemiology in the Department of Infectious Disease at the London School of Hygiene and Tropical Medicine.

"Our results are derived from a community randomised controlled clinical trial. This means that the effects of the interventions are compared between groups that are similar in all respects apart from the intervention they are receiving. The findings are therefore very unlikely to be due to chance, and the conclusions are more robust than they would have been from an observational study."

Co-authors Lizette Koekemoer, WRIM Research Professor and an honorary member in the Centre for Emerging Zoonotic and Parasitic Diseases at the National Institute for Communicable diseases, and Erica Erlank, WRIM Associate Researcher, provided training and support in entomology [the study of insects] during the trial.

THE TRIAL: DRUGS, SPRAY OR BOTH?

In this study, researchers conducted a trial to evaluate the effectiveness and safety of two interventions: (i) reactive focal mass drug administration (rfMDA) and (ii) reactive focal vector control (RAVC), and their combination.

This trial is unique because it is the first randomized controlled trial of rfMDA and/or RAVC. Study communities were randomly assigned to receive either rfMDA, or RAVC, or the combination, or neither of these two interventions (the latter being the control group).

The study took place in the Zambezi Region, northern Namibia, and targeted people that were at the highest risk of malaria infection based on their proximity within 500 meters of malaria index cases that emerged during the transmission season.

In one arm of the trial, these neighbours of any new malaria case were offered a standard dose of the anti-malarial drug Coartem®, without first testing whether these neighbours carried the parasite that causes malaria. This drug clear them of parasites even if the level of parasites they carried were below the density that can be detected by the standard rapid diagnostic test. The drug would also provide a short period of protection against new infections.

In another arm of the trial, neighbours of index cases had the interior walls of their houses sprayed with a highly effective insecticide, Pirimiphos-methyl, irrespective of whether or not their houses had previously been treated in the annual spray carried out routinely in such areas.

In the randomized trial, communities received either the drug, the house spray, the drug and the house spray, or neither of these interventions.

Both the drug and the house-spraying interventions were shown to be safe and highly effective, either on their own or when administered together. Both the drugs and the house-spraying approaches significantly reduced malaria transmission in this low endemic setting.

WHY THIS TRIAL MATTERS

Mass drug administration (MDA) is the administration of antimalarial drugs to target the parasite reservoir in humans, without necessarily testing if those people carry the parasite that causes malaria. The World Health Organization recommends MDA for the elimination of the Plasmodium falciparum malaria parasite. However, the effort and cost required to implement MDA on a large scale can be challenging.

The Namibian study reduced the 'mass' in MDA by targeting just the small ring of people around recent index cases - the people at the highest risk of malaria - and thus implemented an existing intervention more efficiently and economically.

Indoor residual spraying (IRS) and the use of long-lasting insecticidal nets have since 2000 significantly reduced malaria cases and deaths in target populations in sub-Saharan Africa. These interventions are normally administered in a 'blanket' style before the malaria season (October to May).

The Namibian study targeted a highly effective but expensive insecticide, pirimiphos-methyl, at the small ring of houses around recent index cases. The cost of the insecticide makes it more difficult to use in blanket spraying, but suitable in focal spraying as smaller quantities will be used. The cost of the insecticide is thus offset by its focal use of targeting only high risk populations.

"We found that reactive focal mass drug administration and reactive focal vector control, when implemented alone and in combination, significantly reduced malaria transmission among targeted populations in the Zambezi region of Namibia," says Koekemoer. "Furthermore, the two interventions, when used in combination, had an additive effect - reducing rates of new malaria cases by 75%".

TOWARDS ZERO TRANSMISSION TARGETS

Although malaria still causes an estimated 230 million cases and over 400 000 deaths each year, dramatic success in fighting the disease over the last two decades has inspired many countries to commit to eliminating transmission altogether.

To date, the World Health Organization has certified 38 countries and territories malaria-free. In southern Africa, eight countries - including South Africa and Namibia - have made the elimination of malaria a policy goal.

