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Stuffy noses, itching and fits of sneezing - 130 million people in Europe suffer from hay fever and other forms of allergic rhinitis. Until now, these conditions have typically been diagnosed using blood samples or skin prick tests. The latter method is often seen as particularly uncomfortable because the skin is exposed to various allergens and punctured with a fine needle. Many patients - especially children - even find the blood test quite unpleasant.

Diagnosis with biochip technology

Claudia Traidl-Hoffmann, a professor of environmental medicine at TUM and the director of the Institute of Environmental Medicine at the Helmholtz Zentrum München, has now tested a new diagnostic method for allergic rhinitis with her team. The scientists studied nasal smears using a method originally developed for blood samples: With a recent development in biochip technology, practitioners have been able for some time now to measure antibody concentrations for 112 different allergens with a single small blood sample.

Prof. Traidl-Hoffmann's team used this molecular diagnostics technology to measure concentrations of immunoglobulin E (IgE) antibodies in the blood and nasal secretions of test subjects. These antibodies play a role in certain allergic responses. The researchers studied individuals with and without sensitization to the most common airborne allergens, including dust mite castings, grass pollen and the pollen of birch, hazelnut and alder trees.

Results for a range of allergens

For the same tests, the blood and nasal smears yielded similar results: They detected identical allergic sensitization patterns, i.e. the same sets of substances for which the body had developed an immune response. This was the case for all airborne allergens investigated. Previous studies had already demonstrated a link between the detection of allergy antibodies in the blood and in nasal secretions for certain aeroallergens. The researchers have now confirmed this correlation for a wide range of such allergens.

Gentle method with potential

"A big advantage of allergy diagnostics with a nasal smear is that it is a good option for small children as compared to blood samples or skin prick testing. For that age group, a hyposensitization therapy is important because allergic rhinitis can develop into allergic asthma," says Prof. Claudia Traidl-Hoffmann. PD Dr. Stefanie Gilles adds: "We also believe that, with nasal smears, IgE antibodies specific to certain allergies can be detected that cannot be measured in a blood sample. We now need to do further studies to explore that hypothesis."

As the COVID-19 pandemic continues, a major unanswered question is how SARS-CoV-2 will persist in the human population after its initial pandemic stage. A new modeling study suggests that the total incidence of the virus through 2025 will depend crucially on the duration of human immunity - of which scientists know little now. Longitudinal serological studies are thus urgently required, the authors say, to determine the extent of population immunity, whether immunity wanes, and at what rate. Based on their modeled projections of future virus transmission scenarios, the authors also suggest that while one-time social distancing may suppress critical cases to within hospital capacity (a key metric of success for social distancing), infection will resurge once these measures are lifted, overwhelming hospitals, such that social distancing may need to be maintained intermittently into 2022.
Increasingly, public health authorities consider it unlikely that SARS-CoV-2 will follow its closest cousin, SARS-CoV-1, and be eradicated by intensive public health measures after causing a brief pandemic. Instead, the transmission could resemble that of pandemic influenza by circulating seasonally. Knowing the likelihood of this scenario is key for mounting an effective public health response. Here, using data on seasonality from known human coronaviruses and assuming some cross-immunity between SARS-CoV-2 and other coronaviruses, Stephen M. Kissler and colleagues built a model of multi-year interactions. They used this model to investigate for what duration social distancing measures need to stay in place to maintain control of SARS-CoV-2, projecting the potential dynamics of COVID-19 over the next 5 years. Based on their simulations, they say the key factor modulating virus incidence in coming years is the rate at which virus immunity wanes - which is yet to be determined. They also report that under all scenarios simulated, including one-time and intermittent social distancing, infections resurge when the simulated social distancing measures are lifted. When social distancing is relaxed when virus transmissibility is heightened in the fall, an intense winter outbreak may occur, overlapping with flu season and exceeding capacity of hospitals. Another modeled scenario shows a resurgence in SARS-CoV-2 could occur as far in the future as 2025. New therapeutics could alleviate the need for stringent social distancing but in the absence of these, surveillance and intermittent distancing may need to be maintained into 2022, write Kissler and colleagues. This would give hospitals time to increase critical care capacity while allowing population immunity to accumulate. The authors conclude the study by addressing its limitations. "Our goal in modeling such policies is not to endorse them but to identify likely trajectories of the epidemic under alternative approaches," they write.

