Culture

During the first wave of the COVID-19 pandemic, nearly one in four families responded that they would be unlikely to bring their child to the Emergency Department if they had an emergency condition, according to a survey from Ann & Robert H. Lurie Children's Hospital of Chicago published in the journal Academic Emergency Medicine. Greater hesitancy to seek emergency care was found in families living in under-resourced communities, those who rely on public insurance and in families who are Black, Latinx or Asian.

"We observed greater hesitancy to use the Emergency Department among more vulnerable demographic groups who historically showed high utilization of emergency care for their children," said lead author Michelle Macy, MD, pediatric emergency care specialist at Lurie Children's and Associate Professor of Pediatrics at Northwestern University Feinberg School of Medicine. "This reluctance to seek care in a real emergency might further exacerbate health inequities."

The survey was conducted in the first week of May 2020. In March 2020, the Governor of Illinois issued a Stay-at-Home Executive Order limiting healthcare seeking to emergencies and COVID-19 care. While pediatric outpatient care has rebounded since the restrictions were lifted, emergency care continues to lag behind.

"At Lurie Children's Emergency Department, we are still seeing about half of the patients we would normally expect to see," said Dr. Macy. "This is concerning, since delays in emergency care may lead to a child's condition worsening to the point where they require hospital admission. To avoid a true health crisis, children need to be brought in earlier in the course of their illness. If families are ever concerned, they should contact their child's primary care provider to determine if emergency care is advised. Our Emergency Department is safe and always ready to help."

The survey included 3,896 families in metropolitan Chicago during the first wave of the COVID-19 pandemic. Overall, 23 percent of families were hesitant to seek emergency care for their child, with greatest hesitancy observed in families from the most under-resourced communities (27 percent) compared to those living in more affluent neighborhoods (19 percent). Among families of color, approximately a third responded that they would be unlikely to bring their child to the Emergency Department. Similarly, about a third of families on public insurance were reluctant to seek emergency care if their child needed it. Among Spanish speakers, 36 percent were hesitant to seek emergency care for their child.

Musical notes that sound pleasant together can form a harmony. These notes are usually in a special relationship with each other: when expressed as frequencies, their ratios result in simple fractions, such as four-thirds or three-halves. Similarly, a planetary system can also form a kind of harmony when planets, whose orbital period ratios form simple fractions, regularly attract each other with their gravity. When one planet takes three days to orbit its star and its neighbor takes two days, for example. Using the CHEOPS space telescope, scientists, led by astrophysicist Adrien Leleu of the Center for Space and Habitability of the University of Bern, the University of Geneva and the National Center of Competence in Research PlanetS, found such relationships between five of six planets orbiting the star TOI-178, located over 200 light years away from Earth. The results were published in the journal Astronomy and Astrophysics.

A missing piece in an unexpected puzzle

"This result surprised us, as previous observations with the Transiting Exoplanet Survey Satellite (TESS) of NASA pointed toward a three planets system, with two planets orbiting very close together. We therefore observed the system with additional instruments, such as the ground based ESPRESSO spectrograph at the European Southern Observatory (ESO)'s Paranal Observatory in Chile, but the results were inconclusive.", Leleu remembers. When he and his colleagues first proposed to investigate the system more closely, they were therefore not sure what they would find. The high precision and target-pointing agility of CHEOPS was required to bring clarity, but that turned out to be more difficult than expected. "After analyzing the data from eleven days of observing the system with CHEOPS, it seemed that there were more planets than we had initially thought", Leleu says. The team identified a possible solution with five planets and decided to invest another day of precious observation time on the system to confirm. They found that there were indeed five planets present with orbital periods of around 2, 3, 6, 10 and 20 days respectively.

While a system with five planets would have been quite a remarkable finding in itself, Leleu and his colleagues noticed that there might be more to the story: the system appeared to be in harmony. "Our theory implied that there could be an additional planet in this harmony; however its orbital period needed to be very nearly 15 days.", Leleu explains. To check if their theory was in fact true, the team scheduled yet another observation with CHEOPS, at the exact time that this missing planet would pass by - if it existed. But then, an accident threatened to cancel their plans.

Prediction confirmed despite near-collision

"Just before the time of the observation, a piece of space debris threatened to collide with the CHEOPS satellite", as co-author and Professor of Astrophysics at the University of Bern, Yann Alibert, recalls. Therefore, the control center of the European Space Agency (ESA) initiated an evasive maneuver of the satellite and all observations were interrupted. "But to our great relief, this manoeuver was done very efficiently and the satellite could resume observations just in time to capture the mysterious planet passing by", as Nathan Hara, co-author and astrophysicist from the University of Geneva reports. "A few days later, the data clearly indicated the presence of the additional planet and thus confirmed that there were indeed six planets in the TOI-178 system", Hara explains.

A system that challenges current understanding

Thanks to the precision of CHEOPS' measurements as well as previous data from the TESS mission, the ESO's spectrograph ESPRESSO, and others, the scientists could not only measure the periods and sizes of the planets of 1.1 to 3 times the radius of the Earth, but also estimate their densities. With that came another surprise: compared to the harmonic, orderly way the planets orbit around their star, their densities appear to be a wild mixture.

"It is the first time we observe something like this", as ESA Project Scientist Kate Isaak points out and adds that "in the few systems we know with such a harmony, the density of planets steadily decreases as we move away from the star. In the TOI-178 system, a dense, terrestrial planet like Earth appears to be right next to a very fluffy planet with half the density of Neptune followed by one very similar to Neptune".

As Adrien Leleu concludes, "the system therefore turned out to be one that challenges our understanding of the formation and evolution of planetary systems".

CHEOPS - in search of potential habitable planets

The CHEOPS mission (CHaracterising ExOPlanet Satellite) is the first of ESA's newly created "S-class missions" - small-class missions with an ESA budget much smaller than that of large- and medium-size missions, and a shorter timespan from project inception to launch.

