Body

The key conclusion of the study was not a surprise to the scientists involved: the importance of social media as a primary communication channel grows during a crisis. Inversely, the topicality of the limited regulation of social media lessens. We are seeing a trend in different countries, Estonia among them, of official news being first broadcast on social media.

"In the context of the pandemic, information with varying levels of proof and verifiability is being spread, and often this information is distributed via social media," explained network head Mart Susi, a professor of human rights at Tallinn University. "Information on COVID-19 spreads quickly and misinformation or misleading information can take on a life of its own in social media channels. The consequences can be fatal, since often during a crisis people are forced to make snap decisions while trying to take care of their mental health."

The main recommendation to both civil society and social media channels, Susi adds, is to create methods for fact-checking and to release the results of such checks consistently. "Deleting information indiscriminately might seem like an easy way out, but in reality it's a slippery slope," he cautioned. "Up to this point, the focus of attention among scientists and practitioners has been on critiquing the relaying of information on what's going on in online media portals and the process of users assessing posts - and blame is being cast on the lack of clear standards and transparency. Now the focus has shifted from process to final outcome: the content of the information that's being relayed. We aren't asking how social media is able to battle misinformation, but whether it's even capable of doing so in the first place. If it is, the 'how' is no longer as important. We call this phenomenon the normalisation of arbitrary assessments and of the lack of standards and transparency. What might have taken 10 years under the 'old normal' has taken place in less than a year during the crisis."

The scientists who took part in the study agreed that governments should not be afraid to distribute official announcements on social media, but rather make the most of social media for effective communication.

The study involved 40 scientists and experts from 19 countries in and outside of the European Union. Based on the social media practices that have developed in different countries, it was conducted over a two-month period and funded by the European Commission. The network was founded via the European Union COST programme (European Cooperation in Science and Technology) and connects more than 80 scientists from 32 countries.

The report can be read here:
https://www.tlu.ee/en/taxonomy/term/58/news/study-published-about-growing-influence-social-media-during-covid-19-crisis

Announcing a new publication for BIO Integration journal. In this review article the authors Zeling Guo, Shanping Jiang, Zilun Li and Sifan Chen from Sun Yat-Sen University, Guangzhou, China review how metabolic syndrome "interacts" with COVID-19.

Coronavirus disease 2019 (COVID-19) has rapidly spread worldwide and has exerted a great influence on public health and society. Metabolic disturbance involving various organs has been found in COVID-19 patients, including diabetes, fatty liver and acute kidney injury (AKI). In turn, pre-existing metabolic syndromes could exacerbate the effects of COVID-19. In this review, the authors focus on the close interaction between COVID-19 and metabolic syndrome, as well as the potential of repurposing metabolic-related drugs and the importance of treating metabolic diseases in COVID-19 patients.

BOSTON -- In a perspective published in the Journal of Hospital Medicine, experts from the Massachusetts General Hospital (MGH) Department of Medicine, Office of Equity and Inclusion and Center for Diversity and Inclusion call for a more inclusive and culturally competent ap-proach to clinical care based on best practices developed during the COVID-19 surge in Massachusetts.

Between March 25, 2020 and April 13, 2020, 40% of all MGH's COVID-19 inpatient population were limited English proficient (LEP), Spanish-speaking adults from the hospital's surrounding immigrant communities of color. Many were essential workers who lived in crowded housing, relied upon shared transport or the Massachusetts Bay Transportation Authority's public transit and were simply unable to adequately physically distance. This positioned them at increased risk of exposure to the respiratory virus, according to lead author Steven Knuesel, MD, SFHM.

"We've seen how previous disasters -- like Hurricane Katrina -- disproportionately impacted communities of color. These situations highlight inequities that have created a divide in access to quality health care, stability and support services. COVID-19 was no different and the cities of Chelsea and Revere were hit hard," says Knuesel.

Despite MGH's robust Medical Interpreter Services department, the spike in COVID cases strained resources. Clinicians realized a new approach to providing LEP support was needed immediately. Out of that demand, the Spanish Language Care Group (SLCG) was created. More than 60 native-Spanish speaking, bilingual clinicians ranging from trainees to full professors volunteered to be part of the group and were embedded throughout all areas of the hospital to help COVID surge teams provide condition updates, educate patients and assist in the daily rounding process.

"Our clinicians quickly responded to the call for help. In addition to their increasing workload, they provided medical expertise while also relaying clinical updates and discharge instructions. But perhaps more crucially, they provided empathy and compassion with patients and their families who were scared and anxious," says co-author Elena Olson, executive director of the Mass General Center for Diversity and Inclusion.

Hospitalist Warren Chuang, MD, helped design, oversee and coordinate the effort. "We responded to this critical need by creating the structure which allowed 51 physicians -- representing 14 countries of origin -- to deploy in COVID-19 surge units. The SLCG provided 24/7 coverage and a cultural connection to the hospital's most vulnerable patients who were isolated from family," says Chuang.