In a New England Journal of Medicine "Perspective" published today, Wafaa El-Sadr, MD, MPH, global director of ICAP at Columbia University Mailman School of Public Health, and Jessica Justman, MD, ICAP's senior technical director, and associate professor of epidemiology, urge a coordinated global effort in the face of the COVID-19 pandemic, with "countries around the world [taking] concrete steps to assist Africa in staying ahead of the curve, even as they confront their own epidemics."

"When HIV spread like wildfire across the African continent, it took decades for the world to mobilize a response. Epidemics know no borders, and success in controlling the epidemic in any one country will be limited if epidemics continue to rage elsewhere. Today, we have the chance to avoid a repeat of history. Africans are doing their part. Now is the time for us to do ours," write the authors.

Columbia University Mailman School of Public Health

Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the seventh largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master's and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit http://www.mailman.columbia.edu.

Emergency-style palliative care needs to implemented to meet the needs of Covid-19 patients who wouldn't benefit from a ventilator say researchers.

This is the first time that palliative care has been examined in the light of the current global pandemic.

The researchers describe the challenges of providing palliative care where resources are stretched and demand is high, based on their experiences at a hospital in Switzerland close to the Italian border where there are high rates of the illness.

Professor Nancy Preston, Co-Director of Lancaster University's International Observatory on End of Life Care said: "Many patients are too unwell to benefit from ventilation but still need their symptoms managing."

In a paper published in The Journal of Pain and Symptom Management, the researchers explained how palliative care needs to adapt to an emergency style in order to help make the best decisions and support families.

Professor Preston said: "These people require a conservative approach to their treatment, one which provides maximum support for their physical, emotional and spiritual needs - this is where a recognition that palliative care is required is crucial".

The team based their recommendation on caring for severely ill patients with Covid-19 in the Swiss hospital where treatment plans have changed dramatically.

This is due to a range of factors including competition for palliative care drugs, which are also used in ICU, as well as healthcare workers untrained in palliative care being re-allocated from their own specialities to care for patients with Covid-19.

"It is emergency style palliative care because patients can deteriorate quickly and need a rapid response from their health care team. It is crucial that patients with a high symptom burden are assessed and treated quickly - the recommendations in this paper based on front line experience can make a difference. This approach is therefore being used across the hospital, and in emergency departments too."

"Palliative care teams, intensivists and internal medicine specialists all work side by side as palliative care is recognised to be at the forefront of this crisis, as it can offer symptom management, support to families and spiritual care in a timely manner."

PHILADELPHIA (April 15, 2020) - While the current coronavirus pandemic continues to affect all people, families will still give birth and bring new life into the world. During the COVID-19 crisis, breastfeeding and the provision of human milk to infants is recommended by national and international organizations because it is effective against infectious diseases: It strengthens the immune system by directly transferring antibodies from the mother.

In an editorial in the Journal of Obstetric, Gynecologic & Neonatal Nursing, Diane Lynn Spatz, PhD, RN-BC, FAAN, Professor of Perinatal Nursing & The Helen M. Shearer Professor of Nutrition at the University of Pennsylvania School of Nursing (Penn Nursing), provides guidance regarding breastfeeding and COVID-19 and reaffirms why it is of paramount importance to promote and protect the use of human milk and breastfeeding.

"While it is unknown if COVID-19-positive mothers can transmit the virus through milk, in limited studies the virus has not been detected in human milk," says Spatz. "We should use this pandemic as a way to increase visibility of the critical role of human milk and breastfeeding for all families at all times and educate the public about the importance of the use of human milk and breastfeeding as lifesaving medical interventions."

The editorial, "Using the Coronavirus Pandemic as an Opportunity to Address the Use of Human Milk and Breastfeeding as Lifesaving Medical Interventions" is available now online.

HUNTINGTON, W.Va. - Through the use of a newly developed needle arthroscope, incisionless and single-incision surgical procedures are possible for repairing certain types of knee and shoulder injuries suggests a series of Marshall University studies published in Arthroscopy Techniques, a companion to Arthroscopy: The Journal of Arthroscopic and Related Surgery.

The NanoScope needle arthroscopy system, developed by Arthrex, is both diagnostic and therapeutic in that it allows for direct visualization of intraarticular pathology and nanoscopic instrumentation to treat that pathology, making it a substitute for regular arthroscopy in certain cases.

