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NEW YORK, NY--Treatments for a rare retinal disease may be on the horizon after a new study has identified gene variants that cause a metabolic deficiency in the eye.

The disease, macular telangiectasia type 2 (MacTel), has been a research focus of Rando Allikmets, PhD, a pioneer in the genetics of eye diseases, for nearly 15 years. MacTel occurs in approximately 1 in 5,000 adults over age 40 and slowly causes a significant loss of central vision, which can impair driving, reading, and other activities.

"MacTel is clearly a genetic disease because it tends to run in families, but it's been a tough nut to crack," says Allikmets, the William and Donna Acquavella Professor of Ophthalmic Sciences in the Departments of Ophthalmology and Pathology & Cell Biology at Columbia University Vagelos College of Physicians and Surgeons.

"For many years, we didn't know what was causing the disease, and we couldn't find any genes that would give us some clues."

That began to change a few years ago when Allikmets and an international team of MacTel researchers led by Lowy Medical Research Institute identified two extremely rare mutations that cause the disease.

These genes account for only 0.1% of cases, but their discovery, also made possible by advances in the emerging field of metabolomics, led to a new view of MacTel as a disease of serine deficiency. Serine is one of 20 amino acids that play an important role in metabolism in the eye and throughout the body.

In a landmark study published in NEJM in 2019, the team found that most MacTel patients, regardless of their genetic makeup, have a serine deficiency that leads to the accumulation of a toxic lipid that damages cells in the retina. Some degree of serine deficiency is prevalent in the general population, and some of these individuals can develop various diseases, including MacTel. However, the exact genetic cause is not known for the vast majority of cases.

PHGDH Accounts for 3% to 4% of Cases

Now the team has uncovered another gene that solidifies the link between MacTel and serine deficiency and points the way to effective treatment. Allikmets, working with David Goldstein, PhD, and the Institute of Genomic Medicine at Columbia, used a recently developed method, called collapsing analysis, that can pinpoint difficult-to-find genes.

The researchers found that mutations in the new MacTel gene, PHGDH, directly reduce serine levels by partially disabling phosphoglycerate dehydrogenase, the most important enzyme involved in serine biosynthesis.

And though PHGDH accounts for only about 3% to 4% of MacTel cases, "its identification is significant because it causes the same disease features that we see in a substantial number of patients with MacTel," Allikmets says.

"That suggests that fixing the serine deficiency or targeting the toxic lipids may be a way to prevent vision loss in many MacTel patients, regardless of the patient's precise genetic defect."

Though the MacTel field is hopeful that treatment options are not far away, Allikmets adds that new therapeutic ideas must be tested first in clinical trials and may not be available for several years.

GALVESTON, Texas - A new study conducted at the Galveston National Laboratory at the The University of Texas Medical Branch at Galveston (UTMB) has shown substantial benefit to combining monoclonal antibodies and the antiviral remdesivir against advanced Marburg virus. The study was published today in Nature Communications.

"Marburg is a highly virulent disease in the same family as the virus that causes Ebola. In Africa, patients often arrive to a physician very ill. It was important to test whether a combination of therapies would work better with really sick people, said Tom Geisbert, a professor in the Department of Microbiology & Immunology at UTMB and the principal investigator for the study. "Our data suggests that this particular combination allowed for recovery when given at a very late stage of disease."

Dr. Zachary A. Bornholdt, Senior Director of Antibody Discovery and Research for Mapp Biopharmaceutical and a co-author on the study, said, "Often small molecules and antibodies are positioned to compete with each other for a single therapeutic indication. Here we see the benefit of pursuing both treatment strategies in tandem and ultimately finding synergy upon combining both approaches together."

Geisbert, Bornholdt and a large team at UTMB, Mapp Biopharmaceuticals and Gilead have been developing monoclonal antibody (mAbs) therapies to treat extremely dangerous viruses like Marburg and Ebola for several years. The treatments have proven to be highly effective in laboratory studies and emergency use, particularly when delivered early in the disease course.

In this study, using a rhesus model, treatment with monoclonal antibodies began six days post infection, a critical point in disease progression. The combination therapy with the antiviral remdesivir showed an 80 percent protection rate, indicating promise for treatment of advanced Marburg infections.

New Edith Cowan University (ECU) research has found that despite having the best intentions, most people give up on their New Year resolutions within the first month.

The study also revealed that approximately half the people surveyed had the same, or nearly the same, resolution as in the previous year, and more than half of the resolutions listed focused on either diet or exercise.

The research, led by ECU Associate Professor Joanne Dickson, investigated personal goal factors that predicted greater wellbeing and sticking with one's most important New Year resolution over time. Around 180 Australian and UK participants took part in an online survey over a two-month period. The average age of participants was 37 years and ranged from 18 to 77 years.

Key findings:

Two thirds of participants gave up on their New Year resolutions within the first month.

Just over half the participants pursued the same (or similar) resolution as in the previous year.

More than half of the resolutions focused on either diet (29%) or exercise (24%).

Approximately two thirds (64%) of the listed resolutions were described as 'general'. A general resolution referred to an overly general or vague resolution (e.g. to get fit).

Flexibility around achieving goals significantly predicted greater wellbeing over time.

Goal tenacity (being persistent) did not predict wellbeing over time, nor the ability to stick to one's most important New Year resolution.

No significant gender or age or country differences were seen.

Set specific resolutions

Despite participants reporting a strong commitment to their most important New Year resolution and a belief that they would succeed, about two thirds of participants gave up within one month.

