Culture

The SARS-CoV-2 coronavirus RNA genome structure was studied in detail by researchers from the University of Groningen, the International Institute of Molecular and Cell Biology in Warsaw, and Leiden University. The RNA structures are potential targets for the development of drugs against the virus. The results were published on 10 November as 'Breakthrough paper' in the journal Nucleic Acid Research.

Infectious diseases caused by bacteria and viruses have been around throughout the history of mankind. Over the past 18 years, many deaths worldwide have occurred because of severe acute respiratory syndromes caused by coronaviruses, including SARS and MERS. This, together with the ongoing COVID-19 pandemic that has already taken more than a million lives, demonstrates the urgent need for new ways of combating coronavirus infections.

Genome structure

COVID-19 is caused by SARS-CoV-2, a beta coronavirus with a linear single-stranded, positive-sense RNA genome. Similar to those in other RNA viruses, the SARS-CoV-2 RNA structures are expected to play a crucial role in how the coronavirus replicates in human cells. Despite this importance, only a handful of functionally relevant coronavirus structural RNA elements have been studied to date. Therefore, researchers from the IIMCB (Poland), together with scientists from the University of Groningen and Leiden University (both in the Netherlands), performed an extensive characterization of the SARS-CoV-2 RNA genome structure using various advanced techniques.

The study, coordinated by Dr Danny Incarnato from the University of Groningen, involved RNA structure probing to obtain single-base resolution secondary structure maps of the full SARS-CoV-2 coronavirus genome both in vitro and in living infected cells. Subsequently, the team identified at least 87 regions in the SARS-CoV-2 RNA sequence that appear to form well-defined compact structures. Of these, at least 10% are under strong evolutionary selection pressure among coronaviruses, suggesting functional relevance. Importantly, this is the first time that the structure of the entire coronavirus RNA (one of the longest viral RNAs with approximately 30,000 nucleotides) was determined.

Drug

'We first identified the structures in vitro, and subsequently confirmed their presence in the RNA of viruses inside cells,' explains Incarnato. 'This means that our results are very robust.' Also, pockets were identified in some RNA structures that could be targeted by small molecules to hamper the function of the viral RNA. 'Furthermore, a number of the structures are conserved between different coronaviruses, meaning that a successful drug targeting SARS-CoV-2 could also be effective against future new virus strains .'

The scientists also identified parts of the SARS-CoV-2 RNA that are intrinsically unstructured. 'These could be targeted by antisense oligonucleotide therapeutics,' explains Incarnato. Adding short nucleic acid strands that can bind to these viral RNA sections would create double-stranded regions, which are naturally targeted by enzymes inside human cells.

Weak spots

In conclusion, this collaborative research establishes a firm foundation for future work aimed at developing potential small-molecule drugs for the treatment of SARS-CoV-2 infections and possibly also infections by other coronaviruses. 'This work would not have been possible without the collaboration between the Netherlands and Poland,' says Janusz Bujnicki, head of the Laboratory of Bioinformatics and Protein Engineering at the IIMCB in Warsaw. 'Together, we invented a new way of searching for potential weak spots in large viral RNAs. Collectively, our work lays the foundation for the development of innovative RNA-targeted therapeutic strategies to fight SARS-CoV-2 infections.'

The article describing the results of these analyses has been published in Nucleic Acids Research and reviewers who evaluated the manuscript nominated it for featured status as a 'breakthrough paper'.

Reference: Ilaria Manfredonia, Chandran Nithin, Almudena Ponce-Salvatierra, Pritha Ghosh, Tomasz K. Wirecki, Tycho Marinus, Natacha S. Ogando, Eric J. Snider, Martijn J. van Hemert, Janusz M. Bujnicki, Danny Incarnato: Genome-wide mapping of therapeutically-relevant SARS-CoV-2 RNA structures. Nucleic Acids Research, 10 November 2020

Relapse in people with bipolar disorder can be predicted accurately by their tendency towards having pessimistic beliefs, according to a study published today in eLife.

The results could provide an urgently needed tool for doctors to predict upcoming relapse and provide timely treatment.

Bipolar disorder is characterised by successive periods of elation (mania) and depression, interspersed with asymptomatic phases, called euthymia. People who have shorter periods of asymptomatic euthymia are more likely to suffer disability, unemployment, hospitalisation and increased suicidal feelings. However, predicting relapses using existing clinical diagnostic tools or demographic information has proven largely ineffective in bipolar disorder.

"It is already known that people with depression tend to give negative information more weight than positive information, leading to pessimistic views that may make symptoms worse," explains lead author Paolo Ossola, Research Fellow at the Department of Medicine and Surgery, University of Parma, Italy. "We wanted to test the idea that, before symptomatic relapse occurs in bipolar disorder, patients show a specific pattern in the way they update their beliefs according to new information, and this pattern makes them more vulnerable to relapse."

The team carried out a belief update task with 36 people with bipolar disorder and then monitored them every two months for five years to see when they developed symptoms of a relapse. In the belief update task, patients were given information about 40 adverse life events, such as robbery or credit card fraud. They were asked to estimate how likely they thought the event was to happen to them.

Next, they were given information on the real probability of the event happening. In some cases, they received bad news (for example, a higher chance of a robbery than they thought) and in some cases, good news (for example, they were less likely to be a victim of card fraud than they thought). In a second later session they were asked again to estimate their own likelihood of encountering the event. The difference between how much they updated their beliefs in response to good or bad news (called the belief update bias) was then compared with how soon they had a relapse.

The analysis showed that people who had a greater change in their beliefs in response to positive information, and were more likely to take an optimistic view, had a longer time period before the next onset of symptoms. However, the task did not predict whether the next episode was likely to be mania or depression.

When tested against other clinical features, such as age, history of psychotic symptoms, and duration of illness, only belief update bias was strongly linked to more time spent in the eurythmic phase, and taking antidepressants was linked with a shorter time spent in eurythmia.

"Our findings show that the extent to which bipolar patients updated their beliefs in response to positive information, compared with negative information, was predictive of when they would relapse," concludes senior author Tali Sharot, Professor of Cognitive Neuroscience at the Department of Experimental Psychology, University College London, UK. "The way patients update their beliefs could be introduced in future as a risk prediction tool for bipolar disorder, allowing patients and clinicians to step up vigilance to recognise symptoms and intervene where necessary."

Researchers have discovered a new "hidden" gene in SARS-CoV-2--the virus that causes COVID-19--that may have contributed to its unique biology and pandemic potential. In a virus that only has about 15 genes in total, knowing more about this and other overlapping genes--or "genes within genes"--could have a significant impact on how we combat the virus. The new gene is described today in the journal eLife.

