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INDIANAPOLIS -- A team from Regenstrief Institute leveraged OpenMRS, a global open-source electronic medical record (EMR), to create an emergency EMR for Indianapolis first responders preparing for a possible influx of COVID-19 patients. This process was completed in a week to allow Indianapolis Emergency Medical Services (IEMS) to register patients, collect basic clinical information, and send these encounters to Indiana's health information exchange, a crucial element to help the response to the COVID-19 pandemic.

IEMS asked Regenstrief research scientists for help as they made plans to create a triage center to treat patients in case the health system in Indianapolis became overwhelmed with COVID-19 patients. IEMS needed a faster, easier way to collected patient information and to send these data to the Indiana Network for Patient Care (INPC), which is managed by the Indiana Health Information Exchange (IHIE). This way patient records would be accessible to health systems and doctors during future visits.

Most EMRs are from large software vendors and vary by health systems. IEMS did not have access to one.

"Our entire team jumped into action, employing the open source system available in OpenMRS," said Jonathan J. Dick, M.D., a project leader and member of Regenstrief's Global Health Informatics program. "We worked with IHIE and IEMS to create forms to enter relevant COVID-19 data into the INPC. Within one week, we were prepared to make the interface live. Thankfully, we never needed to break the glass because the healthcare systems in the state did not become overwhelmed."

This work demonstrates that it is possible to leverage existing tools to create EMRs in emergency situations to improve crisis response.

"We learned valuable lessons from this experience that can be applied to future emergencies. This system can be adapted to work in other states or even countries, and it can be done very quickly," said Burke Mamlin, M.D., a project leader and member of Regenstrief's Global Health Informatics program. "This shows the value of open source and how it can lead to global goods that can benefit us in the United States."

Regenstrief Institute helped to found OpenMRS, which is used to build and manage health systems in underserved countries. The institute continues to be a leader in the worldwide volunteer network, helping with technical direction, implementation and innovation.

The process of creating the EMR was laid out in the peer-reviewed paper "OpenMRS as an Emergency EMR - How we used a Global Good to create an Emergency EMR in a Week" published in the International Journal of Medical Informatics online ahead of print.

In addition to Dr. Mamlin and Dr. Dick, other authors on the paper are Jennifer E. Shivers, MFA, of Regenstrief Institute and Nancy K. Glober, M.D., of Indiana University School of Medicine.

About Regenstrief Institute
Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute's research mission.

About OpenMRS
OpenMRS is a platform that countries and implementers use to create a customized EMR system in response to actual needs on the ground. OpenMRS is also a global community of contributors who build and maintain the OpenMRS platform and other, foundational OpenMRS technical products. The OpenMRS community brings together a diverse group of individuals with expertise in healthcare, global health, software development, quality assurance, and implementation. These contributors bring a wide range of skill sets together and work collaboratively to build and maintain a robust, electronic medical record system platform.

About Jonathan (J.J.) Dick, M.D.
In addition to his role as a research scientist at Regenstrief, Jonathan (J.J.) Dick, M.D., is an assistant professor of clinical medicine at Indiana University School of Medicine. He also serves as the chief medical information officer for AMPATH.

About Burke Mamlin, M.D.
In addition to his role as a research scientist at Regenstrief, Burke Mamlin, M.D., is an associate professor of clinical medicine at Indiana University School of Medicine.

Scientists have shown that the biological molecule PD-L1 is a potential target for the treatment of metastasized oral malignant melanoma in dogs.

There are a number of cancers that affect dogs, but there are far fewer diagnosis and treatment options for these canine cancers. However, as dogs and humans are both mammals, it is likely that strategies and treatments for cancers in humans can be used for canine cancer, with minor modifications.

A team of scientists, including Associate Professor Satoru Konnai from the Faculty of Veterinary Medicine at Hokkaido University, have demonstrated that an anti-cancer therapy that targets the cancer marker PD-L1--a target that has shown great promise for treating cancer in humans--is effective for canine cancer as well. Their findings were published in the journal npj Precision Oncology.