In the Arthroscopy Techniques articles, Chad D. Lavender, M.D., lead author and assistant professor of orthopaedic surgery at the Marshall University Joan C. Edwards School of Medicine, and his team use the NanoScope to perform three types of repair procedures--a single-incision rotator cuff, incisionless partial medial meniscectomy and a single-incision anterior labrum repair. The 1.9 mm NanoScope allowed for fewer to no incisions, resulting in decreased loss of and need for fluid, less swelling and pain and decreased risk of wound infection. However, viewing angles were found to be more limited, meaning the use of a traditional arthroscope may be needed during certain procedures.

"We have yet to fully realize the full potential of the NanoScope as its small size and function make it a prime candidate for other procedures," Lavender said. "Future studies will explore these possibilities."

To date, Lavender and his team have successfully completed more than 15 NanoScope procedures. Patients have reported less pain as well as easier early recovery and return to function. Additional team members include Dana Lycans, M.D., assistant professor of orthopaedic surgery at the school of medicine, and orthopaedic residents, Syed Ali Sina Adil, M.D., Galen Berdis, M.D., Adam Kopiec, M.D., Ardalan Sayan, M.D. and Thomas Schmicker, M.D.

April 16, 2020 - Bars and nightclubs are a promising site for efforts to increase awareness of the risk of opioid overdose due to fentanyl-laced cocaine, suggests a study in the Journal of Public Health Management and Practice (JPHMP). The journal is published in the Lippincott portfolio by Wolters Kluwer.

"Rapid dissemination of the campaign allowed us to reach people at potential risk of overdose in a short time period following identification of fentanyl in the cocaine supply," according to the pilot study by Bennett Allen, MA, and colleagues of the New York City Department of Health and Mental Hygiene (DOHMH). Their pilot study appears as part of a JPHMP special issue on public health approaches to the opioid epidemic.

Bars and Nightclubs Help Raise Awareness of Fentanyl Overdose Risk

A potent synthetic opioid, fentanyl has become a major contributor to deaths from opioid overdose. Although fentanyl is also found in heroin, there is special concern about its potential to cause overdose in cocaine users, who may not have developed tolerance to opioids. Casual cocaine users are also less likely to be knowledgeable about opioid overdose risk, or about the "rescue" medication naloxone.

To raise awareness of fentanyl and educate cocaine users about overdose prevention, DOHMH developed and tested a public health education campaign, focusing on NYC nightlife venues. "Research indicates that bars are a common venue for cocaine use," according to the authors.

The pilot study targeted bars, nightclubs, and music venues in NYC's Lower East Side, a busy nightlife area. DOHMH distributed posters and drink coasters with educational messages about the presence of fentanyl in the cocaine supply and the associated risk of opioid overdose. Owners of 23 venues - about half of those approached - agreed to participate.

In a survey, 87 bar owners or managers had heard about fentanyl, only 43 percent knew about naloxone. Ninety-one percent of owners/managers were interested in naloxone training for bar staff in overdose prevention, including naloxone and information on how to use it.

Despite its small scale, the DOHMH program generated substantial coverage on local media and social media. A single photo posted on Twitter was disseminated by 20,000 users over six months.

The study builds on previous research showing that sexual risk reduction education programs can be delivered effectively in nightlife settings. "Public health authorities could consider similar campaigns to deliver prevention messages to individuals at risk of overdose," Mr. Allen and coauthors conclude.

At the Japanese High-energy Accelerator Research Organization, KEK, in Tsukuba, about 50 kilometers north of Tokyo, the Belle II experiment has been in operation for about one year now. An international team of researchers also from Karlsruhe Institute of Technology (KIT) is searching for exotic particles that are to enhance our understanding of dark matter in the universe. For one of these particles, the so-called Z' boson, mass and coupling strengths have now been limited with previously unattainable accuracy. The results have just been published in the renowned Physical Review Letters.

The Belle II experiment has been collecting data from physical measurements for about one year now. After several years of upgrading work, both the SuperKEKB electron-positron accelerator and the Belle II detector have been improved compared to their predecessors in order to achieve a 40-fold higher data rate.