CHEOPS is dedicated to characterizing the transits of exoplanets. It measures the changes in the brightness of a star when a planet passes in front of that star. This measured value allows the size of the planet to be derived, and for its density to be determined on the basis of existing data. This provides important information on these planets - for example, whether they are predominantly rocky, are composed of gases, or if they have deep oceans. This, in turn, is an important step in determining whether a planet has conditions that are hospitable to life.

CHEOPS was developed as part of a partnership between the European Space Agency (ESA) and Switzerland. Under the leadership of the University of Bern and ESA, a consortium of more than a hundred scientists and engineers from eleven European states was involved in constructing the satellite over five years.

CHEOPS began its journey into space on Wednesday, December 18, 2019 on board a Soyuz Fregat rocket from the European spaceport in Kourou, French Guiana. Since then, it has been orbiting the Earth on a polar orbit in roughly an hour and a half at an altitude of 700 kilometers following the terminator.

The Swiss Confederation participates in the CHEOPS telescope within the PRODEX programme (PROgramme de Développement d'EXpériences scientifiques) of the European Space Agency ESA. Through this programme, national contributions for science missions can be developed and built by project teams from research and industry. This transfer of knowledge and technology between science and industry ultimately also gives Switzerland a structural competitive advantage as a business location - and enables technologies, processes and products to flow into other markets and thus generate added value for our economy.

More information: https://cheops.unibe.ch

Bernese space exploration: With the world's elite since the first moon landing

When the second man, "Buzz" Aldrin, stepped out of the lunar module on July 21, 1969, the first task he did was to set up the Bernese Solar Wind Composition experiment (SWC) also known as the "solar wind sail" by planting it in the ground of the moon, even before the American flag. This experiment, which was planned and the results analysed by Prof. Dr. Johannes Geiss and his team from the Physics Institute of the University of Bern, was the first great highlight in the history of Bernese space exploration.

Ever since Bernese space exploration has been among the world's elite. The numbers are impressive: 25 times were instruments flown into the upper atmosphere and ionosphere using rockets (1967-1993), 9 times into the stratosphere with balloon flights (1991-2008), over 30 instruments were flown on space probes, and with CHEOPS the University of Bern shares responsibility with ESA for a whole mission.

The successful work of the Department of Space Research and Planetary Sciences (WP) from the Physics Institute of the University of Bern was consolidated by the foundation of a university competence center, the Center for Space and Habitability (CSH). The Swiss National Fund also awarded the University of Bern the National Center of Competence in Research (NCCR) PlanetS, which it manages together with the University of Geneva.

Exoplanet research in Geneva: 25 years of expertise awarded a Nobel Prize

CHEOPS will provide crucial information on the size, shape, formation and evolution of known exoplanets. The installation of the "Science Operation Center" of the CHEOPS mission in Geneva, under the supervision of two professors from the UNIGE Astronomy Department, is a logical continuation of the history of research in the field of exoplanets, since it is here that the first was discovered in 1995 by Michel Mayor and Didier Queloz, winners of the 2019 Nobel Prize in Physics. This discovery has enabled the Astronomy Department of the University of Geneva to be at the forefront of research in the field, with the construction and installation of HARPS on the ESO's 3.6m telescope at La Silla in 2003, a spectrograph that remained the most efficient in the world for two decades to determine the mass of exoplanets. However, this year HARPS was surpassed by ESPRESSO, another spectrograph built in Geneva and installed on the VLT in Paranal.

CHEOPS is therefore the result of two national expertises, on the one hand the space know-how of the University of Bern with the collaboration of its Geneva counterpart and on the other hand the ground experience of the University of Geneva supported by its colleague in the Swiss capital. Two scientific and technical competences that have also made it possible to create the National Center of Competence in Research (NCCR) PlanetS.

January 25, 2021 -- In a study to gain understanding of the future public health workforce, researchers at Columbia University Mailman School of Public Health and the Association of Schools and Programs of Public Health (ASPPH), conducted a large-scale analysis of the first employment outcomes of public health graduates and found that 78 percent were employed including 5 percent employed in fellowships and internships. Fifteen percent were continuing their studies; only 5 percent were not employed and job seeking. These indicators may ultimately expand public health's reach and lead to healthier communities overall. The study is the first national analysis of employment outcomes of public health graduates, and one of the only such analyses ever conducted. The results are published in the American Journal of Public Health.

"We conducted an assessment of first-destination outcomes of public health graduates to ensure that there are enough trained public health professionals to fill rapidly changing workforce demands," said Heather Krasna, MS, assistant dean and director of career services at Columbia Mailman School, and a co-lead author of the study. "It is important for both academia and practice to know that graduates have a wide choice of employment options, stretching beyond government and into academia and the health care, nonprofit, and for-profit sectors."
Using descriptive statistics and the Pearson χ2 test, the researchers assessed first-destination employ- ment and educational outcome data reported by members of ASPPH, the membership organization for domestic and international Council on Education for Public Health-accredited schools and programs of public health. The data included 64,592 public health graduates, of which 53,463 had a known first-destination outcome, from the graduating years 2015-2018. There were 9,513 graduates from 55 institutions in 2015, 13,588 graduates from 75 institutions in 2016, 20,394 graduates from 112 institutions in 2017, and 21,097 graduates from 111 institutions in 2018. Across the pooled data, 31 percent of graduates were from bachelor's, 63 percent from master's, and 7 percent from doctoral degree programs.

The researchers found that overall, 73 percent of graduates in public health were employed; 15 percent enrolled in further education; 5 percent entered a fellowship, internship, residency, volunteer, or service program; and 6 percent were not employed (including 1 percent not job seeking by choice). Employed graduates went to work in health care (27 percent), corporations (24 percent), academia (19 percent), government (17 percent), and nonprofit (12 percent). In 2018, 9 percent of bachelor's, 4 percent of master's, and 2 percent of doctoral graduates were not employed but seeking employment by a year after graduation. Employment by degree level shows that graduates with advanced public health degrees had better employment outcomes.

