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A survey of more than 4,000 UK emergency care doctors has shown that they need more support to recover from work pressures between shifts.

Published today in the BMJ Open, the study highlighted how the doctors' 'need for recovery' was higher than anything recorded in previous studies of a similar nature - and could be helped by factors such as reducing the number of antisocial shift patterns and improving access to leave.

Led by a newly formed Trainee Emergency Research Network, sponsored by University Hospitals Plymouth NHS Trust (UHPNT), and with collaboration from the University of Plymouth and the Royal College of Emergency Medicine, the research asked a total of 4,247 doctors in emergency departments from 112 NHS Trusts around the UK to complete a validated Need for Recovery (NFR) Scale. This 11-item questionnaire assesses how work affects inter-shift recovery, with items compiled to form a score between 0 and 100.

The median average NFR result was 70 - higher than any scores reported in other professions or populations to date.

In addition, a higher proportion of antisocial working was associated with a higher NFR score, suggesting that any reduction in antisocial shifts could help improve wellbeing.

Known as the TIRED study, it was the largest healthcare study to date of a tool that assesses the need for staff to physically and psychologically recuperate following a period of work. The authors also propose that the use of this tool could identify staff wellbeing issues before they progress to burnout.

The research took place in 2019 before the COVID-19 pandemic, but authors suggest the study findings remain relevant given that pressures on emergency care doctors are only likely to have increased.

Lead author Dr Laura Cottey, Chief Investigator for the Trainee Emergency Research Network study, said: "We all know that emergency care can be a high-pressure environment, but these results provide the evidence of the impact this work demand is having on staff wellbeing. Previous Need for Recovery scores among a variety of population groups were reported between 36 and 44, so for the median score to be 70 among over 4,000 doctors is definitely something that needs to be addressed.

"Among our respondents, we saw that NFR scores were increased by difficulty accessing annual and study leave, as well as an increased proportion of antisocial working - such as night shifts. Better access to leave and any reduction in antisocial shifts might result in direct improvements in NFR and help protect against the development of burnout."

Co-author Dr Blair Graham, Lecturer in Urgent and Emergency Care at the University of Plymouth and Specialty Registrar in Emergency Medicine at UHPNT, said: "The first step to overcoming any problem is recognising that there is one - so having these results is a good start. Even if fewer antisocial shifts cannot be achieved, acknowledgement of a problem and the provision of rest facilities may help to mitigate the issue.

"The next step would be for us to carry out the research at different times of year to understand whether the results are seasonal, or affected by other factors. Although this study was conducted prior to COVID-19 arriving in the UK, we believe the findings still need to be taken into account as pressures on emergency care doctors are only likely to have increased during the pandemic."

Professor Gary Minto, Director of Research and Development at UHPNT, said: "Here at University Hospitals Plymouth, our research strategy is that, in addition to our longstanding strength in running clinical trials, we also expand our focus into other areas of social care, health and wellbeing. The TIRED study, which addresses mental health in Emergency Doctors, is a great example. This prominent nationwide study, initiated, led and delivered by doctors in training contains important messages about downtime and shift patterns which are relevant across the UK, particularly as the COVID-19 situation evolves."

PHOENIX, Ariz. ? Genetic testing can uncover inherited genetic mutations, and could individualize cancer therapies, improve survival, manage cancer in loved ones and push the boundaries of precision medicine.

In a new study published in JAMA Oncology, scientists with Mayo Clinic's Center for Individualized Medicine conducted genetic testing in more than 3,000 patients who were diagnosed with cancer at Mayo Clinic Cancer Center locations in Arizona, Florida and Minnesota. In all, the scientists found that 1 in 8 patients with cancer had an inherited cancer-related gene mutation. This mutation would not have been detected in half of these patients using a standard guideline-based approach.

"We found that 13.5% of patients had an inherited mutation in a gene associated with the development of their cancer," says Niloy Jewel Samadder, M.D., a Mayo Clinic gastroenterologist and hepatologist, who is the study's author. "Everyone has some risk of developing cancer, and in most cases the disease develops by chance. However, some people are genetically predisposed to developing certain types of cancer, such as breast or colon cancers."

A genetic mutation can cause a gene to malfunction and lead to a cell becoming cancerous. Although many mutations that cause cancer happen by chance in a single cell, the study confirms that nearly 10%-25% are inherited mutations that set off a cycle of events that can lead to cancer.

Dr. Samadder says uncovering these hidden inherited genetic mutations could lead to opportunities for cancer management in families and targeted cancer therapies that can save lives.