Professor Dickson said this might be because many of the participants set general resolutions like they wanted 'to get fit' or 'exercise regularly', rather than setting specific resolutions and plans.

"An example of a specific resolution might be--to go for a 40-minute walk around the lake with my friend Sam on Monday, Wednesday and Friday mornings," Professor Dickson said.

"Previous research has shown that setting specific goals that include a time, place and/or people provide the mental cues to assist people to stick to their resolution goals.

"General goals or resolutions also require more thinking time, making them harder to stick to than goal resolutions that have a plan."

Flexibility is the key to wellbeing

Professor Dickson said it was possible that people gave up pursuing their New Year resolutions because they were not associated with more meaningful underlying goals and values.

"The resolution to lose five kilos will more likely endure in the face of obstacles, difficulties or other competing resolutions if it's linked to higher personal values, such as beliefs about one's health or appearance," Professor Dickson said.

"Our study also found that the ability to flexibly adapt one's resolutions in response to changing situations or obstacles was positively associated with increased mental wellbeing. Whereas the ability to stick to a goal did not increase mental wellbeing or sustained resolution pursuit."

PLYMOUTH MEETING, PA [March 25, 2021] -- New recommendations to advance racial equity, ways to mitigate the impacts of the COVID-19 pandemic on cancer care, and ongoing strategies for preventing and controlling HPV-associated cancers led the conversation at the National Comprehensive Cancer Network® (NCCN®) 2021 Virtual Annual Conference March 18-20. More than 1,300 attendees from across the United States and more than 40 countries met online to learn about updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and new research in the field. Sessions explored supportive care and ways to help survivors return to work, updates on best practices, and the most contemporary treatments for multiple malignancies including breast cancer, non-small cell lung cancer, gynecologic cancers, and head and neck cancers.

"Despite a year-long pandemic that made both research and patient care more challenging, NCCN's panels of experts from leading academic cancer centers developed continuous updates to the NCCN Guidelines that helped oncology professionals worldwide maintain service to patients with best practices under evolving circumstances," said NCCN Chief Executive Officer Robert W. Carlson, MD.

"At the same time, it was a year of reckoning with the United States' history of racial inequity, in which NCCN and the greater healthcare community have been called with renewed urgency to develop ways to make quality cancer care more accessible and equitable."

Preventing and controlling HPV-associated cancers

The first of three keynote panels addressed the importance of vaccination, screening, public and professional education, and system/process improvement in preventing cancers common in people infected with HPV (human papillomavirus).

"HPV vaccination will have a significant impact on reducing cancer incidence in the U.S., as well as globally," said Wui-Jin Koh, MD, Chief Medical Officer, NCCN, who chaired the panel. "We know that vaccination against HPV can prevent most cases of cervical cancer, for example, yet many countries still have low vaccination rates, and misinformation about vaccines is rampant. Beyond cervical cancer, HPV is also causative in many cancers of the anus, vulvar, vagina, penis, and oropharynx. Strategies to increase vaccination and otherwise control HPV are vital to cancer prevention."

Elevating racial equity

At the conference, representatives from the Elevating Cancer Equity Working Group--convened by NCCN along with the American Cancer Society Cancer Action Network (ACS CAN) and the National Minority Quality Forum (NMQF)--discussed detailed recommendations for reducing racial disparities in cancer care. People of color--especially Black, Latinx, and Indigenous people--often have higher cancer rates and yet are medically underserved, experiencing later diagnosis and worse outcomes.

"These disparities result from systemic inequality and bias in access and care delivery," commented Dr. Carlson. "Oncology professionals have a responsibility to respond, and help ensure their patients have access to guideline-adherent cancer care."

Presenters Lisa A. Lacasse, MBA, President, ACS CAN and Elizabeth Harrington, Partner, Public Opinion Strategies (POS) took a deeper look at a recent poll commissioned by the working group that found 63% of African American and 67% of Latinx cancer patients, survivors, and caregivers reported negative interactions with their care team, compared with 43% of white patients. The presentation also included a real-time poll of the audience regarding the importance and feasibility of implementing the recommendations for improving equity in cancer care. In many cases, attendees reported that they already have these policies in place.

"This is where the rubber meets the road. You can have great ideas, but how they're operationalized is critical to any success. It feels big, but certainly people are doing it," said Robert Winn, MD, Director, Virginia Commonwealth University Massey Cancer Center who co-chaired the working group along with fellow presenter, Shonta Chambers, MSW, EVP Health Equity Initiatives and Community Engagement, Patient Advocate Foundation.

Adapting care in a pandemic

The COVID-19 pandemic forced oncology professionals to adapt in order to provide ongoing care for cancer patients--especially those at high risk. The final keynote session, "Effects of the Pandemic on Cancer Care/Future Directions of Cancer Care," reviewed the COVID-related difficulties cancer centers have faced, how they adapted, and the possibility of permanent shifts to incorporate more telemedicine.

"In a moment of crisis, it is important for us to meet the crisis but then to gain something that we carry forward," said Timothy Kubal, MD, MBA, Moffitt Cancer Center, Co-Chair, NCCN Best Practices Committee. "As healthcare providers, I think we are realizing that many of the things that we have held sacred aren't as important to the patient as we thought. The in-person visit, full physical exam and on-site labs, imaging and chemotherapy are the way things have been done for a generation, but telemedicine challenges many aspects of such tradition. We all thought this would be terrible for the patient but as it turns out, in most cases, it's okay. We need to carry this learning forward to better meet the needs of our patient population and to drive innovation in healthcare delivery.