The authors make the point that with the growth and changes in public health degree programs, it is important to know which areas of study are achieving the best employment outcomes, identify which sectors are recruiting these graduates, and help schools and programs of public health communicate their impact to prospective students, and employers.

"Graduates' first-destination outcomes provide academia insight into changes in the job market, which may then inform decisions on the degrees and areas of study an institution offers," observed Christine Plepys, senior director of data analytics at ASPPH, and co-lead author of the study. "A school's or program's ability to prepare graduates with the competencies demanded by the workforce may help ensure student success, not only in finding employment that uses their education but also in finding career satisfaction."

General public health was the most common area of study (23 percent of graduates), followed by health policy and management (14 percent), health education or behavioral sciences (14 percent), and epidemiology (13 percent).

Graduates in certain areas of study had higher rates of job-seeking after graduation, including maternal and child health (19 percent) at the bachelor's degree level. At the master's level, graduates in certain areas of study had higher rates of job-seeking as compared to the average, including 13 percent of graduates studying health disparities, followed by nutrition (11 percent), and global health (8 percent), while others had lower rates, such as biostatistics (3 percent) or health informatics (2 percent).

The authors also point out that governmental public health remains a key necessity for communities, nations, and the world, as shown in the COVID-19 response. Historically, graduates entered governmental public health at higher rates than they do now. "As public health responds to the COVID-19 pandemic, new competencies may be needed to address such crises and there may be demand for different education formats to replace or bolster formal degrees (certifications, micromasters, etc.) that increase the number of public health workers with needed competencies," according to Plepys.

"The good news is that for both traditional public health roles and new COVID-19-related positions, graduates appear to be more flexible about the roles they will accept. Regardless of what we now know about the workforce, recalibration may be necessary after the current pandemic," said Krasna. She also noted that in this study only 17 percent of graduates enter government work, which underscores the need for continued policy efforts to increase funding and encourage employment in the government sector.

A survey of dog owners from across the U.S. shows that when it comes to seeking veterinary care for dogs, barriers to access - including a lack of trust - have more effect on the decision-making process than differences in race, gender or socioeconomic status. The results could aid veterinarians in developing outreach strategies for underserved communities.

"I was interested in how different demographic groups viewed health care and how those views might affect relationships between veterinarians and their clients," says Rachel Park, a Ph.D. student at North Carolina State University and first author of a paper describing the work. "The existing literature wasn't national in scope and hadn't accounted for multiple identities held, such as one's socioeconomic status or education, so I saw a knowledge gap that could be filled."

Using Amazon's Mechanical Turk, Park conducted an online survey of 858 self-identified dog owners. Participants were asked to indicate how likely they would be to seek veterinary care under 18 different circumstances. Participants were also asked supplemental questions about their relationship with their dog, previous veterinary behavior and demographic information.

While there was some variance for different medical scenarios, the overall likelihood of dog owners to seek care did not differ significantly across demographics, regardless of race, gender, or socioeconomic status. However, there were demographic differences related to barriers to veterinary care, as well as to the owner's relationship with the dog.

"We did see that women (58.0%), white (48.9%) and Asian (64.4%) dog owners were more likely to describe the dog as a member of the family, rather than as property, whereas some Black (24.4%) or Native American (25.0%) dog owners were more likely to consider the dog property," says Park. "But the difference in the way the relationship was described didn't carry over into a difference in likelihood to seek veterinary care."

The primary barriers to care that respondents identified were transportation, veterinary office hours of operation, cost, language differences and trust. Cost was a bigger factor for dog owners under 29 years old or households making less than $60,000 per year. However, these barriers - with the exception of trust - cut across all demographics: race, gender, education level and socioeconomic status.

Black and Native American respondents were about 10 to 15% more likely to indicate a lack of trust as a barrier to seeking veterinary care.

"This was the most interesting finding," Park says. "Respondents had the ability to select 'had a bad prior experience with veterinarian' as an option, but those who indicated lack of trust didn't choose that as the reason. Research has long reported that racial and ethnic minorities often experience mistrust in health professionals in human medicine and consequently seek health care at a lower rate. Our findings reveal that Black and Native American dog owners experience a similar mistrust in veterinary medicine. This appears to be an important avenue for future research."

While there are limitations to the survey - no statistical weighting to adjust for over- or under-sampling - Park says that the results are still useful for identifying opportunities for outreach from the veterinary community.

"I'm hopeful that this study can help us better understand the barriers different communities face," Park says. "Everyone wants to do what's best for their dog, so the veterinary community has the opportunity to help ensure equal access to care and try and ease those barriers."

In the past 20 years, humans have suffered several serious epidemics from emerging viruses, such as SARS, swine flu, Ebola, MERS and (most recently) SARS-CoV-2. During each epidemic, an accurate, rapid, and accessible molecular diagnostic test is highly essential for the control and prevention of viral diseases. In particular, coronavirus disease 2019 (COVID-19) is spreading rapidly in most countries, resulting in a severe global pandemic, which has a profound impact on the world economy and people's normal life. Accurate and rapid diagnosis of COVID-19 has been the most crucial measure for controlling the ongoing pandemic. In general, reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) is the primary method for detection of nucleic acid-based genetic sequences. Because of the labor-intensive sample preparation, which must be conducted in a biological laboratory by professionals using specialized instruments, the typical turn-around time of the RT-qPCR method is longer than 24 h. In addition, the complex RT-qPCR process might also reduce clinical sensitivity, resulting in false negative results.