In recent years, however, progress towards eliminating transmission has slowed in many regions including Africa, highlighting the need for new approaches. Where malaria cases have been reduced to low levels, transmission still occurs due a reservoir of chronic, low density infections in people without symptoms. This means that these infections are largely undetectable through standard surveillance approaches.

Because the mosquitoes that carry the malaria parasite are still present, these infections may seed further infections in their immediate neighborhood, potentially leading to outbreaks of malaria cases. To prevent such outbreaks from leading to wider epidemics, effective focal responses that target high-risk populations, such as those assessed in the Namibian study, need to be mobilized.

While additional studies will help determine the optimal scenarios in which these approaches could be implemented, the Namibian study suggests that reactive focal mass drug administration and reactive focal vector control can be applied in other countries that (i) have Plasmodium falciparum parasite-carrying mosquitos (ii) are close to eliminating transmission and (iii) have good case reporting systems.

"These approaches can only be used if index cases are promptly and reliably reported and becauseSouth Africa has a responsive and reliable malaria case reporting system, the country is well placed to take advantage of these interventions," says Koekemoer.

The Namibian study shows how tailoring and targeting existing interventions can help improve their effectiveness and contribute to the elimination of malaria transmission permanently.

New research has revealed new insights into common asthma aerosol treatments to aid the drug's future improvements which could benefit hundreds of millions of global sufferers.

Lung diseases such as asthma are a major global health burden, with an estimated 330 million asthma sufferers worldwide. The most effective treatments are through direct inhalation of medicine to the lungs. However, generating the aerosols for inhalation is a scientific challenge because of our limited knowledge of the microstructure of drug products before they are aerosolised.

In new research announced today University of Manchester-based scientists demonstrate how they have used x-ray CT scanning to quantify the tiny microstructures of individual particles from the drug product at the nano-scale.

This is the first time that the 3D microstructure has been revealed and gives scientists and pharmaceutical producers a better understanding of the behaviour of the drug product under aerosolisation.

Lead author of the research, Dr Parmesh Gajjar said: "We have been able to visualise a drug-blend in 3D, and see the interplay between drug and non-drug particles in the medicine. This is important for final quality control of asthma medicines to check the actual amount of drug and to help formulate improved asthma medications."

Due to the new technological innovation the findings was announced at the Respiratory Drug Delivery (RDD) 2020 conference. The groups work was selected to be a key presentation at the global conference, originally scheduled to take place in Palm Springs but now occurring in a digital format as a result of the global COVID19 pandemic.

The work was made possible through the high-resolution x-ray computed tomography (XCT) instruments in the word leading Henry Moseley X-ray Imaging Facility (HMXIF) at The University of Manchester that provide the capability to analyse a sample at up to 50 nanometres in resolution.

This is particularly important for the inhalation medicines which require aersolisation to generate particles small enough to be adsorb via the lungs. In this project the particles measured less than 5 μm to reach the deepest parts of the lungs.

Dr Sabrina Germain, a Senior Lecturer in The City Law School, says the COVID-19 pandemic could signal the end of the National Health Service based on the liberal egalitarian conception of distributive justice.

In her paper, "Will COVID-19 Mark the End of an Egalitarian National Health Service?", published in the European Journal of Risk Regulation, Dr Germain considers, first of all, why the allocation of healthcare resources is fundamentally a question of justice in Britain and explains why healthcare law and policy require a philosophical approach in times of crucial change and crisis. Secondly, the paper provides a critical analysis of the current situation for the allocation of healthcare resources and the provision of services to patients directly or indirectly affected by the virus.

The paper concludes that the liberal egalitarian conception of distributive justice at the heart of the NHS, aiming to guarantee free and equal access to healthcare, is now in jeopardy and is being replaced by a utilitarian approach based on a priority ranking of patients for the provision of services at this critical time.