They say the only thing that matters in real estate is 'location, location, location.' But, for our patients, what really matters is, 'What location works for you?'"

The NCCN Annual Conference convenes oncology professionals--physicians, nurses, pharmacists, researchers, payers, advocates, and policymakers--to advance cancer treatment and patient care by exploring emerging therapies and addressing the latest issues and updates. The virtual conference featured more than 35 educational sessions with interactive polling, and moderator-facilitated Q&A. The conference also featured more than 90 research posters and more than 50 virtual interactive exhibits.

The online conference platform will allow attendees to continue accessing all sessions until May 19, 2021. At that time, the sessions will be made available as recorded webcasts via the NCCN Continuing Education portal at education.nccn.org, with a clinical synopsis publishing in JNCCN-Journal of the National Comprehensive Cancer Network this summer. Take part in the post-conference discussion on social media by using the hashtag #NCCN2021, or visit NCCN.org/news for updates.

The 2022 NCCN Annual Conference will take place March 31 - April 2, 2022. More information will soon be available at NCCN.org/conference.

Osaka, Japan - Most of the devices used in our daily lives are operated and controlled by electricity. From the standpoint of safety and the tight supply and demand of electricity, circuit design that satisfies low electromagnetic noise and power saving is becoming increasingly important.

In an electric circuit, electric signals transmit inside the conductor, and electromagnetic fields radiate outside the conductor. Furthermore, the electromagnetic field propagates through the air and is converted into signals for itself and other circuits, which leads to electromagnetic noise. Now, a research team at Osaka University has formulated a numerical method to visualize how signals propagate and radiate depending on the conductor's shape, allowing us to anticipate the causes of electromagnetic noise in the circuit designing stage.

"It is necessary to simultaneously calculate electrical signals and external radiation phenomena to treat electromagnetic noise. To this end, we aimed to precisely solve the delay integral equations of the scalar potential (potential) U and the vector potential A derived from Maxwell's equations, as shown in Fig. 1," says lead author Souma Jinno.

In the conventional method, as shown in Fig. 2, the delay time is approximated by a constant that does not depend on space, but this numerical calculation is not stable. This research has achieved numerical stability through a numerical calculation (discretization) method that more strictly considers the delay time. The team also developed an algorithm that simultaneously calculates Ohm's law and the equation of continuity and the circuit element of the boundary (lumped parameter circuit).

"We will show the effect of radiation on the conducted signal by applying our method to the circuit shown in Fig. 3 and comparing it with a calculation result that ignores radiation, shown as a red and blue line, respectively. By comparing the two results, we can see that the calculation with radiation is immediately damped and converges to zero, while the calculation without radiation continues to oscillate without damping. Since the conductor's resistance component is assumed to be zero, there is no loss due to conduction. From the above results, the conduction signal current attenuates due to external radiation. The attenuation indicates that a single conductor is not suitable for conducting a signal because of the extensive external radiation. Usually, electrical circuits use two conductors, which can conduct with less radiation," explains Souma Jinno.

"In order to achieve the Sustainable Development Goals (SDGs), society is moving toward electrification. However, rapid electrification has potential problems such as tight supply and demand for electricity and invisible environmental pollution caused by electromagnetic noise. Using the electromagnetic circuit simulator developed in this research, we aim to realize a 'sustainable electrified society' by further reducing noise and power consumption of electric circuits by correctly handling and consuming electric power," says corresponding author Masayuki Abe.

Ruptures of the carotid artery (cervical artery dissection) are the most common cause of stroke in people under 50 years of age, with an annual incidence of 2-3 cases per 100,000 persons. Salicylic-acid preparations (acetylsalicylic acid: aspirin, Aspegic) and blood-thinning medication (anticoagulants) are used for treatment. The multicenter therapy study "Biomarkers and Antithrombotic Treatment in Cervical Artery Dissection (TREAT-CAD, NCT02046460)" investigated whether dissections - tears in the wall of vessels supplying blood to the brain - can be treated with aspirin or whether more complex blood thinning (anticoagulation) is necessary. The study was published in The Lancet Neurology on March 23, 2021.

Aspirin not equally effective

Nearly 200 patients took part in the study. The evaluation showed that in the group treated with aspirin, 23 percent had subsequent problems compared with just under 15 percent in the group treated with blood thinners. This is the first scientific study to show that in the first 90 days aspirin is not as effective as blood thinning with anticoagulation.

A broad-based study

The international study was conducted at ten centers, seven in Switzerland, two in Germany and one in Denmark. The study was led by Prof. Dr. Stefan Engelter (University Geriatric Medicine FELIX PLATTER, UAFP and University Hospital Basel, USB). He was supported by Dr. Christopher Traenka (UAFP, USB), Prof. Dr. Philippe Lyrer (USB), and Prof. Dr. Marcel Arnold (Inselspital Bern, Bern University Hospital and University of Bern).

Impact on guidelines expected

The study suggests that the evidence to consider aspirin as standard of care in patients with cervical artery dissection is insufficient. Aspirin cannot simply replace conventional standard therapy with a blood thinner. With the results of this study, however, a general superiority of blood thinning with anticoagulation has not yet been proven. The investigation of further aspects and a review of the benefit-risk profiles must provide more precise information.

New research from the University of Kent and Leeds Beckett University has found that feelings of shame and stigmatisation at the idea of contracting Covid-19 are linked to lower compliance of social distancing and the likelihood of reporting infection to authorities and potential contacts in Italy, South Korea and the USA.