"Overlapping genes may be one of an arsenal of ways in which coronaviruses have evolved to replicate efficiently, thwart host immunity, or get themselves transmitted," said lead author Chase Nelson, a postdoctoral researcher at Academia Sinica in Taiwan and a visiting scientist at the American Museum of Natural History. "Knowing that overlapping genes exist and how they function may reveal new avenues for coronavirus control, for example through antiviral drugs."

The research team identified ORF3d, a new overlapping gene in SARS-CoV-2 that has the potential to encode a protein that is longer than expected by chance alone. They found that this gene is also present in a previously discovered pangolin coronavirus, perhaps reflecting repeated loss or gain of this gene during the evolution of SARS-CoV-2 and related viruses. In addition, ORF3d has been independently identified and shown to elicit a strong antibody response in COVID-19 patients, demonstrating that the new gene's protein is manufactured during human infection.

"We don't yet know its function or if there's clinical significance," Nelson said. "But we predict this gene is relatively unlikely to be detected by a T-cell response, in contrast to the antibody response. And maybe that has something to do with how the gene was able to arise."

At first glance, genes can seem like written language in that they are made of strings of letters (in RNA viruses, the nucleotides A, U, G, and C) that convey information. But while the units of language (words) are discrete and non-overlapping, genes can be overlapping and multifunctional, with information cryptically encoded depending on where you start "reading." Overlapping genes are hard to spot, and most scientific computer programs are not designed to find them. However, they are common in viruses. This is partly because RNA viruses have a high mutation rate, so they tend to keep their gene count low to prevent a large number of mutations. As a result, viruses have evolved a sort of data compression system in which one letter in its genome can contribute to two or even three different genes.

"Missing overlapping genes puts us in peril of overlooking important aspects of viral biology," said Nelson. "In terms of genome size, SARS-CoV-2 and its relatives are among the longest RNA viruses that exist. They are thus perhaps more prone to 'genomic trickery' than other RNA viruses."

Prior to the pandemic, while working at the Museum as a Gerstner Scholar in Bioinformatics and Computational Biology, Nelson developed a computer program that screens genomes for patterns of genetic change that are unique to overlapping genes. For this study, Nelson teamed up with colleagues from institutions including the Technical University of Munich and the University of California, Berkeley, to apply this software and other methods to the wealth of new sequence data available for SARS-CoV-2. The group is hopeful that other scientists will investigate the gene they discovered in the lab to define its function and possibly determine what role it might have played in the emergence of the pandemic virus.

Charlottesville, VA (November 10, 2020). It's 2020, and as much as we wish it weren't so, sexual harassment is still with us. One need only look at social media or a steady stream of court cases: most recently, the #MeToo movement has cast a light on sexual harassment.

Sexual harassment isn't defined by social status, wealth, or educational experience. It affects both women and men. Sexual harassment can be found in the workplace, at social activities, and even in the home. It is also found in the medical specialties.

Do neurosurgeons face sexual harassment in their profession? Yes. We've known this for some time from anecdotal evidence. What we did not know, until now, is the depth and breadth of sexual harassment in this field.

At the behest of the One Neurosurgery Summit, which represents the major neurosurgical organizations in North America, a survey on this matter was developed and disseminated to members of the neurosurgical community. The results of this survey have been published in a new article in the Journal of Neurosurgery: "Toward an understanding of sexual harassment in neurosurgery" by Deborah L. Benzil, MD, and colleagues. "While the results of this study are distressing, having the information will allow us to start some important conversations and continue forward progress!" the lead author has remarked.

Broadly speaking, the survey was designed to elicit the following information: 1) respondents' perceived attitudes about systemic issues in neurosurgery that permit sexual harassment; 2) the prevalence and severity of sexual harassment in the field; and 3) populations at highest risk of experiencing sexual harassment and those most likely to perpetuate it.

The survey was performed using the SurveyMonkey platform, and all responses were collected confidentially and anonymously. To capture respondents from all levels of neurosurgery, emailed invitations were sent to active and resident members of the Society of Neurological Surgeons and the Congress of Neurological Surgeons (CNS), as well as to transitional, emeritus, and inactive members of the CNS. The emails were sent to 5166 persons; 622 (12%) completed the entire survey.

Twenty percent of the survey respondents were female, and this represents a greater percentage than that of women actively engaged in neurosurgery: 19% of residents and 8% of practicing neurosurgeons are female. Looking back over their neurosurgical careers, 62% of respondents reported that they had witnessed sexual harassment and 55% reported that the harassment had been directed against them.

Sexual harassment was demonstrated across several behaviors: "the telling of explicit or offensive jokes (49%) ... unwelcome flirtations (22%), inappropriate physical contact (16%), discussion about sex/personal life (18%), and inappropriate comments about the body (15%). Although rare, rape was reported by 2 individuals (

Of persons who had been subjected to sexual harassment, 78% experienced it during training, 49% during post-residency employment, and 17% while attending national professional or educational meetings. Disappointingly, 37% reported that they had experienced sexual harassment more than 10 times.
One would like to believe that over the years such occurrences have become less frequent. Unfortunately, the authors tell us, "there was a fairly even distribution between less than 1 year and more than 10 years ago."

Fewer than one-third of respondents reported that they had addressed incidents of sexual harassment when they occurred, and 85% reported barriers to reporting incidents, such as fear of retaliation or retribution, negative impact on future careers, loss of reputation, and associated stress.

Given the predominance of men in the neurosurgical community, it is not surprising that men were identified far more often as perpetrators of the harassment (72%).
Female neurosurgeons were more likely to report having witnessed or experienced harassment, but it does affect both women and men. People in positions of power (such as chairs, faculty members, or supervisors) (86%) were most often identified as the persons responsible for the harassment.

"Male dominance, a strong hierarchical structure, and a permissive environment" are associated with the risk of sexual harassment in institutions. Based on the responses to the survey, all three can be found in neurosurgery, despite the fact that the profession has made great strides in the last decade to attract and retain more women. One effect of sexual harassment is that it can deter talented people from following their professional goals. The authors worry that such an atmosphere can lead to female neurosurgeons experiencing burnout and having less involvement in the profession. As Dr. Benzil has commented, "We want the best and brightest to enter and succeed in neurosurgery. The data about sexual harassment suggests we still have work to do."

To counteract the negative behaviors revealed by the survey, the authors suggest a change in the culture of the neurosurgical profession, "starting with an improved awareness of unconscious bias in medical school and reaching every level of organized neurosurgery and leadership." Some practical steps are proposed, such as a profession-wide zero tolerance statement with regard to sexual harassment, fair and transparent mechanisms of reporting its occurrences, establishment of best practices for social events, and greater diversity in speakers, honored guests, and scientific panels.