The proteins Programmed Cell Death 1 (PD-1) and its associated molecule, PD-ligand 1 (PD-L1) are involved in the immune response in humans. PD-L1 is overexpressed by many types of cancer in humans, enabling these cancers to suppress the immune response. Studies in mice models and in human cell lines have shown that PD-1 and PD-L1 have great promise in the treatment of cancer as blocking them strengthens the immune response to cancer.

Malignant melanomas are a canine cancer that is both relatively common and fatal. In particular, oral malignant melanomas (OMMs) are highly invasive and metastatic; with treatment, the median survival time is less than two months. As new treatments are needed for this cancer, the scientists chose to explore the options available.

The scientists first developed a novel anti-PD-L1 monoclonal antibody to detect PD-L1 in various canine cancers by immunohistochemical staining. Using this antibody, they demonstrated that malignant canine cancers expressed PD-L1; out of 20 samples for each cancer tested, nasal adenocarcinoma, transitional cell carcinoma, osteosarcoma and mammary adenocarcinoma had a 100% positive rate, while anal sac gland carcinoma and OMM had a 95% positive rate.

A prior pilot study had shown that another canine chimeric anti-PD-L1 monoclonal antibody had anti-tumor effect against OMM, when tested on nine dogs. For the current study scientists selected 29 dogs with primary OMM and pulmonary metastasis, where the melanoma has spread to the lungs, and most of which had been subjected to at least one round of treatment. These dogs were treated with the chimeric antibody every two weeks, and other interventions to achieve local control of cancer were allowed.

The survival time of dogs treated with the chimeric antibody was significantly longer, with a median survival time of 143 days, compared to 54 days for the control group, from historical data. Thirteen dogs had measurable cancer (i.e., at least one tumor >10 mm in diameter in CT scan), while 16 had non-measurable cancer (all tumors

"Our findings are limited by the small size of the historical control group," says Satoru Konnai. "Nevertheless, as there is no systemic therapy that prolongs the survival of dogs with pulmonary metastatic OMM, the increased survival time encourages the further development of anti-PD-L1 therapy in dogs."

Notch proteins are key regulators of growth and differentiation of both normal and cancer cells. Researchers in Turku, Finland, have now demonstrated that the activities of distinct Notch family members are modified differently by phosphorylation. These results can be used in the development of new cancer treatments, especially for hormone-dependent breast cancer.

Breast cancer is the most common type of cancer in women in Finland and other Western countries. Due to the availability of hormonal therapies, the estrogen-responsive breast cancer cases have a relatively good prognosis as compared to other breast cancer subtypes. However, some of them can also develop into an aggressive, metastatic disease, for which new types of therapeutic ideas are needed.

Research groups led by Dr Päivi Koskinen from the University of Turku and Professor Cecilia Sahlgren from Åbo Akademi University have been investigating the interactions of PIM and Notch proteins in cancer cells. The PIM kinases are enzymes that phosphorylate other proteins, whereas Notch proteins are transmembrane receptors, the intracellular part of which can be released and translocated to the nucleus to regulate the expression of Notch target genes.

While overexpression of PIM kinases has been shown to support survival and metastatic motility of cancer cells, the roles of distinct Notch family members have remained less clear in the development of cancer.

"We have now shown that PIM kinases phosphorylate the intracellular domains of both Notch1 and Notch3 proteins. To our surprise, phosphorylation is targeted to distinct sites of these structurally highly similar proteins," tells University Teacher Niina Santio from the University of Turku.

"Phosphorylation stimulates the transcriptional activity of Notch1 but has the opposite effects on Notch3. Yet, both act as oncogenes when they are phosphorylated, which is also surprising," states Postdoctoral Researcher Sebastian Landor from Åbo Akademi University.

In addition to experiments carried out with cultured cells and chick embryo xenografts, patient databases were analysed. This analysis revealed that the overexpression of both PIM1 and Notch3 is connected to poor prognosis in advanced cases of estrogen-responsive breast cancer.

"The clinical data together with our experimental observations suggest that drugs targeting PIM or Notch proteins might be able to provide new treatment options especially for the most difficult cases of breast cancer," says Niina Santio.