Scientists from twelve institutes in Germany are involved in constructing and operating the detector, developing evaluation algorithms, and analyzing the data. For Belle II, KIT has developed software for the reconstruction of particle tracks, designed and produced application-specific integrated circuits (ASICs) for data readout, constructed hardware with modern machine-learning algorithms to detect particle tracks, and performed calculations to link future Belle II data to fundamental theories of elementary particle physics. "Work of KIT is characterized in particular by a close cooperation of physicists and electrical engineers," says Professor Ulrich Nierste of KIT's Institute for Theoretical Particle Physics, whose working group carries out theoretical studies for the experiment.

With the help of Belle II, scientists are searching for traces of new physics that can be used to explain the unequal occurrence of matter and anti-matter or the mysterious dark matter. One of the so far undiscovered particles that the Belle II detector is looking for is the Z' boson - a variant of the already detected Z boson that acts as an exchange particle for the weak interaction.

As far as we know, about 25% of the universe consists of dark matter, whereas visible matter accounts for just under 5% of the energy budget. Both forms of matter attract each other through gravity. Dark matter thus forms a kind of template for the distribution of visible matter. This can be seen, for example, in the arrangement of galaxies in the universe.

Link between Dark and Normal Matter

The Z' boson might play an interesting role in the interaction between dark and visible matter. It could be a kind of mediator between the two forms of matter. The Z' boson can - at least theoretically - result from the collision of electrons (matter) and positrons (anti-matter) in the SuperKEKB and then decay into invisible dark matter particles. "The Z' boson can thus help scientists understand the behavior of dark matter, and what is more, the discovery of the Z' boson could also explain other observations that are not consistent with the standard model, the fundamental theory of particle physics," Ulrich Nierste explains.

Important Clue: Detection of Muon Pairs

But how can the Z' boson be detected in the Belle II detector? Not directly, that much is sure. Theoretical models and simulations predict that the Z' boson could reveal itself through interactions with muons, the heavier relatives of electrons. If scientists would discover an unusually high number of muon pairs of opposite charge after the electron-positron collisions as well as unexpected deviations in energy and momentum conservation, this would be an important indication of the Z' boson.

However, the new Belle II data have not yet provided any indication of the Z' boson. But with the new data, the scientists can limit the mass and coupling strengths of the Z' boson with previously unattainable accuracy.

More Data, More Precise Analyses

These first results are obtained from the analysis of a small amount of data collected during the startup phase of SuperKEKB in 2018. Belle II went into full operation on March 25, 2019. Since then, the experiment has been collecting data while continuously improving the collision rate of electrons and positrons. When the experiment will be perfectly tuned, it will provide far more data than used in the recently published analyses. The physicists thus hope to gain new insights into the nature of dark matter and other unanswered questions. "More data will open up new opportunities to study dark matter: Decays of heavy mesons may produce Z' bosons or other "dark" exchange particles that leave the detector, but are still noticed as a deficit in the energy balance of decay," explains Dr. Goldenzweig, whose working group of KIT's Institute of Experimental Particle Physics has specialized in such measurements.

STRASBURG, PA- A new study summarizes more than 30 years of clinical experience and describes the clinical course of 28 individuals homozygous for damaging mutations in the UGT1A1 gene who were born between 1984 and 2015 with Crigler-Najjar syndrome. This morbid and life-threatening disorder is characterized by high levels of toxic bilirubin in the blood which can lead to irreversible brain damage or death. The study yields novel insights about the pathophysiology of bilirubin encephalopathy, demonstrates principles of effective phototherapy, and provides a framework to judge emerging molecular therapies. The project was a broad collaborative effort led by clinicians and researchers at the Clinic for Special Children (CSC) and appears in the journal Hepatology.

The study cohort was followed for 520 aggregate patient-years and provided critical data regarding the effectiveness of phototherapy and liver transplantation therapies. Researchers used an index of neurological risk by measuring unbound ("free") bilirubin in patient blood sera to determine the binding of unconjugated bilirubin to albumin. Four infants (14%) developed brain damage between 14 and 45 days of life, demonstrating the need for early intervention for Crigler-Najjar syndrome.

Two different systems of blue light therapy (i.e. phototherapy) were used to control bilirubin levels in the blood. Researchers found that starting phototherapy as early as possible is crucial; treatment delayed for more than 13 days after birth increased the risk of brain damage 3.5-fold. Consistent phototherapy kept bilirubin levels within safe limits throughout childhood, but average blood bilirubin increased with advancing age to reach dangerous concentrations by age 18 years.