"Our experience with the Spanish Language Care Group has highlighted the value of language-concordant care, the power of cultural and linguistic competency, and the resiliency that diversity brings to a hospital's professional staff. Our urgent response to COVID-19 has unroofed a long-simmering challenge: the detriment to care that arises when language becomes an obstacle," says Joe Betancourt, vice president and chief equity and inclusion officer. "The SLCG solved that, made the impact of this work clear to all, and provided invaluable lessons that we will leverage in the future, principal among these including redoubling our efforts to recruit a diverse, multilingual staff."

The article offers recommendations for other institutions that want to develop similar language response groups, with particular focus on pre-identifying multilingual physicians as well as creating an activation strategy. More importantly, however, these best practices reinforce the need for hospitals to address the growing needs of culturally diverse patients and recognize language as an asset that can help improve patient understanding and outcomes.

December 23, 2020 - When patients have a do-not-resuscitate (DNR) order, it means they have chosen not to receive cardiopulmonary resuscitation (CPR). But hospital nurses report significant variations in the way DNR orders are perceived or acted on in clinical practice, reports a survey study in the January issue of the American Journal of Nursing (AJN). The journal is published in the Lippincott portfolio by Wolters Kluwer.

"While the definition of DNR might seem straightforward, its interpretation in clinical practice can be complicated," according to the new research, led by Patricia A. Kelly, DNP, APRN, AGN-BC, AOCN, of Texas Health Presbyterian Hospital of Dallas, and Kathy A. Baker, PhD, APRN, ACNS-BC, FCNS, FAAN, of Harris College of Nursing and Health Sciences at Texas Christian University.

Differing perceptions of DNR orders may lead to unintended consequences

Do-not-resuscitate orders have been a part of healthcare for more than 40 years. Published guidelines define DNR in terms of deciding to withhold CPR only, however, studies have shown healthcare providers and patients may be confused about the meaning and implications of DNR orders. An American Nurses Association position statement (PDF link) emphasizes that "patients with do-not-resuscitate orders must not be abandoned, nor should these orders lead to any diminishment in quality of care."

Based on her experiences, clinical nurse Karen Hodges, BSN, RN, OCN wondered, "How do nurses understand and act on DNR orders?" In response, Drs. Kelly, Baker, and colleagues performed a survey and interviews with 35 hospital nurses involved in caring for patients with DNR orders.

Analyzing the responses, the researchers identified one major theme: "Varying interpretations of DNR orders among nurses were common, resulting in unintended consequences." Within this overarching theme, there were three key subthemes:

While the nurses provided clear definitions of DNR, they gave varying interpretations of the specifics of care. For example, while nurses agreed that DNR meant no CPR, some interpreted it as meaning no other aggressive lifesaving measures.
The nurses reported situations where healthcare team members disagreed about how DNR orders affected clinical care and responsibilities. One nurse pointed out that having a DNR doesn't mean the person is a hospice patient: "It doesn't mean that you're not going to do everything that you would for anybody else."
The nurses encountered family conflicts and confusion about DNR orders, particularly when the patient's condition changed, and patients and family members sometimes disagreed about DNR status.

These differing perceptions have the potential to affect care in many ways, including varying responses when the patient's condition deteriorates, tensions among team members, and differences in role expectations. "Lack of clarity and agreement about what DNR means in practice has a far-reaching impact," Dr. Kelly and colleagues write. "It's critical for nurses to understand that DNR orders do not substitute for plans of care."

Maureen Shawn Kennedy, MA, RN, FAAN, editor in chief of AJN, notes that the study is important because, "Everyone - nurses, physicians, and families - needs to be on the same page in understanding the level of care a patient will receive."

Dr. Kelly, Baker, and coauthors believe that nurses play a key role in making sure that patients, families, and healthcare providers have a clear understanding of what DNR orders mean - and what they don't mean. "In every setting, nurses have opportunities to clarify such misinterpretations through practice, education, advocacy and policy, and research," the researchers conclude. "After 40 years as one of the most widely recognized medical abbreviations, DNR should mean 'do not resuscitate,' not an acronym that may diminish care."

New Rochelle, NY, December 22, 2020--Women were 39% more likely to die by 1 year after a first stroke. The sex difference was due to advanced age and more severe strokes in women, according to a new study in the Journal of Women's Health. Click here to read the article now.

Among women and men with a first-ever stroke, women were approximately 7 years older. In addition, 9.3% fewer women could walk independently on admission to the hospital, suggestive of a more severe stroke.

"Among those deceased by any cause, men had more deaths due to cancer (12% vs women 6%) and ischemic heart disease (8% vs women 6%) while women had more deaths attributed to stroke (50% vs men 41%) or other cardiovascular disease (16% vs men 13%), state Dominique Cadilhac, PhD, School of Clinical Sciences at Monash Health, and coauthors.