BOSTON - Legislation currently under consideration in the U.S. Congress would increase regulatory oversight of certain diagnostic tests, and a new study by researchers at Massachusetts General Hospital (MGH) and colleagues from several other institutions demonstrates that its potential impact will depend on key details in the bill's final language. This study, published in JCO Oncology Practice, offers the first evidence-based analysis of how new rules proposed for the regulation of laboratory-developed tests (LDTs) could affect health care costs in the United States.

"The idea of having more oversight of LDTs is justified," says Jochen Lennerz, MD, PhD, medical director of the MGH Center for Integrated Diagnostics (CID) and the study's senior author. "But our results show that it's very important to align the language in this new law with the intent of what it's trying to accomplish."

From a regulatory standpoint, there are two categories of in vitro clinical tests (IVCTs), which include diagnostic tests performed in a test tube, culture dish, or elsewhere outside a living organism. Manufactured tests for many different conditions are commercially available. The Food and Drug Administration (FDA) closely regulates these tests, requiring manufacturers to submit data for premarket approval before they can be sold. However, clinical laboratories at hospitals and in other health care settings can create their own IVCTs for use in-house, which are known as LDTs. Currently, the FDA does not require premarket approval of LDTs and exercises little oversight of their use.

LDTs serve a variety of purposes, but one critically important role is identifying patients for novel drug therapies that target specific DNA variations, particularly if a commercial test is not yet available. This form of therapy, known as personalized medicine, is becoming increasingly important in cancer treatment.

Unfortunately, faulty IVCTs can produce inaccurate results, causing some patients to forgo potentially beneficial treatments and others to receive unnecessary and potentially harmful therapies. The proposed legislation, currently known as the Verifying Accurate and Leading-edge IVCT Development (VALID) Act, clarifies the authority of the FDA over all diagnostics tests.

If passed, VALID would focus on so-called high-complexity IVCTs, which have the greatest potential for patient harm if the results are incorrect. To comply with VALID, clinical laboratories would have to demonstrate accuracy of their LDTs, which includes a process called technology certification.

Lennerz believes that the stringency of how VALID is interpreted, which is not currently defined in the bill, will influence whether the proposed law can improve the quality of LDTs without significantly increasing future health care costs. He joined lead author Richard Huang, MD, and several colleagues in an effort to model the overall expense of maintaining the technology certification framework under VALID for cancer diagnostics. They based their estimates on 2019 data from CID, which performs more than 10,000 high-complexity LDTs for MGH patients each year.

The study found that maintenance costs for a lab performing that volume of LDTs would be $638,000 a year under low stringency and slightly higher ($685,000) under moderate stringency, but soar to $1.2 million under highly stringent enforcement. Extrapolating that data to reflect the added expense for the nation's 886 cancer treatment centers, complying with VALID would increase U.S. health care costs by $565 million, $606 million, or $1.1 billion over a three-year period, depending on stringency of enforcement.

Lennerz believes the study's important contribution is putting a price tag on VALID, which no one has yet done. "The key finding is that maintaining this new infrastructure will come at a cost," he says.

And while those numbers may seem high to some, they should be kept in perspective, says study co-author Jeff Allen, president and CEO of Friends of Cancer Research, a nonprofit patient advocacy organization in Washington, D.C.: "In the United States, we consistently see increases in health expenditures in the realm of $200 billion annually." Even with added FDA enforcement, the increased costs of VALID amounts to less than 0.5% of annual increased expenditures, he notes. "At the gain of assured quality in testing, the avoidance of medical errors, and improved support for medical decisions, the costs offset. But most important, patient care will improve," says Allen. VALID has bipartisan support in both houses of Congress, which will likely begin debate on the bill in early summer.

OAK BROOK, Ill. - An artificial intelligence-driven system that automatically combs through brain MRIs for abnormalities could speed care to those who need it most, according to a study published in Radiology: Artificial Intelligence.