This paper offers detailed tables showing responses to the survey questions broken down by age or gender, and abundant demographic information on the respondents.
Supplemental online materials include the questionnaire itself as well as written responses by respondents on incidents of sexual harassment that they have faced. These personal accounts are well worth reading.

When asked about the article, Dr. Benzil responded, "Unfortunately, many of us knew how serious this problem was within neurosurgery, but we needed to make all aware of the depth and breadth of it. With this data in hand, we can build on the positive steps neurosurgery has made, face the problem and find effective solutions."

The article is accompanied by an editorial by Drs. Doug Kondziolka and Linda Liau, who discuss some findings of the survey and steps to address and overcome sexual harassment in the neurosurgical community.

Brain-computer interface (BCI) technologies are no longer hypothetical, yet there are fundamental aspects of the technology that remain unaddressed by both ethicists and policy-makers. Two new papers address these issues by outlining the outstanding ethical issues, offering guidance for addressing those issues, and offering particular insight into the field of BCI tech for cognitive enhancement.

"BCI technologies are devices that detect brain signals conveying intention and translates them into executable output by a computer," says Allen Coin, a graduate student at North Carolina State University and lead author of both papers. "BCI technologies can also provide feedback to the user, reflecting whether he or she attained a goal or completed a desired action."

"BCI devices can be non-invasive devices that users wear, or they can be invasive devices, which are surgically implanted," says Veljko Dubljevi?, an assistant professor in NC State's Science, Technology & Society program and co-author of both papers. "The invasive devices are more efficient, since they can read signals directly from the brain. However, they also raise more ethical concerns.

"For example, invasive BCI technologies carry more associated risks such as surgery, infection, and glial scarring - and invasive BCI devices would be more difficult to replace as technology improves."

Many BCI devices, such as cochlear implants, are already in use. And this field of technology has garnered increased attention due to a company called Neuralink, which is focused on building what it calls a brain-machine interface.

"Neuralink highlights the immediacy of these ethical questions," Dubljevi? says. "We can't put the questions off any more. We need to address them now."

And Dubljevi? would know.

He, Coin and NC State undergraduate Megan Mulder recently published a comprehensive review of the research literature that addresses ethical considerations of BCI. A previous review had been done as recently as 2016, but almost as much research had been done on the ethics of BCI since 2016 as had been done before 2016.

One of the key take-aways from the analysis is that there are two areas that ethicists have not adequately addressed and that should be prioritized for future work: physical effects of BCI and psychological effects.

"On the physical side, there's been little analysis by ethicists of the potential long-term health effects of BCI on users," Coin says. "There's also been inadequate discussion of ethical considerations related to the use of animals in testing invasive BCI technologies. These are, after all, surgical operations."

On the psychological side, researchers found reason for concern - but a lack of ethical analysis. For example, one study evaluated the use of invasive BCI to give patients with epilepsy advanced warning of seizures. While some people adjusted well to the technology, others reported experiencing radical psychological distress.

"This is an issue that must be addressed," Dubljevi? says. "We also need to assess questions on the extent to which users feel the BCI is an empowering extension of their minds, as opposed to challenging their sense of self. These are big questions, not afterthoughts."

"Another thing our review really drove home is that the ethical analysis of BCI has been done by ethicists who are writing almost exclusively for other ethicists," Coin says. "As a result, little of the work is framed in a way that is directly relevant - or even accessible - to policy makers and the public."

The researchers also laid out a constructive framework for guiding future research on the ethics of BCI. At its core is one overarching question: "What would be the most legitimate public policies for regulating the development and use of various BCI neurotechnologies by healthy adults in a reasonably just, though not perfect, democratic society?"

"That question is long, technical, and steeped in scholarship of ethics and policy of new technology, but it's critical to guiding the development of BCIs," Dubljevi? says.

In a separate paper, Coin and Dubljevi? explored issues related to authenticity and machine-augmented intelligence. In this context, authenticity refers to the extent to which an individual feels that their abilities and accomplishments are their own, even if those abilities are augmented by BCI technologies, or their accomplishments were made with the assistance of BCI technologies.

"And machine-augmented intelligence refers to BCI technologies that enhance cognition - which are not yet on the market," Dubljevi? says. "However, they are clearly a goal of BCI developers, including Neuralink."

In this paper, the researchers were focused on the fact that there have been very few concerns about authenticity in the context of cognitive enhancement BCI technologies, despite the fact that these concerns have come up repeatedly in regard to other cognitive enhancement tools - such as drugs that can improve concentration.

In other words, if ethicists care about whether people on "smart drugs" have "earned" their test scores, why don't they have similar concerns about BCIs?

The answer appears to be twofold.

First of all, the majority of the proposed cognitive enhancement BCI devices are therapeutic in nature.

"When a patient receives a cochlear implant, that's a BCI that helps them hear," Coin says. "Nobody questions whether that patient's hearing is authentic. Similarly, cognitive enhancement BCI devices are often presented as similarly therapeutic tools, helping patients overcome a challenge.

"However, we are now hearing more about the potential for BCI devices to enhance cognition in ways that go beyond therapeutic applications, yet there is still limited debate about their authenticity," Coin says. "We think that this is because these BCI technologies are generally envisioned as being implants, which means the device would effectively be a permanent - or semi-permanent - change, or even an extension, to a person's mind. These aren't drugs that wear off. They're there to stay."

"Ultimately, these two papers get at some of the big questions that we need to address as a society about BCI technologies," Dubljevi? says. "The technologies are coming whether we're ready or not. How will we regulate them? Who will have access to them? How can they be used? We need to start thinking about those questions now."

Amsterdam, NL, November 10, 2020 - Social Security Disability Insurance (SSDI) benefits do not always keep individuals with disabilities out of poverty. To support these individuals' efforts to lift themselves out of poverty, the Substantial Gainful Activity (SGA) Project was piloted in Kentucky and Minnesota. It showed that individuals who engaged in a vocational rehabilitation services intervention were able to earn increased income above SGA-level earnings. The authors recommend expanding the project to other US state agencies.

In a special issue of the Journal of Vocational Rehabilitation Guest Editors Susan Foley, PhD, Institute for Community Inclusion (ICI), University of Massachusetts Boston, Boston, MA, USA, and Purvi Sevak, PhD, Mathematica, Princeton, NJ, USA, have assembled seven insightful reports on the SGA Project from early design through completion of randomized controlled trials in two states. Stephen Wooderson and John Connelly of the Council of State Administrators of Vocational Rehabilitation (CSAVR) were invited to author a paper about how vocational rehabilitation agency leaders view and value participation in research. Two additional papers report on recent related research.