"Cadilhac and colleagues showed that women had a 65% greater risk of death associated with stroke. Not only were women more likely to be older at first stroke and to have greater stroke severity, but they were also less likely to be treated with aspirin for secondary stroke prevention," says Journal of Women's Health Editor-in-Chief Susan G. Kornstein, MD, Executive Director of the Virginia Commonwealth University Institute for Women's Health, Richmond, VA.

Toronto, CANADA - Attention Deficit Hyperactive Disorder (ADHD) can have negative consequences on mental health into adulthood. A nationally representative Canadian study reported that the lifetime prevalence of suicide attempts was much higher for women who had ADHD (24%) compared to women who had not (3%). Men with ADHD were also more likely to have attempted suicide compared to men without ADHD (9% vs. 2%).

"ADHD casts a very long shadow. Even when we took into account history of mental illness, and the higher levels of poverty and early adversities that adults with ADHD often experience, those with ADHD still had 56% higher odds of having attempted suicide than their peers without ADHD" reported lead author Esme Fuller-Thomson, Professor at University of Toronto's Factor-Inwentash Faculty of Social Work and Director of the Institute for Life Course and Aging.

Because ADHD is more common among men than among women, little research or clinical attention has focused on women with the disorder. In this study, women with ADHD had more than twice the odds of suicide attempts compared to men with ADHD.

"Our finding that one in four Canadian women with ADHD had attempted suicide highlights the urgency of providing adequate mental health supports across the life course to this vulnerable and neglected group," said Lauren Carrique, a recent graduate of University of Toronto's Masters in Social Work (MSW) program who is a social worker at Toronto General Hospital.

Adults with ADHD who had been exposed to chronic parental domestic violence had triple the odds of suicide attempts compared to their peers with ADHD who had not experienced that childhood adversity. Parental domestic violence was defined as "chronic" if it had occurred more than 10 times before the respondent was age 16.

"The cross-sectional nature of this study prohibits our ability to determine possible causality; the relationship between chronic parental domestic violence and suicide attempts could flow in either direction," stated co-author Raphaël Nahar Rivière, a medical resident in anesthesiology at the University of Toronto.

"We speculate that violent parental conflict may cause extreme stress for the child with ADHD and predispose these individuals to mental illness and suicidal thoughts. In addition, the challenges of raising a child with ADHD who is struggling with severe mental health issues may cause parental conflict, which may escalate into domestic violence."

The study examined a nationally representative sample of 21,744 Canadians, of whom 529 reported they had been diagnosed with ADHD. Data were drawn from the Canadian Community Health Survey-Mental Health.

"The disturbingly high prevalence of suicide attempts among people with ADHD underline the importance of health professionals screening patients with ADHD for mental illness and suicidal thoughts," said co-author Senyo Agbeyaka, a recent University of Toronto MSW graduate who is a social worker at University Health Network.

"Knowing that women with ADHD who have experienced childhood adversities and adults with a history of substance dependence and/or depression are particularly vulnerable to attempting suicide will hopefully help clinicians improve targeting and outreach to this population."

E-cigarette use has risen steeply and mostly without regulation over the past decade. The devices have diversified into a dizzying array of vape pens, tank systems, "mods," and more, mass-marketed and sold to the public. The U.S. Food and Drug Administration (FDA) is in the midst of considering whether to approve thousands of pre-market applications for the sale of e-cigarettes as consumer products.

In these applications and related advertisements, the owners of e-cigarette brands claim that their products help smokers quit and can therefore be considered "appropriate for the protection of public health," as stipulated by law. But a new systematic review by UC San Francisco researchers of the scientific literature on this topic puts those claims to the test.

In the new study, published December 22, 2020 in the American Journal of Public Health, a team led by UCSF's Richard Wang, MD, MAS, surveyed the scientific community's understanding of e-cigarettes and found that, in the form of mass-marketed consumer products, they do not lead smokers to quit.

In their paper, the authors write, "If e-cigarette consumer product use is not associated with more smoking cessation, there is no population-level health benefit for allowing them to be marketed to adults who smoke, regardless of the relative harm of e-cigarettes compared with conventional cigarettes. Moreover, to the extent that people who smoke simply add e-cigarettes to their cigarette smoking (becoming so-called dual users), their risk of heart disease, lung disease, and cancer could increase compared with smoking alone."

"The question we explored is of both scientific interest and public health interest," said Wang, assistant professor of medicine, "and we hope that the FDA will pay attention to our study as they try to make these decisions." Wang was joined in the study by co-first author Sudhamayi Bhadriraju, MD, a former UCSF postdoctoral fellow who is now a pulmonologist at Kaiser Permanente in Redwood City, Calif., and senior author Stanton A. Glantz, PhD, professor of medicine.

