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Philadelphia, May 20, 2021 - Research has shown empathy gives healthcare workers the ability to provide appropriate supports and make fewer mistakes. This helps increase patient satisfaction and enhance patient outcomes, resulting in better overall care. In an upcoming issue of the Journal of Medical Imaging and Radiation Sciences, published by Elsevier, multidisciplinary clinicians and researchers from Dalhousie University performed an integrative review to synthesize the findings regarding virtual reality (VR) as a pedagogical tool for eliciting empathetic behavior in medical radiation technologists (MRTs).

Informally, empathy is often described as the capacity to put oneself in the shoes of another. Empathy is essential to patient-centered care and crucial to the development of therapeutic relationships between carers (healthcare providers, healthcare students, and informal caregivers such as parents, spouses, friends, family, clergy, social workers, and fellow patients) and care recipients. Currently, there is a need for the development of effective tools and approaches that are standardizable, low-risk, safe-to-fail, easily repeatable, and could assist in eliciting empathetic behavior.

This research synthesis looked at studies investigating VR experiences that ranged from a single eight-minute session to sessions lasting 20-25 minutes in duration delivered on two separate days, both in immersive VR environments where participants assumed the role of a care recipient, and non-immersive VR environments where the participants assumed the role of a care provider in a simulated care setting. The two types of studies helped researchers gain an understanding of what it is like to have a specific disease or need and to practice interacting with virtual care recipients.

"Although the studies we looked at don't definitively show VR can help sustain empathy behaviors over time, there is a lot of promise for research and future applications in this area," explained lead author Megan Brydon, MSc, BHSc, RTNM, IWK Health Centre, Halifax, Nova Scotia, Canada.

The authors conclude that VR may provide an effective and wide-ranging tool for the learning of care recipients' perspectives and that future studies should seek to determine which VR experiences are the most effective in evoking empathetic behaviors. They recommend that these studies employ high order designs that are better able to control biases.

Type 2 diabetes patients who also have asthma are benefitting from a diabetes medication, typically given to help the pancreas produce more insulin, that also improves asthma symptoms and may reduce lung and airway inflammation.

These types of medication -- GLP-1 receptor agonists -- are a newer class of FDA-approved therapeutics that are generally used in addition to metformin for control of blood sugar or to induce weight loss in patients with obesity.

Researchers from Vanderbilt University Medical Center, Brigham and Women's Hospital, Harvard Medical School and University Hospital Zurich in Switzerland used electronic health record (EHR) data of patients with asthma and type 2 diabetes who initiated treatment with GLP-1R agonists, finding lower rates of asthma exacerbations and reduced asthma symptoms as compared to those who initiated other type 2 diabetes medications.

Their findings were published in the American Journal of Respiratory and Critical Care Medicine.

"We have demonstrated really for the first time that this class of medications used to treat type 2 diabetes and obesity may also have benefit for our patients who have asthma," said lead author Katherine Cahill, MD, medical director of Clinical Asthma Research in the Division of Allergy, Pulmonary, and Critical Care Medicine at VUMC.

"In a six-month period, type 2 diabetes patients who received this form of medication to improve blood sugar control also had better control of their asthma disease and symptoms compared to those who took alternative therapies," she said.

Cahill's study was a retrospective, observational study, so definitive prospective studies such as a clinical trial in patients with asthma, with and without comorbid type 2 diabetes, are required to confirm these medications provide benefit for asthma.

"For patients who have type 2 diabetes and asthma it means that some of their medications for type 2 diabetes may actually help their asthma control," Cahill said.

"For patients who have asthma but may not have type 2 diabetes it means that there could be a new class of medications that could be used for treatment."

In preclinical models completed at VUMC, GLP-1R agonists have been shown to reduce allergic airway inflammation and viral-induced airway inflammation. To translate these findings into human disease, Cahill and colleagues took advantage of the widespread use of GLP-1R agonists for the treatment of type 2 diabetes and available clinical information in EHR data.

VUMC colleagues Shinji Toki, PhD, Melissa Bloodworth, MD, PhD, Stokes Peebles, MD, and Kevin Niswender, MD, PhD, had previously shown in preclinical models of asthma that this class of medications reduces inflammation in the lung as well as how the lung responds to certain challenges like allergies and viruses. Other early preclinical data also suggest it is possible this therapy could have benefits in the airway for other airway diseases.

"In our study we found that patients with asthma received benefits from this medication because they had improved asthma control, so fewer asthma symptoms, and fewer acute flares, or what we call exacerbations, of their asthma," Cahill said.

"Our study demonstrated that the patients reported better breathing symptoms and fewer reports of shortness of breath and cough."

One member of the class of medications that induces early satiety, leading to weight loss, is already approved for the treatment of obesity. Future studies will investigate if the drug could improve outcomes for patients with both asthma and obesity.

Cahill and VUMC colleagues have received National Institutes of Health (NIH) funding to initiate a randomized, controlled clinical trial of GLP-1R agonists in asthma during the next year.

"Our next step is to take this medication and study it in patients with asthma. Here at Vanderbilt, we are going to actually be looking at patients who are obese and have asthma and assess whether the drug actually makes their asthma better or not," Cahill said.

PHILADELPHIA--A five-year community outreach and engagement effort by the Abramson Cancer Center at the University of Pennsylvania (ACC) to increase enrollment of Black patients into cancer clinical trials more than doubled the percentage of participants, improving access and treatment for a group with historically low representation in cancer research. The percentage of patients enrolled into a treatment clinical trial, for example, increased from 12 to 24 percent. A significant increase was also observed in non-therapeutic interventional and non-interventional trials.