The relationship between earnings and SSDI benefits receipt has been a major issue in the United States since the program began in 1956. One metric used to determine if a person is unable to engage in work is termed "substantial gainful activity," a monthly dollar amount calculated by the Social Security Administration. State vocational rehabilitation agencies provide employment services to people with disabilities including those receiving SSDI.

"We are in another economic downturn. It is not easy to predict what will happen and how this will affect people with disabilities, but if past is prologue, the next few years may see more applicants to poverty and disability insurance programs," explained Dr. Foley and Dr. Sevak. "During the coronavirus pandemic, vocational rehabilitation agencies are again innovating to consider more remote and virtual ways of connecting, expanding dual customer approaches to serve businesses and workers as clients, and looking for more tools to put in a practitioner's toolbox. Finding solutions to help people return to work and find work that can provide economic stability will be an important role for state vocational rehabilitation agencies."

The Rehabilitation Services Administration funded the SGA Project to identify vocational rehabilitation agency practices that lead to improved earnings for SSDI clients upon completion of vocational rehabilitation. It awarded a cooperative agreement to the Institute for Community Inclusion at the University of Massachusetts Boston and Mathematica Policy Research.

Working with more than 100 practitioners representing over 20 vocational rehabilitation agencies, the design phase of the SGA Project identified high performing agencies and key practices that might contribute to that performance with the ultimate goal of designing an effective intervention.

The testing phase of the project tested an intervention designed to improve earnings outcomes of SSDI beneficiaries who were clients of Kentucky and Minnesota state vocational rehabilitation agencies. Mathematica Policy Research assessed service, employment, and earnings outcomes, while ICI interviewed and followed SSDI clients who participated to understand why people seek work, what influences their choices about earnings levels, and how vocational rehabilitation services played a role in their decisions.

Frank Martin, PhD, and Purvi Sevak, PhD, both from Mathematica, Princeton, NJ, USA, review the implementation and impacts of the SGA Project demonstration in Kentucky, They describe the SGA Project model components, the implementation experience in Kentucky, and the impact of the innovations on vocational rehabilitation service and employment outcomes. Although results from the present study showed that participants did not consistently receive all components of the innovations, the innovations led to a 17 percentage point increase in clients with a signed individualized plan for employment (IPE) within 30 days of application, an 8 percentage point increase in closures with competitive employment, and a nearly 6 percentage point increase in the number of clients with earnings at or above the SGA level. The SGA earnings threshold for non-blind SSDI beneficiaries was $1,090 at the start of the testing phase in 2015 and $1,170 at the end of the testing phase in 2017.

A noteworthy aspect of the project was that it emphasized financial counseling, which required the hiring of work incentive coordinators, who were trained and certified to provide a much richer set of early and ongoing financial counseling. "Kentucky's successful implementation of an office-level random assignment design permitted a rigorous test of the SGA Project innovations," noted the authors. "Early, positive impacts on key outcomes suggest other agencies might use this approach to rigorously assess the effectiveness of new services and programs and for a broader set of vocational rehabilitation clients."

Key findings from the SGA Project include:

Delivering services at a faster pace is feasible. The number of days to signed individual plan for employment (IPE) was reduced; the number of clients with a signed IPE within 30 days of their application increased by 17 percentage points. Quicker access to and progress through services allow people to maintain momentum in their search for work.

SGA Project innovations can increase competitive employment. A combination of rapid client engagement, a faster pace of vocational rehabilitation services, financial and benefits planning, job placement services, and a coordinated team approach led to an 8 percentage point increase in employment and a 5.7 percentage point increase in the rate of SGA-level earnings for SSDI beneficiaries, potentially helping them on their path to higher income and financial independence.

People with disabilities are able to return to work after receiving SSDI benefits. Researchers found that having a team of trusted individuals to provide accurate information, counsel clients, and help identify the types of jobs clients would like to do in their local labor market was a successful strategy.

Partnerships between state vocational rehabilitation agencies and researchers in universities and private organizations are increasing knowledge about what will work to help people with disabilities advance economic opportunities.

Randomized controlled trials of public vocational rehabilitation services, the gold standard to find out what works, while admittedly challenging to implement, are possible.

Research that vocational rehabilitation agencies value and can use have a likelihood of improving outcomes for clients.

Writing about the Council of State Administrators of Vocational Rehabilitation (CSAVR), John Connelly, JD, and Stephen Wooderson, MS, both from CSAVR, Rockville, MD, USA, present the case for why researcher-vocational rehabilitation partnerships are an important strategy for innovation and provide suggestions for strengthening those partnerships.

CSAVR launched its Vision 2020 goals with an express interest in innovation. The CSAVR is a membership organization of the chief administrators of the 78 public vocational rehabilitation agencies. The Council's members and their agency staff assist some 1.2 million persons with disabilities to become or remain productive members of the workforce, as well as provide support to their business customers with such issues as recruitment and the provision of reasonable accommodations.

The authors describe CSAVR's investment in research and provide data from a survey of state vocational rehabilitation agencies on research participation. "Researchers can increase state vocational rehabilitation agency participation in their projects by involving the agency in study design, minimizing the time and resource burden on the agency, and demonstrating that the proposed research will yield products that benefit customers and improve staff competency," they commented. "Vocational rehabilitation agencies are motivated to engage in research that will clearly add value and improve operations with minimal burden. It is hoped that greater agency participation in research will yield better data to guide agencies in the future."

The Guest Editors point to some of the challenges encountered during the project. Access to work incentives counseling, finding high paying jobs through job placement services, and team communication across large geographic areas can create barriers to services for people receiving SSDI. Another challenge noted was that vocational rehabilitation staff may be skeptical in adopting the SGA model. "Because the pacing innovation was a major shift from their usual, more deliberate approach, some counselors initially resisted adopting the faster approach," they commented.

Dr. Foley and Dr. Sevak suggest that the rapid engagement coordinated team approach studied by the SGA Project is another tool in the toolbox to attain goals. "We are finding more and more practices that are showing promise. Team approaches, rapid response, and dual customer strategies that match talent to opportunity are evolving. Every worker gets a job, every job gets a worker," they concluded.

Viruses such as HIV, hepatitis B and hepatitis C evade or disrupt the immune system to create persistent infections. These viruses remain a serious health threat, but researchers from the University of Missouri School of Medicine have discovered how an enzyme that regulates several cellular processes might be a key target to preventing viruses from disarming the human immune response.