The authors searched the literature, compiling results from 64 studies to answer this question. The studies selected for formal analysis encompassed observational studies, in which participants were surveyed, but not directed, about their use of e-cigarettes, as well as clinical trials in which smokers who were trying to quit were given free e-cigarettes under medical supervision.

This distinction mattered for their analysis, Wang noted. "In observational studies, you're basically asking people 'out in the wild' about their use of e-cigarettes that they've purchased themselves from a corner store, without specific guidance to quit. But in a randomized trial you're testing a product, treating it like a therapy -- a medicine -- to see if an e-cigarette or some other product is more conducive to quitting."

In their analysis of observational studies that involved groups of people who already smoked and used e-cigarettes, whether or not they wanted to quit, the team found no appreciable effect of e-cigarettes on participants' ability to quit. In the next group of studies, which surveyed smokers using e-cigarettes who did indicate a desire to quit, the researchers also found no effect.

Then the team tried to tease apart the effects of frequency of use -- whether people who used e-cigarettes daily might quit at different rates than people who used them less often. The researchers found that daily users quit at a higher rate than more infrequent users, although they cautioned that most participants in U.S. studies fall into the second category.

Finally, they examined nine clinical trials, which provided some type of e-cigarette, for free, to participants who were specifically encouraged to use the devices to help them quit. Though the devices and the controls employed in the studies differed, Wang concluded that being provided with certain e-cigarette products in a clinical trial context led to more quitting than some other therapies.

The 2009 Family Smoking Prevention and Tobacco Control Act (TCA) charges the FDA with only allowing e-cigarettes on the market when manufacturers can prove their tobacco-based products are "appropriate for the protection of public health." But the FDA delayed enforcing the law until a federal court order required companies to submit pre-market approval applications to the agency before September 2020 in order to continue selling e-cigarettes to consumers. The FDA is now evaluating thousands of such applications to sell e-cigarettes.

"It's important to recognize that in clinical trials, when certain e-cigarette devices are treated more like medicine, there may actually be an effect on quitting smoking," said Wang. "But that needs to be balanced against the risks of using these devices. Also, only seven e-cigarette devices were studied in the clinical trials. Whether the effect observed with these seven devices is the same or different than that of the thousands of different e-cigarette products available for sale is unknown."

In addition, he said, the new study does not analyze the increase in youth and teen smoking as a result of e-cigarette marketing and availability, nor does it compare the negative health effects of e-cigarettes to traditional tobacco products.

With regard to the current decision before the FDA, Wang said, "The standards that the FDA has to apply to approve e-cigarettes as consumer products or therapeutic devices are fundamentally different."

Preliminary results of a phase 3, randomized, placebo-controlled clinical trial testing the investigative monoclonal antibody LY-CoV555 in hospitalized COVID-19 patients were published today in the New England Journal of Medicine. The antibody did not provide clinical benefit compared to placebo. The trial, which had been halted to new enrollment in late October following a recommendation by the independent Data and Safety Monitoring Board (DSMB), is part of the Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) program. The trial is sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The ACTIV-3 trial used a master protocol designed to allow study of multiple investigational agents compared to placebo in adults hospitalized with COVID-19. Participants in ACTIV-3 are randomly assigned to receive either an experimental agent or a matched placebo. All participants also receive standard of care for patients hospitalized with COVID-19, including the antiviral remdesivir. Five days after enrollment, participants' clinical status is assessed based on an ordinal scale. If the investigational agent appears to be safe and effective based on an evaluation of the first 300 participants (stage 1), an additional 700 participants are randomized and followed for 90 days to assess sustained recovery, defined as being discharged, alive and home for 14 days (stage 2). Patients with end-stage organ failure are not enrolled in stage 1, but such patients are allowed to enroll if the trial proceeds to stage 2.

The first agent evaluated in ACTIV-3 was LY-CoV555. The monoclonal antibody was discovered by AbCellera Biologics, based in Vancouver, in collaboration with NIAID's Vaccine Research Center. Subsequently, it was developed and manufactured by Indianapolis-based Lilly Research Laboratories, Eli Lilly and Company, in partnership with AbCellera.

The trial was closed to new enrollees on October 26, after the DSMB reviewed data from stage 1 of the trial and recommended that no further participants be randomized to receive LY-CoV555 and that the investigators be unblinded to the data. This recommendation was based on a low likelihood that the intervention would be of clinical value in this population of hospitalized patients without end-stage organ failure. Enrollment in the LY-CoV555 sub-study closed with 326 total participants, 314 of whom were randomized to receive either LY-CoV555 (163 participants) or placebo (151 participants). After five days, 50% of LY-CoV555 recipients and 54% of placebo recipients were in one of the two most favorable outcome categories. The investigators concluded that LY-CoV555 did not accelerate clinical improvement compared to placebo at day 5 using the ordinal scale among hospitalized COVID-19 patients without end-stage organ failure. Likewise, there was no difference in either time to hospital discharge or the primary outcome of sustained recovery, back at home for 14 days, among recipients of LY-CoV555 compared to placebo.