The findings were published today in an abstract to be presented at the American Society of Clinical Oncology annual meeting on June 5. (Abstract #100). [ADD LINK https://meetinglibrary.asco.org/record/196644/abstract]

"An important goal of the Abramson Cancer Center is to serve and engage our community --and that includes improving access to clinical trials for all patients," said senior author Robert H. Vonderheide, MD, DPhil, director of the ACC and vice president for Cancer Programs in the University of Pennsylvania Health System. "Aligning the number of Black patients with cancer we care for with the number enrolled in our trials is how we can help bring more equitable care to the community, close gaps in disparities, and sustain trust. There's more work to be done to improve access and inclusion of minority groups, and the impact of this outreach and engagement effort is an important step forward."

Despite making up 13.4 percent of the U.S. population, only five percent of Black patients with cancer are enrolled in clinical trials. Of 8,700 patients who participated in trials nationwide related to the 28 oncology drugs approved by the U.S. Food and Drug Administration in 2018 and 2019, only 4 percent were Black, according to FDA Drug Trial Snapshot reports.

In 2014, Black residents comprised 19 percent of the population and 16.5 percent of cancer cases in the 12-county catchment area surrounding Philadelphia, but only 11.1 percent of ACC patients were Black. The percentages of Black participants accrued into treatment, non-therapeutic interventional, and non-interventional trials at the ACC were 12.2 percent, 8.3 percent, and 13.0 percent, respectively.

To address these gaps, the ACC established a center-wide program with community guidance and engagement that included: culturally tailored marketing strategies; new partnerships with faith-based organizations serving Black communities to conduct educational events; establishment of an ACC community Advisory Board and community educational forums; pilot programs with Lyft and Ride Health to address transportation barriers; and patient education by nurse navigators regarding cancer and clinical trials.

The efforts reached more than 10,000 individuals in churches, neighborhoods, community parks and centers, and health centers with formats ranging from educational forums to wellness fairs. In addition, ACC promoted clinical trials that address the cancer burden in Black residents of the catchment area, required that each protocol have a minority accrual plan to obtain approval, and increased access to language-tailored consent forms and translation services for patients.

By 2018, the researchers found that the percentage of Black patients seen at ACC had increased to 16.2 percent. The percentages of Black participants accrued onto treatment, non-therapeutic interventional, and non-interventional trials were 23.9 percent, 33.1 percent, and 22.5 percent, respectively -- a 1.7- to 4.0-fold increase and higher than the percentage of Black patients seen at the ACC.

As part of its long-term strategy to improve access, the ACC has also collaborated with the Lazarex Cancer Foundation to implement its IMPACT program (IMproving Patient Access to Cancer Clinical Trials), a first-of-its-kind effort at the ACC combining financial reimbursement for travel related expenses, outreach, and educational programs to help patients with cancer learn about and access advanced treatment in clinical trials. Reimbursement covers plane tickets, hotels, gas, tolls, cabs, and parking for the patient, and a companion.

"We've shown here that a multifaceted, community-based engagement initiative works to improve access to cancer clinical trials by Black patients with cancer," said first author Carmen E. Guerra, MD, MSCE, FACP, an associate professor of Medicine and associate director for Diversity and Outreach in the ACC. "We will continue to work with collaborators such as Lazarex that share in our vision to increase participation of underrepresented patients in trials, while at the same time engage with the community to develop strategies that address needs and barriers, from different social determinants of health to solidifying their trust."

Antiretroviral therapy, the common approach in the treatment of HIV, halts replication of the virus and has saved the lives of millions of people. However, for patients the drug cocktail becomes a lifetime necessity because they continue to harbor latent HIV in a small number of immune system cells. In the absence of treatment, HIV can again replicate and rebound into full blown AIDs.

A new study, however, suggests that addition of a single small molecule can rip away the cloak that shields those cells containing HIV and make them susceptible the patient's own antibodies that otherwise are not normally of much use against HIV.

For the study, a team of researchers led by scientists at Yale and the University of Montreal Hospital Research Centre stopped antiretroviral treatment for mice carrying human plasma and blood cells infected with HIV. They then treated the mice with a drug developed at the University of Pennsylvania that mimics receptors of immune T cells called CD4. The CD4-like molecule binds to and exposes vulnerable parts of the viral envelope on infected cells.

The mice experienced either no rebound of infection or long delays before active HIV infection restarted, the researchers report May 20 in the journal Cell Host & Microbe.

Researchers hope one day the new treatment may eliminate the need for long-term antiretroviral treatments.

It's sort of like pawn promotion in the game of chess, said Priti Kumar, associate professor of infectious diseases at Yale School of Medicine and lead author of the study

"These antibodies are like pawns," Kumar said. "There are many of them, but they are useless against the source of virus. But with the right move, they can be promoted to a powerful position and score a decisive victory by eliminating infected cells."

The CD-4 like molecule in the presence of antibodies acts like a "can opener" that allows antibodies to recognize the virus and trigger an immune response.

"The virus can now be recognized by patient antibodies that call the immune system's 'police,' the natural killer cells, to get rid of the infected cells," said Andrés Finzi, co-lead author of the study and professor at the Université de Montréal.

"In this way, a patient's own antibodies and cells that are commonly present can eliminate the viral reservoir and prevent viral rebound," Kumar said. "The hope is one day we might be able to do away with antiretroviral therapies altogether."

A national study from researchers at Michigan Medicine found that nearly 3% of insured U.S. adults under 65 take medications that weaken their immune systems.