Recently, Guo and coworkers from Peking University developed an unprecedented accurate, rapid, and portable electrical detector based on the use of graphene field-effect transistors (G-FETs) for detection of RNA from COVID-19 patients. As shown in Fig. 1, the detection system mainly consists of two parts: a plug-and-play packaged biosensor chip and a home-developed electrical measurement machine. The unique feature of this method is that the extent of hybridization between the ss-DNA probe and viral RNA can be directly converted to the current change of graphene channels without repetition of the PCR process, thus affording an ultra-low limit of detection (LOD) of ?0.1 fg/mL for the detection of the RNA-dependent RNA polymerase (RdRp) gene target of SARS-CoV-2. Furthermore, this method was validated using clinical samples collected from many patients with COVID-19 infection and healthy individuals as well, and the testing results were in full agreement with those of PCR-based optical methods. The entire process, precluding the extraction of detection targets from oropharyngeal swabs, requires approximately 10 min. Because it does not involve time-consuming PCR step nor expensive instruments, this detection system enables massive point-of-care testing of COVID-19, outside of specialized diagnostic laboratories, with the advantage of high accuracy, sensitivity and low cost.

Notably, false negative results are inevitable in the course of nucleic acid testing; thus, the use of immunodetection as an auxiliary technique is important in the diagnosis of COVID-19 patients, especially those with suspected diseases. By replacing the ss-DNA probe with a SARS-CoV-2 antigen protein, this detection system can also detect SARS-CoV-2 IgM and IgG antibodies with an ultra-low LOD of ?1 fg/mL. Immunoassays of serum specimens of COVID-19 patients and healthy subjects matched excellently with those of PCR-based optical methods.

This detecting system exhibits obvious advantages of high sensitivity, rapid speed (?10 min for RNA analysis and ?5 min for immunoassay), and bifunction (both RNA analysis and immunoassay). These advantages enable high-throughput point-of-care testing, which may facilitate management of the current severe public health crisis. Furthermore, this detection system offers a universal methodology that is ready for immediate application in rapid detection of novel viruses in future.

FINDINGS

A study led by researchers at the UCLA Jonsson Comprehensive Cancer Center found shortening a traditional 45-day course of radiation to a five-day course delivered in larger doses is safe and as effective as conventional radiation for men with high-risk forms of prostate cancer.

The findings show the five-day regimen of stereotactic body radiotherapy, a form of external beam radiation therapy that uses a higher dose of radiation, had a four-year cure rate of 82%. Severe side effects were also rare. Around 2% experienced urinary issues and less than 1% had bowel side effects.

BACKGROUND

Building on previous UCLA research that provided significant evidence that a shortened regimen of radiation could be a viable treatment option for men with low- and intermediate-risk prostate cancer, researchers decided to broaden the study to see if a shorter course would a viable option for men with aggressive disease.

METHOD

Researchers analyzed data from 344 men with high-risk prostate cancer who were enrolled in a clinical trial from seven institutions across the globe, including UCLA. Minimum follow-up was 24 months and the median follow-up was 49.5 months. This the largest dataset to date that looked at this type of treatment in men with more aggressive prostate cancers can help improve the overall quality of life for men with prostate cancer.

IMPACT

Conventional radiation, which requires daily visits for treatment, can be burdensome for many. Shortening radiation therapy from six-and-a-half weeks to five days is a significant advancement that can help improve the overall quality of life for men with prostate cancer.

(Boston)--Atrial fibrillation (AF) is associated with a higher risk of complications including ischemic stroke, cognitive decline, heart failure, myocardial infarction and death. AF frequently is undetected until complications such as stroke or heart failure occur.

While the public and clinicians have an intense interest in detecting AF earlier, the most appropriate strategies to detect undiagnosed AF and medical prognosis and therapeutic implications of AF detected by screening are uncertain.

A new report led by Boston University School of Medicine (BUSM) researcher Emelia J. Benjamin, MD, ScM, builds upon a recently conducted National Heart, Lung, and Blood Institute's virtual workshop that focused on identifying key research priorities related to AF screening.

Global experts reviewed major knowledge gaps and identified critical research priorities in the following areas: 1) role of opportunistic screening; 2) AF as a risk factor, risk marker, or both; 3) relationship between AF burden detected with long-term monitoring and outcomes/treatments; 4) designs of potential randomized trials of systematic AF screening with clinically relevant outcomes; and 5) role of AF screening after ischemic stroke.

"The research gaps and opportunities outlined in the workshop will hopefully accelerate AF screening research to improve the diagnosis, management and prognosis of patients with undiagnosed AF," said corresponding author Benjamin, professor of medicine at BUSM.

According to the researchers several themes emerged from the workshop to advance the field of AF screening including developing a compelling evidence base and sharing data across studies and the need to investigate diverse patient subgroups (age, sex, race/ethnicity, urban/rural and comorbidities).

The researchers submit that close attention will need to be paid to both the potential benefits and adverse outcomes of AF screening strategies on the patient (anxiety, testing, treatment complications) and the health system (e.g., disparities, costs, and clinician liability and fatigue) before recommending widespread screening.

These findings appear in the journal Circulation.

Scientists conducted the first study to examine the fetal health impact of light pollution based on a direct measure of skyglow, an important aspect of light pollution. Using an empirical regularity discovered in physics, called Walker's Law, a team from Lehigh University, Lafayette College and the University of Colorado Denver in the U.S., found evidence of reduced birth weight, shortened gestational length and preterm births.

Specifically, the likelihood of a preterm birth could increase by approximately 1.48 percentage points (or 12.9%), according to the researchers, as a result of increased nighttime brightness. Nighttime brightness is characterized by being able to see only one-fourth to one-third of the stars that are visible in the natural unpolluted night sky. The findings have been published in an article in Southern Economic Journal called, "Light pollution, sleep deprivation, and infant health at birth."

One possible biological mechanism underlying the findings, based on the existing literature, is light-pollution-induced circadian rhythm disruption, according to Muzhe Yang, a co-author of the study and a professor of economics in Lehigh's College of Business. Yang says circadian rhythm disruption can cause sleep disorders that subsequently lead to adverse birth outcomes.

"While greater use of artificial light at night (ALAN) is often associated with greater economic prosperity, our study highlights an often neglected health benefit of 'darkness,'" says Yang. "We must realize that the biological clock (i.e., the circadian rhythm) of a human body, like all lives on the earth, needs the 'darkness' as part of the light-dark cycle, in order to effectively regulate physiological functions, such as sleep."