MRI produces detailed images of the brain that help radiologists diagnose various diseases and damage from events like a stroke or head injury. Its increasing use has led to an image overload that presents an urgent need for improved radiologic workflow. Automatic identification of abnormal findings in medical images offers a potential solution, enabling improved patient care and accelerated patient discharge.

"There are an increasing number of MRIs that are performed, not only in the hospital but also for outpatients, so there is a real need to improve radiology workflow," said study co-lead author Romane Gauriau, Ph.D., former machine learning scientist at Massachusetts General Hospital and Brigham and Women's Hospital Center for Clinical Data Science in Boston. "One way of doing that is to automate some of the process and also help the radiologist prioritize the different exams."

Dr. Gauriau, along with co-lead author Bernardo C. Bizzo, M.D., Ph.D., and colleagues, and in partnership with Diagnosticos da America SA (DASA), a medical diagnostics company in Brazil, developed an automated system for classifying brain MRI scans as either "likely normal" or "likely abnormal." The approach relies on a convolutional neural network (CNN), a sophisticated type of AI that allows the model to learn directly from the images.

The researchers trained and validated the algorithm on three large datasets totaling more than 9,000 examinations collected from different institutions on two different continents.

In preliminary testing, the model showed relatively good performance to differentiate likely normal or likely abnormal examinations. Testing on a validation dataset acquired at a different time period and from a different institution than the data used to train the algorithm highlighted the generalization capacity of the model. Such a system could be used as a triage tool, according to Dr. Gauriau, with the potential to improve radiology workflow.

"The problem we are trying to tackle is very, very complex because there are a huge variety of abnormalities on MRI," she said. "We showed that this model is promising enough to start evaluating if it can be used in a clinical environment."

Similar models have been shown to significantly improve turnaround time for the identification of abnormalities in head CTs and chest X-rays. The new model has the potential to further benefit outpatient care by identifying incidental findings. An incidental finding is an abnormality not related to the reason the physician ordered the test.

"Say you fell and hit your head, then went to the hospital and they ordered a brain MRI," Dr. Gauriau said. "This algorithm could detect if you have brain injury from the fall, but it may also detect an unexpected finding such as a brain tumor. Having that ability could really help improve patient care."

The work was the first of its kind to leverage a large and clinically relevant dataset and use full volume MRI data to detect overall brain abnormality. The next steps in the research include evaluating the model's clinical utility and potential value for radiologists. Researchers would also like to develop it beyond the binary outputs of "likely normal" or "likely abnormal."

"This way we could not only have binary results but maybe something to better characterize the types of findings, for instance, if the abnormality is more likely to be related to tumor or to inflammation," Dr. Gauriau said. "It could also be very useful for educational purposes."

Further evaluation is currently ongoing in a controlled clinical environment in Brazil with the research collaborators from DASA.

MINNEAPOLIS - Intracerebral hemorrhage is a life-threatening type of stroke caused by bleeding within the brain tissue. Survivors are at high risk of having another bleeding stroke. Most of these strokes are caused by changes in the narrowest blood vessels in the brain, a condition known as cerebral small vessel disease. A new study has found that differences in the extent of one type of cerebral small vessel disease may contribute to differences in people's risk for a second bleeding stroke. The research is published in the April 21, 2021, online issue of Neurology®, the medical journal of the American Academy of Neurology.

Cerebral small vessel disease is an umbrella term for a number of conditions that involve changes in the smallest blood vessels in the brain. These changes become more common with age and can lead to stroke. One type of cerebral small vessel disease is hypertensive arteriopathy, which is arterial degeneration resulting from high blood pressure.

"While Black and Hispanic bleeding stroke survivors in the United States display greater hypertension severity and higher blood pressure variability, these differences in hypertension control do not fully account for disparities in bleeding stroke recurrence risk," said study author Alessandro Biffi, M.D., of Massachusetts General Hospital in Boston, and a member of the American Academy of Neurology.

The study looked at 922 people who had survived a bleeding stroke. Of the group, 655 identified as white, 130 Black and 137 Hispanic. People were interviewed three months after their first stroke and every six months afterwards for an average of 18 months to about two years to determine if they had had a second stroke. Medical records were also reviewed.