Liver transplantation restored nearly 100% functional UGT1A1 enzyme activity and provided protection from brain damage. Seventeen (60%) of 28 patients received a liver transplant at a median age of 16.2 years. Bilirubin levels decreased dramatically within days after transplant and remained stable thereafter, eliminating the need for daily phototherapy. Post-transplant graft and patient survival were 100%. The researchers noted while liver transplantation provides an effective therapy, it entails well established short- and long-term risks.

Based on these observations, the authors conclude that despite advances in clinical care, Crigler-Najjar Syndrome remains a morbid and potentially fatal disorder, and there
remains a critical unmet need for safer and more effective disease-modifying interventions that leverage emerging gene replacement and editing technologies.

New research from entomologists at UC Davis clears a potential obstacle to using CRISPR-Cas9 "gene drive" technology to control mosquito-borne diseases such as malaria, dengue fever, yellow fever and Zika.

The idea is to create genetically engineered mosquitoes (GEM) that either fail to reproduce, reducing the mosquito population, or that resist carrying viruses and parasites that cause disease. These mosquitoes would be created in a lab and released to interbreed with wild mosquitoes.

That's where gene drive technology comes in. Using the Cas 9 enzyme, researchers can ensure that the new, modified genes would be inherited by all of the mosquito's offspring when they mate with wild mosquitoes.

Genetic variation not an obstacle

Cas-9 works by recognizing a 23-base pair stretch of DNA. A number of research teams have pointed out that mosquito genomes carry so much DNA sequence variation that a significant proportion of any wild mosquito population will almost certainly be resistant to gene drive. If resistance to the gene drive is favorable to the mosquito, then the gene drive strategy will fail, they argue.

A new study by Hanno Schmidt, Gregory Lanzaro and colleagues at the Vector Genetics Laboratory in the UC Davis School of Veterinary Medicine, published in Nature Communications, shows that this is not the case. After analyzing genomes of hundreds of mosquitoes from three major disease-carrying species, they concluded that 90 percent of protein-coding genes had at least one good Cas9 target sequence. Therefore the mosquitoes should still be susceptible to the gene drive strategy.

"Our results demonstrate that the high level of genetic diversity carried by mosquito populations in nature should not influence the sustainability of strategies based on the introduction of pathogen blocking genes. This is great news for those pursuing a GEM strategy for the elimination of malaria," Lanzaro said.

Additional authors on the paper are Travis Collier, Mark Hanemaaijer, Parker Houston and Yoosook Lee, all at the Vector Genetics Laboratory. Funding was provided by the UC Irvine Malaria Initiative, the CDC and NIH.

As part of the multi-campus UC Irvine Malaria Initiative the UC Davis team is tasked with developing a strategy to move GEM from the laboratory to contained field trials at sites in Africa. A major part of this work is a description of the genetics of mosquito populations at putative sites.

PHILADELPHIA - A blood test may be able to detect the most common form of pancreatic cancer while it is still in its early stages while also helping doctors accurately stage a patient's disease and guide them to the appropriate treatment. A multidisciplinary study from the University of Pennsylvania found the test - known as a liquid biopsy - was more accurate at detecting disease in a blinded study than any other known biomarker alone, and was also more accurate at staging disease than imaging is capable of alone. The team, which includes researchers from the Perelman School of Medicine, the Abramson Cancer Center, and the School of Engineering and Applied Science, published their findings today in Clinical Cancer Research, a journal of the American Association for Cancer Research.

Pancreatic ductal adenocarcinoma (PDAC), the most common form of pancreatic cancer, is the third leading cause of cancer deaths. The overall five-year survival rate is just nine percent, and most patients live less than one year following their diagnosis. One of the biggest challenges is catching the disease before it has progressed or spread. If the disease is caught early, patients may be candidates for surgery to remove the cancer, which can be curative. For locally advanced patients - meaning patients whose cancer has not spread beyond the pancreas but who are not candidates for surgery based on the size or location of the tumor - treatment involves three months of systemic therapy like chemo or radiation, then reassessing to see if surgery is an option. For patients whose disease has spread, there are currently no curative treatment options.