While essential to a modern society, ALAN can disrupt a human body's circadian rhythm and therefore become a "pollutant." The societal benefits of ALAN, for example through increased economic activity, may be offset by ALAN's negative externalities such as adverse health effects, say the authors.

The contribution of ALAN to the alteration of natural nocturnal lighting levels is often referred to as light pollution. Light pollution is considered a worldwide ongoing problem.

The Special Issue, Volume 10, of Inter Faculty takes up the theme of resonance in the context of the Covid-19 pandemic and its ensuing societal shifts. For, the pandemic this year (2020) reminded us more than ever that we live in 'VUCA' - volatility, uncertainty, complexity and ambiguity. Many things that used to be taken for granted up until a year ago crumbled abruptly and globally. The pandemic struck many aspects or our societies such as public health, economy and social bonds thereby uncovering the vulnerability of the modern society. Universities are no exception to this. Just as one nation by itself cannot tackle these global challenges, neither can these challenges be solved by a single discipline.

Resonance then, gives voice to individual researchers from a broad spectrum of the human and social sciences. From their different perspectives and interpretations of the present upheavals facing our contemporary societies, a wider consideration becomes apparent - that humankind is at a critical turning point in relation to the planet and its natural world.

A new study demonstrates that antibodies generated by the novel coronavirus react to other strains of coronavirus and vice versa, according to research published today by scientists from Oregon Health & Science University.

However, antibodies generated by the SARS outbreak of 2003 had only limited effectiveness in neutralizing the SARS-CoV-2 virus. Antibodies are blood proteins that are made by the immune system to protect against infection, in this case by a coronavirus.

The study published today in the journal Cell Reports.

"Our finding has some important implications concerning immunity toward different strains of coronavirus infections, especially as these viruses continue to mutate," said senior author Fikadu Tafesse, Ph.D., assistant professor of molecular microbiology and immunology in the OHSU School of Medicine.

Given the speed of mutations - estimated at one to two per month - it's not surprising that an antibody generated from a virus 18 years ago provides a meager defense against the new coronavirus. Nonetheless, Tafesse said the findings suggest more work needs to be done to determine the lasting effectiveness of COVID-19 vaccines.

"I don't think there is any one size-fits-all vaccine," he said. "Although the vaccines coming out now may break the momentum of the virus and end the pandemic, they may not be the end game."

Tafesse noted that researchers used individual antibody clones to test cross-reactivity, and that a body's normal immune system will generate many antibodies that are more likely to neutralize a wider series of targets on the mutating virus.

"I'm not personally terribly concerned," said lead author Timothy Bates, a fourth-year molecular microbiology and immunology graduate student in the OHSU School of Medicine. "Emerging mutant viruses may have some propensity to escape certain antibodies raised by previous infection or vaccine.

"Every individual has a different immune system that will make a unique repertoire of different antibodies that bind to different places on the virus, so the chance of any one SARS-CoV-2 variant escaping from all of them is quite low."

The study also suggests that efforts to accurately discern a previous COVID-19 infection, by analyzing antibodies in blood, may be confounded by the presence of antibodies reacting to other strains of coronavirus including the common cold. Although this complicates diagnosis of older infections, researchers say the finding actually expands scientists' ability to study the biology and disease-causing effects of the SARS-CoV-2 virus since they know it reacts to antibodies of multiple strains of coronaviruses.

"It provides more tools to study the biology of this virus because we have very limited reagents available right now for SARS-CoV-2," Tafesse said.

An analysis undertaken by Faculty of Law professors and a physician-researcher from the Faculty of Medicine at the University of Ottawa feels provincial and territorial governments should set clear rules for vaccinating health care workers against SARS-CoV-2, the virus that causes COVID-19, in public and private settings.

Mandatory vaccination for health care workers: an analysis of law and policy, published in the Canadian Medical Association Journal (CMAJ), describes legal precedents from attempts to mandate influenza vaccines for health care workers and how those precedents might apply to SARS-CoV-2 vaccination. It also describes the legal justification for mandating SARS-CoV-2 vaccination for health care workers and other legal considerations.

When creating policy for mandatory vaccination of health care workers, it will be important to include exemptions for people who cannot receive a vaccine because of underlying health issues or other reasons. These exemptions will help protect government mandates if there is a challenge under the Canadian Charter of Rights and Freedoms. Based on current evidence, these challenges would likely be unsuccessful if there are exemptions in place for employees. It is important to note that any vaccinate or stay at home order would not force a health care worker to be vaccinated.

"An effective vaccine provided to health care workers will protect both the health workforce and patients, reducing the overall burden of COVID-19 on services and ensuring adequate personnel to administer to people's health needs through the pandemic," writes Colleen Flood, Professor of Law - Common Law section and Research Chair in Health Law & Policy, with coauthors.

"What is less clear is whether or not a health care worker could argue that they should be able, in lieu of vaccination, to wear personal protective equipment," says Professor Flood. "Initially, even those vaccinated will continue to wear PPE, but we think courts should accept the application of the precautionary principle to require vaccination in most circumstances. It will, however, be essential to collect and weigh real-world evidence of the benefits of both vaccines and PPE."

"This is an important issue to address with science and law working together," says Dr. Kumanan Wilson, Clinical Research Chair in Digital Health Innovation at uOttawa and a Senior Scientist at The Ottawa Hospital. "Given the rapid development of various COVID-19 vaccines and emerging evidence, new data will determine whether these policies will stay in effect or will be modified."

Restricting eating to an eight-hour window, when activity is highest, decreased the risk of development, growth and metastasis of breast cancer in mouse models, report researchers at University of California San Diego School of Medicine, Moores Cancer Center and Veterans Affairs San Diego Healthcare System (VASDSH).