During that time, 111 people had a second bleeding stroke, including 64 white people, 24 Black people and 23 Hispanic people. After researchers adjusted for other factors that could affect stroke risk such as age and sex, they found that on average, Black people were 60% more likely to have another bleeding stroke than white people. Hispanic people were 50% more likely to have another bleeding stroke than their white counterparts.

Researchers looked at the people's brain scans for markers of cerebral small vessel disease and subtypes, including hypertensive arteriopathy. For this subtype, they rated the severity of four markers on a scale of zero to four. For example, one point was given for the presence of a certain type of white matter hyperintensities, which are brain lesions that are signs of brain damage; another point for a kind of cerebral microbleeds, which are small deposits of blood in the brain.

The average score for white people was 1.5 points compared to an average of 2.5 points for Black people and Hispanic people.

Researchers found that people who had more small vessel disease markers right after their first stroke were at higher risk for a second stroke. They also found that people with greater severity of hypertensive arteriopathy were at increased risk of second stroke.

"In the United States, people who are Black or Hispanic often do not have the same access to preventive and curative health care as white people do," Biffi said. "That may explain why in this study, Black and Hispanic people were more likely to have changes show up on their MRI that are markers for cerebral small vessel disease, particularly one associated with high blood pressure. This may also explain why those groups have a higher risk of a second stroke."

A limitation of the study is that most participants were from care centers with expertise in stroke care. As a result, the study may have included more people with more severe strokes and greater amounts of cerebral small vessel disease than the general population.

WHO Peter Libby, MD, cardiovascular medicine specialist at Brigham and Women's Hospital and the Mallinckrodt Professor of Medicine at Harvard Medical School; author of a new review paper published in Nature.

WHAT Atherosclerosis -- hardening of the arteries -- is now involved in the majority of deaths worldwide, and advances in our understanding of the biology of the disease are changing traditional views and opening up new avenues for treatment.

The picture of who may be at risk for a heart attack has evolved considerably in recent decades. At one time, a heart attack might have conjured up the image of a middle-aged white man with high cholesterol and high blood pressure who smoked cigarettes. Today, traditional concepts of what contributes to risk have changed. These updated views include new thinking around:

Global disease burden: Atherosclerotic cardiovascular disease is now the leading cause of death worldwide.

Clinical profile: Women, younger individuals, and people of diverse backgrounds bear an increasing burden of atherosclerotic cardiovascular disease.

Role of "good cholesterol": The protective role of HDL cholesterol (so-called "good cholesterol") has been called into question and triglycerides have emerged as a promising target for reducing heart disease risk.

Inflammation drives atherosclerosis: New data suggests that inflammation may be a critical link between traditional risk factors such as abnormal lipids, smoking, and diabetes and complications of atherosclerosis including heart attack and stroke.

"Advances in our understanding of the biology of atherosclerosis have opened avenues to therapeutic interventions that promise to improve the prevention and treatment of now-ubiquitous atherosclerotic diseases," writes Libby. "From a therapeutic perspective, we have reason for optimism in addressing the growing burden of atherosclerotic risk."

Two of the COVID-19 vaccines currently approved in the United States require two doses, administered three to four weeks apart, however, there are few data indicating how best to minimize new infections and hospitalizations with limited vaccine supply and distribution capacity. A study published on 21st April, 2021 in the open access journal PLOS Biology by Seyed Moghadas at York University in Toronto, Canada, and colleagues suggests that delaying the second dose could improve the effectiveness of vaccine programs.

The emergence of novel, more contagious SARS-CoV-2 variants has led to a public health debate on whether to vaccinate more individuals with the first dose of available vaccines and delay the second dose, or to prioritize completion of the two-dose series based on tested schedules in clinical trials.

In order to compare the epidemiological impact of each vaccination strategy, researchers built a mathematical model that simulated both COVID-19 transmission and various delayed second dose vaccination schedules. The model simulated several scenarios, including a range of levels of preexisting immunity in the population and decreased vaccine efficacy of the first dose when followed by a longer interval between doses.

