Body

Between 11% to 40% of adults in the United States experience chronic pain, and primary care physicians may feel ill-equipped to effectively and safely care for patients with chronic pain, addiction or both. Researchers from Tufts University conducted a study to evaluate the effectiveness of an interdisciplinary consultation service that supports primary care physicians who care for patients experiencing chronic pain and addiction. The goal was to identify new and effective strategies that clinics can use to support PCPs.

From that interdisciplinary consultation service, the researchers collected and thematically analyzed 66 referral questions and 14 interviews with PCPs to better understand the types of support physicians would find most beneficial.

PCPs' expressed needs included needing expertise in addiction, safe prescribing of opioids, non-opioid treatment options, communication strategies for difficult conversations, a comprehensive review of the case, and a biopsychosocial approach to management. Some additional needs were identified after interviews, including confirmation of their medical decision-making process, emotional validation, feeling more control, having an outside entity take the burden off the PCP for management decisions, boundary setting and reframing the visit to focus on the patient's function, values and goals.

The authors concluded that an interdisciplinary consultation service can effectively support primary care physicians who care for patients battling pain and addiction. They then offer some potential strategies that health systems can use to support PCPs in this important role.

Antibiotics: Patient Expectations and Doctors' Prescribing Habits May Contribute to Antimicrobial Resistance

Inappropriate antibiotic prescribing for upper respiratory tract infections contributes to antibiotic resistance, making some bacterial infections difficult to treat. This often leads to higher medical costs, prolonged hospital stays and increased mortality. Still, many physicians report prescribing antibiotics at their patients' request. To address patients' expectations for antibiotic prescribing for URTIs, researchers conducted an experiment in which study participants were assigned brief educational videos to watch on a tablet immediately prior to their appointment.

The authors randomized patients into three groups - one that viewed a presentation about the futility of antibiotic treatment of URTIs; a second group that viewed a presentation about the adverse effects associated with antibiotics; and a third control group that learned about the benefits of healthy diet/exercise. The researchers then measured the effects of the presentations on patients' beliefs that antibiotics are helpful for URTIs; their expectations to be prescribed an antibiotic; and whether they were actually prescribed antibiotics for their URTIs. Participants who viewed either the futility or adverse effects presentations had greater reductions in their expectations of receiving antibiotics compared to the group that viewed the video about the benefits of healthy/diet and exercise. However, there was no significant difference between the three groups when it came to doctors actually prescribing antibiotics to patients. Researchers concluded that a brief, tablet-based waiting room intervention significantly changes participants' expectations on receiving antibiotics for URTIs, but that future efforts to improve antibiotic prescribing need to involve both patients and their doctors.

An article published in Frontiers in Immunology suggests that sepsis can cause alterations in the functioning of defense cells that persist even after the patient is discharged from hospital. This cellular reprogramming creates a disorder the authors call post-sepsis syndrome, whose symptoms include frequent reinfections, cardiovascular alterations, cognitive disabilities, declining physical functions, and poor quality of life. The phenomenon explains why so many patients who survive sepsis die sooner after hospital discharge than patients with other diseases or suffer from post-sepsis syndrome, immunosuppression and chronic inflammation.

The article presents a review of studies conducted to investigate cases of septic patients who died up to five years after being discharged from hospital.

Considered one of the leading causes of death in intensive care units, sepsis is a life-threatening systemic organ dysfunction triggered by the organism’s dysregulated response to an infectious agent, typically a bacterium or fungus. The defense system injures the body’s own tissues and organs while combating the infectious agent. 

If it is not promptly recognized and treated, the condition can lead to septic shock and multiple organ failure. Patients with severe COVID-19 and other infectious diseases run a heightened risk of developing and dying of sepsis. 

New cases of sepsis are estimated to total some 49 million per year worldwide. Hospital mortality from septic shock exceeds 40% globally, reaching 55% in Brazil, according to the Sepsis Prevalence Assessment Database (SPREAD) study, conducted with support from FAPESP. 

“The massive infection and the accompanying intense immune response with a cytokine outpouring during sepsis may promote irreversible cell metabolic reprogramming. Cell reprogramming is unlikely to occur in leukocytes or bone marrow only. This might happen in several tissues and cells that prompt systemic organ dysfunctions […] Bacteria can transfer genetic material to host cell DNA as eukaryotic cells develop tools to protect themselves against the microorganism invasion. The latter may induce cell biology and metabolic reprogramming that remains even after the infection’s elimination,” the researchers state in the article. 

According to Raquel Bragante Gritte, joint first author with Talita Souza-Siqueira, one of the hypotheses investigated by the group was that metabolic reprogramming starts in the bone marrow, whose cells acquire a pro-inflammatory profile. “Our analysis of blood samples from patients even three years after ICU discharge showed that monocytes [a type of defense cell] were activated and ready for battle. They should have been neutral. Monocytes are normally activated only when they are ‘recruited’ to the tissue,” Gritte told Agência FAPESP. Both Gritte and Souza-Siqueira are researchers at Cruzeiro do Sul University (UNICSUL) in the state of São Paulo, Brazil.