Although LY-CoV555 did not perform better than placebo in the hospitalized COVID-19 patients studied in this trial, this same investigational monoclonal antibody was granted an Emergency Use Authorization (EUA) by the U.S. Food and Drug Administration in November. The EUA authorized use of LY-CoV555 in non-hospitalized adolescents and adults with mild to moderate COVID-19 symptoms who are at elevated risk of progressing to severe COVID-19 disease.

The ACTIV-3 trial is being conducted at hospitals worldwide that are part of existing clinical trials networks. The lead network, the International Network of Strategic Initiatives in Global HIV Trials (INSIGHT), is supported by NIAID. Collaborating clinical trial networks include the Prevention and Early Treatment of Acute Lung Injury network (PETAL) and Cardiothoracic Surgical Trials Network (CTSN), supported by the NIH's National Heart, Lung and Blood Institute through the Collaborating Network of Networks for Evaluating COVID-19 and Therapeutic Strategies (CONNECTS) program, and the U.S. Department of Veterans Affairs Medical Centers.

People with severe COVID-19 and a secondary blood infection were significantly sicker upon hospital admission, had longer hospital stays and poorer outcomes, according to a Rutgers study.

The study, published in the journal Clinical Infectious Diseases, is the first to assess the microbiology, risk factors and outcomes in hospitalized patients with severe COVID-19 and secondary bloodstream infections.

The researchers looked at 375 patients diagnosed with severe COVID-19 from March to May 2020. Of that group, they sampled 128 cases who had secondary bloodstream infections, 92 percent of which were bacterial infections.

"These patients were more likely to have altered mental status, lower percent oxygen saturation, septic shock and to be admitted to the intensive care unit compared to those without bloodstream infections," said co-lead author Pinki Bhatt, an assistant professor at Rutgers Robert Wood Johnson Medical School's Division of Allergy, Immunology and Infectious Disease.

The researchers also found that patients who needed more advanced types of supplemental oxygen upon hospital admission had higher odds of secondary bloodstream infections.

The in-hospital mortality rate for these patients was more than 50 percent, but the study reported these deaths were associated with, not caused by, the condition.

According to the study, infections in COVID-19 patients may have contributed to the severity of illness or it may reflect other underlying physiological and immunological complications of COVID-19.

The study showed that the most common cause of secondary blood stream infections was unknown or not determined followed by central-line associated bloodstream infection as the most common presumed source.

The study found that 80 percent of all the patients in the study received antimicrobials at some point during hospitalization, including those who did not have bloodstream infections. "This likely reflects clinicians' inclination to administer antimicrobials given the limited information on the natural course of this novel disease," Bhatt said. She noted that further studies are needed to better understand when to suspect and treat empirically for secondary bloodstream infections in severe COVID-19.

"Antimicrobial stewardship remains crucial during this unprecedented time," said co-author Navaneeth Narayanan, a clinical associate professor at Rutgers Ernest Mario School of Pharmacy. "Given the scale of the pandemic, indiscriminate antimicrobial use will inevitably lead to widespread complications such as adverse drug reactions, antimicrobial resistance and Clostridium difficile infections."

World-first techniques for predicting breast cancer risk from mammograms that were developed in Melbourne could revolutionise breast screening by allowing it to be tailored to women at minimal extra cost.

Published in the International Journal of Cancer, the University of Melbourne-led study found two new mammogram-based measures of risk. When these measures are combined, they are more effective in stratifying women in terms of their risk of breast cancer than breast density and all the known genetic risk factors.

Researchers say if successfully adopted, their new measures could substantially improve screening, make it more effective in reducing mortality and less stressful for women, and therefore encourage more to be screened. They could also help address the problem of dense breasts.

Since the late 1970s, scientists have known that women with denser breasts, which shows up on a mammogram as having more white or bright regions, are more likely to be diagnosed with breast cancer and to have it missed at screening.

Collaborating with Cancer Council Victoria and BreastScreen Victoria, University of Melbourne researchers were the first to study other ways of investigating breast cancer risk using mammograms.

Using computer programs to analyse mammogram images of large numbers of women with and without breast cancer, they found two new measures for extracting risk information. Cirrocumulus is based on the image's brightest areas and Cirrus on its texture.

First, they used a semi-automated computer method to measure density at the usual, and successively higher levels of brightness to create Cirrocumulus. They then used artificial intelligence (AI) and high-speed computing to learn about new aspects of the texture (not brightness) of a mammogram that predict breast cancer risk and created Cirrus.

When their new Cirrocumulus and Cirrus measures were combined, they substantially improved risk prediction beyond that of all other known risk factors.

Lead researcher and University of Melbourne Professor John Hopper said that in terms of understanding how much women differ in their risks of breast cancer, these developments could be the most significant since the breast cancer genes BRCA1 and BRCA2 were discovered 25 years ago.