In the two-year Interrogating Cancer Etiology Using Proactive Genetic Testing (INTERCEPT) study, Mayo Clinic provided free genetic testing and counseling to 3,084 Mayo Clinic patients as part of their standard cancer care. The project, representing the largest known multicenter study of universal testing of patients with cancer, included a broad mix of cancer stages and types, including breast, colorectal, lung, ovarian, pancreatic, bladder, prostate and endometrial cancers.

The researchers were surprised to find that the standard guidelines physicians relied on to determine which patients with cancer should undergo genetic testing were only able to identify 48% of the patients with an inherited genetic mutation.

"More than half of the patients who developed cancer due to inherited mutations were being missed, and that has major implications for family members," Dr. Samadder says.

"Everyone has some risk of developing cancer, and in most cases the disease develops by chance. However, some people are genetically predisposed to developing certain types of cancer, such as breast or colon cancers." - Dr. Samadder

During the study, when the researchers examined the effects of a genetic mutation discovery, they found that one-third of the patients with the highest-risk cancer genes had a change in their medical management, including the type of surgery or chemotherapy they received.

"This targeted treatment would have been lost if the patients had not received genetic testing," Dr. Samadder emphasizes.

"Genetic testing is underutilized in cancer care, both for patients and for their families, often due to outdated guidelines that restrict testing to a narrow group of high-risk patients," says Robert Nussbaum, M.D., chief medical officer of Invitae Corporation. "All cancer patients should have access to complete genetic information that can guide their care and inform their families' health." Dr. Nussbaum was a contributing author on the study.

Sharing genetic risks with family members

Dr. Samadder says equally important to the discovery of a patient's inherited cancer mutation is the potential for patients to share the heretible-cause of their disease with their relatives, allowing family members to pursue care for earlier disease detection and cancer management.

"We can help prevent cancer in their loved ones because it is genetic, and they share these cancer-causing genetic changes with their children, siblings and others in their families," Dr. Samadder explains. "We can target prevention strategies for those high-risk individuals and hopefully prevent cancer altogether in future generations of their family."

All blood-related family members of patients found to have a genetic mutation were offered free genetic testing. Overall, 1 in 5 of these family members underwent testing. The next steps will be to incorporate the study findings into the care of all patients with cancer at Mayo Clinic.

"Steps are being taken to ensure all patients are offered genomic sequencing to better understand the genes that led to the development of their cancer, and how to precisely target treatment and improve survival," Dr. Samadder says.

Blood clots continue to wreak havoc for patients with severe COVID-19 infection, and a new study explains what may spark them in up to half of patients.

The culprit: an autoimmune antibody that's circulating in the blood, attacking the cells and triggering clots in arteries, veins, and microscopic vessels. Blood clots can cause life-threatening events like strokes. And, in COVID-19, microscopic clots may restrict blood flow in the lungs, impairing oxygen exchange.

Outside of novel coronavirus infection, these clot-causing antibodies are typically seen in patients who have the autoimmune disease antiphospholipid syndrome. The connection between autoantibodies and COVID-19 was unexpected, says co-corresponding author Yogen Kanthi, M.D., an assistant professor at the Michigan Medicine Frankel Cardiovascular Center and a Lasker Investigator at the National Institutes of Health's National Heart, Lung, and Blood Institute.

"In patients with COVID-19, we continue to see a relentless, self-amplifying cycle of inflammation and clotting in the body," Kanthi says. "Now we're learning that autoantibodies could be a culprit in this loop of clotting and inflammation that makes people who were already struggling even sicker."

'Some of the worst clotting we've ever seen'

Co-corresponding author Jason Knight, M.D., Ph.D., a rheumatologist at Michigan Medicine, has been studying antiphospholipid syndrome antibodies in the general population for years.

"Half of the patients hospitalized with COVID-19 were positive for at least one of the autoantibodies, which was quite a surprise," says Knight, also an associate professor of internal medicine and a leading expert on diseases caused by autoantibodies.

In the new Science Translational Medicine publication, they found about half of the patients who were very sick with COVID-19 were exhibiting a combination of high levels of both the dangerous antibodies and super-activated neutrophils, which are destructive, exploding white blood cells. In April, the team was the first to report that patients hospitalized for severe COVID-19 had higher levels of neutrophil extracellular traps in their blood.

To learn more, they studied the explosive neutrophils and the COVID-19 antibodies together in mouse models to see if this could be the dangerous combination behind the clots.

"Antibodies from patients with active COVID-19 infection created a striking amount of clotting in animals - some of the worst clotting we've ever seen," Kanthi says. "We've discovered a new mechanism by which patients with COVID-19 may develop blood clots."

Attacking COVID-19 blood clots from all angles

The researchers say these findings aren't yet ready for clinical practice, but they add a new perspective to the robust thrombosis and inflammation research in patients with COVID-19.