Research line

The Frontiers in Immunology article is one of the first to be published by the group on this subject. The co-authors include two medical doctors and professors at the University of São Paulo (USP): Marcel Cerqueira Cesar Machado, principal investigator for a project supported by FAPESP; and Francisco Garcia Soriano. Their research line has brought to light recent discoveries in studies of post-discharge sepsis patients available from PubMed, a leading database of references and abstracts on life sciences and biomedical topics. 

According to Gritte, the group conducted a follow-up study of 62 patients for three years after discharge from the ICU at USP’s University Hospital, analyzing alterations in monocytes, neutrophils and lymphocytes, as well as microRNAs, to try to identify prognostic markers and factors associated with post-sepsis syndrome.

“Our hypothesis is that white blood cells conserve a memory of sepsis, which helps explain why patients remain sick after they leave hospital,” said Rui Curi, another co-author of the article. Curi is a professor at UNICSUL and a director of Butantan Institute.

In the article, the researchers suggest sepsis may generate a specific macrophage phenotype that remains active after discharge from hospital. “Cell metabolism reprogramming is also involved in the functions and even generation of the different lymphocyte subsets. Several stimuli and conditions change lymphocyte metabolism, including microenvironment nutrient availability,” they write.

According to Gritte, next steps include studies of bone marrow to understand how cells are reprogrammed by sepsis. “We think the key to this alteration is in bone marrow,” she said. “However, another possibility is that activation occurs in the blood. We’ll need to do more in-depth research to find answers.” 

The knowledge acquired in this study can serve as a basis for the development of strategies to minimize or block post-sepsis alterations.

Last year the World Health Organization (WHO) published its first report on the global epidemiology of sepsis, noting that much of the burden of sepsis incidence and mortality weighs on low- and middle-income countries and that a severe lack of population-based sepsis data, especially in such countries, hinders efforts to address the problem.

The WHO report recommends a concerted global effort to increase funding and research capacity for the generation of epidemiological evidence on sepsis, as well as the development of rapid, affordable, and appropriate diagnostic tools to improve sepsis identification, prevention, and treatment.

In order to make meaningful gains in cardiovascular disease care, primary care medical practices should adopt a set of care improvements specific to their practice size and type, according to a new study from the national primary care quality improvement initiative EvidenceNOW. High blood pressure and smoking are among the biggest risk factors associated with cardiovascular disease. Primary care physicians help patients manage high blood pressure and provide smoking cessation interventions.

Researchers found that there is no one central playbook for all types of practices, but they did identify combinations of practice characteristics, amount of practice facilitation, and operational changes linked with improved cardiovascular disease care. Smaller, solo and clinician-owned practices that changed routine aspects of their process, such as training medical assistants to perform accurate blood pressure readings; allowing staff to take repeated blood pressure measures and note second readings in electronic medical records; and equipping clinicians with the tools to perform smoking screening and cessation referrals, were able to make substantial improvements.

In addition, working with a practice facilitator helped. Smaller practices that participated in a moderate amount of facilitation were able to make these improvements. However, for larger hospital or health system-owned practices and Federally Qualified Health Centers more facilitation was necessary, leading researchers to conclude that "making operational changes alone--in certain clinical settings--was insufficient to achieve meaningful improvements." In practices that are part of larger, more complex systems, external facilitation along with prioritization of operational changes may be critical to successful quality improvement.

Improving Smoking and Blood Pressure Outcomes: The Interplay Between Operational Changes and Local Context
Deborah J. Cohen, Ph.D., et al
Oregon Health & Science University, Department of Family Medicine, Portland, Oregon
https://www.annfammed.org/content/19/3/240

In a corresponding editorial titled "The Need for Coaches in a Clinical World", Robert L. Phillips, Jr, MD, MSPH, of the American Board of Family Medicine, identifies a common thread running throughout five studies in the May-June 2021 issue Annals of Family Medicine. Dr. Phillips notes that practice facilitation is key to improving primary care at a systems level. Each study he discusses investigates a different, though widely experienced, medical issue, including cardiovascular disease, antibiotic resistance, chronic pain and addiction and cesarean births. He writes that these studies offer meaningful insights about facilitating behavior change, the importance of culture, and respecting complexity.

The Need for Coaches in the Clinical World
Robert L. Phillips, Jr, M.D., MSPH
American Board of Family Medicine, Lexington, Kentucky
https://www.annfammed.org/content/19/3/194

Although new family medicine graduates intend to provide a broader scope of practice than their senior counterparts, individual family physicians' scope of practice has been decreasing, with fewer family physicians providing basic primary care services, such pediatric and prenatal care. Russell et al conducted a study to explore family medicine graduates' attitudes and perspectives on modifiable and non-modifiable factors that influenced their scope of practice and career choices. The authors conducted five focus group discussions with 32 family physicians and explored their attitudes and perspectives on their desired and actual scope of practice. Using a conceptual framework to understand the influences on practice scope, the authors found that personal factors played a role on desired scope while workplace, environmental and population factors influenced actual practice scope. Stressors that occurred in these four categories often caused family physicians to narrow their scope of practice. Understanding personal, environmental, workplace and population factors that influence practice scope can inform specific interventions that create desirable jobs for family physicians and improve their ability to meet changing population needs. Supportive factors of a broader-scope practice include training and access to additional medical education after training; access to mentors; strong organizational leadership; and team-based care.