In contrast, the study found that individuals who trust their Government's response to the Covid-19 pandemic and feel a mutual solidarity are more likely to report Covid-19 contraction to authorities and acquaintances.

In Italy and South Korea, individuals are also more likely to follow social distancing regulations if they trust their Government's response to the pandemic, while in the USA, trust does not lead to social distancing compliance. This could be explained by the behaviour of the former administration that emphasised values of deference to authority and an "American First" policy, while signalling contempt for scientific advice and social distancing.

Many governments around the world have responded to the Covid-19 pandemic by implementing lockdown measures of various degrees of intensity. To be effective, these measures must rely on citizens' cooperation. These findings published by Frontiers in Psychology suggest that values of hierarchy and interdependence from governments shaming people into obedience may backfire and even make authorities less likely to trace and test new cases, while people may be less likely to comply with regulations. In turn this can negatively impact public health.

The research, led by Dr Giovanni Travaglino (Kent) and Dr Chanki Moon (Leeds Beckett), indicates the importance of cooperation and solidarity in explaining people's compliance with the norms of social distancing.

Dr Travaglino said: 'Our research highlights the importance of managing the stigma associated with Covid-19, which may undermine authorities' efforts to control it. Governments and decision-makers may achieve better transparency and compliance by focusing on the importance of social cohesion and trustworthiness in their attempts to tackle the pandemic and manage public responses.'

Dr Moon said: 'In our research, we identified that roles of trust in governments and self-conscious emotions (shame and guilt) were determinant factors for people's compliance with social distancing and intentions of reporting infections to health authorities or acquaintances. When governments and decision-makers make policies and regulations in relation to Covid-19, they should be aware that stigmatising or blaming people for contracting the infection could potentially backfire. The governments' efforts to boost trust are probably the key to overcoming the coronavirus crisis.'

BEER-SHEVA, Israel...March 24, 2021 - Surprisingly, exposure to a high background radiation might actually lead to clear beneficial health effects in humans, according to Ben-Gurion University of the Negev and Nuclear Research Center Negev (NRCN) scientists. This is the first large-scale study which examines the two major sources of background radiation (terrestrial radiation and cosmic radiation), covering the entire U.S. population.

The study's findings were recently published in Biogerontology.

Background radiation is an ionizing radiation that exists in the environment because of natural sources. In their study, BGU researchers show that life expectancy is approximately 2.5 years longer among people living in areas with a relatively high vs. low background radiation.

Background radiation includes radiation emanating from space, and radiation from terrestrial sources. Since the 1960s, there has been a linear no-threshold hypothesis guiding policy that any radiation level carries some risk. Hundreds of billions of dollars are spent around the world to reduce radiation levels as much as possible.

"Decades of scientific theory are potentially being disproven by the remarkable researchers at BGU," says Doug Seserman, chief executive officer, American Associates, Ben-Gurion University of the Negev. "These findings might even provide a sense of relief for those who reside in areas in the U.S. with higher-than-average background radiation."

According to BGU Professors Vadim Fraifeld and Marina Wolfson, along with Dr. Elroei David of the Nuclear Research Center Negev, lower levels of several types of cancers were found when the radiation levels were on the higher end of the spectrum rather than on the lower end. Among both men and women, there was a significant decrease in lung, pancreatic, colon and rectal cancers. Among men, there were additional decreases in brain and bladder cancers. There was no decrease in cervix, breast or prostate cancers or leukemia.

Using the United States Environmental Protection Agency's radiation dose calculator, the researchers retrieved data about background radiation from all 3,129 U.S. counties. The study's data regarding cancer rates was retrieved from the United States Cancer Statistics. Life expectancy data was retrieved from the Institute for Health Metrics and Evaluation at the University of Washington Medical Center.

"It is reasonable to suggest that a radiation threshold does exist, yet it is higher than the upper limit of the natural background radiation levels in the US (227 mrem/year)," the researchers write. "These findings provide clear indications for re-considering the linear no-threshold paradigm, at least within the natural range of low-dose radiation."

Ahead of the first U.S. emergency use authorization for a COVID-19 vaccine, only half of Americans said they were likely to get vaccinated as soon as possible, according to an in-depth study led by researchers at the Johns Hopkins Bloomberg School of Public Health.

The researchers conducted an online survey of 2,525 Americans in a two-week period from late November to early December, asking them about their intentions regarding COVID-19 vaccination as well as other values and beliefs. About 50 percent responded that they intended to get vaccinated as soon as possible. About 10 percent said they intended not to be vaccinated at all. The remaining 40 percent replied that they probably wouldn't be vaccinated, or probably would be but not as soon as possible.

The findings were published online March 24 in the journal Vaccine.

The authors labeled these groups "intenders" (as soon as possible), "unlikelys" (not at all), and "wait and learn" (maybe not, definitely not as soon as possible). While the numbers may have shifted somewhat as vaccinations rolled out across the U.S. this winter, the authors say outreach should focus on the "wait-and-learn" group, people who expressed an inclination to possibly or eventually get the vaccine, even if it wasn't as soon as possible.

"Once we get the first 50 percent vaccinated, we're going to be left with as many as 40 percent that are unsure, so we need to start working with them now," says study lead author Daniel Salmon, PhD, a professor in the Department of International Health and director of the Institute for Vaccine Safety at the Bloomberg School. "With these survey results, we now understand that critical 40-percent group much better."