Kanthi, Knight, first author Yu (Ray) Zuo, M.D., and colleagues now want to know whether severely ill patients with high levels of these antibodies would have better outcomes if the antibodies are blocked or removed.

If so, that might warrant an aggressive treatment like plasmapheresis, which is commonly used in severe autoimmune diseases, Zuo explains. It involves draining blood through an IV, filtering it and replacing it with fresh plasma that doesn't contain those antibodies associated with blood clots.

"We know people with the highest levels of autoantibodies did worse in terms of respiratory function, and the antibodies caused inflammation even in healthy cells" says Zuo, an assistant professor of internal medicine and a rheumatologist at Michigan Medicine.

"We don't yet know what is triggering the body to produce these antibodies, so the next step would be additional research to identify the triggers and the targets of the antibodies," Knight adds.

In addition, these findings bring up new questions surrounding the use of convalescent plasma as a possible COVID-19 treatment, but the team says more research is needed to examine this concern.

"We're now investigating how long these antibodies remain in circulation after recovery from the novel coronavirus," Knight says.

The researchers are also currently running a randomized clinical trial called DICER, which is testing a well-known anti-clotting agent, dipyridamole, in patients with COVID-19 to determine whether it's more effective than a placebo in reducing excessive blood clots.

"Dipyridamole is an old drug that is safe, inexpensive, and scalable," Kanthi says. "The FDA approved it 20 years ago to prevent clotting, but we only recently discovered its potential to block this specific type of inflammation that occurs in COVID."

DALLAS, Nov. 2, 2020 -- People who experience high blood pressure while sleeping are more likely to experience future cardiovascular disease especially heart failure, even when their daytime blood pressure is within normal ranges, according to new research published today in the American Heart Association's flagship journal Circulation.

Health care professionals typically use in-office and daytime blood pressure measurements to determine a patient's hypertension medication needs and dosages. However, many patients may have undetected nocturnal hypertension -- high blood pressure while sleeping.

"Nighttime blood pressure is increasingly being recognized as a predictor of cardiovascular risk," said Kazuomi Kario, M.D., Ph.D., lead author of the study and a professor of cardiovascular medicine at Jichi Medical University in Tochigi, Japan. "This study provides much more in-depth information about the cardiovascular risk associated with high nighttime blood pressure and different nighttime blood pressure phenotypes than have been reported previously."

The Japan Ambulatory Blood Pressure Monitoring Prospective (JAMP) study enrolled 6,359 patients from across Japan between 2009 and 2017 and measured daytime and nighttime levels using an at-home, wearable, ambulatory monitor. Blood pressure was measured during daily activities and sleep for at least 24-hours at a time, and device data were periodically downloaded at a health care clinic. Almost half of the study participants were male, and more than half were over the age of 65 years. The patients all had at least one cardiovascular risk factor, and three-quarters of them were taking blood pressure medications, and none had symptomatic cardiovascular disease when the study began.

The study participants were instructed to rest or sleep during nighttime hours and maintain their usual daytime activities. Their daily activities and sleep and wake times were self-reported in a diary. Almost every participant recorded 20 daytime and seven nighttime automated blood pressure measurements. To determine nighttime measurements, patients self-reported the time they fell asleep and woke up. All other readings were defined as daytime.

Follow-up occurred annually via phone or clinic visit, with total follow up ranging from two to seven years. Researchers analyzed the rates of cardiovascular disease events, including heart attacks, strokes, heart failure and death, among the participants. The occurrence and timing of heart events in relation to blood pressure variations was analyzed to determine whether there were any associations. Study participants experienced a total of 306 cardiovascular events, including 119 strokes, 99 diagnoses of coronary artery disease and 88 diagnoses of heart failure.

The analysis indicates:

Increased levels during sleep--a systolic blood pressure measuring 20 mm Hg above a person's daytime systolic reading--was significantly associated with the risk of atherosclerotic cardiovascular disease and heart failure.

The participants who had an abnormal circadian pattern, which is when sleep blood pressure exceeds daytime readings, were at particular risk of developing heart failure and had a greater risk of experiencing any cardiovascular disease events.

Excessive reduction of blood pressure during sleep may also be detrimental. Patients with well-controlled hypertension showed a significantly increased risk of stroke when nighttime systolic pressure took extreme dips.

"Results indicate that nighttime systolic blood pressure was a significant, independent risk factor for cardiovascular events," said Kario. "The study highlights the importance of including nighttime blood pressure monitoring in patient management strategies and will hopefully encourage physicians to ensure that antihypertensive therapy is effectively lowering blood pressure throughout the 24-hour dosing period."