Pregnant women who develop severe COVID-19 infections that require hospitalization for pneumonia and other complications may not be more likely to die from these infections than non-pregnant women. In fact, they may have significantly lower death rates than their non-pregnant counterparts. That is the finding of a new study published today in the Annals of Internal Medicine conducted by researchers at the University of Maryland School of Medicine (UMSOM).

The study examined medical records from nearly 1,100 pregnant women and more than 9,800 non-pregnant patients aged 15 to 45 who were hospitalized with COVID-19 and pneumonia. Slightly less than 1 percent of the pregnant patients died from COVID-19 compared to 3.5 percent of non-pregnant patients, according to the study findings.

There are, however, some important caveats to the study data in terms of differences between the two populations. Pregnant patients were more likely to be younger and have fewer health conditions, including diabetes, obesity, hypertension, and chronic lung disease, compared to the non-pregnant patients. Given the small number of deaths seen in the study, the researchers were unable to control for these differences to determine whether they significantly affected mortality risk.

"I think this is reassuring news for women who are pregnant and worried about getting infected with COVID-19 as new variants emerge," said study corresponding author Anthony Harris, MD, MPH, Professor of Epidemiology & Public Health at UMSOM. "While the study does not tell us for certain that pregnancy does not pose added risks for women, the data certainly point in that direction."

Researchers from The University of Texas Health Science Center at Houston also participated in this study. UMSOM faculty who were co-authors of this study include Katherine Goodman, JD, PhD, Lisa Pineles, MA, Lyndsay O'Hara, PhD, Gita Nadimpalli, MD, MPH, Laurence Magder, PhD, and Jonathan Baghdadi, MD, PhD.

"I am so pleased we can provide some reassuring news to pregnant women who have faced an added burden during the COVID-19 pandemic," said E. Albert Reece, MD, PhD, MBA, Executive Vice President for Medical Affairs, UM Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor and Dean, University of Maryland School of Medicine. "This is an important study that adds to our knowledge of the COVID-19 pandemic at a critical time."

A receptor that helps conserve energy when food is scarce may be the key to a safer approach to treating diet-induced obesity, research led by the Garvan Institute of Medical Research has revealed.

In a study using experimental models and fat tissue biopsies from obese individuals, the team revealed that blocking a specific receptor of the molecule neuropeptide Y (NPY), which helps our body regulate its heat production, could increase fat metabolism and prevent weight gain.

"The Y1 receptor acts as a 'brake' for heat generation in the body. In our study, we found that blocking this receptor in fat tissues transformed the 'energy-storing' fat into 'energy-burning' fat, which switched on heat production and reduced weight gain," says Dr Yan-Chuan Shi, Leader of the Neuroendocrinology Group at Garvan and co-senior author of the paper published in Nature Communications.

"Most of the current medications used to treat obesity target the brain to suppress appetite and can have severe side effects that limit their use. Our study reveals an alternative approach that targets the fat tissues directly, which may potentially be a safer way to prevent and treat obesity."

Y1 receptor linked to obesity

Obesity and overweight are major public health issues, which in Australia are estimated to affect two thirds of all adults. The condition can lead to severe medical complications, including diabetes, cardiovascular disease and some cancers, and while lifestyle changes are essential to weight loss, medication is a crucial adjunct treatment option for some.

The authors of the study investigated Y1 receptors controlled by the molecule NPY, which is released in the body under conditions of starvation to help reduce energy expenditure and increase fat storage. Surprisingly, the team discovered that Y1 receptors were produced at higher levels in the fat tissue of obese individuals.

The team then blocked the Y1 receptor using the experimental treatment BIBO3304 in a mouse model of obesity.

"In our study, we found that mice that were administered BIBO3304 and fed a high-fat diet gained about 40% less body weight over seven weeks than mice on a high-fat diet alone. This significant reduction of body weight gain was caused by an increase in body heat generation and reduction in fat mass," says Dr Shi.

"Further, when we applied BIBO3304 to human fat cells isolated from obese individuals, we found that the cells began switching on the same genes involved in producing heat as the ones in mice, which suggests that targeting the Y1 receptor pathway may similarly increase fat metabolism and reduce weight gain in humans," Dr Shi adds.

Targeting obesity at the source

"NPY is a metabolism regulator that plays a critical role during states of low energy supply, where it helps store fat as a survival mechanism. Today however, these advantageous effects can exacerbate existing diet-induced weight gain, leading to obesity and metabolic disease," says co-senior author Professor Herbert Herzog, Head of the Eating Disorders Lab at Garvan.

The researchers say a crucial component of the study was to demonstrate that the experimental treatment BIBO3304 did not cross the blood brain barrier, and that the anti-obesity effects of blocking the Y1 receptor pathways occurred not via the brain, but specifically only in peripheral tissues.

"Most current prescribed treatments are aimed at reducing food intake by targeting the central nervous system. However, these can have significant psychiatric or cardiovascular side effects, which have resulted in over 80% of these medications being withdrawn from the market," says Dr Shi.