"These measures could revolutionise mammographic screening at little extra cost, as they simply use computer programs," Professor Hopper said.

"The new measures could also be combined with other risk factors collected at screening, such as family history and lifestyle factors, to provide an even stronger and holistic picture of a woman's risk.

"Tailored screening - not 'one size fits all' - could then be based on accurately identifying women at high, as well as low, risk so that their screening can be personalised.

"Given mammography is now digital, and our measures are now computerised, women could be assessed for their risk at the time of screening - automatically - and given recommendations for their future screening based on their personal risk, not just their age."

Professor Hopper said this information could be used to ease pressure on BreastScreen, which had to close for a period during the COVID-19 pandemic and is looking for ways to best handle the backlog while continuing to provide a valuable service with limited resources.

He said the current breakthrough could not have occurred without the extraordinary support his mammogram research had received from the National Breast Cancer Foundation, starting with its first funding round more than 20 years ago.

"Only around 55 per cent of Australian women aged 50-74 currently present for screening aimed at detecting breast cancers early," he said.

"Knowing that screening could also give an accurate risk prediction could encourage more women to take up the offer of free screening. Women with high risk based on their mammogram would also benefit greatly from also knowing their genetic risk."

Adjunct Associate Professor Helen Frazer, Clinical Director of St Vincent's BreastScreen Melbourne, said that improvements in assessing a woman's risk of breast cancer would be transformative for screening programs.

"Using AI developments to assess risk and personalise screening could deliver significant gains in the fight against breast cancer," Adjunct Associate Professor Frazer said.

PHILADELPHIA and MINNETONKA, Minn. -- High rates of COVID-19 in the county where a hospital is located appears to reduce survival rates among hospitalized patients with the virus, according to a new study from researchers in the Perelman School of Medicine at the University of Pennsylvania and at UnitedHealth Group. These findings were published in JAMA Internal Medicine.

"We have known that individual risk factors like age and gender, comorbidities such as obesity, and whether someone is a nursing home resident, are all part of what determines whether patients have a good or bad outcome. But our research shows it also matters where a patient is admitted," said lead investigator David Asch, MD, director of the Center for Health Care Innovation and a Professor of Medicine at the University of Pennsylvania.

The team analyzed nearly 40,000 patients with COVID-19 admitted to 955 hospitals across the nation between January 1 and June 30, 2020. They examined what proportion of those patients either died in the hospital within 30 days of being admitted or were discharged to hospice, which could also signal a likely death from the virus. They found that, on average, almost 12 percent of patients admitted with COVID-19 to hospitals nationwide died, but the mortality rates in the hospitals with the best outcomes was 9 percent compared to nearly 16 percent for the group of hospitals with the worst outcomes.

Data were also split into two periods of time - one extending from January to the end of April - widely regarded as the most challenging period of the first COVID-19 surge - and another from the beginning of May to the end of June - when case numbers started to decline. Across the two time periods, 398 of the hospitals studied had enough COVID-19 patients to allow a comparison of mortality. Patients in the early period had a mortality rate of more than 16 percent compared to roughly 9 percent in the group from May and June. All but one of the hospitals improved their survival rate -- in fact, 94 percent improved their numbers by 25 percent or more.

"COVID-19 outcomes in U.S. hospitals have improved remarkably, and remarkably fast," said Natalie Sheils, PhD, research scientist at UnitedHealth Group. "But a death rate of more than 9 percent among hospitalized patients is still very high, and COVID-19 remains a very dangerous disease."

While this data could correlate with increased knowledge of COVID-19 and treatment for its patients, the analysis found a different, prevailing factor.

"Improvement, in general, likely comes from experience in how to manage oxygenation for these patients, as well as new treatments like dexamethasone," Asch explained. "But what explains the variation in outcomes across hospitals and the variation in their improvement is an entirely different story. The factor most strongly associated with outcomes or their improvement, based on our data, was how much COVID-19 spread there was in the hospital's surrounding community."

The team found that hospitals located in counties with higher COVID-19 case rates had worse outcomes. Hospitals situated in counties where case rates declined had the most improvement over time.

"With the current surge this winter, I'm worried hospitals will give up some of the positive gains from the summer," Asch said. "Not only will raw death numbers go up, but death rates may go up as well."

The association between high community case rates and high mortality is what prompted the goal to "flatten the curve." The idea was to keep rates as low as possible -- even over a more prolonged period -- because cases coming all at once was worse than cases spread out over time. This study's findings appear to support that view.
While vaccines are being approved for emergency use, widespread vaccination of the general public is likely months away.

"If it is the community burden of COVID-19 that determines how well our hospitalized patients do, as our study shows, then the best advice hasn't changed: stay apart, wash your hands, mask up," Asch said. "Hospitals need our help."