The authors noted that the study was not without limitations. Ambulatory data were obtained once at the start of the study, however, no information was available regarding the contributions of subsequent changes in ambulatory blood pressure levels up until the time of diagnosis of a cardiac event. The study focused on systolic, rather than diastolic, measurements due to the older age of the participants. Additionally, study evaluations did not include echocardiograms, thus preventing some degree of differentiation for types of heart failure.

For decades, scientists have predicted that a deadly pandemic would sweep the globe -- but what they didn't expect was that basic public health measures such as mask wearing and social distancing would become political flashpoints, especially in the United States.

But according to new research from the UBC Sauder School of Business, a different approach to public health messaging could help ease those tensions - and potentially save lives.

In the U.S., more than eight million people have been infected with the fast-moving virus, and more than 225,000 have died. Still, millions of Americans, many of them conservatives, doggedly refuse to wear masks, social distance or obey limits on social gatherings.

In fact, for some, snubbing those prevention measures has in itself become a political statement.

Through a series of studies involving more than 2,300 U.S. participants, both Republicans and Democrats, researchers from UBC Sauder, Boston University and Stockholm Business School set out to determine why that was, and how respondents from both sides of the political fence felt about personal responsibility.

What they found was that conservatives tend to focus on self-reliance and feel responsible for their own outcomes, whereas liberals take more of a community-minded view and are more likely to take responsibility for others.

Democrats tend to feel their community-minded actions make a difference, whereas many Republicans believe they aren't particularly helpful.

"Republicans have this perception that if they do the social distancing, the mask wearing, the hand sanitizing and all these different things, they have less of an impact on others -- whereas the Democrats feel like these behaviours will have an impact on others," explains UBC Sauder Professor Katherine White, who is also the academic director of the Dhillon Centre for Business Ethics.

"So Republicans basically say, 'It's my choice and I'm going to do what I want. It's not really affecting anyone else.'"

In one study, the researchers asked participants to adopt and use a contact-tracing app, which helps track positive cases of COVID-19 and alert users when they've been near an infected person. The participants were given different messages about the benefits of the app, some focused on protecting the self ("Keep Yourself Safe") and some aimed at helping others ("Help Save Lives").

"We find that the self-focused messages resonate significantly better with Republicans and make them more likely to use the app," says White, who adds that focusing on individual protections doesn't alienate Democrats or cause a backfire effect.

The study authors didn't only divide people into those two political camps; they also surveyed participants to determine their level of liberalism or conservatism, and noticed the study's findings were amplified when participants were more deeply rooted in their respective political camps.

But the findings don't necessarily mean that conservatives are less compassionate, emphasizes White. "Some people say, 'Conservatives just don't care about other people.' And I don't think that's what we're finding," she says. "What we're finding is that they don't see their behaviours as impacting others, which is very interesting."

Because of the Republican-Democrat divide when it comes to COVID-19 measures, White recommends that public health officials carefully consider where they're placing their messages, then tailor them to the specific audience.

"You could have one that says 'do it for others' in the more liberal media, and then have more of the 'think about yourself and your close family' for Republican audiences," says White. "Don't necessarily assume it's one size fits all."

LUGANO, 31 October, 2020 - New research (1) launched at the 29th EADV Congress, EADV Virtual, has found that despite the COVID-19 (SARS-CoV-2) lockdown restrictions, diagnosis of sexually transmitted infections (STIs), including gonorrhoea, secondary syphilis and mycoplasma genitalium (MG), have increased.

The research, conducted in two main STI centres in Milan, Italy, compared the number of confirmed diagnoses of the most common STIs in patients with symptoms for the period 15 March 2020 to 14 April 2020 following social isolation measures (lockdown) adopted to control the epidemic, with the same period in 2019.

The results revealed that despite a reduction in the total number of attendances by over a third (37%, 233 in 2019 vs 147 in 2020), the number of acute bacterial infections, most associated with men who have sex with men (MSM), increased during the observational period, including secondary syphilis and gonorrhoea. Cases fell, however, in the non-acute cases, such as genital warts and Molluscum Contagiosum.

It concludes that the COVID-19 pandemic, despite lockdown and advice on Social/Physical distancing, did not inhibit risky behaviours and that acute STIs actually increased.

Dr Marco Cusini, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy, explains: "It was assumed that the lockdown would reduce the opportunity for sexual encounters and STIs. However, I was surprised by the number of new acute infections diagnosed in this short period of time. Gonhorrhea and syphillis are typically more prevelant in people in their 30s, so infection may have increased because the concentration of COVID-19 morbidity and mortality in the elderly made the younger, more active, cohort feel protected and so less risk averse. Whilst it is unrealistic to prevent people from having sex, even in this extraordinary pandemic, close contact during sexual intercourse inevitably involves an increased risk of SARS-CoV-2 contagion.The findings show the importance of ongoing screening for STIs and the real benefit of having these types of services open and available during these unprecedented times."