"There is very little research on how the sphingosine kinase 2 (SphK2) enzyme affects the immune responses to viral infections," said senior author Bumsuk Hahm, PhD, associate professor of surgery and molecular microbiology and immunology. "We hypothesized that this enzyme suppresses the T cells that fight infections and allows viruses to persist."

Hahm and his team tested their hypothesis by infecting mice with the lymphocytic choriomeningitis virus, a common rodent-borne virus. Mice in the study that received an oral therapy that briefly inhibited the SphK2 enzyme experienced a robust immune response and an accelerated destruction of the virus.

"SphK2 is shown to regulate immune cell responses during a viral infection, and inhibition of this enzyme is effective in clearing a persistent viral infection," Hahm said. "We believe targeting SphK2 may provide a promising route for developing a drug to elicit protective immunity against viral infections that have a devastating impact on human health."

Another key finding from the study demonstrated that SphK2 plays a role in preventing the immune system from attacking the kidneys during an infection. Hahm's team found SphK2 deficient mice died within two weeks of infection from kidney failure. All showed evidence of immune cell infiltration in the kidneys.

Hahm's team also discovered SphK2 inhibition may also treat some types of cancer by promoting activation of the immune system. Other clinical trials are already exploring the idea that SphK2 inhibition can slow cancer cell growth by directly blocking cancer cell proliferation.

"Our study suggests that SphK2 can be targeted for restoring T cell immunity to circumvent an immune suppressive environment," Hahm said. "This finding may be applicable to cancer studies as well as other diseases caused by immune disruption."

Who says you can't get hotter with age?

Researchers from Johns Hopkins University and other institutions have found that, on average, the temperature of galaxy clusters today is 4 million degrees Fahrenheit. That is 10 times hotter than 10 billion years ago, and four times hotter than the Sun's outermost atmosphere called the corona. The findings are published in the Astrophysical Journal.

"We have measured temperatures throughout the history of the universe," said Brice Ménard, a Johns Hopkins professor of physics and astronomy. "As time has gone on, all those clusters of galaxies are getting hotter and hotter because their gravity pulls more and more gas toward them."

Yi-Kuan Chiang, lead author of the study who was a Johns Hopkins post-doctoral researcher until moving to Ohio State University last year, added: "This drag is so violent that more and more gas is shocked and heated up."

Imagine all those gas atoms being sucked towards galaxies like they were myriads of meteoroids piercing Earth's atmosphere, Ménard said. They accelerate as gravity pulls them toward the Earth's surface and heat up due to friction with the atmosphere before burning into what are seen as shooting stars, he added. This pattern of heating due to gravitational forces can be applied to entire galaxies, clusters of galaxies and beyond into the "large scale structures" of the universe formed by gravity - a theory attributed to James Peebles, the 2019 Nobel laureate in physics.

"Our measurements are a great confirmation of that theory," Ménard said.

To perform this analysis, the team used data collected by the astronomical community over two decades, first from a telescope on the ground that conducted the Sloan Digital Sky Survey and then the Planck mission, a space telescope led by the European Space Agency.

The team used a technique that Ménard developed with Chiang. With it, they estimated the "redshift" of gas concentrations seen in images of microwave light going back in time all the way to 10 billion years ago. "Redshift" describes the way wavelengths of light lengthen due to the expansion of the universe. The farther away something is, the longer its wavelength - and the older its origin.

The method allowed them to measure the gradual increase in the gas temperature as a function of the age of the universe. This trend is also predicted by numerical simulations showing how dark matter and the atoms present in the gas evolve with time. As illustrated in the figure, these visualizations show gas temperatures changing from a cool blue canvas from 10 billion years ago into one speckled with hot red today.

The warming of the universe has nothing to do with climate warming on Earth, Ménard said. It is a consequence of gravitational attraction that had been predicted but which now can be precisely measured with these novel techniques.

Scientists have shown that the size and makeup of groups of social birds can predict how efficiently they use and move through their habitat, according to new findings published today in eLife.

The study suggests that intermediate-sized groups of vulturine guineafowl - a ground-dwelling social bird found in east African savannahs - exhibit the most effective balance between a decreased ability to coordinate movements and increased accuracy of navigation.

These findings add to our understanding of a key question in animal sociality - namely, whether groups have an optimal size - by showing that the number of individuals in a group determines the ability of that group to make the most effective use of their environment.

"For many social animals, larger groups benefit from information pooling, where inputs from multiple individuals allow for more accurate decisions about navigation," explains first author Danai Papageorgiou, IMPRS Doctoral Student at the Department of Collective Behaviour, Max Planck Institute of Animal Behavior, and at the Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Germany. "However, as groups become larger they start to face challenges in coordinating their actions, such as reaching a consensus about where to go next or maintaining cohesion as they move through vegetation."

Papageorgiou and her PhD advisor, Professor Damien Farine, investigated the relationship between the size and collective movement of groups of vulturine guineafowl. They predicted that the optimal group size of these birds would be determined by the balance between their ability to coordinate movement and their ability to make accurate decisions when navigating.

The team fitted individual birds from 21 distinct social groups with GPS tags and collected movement data over five two-month-long seasons. They used these data to calculate the groups' habitat use, including their home-range size, the distance that they travelled each day and their movement speed while 'on the go'. By observing the groups each week, they could also measure the size of each group and record their makeup. Specifically, they recorded the number of chicks in each group, as they predicted that the birds' movement abilities may be restricted when there are more chicks because they are slower and much more vulnerable to predators.

The researchers found that intermediate-sized groups, consisting of 33-37 birds, ranged over larger areas and achieved this by travelling shorter distances each day, compared to smaller and larger groups. They also explored the most new areas. These results suggest that intermediate-sized groups were more efficient in using the space, potentially encountering more resources while spending less energy and lowering their chances of being tracked by predators. Additionally, data collected on the birds' reproductive success reinforced the fact that intermediate-sized groups benefited from these movement characteristics, as they also had more chicks.

However, the study also found interesting consequences of having a beneficial group size for movements. Groups with many chicks, despite being the optimal size, had more restricted home ranges. This was likely because the chicks needed more protection from predators, and therefore stayed in the protected vegetation for longer periods of time, and their small sizes slowed down the group while moving.

As a result, the study showed that intermediate-sized groups were in fact rarer than smaller and larger groups. Papageorgiou and Farine suggest this is because the benefits of being in an optimal-sized group makes the size of these groups less stable. For example, higher reproductive success inevitably pushes the group past its optimal group size.