What The Study Did: This report of maternal viral load, transplacental antibody transmission and placental pathology in 127 pregnancies during the SARS-CoV-2 pandemic provides needed data about maternal viral control, reduced transplacental transfer of anti-SARS-CoV-2 antibodies and lack of vertical transmission in mother-newborn pairs.

Authors: Andrea G. Edlow, M.D., M.Sc., of the Massachusetts General Hospital in Boston, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamanetworkopen.2020.30455)

Editor's Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

ATLANTA - DECEMBER 22, 2020 - A new American Cancer Society study finds that adult-onset cancer survivors run a greater risk of developing and dying from subsequent primary cancers (SPCs) than the general population. Cancers associated with smoking or obesity comprised a majority of SPC incidence and mortality among all survivors. The study appears in JAMA.

"These findings highlight the importance of ongoing surveillance and efforts to prevent new cancers among survivors," said lead author, Hyuna Sung, PhD. "The number of cancer survivors who develop new cancers is projected to increase, but, until now, comprehensive data on the risk of SPCs among survivors of adult-onset cancers has been limited."

For the study, investigators analyzed data on nearly 1.54 million cancer survivors from 1992 to 2017 from 12 Surveillance, Epidemiology, and End Results registries in the United States. The survivors analyzed were between the ages of 20 to 84 (mean age, 60.4 years), 48.8% women, and 81.5% white.

The findings suggest that among the 1,537,101 survivors, 156,442 were diagnosed with an SPC and 88,818 died of an SPC. Results found that male survivors had an 11% higher risk of developing SPCs and a 45% higher risk of dying from SPCs compared with the risk in the general population. Female survivors had a 10% higher risk of developing SPCs and a 33% higher risk of dying from SPCs.

The investigators found men who survived laryngeal cancer and Hodgkin lymphoma ran the greatest risk of developing an SPC, while men who survived gallbladder cancer ran the greatest risk of dying from an SPC. Among women, survivors of laryngeal and esophageal cancers ran the greatest risk of developing an SPC, and laryngeal cancer survivors also ran the greatest risk of SPC mortality.

Substantial variation existed in the associations of specific types of first cancers with specific types of SPC risk. However, study authors note the prevalence of smoking- and obesity-related cancers in SPC incidence and mortality. Results show the risks of smoking-related SPCs were commonly elevated among survivors of smoking-related first cancers. Among survivors of all cancers, four common smoking-related SPCs including lung, urinary bladder, oral cavity/pharynx, and esophagus, accounted for 26% to 45% of the total SPC incidence and mortality. Furthermore, lung cancer alone comprised 31% to 33% of the total mortality from SPCs. Similarly, survivors of many obesity-related cancers had an elevated risk of developing obesity-related SPCs. Among survivors of all cancers, four common obesity-related cancers colorectum, pancreas, corpus uteri, and liver, comprised 22% to 26% of total SPC mortality.

"These findings reinforce the importance of coordinated efforts by primary care clinicians to mitigate the risks of SPCs through survivorship care, with greater focus on lifestyle factors, including smoking cessation, weight management, physical activity, and healthy eating, as receipt of counseling or treatment (tobacco only) to aid in the adoption of healthy habits," said Ahmedin Jemal, PhD, senior author of the paper.

Life originates from water. Hydrogels--hydrophilic polymer network swelling in water--resembles the original form of life, the algae and bacterium. In the modern life, hydrogels are ubiquitous in nature, from muscle and cartilage in animal tissues to xylems and phloems in plants. The intrinsic biocompatibility of hydrogels makes them prevailing in medical applications, such as wound dressing, drug delivery, and tissue scaffold.

In recent years, the diversity of synthetic hydrogels in topology and chemical composition of polymer network makes them highly adaptive to a vast array of functions and applications, such as stimuli responsive hydrogels by temperature, electrical field, and pH, lubricious hydrogels, anti-fouling hydrogels, and tough hydrogels. The synthetic hydrogels play an irreplaceable role in smart soft devices and soft robotics. Thanks to the achievement of strong bonding of hydrogels on various substrates, the applications of hydrogels have been further extended by functional hydrogel coatings. Through functional hydrogel coatings, one can integrate the functions of hydrogels or generates new applications by this combination without influence on the mechanical properties of the target substrates, such as stiffness, toughness, and strength. Functional hydrogel coating is one of the research hotspots of hydrogels.

Recently, Junjie Liu, Shaoxing Qu, and Wei Yang from Zhejiang University and Zhigang Suo from Harvard University reviewed the emerging topic of functional hydrogel coatings from three aspects: functions and applications of hydrogel coatings, methods of preparing hydrogel coatings with strong adhesion, and tests to evaluate the adhesion. This review, entitled "Functional hydrogel coatings", was published in the National Science Review.