Dr Germain argues that long before the advent of the COVID-19 pandemic, the resources available and mobilised for healthcare delivery in the UK have not matched the growing needs of society.

Dr Germain's research has put a spotlight on the difficulties faced by governments such as the UK, in allocating scarce resources and services funded by taxpayers:

"Even though the NHS remains publicly funded, the provision of services is now ranking the needs of patients that are directly or indirectly affected by the virus rather than providing equal access to treatment for all. Going back to the egalitarian model that was already under strain prior to the advent of COVID-19 will be practicably impossible, even if current utilitarian emergency policies are suspended. The NHS will nonetheless need to first address the delays in treatment that occurred during the time of the pandemic. Second, the public health strategy will have to be reassessed to prepare for a potential future incident of a similar scale and to learn the lessons from the current episode."

Dr Germain's research interests lie in the connections between healthcare law and public policy and most particularly in questions of justice in the allocation of healthcare resources.

Her award nominated monograph "Justice and Profit in Health Care Law" (Hart, 2019) is a comparative study that puts forward the influence of justice principles and for-profit actors (the medical profession, employers and insurers) on the development of laws to allocate healthcare resources in western welfare states.

At City, she convenes the medical law and bioethics module and teaches tort law. In 2019, Oxford University Press awarded her the Law Teacher of the Year Prize.

Amid the rapidly evolving global coronavirus disease 2019 (COVID-19) pandemic that has already had profound effects on public health and medical infrastructure across the globe, many questions remain about its impact on child health. New research published in the Journal of Clinical Virology indicates that the vulnerability of neonates and children and their role in the spread of the virus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) should be included in preparedness and response plans.

According to lead author Kathleen M. Muldoon, Ph.D., Associate Professor, Anatomy at the Arizona College of Osteopathic Medicine at Midwestern University, the COVID-19 pandemic poses substantial and underappreciated risks to pregnant women, and perinatal infections endanger pregnancy outcomes. "Studies to date suggest that the virus can be transmitted to the fetus in utero," Dr. Muldoon says. "Although the evidence for infection is under debate, the possible routes for infection are such that infection control measures are required to protect newborns."

The potential for neonatal infection with the COVID-19 virus demands intensive study, including how viral pathology may or may not affect breast milk as the preferred method of infant nutrition, as well as the potential effects of vaccines on women of child-bearing age, unborn fetuses, and newborn infants.

"We are presenting the state of knowledge acquired to date about potential risks of transmission of SARS-CoV-2 to the fetus and newborn," continues Dr. Muldoon. "This research is timely because information regarding the potential routes of acquisition of SARS-CoV-2 infection in the prenatal and perinatal setting is of a high public health priority. Vaccines targeting women of reproductive age, and in particular pregnant patients, should be evaluated in clinical trials and should include the endpoints of neonatal infection and disease."

Skin rash combined with head and joint pain: these are the symptoms which patients with familial (hereditary) cold urticaria develop when exposed to temperatures below 15 °C. Researchers from Charité - Universitätsmedizin Berlin have discovered a new, previously unknown form of this inflammatory skin disorder. In addition to explaining why conventional treatments are ineffective in some people with the disorder, their findings also point to potential alternatives. The results of this research have been published in Nature Communications*.

When exposure to cold temperatures causes itchy hives to appear on the skin, this is referred to as cold urticaria. In many people, this disorder will develop suddenly, but gradually lessen and disappear again after a number of years. Why it appears at all remains unknown. A small proportion of sufferers inherit the disorder from their parents. In these people, the immune system response to cold temperatures is due to a genetic defect which, in addition to a skin rash, will cause signs of systemic inflammation, including fever and joint pain. Researchers led by PD Dr. Karoline Krause of the Department of Dermatology, Venereology and Allergology on Campus Charité Mitte have now discovered a new form of cold urticaria which is caused by a previously unknown mutation in the 'Factor 12' gene. The name proposed for this new hereditary disorder is 'Factor XII-associated cold autoinflammatory syndrome', or FACAS.