"Our study highlights how all groups are not equal, with the effects of group size and composition playing a major role in shaping how social species use their habitat," Farine says. "What is particularly interesting is that optimally sized groups are not expected to be common. Future studies should investigate whether these relationships change across different environmental conditions, and how animal groups cope with the different challenges that each season brings."

Medical diagnoses involving alcohol-related disorders, substance-related disorders and suicidal thoughts and behaviors -- commonly referred to as diseases of despair -- increased in Pennsylvania health insurance claims between the years 2007 and 2018, according to researchers from Penn State Clinical and Translational Science Institute and Highmark Health Enterprise Analytics.

Princeton economists Anne Case and Angus Deaton proposed the concept of deaths of despair in 2015. Case and Deaton's research observed a decline in life expectancy of middle-aged white men and women between 1999 and 2015 -- the first such decline since the flu pandemic of 1918. They theorized that this decline is associated with the social and economic downturn in rural communities and small towns. These changes include loss of industry, falling wages, lower marriage rates, increasing barriers to higher education, an increase in one-parent homes and a loss of social infrastructure.

"It is theorized that these changes have fostered growing feelings of despair including disillusionment, precariousness and resignation in many peoples' lives," Daniel George, associate professor of humanities and public health sciences, Penn State College of Medicine, said. "Despair can trigger emotional, cognitive, behavioral and even biological changes, increasing the likelihood of diseases that can progress and ultimately culminate in deaths of despair."

With the commonwealth's considerable rural and small-town population, particularly around Penn State campuses, Penn State Clinical and Translational Science Institute led a research study to understand the rate of diseases of despair in Pennsylvania. Institute researchers collaborated with Highmark Health, one of the state's largest health insurance providers. Highmark provides employer-sponsored, individual, Affordable Care Act and Medicare plans.

Highmark Health's Enterprise Analytics team analyzed the claims of more than 12 million people on their plans from 2007 to 2018. Penn State did not have access to Highmark member data or individual private health information. Although the insurance claims included members from neighboring states, including West Virginia, Delaware, and Ohio, the majority of the claims were from Pennsylvania residents. Researchers reported their results in BMJ Open.

The researchers defined diseases of despair as diagnoses related to alcohol use, substance use and suicidal thoughts or behaviors. They searched the claims data for the International Classification of Diseases (ICD) codes related to these diagnoses. ICD codes form a standardized system maintained by the World Health Organization and are used in health records and for billing.

The researchers found that the rate of diagnoses related to diseases of despair increased significantly in the Highmark claims in the past decade. Nearly one in 20 people in the study sample was diagnosed with a disease of despair. Between 2009 and 2018, the rates of alcohol-, substance-, and suicide-related diagnoses increased by 37%, 94% and 170%. Following Case and Deaton's findings, the researchers saw the most substantial percentage increase in disease of despair diagnoses among men ages 35 to 74, followed by women ages 55 to 74 and 18 to 34.

The rate of alcohol-related diagnoses significantly increased among men and women ages 18 and over. The most dramatic increases were among men and women ages 55 to 74. Rates increased for men in this age group by 50% and 80% for women.

The rate of substance-related diagnoses roughly doubled for men and women ages 35 to 54 and increased by 170% in ages 55 to 74. In 2018, the most recent year of claims included in the study, rates of substance-use diagnoses were highest in 18-to-34-year-olds.

The rate of diagnoses related to suicidal thoughts and behaviors increased for all age groups. Among 18-to-34-year-olds, rates increased by at least 200%. The rate for all other age groups increased by at least 60%.

The type of insurance patients had also mattered. People with Medicare insurance had 1.5 times higher odds of having a disease of despair diagnosis and those with Affordable Care Act insurance had 1.3 times higher odds.

One increase stood out to researchers: among infants, substance-related diagnoses doubled.

"This increase was entirely attributable to neonatal abstinence syndrome and corresponded closely with increases in substance-related disorders among women of childbearing age," Emily Brignone, senior research scientist, Highmark Health Enterprise Analytics, said.

Neonatal abstinence syndrome occurs when a baby withdraws from substances, especially opioids, exposed to in the womb.

Future research can concentrate on identifying "hot spots" of diseases of despair diagnoses in the commonwealth to then study the social and economic conditions in these areas. With this data, researchers can potentially create predictive models to identify communities at risk and develop interventions.

"We found a broad view of who is impacted by increases in diseases of despair, which cross racial, ethnic and geographic groups," Jennifer Kraschnewski, professor of medicine, public health sciences and pediatrics, said. "Although originally thought to mostly affect rural communities, these increases in all middle-aged adults across the rural-urban continuum likely foreshadows future premature deaths."

For adults, the goal of exercise is often to shed some pounds, but new research from the University of Georgia suggests the objective should be different for kids.

Physical education should focus on improving students' physical skills, knowledge of the benefits of exercise and motivation to be active. The goal should be to build students' cardiorespiratory endurance, a measure of how well the body handles long periods of exercise--not to help them lose weight, according to the study's authors. Kids can be overweight (as measured by the Body Mass Index, or BMI) and still able to reach the recommended 60 minutes of moderate to vigorous physical activity each day. And students who are more active during PE, despite their weight, are more likely to stay active after school as well.

"Research has shown that even in young children, people who are fitter in terms of cardiorespiratory endurance participate in more intense physical activities," said lead author Sami Yli-Piipari, an associate professor in UGA's Mary Frances Early College of Education. "It's not really your weight that matters. Children can be a little bit overweight but still be relatively fit."

The study followed 450 children, ages 10 through 12, who took 90 minutes of mandatory PE every week. The students wore an accelerometer on their right hip during the day to track their total physical activity for a week, and simple tests--such as being able to do a regular or modified pushup or crunch-- were used to determine their mastery of physical skills. The researchers also explored whether students enjoyed PE or participated out of obligation.

"Physical education matters," Yli-Piipari said. "It's not only where students learn the skills, abilities and motivation to be active; it's where students are having to do something active at a higher intensity than they probably would after school."

The study took place in Finland, where children have more PE on average than American students, and the class also focuses on the importance of exercise and how to incorporate it into everyday life. In keeping with previous research, boys tended to be more active than girls. But surprisingly, muscle strength and motor skills didn't play a role in activity levels. Neither did motivation--whether the child wanted to participate in PE--nor enjoyment of PE classes.

The students who didn't participate in after-school sports were also typically less active during their down time. For many of these students, PE was the only time they exercised hard enough to work up a sweat, which makes it even more important to use class time effectively in a way that will get students moving and motivated to keep it up.

To help children learn to be physically literate, Yli-Piipari suggests teaching them in a way that gets students up and active.