The authors found that delaying the second dose for 9-15 weeks after the first dose avoided more hospitalizations, infections, and deaths compared to following the recommended schedules for Moderna and Pfizer-BioNTech vaccines.

The authors note that the study has several limitations, including a lack of clinical evidence quantifying the durability of the vaccines when administered under different schedules. Researchers thus assumed that protection levels of the first dose were stable if second doses were delayed, and that the protection level after delaying second doses was identical to overall protection after two doses when vaccinating according to schedule. Further studies are needed to pinpoint the optimal time between doses for each type of vaccine.

According to the authors, "When racing against a burgeoning outbreak, our results show that prioritizing vaccine coverage with rapid distribution of the first dose would be critical to mitigating adverse outcomes and allow the healthcare system to also address non-COVID-19 medical needs of the population."

"We still do not have the full picture of vaccine effectiveness as new and more contagious variants spread. Efficacy of vaccines against these variants is an additional factor that would need to be considered in determining the outcomes of on-time versus delayed second dose and interval between doses," said Moghadas, the lead author of the study.

Boston, MA - In a worldwide survey, pregnant and postpartum women reported high levels of depression, anxiety, loneliness, and post-traumatic stress during the COVID-19 pandemic, according to researchers at Harvard T.H. Chan School of Public Health. Such high levels of distress may have potential implications for women and for fetal and child health and development, according to the study.

The study will be published online in PLOS ONE on April 21, 2021.

"We expected to see an increase in the proportion of pregnant and postpartum women reporting mental health distress, as they are likely to be worried or have questions about their babies' health and development, in addition to their own or their family's health," said study senior author Karestan Koenen, professor of psychiatric epidemiology at Harvard Chan School. "However, the number of women who had significantly elevated symptoms was much larger than what had previously been published during the pandemic."

Koenen and her co-authors were interested in pregnant and postpartum women because prior research suggests that perinatal mental health problems can adversely impact not only women's own health but also infant outcomes, mother-infant bonding, and children's health over time. To gauge the mental health of pregnant and postpartum women during the pandemic, the researchers conducted an anonymous, online, cross-sectional survey of women in 64 countries between May 26, 2020 and June 13, 2020. The survey, available in 12 languages, was hosted on the Pregistry platform for COVID-19 studies.

Of the 6,894 participants, substantial proportions of women scored at or above the cutoffs in widely-used psychological screening tools for elevated levels of anxiety/depression (31%), loneliness (53%), and post-traumatic stress in relation to COVID-19 (43%), despite the fact that only 117 women (2%) had been diagnosed with COVID-19 and 510 (7%) had been in contact with someone with COVID-19. The levels of psychiatric distress were significantly higher than previously published data on such distress in the general population during the pandemic and among pregnant and postpartum women before the pandemic.

Certain factors were linked with worse mental health among the women surveyed. Seeking information about the pandemic five or more times a day from any source (e.g., social media, news, or word-of-mouth) was associated with more than twice the odds of elevated post-traumatic stress in relation to COVID-19 and anxiety/depression. Worries about children and childcare and economic worries were also important factors in women's mental health.

The majority of participants reported engaging in COVID-19 prevention behaviors (e.g., 93.3% reported practicing hand hygiene and 84.5% reported wearing a face mask) but these behaviors were not associated with anxiety or depression symptoms.

First author Archana Basu, research scientist of the Department of Epidemiology, said that the study's results indicate that public health campaigns and medical care systems should explicitly address the impact of COVID-19-related stressors on mental health in pregnant and postpartum women.

"In addition to screening and monitoring mental health symptoms, addressing potentially modifiable factors such as excessive information seeking and women's worries about access to medical care and their children's well-being, and developing strategies to target loneliness, such as online support groups, should be part of intervention efforts for perinatal women," Basu said.

Other Harvard Chan School researchers who contributed to the study include Hannah Hayoung Kim, Rebecca Basaldua, Nora Kelsall, and Sonia Hernández-DÍaz.