"Our study is crucial evidence that blocking Y1 receptors in peripheral tissues without affecting the central nervous system is effective at preventing obesity by increasing energy expenditure. It reveals a new therapeutic approach that is potentially safer than current medications that target appetite," says Professor Herzog.

"Our team and other groups have revealed further potential benefits in targeting the NPY-Y1 receptor system, including the stimulation of bone cell growth, and improvement in cardiovascular function and insulin resistance," he adds. "We hope that the publication of our findings will lead to increased interest for exploring BIBO3304 and related agents as potential treatments for obesity and other health conditions."

An experimental form of gene therapy developed by a team of researchers from UCLA and Great Ormond Street Hospital in London has successfully treated 48 of 50 children born with a rare and deadly inherited disorder that leaves them without an immune system.

Severe combined immunodeficiency due to adenosine deaminase deficiency, or ADA-SCID, is caused by mutations in the ADA gene that creates the enzyme adenosine deaminase, which is essential to a functioning immune system. For children with the condition, even day-to-day activities like going to school or playing with friends can lead to dangerous, life-threatening infections. If untreated, ADA-SCID can be fatal within the first two years of life.

The investigational gene therapy method involves first collecting some of the child's blood-forming stem cells, which have the potential to create all types of blood and immune cells. Next, using an approach developed by the research team, a new copy of the ADA gene is delivered into the stem cells by a modified lentivirus, or "viral vector." The corrected cells are then returned to the child's body, where they are intended to produce a continual supply of healthy immune cells capable of fighting infection.

In a study published today in the New England Journal of Medicine, co-lead authors Dr. Donald Kohn of UCLA and Dr. Claire Booth of Great Ormond Street Hospital, or GOSH, report two- and three-year outcomes for children treated with the investigational lentiviral gene therapy in clinical trials at GOSH, UCLA Mattel Children's Hospital and the National Institutes of Health between 2012 and 2017.

"Between all three clinical trials, 50 patients were treated, and the overall results were very encouraging," said Kohn, a distinguished professor of microbiology, immunology and molecular genetics and a member of the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research at UCLA. "All the patients are alive and well, and in more than 95% of them, the therapy appears to have corrected their underlying immune system problems."

No complications or treatment-limiting events were reported among the patients. Most adverse events were mild or moderate, and were considered to be related to routine procedures performed in preparation for the experimental gene therapy treatment or effects of the immune system rebuilding.

"Treatment was successful in all but two of the 50 cases, and both of those children were able to return to current standard-of care-therapies and treatments, with one eventually receiving a bone marrow transplant," said Kohn, who has been working to develop gene therapies for ADA-SCID and other blood diseases for 35 years.

The investigational gene therapy -- a one-time procedure that the researchers say may provide lifelong results -- is a welcome potential new treatment option for children with ADA-SCID, who otherwise must undergo once- or twice-weekly injections of the ADA enzyme until a matched bone marrow donor, usually a close family member, can be found. If a donor is not available, patients require lifelong injections, along with antibiotics, antifungal medications and monthly infusions of immunoglobulin, which contains infection-fighting antibodies. These treatments are expensive and therefore out of reach for patients in many countries.

"If approved in the future, this treatment could be standard for ADA-SCID, and potentially many other genetic conditions, removing the need to find a matched donor for a bone marrow transplant and the toxic side effects often associated with that treatment," said Booth, a GOSH consultant in pediatric immunology and gene therapy.

The benefits of lentiviral gene therapy

Prior to teaming up, both Booth and Kohn worked separately for years on successful gene therapies for ADA-SCID that used viral vectors made from retroviruses. Retroviral vectors, however, can only enter cells' nuclei to deliver genes while the cells are dividing, limiting the number of cells receiving the genetic payload and, thereby, the potential efficacy of the treatment.

Additionally, while neither Kohn nor Booth observed serious complications in their ADA-SCID trials, other earlier studies testing retroviral vector-based gene therapies did report some serious side effects, including leukemia, in some patients.

In 2008, Booth and Kohn began collaborating with professors Bobby Gaspar and Adrian Thrasher of University College London to develop an improved viral vector using a different kind of virus, called a lentivirus. Viruses of this kind can enter non-dividing cells' nuclei and, when used as vectors, have the potential to make gene therapies safer and more effective. ADA-SCID patients began receiving the new gene therapy at GOSH in 2012; the following year, the experimental treatment was offered at UCLA and the NIH.

"More than 200 patients with various genetic conditions across the world have now been treated with experimental lentiviral gene therapies, and applying gene therapy to ADA-SCID is another significant scientific advance," said Thrasher, a senior author of the study who is also a professor of pediatric immunology at GOSH.

Ten of the children in the UCLA study were treated using a frozen preparation of corrected stem cells. These children experienced similar outcomes to the children treated with cells that were not frozen. The freezing approach may allow children with ADA-SCID to have their stem cells collected locally, then have them transported and processed at a manufacturing facility elsewhere and shipped back to a specialized hospital near them, removing the need for patients and their families to travel long distances to specialist centers.