"Right now, the majority of patients who are diagnosed already have metastatic disease, so there is a critical need for a test that can not only detect the disease earlier but also accurately tell us who might be at a point where we can direct them to a potentially curative treatment," said the study's co-senior author Erica L. Carpenter, MBA, PhD, director of the Liquid Biopsy Laboratory and a research assistant professor of Medicine. The study's other co-senior author is David Issadore, PhD, an associate professor of Bioengineering and Electrical and Systems Engineering.

Researchers in this study developed a blood test to screen for a panel of biomarkers instead of just one biomarker on its own. These markers include carbohydrate antigen 19-9 (CA19-9) and KRAS mutational burden, which are known to be associated with PDAC. In a blinded test group of 47 patients (20 with PDAC, 27 who were cancer free), the test was 92 percent accurate in its ability to detect disease, which outperforms the best known biomarker, CA19-9 (89 percent), alone.

The researchers then used samples from the 25 patients who imaging showed did not have metastatic disease. The Penn test was 84 percent accurate in determining disease staging, which is significantly higher than imaging alone (64 percent).

While the test still needs to be validated in a larger cohort, researchers say they are excited by the promise of what it could potentially mean for a patient population in need of this kind of advancement.

"If validated, this test could not only provide a key tool for at-risk patients, but also a monitoring tool for patients with certain known risk factors like BRCA mutations," Carpenter said.

Coronary artery disease is the most common type of heart disease, according to the Centers for Disease Control and Prevention. About 18.2 million adults in the United States have coronary artery disease.

CT and MRI are established methods for noninvasive cardiac imaging and evaluation of coronary artery disease. CT is particularly useful for high-resolution images of the coronary anatomy, while cardiac MRI can provide information on blood supply to the heart muscle without exposing patients to ionizing radiation.

Despite their complementary strengths, CT and MRI findings are often analyzed separately, limiting the ability to fully leverage the strengths of the two methods.

"From this experience, the idea came up to fuse information on different pathologic aspects of the disease and to combine them in a single 3D image, which can be interpreted in a very quick but highly accurate fashion," said study lead author, Jochen von Spiczak, M.D., M.Sc., radiologist and computer scientist at Institute of Diagnostic and Interventional Radiology, University Hospital Zurich in Zurich, Switzerland.

Existing methods of combining CT and MRI have limitations, as they look at only a limited subset of the many aspects of coronary artery disease. Dr. von Spiczak and colleagues overcame these limitations by developing an approach that depicts all the available information from CT and cardiac MRI in one 3D image.

They compared their approach with conventional 2D readouts in 17 patients who underwent cardiac CT and cardiac MRI due to suspected or known coronary artery disease.

Conventional 2D readout of the images resulted in uncertain findings in eight cases. The new approach helped solve the divergent findings in six of those cases.

Information from the 3D fused image helped correlate specific stenoses, or areas of narrowing in the coronary arteries, and their severity with possible cardiac scar tissue and ischemia--a condition in which parts of the heart muscle don't get enough blood. This could be used to help guide interventional or surgical revascularization procedures like stenting or bypass surgery that improve blood supply to the heart.

"The technique may allow for an easier and possibly more accurate identification of patients and coronary stenoses that are likely to benefit from revascularization," Dr. von Spiczak said. "Applying today's clinical 2D standard led to a substantial number of uncertain findings in our study, whereas most of these divergent findings could be solved when including additional information from CT-derived blood flow estimates information and 3D image fusion."

The study points to a role for the fused approach in complex cases that yield uncertain findings in the first test, such as when results from CT and MRI are inconsistent or even contradictory.

Obstacles to its implementation include higher costs and complexity, problems that may be eased by advances in software, according to Dr. von Spiczak.

What The Viewpoint Says: The importance of recognizing and directly addressing the challenges created by COVID-19 era physical distancing in the care of older adults is addressed.

Authors: Michael A. Steinman, M.D., of the University of California, San Francisco, and the San Francisco VA Medical Center, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamainternmed.2020.1661)

Editor's Note: The article contains conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, conflicts of interest and financial disclosures, and funding and support.

The antiviral drug, baloxavir (tradename Xofluza), is the first treatment for influenza with a new mode of "action" to be licensed in nearly 20 years. It was approved in Australia in February 2020 by the Therapeutic Goods Administration (TGA) and has been used to treat influenza in Japan, the USA, and several other countries since 2018.