"A cross-national study of factors associated with women's perinatal mental health and wellbeing during the COVID-19 pandemic," Archana Basu, Hannah Hayoung Kim, Rebecca Basaldua, Karmel W. Choi, Lily Charron, Nora Kelsall, Sonia Hernández-Díaz, Diego F. Wyszynski, and Karestan C. Koenen, PLOS ONE, online April 21, 2021, doi: 10.1371/journal.pone.0249780

Plenty of people struggle to make sense of a multitude of converging voices in a crowded room. Commonly known as the "cocktail party effect," people with hearing loss find it's especially difficult to understand speech in a noisy environment.

New research suggests that, for some listeners, this may have less to do with actually discerning sounds. Instead, it may be a processing problem in which two ears blend different sounds together - a condition known as binaural pitch fusion.

The research, co-authored by scientists at Oregon Health & Science University and VA Portland Health Care System, was published today in the Journal of the Association for Research in Otolaryngology.

The study's lead author attributes these difficulties to abnormally broad binaural pitch fusion in people with hearing impairment. The new study suggests that, for people with hearing impairment, fusing of different sounds from both ears leads to sound blending together in a way that is often unintelligible.

"This differs from what people with normal hearing experience in what is known as the 'cocktail party effect,'" said Lina Reiss, Ph.D., associate professor of otolaryngology/head and neck surgery in the OHSU School of Medicine. "People with normal hearing can separate and understand the multiple voices, but they just get confused about which voice is saying what."

Reiss, who has hearing impairment herself and is part of the Oregon Hearing Research Center at OHSU, previously co-authored research in 2018 that first demonstrated broad binaural pitch fusion in hearing impairment. Together with another study showing blending of the fused pitches, the research suggested the possibility that similar fusion and blending could occur with sounds in speech.

The new study put the theory to the test.

Researchers with OHSU and the VA's National Center for Rehabilitative Auditory Research recruited 11 people with normal hearing and 10 with hearing loss. Participants were fitted with headphones in a double-walled, sound-attenuated booth in OHSU's Hatfield Research Center.

Two vowel sounds were played simultaneously through the headphones, with a different vowel sound played to each ear, and with voice pitch varying between male and female voices. Participants were then asked to respond on a touchscreen to identify the specific vowel sounds.

Using statistical analysis, researchers definitively revealed that people with hearing loss experienced abnormal fusion of speech across both ears, even for different voice pitches.

When different vowel sounds were fused, participants heard an entirely new vowel sound. For example, the vowel "ah" (as in "hot") spoken by a female talker would fuse with the vowel "ee" (as in "heed") spoken by a male talker, and be heard as "eh" (as in "head").

"Abnormal binaural fusion may provide a new explanation for the difficulties that hearing-impaired listeners have with understanding speech in multi-talker environments," the authors concluded.

Reiss called it a breakthrough, suggesting the possibility of new therapies to improve the perception of speech among the millions of people worldwide with hearing impairment.

"This suggests more targeted rehabilitation strategies to improve speech perception in noise," she said.

By targeting a receptor in the brains of mice, researchers have successfully altered feeding and anxiety-like behaviors linked to anorexia. Although more work is needed in humans, their study suggests that fine-tuning the receptor's activity could help change feeding habits and promote weight gain in patients with eating disorders. Anorexia and other eating disorders affect at least 28 million Americans and cause more than 10,000 deaths in the U.S. each year, according to the National Association of Anorexia Nervosa and Associated Disorders. Studies have linked anorexia to neurons that bear a protein named AgRP; these neurons reside in an area of the brain called the hypothalamus that controls feeding behavior. Researchers have found that removing AgRP neurons leads to fatal anorexia in mice, while activating the neurons results in excessive appetite and obesity. However, there are currently no approved drugs that can target these neurons and change feeding behaviors. In this study, Patrick Sweeney and colleagues discovered that AgRP-bearing neurons controlled feeding in mice via a receptor named MC3R. Deleting MC3R led to anorexia and anxious behavior in the rodents, but activating the receptor with the experimental molecule C18 instead stimulated the rodents' appetites, boosted weight gain, and prevented anxious movement. Interestingly, the team also observed that the Mc3r gene showed sex-specific differences. Female mice had far higher amounts of Mc3r-expressing neurons in the AVPV region of the hypothalamus, and the team also noted sex-specific differences in MC3R expression while analyzing a human transcriptomic dataset. Sweeney et al. speculate that targeting MC3R could either treat anorexia or promote weight loss in obesity and call for safety studies in humans.