The findings, published in the January 25, 2021 edition of Nature Communications, show that time-restricted feeding -- a form of intermittent fasting aligned with circadian rhythms -- improved metabolic health and tumor circadian rhythms in mice with obesity-driven postmenopausal breast cancer.

"Previous research has shown that obesity increases the risk of a variety of cancers by negatively affecting how the body reacts to insulin levels and changing circadian rhythms," said senior author Nicholas Webster, PhD, professor at UC San Diego School of Medicine and senior research career scientist at VASDSH. "We were able to increase insulin sensitivity, reduce hyperinsulinemia, restore circadian rhythms and reduce tumor growth by simply modifying when and for how long mice had access to food."

Breast cancer is the second most common cancer among women in the United States, after skin cancers. One in eight women will develop breast cancer in their lifetime.

Researchers used female mouse models mimicking postmenopausal hormone conditions to investigate whether time-restricted feeding of obese mice affected the development and growth of tumors and reduced breast cancer metastasis to the lungs. Three groups were compared in different mouse models. One group had 24-hour access to food. A second had food access for eight hours at night when mice are most active and a third group had an unrestricted low-fat diet.

Both obesity and menopause can disrupt circadian rhythms, which in turn can lead to the development of insulin resistance, predisposing individuals to chronic diseases like cancer.

Data indicates that elevated insulin levels in obese mice are driving the accelerated tumor growth. Artificially elevating insulin levels accelerated tumor growth, whereas reducing insulin levels could mimic the effect of the time-restricted feeding. The results suggest that the antitumor effect of time-restricted feeding is due to improving metabolic health and lowering the levels of insulin, said Manasi Das, PhD, postdoctoral fellow in the Webster lab and first author.

"Time-restricted eating has a positive effect on metabolic health and does not trigger the hunger and irritability that is associated with long-term fasting or calorie restriction," said Das. "Through its beneficial metabolic effects, time-restricted eating may also provide an inexpensive, easy to adopt, but effective strategy to prevent and inhibit breast cancer without requiring a change in diet or physical activity."

Exploring the ability of time-restricted eating to prevent breast cancer in women, or cancer in general, could affect a wide range of patients, said Webster, suggesting that clinical trials are warranted.

"The increase in risk of breast cancer is particularly high in women who are overweight and have been through menopause. For this reason, doctors may advice women to adopt weight loss strategies to prevent tumor growth," said Das. "Our data suggests that a person may benefit from simply timing their meals differently to prevent breast cancer rather than changing what they eat."

New estimates reveal extent of the health burden of armed conflict--affecting at least 630 million women and children worldwide in 2017, and contributing to more than 10 million deaths among children under 5 years of age over 20 years.

Changing nature of war is a growing threat to humanitarian access and the provision of essential health services for women and children, but responses in countries like Syria, Pakistan, and Colombia may provide context-specific innovative ways forward.

Armed conflicts are becoming increasingly complex and protracted and a growing threat to humanitarian access and the delivery of essential health services, affecting at least 630 million women and children--over 8% of the world's population--in 2017, according to a new four-paper Series exposing the far-reaching effects of modern warfare on women's and children's health, published today in The Lancet.

The authors highlight the failure of the global community to prioritise women's and children's health in areas of conflict, and call for an international commitment from humanitarian actors and donors to confront political and security challenges, together with consensus on a framework for identifying high-priority interventions to reach the most vulnerable women and children with the best care possible.

The Series led by academic co-investigators and partners affiliated with the BRANCH (Bridging Research & Action in Conflict Settings for the Health of Women & Children) Consortium synthesises existing evidence with new modelling and insights from a range of local research partners, humanitarian agencies, and civil society organisations.

"The new estimates provide compelling evidence of the enormous indirect toll of modern warfare caused by easily preventable infectious diseases, malnutrition, sexual violence, and poor mental health, as well as the destruction of basic services such as water and medical facilities", says Professor Zulfiqar Bhutta from the Centre for Global Child Health, The Hospital for Sick Children in Toronto in Canada and the Institute for Global Heath & Development, The Aga Khan University, who led the Series. [1]

He continues, "Today, more than half of the world's women and children are living in countries experiencing active conflict. The international community cannot continue to ignore their plight. It's time for a radical rethink of the global response that confronts challenges to insecurity, access, politics, coordination, and the logistics of delivering high-priority interventions to women and children in politically unstable and insecure settings." [1]

The Series papers explore the changing nature of war and conflict, its short- and long-term health effects on women and children, strategies for identifying best responses, and interventions supported by in-country assessments and studies.

Growing threats of armed conflict to women's and children's health

New estimates suggest that the number of women and children affected by armed conflict around the world has risen steadily since 2000, as a result of population growth, more conflicts, increasing use of explosive and chemical weapons in urban areas, and growing numbers of refugees and internally displaced people [2].

In 2017, one in 10 (10%) women and almost one in six (16%) children worldwide were either forcibly displaced by conflict or living dangerously close (ie, within 50 km) to conflict zones. Around a third of those affected live in Pakistan, Nigeria, and India.

Evidence suggests that the risk of dying from non-violent causes increases substantially with proximity to more intense and chronic conflicts, with women of childbearing age in Africa living near the highest-intensity fighting three times more likely to die than women in peaceful areas, and the risk of death among infants higher by more than 25%.

Between 6·7 and 7·5 million infants, and more than 10 million children under 5 years of age, born within 50 km of armed conflict are estimated to have died from the indirect consequences of fighting across Africa, Asia, and the Americas between 1995 and 2015.