Firstly, the main functions and applications of functional hydrogel coatings in both medical and non-medical areas are presented. In non-medical area, typical applications include sensing, actuation, anti-marine creatures fouling and oil-water separation. While hydrogel coatings are used for drug delivery, lubrication, anti-biofouling and conductivity for neural electrodes in medical area.

This review pointed out that a well-established hydrogel coating method should be able to coat target substrates with arbitrary shape, achieve strong bonding between hydrogel coating and substrate, and be compatible with various hydrogels and substrates. The existing hydrogel coating methods that satisfy these requirements include the surface bridge method, the surface initiation method, and the hydrogel paint method, as illustrated in Figure 1.

Adhesion between the hydrogel coating and substrate, which is the energy required to peel away a unit area of hydrogel coating and has units of J/m2, quantifies the resistance to debonding of the coating. Tests for adhesion of hydrogel coatings include the peel test, the simple stretch test, the scratch test, the probe pull test, and the double cantilever beam test. These test methods are schematically illustrated in Figure 2. Among these, the peel test is the most frequently used one.

Finally, the authors proposed several research directions of the functional hydrogel coatings:

1. To optimize hydrogel coating methods for the translation to mass production;

2. The long term stability of functional hydrogel coatings in aqueous environment, such as in seawater, body fluid, and blood;

3. The fatigue of stretchable hydrogel adhesion under cyclic loading;

4. A general method for testing the adhesion of hydrogel coating with extreme thin thickness.

BOSTON -- In the first human clinical trial, researchers at Massachusetts General Hospital (MGH) and surgeons at Beth Israel Deaconess Medical Center (BIDMC) have validated the practicality and accuracy of an oxygen-sensing liquid bandage that measures the concentration of oxygen in transplanted tissue. The trial, published in Science Advances, compared the performance of a novel, paint-on bandage made with phosphorescent materials to a wired tissue oximeter (ViOptix device) -- the current standard for monitoring tissue oxygenation -- in women undergoing breast reconstruction surgery after cancer.

"Our trial showed that the transparent liquid bandage detected tissue oxygenation as well as the gold standard of an oximeter, which uses old technology, is uncomfortable for the patient, obstructs visual inspection of the tissue, and can give false readings based on lighting conditions and the patient's movements," says Conor L. Evans, PhD, the paper's senior author and a principal investigator at MGH's Wellman Center for Photomedicine. "The standalone bandage is a major advancement from a wired oximeter that restricts a patient's movements and is complicated to use."

The research team took on the challenge of building a better tissue oxygenation sensor following a request from the Department of Defense seeking to reduce failure rates of tissue transplant surgeries and skin grafts in injured soldiers. The technology underlying the bandage was developed through the support of the Military Medical Photonics Program. The trial tests the bandage in breast reconstruction, a common type of free-flap transplant surgery in which plastic surgeons harvest skin, fat, arteries and blood vessels from the patient's abdomen and microsurgically reattach the tissue and vessels to the chest.

"Up to 5% of free-flap surgeries can fail, typically within 48 hours after surgery, if blood flow to the transplanted tissue is interrupted or inadequate, which is a devastating outcome," says Samuel J. Lin, MD, MBA, plastic and reconstructive surgeon at BIDMC and senior author. By monitoring how much oxygen gets to the transplanted tissue, surgeons can quickly detect a vascular problem and intervene to save the transplant.

Five women undergoing breast reconstruction were enrolled in the trial from March to September 2017. The liquid bandage was painted on in a 1 cm by 1 cm area on seven transplanted flaps (two women had both breasts reconstructed). A wired oximeter was also placed on each flap, and tissue oxygenation was monitored for 48 hours after surgery. The bandage measures the amount of oxygen getting to the tissue itself, while the ViOptix reads the amount of oxygen saturation in the blood with near-infrared spectroscopy--a less direct measurement of crucial blood flow to the transplant.

In this study, a clinician-researcher took photos of the bandage with a digital camera with custom filters following surgery. The flash from the camera excited the phosphorescent material in the bandage, which then glowed red to green based on the amount of oxygen present in the tissue. Evans and colleagues have since developed a battery-powered sensor head for the bandage that eliminates the need for the camera and makes the bandage self-contained. The prototype study was published in Biomedical Optics Express.

In all seven flaps, the tissue oxygenation rate of change measured by the bandage correlated with the oximeter, and all seven flaps were successful. The researchers are currently designing a clinical trial to study how well the bandage detects a flap that is failing from lack of oxygen.

"The ability to have a wireless oxygen monitoring device for blood flow is potentially a gamechanger," says Lin.

Clinical applications for an oxygen-sensing bandage could include monitoring wound healing, tissue transplants for trauma, skin grafts for burns, limbs affected by peripheral artery disease and chronic ischemia (reduced blood flow). "The technology might also detect important tissue changes in patients with heart disease and other chronic medical conditions, providing an early warning signal that disease is progressing," says Lin. "And there are likely other clinical uses we haven't yet considered."