The findings, published in JAMA Network Open, are based on data from over 3 million patients with private insurance. They focus on patients' use of immunosuppressive drugs, including chemotherapy medications and steroids such as prednisone.

The analysis reveals nearly 90,000 people met the study criteria for drug-induced immunosuppression that may elevate risk for severe COVID-19 symptoms and hospitalization if they became infected. Two-thirds of them took an oral steroid at least once, and more than 40% of patients took steroids for more than 30 days in a year.

"This study gives us previously unavailable information about how many Americans are taking immunosuppressive medications," says Beth Wallace, M.D., a rheumatologist at Michigan Medicine and lead author of the paper. "It also reinforces that many Americans continue to take oral steroids, which are associated with serious side effects and can often be avoided or substituted with alternative medications."

When the team of researchers examined the data, a vaccine against COVID-19 was not yet available outside clinical trials. The evidence is growing, however, that taking immunosuppressive drugs may reduce the efficacy of the shot, Wallace says.

"We're starting to realize that people taking immunosuppressive drugs may have a slower, weaker response to COVID vaccination, and, in some cases, might not respond at all," she says. "We don't have a full picture on how these drugs affect the vaccine's effectiveness, so it's difficult to formulate guidelines around vaccinating these patients." Wallace mentions several strategies, including holding medications around the time of vaccination and giving an extra "booster" shot, that scientists are testing to look into this question.

Wallace also expresses concern over how this group of immunosuppressed patients should proceed following the CDC's relaxation of masking and distancing guidelines for vaccinated people.

"The CDC acknowledges this cohort might not be as protected as other fully vaccinated people, but there are no set recommendations for what precautions they should take," she says. "For now, this is going to be an individual decision people make with their doctor."

Moving forward, Wallace says, researchers need prospectively look at vaccine response in this vulnerable population.

"Until we know more about this, we really won't be able to say if immunosuppressed people are actually protected," she says.

Young children who practice visual working memory and reasoning tasks improve their math skills more than children who focus on spatial rotation exercises, according to a large study by researchers at Karolinska Institutet in Sweden. The findings support the notion that training spatial cognition can enhance academic performance and that when it comes to math, the type of training matters. The study is published in the journal Nature Human Behaviour.

"In this large, randomized study we found that when it comes to enhancing mathematical learning in young children, the type of cognitive training performed plays a significant role," says corresponding author Torkel Klingberg, professor in the Department of Neuroscience, Karolinska Institutet. "It is an important finding because it provides strong evidence that cognitive training transfers to an ability that is different from the one you practiced."

Numerous studies have linked spatial ability--that is the capacity to understand and remember dimensional relations among objects--to performance in science, technology, engineering and mathematics. As a result, some employers in these fields use spatial ability tests to vet candidates during the hiring process. This has also fueled an interest in spatial cognition training, which focuses on improving one's ability to memorize and manipulate various shapes and objects and spot patterns in recurring sequences. Some schools today include spatial exercises as part of their tutoring.

However, previous studies assessing the effect of spatial training on academic performance have had mixed results, with some showing significant improvement and others no effect at all. Thus, there is a need for large, randomized studies to determine if and to what extent spatial cognition training actually improves performance.

In this study, more than 17,000 Swedish schoolchildren between the ages of six and eight completed cognitive training via an app for either 20 or 33 minutes per day over the course of seven weeks. In the first week, the children were given identical exercises, after which they were randomly split into one of five training plans. In all groups, children spent about half of their time on mathematical number line tasks. The remaining time was randomly allotted to different proportions of cognitive training in the form of rotation tasks (2D mental rotation and tangram puzzle), visual working memory tasks or non-verbal reasoning tasks (see examples below for details). The children's math performance was tested in the first, fifth and seventh week.

The researchers found that all groups improved on mathematical performance, but that reasoning training had the largest positive impact followed by working memory tasks. Both reasoning and memory training significantly outperformed rotation training when it came to mathematical improvement. They also observed that the benefits of cognitive training could differ threefold between individuals. That could explain differences in results from some previous studies seeing as individual characteristics of study participants tend to impact the results.

The researchers note there were some limitations to the study, including the lack of a passive control group that would allow for an estimation of the absolute effect size. Also, this study did not include a group of students who received math training only.

"While it is likely that for any given test, training on that particular skill is the most time-effective way to improve test results, our study offers a proof of principle that spatial cognitive training transfers to academic abilities," Torkel Klingberg says. "Given the wide range of areas associated with spatial cognition, it is possible that training transfers to multiple areas and we believe this should be included in any calculation by teachers and policymakers of how time-efficient spatial training is relative to training for a particular test."

The researchers have received funding by the Swedish Research Council. Torkel Klingberg holds an unpaid position as chief scientific officer for Cognition Matters, the non-profit foundation that owns the cognition training app Vektor that was used in this study.

Examples of training tasks in the study

In a number line task, a person is asked to identify the right position of a number on a line bound by a start and an end point. Difficulty is typically moderated by removing spatial cues, for example ticks on the number line, and progress to include mathematical problems such as addition, subtraction and division.

In a visual working memory task, a person is asked to recollect visual objects. In this study, the children reproduced a sequence of dots on a grid by touching the screen. Difficulty was increased by adding more items.

In a non-verbal reasoning task, a person is asked to complete sequences of spatial patterns. In this study, the children were asked to choose the correct image to fill a blank space based on previous sequences. Difficulty was increased by adding new dimensions such as colors, shapes and dots.