Understanding attitudes around vaccines is essential for achieving community or herd immunity which, when enough people have been vaccinated, greatly reduces and controls community transmission and protects even the unvaccinated. Without vaccinating children younger than 16, achieving community immunity for SARS-CoV-2--the virus that causes COVID-19--will require that up to 90 percent of adults get highly effective vaccines. The researchers note that widespread hesitancy about COVID-19 vaccination appears to be a major obstacle to this goal.

Compared to the intenders, those who planned on getting vaccinated as soon as they could, the wait-and-learn group was overall more likely to have lower levels of trust in local, state, and federal public health authorities and health care professionals, along with less confidence in vaccine safety. The wait-and-learn respondents were more likely, for example, to be concerned that governments and drug companies used people "like them" to conduct experiments. "Like them" was intentionally undefined in the survey and could have been interpreted to be age, race, or ethnicity, or a medical condition. They also reported they were more likely to know someone who had a serious reaction to a vaccine.

The survey included 2,525 people, and oversampled African Americans and Hispanics to increase the statistical power of analyses concerning these groups. The results were adjusted to weight different demographic groups according to their true proportions in the U.S. population.

More than half--52 percent--of Black respondents were in the wait-and-learn group, reporting they may not get the vaccine or delay getting it. In comparison, 35 percent of white respondents and 39 percent of Hispanic respondents were in the wait-and-learn group. The data suggest that historical injustices and present-day racism against Black people may be factors in vaccine hesitancy. For example, three quarters of Black respondents in the wait-and-learn group are concerned that the government and drug companies experiment on people like them, compared to just over half of white respondents (54 percent) and two-thirds (69 percent) of Hispanic respondents. Thirty-nine percent of Black respondents in this group were confident that vaccines are safe, compared to over half of white (55 percent) and Hispanic (52 percent) respondents.

Salmon and colleagues conducted the survey in English and Spanish between November 25 and December 7 of last year, using Ipsos KnowledgePanel®, a panel of thousands of people in United States households who stand ready to take part in polls and surveys. During this survey period, the first successful phase 3 clinical trial results for COVID-19 vaccines had already been announced, but the Food and Drug Administration had not yet approved any of them for emergency use.

"Everything about the 'wait-and-learn' group suggests that there will continue to be challenges," Salmon says. "A near-term approach we see is for public health to work with community leaders to connect with people with low levels of trust in government. COVID-19 vaccines afford the opportunity to work with local communities to build trust and reduce inequities."

In addition, the authors say public health leaders should continue to provide accessible information about side effects, including rare ones that could potentially erode confidence in new COVID-19 vaccines.

March 24, 2021 - With heavy workloads and high professional and personal demands, medical residents in training - and those in urology residency programs - face a high risk of burnout. At one urology department, a wellness program designed by and for residents produced meaningful reductions in burnout risks, reports a study in Urology Practice®, an Official Journal of the American Urological Association (AUA). The journal is published in the Lippincott portfolio by Wolters Kluwer.

The Resident Wellness Curriculum (RWC) in the Scott Department of Urology at Baylor College of Medicine, Houston, led to significant improvements in key aspects of burnout, according to the new research by Jennifer M. Taylor, MD, and colleagues. "We found a purposeful approach to promoting residents' well-being can improve their perceptions of the training program's organizational culture - leading to measurable improvement in some of the defining characteristics of burnout," Dr. Taylor comments.

Proactive approach to addressing high risk of burnout in urology residents

"The RWC grew out of a purposeful programmatic effort to effect true positive culture change in our urology residency program in the domains of wellness and burnout," comments Program Director and co-author Dr. Wesley Mayer. "We began by facilitating open and honest dialogue with our residents in flipped classroom sessions, leading to a detailed needs assessment. We then executed on resident feedback and suggestions, which helped build a culture of trust between the residents and program leadership."

The program includes resident-faculty social groups, seeking to bolster relationships and build rapport outside the work environment; structured mentorships, with time set aside for formal mentoring meetings between residents and faculty; resident social outings, for trainees to interact and socialize outside of work; and wellness education, including education and information on physician wellness. It also includes an annually restocked Wellness Fund, which gives the residents a mechanism to request an event or a resource that they have chosen as a group.

Developed in collaboration between urology faculty, residents and department leadership, the RWC was entirely funded by donations from program faculty. "We were fortunate to have 100 percent participation from faculty members," said urology resident Dr. James Anaissie, lead author of the study. "It really affirmed our department's commitment to resident wellness, and led to improvements in residents' perceptions of the program's culture."

The researchers performed before-and-after surveys to evaluate how the program affected residents' burnout risks and well-being. A standard assessment (the Maslach Burnout Index) was used to assess the RWC's effects on the three defining characteristics of burnout, resulting in:

Scores for depersonalization decreasing by 28 percent. On average, the residents moved from high to moderate depersonalization scores from before to after the RWC.
Scores for emotional exhaustion decreasing by 20 percent. Again, the average score improved from the high to the moderate range.
Scores for personal accomplishment showing no significant change and remaining in the moderate range.

Scores on a rating of physicians' wellness (the Mayo Clinic Well-Being Index) improved by more than 50 percent, indicating decreased levels of distress. Of all initiatives included in the RWC, the resident social outings were rated most meaningful by the residents.

The promising results have encouraged the authors to continue to improve the program's culture in innovative ways. They continue periodic de-identified surveys of the residents and evaluate the responses. Most recently, a resident-designated ombudsman role was created, providing a structured and trusted mechanism for residents to anonymously bring up topics regarding wellness and program improvement with their program leadership.