Severe cases of COVID-19 can involve extensive inflammation in the body, and clinicians have wondered if this state is similar to what are called cytokine storm syndromes, in which the immune system produces too many inflammatory signals that can sometimes lead to organ failure and death. A new study published in Arthritis & Rheumatology indicates that different markers in the blood clearly differentiate excessive inflammation in critical COVID-19 from cytokine storm syndromes.

The research, which was led by investigators at University Children's Hospital Muenster in Germany, will be useful when deciding which medications to use in different patients. For example, targeting some key molecules and pathways associated with cytokine storm syndromes may not be effective for treating patients with COVID-19.

"When we first became aware of a possible association of particularly critical COVID-19 with cytokine storm, this was intriguing for us, as in the field of autoinflammation we are treating and investigating such conditions on a regular basis," said lead author Christoph Kessel, PhD.

"Our present research delivers broad insights on the nature and significance of systemic hyperinflammation following SARS-COV-2 infection," added co-lead author Richard Vollenberg, MD. "We consider this relevant as we still lack proper angles of attack to treat critically ill patients."

A new study published in Acta Obstetricia et Gynecologica Scandinavica found that taking a particular probiotic strain improves iron levels in healthy pregnant women and may therefore help to prevent iron deficiency.

A total of 326 healthy women were randomized to receive a placebo or the probiotic strain Lactiplantibacillus plantarum 299v (Lp299v) administered with a low dose of iron, folic acid, and ascorbic acid. They took the placebo or the combination product twice daily during pregnancy.

Compared with taking placebo, taking the probiotic product reduced the prevalence of iron deficiency (78% versus 59%) and iron deficiency anemia (21% versus 7.4%) towards the end of pregnancy. (When a person develops iron deficiency anemia, the body cannot get the amount of oxygen it needs.)

Iron deficiency is common in women of childbearing age and is a global health problem. In a pregnant woman, this can lead to a number of complications for the mother and her child.

"We have previously shown that the Lp299v strain together with a low dose of iron increase iron absorption. With this study, we proved that this translates into an improved iron status in pregnant women," said lead author Ulrika Axling, PhD, of Probi AB, in Sweden. "Iron deficiency is especially common during pregnancy and high-dose iron supplements are often recommended. Since these typically come with side effects such as stomach pain and constipation, there is a need for new solutions. This probiotic product could offer a novel and safe approach for improving iron status during pregnancy."

After undergoing treatment for cancer, patients may worry that the disease will recur. An analysis of published studies indicates that fear of cancer recurrence may lead to an increased use of healthcare resources--such as more visits to see physicians and greater use of medications--by cancer survivors.

The analysis, which is published in Psycho-Oncology, also found evidence that some interventions to address fear of cancer recurrence are likely to be cost?effective for reducing fear and improving quality of life.

"The possibility of cancer returning causes a great mental health cost for cancer survivors, but there is also a hidden cost to the healthcare system. Globally, millions of cancer survivors struggle with fear of cancer recurrence, despite the existence of effective interventions that would save both money and distress," said lead author Jake Williams, MPH, of the University of Sydney, in Australia. "Implementing existing effective interventions for fear of cancer recurrence may improve both cancer survivors' mental health and reduce their unnecessary healthcare usage."

A Wireless Sensor Network--a set of sensor nodes placed in different locations that sense their surroundings and transmit sensed data--can have a range of applications related to the environment, healthcare, transportation, security, and other areas. An analysis of published research provides an overview of the ability of "mobile elements" to improve terrestrial and underwater Wireless Sensor Networks.

As described in the analysis published in the International Journal of Communication Systems, mobile elements improve communication between sensor nodes by visiting static sensor nodes and collecting their data. This leads to a decrease in energy consumption, improvement in energy efficiency, and extension of the network lifetime.