While gonorrhoea is still highly susceptible to the mainstay antibiotic treatment option ceftriaxone, the emergence of antimicrobial resistant gonorrhoea remains of concern. Recommended combinations with antibiotics such as azithromycin should be avoided in the light of antibiotic stewardship, necessitating new treatment guidelines. Dr Henry J.C. de Vries of the STI outpatient clinic Health Service Amsterdam presented on The threat of antimicrobial resistant gonorrhoea at 12:00-12:15 CET on Thursday 29th October 2020.

Gonorrhoea is caused by the bacterium Nesisseria gonorrhoeae (2). It often, but not always, presents no symptoms in females and is mostly symptomatic in males (3). Common symptoms in men include urethral discharge and pain upon urination (dysuria), and women may present with odourless vaginal discharge, dysuria and pain during sexual intercourse (3). Symptoms usually appear between 1-10 days after infection (4). Gonorrhoea is on the rise across Europe, in 2017 alone, there were more than 89,000 confirmed cases (240 per day), of which MSM accounted for almost half of all the cases (47%) (5). The United Kingdom reported 55% of all cases (75 per 100 000) followed by Ireland (47), Denmark (33), Iceland (29), Norway (27) and Sweden (25) (4).

The first symptoms of syphilis usually develop around 2 or 3 weeks after infection, although they can start later than this. the main symptom is a small, painless sore or ulcer typically on the penis, vagina, or around the anus, although it can sometimes appear in the mouth or on the lips, fingers or buttocks (6). Secondary syphilis is a progression of the disease and symptoms, however is curable with treatment (7). In 2018, there were 33,927 confirmed cases in Europe. The highest rate was observed in Malta (17.9 cases per 100 000 population), followed by Luxembourg (17.1), the United Kingdom (12.6) and Spain (10.3) (8).

What The Study Did: Researchers investigated the association between sleep disorders and symptoms of burnout among faculty and staff in a large teaching hospital system.

Authors: Matthew D. Weaver, Ph.D., of Brigham and Women's 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.2020.23256)

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.

#  #  #

Media advisory: The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2020.23256?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=103020

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

What The Study Did: Whether quality of diet was associated with overall survival among patients beginning treatment for metastatic colorectal cancer was examined in this study.

Authors: Erin Van Blarigan, Sc.D., of the University of California in San Francisco, 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.2020.23500)

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.

#  #  #

Media advisory: The full study and commentary are linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2020.23500?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=103020

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

LUGANO, 30 October, 2020 - New research (1) presented at the 29th EADV Congress, EADV Virtual, shows that socks coated in zinc oxide nanoparticles (ZnO-NPs) can prevent bromodosis (foot odour) and pitted keratolysis (bacterial infection causing smelly feet), reducing the negative impact this embarrassing condition has on quality of life (2).

Developed by the Royal Thai Airforce, the ZnO-NP-coated socks were trialled in a real-life setting by researchers at Siriraj Hospital, Mahidol University in Thailand. They found that the antibacterial efficacy of ZnO-NPs, along with its safety and compatibility with human skin, makes it the perfect compound to incorporate into textiles, including socks, to prevent unpleasant foot odour.

The double-blinded, randomised, controlled trial was conducted with 148 cadets at the Thai Naval Rating School. Bromodosis and pitted keratolysis are a common complaint in military personnel, with foot lesions, including pitted keratosis, occurring in over a third of naval cadets in Thailand (38.5%) (2).

The study demonstrated that those with the ZnO-NP-coated socks had significantly less foot malodour compared to baseline (p=0.009). This was compared to the uncoated-sock group who experienced more intense foot odour with a greater negative effect on their daily life (p=0.04). They also found that participants with the uncoated-socks were more likely to develop pitted keratolysis compared to those with the ZnO-NP-coated-socks (p=0.05).

The study is a result of the first-hand experience of lead author Dr Punyawee Ongsri, a naval officer and final year resident at the Department of Dermatology, Siriraj hospital, Mahidol University. He saw an issue with military personnel while working in the naval medical department. Dr Ongsri explains: "While completing an internship as a naval officer in the medical department, I saw a high number of foot infections in military personnel. I wanted to find a way to prevent and treat these fungal and bacterial infections and those conditions associated. Previous studies had demonstrated zinc oxide nanoparticles's antibacterial properties therefore my professor Dr. Bunyaratavej, Dr. Leeyaphan and our research team wanted to test the efficacy of this new technology in a real-life setting."

He continues, "Our results prove the efficacy of ZnO-NP-coated socks in preventing bromodosis and inhibiting the development of pitted keratolysis. These socks could provide a new primary prevention option for both military personnel and those susceptible to these embarrassing and unpleasant conditions. We are continuing our research with other textiles and hope to treat and prevent the growth of bacterial and fungal infections."