"Our experience adds to studies from other training programs in showing proactive and comprehensive identification of the potential causes of burnout can enhance residents' well-being, including significant reductions in some of the key aspects of burnout," says Dr. Taylor. "Making systematic changes to our department culture, with input from residents and full support from faculty, helped to promote trainees' professional growth in a demanding specialty while supporting their mental health and well-being."

Today, Cochrane, a global independent network that gathers and summarizes the best evidence from research to help informed health decision-making, publishes an updated systematic review assessing rapid tests for the detection of SARS-CoV-2 infection (COVID-19). The review shows that rapid antigen tests are better at correctly identifying cases of COVID-19 in people with symptoms than in people without symptoms. There are large differences in the accuracy of different brands of test, with very few meeting the World Health Organization (WHO) minimum acceptable performance standards.

During the COVID-19 pandemic, swift diagnosis of people who are infected with SARS-CoV-2 is important. Then decisions can be made quickly about treating people who are infected, and other measures such as isolation and contact tracing can start. Tests have been developed for diagnosing COVID-19 that can provide results ‘while you wait’. Two types of rapid ‘point of care’ tests are available, both of which use nose or throat samples. Antigen tests identify proteins on the virus and come in disposable plastic cassettes similar to pregnancy tests, with results available within 30 minutes. Molecular tests detect the virus’s genetic material, using desktop analysers or small handheld devices with results typically available in 30 minutes to 2 hours.

The Cochrane researchers wanted to know how accurate these tests are in determining infection in people with symptoms and in people without symptoms. They identified and summarised studies that measured the accuracy of any point-of-care tests used in hospitals or the community compared with the accepted standard laboratory test, RT-PCR, to detect current SARS-CoV-2 infection.

The first version of this review included 22 studies and was published in August 2020. The updated review now includes evidence from 64 studies. Most of the studies included in the review were from Europe and USA and assessed the accuracy of rapid antigen tests. Only three studies were exclusively in people without symptoms - two in people who were contacts of confirmed cases and one involved staff screening. Over half of the antigen test studies included samples from people being tested in the community, for example at test centres, emergency departments, or as part of contact tracing or outbreak investigations. Molecular test studies were mainly done in laboratories and not in the community where the tests were intended to be used.

The review authors found antigen tests were better at identifying COVID-19 in people with symptoms than they were in people without symptoms. In people with symptoms, on average 72% of people who had COVID-19 were correctly identified as being infected; tests performed best in the first week after symptoms began when they identified 78% of people who had COVID-19. In people without symptoms, on average, the antigen tests correctly identified 58% of those who were infected. Antigen tests correctly ruled out infection in 99.5% of uninfected people with COVID-19-like symptoms and 98.9% of uninfected people without symptoms.

The percentage of people with COVID-19 who were correctly identified varied between brands and also depended on whether manufacturers’ instructions for using the tests were followed. For people with symptoms of COVID-19, correct identification across test brands ranged from 34% (Coris Bioconcept assay), to 58% (Innova assay), and up to 88% (SD Biosensor STANDARD Q assay) of infected people. The WHO have established performance standards for tests that identify infection in people with symptoms. To meet these standards, a test must be able to correctly identify at least 80% of people with infection and correctly exclude infection in 97% of people who are not infected.

To illustrate their results the researchers looked at the effect of two of the better performing brands of test (Abbott Panbio and SD Biosensor STANDARD Q ) in people with symptoms (75% to 88% of COVID-19 cases correctly identified) and in people who did not have symptoms (49% to 69% of COVID-19 cases correctly identified).

In a population of 1000 people with symptoms where there are 50 people with COVID-19, we would expect that about 40 people would be correctly identified as having COVID-19 by rapid tests, and between 6 and 12 cases of COVID-19 would be missed. Between 5 and 9 positive test results would turn out to be false positives.

The true number of cases of COVID-19 is likely to be lower in mass testing of people without symptoms. In a population of 10,000 people with no symptoms, where 50 people really had COVID-19, between 24 and 35 people would be correctly identified as having COVID-19, and between 15 and 26 cases would be missed. We would expect the tests to return between 125 and 213 positive results and between 90 and 189 of those positive results would be false positives.

Dr Jac Dinnes, Senior Researcher in Public Health, Epidemiology and Biostatistics at the University of Birmingham, an author of the review said: “Our review shows that some antigen tests may be useful in healthcare settings where COVID-19 is suspected in people with symptoms. These tests do not appear to perform as well in people who don’t have symptoms of COVID-19. Confirming a positive result from a rapid test with a RT-PCR test, particularly where cases of COVID-19 are low, may help avoid unnecessary quarantine. All antigen tests will miss some people with infection, so it is important to inform people who receive a negative test result that they may still be infected.

There is some emerging evidence that the accuracy of the test is affected by who is doing it. Future studies should look at the relationship between the experience of the person administering the test and the sensitivity of the test. Future research should also evaluate molecular tests in the settings in which they are intended to be used to clarify their performance in practice.”

Author, Jon Deeks, Professor of Biostatistics at the University of Birmingham added, “It is good to have found evidence that some test brands do meet the minimum 'acceptable' performance standards set by WHO for testing people with symptoms. However, they represent only a very small proportion of the commercially available tests. The situation is different for testing people without symptoms, particularly for the use of repeated rapid antigen tests to screen for SARS-CoV-2 infection in school pupils and staff, and hospital and care home workers. We didn’t find any data or studies evaluating the accuracy of these tests when used in repeated screening of people with no known exposure to SARS-CoV-2. These testing policies have been implemented without any supporting real-world evidence.”