"It is clear that the indirect effects of armed conflict on women and children are far greater than the effects of actual fighting", says Series co-author Dr Hala Ghattas, Director of the Center for Research on Population and Health, American University of Beirut, Lebanon. "But the reality could be much worse. Insecurity and insufficient resources mean data are often scarce and of poor quality. Far greater investment in strengthening data collection and collaboration between humanitarian agencies and local authorities is needed to generate better, more readily available, and actionable information to improve the response in humanitarian crises." [1]

Changing nature of armed conflict demands new humanitarian strategies

In 2019, there were 54 ongoing state-based armed conflicts in 35 countries, averaging 20 years or more [3]. Once mostly confined to warring nations, armed conflict increasingly involves clashes between nations and insurgent groups in control of large geographical areas, and is characterised by a lack of respect for International Humanitarian Law, the systematic use of explosive and chemical weapons in cities, pervasive sexual violence against women and girls, and hybrid warfare (eg, cyberattacks and the manipulation of social media).

How war is being fought and who is fighting bring new challenges to humanitarian access, the delivery of health services, and the protection of humanitarian workers and health facilities from attack. Climate change and new health threats such as the COVID-19 pandemic have further complicated the response. At the same time, new medical capabilities such as modern trauma care offer opportunities for improved health provision.

According to Series co-author, Dr Michele Barry, Senior Associate Dean for Global Health and Director of the Center for Innovation in Global Health, Stanford University School of Medicine: "Given the changing nature of armed conflict, this Series underscores the importance of a humanitarian response that includes the empowerment of local communities and leaders as they are best able to deliver life-saving services, services that rely on a community's capabilities, perceptions, and trust." [1]

Lessons learnt from ten conflict-affected countries

The Series also assessed the provision of proven health interventions for women and children in 10 conflict-affected countries in different stages (eg, acute, protracted, post-conflict) of conflict and geographical, political, and economic conditions--Afghanistan, Colombia, Democratic Republic of the Congo, Mali, Nigeria, Pakistan, Somalia, South Sudan, Syria, and Yemen.

While priority is commonly given to a range of interventions including antenatal care, emergency obstetric care, childhood vaccination, and infant and young child feeding, evidence suggests that the delivery of many life-saving services, including most sexual, reproductive, newborn, and adolescent health services, is limited.

The authors recognise that humanitarian agencies and national authorities face a wide variety of barriers to delivery, from limited funding and shortages of skilled health-care workers (eg, midwives and nurses in Pakistan and Syria) to insecurity (eg, attacks and kidnapping of health workers in Colombia and Somalia), and mistrust due to the politicisation of aid.

But these challenges have also spurred extraordinary creativity in the humanitarian response. Innovative approaches include: task sharing and hiring other types of community health workers (eg, traditional healers and birth attendants); using new modes of delivery such as remote management (ie, subcontracting to local organisations) and technology like WhatsApp; and establishing contingency funds for emergencies.

In Afghanistan, for example, mobile clinics are used to deliver health services to remote areas, and in South Sudan, donors made emergency funds available to stock up on medical supplies to ensure rapid respond to future disease outbreaks (eg, cholera). In Pakistan, senior health workers living in the middle of the Keich district rotate week-long visits to remote areas every month to address the workforce shortage.

Professor Isabel Garcés-Palacio from the Universidad de Antioquia in Colombia says, "Although these solutions need more rigorous evaluation, they have the potential to provide a timely response to current implementation challenges and remind health authorities of their responsibility to deliver basic health services to the whole population." [1]

However, there are also wider issues in the humanitarian system that need to be addressed. "Predefined packages of priority health services for women and children are not commonly agreed upon. Instead, international donors remain the key drivers of influencing what, where, and how interventions are delivered", explains Dr Jai Das from The Aga Khan University in Pakistan. "Although technical and operational guidance on promoting women's and children's health in humanitarian crises exist, they are not specific to conflict settings and have been developed as a broad response to a range of emergencies including natural disasters and epidemics."[1]

A way forward

As a first step towards filling the guidance gap, the authors call for humanitarian health actors including global and local agencies and NGOs, and academia working in conflict settings to establish a decision-making framework to guide the selection of priority interventions and improve accountability.

"While the needs of conflict-affected communities are great, their voices are also often unheard or overlooked, so it is imperative they have a seat at the table--and that humanitarian actors listen to them--when decisions concerning them are made", says Series co-author Assistant Professor Neha Singh, Co-Director of the Health in Humanitarian Crises Centre at The London School of Hygiene & Tropical Medicine, UK. "It is imperative that the world make more concerted efforts to reduce the risk of conflict, but until that happens, improving the delivery of health and nutrition services for women, children, and adolescents affected by conflict remains an ethical and moral responsibility." [1]

Writing in a linked Comment, Helen Clark, Chair of The Partnership for Maternal, Newborn & Child Health (PMNCH) and former Prime Minister of New Zealand (who was not involved in the Series papers) writes: "The rights and needs of women, children, and adolescents must to be placed at the centre of all humanitarian, development, and peace-building efforts, in line with the concept of centrality of protection. Doing this isn't the responsibility of any one sector or stakeholder group, and all actors need collectively to agree on and demand greater alignment, investment, and political attention for women, children, and adolescents who are trapped in conflict zones. Only then can the unequal burden of preventable morbidity and mortality in the world's most challenging regions be addressed in a way that ensures that no one is left behind."

A group of scientists is calling on governments to consider the continued use of strict control measures as the only way to reduce the evolution and spread of new COVID-19 variants.

The experts in evolution, virology, infectious disease and genomics - at the University of East Anglia (UEA), Earlham Institute and University of Minnesota - warn that while governments are negotiating a "precarious balance" between saving the economy and preventing COVID-19 fatalities, stronger action now is the best way to mitigate against more serious outcomes from such virulent strains later.

While COVID-19 vaccine deployment is now underway, a threat to vaccine effectiveness comes from other emerging strains, both existing - such as the UK, South Africa and Brazil variants - and those yet to come.

In an editorial for the journal Virulence, Professors Cock van Oosterhout, Neil Hall, Hinh Ly, and its editor-in-chief Prof Kevin Tyler say "continuing public health efforts to encourage vaccination as well as continued use of proper personal protective equipment (PPE), such as proper masking and maintaining safe social interactions, is of utmost importance.