One patient's story: A life-changing treatment

One of the patients who received a frozen preparation of cells at UCLA, Cora Oakley of Morristown, New Jersey, was diagnosed with ADA-SCID through newborn genetic screening at just 7 days old, in April 2017. "I remember asking the doctor if my daughter was going to die," Cora's mother, Chelsea Oakley, said of receiving the diagnosis. "And his response was, 'I hope not.' It was the darkest day of my life."

Cora was the last child to enroll in the clinical trial and received her own corrected cells in September 2017. Following the gene therapy, Cora and her family spent a month in the bone marrow transplant unit of a hospital closer to their home for Cora's follow-up treatment. The experiences of the other young patients in this unit opened Oakley's eyes to what her daughter would have gone through if the experimental gene therapy hadn't been an option.

"I saw young bone marrow transplant patients who developed graft-versus-host disease and others who had to take all these anti-rejection medications and still had issues. I just thought no one should have to suffer like this," she said. "And then here's my daughter who had this life-changing treatment that felt like a miracle. It still shocks me all the time how unbelievably fortunate we are."

Now a healthy and exuberant 4-year-old, Cora is described by her mom as a "rough and tumble, outdoors kind of kid" who loves all animals and is incredibly social. "I'll never forget what it felt like when we didn't know if she'd ever be able to do any of these things," Oakley said.

A novel technique for studying vortices in quantum fluids has been developed by Lancaster physicists.

Andrew Guthrie, Sergey Kafanov, Theo Noble, Yuri Pashkin, George Pickett and Viktor Tsepelin, in collaboration with scientists from Moscow State University, used tiny mechanical resonators to detect individual quantum vortices in superfluid helium.

Their work is published in the current volume of Nature Communications.

This research into quantum turbulence is simpler than turbulence in the real world, which is observed in everyday phenomena such as surf, fast flowing rivers, billowing storm clouds, or chimney smoke. Despite the fact it is so commonplace and is found at every level, from the galaxies to the subatomic, it is still not fully understood.

Physicists know the fundamental Navier-Stokes Equations which govern the flow of fluids such as air and water, but despite centuries of trying, the mathematical equations still cannot be solved.

Quantum turbulence may provide the clues to an answer.

Turbulence in quantum fluids is much simpler than its "messy" classical counterpart, and being made up of identical singly-quantised vortices, can be thought of as providing an "atomic theory" of the phenomenon.

Unhelpfully, turbulence in quantum systems, for example in superfluid helium 4, takes place on microscopic scales, and so far scientists have not had tools with sufficient precision to probe eddies this small.

But now the Lancaster team, working at temperature of a few thousandths of a degree above absolute zero, has harnessed nanoscience to allow the detection of single quantum vortices (with core sizes on a par with atomic diameters) by using a nanoscale "guitar string "in the superfluid.

How the team does it is to trap a single vortex along the length of the "string" (a bar of around 100 nanometres across). The resonant frequency of the bar changes when a vortex is trapped, and thus the capture and release rate of vortices can be followed, opening a window into the turbulent structure.

Dr Sergey Kafanov who initiated this research said: "The devices developed have many other uses, one of which is to ping the end of a partially trapped vortex to study the nanoscale oscillations of the vortex core. Hopefully the studies will add to our insight into turbulence and may provide clues on how to solve these stubborn equations."

COLUMBUS, Ohio - People are more persuaded by the actual messages contained in social media posts than they are by how many others viewed the posts, a new study suggests.

Researchers found that when people watched YouTube videos either for or against e-cigarette use, their level of persuasion wasn't directly affected by whether the video said it was viewed by more than a million people versus by fewer than 20.

What mattered for persuasion was viewers' perception of the message as truthful and believable.

"There wasn't a bandwagon effect in which people were persuaded by a video just because a lot of other people watched it," said Hyunyi Cho, lead author of the study and professor of communication at The Ohio State University.

"The message itself was most important for persuasion."

The study will appear in the June 2021 issue of the journal Media Psychology.

The study involved 819 demographically diverse American adults aged 18-35.

Most of them were shown two YouTube videos either for or against vaping. The pro-vaping videos were commercials for e-cigarette brands. The anti-vaping videos were public service announcements produced by anti-smoking nonprofit organizations.

The researchers, though, manipulated the view numbers that participants saw for the videos. Participants saw view numbers either around 10, 100, 100,000 or 1,000,000.

Participants rated how persuasive the videos were to them: whether they affected their curiosity about e-cigarettes, positive attitude toward e-cigarette use, and susceptibility to using e-cigarettes in the future.

Results showed that participants were more persuaded when they rated them as more truthful and believable. The number of views that the video had did not have a direct impact on how much they were persuaded.

Participants were also asked how much they thought the videos they watched would influence other young adults, Cho said.

Results showed that how participants themselves viewed the videos - whether they thought the videos were believable and truthful - was directly related to their estimation of the videos' impact on other people.

"People focused more on self-related factors - how they felt about the video - when considering how much influence it would have on others," Cho said.

"They concentrated less on other-focused factors - such as view numbers - as a reason why a video might be persuasive."

In addition, participants in the study didn't think that mass media would have as far of a reach as social media would.