In a rotation task, a person is asked to figure out what an object would look like if rotated. In this study, the children were asked to rotate a 2D object to fit various angles. Difficulty was moderated by increasing the angle of the rotation or the complexity of the object being rotated.

BOSTON - Dana-Farber Cancer Institute researchers are presenting dozens of research studies at the 2021 Annual Meeting of the American Society of Clinical Oncology (ASCO). The studies will be presented during the virtual program on June 4-8, 2021. ASCO is the world's largest clinical cancer research meeting, attracting more than 30,000 oncology professionals from around the world.

Toni K. Choueiri, MD, the director of the Lank Center for Genitourinary Oncology at Dana-Farber, will present results from the randomized, double-blind, phase III KEYNOTE-564 trial evaluating pembrolizumab versus placebo after surgery in patients with renal cell carcinoma (abstract LBA5) during ASCO's Plenary Session on Sunday, June 6, 2021, 1:00pm-4:00pm ET. The plenary session features five studies deemed to have the greatest potential impact on patient care.

F. Stephen Hodi, MD, the director of the Melanoma Center and Center for Immuno-Oncology at Dana-Farber is co-senior author on the RELATIVITY-047 study evaluating combination treatment with two immunotherapies (relatlimab plus nivolumab) versus nivolumab alone in first-line treatment for patients with advanced melanoma (abstract 9503). Findings from the RELATIVITY-047 study will be presented during the Melanoma/Skin Cancers Oral Abstract Session on Sunday, June 6, 2021, 8:00am-11:00am ET. The study is included in the ASCO Press Program.

Other key research shows new treatments and diagnostic advances in lung cancer, leukemia, head and neck cancer, pediatrics, and many others. Some of the research highlights include:

Antibody drug conjugate shows promise against non-small cell lung cancer resistant to targeted therapy

An antibody fused to a targeted drug has produced impressive results in a Phase I clinical trial involving patients with advanced non-small cell lung cancer (NSCLC) whose tumors had become resistant to a standard targeted therapy. Dana-Farber's Pasi A. Ja?nne, MD, PhD, is lead author of the study.

The trial evaluated the safety and effectiveness of patritumab deruxtecan, an antibody drug conjugate consisting of an antibody targeting the protein HER3 and an inhibitor of the topoisomerase 1 enzyme, in 57 patients whose NSCLC carried an EGFR gene mutation but no longer responded to EGFR-targeting drugs. Patients who become resistant to such drugs and to platinum-based chemotherapy usually have few treatment options.

After a median treatment time of 5.5 months, 39% of the participants had a confirmed clinical response to the conjugate - a reduction in tumor size or extent. Among these patients, the median progression-free survival was 8.2 months. The antitumor effect occurred in patients whose resistance to EGFR inhibitors arose from a range of molecular mechanisms and in those with no clear identifiable resistance mechanism.

The most common severe side effects were decreased blood platelet counts, lowered counts of neutrophils (a type of white blood cell), and fatigue - all consistent with previous safety studies.

The results have prompted investigators to open a Phase 2 trial of the conjugate for patients with EGFR-mutant NSCLC whose disease has become resistant to EGFR-targeting drugs and chemotherapy.

Title: Efficacy and safety of patritumab deruxtecan (HER3-DXd) in EGFR inhibitor-resistant, EGFR-mutated (EGFRm) non-small cell lung cancer (NSCLC)

Abstract: 9007

Presenter: Pasi A. Ja?nne, MD, PhD

Session/Time: Oral Abstract Session: Lung Cancer - Non-Small Cell Metastatic; Broadcasting: June 4, 1:00pm-4:00pm

PET scans following initial treatment help many patients with bulky early-stage Hodgkin lymphoma avoid radiotherapy

Many early-stage patients with bulky classic Hodgkin lymphoma (cHL) can avoid radiotherapy treatment and still have excellent outcomes, according to a clinical study in which treatment was adapted to findings on PET imaging. Bulky disease - characterized by large tumors typically in the center of the chest - is associated with poorer outcomes in cHL and is traditionally treated with radiotherapy following chemotherapy. However, radiation treatment to the chest can have long-term toxic effects including an increased risk of breast cancer and heart problems.

The results, presented by Ann LaCasce, MD, MMSc, of Dana-Farber, included 94 patients with stage IA-IIB cHL and disease bulk greater than 10 cm or .33 maximum intrathoracic diameter on chest X-ray. Patients received two cycles of chemotherapy (ABVD) and then underwent PET imaging. Patients whose disease showed uptake less than liver on interim PET scan (PET2-) - 78% of the patients -- received four additional cycles of chemotherapy, but no radiotherapy. Patients classed as PET2+ received intensified chemotherapy with four cycles of escBEACOPP plus radiation therapy.

The estimated progression-free survival (PFS) was 93.1% in the PET2- patients and 89.7% in PET2+ patients. With a median follow-up of 5.5 years, estimated 3-year overall survival was 98.6% in PET2- patients and 94.4% in PET2+ patients. (Overall survival was not a primary or secondary outcome of the study).

The investigators said the PET-adapted approach achieved excellent PFS outcomes "that allowed omission of radiotherapy in 78 percent of patients." The PET2+ patients who received BEACOPP and radiotherapy "did not have inferior outcomes."