"Our report relates to several members of the same family seen in our department. At least one person in each generation of this family reported identical symptoms, which they had suffered from birth," explains PD Dr. Krause. She adds: "These individuals all developed a burning skin rash after 30 minutes of exposure to temperatures below 15°C (59°F). The rash was exacerbated by windy weather and humid conditions, and only resolved several hours after the individual returned to a warmer room." The patients also reported other symptoms like chills, fatigue, headache and joint pain. In contrast to people who develop cold urticaria spontaneously, these patients did not respond to a cold provocation test known as the 'ice cube test'. Their symptoms also failed to respond to antihistamines, which are normally an effective treatment for cold urticaria. "The family's symptoms were clearly indicative of a hereditary form of cold urticaria," says the dermatologist. "We therefore studied the affected individual's genetic information, looking for mutations which are known to cause the disorder's hereditary form; but to no avail. What we found instead was a previously unknown defect in the Factor 12 gene."

The researchers were then able to show that this defect leads to the activation of the contact system pathway, and that the hives are produced as a result of the subsequent release of inflammatory mediators. "Interestingly, defects in the Factor 12 gene had previously been known to cause a very different condition which we refer to as hereditary angioedema," explains PD Dr. Krause. Hereditary angioedema is characterized by sudden attacks of severe and painful swelling in the deeper tissues. "While the symptoms reported by FACAS patients are those of hereditary cold urticaria, the underlying mechanisms causing these symptoms are entirely different. These patients therefore qualify for treatment with drugs normally used in hereditary angioedema." Interestingly, one of the FACAS patients showed an immediate response when given icatibant, a drug normally used to treat acute attacks of hereditary angioedema. Upon administration, the patient's cold-induced symptoms resolved quickly and almost completely.

PHILADELPHIA (April 27,2020) - Nursing research has an important influence on evidence-based health care practice, care delivery, and policy. Two editorials in the journal Research in Nursing & Health, by researchers at the University of Pennsylvania School of Nursing (Penn Nursing), explore how nursing research has been paramount in dealing with the emerging coronavirus pandemic.

Nursing Research is Coronavirus Research

Nursing practice is saving lives in the pandemic and wide-ranging nursing research plays a critical role. Nurse researchers are working to understand the experiences of nurses practicing in under?resourced hospitals and nursing homes in order to advance more supportive work environments that save patient lives and promote recovery. They are investigating how individuals sheltering at home are managing diets that affect their chronic conditions and how in-home nursing care is able to stabilize those conditions. And they are uncovering lessons from the past that have significant policy implications for today's coronavirus crisis.

"So much of nursing's research is coronavirus research. We applaud the search for reliable epidemiological data, effective treatments, and vaccines. We, though, must articulate nursing research's fundamental frame. We focus on the lived experiences of clinicians, patients, families, and communities," write the authors: Patricia D'Antonio, PhD, Director of the Barbara Bates Center for the Study of the History of Nursing; Mary D. Naylor, PhD, Director of the NewCourtland Center for Transitions and Health; and Linda H. Aiken, PhD, Director of the Center for Health Outcomes and Policy Research.

How Effective Response to COVID-19 Relies on Nursing Research

In the weeks as the COVID-19 health crisis unfolded, several challenges to responding effectively became evident: restricted access to health care, surging demand for health care personnel, and the moral distress that health care providers face. Nursing research in policy response and institutional preparedness were key in helping institutions better meet the demands of the pandemic.

"Nursing research provides answers during crises. In a time of profound upheaval, risk, and strain, it is reassuring to have evidence?based solutions to the challenges confronting our health care system and its clinicians," writes Eileen T. Lake, PhD, Associate Director of the Center for Health Outcomes and Policy Research, and Editor in Chief of the journal Research in Nursing & Health.