Some participants saw the videos in a mock TV condition rather than in the YouTube condition. Overall, participants in the TV condition estimated the videos would have fewer views than did the participants in the YouTube condition.

"Social media may be seen as more pervasive than mass media like television because sites like YouTube do not have the same geographic boundaries as mass media may have," Cho said.

Overall, the results suggest that people should not equate popularity of YouTube videos and other social media posts with how many people find their messages persuasive or are persuaded by them, Cho said.

"We may choose to watch a YouTube video because it has a lot of views, but that is different from whether we are persuaded by the message," she said.

Pregnant women who are hospitalized with COVID-19 and viral pneumonia are less likely than non-pregnant women to die from these infections, according to a new study by researchers with The University of Texas Health Science Center at Houston (UTHealth) and the University of Maryland School of Medicine (UMSOM).

The study was published today in Annals of Internal Medicine.

The study examined medical records from nearly 1,100 pregnant patients and more than 9,800 non-pregnant women ages 15 to 45 who were hospitalized with COVID-19 and pneumonia. Less than 1% of the pregnant patients died from COVID-19 compared to 3.5% of non-pregnant patients, according to the study findings.

Currently, the Centers for Diseases and Control and Prevention (CDC) say pregnant women are at a high risk of developing severe complications from COVID-19.

"We were surprised when we first analyzed the data," said Beth Pineles, MD, PhD, a maternal-fetal medicine fellow in the Department of Obstetrics, Gynecology and Reproductive Sciences with McGovern Medical School at UTHealth and first author of the study. "We had expected to confirm the results of the CDC and other U.S. researchers showing that pregnancy increases the risk for dying from COVID-19. However, once we compared our results to data from the UK and reviewed the CDC reports more carefully, we found confirmation that our results were likely to represent the true risks of COVID-19 in these populations, despite the limitation of pregnant women being younger and healthier than non-pregnant women."

Researchers found that pregnant patients were more likely to be younger and have fewer health conditions, including diabetes, obesity, hypertension, and chronic lung disease, compared to the non-pregnant patients. Given the small number of deaths seen in the study, researchers were unable to determine whether these conditions significantly affected the difference in mortality risk between pregnant and non-pregnant patients.

"At the start of the pandemic, the existing data showed that pregnant women would face severe complications if they contracted the virus," said Jacqueline Parchem, MD, assistant professor in the Department of Obstetrics, Gynecology and Reproductive Sciences with McGovern Medical School at UTHealth and co-author on the study. "While pregnant women are certainly susceptible to severe complications of COVID-19 including death, we view these data has reassuring that the absolute risk of death is low."

Pineles and Parchem still want to encourage pregnant women to wear their mask and get their COVID-19 shot. The risk of getting severely ill or dying is low, but it is still much higher than for healthy pregnant women without COVID-19.

"I think this is reassuring news for women who are pregnant and worried about getting infected with COVID-19 as new variants emerge," said Anthony Harris, MD, MPH, professor of epidemiology & public health at UMSOM and senior and corresponding author of the study.

New research presented at this year's European Congress on Obesity (held online, 10-13 May) shows that fat around the waist (abdominal obesity) is more important than general obesity as shown by body mass index (BMI) in predicting the severity of chest X-ray results in patients with COVID-19. The study is by Dr Alexis Elias Malavazos, I.R.C.C.S.Policlinico San Donato, San Donato Milanese, Italy, and colleagues.

Previous research has established that both chest x-ray (CXR) severity score and obesity are predictive risk factors for COVID-19 hospital admission. However, the relationship between abdominal obesity and CXR severity score is not fully explored. This retrospective cohort study analysed the association of different methods of measuring obesity, including waist circumference and body mass index (BMI), with CXR severity score in 215 hospitalised patients with COVID-19.

CXR severity scores are calculated by dividing each lung into 3 zones, and each zone scores a maximum of 3 points where from zero representing normal lung performance up to 3 points for the poorest lung function. Thus the maximum (and therefore worst) CXR score is 18 points.

In this study, a high CXR severity score was defined as 8 or over. Patients with abdominal obesity had significantly higher CXR severity scores (median 9) versus those without abdominal obesity (median 6). Of those with abdominal obesity, 59% had a high CXR score compared to 35% without abdominal obesity. Both findings were statistically significant.

When looking at the traditional method for determining obesity using BMI, there were no statistically significant differences in scores between those with normal weight, overweight or general obesity, while rates of high scores were also similar between groups (33% versus 39% versus 31% for normal weight, overweight and obesity, respectively, again not statistically significant).

Both waist circumference and waist-to-height ratio correlated more closely with CXR severity score than BMI, especially for high CXR severity scores. Analysis of and adjustment for multiple patient variables showed that abdominal obesity, bronchial asthma and oxygen saturation on admission were the only independent predictors of a high CXR severity score.

Patients with abdominal obesity were at a 75% increased risk of a higher CXR severity score (and therefore a worse COVID-19-related outcome) than those without abdominal obesity. Bronchial asthma increased the risk of a high CXR severity score by 73%, while high oxygen saturation in the blood (95% or higher) on admission to hospital reduced the risk of high CXR score by 4% compared with those patients with lower oxygen saturation.