Title: CALGB 50801 (Alliance): PET adapted therapy in bulky stage I/II classic Hodgkin lymphoma (cHL)

Abstract: 7507

Presenter: Ann S. LaCasce, MD, MMSc

Session/Time: Oral Abstract Session: Hematologic Malignancies - Lymphoma and Chronic Lymphocytic Leukemia; Broadcasting: June 7, 11:30am-2:30pm

Additional cycle of pembrolizumab before surgery improves response rates in locally advanced head and neck cancer

Increasing neoadjuvant pembrolizumab from one to two cycles prior to surgery improved pathological response rates in patients with surgically resectable locally advanced, HPV-negative head and neck squamous cell carcinoma, reported Ravindra Uppaluri, MD, PhD, Dana-Farber/Brigham and Women's Cancer Center. A previous study in which patients (36 total) received one neoadjuvant cycle of pembrolizumab followed by surgery two to three weeks later yielded a 22% rate of >50% pathologic response (tumor cell death and other evidence of response designated as pTR-2) and a 22% pTR-1 rate (10-49% pathologic response). The new report was on a 28-patient phase 2 trial in which patients received two cycles of pembrolizumab 42 and 21 days prior to surgery. Twelve of 28 patients (43%) experienced a pTR-2 and four (16%) of these patients had a major pathologic response including 1 complete response at the primary site.

Neoadjuvant therapy was well tolerated and clinical outcomes in this advanced disease population were excellent with only one recurrence noted to date. The researchers said the data suggest that the frequency of pathologic responses to neoadjuvant pembrolizumab can be improved by increasing the number of cycles and the treatment interval.

Title: Enhanced pathologic tumor response with two cycles of neoadjuvant pembrolizumab in surgically resectable, locally advanced HPV-negative head and neck squamous cell carcinoma (HNSCC)

Abstract: 6008

Presenter: Ravindra Uppaluri, MD, PhD

Session/Time: Oral Abstract Session: Head and Neck Cancer; Broadcasting: June 7, 2:45pm-5:45pm

Molecular profiling of tumor tissue can benefit many young patients with cancer, study suggests

Testing solid tumors for genetic changes that can be targeted by drugs has revolutionized the treatment of many adults with cancer. New research by scientists at Dana-Farber/Boston Children's Cancer and Blood Disorders Center suggests it can have significant benefits for many younger patients as well.

Alanna J. Church, MD, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, will present results from the GAIN/iCat2 consortium study, which is evaluating the use of genomic profiling of solid tumors in children and young adults. The report includes data on 345 study participants with molecular profiling, who were diagnosed with solid, non-brain tumors at age 30 or younger. 299 patients (87%) had at least one genomic alteration that could impact the diagnosis, treatment, and prognosis of their disease, the researchers found.

Thirty-one patients were treated with matched targeted therapies and six patients had extraordinary responses to treatment. All patients with extraordinary responses matched to a gene fusion, and 78% of diagnostically significant alterations were fusions.

Molecular tumor profiling has a significant impact on diagnosis and treatment recommendations for young patients with solid tumors. These results emphasize the importance of fusion detection for patients with sarcomas and rare tumors, said Church, the lead author of the study, which was the highest rated pediatric oncology abstract at the ASCO conference, and winner of the Conquer Cancer Nachman Award.

Title: Clinical impact of molecular tumor profiling in pediatric, adolescent, and young adult patients with extra-cranial solid malignancies: An interim report from the GAIN/iCat2 study

Abstract: 10005
Presenter: Alanna J. Church, MD
Session Time: Oral Abstract Session: Pediatric Oncology I; Broadcasting: June 5, 10:00am-1:00pm

May 20, 2021 - Women with a history of weight cycling - losing and regaining 10 pounds or more, even once - have increased rates of insomnia and other sleep problems, reports a study in The Journal of Cardiovascular Nursing, official journal of the Preventive Cardiovascular Nurses Association. The journal is published in the Lippincott portfolio by Wolters Kluwer.

"History of weight cycling was prospectively associated with several measures of poor sleep, including short sleep duration, worse sleep quality, greater insomnia, greater sleep disturbances, and greater daytime dysfunction among diverse US women across various life stages," according to the new research by Brooke Aggarwal, EdD, MS, FAHA, of Columbia University Vagelos College of Physicians and Surgeons, New York, and colleagues.

Weight cycling predicts shorter, poorer-quality sleep and higher sleep apnea risk

The researchers analyzed data on 506 women, average age 37 years, enrolled in an ongoing American Heart Association-funded "Go Red for Women" research project. The women represented every stage of adult life, including childbearing, premenopausal, menopausal, and postmenopausal. About 60 percent of the women identified themselves as a racial/ethnic minority.

Seventy-two percent of the women reported one or more episodes of weight cycling, defined as losing or gaining at least 10 pounds (excluding pregnancy). History of weight cycling was evaluated for associations with a wide range of sleep problems, both at the time of study entry and at a one-year follow-up visit. The analyses adjusted for other factors known to affect women's weight history, including pregnancy history and menopausal status.

At both times, sleep problems were more likely for women with any history of weight cycling. Each additional episode of weight cycling was associated with shorter sleep time, poorer sleep quality, longer time to falling asleep, more severe insomnia, more sleep disturbances, less-efficient sleep, and more frequent use of sleep medications.

History of weight cycling also predicted an increased risk of sleep problems at follow-up. After adjustment for other factors, women with even a single episode of weight cycling were at higher risk of shorter sleep duration (less than seven hours), lower scores for sleep quality and efficiency, and longer time to falling asleep (about half an hour or more).

Women with episodes of weight cycling were also five times more likely to score in the high-risk range for developing obstructive sleep apnea (OSA). Patients with OSA have interruptions or other abnormalities of breathing during sleep. Obstructive sleep apnea is an important risk factor for serious health problems, including heart disease and stroke.