Researchers at the WHO Collaborating Centre for Reference and Research on Influenza at the Peter Doherty Institute for Infection and Immunity (Doherty Institute - a joint venture between the University of Melbourne and Royal Melbourne Hospital) and Imperial College London tested whether baloxavir could prevent the spread of influenza virus in an animal model in conditions that mimicked household settings, including direct and indirect contact. They also compared the treatment to oseltamivir (tradename Tamiflu), a widely prescribed influenza antiviral.

Published today in PLoS Pathogens is a detailed report of the study, which was conducted in ferrets - considered the gold standard animal model for evaluating influenza - detailing how baloxavir reduced the transmission of influenza across all settings, and did so immediately. Conversely, oseltamivir did not reduce the transmission of influenza to other ferrets.

First author Leo Yi Yang Lee, a medical scientist at the WHO Collaborating Centre for Reference and Research on Influenza, believes the results are an important breakthrough in our understanding of managing the influenza virus.

"Our research provides evidence that baloxavir can have a dramatic dual effect: a single dose reduces the length of influenza illness, while simultaneously reducing the chance of passing it on to others," Mr Lee said.

"This is very important, because current antiviral drugs only treat influenza illness in the infected patient. If you want to reduce the spread of influenza to others, people in close contact need to take antiviral drugs themselves to stave off infection."

Senior author Professor Wendy Barclay, head of the Department of Infectious Disease at Imperial College London, said if the results of the study were replicated in humans, the discovery could be a game changer in stemming outbreaks of influenza, particularly amongst vulnerable groups.

"We know that influenza can have serious and devastating outcomes for people with compromised immune systems, such as those in care facilities and hospitals, where finding more ways to reduce transmission is essential," Professor Barclay said.

A first-of-its-kind clinical trial is currently underway to test the effectiveness of baloxavir in reducing transmission amongst human household contacts by treating individuals infected with influenza and monitoring for infection in household members.

"If further trials prove successful, baloxavir could dramatically change how we manage seasonal influenza outbreaks and pandemic influenza in the future," Professor Barclay said.

Preeclampsia is the leading cause of death and disability, for both mothers and babies, killing approximately 76,000 mothers and 500,000 babies globally every year. Despite this, the only cure at present is to deliver the placenta and the baby, with the potential for long term complications.

In recent years stem cell therapies have been investigated in animal models. A review article published in Current Hypertension Reports investigates mesenchymal stem/stromal cells (MSCs) as a potential new treatment for preeclampsia.

Senior author, Dr Lana McClements, from the University of Technology Sydney (UTS) said that preeclampsia is a pregnancy complication which manifests as a sudden onset of high blood pressure and organ damage, often involving kidneys or liver, in the second half of pregnancy.

"Most of the deaths associated with preeclampsia occur in developing or low-resource countries however preeclampsia rates in developing countries are increasing due to increase rates of obesity, diabetes and age of women getting pregnant. While there are fewer deaths caused by preeclampsia in developing countries, the economic burden on the healthcare systems is significant", she says.

"In addition, studies show that beyond life-threatening complications in pregnancy preeclampsia is associated with increased maternal and offspring ill health in later life which makes this review important. If stem cell therapies have potential to treat this condition in pregnancy then their application needs to be assessed for clinical trials," she says.

Dr McClements and her co-authors from the Mayo Clinic (USA); University of Belgrade (Serbia); University of Nis (Serbia), Queen's University Belfast (UK) and Serbian Academy of Sciences and Arts, reviewed the therapeutic potential and mechanisms of MSCs in the context of preeclampsia.

MSCs are the most widely used stem cells for treatment of many diseases including cardiovascular disease. More recently, a limited number of studies (five) have tested these stem cells, or their associated secreted cargo (vesicles) as novel treatment options for preeclampsia in pre-clinical (animal) models showing promising results.

The authors say that of particular interest to low-resourced countries are vesicles secreted from these stem cells due to their stability and avoiding the need for expensive GMP cell manufacturing facilities.

"Preeclampsia develops due to a complex set of conditions. Our review shows that there is potential to use stem cells as therapy but we still don't understand the mechanism by which MSCs might repair damage in the condition.

"Further work is needed to maximize their therapeutic potential and minimise possible side effects before they can be introduced in a clinical setting, this is why we are pursuing this important research in my laboratory at UTS to help treat such a devastating disease," Dr McClements says.