The authors conclude: "Abdominal obesity might predict a high chest X-ray severity score better than general obesity in hospitalised patients with COVID-19. Therefore, in hospital, waist circumference should be measured and patients with abdominal obesity should be monitored closely."

New research presented at this year's European Congress on Obesity (held online, 10-13 May) reveals an association between increasing body mass index (BMI) and the risk of testing positive SARS-CoV-2, the virus which causes COVID-19. The study is by Dr Hadar Milloh-Raz, The Chaim Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Israel, and colleagues.

Obesity-related factors, including changes to the innate and adaptive immune systems brought on by excess weight, are believed to be associated with an increased risk of contracting various viral diseases. This association between BMI and viral infection risk suggests that a similar relationship may also exist between an individual's BMI and their risk of contracting SARS-CoV-2.

This study aimed to assess the relationship between BMI and likelihood testing positive in patients who were tested for SARS-CoV-2 at the largest medical centre in the Middle East. The team analysed the details of patients who had been tested for the virus during a 9-month period, collecting data on BMI, age, sex, and presence of comorbidities including congestive heart failure (CHF), diabetes mellitus (DM), hypertension (HTN), ischemic heart disease (IHD), stroke (CVA), and chronic kidney disease (CKD). The study did not look at COVID-19 mortality or outcomes, only the risk of testing positive.

At the start of the pandemic, the Chaim Sheba Medical Center introduced a policy in which all hospitalised patients were tested for COVID-19, regardless of their symptoms or reason for admission (whether they were suspected to have COVID-19, or for completely different reasons such as elective surgery, traffic accidents). In total 26,030 patients were tested across the study period (between March 16 and December 31, 2020), and 1,178 positive COVID-19 results were recorded. The numbers of patients in each BMI category and the proportion of positive tests varied as shown in the table:

https://drive.google.com/file/d/1kjCthuIJ33B2W8YIMCYnCIRlwR5VzgOP/view?usp=sharing

The authors found that the odds of testing positive for SARS-CoV-2 were significantly higher in patients who were overweight or obese compared to those with a normal BMI. Those patients classed as overweight (BMI 25.0-29.9 kg/m2) were 22% more likely to test positive than those of normal weight (BMI 18.5-24.9 kg/m2).

The likelihood of testing positive was even higher in patients with obesity relative to their normal weight counterparts, and those odds rose with increasing BMI. Class I obesity (BMI 30.0-34.9 kg/m2) was linked to a 27% higher risk of testing positive, which increased to 38% for class II obesity (BMI 35.0-39.9 kg/m2), and an 86% higher risk in class III or morbid obesity (BMI at or above 40.0 kg/m2).

The relationship between BMI and the probability of a patient testing positive remained significant even after adjusting for the age and sex of the patient and having accounted for any comorbidities that were present. The authors found that every 1 kg/m2 rise in a patient's BMI was associated with an increase of around 2% in the risk of testing positive for SARS-CoV-2.

The study also found both positive and negative associations between the risk of testing positive and the presence of comorbidities linked to obesity. Diabetes was associated with a 30% higher likelihood of testing positive, while the risk of testing positive was almost 6 times greater in patients with hypertension. Conversely, the authors found that the odds of a positive test were 39%, 55%, and 45% lower among patients with a history of stroke, IHD, and CKD, respectively. The authors cannot provide an explanation for why patients with stroke, IHD or CKD would have a lower risk of testing positive for SARS-CoV-2.

The authors conclude: "As BMI rises above normal, the likelihood of a positive SARS-CoV-2 test result increases, even when adjusted for a number of patient variables. Furthermore, some of the comorbidities associated with obesity appear to either be associated with an increased risk of infection or to be protective."

Researchers at KU Leuven (Belgium) have developed a 3D printing technique that extends the possibilities of lateral flow testing. These tests are widespread in the form of the classic pregnancy test and the COVID-19 self-tests. With the new printing technique, advanced diagnostic tests can be produced that are quick, cheap, and easy to use.

The COVID-19 pandemic has made everyone aware of the importance of rapid diagnosis. The sale of self-tests in pharmacies has been permitted in Belgium since the end of March. This self-test is a so-called lateral flow test. Using a wiper, a sample is taken through the nose. Next, it is dissolved in a solvent, and applied to the test kit. Absorbent material in the kit moves the sample downstream and brings it in contact with an antibody. If virus is present, a coloured line appears. The advantage of these tests is that they are cheap and do not require any specialised appliances.

Lateral flow tests are useful for simple tests that result in a yes-no answer, but not for tests that require a multi-step protocol. That is why bioengineers at KU Leuven set out to develop a new type of lateral flow test with more capabilities.

Precise prints

Using a 3D printer, the researchers fabricated a 3D version of a lateral flow test. The basis is a small block of porous polymer, in which 'inks' with specific properties are printed at precise locations. In this way, a network of channels and small 'locks' is printed that let the flow through or block it where and when necessary, without the need for moving parts. During the test, the sample is automatically guided through the different test steps. That way, even complex protocols can be followed.