Being overweight or obese is a known risk factor for sleep problems. In previous studies in their "Go Red for Women" research cohort at Columbia University, Dr. Aggarwal and colleagues found that women with a history of weight cycling had increased odds of poor cardiovascular health. The relationship between weight cycling and sleep problems may be "bidirectional" - reflecting the "intricate interplay" between sleep and weight loss/weight maintenance.

The researchers emphasize the need for further studies of how body weight changes across the life span may affect sleep, in men as well as women and across racial/ethnic groups. In the meantime, asking women about their history of weight cycling might be helpful in identifying their risk for sleep problems, including OSA.

The findings also suggest that maintaining a stable body weight over time might promote better quality sleep. Dr. Aggarwal and coauthors conclude, "Future research can potentially inform more targeted weight maintenance interventions for sleep health and cardiovascular health promotion."

ROCHESTER, Minn. -- You might be older - or younger - than you think. A new study found that differences between a person's age in years and his or her biological age, as predicted by an artificial intelligence (AI)-enabled EKG, can provide measurable insights into health and longevity.

The AI model accurately predicted the age of most subjects, with a mean age gap of 0.88 years between EKG age and actual age. However, a number of subjects had a gap that was much larger, either seemingly much older or much younger by EKG age.

The likelihood to die during follow-up was much higher among those seemingly older by EKG age, compared to those whose EKG age was the same as their chronologic or actual age. The association was even stronger when predicting death caused by heart disease. Conversely, those who had a lesser age gap ? considered younger by EKG - had decreased risk.

"Our results validate and expand on our prior observations that EKG age using AI may detect accelerated aging by proving that those with older-than-expected age by EKG die sooner, particularly from heart disease. We know that mortality rate is one of the best ways to measure biological age, and our model proved that," says Francisco Lopez-Jimenez, M.D., chair of the Division of Preventive Cardiology at Mayo Clinic. Dr. Lopez-Jimenez is senior author of the study.

When researchers adjusted these data to consider multiple standard risk factors, the association between the age gap and cardiovascular mortality was even more pronounced. Subjects who were found to be oldest by EKG compared to their actual age had the greatest risk, even after accounting for medical conditions that would predict their survival, while those found the youngest compared to their actual age had lower cardiovascular risks.

Mayo Clinic researchers evaluated the12-lead EKG data of more than 25,000 subjects with an AI algorithm previously trained and validated to provide a biologic age prediction. Subjects with a positive age gap -- an EKG age higher than their chronological or actual age -- showed a clear connection to all-cause and cardiovascular mortality over time. The findings are published in European Heart Journal - Digital Health.

Study subjects were selected through the Rochester Epidemiology Project, an index of health-related information from medical providers in Olmsted County, Minnesota. The subjects had a mean age around 54 and were followed for approximately 12.5 years. The study excluded those with a baseline history of heart attacks, bypass surgery or stents, stroke or atrial fibrillation.

"Our findings open up a number of opportunities to help identify those who may benefit from preventive strategies the most. Now that the concept has been proven that EKG age relates to survival, it is time to think how we can incorporate this in clinical practice.More research will be needed to find the best ways to do it," says Dr. Lopez-Jimenez.

Around the world and within the U.S., the percentage of people wearing masks during the Covid-19 pandemic has varied enormously. What explains this? A new study co-authored by an MIT faculty member finds that a public sense of "collectivism" clearly predicts mask usage, adding a cultural and psychological perspective to the issue.

The study uses a series of datasets about mask usage and public attitudes, along with well-established empirical indices of collectivism, to evaluate the impact of those cultural differences on this element of the pandemic response.

"Our data both within the United States and across the world shows that collectivism is a strong and important predictor of whether people in a region wear masks or not," says Jackson G. Lu, an assistant professor at the MIT Sloan School of Management and co-author of a new paper detailing the results.

Collectivism broadly refers to the inclination to prioritize a group's needs over an individual's concerns, and social scientists have often worked to measure its presence among different populations. The researchers found a culture of collectivism to be a key driver of mask use even after accounting for many other factors, including political orientation, state policies, the severity of Covid-19 outbreaks, and more.

"In collectivistic cultures, people consider wearing masks not only a responsibility or duty, but also, a symbol of solidarity -- that we're standing together and fighting this pandemic together," Lu says.

The paper, "Collectivism Predicts Mask Use During COVID-19," appears today in Proceedings of the National Academy of Sciences. The authors are Lu, who is the Mitsui Career Development Professor at MIT Sloan; Peter Jin, a research associate at MIT Sloan; and Alexander S. English, a researcher in the Department of Psychology and Behaviorial Sciences at Zhejiang University in Hangzhou, China.

To conduct the study, the researchers analyzed four datasets. The first, collected in July 2020, was a one-question survey about mask usage in the U.S., collected by The New York Times and research firm Dynata, and including 248,941 Americans across all 3,141 U.S. counties. The second dataset was a survey of 16,737 Americans across all 50 U.S. states about mask usage, from April through September 2020, run by YouGov and the Institute for Global Health Innovation.

Analyzing both datasets, the researchers examined how strongly mask wearing correlated with the measures of collectivism in the 50 U.S. states. A U.S. state's collectivism can be graded based on survey responses by representative samples of the population.

"Collectivism versus individualism is one of the most established cultural dimensions in psychology," Lu says.

In analyzing the results, the researchers controlled for a large set of other factors that might influence mask wearing, including the severity of Covid-19 outbreaks in states, government policies, political affiliations across the public, education levels, population density, per-capita income, age, and gender.