What The Study Did: This study used the Medicare COVID-19 Nursing Home Database, a federally mandated weekly survey of all Medicare-certified skilled nursing facilities, to examine facility-reported test result turnaround time.

Authors: Michael L. Barnett, M.D., M.S., of the Harvard T. H. Chan School of Public Health 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/jamainternmed.2020.7330)

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.

With more than 650 Australians diagnosed with malignant mesothelioma last year, Flinders University is leading new research to discover alternatives to chemotherapy and even prevent deaths by early detection in future.

One novel approach, using natural therapeutic benefits of curcumin, a key component of the spice turmeric, will be put to the test in a clinical trial in 2021 as part of world-leading research at Flinders University.

While asbestos is now banned from being used for new buildings, many houses still contain asbestos, so exposure during renovations is common. Australia has one of the highest per-capita rates of asbestos-related disease in the world.

Flinders University researchers are studying the safety and feasibility of using a form of intrapleural liposomal curcumins to benefit patient survival and quality of life - with fewer toxic side-effects than chemotherapy.

"That's why it's important to explore alternative therapies and facilitate early diagnosis to reduce suffering and support early intervention measures," says Flinders University lead researcher Associate Professor Sonja Klebe.

As well, the researchers are looking for early diagnostic methods with a special lung fluid test. "In most cases, malignant mesothelioma is not diagnosed until it is in the late stages," she says. "We're hoping to find a way to test for the disease before it becomes invasive."

Patients diagnosed with malignant mesothelioma, the cancer caused by asbestos exposure, experience poor survival of 6-12 months following diagnosis and a five-year survival of less than 5%. Therapeutic options are limited due to high resistance rates to chemotherapy and the advanced age of patients (median age 75).

Associate Professor Klebe's team will test the safety and feasibility of intrapleural liposomal curcumin to benefit patient survival and quality of life. Future treatments are expected to have fewer toxic side-effects than chemotherapy.

In addition, the researchers are investigating methods to facilitate early diagnosis, using novel techniques on the lung fluid that is drained in the early stages of diagnosis.

"In most cases, malignant mesothelioma is not diagnosed until it is in the late stages," she says. "We're hoping to find a way to test for the disease before it becomes invasive."

In time for Asbestos Awareness Month in November, the experts warn the high number of cases could persist for years with hundreds more cases of the deadly disease possible after latency of more than 30 years from work-related (builders, plumbers, gasfitters, mechanics and marine engineers) or other exposure. Firefighters may also be at risk after the devastating bushfires razed old buildings and sheds across Australia.

A new study examines local perceptions of Chagas disease in a region where the infectious agent is endemic. The results underline the need to take social and cultural factors into account in campaigns designed to curb infectious diseases.

Chagas disease is found primarily in Latin America, but globalization is promoting its spread beyond the subcontinent. The condition is caused by the unicellular organism Trypanosoma cruzi, which is transmitted to humans by certain species of blood-sucking bugs. If left untreated, the infection can become chronic, which may in turn result in life-threatening damage to the heart or the intestinal tract. The World Health Organization (WHO) has classified Chagas disease as one of the world's neglected tropical diseases. Cases have also been reported in Germany, mainly among immigrants from Latin America. An international team of researchers led by Michael Pritsch (Division of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-Universitaet (LMU) in Munich Medical Center) has now carried out a study of public perceptions of the disease in the Monteagudo region of Bolivia, the country with the highest incidence of infection worldwide. The results suggest new approaches that should help to enhance the long-term efficacy of campaigns intended to check the spread of infectious diseases by ensuring that the measures selected are more widely accepted and utilized by the populations affected.

Monteagudo is located in the Bolivian Chaco - a region in the southeast of the country, where around half of all adult inhabitants are infected with T. cruzi. "Several NGOs have already initiated health projects specifically intended to reduce the incidence of infection with T. cruzi," says Sandra Parisi, the lead author of the new report. As part of her work for the German charity DAHW Deutsche Lepra und Tuberkulosehilfe e.V., Parisi interviewed in collaboration with Bolivian medical students and clinical researchers approximately 10% of all households in Monteagudo with the aim of assessing their attitudes to the campaigns that are underway, and their level of knowledge of both the disease and ways to reduce the risk of infection. The project presented several logistical challenges. "In some cases, we had to undertake journeys lasting several days in order to reach these people. And very often, the only way to travel to the households was on horseback," Parisi explains. In addition to visiting people in their homes, the team conducted in-depth interviews with other key protagonists including patients, doctors, community leaders and traditional healers. "To the best of our knowledge, this is the largest and most comprehensive such study that has ever been done in this region," says senior author Michael Pritsch.