Don't just lecture and tell kids to do something. Take them to places, get them moving, and let them try different things themselves.

Variety is key. Introduce children to multiple ways they can get their heart pumping and explain why it's important to stay active.

Finally, model lifestyle and behaviors that show that physical activity and exercise have an important value for you. Help connect the dots from exercising to the positive physical and mental health effects it can have on an individual.

November 10, 2020 - A growing body of evidence supports the effectiveness of mindfulness approaches to promote positive changes in health behaviors. New neurobiologically based models of "mindful self-regulation" help to explain the how mindfulness-based interventions (MBIs) work to help people make healthy behavior changes, according to a review in the November/December issue of Harvard Review of Psychiatry. The journal is published in the Lippincott portfolio by Wolters Kluwer.

Mindfulness approaches can help patients with a wide range of physical and mental health conditions to initiate and sustain changes in health behaviors, according to the article by Zev Schuman-Olivier, MD, of Harvard Medical School and colleagues. They present an integrated model that "synthesizes the neuroscience of mindfulness and integrates motivation and learning mechanisms within a mindful self-regulation model for understanding the complex effects of mindfulness on behavior change." Dr. Schuman-Olivier is Director of the Center for Mindfulness and Compassion at the Cambridge Health Alliance.

MBIs help patients regulate attention, emotions, and thoughts

Changing unhealthy behaviors can be "exceptionally difficult" - but it's the key to prevention and treatment of many chronic medical and psychiatric illnesses. Mindfulness has been described as "the awareness that arises when paying attention to the present moment nonjudgmentally." The process for cultivating mindfulness often includes various approaches to mindfulness meditation - although the authors emphasize that "not all meditation is mindfulness and not all mindfulness is meditation."

In their comprehensive review of the field, Dr. Schuman-Olivier and colleagues seek to "describe and expand existing models of mindful self-regulation based on neurobiological mechanisms of mindfulness, motivation, and learning." Self-regulation refers to the ability to adapt one's attention, emotions, thoughts, and behavior to respond effectively to internal and external demands.

The article gives an updated account of current neuroscientific understanding of the systems involved in healthy self-regulation - including attentional and cognitive control, emotion regulation, and self-related processes - and the way these neural systems interact with those involved in motivation and learning.

In the authors' proposed model, MBIs can help patients regulate their attention, emotions, and thoughts. Mindfulness training increases the capacity for interoceptive awareness: the ability to identify, access, understand, and respond appropriately to the patterns of internal bodily signals. Patients become aware of negative and self-critical thought patterns, and better able to respond kindly to themselves when they are suffering, make mistakes, or have difficulty (self-compassion).

The authors differentiate between a traditional "cool" pathway for teaching mindfulness, focused solely on attention; and an emerging "warm" pathway that may aid in preventing adverse events and increasing accessibility to MBIs for those who have experienced trauma. The "warm" pathway encourages finding a "window of tolerance" and cultivating inner warmth and self-kindness - alongside attentional and interoceptive awareness training. This approach helps patients learn, develop, and integrate key self-regulatory capacities for "warmly being with present-moment experience."

Dr. Schuman-Olivier and colleagues highlight some key areas of research on mindfulness and behavior change, including alcohol and substance abuse disorders. In addition to general changes in self-regulation, MBIs can address disease-specific issues such as cravings for alcohol and drugs.

Research finds MBIs effective for food-related behaviors and weight loss, including reductions in binge eating and emotional eating. Studies of tobacco smoking suggest that MBIs may provide better outcomes than other accepted treatments. Mindfulness interventions have also led to improvements in self-care for patients with chronic illness and show promise in reducing aggressive behavior, suicide, and self-injury.

The authors draw attention to the need to monitor adverse events and to ensure that mindfulness programs are trauma-informed and accessible to diverse populations. Dr. Schuman-Olivier and colleagues conclude: "While evidence supports the impact of mindfulness on behavior change for key health behaviors related to psychiatric practice, more high-quality research is needed, especially with objective measures, larger samples, replication studies, active controls, and formal monitoring of adverse events."

Researchers at Karolinska Institutet in Sweden have explored all COVID-19 research published during the initial phase of the pandemic. The results, which were achieved by using a machine learning-based approach and published in the Journal of Medical Internet Research, will make it easier to direct future research to where it is most needed.

In the wake of the rapid spread of COVID-19, research on the disease has escalated dramatically. Over 60,000 COVID-19-related articles have been indexed to date in the medical database PubMed. This body of research is too large to be assessed by traditional methods, such as systematic and scoping reviews, which makes it difficult to gain a comprehensive overview of the science.

"Despite COVID-19 being a novel disease, several systematic reviews have already been published," says Andreas Älgå, medical doctor and researcher at the Department of Clinical Science and Education, Sodersjukhuset at Karolinska Institutet. "However, such reviews are extremely time- and resource-consuming, generally lag far behind the latest published evidence, and only focus on a specific aspect of the pandemic."

To obtain a fuller overview, Andreas Älgå and his colleagues have employed a machine learning technique that enables them to map key areas of a research field and track the development over time. This present study included 16,670 scientific papers on COVID-19 published from 14 February to 1 June 2020, divided into 14 different topics.

The study shows that the most common research topics were health care response, clinical manifestations, and psychosocial impact. Some topics, like health care response, declined over time, while others, such as clinical manifestations and protective measures, showed a growing trend of publications.

Protective measures, immunology, and clinical manifestations were the research topics published in journals with the highest average scientific ranking. The countries that accounted for the majority of publications (the USA, China, Italy and the UK) were also amongst the ones hardest hit by the pandemic.

"Our results indicate how the scientific community has reacted to the current pandemic, what issues were prioritised during the early phase and where in the world the research was conducted," says fellow-researcher Martin Nordberg, medical doctor and researcher at the Department of Clinical Science and Education, Sodersjukhuset.

The researchers have also developed a website, where regular updates on the evolution of the COVID-19 evidence base can be found.

"We hope that our results, including the website, could help researchers and policy makers to form a structured view of the research on COVID-19 and direct future research efforts accordingly," says Dr Älgå.

There's bad news for parents who frequently plop their kids in front of the TV to give themselves a break: It might actually end up leaving moms and dads more stressed.

Why? Because the more television that kids watch, the more they're exposed to advertising messages. The more advertising they see, the more likely they are to insist on purchasing items when they go with their parents to the store - and perhaps make a fuss if told "no." All that, researchers say, may contribute to parents' overall stress levels, well beyond a single shopping trip.

The findings come from a University of Arizona-led study, published in the International Journal of Advertising, that explores the potential effects of children's television watching habits on their parents' stress levels.