They found that a U.S. state's collectivism rating is a strong and consistent predictor of mask usage no matter what. For example, Hawaii, has the highest collectivism rating in the U.S., and the second-highest level of mask usage (slightly behind Rhode Island). On the other end of the spectrum, a handful of states from the Great Plains and Mountain West have both low collectivism scores and low levels of mask wearing, including Wyoming, South Dakota, Montana, and Kansas.

"The patterns across the two U.S. datasets are so strikingly similar, which made us feel confident of the link between collectivism and mask use," Lu says.

The researchers also used two global datasets to apply the same method to a set of countries. The first dataset was based on the same 2020 survey conducted by YouGov and the Institute for Global Health Innovation, this time generating data on mask usage from 367,109 people from 29 countries and territories.

The second global dataset is one the MIT researchers developed in collaboration with Facebook, creating a weighted survey on mask use that generated responses from 277,219 participants in 67 countries and territories.

In countries around the world, as in the U.S., the results were the same: Collectivism scores again predict which countries tended to have high levels of mask wearing.

The research also uncovered other factors that influenced mask wearing. For instance, in the U.S., party affiliation was also a strong predictor of mask wearing, with Democrats more likely to wear masks than Republicans.

Lu suggests there are multiple kinds of future research that could stem from the current study. For one thing, the role of collectivism could be studied in other crises, such as wildfires or hurricanes. Beyond that, the authors suggest, it would be important to study whether or not the pandemic itself has affected the sense of collectivism or individualism that has previously been measured in countries and U.S. states. Both of those things could be useful knowledge for public officials and policymakers, whether to curb the current pandemic or save lives in the future.

"Understanding cultural differences not only provides insight into the pandemic, but helps the world prepare for future crises," Lu says.

Within the next decade, the novel coronavirus responsible for COVID-19 could become little more than a nuisance, causing no more than common cold-like coughs and sniffles. That possible future is predicted by mathematical models that incorporate lessons learned from the current pandemic on how our body's immunity changes over time. Scientists at the University of Utah carried out the research, now published in the journal Viruses.

"This shows a possible future that has not yet been fully addressed," says Fred Adler, PhD, professor of mathematics and biological sciences at the U. "Over the next decade, the severity of COVID-19 may decrease as populations collectively develop immunity."

The findings suggest that changes in the disease could be driven by adaptations of our immune response rather than by changes in the virus itself. Adler was senior author on the publication with Alexander Beams, first author and graduate student in the Department of Mathematics and the Division of Epidemiology at University of Utah Health, and undergraduate co-author Rebecca Bateman.

Although SARS-CoV-2 (the sometimes-deadly coronavirus causing COVID-19) is the best-known member of that virus family, other seasonal coronaviruses circulate in the human population--and they are much more benign. Some evidence indicates that one of these cold-causing relatives might have once been severe, giving rise to the "Russian flu" pandemic in the late 19th century. The parallels led the U of U scientists to wonder whether the severity of SARS-CoV-2 could similarly lessen over time.

To test the idea, they built mathematical models incorporating evidence on the body's immune response to SARS-CoV-2 based on the following data from the current pandemic.

There is likely a dose response between virus exposure and disease severity.

A person exposed to a small dose of virus will be more likely to get a mild case of COVID-19 and shed small amounts of virus.

By contrast, adults exposed to a large dose of virus are more likely to have severe disease and shed more virus.

Masking and social distancing decrease the viral dose.

Children are unlikely to develop severe disease.

Adults who have had COVID-19 or have been vaccinated are protected against severe disease.

Running several versions of these scenarios showed that the three mechanisms in combination set up a situation where an increasing proportion of the population will become predisposed for mild disease over the long term. The scientists felt the transformation was significant enough that it needed a new term. In this scenario, SARS-CoV-2 would become "Just Another Seasonal Coronavirus," or JASC for short.

"In the beginning of the pandemic, no one had seen the virus before," Adler explains. "Our immune system was not prepared." The models show that as more adults become partially immune, whether through prior infection or vaccination, severe infections all but disappear over the next decade. Eventually, the only people who will be exposed to the virus for the first time will be children--and they're naturally less prone to severe disease.

"The novel approach here is to recognize the competition taking place between mild and severe COVID-19 infections and ask which type will get to persist in the long run," Beams says. "We've shown that mild infections will win, as long as they train our immune systems to fight against severe infections."

The models do not account for every potential influence on disease trajectory. For example, if new virus variants overcome partial immunity, COVID-19 could take a turn for the worse. In addition, the predictions rely on the key assumptions of the model holding up.

"Our next step is comparing our model predictions with the most current disease data to assess which way the pandemic is going as it is happening," Adler says. "Do things look like they're heading in a bad or good direction? Is the proportion of mild cases increasing? Knowing that might affect decisions we make as a society."

Maywood, Ill. - May 19, 2021 - A team of scientists from Loyola University Chicago's Stritch School of Medicine have discovered a critical component for renewing the heart's molecular motor, which breaks down in heart failure.

Approximately 6.2 million Americans have heart failure, an often fatal condition characterized by the heart's inability to pump enough blood and oxygen throughout the body. This discovery could represent a novel approach to repair the heart.

Their findings, published in the May 19 issue of Nature Communications, show how a protein called BAG3 helps replace "worn-out" components of the cardiac sarcomere. The sarcomere is a microscopic structure inside every heart muscle cell that causes it to contract. All the cells then work together to make the heart pump blood around the body.

"While the heart has to beat every second of every day of your life," explained Senior Investigator Jonathan A. Kirk, PhD, associate professor, Stritch, "the microscopic engine powering contraction is under a lot of stress and the proteins that comprise it must be replaced with new ones every couple days or weeks," he said.