Additional information: What are diagnostic test accuracy reviews?

March 24, 2021 - For premature infants who can't breastfeed on their own, "mother's own milk" (MOM) is by far the best nutrition. There's an urgent need for effective ways to increase the relatively low rates of MOM feeding for preterm infants born to Black and Hispanic mothers. But so far, research has offered little or no specific guidance, concludes an evidence-based review in Advances in Neonatal Care, official journal of the National Association of Neonatal Nurses. The journal is published in the Lippincott portfolio by Wolters Kluwer.

Until studies of targeted, culturally appropriate interventions are performed, available evidence points to some promising approaches to overcoming obstacles and facilitating MOM feedings for premature infants of Black or Hispanic mothers, according to the review by Diana Cartagena, PhD, RN, CPNP, of Old Dominion University, Virginia Beach, Va., and colleagues.

No studies specifically designed to encourage MOM feedings for Black or Hispanic preterm infants
Provided primarily by expressing (pumping) the mother's breast milk, MOM feedings have critical benefits for preterm infants - ranging from a lower risk of prematurity-related complications to fewer neurodevelopmental difficulties and disabilities later in childhood. The higher the "dose" of breast milk, the better the outcomes.

Minority mothers of premature infants may face special challenges in providing MOM feedings. "In the United States, Hispanic and Black preterm infants are less likely than their white counterparts to receive feedings consisting of MOM," Dr. Cartagena and coauthors write. They performed a comprehensive review of the past decade of research, looking for evidence-based strategies to encourage and improve MOM feedings to this group of infants.

However, the initial search identified "zero articles" - not a single study evaluating specific programs designed to promote MOM feedings in Black or Hispanic preterm infants. "All current strategies to encourage and improve breast milk expression and feeding in minority mothers are based on programs developed and tested mainly in White mothers," Dr. Cartagena comments.

Thus the researchers broadened their search for promising approaches to decreasing racial/ethnic disparities in breast milk expression - focusing on studies that included at least 30 percent Black or Hispanic mothers. Based on ten such studies, Dr. Cartagena and colleagues make some recommendations to improve MOM feedings, including:

Providing a welcoming, family-centered neonatal ICU environment. Professional lactation support is essential for all mothers of premature infants, including early help with breast milk expression and access to breast pumps and supplies. Giving mothers the opportunity to provide skin-to-skin care for their babies is a promising approach to establishing and maintaining the milk supply.

Addressing language and cultural barriers. For Hispanic mothers, having translators and providing educational materials in the mother's native language are important strategies to reduce disparities. In one study, providing lactation support from bilingual counselors increased MOM feeding at discharge. In another study, Black women who set an initial goal to provide any breast milk for their premature infant were more likely to provide MOM after leaving the hospital.

Providing social and emotional support. Black women may lack breastfeeding role models and experience; their own mothers (the baby's grandmother) may be an especially important source of support. For younger mothers, social media and even mobile apps may be appealing options. Emotional and technical support from hospital staff may help to overcome barriers to providing MOM, such as obtaining and learning to use a breast pump or challenges in the home environment.

"Limited evidence suggests that variation in neonatal ICU breastfeeding support practices may explain (in part), variation in disparities and supports further research in this area," Dr. Cartagena and colleagues write. They emphasize the need for rigorous, well-designed studies "to evaluate the effectiveness of targeted and culturally sensitive lactation support interventions in Hispanic and Black mothers."

Click here to read "Strategies to Improve Mother's Own Milk Expression in Black and Hispanic Mothers of Premature Infants."

DOI: 10.1097/ANC.0000000000000866

HOUSTON - (Mar 24, 2021) -The mammalian center for learning and memory, hippocampus, has a remarkable capacity to generate new neurons throughout life. Newborn neurons are produced by neural stem cells (NSCs) and they are crucial for forming neural circuits required for learning and memory, and mood control. During aging, the number of NSCs declines, leading to decreased neurogenesis and age-associated cognitive decline, anxiety, and depression. Thus, identifying the core molecular machinery responsible for NSC preservation is of fundamental importance if we are to use neurogenesis to halt or reverse hippocampal age-related pathology.

While there are increasing number of tools available to study NSCs and neurogenesis in mouse models, one of the major hurdles in exploring this fundamental biological process in the human brain is the lack of specific NSCs markers amenable for advanced imaging and in vivo analysis. A team of researchers led by Dr. Mirjana Maletic-Savatic, associate professor at Baylor College of Medicine and investigator at the Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, and Dr. Louis Manganas, associate professor at the Stony Brook University, decided to tackle this problem in a rather unusual way. They reasoned that if they could find proteins that are present on the surface of NSCs, then they could eventually make agents to "see" NSCs in the human brain.

"The ultimate goal of our research is to maintain neurogenesis throughout life at the same level as it is in the young brains, to prevent the decline in our cognitive capabilities and reduce the tendency towards mood disorders such as depression, as we age. To do that, however, we first need to better understand this elusive, yet fundamental process in humans. However, we do not have the tools to study this process in live humans and all the knowledge we have gathered so far comes from analyses of the postmortem brains. And we cannot develop tools to detect this process in people because existing NSC markers are present within cells and unreachable for in vivo visualization," Maleti -Savati said. "So, in collaboration with our colleagues from New York and Spain, we undertook this study to find surface markers and then develop tools such as ligands for positron emission tomography (PET) to visualize them using advanced real-time in vivo brain imaging."