"The more advertising children see, the more they ask for things and the more conflict is generated," said lead study author Matthew Lapierre, an assistant professor in the UArizona Department of Communication in the College of Social and Behavioral Sciences. "What we haven't looked at before is what the potential effect is on parents. We know kids ask for things, we know it leads to conflict, but we wanted to ask the next question: Could this be contributing to parents' overall stress?"

The study suggests that it could.

There are a few things parents can do, perhaps the most obvious of which is limiting screen time.

"Commercial content is there for a reason: to elicit purchasing behavior. So, if this is a problem, maybe shut off the TV," Lapierre said.

Of course, that can be easier said than done, he acknowledged.

Another thing parents can try, especially as advertising geared toward children ramps up around the holidays: Consider how they talk to their kids about consumerism.

The researchers looked at the effectiveness of three types of parent-child consumer-related communication:

--Collaborative communication is when a parent seeks child input on family purchasing decisions - for example, saying things such as, "I will listen to your advice on certain products or brands."
--Control communication is when a parent exhibits total control in parent-child consumer related interactions - for example, saying things such as, "Don't argue with me when I say no to your product request."
--Advertising communication is when parents talk to their children about advertising messages - for example, saying things such as, "Commercials will say anything to get you to buy something."

They found that, in general, collaborative communication is associated with less parent stress. However, the protective effect of collaborative communication decreases as children's purchase initiation and coercive behaviors - such as arguing, whining or throwing temper tantrums - increase.

Both control communication and advertising communication are associated with more purchase initiations and children's coercive behavior, the researchers found, suggesting that engaging less in those communication styles could be beneficial.

However, when children have higher levels of television exposure, the protective effect of engaging in less advertising communication decreases.

"Overall, we found that collaborative communication between parents and children was a better strategy for reducing stress in parents. However, this communicative strategy shows diminishing returns when children ask for more products or engage in more consumer conflict with parents," said study co-author Eunjoo Choi, a UArizona doctoral student in communication.

The study is based on survey data from 433 parents of children ages 2 to 12. The researchers focused on younger children because they have less independent purchasing power and spend more time shopping with their parents than older kids, Lapierre said.

In addition to answering questions about their communication styles, the parents in the study also responded to questions designed to measure:

--How much television their child watches in a day.
--How often their child ask for or demands a product during shopping trips, or touches a product without asking.
--How often their child engages in specific coercive behaviors during shopping trips.
--Parent stress levels.

Advertisers Find a Way

Lapierre acknowledged that the way people consume entertainment is changing. With the rise of the DVR and streaming services, many viewers are no longer being exposed to the traditional advertising of network or cable TV. However, advertisers are finding creative ways around that, through tactics such as product placement and integrated branding - incorporating product or company names into a show's narrative - Lapierre said. And advertising toward children remains a multibillion-dollar industry.

"In general, more television exposure means more exposure to commercialized content. Even if I'm streaming, if I I'm watching more of it, I'm likely seeing more integrated branding," Lapierre said.

Advertising aimed at children - which often features lots of bright colors, upbeat music and flashy characters - can be especially persuasive, since, developmentally, children aren't fully capable of understanding advertising's intent, Lapierre said.

"Advertising for kids is generated to makes them feel excited. They do a lot of things in kids' advertising to emotionally jack up the child," Lapierre said. "Children don't have the cognitive and emotional resources to pull themselves back, and that's why it's a particular issue for them."

A kidney transplant is often denied to patients who are obese due to an increased risk of surgical complications, particularly infections. Surgeons at UI Heath -- the clinical and academic health enterprise of the University of Illinois Chicago -- have pioneered the use of robotic-assisted surgery for kidney transplants in obese patients to successfully reduce surgical complications. The procedure has opened up a life-saving door to patients who would otherwise be stuck on dialysis to treat their kidney disease, which carries its own serious risks.

The UIC team, led by Dr. Enrico Benedetti, professor and Warren H. Cole Chair of Surgery, has shown that robotic-assisted kidney transplant and weight loss surgery can be performed safely. Their results are published in the American Journal of Transplantation.

"Obesity is a major risk factor for kidney disease," said Dr. Pierpaolo Di Cocco, assistant professor of surgery at UIC and co-author of the paper. "Performing robotic-assisted weight loss surgery together with kidney transplant is the logical next step because with one surgery, we give the transplant a better shot at success because the weight loss the patient will experience helps improve cardiac function and reduce stress on the new organ."

"With this simultaneous surgical approach, we can address end-stage kidney disease obesity -- a major player in kidney disease -- at the same time with a single operation and a single course of anesthesia," said Dr. Tzvetanov, associate professor of surgery, chief of transplantation and a co-author on the paper.

Obesity is considered a worldwide epidemic, according to the World Health Organization. By 2030, the number of overweight and obese individuals worldwide is projected to reach 2.16 billion and 1.12 billion, respectively.

Obesity is a major risk factor for cardiovascular disease and diabetes, which in turn affects the progression of chronic kidney disease. Often patients are treated with dialysis for years before they receive a kidney transplant, which remains the best treatment for end-stage kidney disease. But for patients with obesity, a kidney transplant may not be approved.

Sleeve gastrectomy is a procedure that reduces the size of the stomach by approximately 75% and is one of the most common weight-loss surgeries.

Di Cocco and colleagues enrolled 20 patients into the study between 2012 and 2019. On average, patients had body mass indices, or BMI, of 44. A BMI of 30 or above is indicative of obesity.

Eleven patients received a robotic-assisted kidney transplant and sleeve gastrectomy and nine patients received robotic-assisted kidney transplantation alone.

All patients received weight-loss education and participated in a medically supervised weight loss program, which consisted of exercise and diet recommendations as well as visits with a multidisciplinary team of bariatric surgeons, nurse practitioners, medical consultants, dietitians, psychologists and exercise physiologists.

Patients who underwent both procedures were under anesthesia approximately 1 hour longer than those who underwent kidney transplantation alone. Two patients in the kidney transplant group experienced organ rejection at one year and three years post-surgery. No patients in the kidney-transplant-plus-sleeve-gastrectomy group experienced organ rejection.

A year after the surgery, BMI dropped an average of nine points in the group who received the combined robotic sleeve gastrectomy and robotic-assisted kidney transplants. The transplant-only group gained an average of two points. Patients in the dual-procedure group experienced a 50% drop in excess weight, approximately.

"While it is encouraging that patients can safely undergo both robotic-assisted kidney transplant and weight loss surgery safely, it will take more follow-up time for us to understand all the potential benefits of this procedure," Tsvetanov said.