How the sarcomere is renewed has long been a mystery. "Imagine taking your car to have the engine repaired but you cannot stop driving. It would be a sophisticated and complicated process," Kirk explained.

The team found that BAG3 anchors to the sarcomere and coordinates a process where old proteins are "chaperoned" out of the sarcomere to be degraded by the cell. Patients with heart failure have a loss of sarcomere-anchored BAG3, resulting in a buildup of worn-out, dysfunctional components. Measuring force produced by individual heart cells from these patients, the team discovered that patients with the lowest levels of BAG3 had the weakest cells.

"These findings show an important, fundamental mechanism of protein renewal in the heart, and serves as exciting insight into the development of better treatments for heart failure in humans," said Meharvan Singh, PhD, vice provost of research at Loyola and professor, Department of Cell and Molecular Physiology at Stritch.

These results suggest that restoring BAG3 levels in the sarcomere could strengthen the heart as a potential treatment for heart failure. To test that hypothesis, the researchers surgically induced heart failure in mice. After two months of severe dysfunction, the team delivered BAG3 gene therapy which renewed the sarcomere and restored its ability to contract at healthy levels.

"We've known for almost half a century that the capacity of the sarcomere to generate force is significantly reduced in heart failure," said lead author and Loyola graduate student Thomas Martin. "However, our research shows the importance of BAG3 and sarcomere protein renewal in disease and this may be an approach to strengthen the weakened heart," he said.

One-quarter to one-third of young, active patients who undergo anterior cruciate ligament reconstruction experience a second ACL injury after they return to sport (RTS). New research indicates that young athletes who feel confident about their knee health at the time of medical clearance for sports participation after ACL surgery have a higher likelihood of meeting all RTS criteria related to physical function but also have a higher likelihood of experiencing a second ACL injury within 2 years after RTS.

The study, which included 159 participants with an average age of 17 years, is published in the Journal of Orthopaedic Research.

"These data suggest that as health care providers, we may need to re-evaluate the tools we currently use to determine readiness to return to sport after ACL reconstruction in young athletes. In addition, we need to better evaluate the role of confidence in patients as they transition back to sports," said lead author Mark Paterno, PT, PhD, SCS, ATC, of Cincinnati Children's Hospital.

In an article published in the International Journal of Mental Health Nursing, experts stress that the COVID-19 pandemic presents the "perfect storm" for family violence, where a set of rare circumstances have combined to aggravate intimate partner violence, domestic abuse, domestic violence, and child abuse.

Factors during the pandemic that have come together to contribute to family violence may include increased stress and trauma, economic hardship, imposed isolation, and decreased access to community and faith-based support.

The authors note that public health officials and mental health professionals need to be aware of the impact of disasters on family violence, and they should strive to identify those at risk and provide much needed support.

"Emergency and disaster situations such as we are seeing with the COVID-19 pandemic are known to increase stress on individuals and families. One unfortunate outcome of that stress is an increase in family violence," said lead author Kim Usher, RN, PhD, of the University of New England, in Australia. "Nurses are well placed to provide early interventions to reduce stress on families and to assist those for whom family violence is a risk or a reality."

Des Plaines, IL - The Canadian Syncope Risk Score (CSRS) is an accurate validated prediction score for emergency department patients with unexplained syncope. These are the results of a study titled Multivariable risk scores for predicting short-term outcomes for emergency department patients with unexplained syncope: A systematic review, to be published in the May issue of Academic Emergency Medicine (AEM) journal, peer-reviewed journal of the Society for Academic Emergency Medicine (SAEM).

Syncope is a common presentation to an emergency department, with patients at risk of experiencing an adverse event within 30 days. Without a standardized risk stratification system of patients, there will be health care disparities and inconsistent patient care, which may lead to poor outcomes.

Overall, this systematic review provides an updated qualitative overview of the accuracy of nine risk stratification scores among adult patients following a syncopal event. Many scores in the study are not validated or not sufficiently accurate for clinical use. Other risk scores were not validated on an independent sample, had low positive likelihood ratios for identifying patients at high risk, or had high negative likelihood ratios for identifying patients at low risk.

While more longitudinal studies are required prior to changing guidelines, the Canadian Syncope Risk Score was the most accurate at classifying patients at low and high risk for adverse events. This provides a promising ability to assist physicians in determining whether patients warrant additional workup or admission to hospital. Its impact on clinical decision making, admission rates, cost, or outcomes of care is not known and therefore, further research is recommended.

The lead author of the report is Rachel A. L. Sweanor, BMBS, from the division of internal medicine, Sunnybrook Health Sciences, and the department of medicine, University of Toronto, both in Toronto, Ontario, Canada.

Commenting on the study is Venkatesh Thiruganasambandamoorthy, CCFP-EM, MSc, associate professor in the department of emergency medicine and the School of Epidemiology and Public Health and senior scientist at the Ottawa Hospital Research Institute. Dr. Thiruganasambandamoorthy also serves as the clinical research chair in cardiovascular emergencies and as a mid-career clinical researcher at Physicians' Services Incorporated Foundation.

"While there have been significant advances in emergency department syncope risk stratification, this systematic review highlights the weaknesses of several risk tools previously published. Risk tools reduce uncertainty in medical decision-making by providing probabilities of serious outcome at a specified time and should have undergone the three major stages of development: derivation, validation, and implementation. Implementation to demonstrate true effect on patient care is the ultimate test for any clinical decision tool."