"Humanity is faced with a new reality. The faster we adapt, the better our long-term prospects. We must stop the evolution and spread of more virulent virus strains now. We, therefore, support public health policies with strict control measures in order to protect our public health system, our individual wellbeing, and our future."

The researchers look back at what has happened and how best to respond now, highlighting that the roll-out of economic stimulus packages and related activities in many countries appears to have fuelled the rate of person-to-person transmission.

As a result, they say at the start of winter the population number of the virus continued from a much higher base than would otherwise have been the case, adding: "By not absolutely minimizing the R number when we had the chance, we extended the pathogen transmission chains, providing more opportunity for it to mutate and evolve into more virulent variants."

Additionally, they highlight that an increased virulence - or higher R value - can also result from the virus evolving the ability to infect people for longer. The authors warn that continued virus evolution in animal hosts, such as cats and mink, followed by transmission into susceptible human hosts, poses a significant long-term risk to public health, suggesting that the vaccination of certain domesticated animals might be important to halt further virus evolution and "spillback" events.

"Vaccination against a viral pathogen with such high prevalence globally is without precedent and we, therefore, have found ourselves in unchartered waters. However, what we can be certain about is that, as long as the vaccine stays effective, a higher uptake of the vaccines will: reduce the number of COVID-19-related deaths, stem the spread of the transmissible strain of the virus, and reduce risk of the evolution of other, even more, virulent strains in the future.

"Furthermore, it is not unthinkable that vaccination of some domesticated animal species might also be necessary to curb the spread of the infection."

Public health researchers, led by UNSW Sydney, have estimated the number of cancer cases requiring surgery globally each year, predicting the number will rise from 9.1 million to 13.8 million from 2018 to 2040 - an increase of 52 per cent or 4.7 million cases.

Their research shows the greatest relative increase will occur in 34 low-income countries, where the number of cases requiring surgery is expected to more than double by 2040 (314,355 cases to 650,164, or 107 per cent).

The modelling study, published in The Lancet Oncology on Friday, analysed global demand for cancer surgery and estimated surgical and anaesthesia workforce requirements between 2018 and 2040.

Lead author Dr Sathira Perera, a UNSW Scientia PhD scholar, said an absence of evidence-based estimates of future demand had restricted efforts to improve cancer care around the world.

Cancer is a leading cause of death and disability globally, and has substantial economic impacts, with recent evidence suggesting a disproportionate burden of disease in low- and middle-income countries.

"Our analysis has revealed that, in relative terms, low-income countries will bear the brunt of increased future demand for cancer surgery, bringing with it a need to substantially increase numbers of surgeons and anaesthetists," Dr Perera said.

"These findings highlight a need to act quickly to ensure that increasing workforce requirements in low-income countries are adequately planned for. There needs to be an increased focus on the application of cost-effective models of care, along with government endorsement of scientific evidence to mobilise resources for expanding services.

"In addition, access to post-operative care is strongly linked to lower mortality - so, improving care systems globally must be a priority in order to reduce the disproportionate number of deaths following complications."

The modelling study was an international collaboration between researchers from UNSW Sydney, University of Toronto, Kings College London, and the World Health Organization.

The researchers used best-practice guidelines, patient characteristics and cancer stage data to calculate the proportion of newly diagnosed cancer cases requiring surgery in 183 countries.

To predict future surgery demand, they applied these rates to GLOBACAN cancer incidence predictions from 2018 to 2040.

The study did not assess the impact of COVID-19, but the researchers acknowledge the delivery of high-quality post-operative care is more challenging during a pandemic.

Global shortage of surgeons, anaesthetists

To deliver cancer surgery services optimally now and in future, the researchers also predicted requirements for surgical and anaesthesia workforces.

To evaluate current staffing gaps, they compared the optimal estimated workforce (the median workforce of 44 high-income countries) with the number of surgeons and anaesthetists in each country.

Dr Perera said there was a current global shortage of 199,000 surgeons and 87,000 anaesthetists.

"This is based on the current workforce of 766,000 surgeons and 372,000 anaesthetists, compared with 965,000 and 459,000 needed for an optimal workforce, respectively, in our modelling study," he said.

"The gap is estimated to be greatest in low-income countries, where the current surgeon availability is 22,000 fewer than the model estimated optimal number of 28,000 surgeons.

"The current number of anaesthetists in low-income countries falls 11,000 below the model estimated demand of 13,000 anaesthetists."

Optimal workforce estimates for 2040

In recognition of the rising global demand for cancer surgery, the researchers also calculated estimates for the optimal surgical and anaesthesia workforces needed in 2040.

Extrapolating 2018 data, taking account of the predicted future cancer incidence burden in each country, their findings revealed the surgical workforce will need to increase from 965,000 in 2018 to 1.416 million in 2040 (a 47 per cent increase).

The anaesthetist workforce would need to rise from 459,000 in 2018 to 674,000 in 2040 (a 47 per cent increase).

The researchers found the greatest relative increase in optimal workforce requirements from 2018 to 2040 would occur in low-income countries, where surgeon numbers are required to rise from 28,210 to 58,219 by 2040 (106 per cent).

Anaesthetist numbers would also need to increase from 13,000 to 28,000 by 2040 (115 per cent).

Dr Perera said: "But to match the current benchmark of high-income countries, the actual number of surgeons in low-income countries would need to increase almost 400 per cent (from 6,000 to 28,000), and anaesthetists by almost 550 per cent (from 2000 to 13,000), of their baseline values.

"This is because the current workforce in low-income countries is already substantially smaller than in high-income countries."

Potential limitations

The researchers acknowledged that estimates in their study relied on several assumptions.
Dr Perera said: "We based predictions of future cancer rates on 2018 estimates, but country-level changes - such as economic developments or altered capacity to screen for early diagnosis - could impact cancer incidence and therefore surgical demand and workforce requirements.

"Furthermore, observed gaps in the workforce could also be narrower than the actual gaps in practice - our predictions were conservative because we only considered initial surgical encounters without accounting for follow-up interactions."