Typically, antibodies are made against known antigens but the team set out to generate antibodies for unknown target proteins, which made their mission rather challenging. They solved this problem by relying on an age-old method of generating antibodies by injecting mice with whole-cell or membrane preparations. This resulted in 1648 clones out of which 39 reacted with NSCs. Upon closer examination, one potential candidate most strongly labeled NSCs. Mass spectrometric analysis of the human hippocampal tissue identified the target protein as the Brain-Abundant Signal Protein 1 (BASP-1), previously shown to be present in the neurons of the mouse brain but not in NSCs. Interestingly, the specific antibody that recognizes BASP-1 in NSCs did not label neurons or any other cells apart from NSCs, indicating that it could be used to visualize these cells in the live mammalian brain.

"Using our new antibody, we found that BASP-1 is restricted to NSCs in neurogenic niches in the mammalian brains, including humans, during development in utero and after birth. Thus, our work identified membrane-bound BASP-1 protein as a possible biomarker of NSCs that would allow us to examine the mechanisms of adult human neurogenesis as well as to explore its role in the process," Maleti -Savati concluded.

With this newly discovered biomarker, scientists can better understand the relevance and intricate mechanisms of neurogenesis, which may lead to new future therapeutic approaches to treat and manage neurological and neuropsychiatric disorders associated with diminished neurogenesis. The study was published in the journal, Scientific Reports.

Probiotics -- those bacteria that are good for your digestive tract -- are short-lived, rarely taking residence or colonizing the gut. But a new study from researchers at the University of California, Davis, finds that in breast milk-fed babies given the probiotic B. infantis, the probiotic will persist in the baby's gut for up to one year and play a valuable role in a healthy digestive system. The study was published in the journal Pediatric Research.

"The same group had shown in a previous study that giving breast milk-fed babies B. infantis had beneficial effects that lasted up to 30 days after supplementation, but this is the first study to show persistent colonization up to 1 year of age," said lead author Jennifer Smilowitz with the UC Davis Department of Food Science and Technology.

B. infantis is a friendly gut microbe that helps babies digest complex sugars, known as oligosaccharides, found in human breast milk. The bacterium was once commonly found in breastfed babies but has largely disappeared in infants in industrialized countries. The dramatic decrease is believed to be due to factors such as increased antibiotic use, formula feeding and cesarean sections.

"B. infantis is like the gatekeeper of the infant gut, it eats these complex sugars and creates an undesirable environment for potential pathogens," Smilowitz said.

Smilowitz said the lack of B. infantis has played a role in the rise of inflammatory diseases such as allergies, asthma and autoimmune diseases. Research has shown that colonization of B. infantis in the infant gut decreases intestinal inflammation.

In a previous study by Smilowitz and a team of researchers, babies were supplemented with B. infantis from seven days to 28 days after birth and found persistent colonization for up to 30 days after supplementation. In this follow-up study, fecal samples were taken from those infants at 4, 6, 8, 10 and 12 months of age. Smilowitz was surprised the probiotic persisted for that amount of time because probiotics are short-lived, and 12-month-old infants given breast milk are also usually eating solid foods, which affect the gut microbiome.

DANVILLE, Pa. - A survey of Geisinger employees conducted over two weeks in December 2020 found a steady increase in intent among healthcare workers to receive the COVID-19 vaccine.

On Dec. 4, 2020, an announcement about anticipated vaccine availability was emailed to all 23,784 Geisinger employees. Recipients were asked to indicate their intention to receive a vaccine when one was available to them and the reasons for any hesitation they might have. More than two-thirds of employees responded to the survey.

Of those who completed the survey before Dec. 10, when an independent FDA advisory committee voted to recommend emergency use authorization (EUA) of the Pfizer-BioNTech COVID-19 vaccine, 53.2% said they would receive a COVID-19 vaccine. By contrast, 80.2% of those who completed the survey after that date said they planned to receive a vaccine. Results of the study were published in JAMA Network Open.

The percentage of employees responding that they intended to receive a vaccine rose steadily after the Dec. 10 vote, coinciding with other widely publicized events, including a vote to recommend EUA for the Moderna vaccine, recommendations for both vaccines by the Centers for Disease Control and Prevention, and news coverage of prominent members of both political parties receiving the vaccine.

"The observed substantial increase in acceptance during the survey period should be interpreted cautiously because of the reduced sample size over time and because survey latecomers may not be representative," the research team wrote. "Still, intervening events may have signaled that receiving a vaccine is safe, normative, historic, and an indication of (healthcare workers') important role in the pandemic response."

Overall, 55.3% of employees said they intended to receive a vaccine, with 16.3% responding that they would decline and 28.4% saying they were undecided. Of those employees who indicated they would not receive the vaccine or were unsure, the vast majority (90.3%) said they worried about unknown risks of COVID-19 vaccines or felt there was insufficient data. Most employees completed the survey prior to the Dec. 10 EUA vote.

"As we near the day when there are enough vaccine doses for everyone who wants one, our attention will need to turn to the problem of vaccine hesitancy," said Michelle Meyer, lead author of the study and an assistant professor in Geisinger's Center for Translational Bioethics and Health Care Policy. "Healthcare workers are important ambassadors of vaccine acceptance for their patients and members of the public. That they appear to be much more accepting themselves of COVID-19 vaccines than several earlier surveys suggested is very good news for public health."