In comparison with earlier studies in Latin American countries, the authors found that the population of Monteagudo knew more about primary preventive measures, i.e. the need to control the insects that transmit the disease. This finding suggests that State-supported and international campaigns in recent years have been successful. On the other hand, far fewer people were aware of the fact that the disease can also be transmitted via contaminated foods and from mother to child.

Chagas is a source of anxiety for the local population, and people who contract the disease can face social consequences - such as exclusion from consideration for jobs and bank loans. In spite of these negative connotations, the researchers were astonished to discover that the disease is also regarded as a normal part of life in the region. "We were often told that if you don't have Chagas, you're not a real chaqueño," says Parisi.  Another factor that the authors found disturbing was widespread opposition to the use of benznidazole, the current treatment of choice. Many prefer alternative treatments because they are more accessible locally and have fewer side-effects than the recommended drug. One reason for this skepticism lies in a misconception regarding the results of rapid, antibody-based tests for the presence of the parasite. - Many patients mistakenly interpret a second positive test as proof that the treatment is ineffective.

"This underlines the importance of including a more active, participatory component in future campaigns, in order to identify and correct such misunderstandings early on," says Pritsch. For the region's inhabitants, the opinions of other members of the local community, veterinarians and traditional healers were accorded at least as much weight as those of the doctors. According to the study's authors, this factor makes it imperative to ensure that all of the relevant protagonists are consulted and informed in future projects.

"Our study constitutes an impressive demonstration of the fact that medical research and the provision of new methods of diagnosis and treatment does not automatically lead to improvements in public health. It represents only one aspect of the process," says Pritsch. He and his colleagues therefore argue that a holistic understanding of illness and its local manifestation, which includes a consideration of its social and cultural aspects in the community concerned, is required to enhance the acceptance and efficacy of health campaigns. Studies of patient-centered provision of healthcare, such as that reported in the new publication, can contribute to improvements in the practical implementation of concepts developed in the field of Global Health.

COPD is a common respiratory condition and one of the top causes of hospital admissions each year, particularly during winter months. In the UK it accounts for over 140,000 hospital admissions and one million bed days at a major cost to the NHS.

At a time when fewer people are able to access face-to-face consultations with their GPs and elderly patients with conditions such as COPD need are shielding, these are very encouraging findings for the future of digital health services.

In this new study, 41 patients admitted to hospital with severe exacerbations of COPD were allocated into two groups, with one group receiving their regular treatments and the second group of patients set up with access to the MyCOPD app as well as receiving treatment as usual.

MyCOPD gives patients access to a broad range of services wherever they are in the world, without the need to travel to clinics or join waiting lists. These services include receiving education from medical experts, information on how factors such as pollen, pollution and the weather in their area could affect their condition and videos that demonstrate how to use inhalers correctly. Users also complete daily diaries of their symptoms and medication, which allows the app to help them identify when they are deteriorating and provide advice on appropriate courses of action.

The results of this latest trial, published in the journal NPJ Digital Medicine, showed that over the course of three months, the number of further exacerbations within the group using the app was nearly half that for those who just received treatment as usual (18 compared to 34). Incorrect use of inhalers also reduced by around 80% for MyCOPD users, compared to a fall of around 30% for the control group.

Significantly, the average age of participants using the app was over 65 and despite not being regular web users, all were able to adapt to the technology.

MyCOPD, developed and hosted by my mhealth, is one of the largest apps of its kind and one of a small number of digital health apps with NICE approval. The Department for Health and Social Care highlighted it in their 2019 review into digital healthcare because of its potential to deliver better outcomes for patients and improve NHS productivity. Now this latest peer reviewed trial provides further evidence of its benefits.

Professor Tom Wilkinson of the University of Southampton who developed the app and led the trial said, "COPD has a significant impact on peoples' daily lives so we wanted to develop a means of healthcare that is like having an expert in your pocket; giving you advice whenever you need it.

"The transition towards digital healthcare has been taking place for some time but has accelerated since the outbreak of COVID-19. Patients with conditions such as COPD can be particularly vulnerable now so it is important that we have evidence of the effectiveness of these technologies.

"Hopefully the success of this will lead to further use and the development of similar products that allow patients to manage other conditions to further improve their wellbeing and reduce the burden on the NHS."

PHILADELPHIA -- (Oct. 30, 2020) -- Scientists at The Wistar Institute have designed and tested the first-of-its-kind synthetic DNA vaccine against Powassan virus (POWV), targeting portions of the virus envelope protein. A rapidly reemerging tick-borne disease, POWV has been reported to be fatal in 10% of infected people with detrimental neurological consequences including encephalitis and meningitis. This new POWV vaccine candidate, described in a paper published today in PLOS Neglected Infectious Diseases, is one of many emerging infectious disease DNA vaccine discoveries being advanced by the Vaccine and Immunotherapy Center at The Wistar Institute.