The researchers evaluated their technique reproducing an ELISA test (Enzyme-Linked Immunosorbent Assay), which is used to detect immunoglobulin E (IgE). Ig E is measured to diagnose allergies. In the lab, this test requires several steps, with different rinses and a change in acidity. The research team was able to run this entire protocol using a printed test kit the size of a thick credit card.

Complexity is not a cost

"The great thing about 3D printing is that you can quickly adapt a test's design to accommodate another protocol, for example, to detect a cancer biomarker. For the 3D printer it does not matter how complex the network of channels is", says Dr. Cesar Parra. The 3D printing technique is also affordable and scalable. "In our lab, producing the Ig E prototype test costs about $ 1.50, but if we can scale it up, it would be less than $ 1," says Dr. Parra. The technique not only offers opportunities for cheaper and faster diagnosis in developed countries, but also in countries where the medical infrastructure is less accessible and where there is a strong need for affordable diagnostic tests.

The research group is currently designing its own 3D printer, which will be more flexible than the commercial model used in the current study. "An optimised printer is kind of like a mobile mini factory which can quickly produce diagnostics. You could then create different types of tests by simply loading a different design file and ink. We want to continue our research on diagnostic challenges and applications with the help of partners", concludes innovation manager Bart van Duffel.

Video: https://youtu.be/qRVa7X_LnV4

Ophthalmologists at New York Eye and Ear Infirmary of Mount Sinai have created a new technique to evaluate patients with sickle cell retinopathy and assess the disease before it progresses and leads to permanent vision loss.

Using optical coherence tomography (OCT) angiography--an advanced imaging system that captures the motion of red blood cells in blood vessels non-invasively--the researchers discovered that sequential imaging of affected retinal blood flow in sickle cell patients can help assess how the disease is progressing and how effective their treatment is for reducing focal vascular strokes. Their study was published in the May issue of Biomedical Optics Express.

"We have added a new dimension to ocular imaging technology that no one has thought of before. For the first time, we have shown that by doing rapid, repeated retinal imaging of sickle cell patients, you can see microscopic changes in blood vessels and blood flow. The more the blood flow fluctuates across images, the more at risk patients are for a permanent blockage, which severely damage their eyesight," says lead investigator Toco Chui, PhD, Director of the Marrus Adaptive Optics Laboratory at New York Eye and Ear Infirmary of Mount Sinai. "Using this approach, we can non-invasively monitor the retina over time and see how a patient is doing before or after initiation of therapy."

Sickle cell disease is an inherited red blood cell disorder caused by a mutation in hemoglobin. The hemoglobin folds abnormally and distorts red blood cells into a sickle shape; the sickle-shaped cells clump together and can block blood flow. This causes repeated damage to capillaries, which become inflamed and sticky, resulting in permanent blockages that can affect vision in the retina, and in some cases, major bleeding and retinal detachment.

"Our work can be a game-changer for sickle cell patients, especially for those who have no symptoms of retinopathy. It can lead to earlier diagnosis of retinal issues and prevention of irreversible blindness. Without this technology, it's impossible to judge their eye condition until patients report vision loss, when it's too late," says co-author Richard Rosen, MD, Belinda Bingham Pierce and Gerald G. Pierce, MD Distinguished Chair of Ophthalmology, and Chief of Retina Services for the Mount Sinai Health System.

The researchers analyzed 27 participants. Thirteen had sickle cell disease with retinopathy of varying severity levels; some were on standard therapy (hydroxyurea) and others were not on treatment. The remaining 14 were controls, with no sickle cell disease or retinopathy. The team used OCT angiography to image all subjects 10 times in a row over a 10-minute span. An hour later they repeated the imaging procedure. They analyzed the blood vessels that repeatedly opened and closed--a trait of sickle cell disease. When this happens, blood cannot flow freely and these blood vessels are at risk of permanent closure which can lead to blindness. For patients without sickle cell disease, scans showed that the blood vessels for the most part remained open, providing continuous blood flow.

For each patient, researchers stacked their groups of ten scans together and counted the blood vessels that "flickered." Healthy blood vessels remain white on all scans with no flickering, indicating consistent blood flow in the vessels. On all scans, the untreated sickle cell patients had substantially more flickering (more intermittent blood flow) than patients on treatment, indicating that treatment was effective. Patients with no sickle cell disease had no or very minimal blood flow fluctuations. Investigators used measurements of flicker frequency and locations of flickering to develop a computer algorithm for assessing risk of retinal blood blockages in sickle cell patients.

"For the first time ever in sickle cell disease, we have too many good drugs and we don't know well enough who should be on what, and what combinations work best. What we hope is that OCT angiography and this new algorithm can be used to solve this problem. Instead of following lab tests and waiting for horrible things to happen to the patient, for the first time we can use this technology to measure the number of vaso-occlusive events that are occurring on a new treatment regimen to find out if it is best for the patient," says Jeffery Glassberg, MD, Director of the Director of Mount Sinai's Comprehensive Sickle Cell Program.

Davis B. Zhou, a medical student from the Icahn School of Medicine at Mount Sinai, played an integral role in creating the algorithm for the study during his extended research elective in the Einhorn Center for Clinical Research at the New York Eye and Ear Infirmary of Mount Sinai.