Unlike the widely recognized Lyme disease, POWV causes a little known, potentially deadly infectious disease that is transmitted through tick bites during fall and spring seasons. POWV is an RNA virus belonging to the flavivirus family, the same as Zika virus, but passed to people by ticks instead of mosquitoes.

Transmission can occur rapidly and symptoms including flu-like fever, body aches, skin rash, and headaches can present anytime during the 1-4 week incubation period. Although still considered relatively rare, in recent years the number of reported cases of people sick from Powassan virus has been increasing in North America, including infecting former U.S. Senator Kay Hagan who contracted Powassan virus and died from the disease. There are no vaccines or therapies available to treat or prevent this emerging infection.

Kar Muthumani, Ph.D., former associate professor and director of the Laboratory of Emerging Infectious Diseases at The Wistar Institute,* and senior author on the study, collaborated with the laboratory of David B. Weiner, Ph.D., executive vice president and director of Wistar's Vaccine and Immunotherapy Center, to design and test this synthetic DNA vaccine.

The effectiveness of this vaccine was evaluated in preclinical studies that showed a single immunization elicited broad T and B cell immune responses in mice similar to those induced naturally in POWV-infected individuals, and that vaccine-induced immunity provided protection in a POWV challenge animal model.

"The significant protection in mice demonstrated by our vaccine is highly encouraging and strongly supports the importance of this vaccine approach for further study," said Muthumani.

Residents of and visitors in POWV-endemic areas are considered at risk of infection, especially during outdoor work and recreational activities. In the U.S., cases of POWV disease have been reported in Northeastern states and the Great Lakes region.

"Given the risk of serious complications from POWV and the 300% increase in incidence of POWV infection over the past 16 years, we will continue efforts to advance this urgently needed emerging infectious disease vaccine candidate towards the clinic," said Weiner.

NEW YORK (October 30, 2020) -- The floors of hospital rooms are quickly and frequently contaminated with antibiotic-resistant bacteria within hours of patient admission, creating a route of transfer of potentially dangerous organisms to patients, according to a study published today as part of the proceedings from Decennial 2020: The Sixth International Conference on Healthcare-Associated Infections. Decennial 2020, an initiative of the Centers for Disease Control and Prevention and the Society for Healthcare Epidemiology of America, was cancelled in March due to the pandemic. All abstracts accepted for the meeting have been published as a supplement issue in the journal Infection Control & Hospital Epidemiology.

"If bacteria stayed on floors this wouldn't matter, but we're seeing clear evidence that these organisms are transferred to patients, despite our current control efforts," said Curtis Donskey, MD, senior author of the study and hospital epidemiologist at the Cleveland VA Medical Center. "Hand hygiene is critical, but we need to develop practical approaches to reduce underappreciated sources of pathogens to protect patients."

Researchers with the Northeast Ohio VA Healthcare System closely tracked contamination in hospital rooms of 17 newly admitted patients to identify the timing and route of transfer of bacteria within patients' rooms. Before testing, rooms were thoroughly cleaned and sanitized and all patients screened negative for methicillin-resistant Staphylococcus aureus (MRSA) and other healthcare-associated bacteria. Researchers then observed patients' interactions with healthcare personnel and portable equipment, collecting cultures one-to-three times per day from patients, their socks, beds and other high-touch surfaces, as well as key sections of the floor.

Nearly half of rooms tested positive for MRSA within the first 24 hours, and MRSA, C. difficile, and vancomycin-resistant enterococci (VRE) pathogens were identified in 58% of patient rooms within four days of admission. Contamination often started on the floors, but ultimately moved to patients' socks, bedding, and nearby surfaces.

"While we're showing that these scary sounding bugs can make their way into a patient's room and near them, not everyone who encounters a pathogen will get an infection," said Sarah Redmond, lead author and a medical student at Case Western Reserve University School of Medicine. "With that in mind, are there simple ways to address these areas of exposure without placing too much emphasis on the risk?"

In a related study published in August in Infection Control & Hospital Epidemiology, the authors reported similar findings of frequent detection of SARS-CoV-2 nucleic acid on floors and on shoes of personnel on a COVID-19 ward. The authors note that further research is needed to clarify the role of floor contamination in transmission of both bacterial and viral pathogens and to identify practical approaches to address contamination. On the COVID-19 ward, contamination was reduced with simple modifications of floor cleaning and disinfection protocols.

Researchers noted several limitations of the study, including the small sample size and variables in characteristics among patients and healthcare personnel that may impact how generalizable the study findings are to other hospitals.