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Early and strict governmental intervention is a key factor in reducing the spread of COVID-19 cases. That's the conclusion reached by a team of researchers comparing outbreaks of the novel coronavirus between the Chinese province of Hunan and Italy in a new paper published in Frontiers in Medicine.

While Hunan and Italy are similar in population size - about 60-70 million people each - the scope of the epidemic in each location has differed dramatically. At time of publication, Italy has the second-most confirmed deaths after the United States and ranks third in total confirmed infections, according to the Johns Hopkins University Coronavirus Resource Center. There are just over 1,000 confirmed cases in Hunan.

The research team, based in China, used data from the John Hopkins database through April 2 to map infection trends in both Hunan and Italy. They modified a standard mathematical model known as a susceptible-infected-removed (SIR) model to account for the effects of different epidemic prevention measures at different periods in time.

"It should be noted that in actual situations, the speed of transmission can be changed through many interventions, such as personal protective measures, community-level isolation and city blockade," said lead author Dr. Wangping Jia with the Chinese PLA General Hospital in Beijing.

The paper's extended SIR (eSIR) model found that under current measures there could be a total of 3,369 (the mean in a possible range of 840-8,013) infected cases in Hunan, with the endpoint of the epidemic having already occurred around March 3. In contrast, total infected cases in Italy are projected to be 182,051 (the mean in a possible range of 116,114-274,378) with an end date around August 6.

The authors speculated that the disparate trends could be due to a couple of reasons. For instance, Italy may not have implemented preventive measures soon enough, as the eSIR model demonstrated that taking action earlier in the case of Hunan drastically reduced infection rates.

The authors noted that "from China's experience, various control measures, including the early detection and isolation of individuals with symptoms, traffic restrictions, medical tracking, and entry or exit screening, can well prevent the further spread of COVID-19."

The paper did not specifically address mortality rates because a number of factors can affect these predictions, according to Jia, such as bed capacity of intensive care units, as well as a patient's age, sex and any underlying health conditions such as cardiovascular disease, hypertension and diabetes.

"Accurate patient-specific data are urgent needs for the prediction of the total deaths," he said.

The Italian government recently announced it would begin to ease lockdown measures beginning May 4 - three months earlier than the eSIR model advises.

"We think it is too early to ease restrictions starting around May 4," Jia said. "The potential second wave may come if restrictions are eased three months earlier. Italy is not in the end period of the COVID-19 epidemic."

The authors concede that the current study has several limitations. First, due to the limited amount of testing, it's likely the number of infected people in Italy and elsewhere is higher than the official count. The eSIR model does not incorporate the disease's incubation period, which could make it less accurate. And there may be other factors that could throw off the estimate, such as the influence of "super spreaders" of the disease on a population.

Despite these possible shortcomings, Jia said the study makes one point abundantly clear: "We want to emphasize that taking government control earlier can greatly decrease the number of infected cases by comparing the epidemic trend in Hunan and Italy."

A new study shows that a financial incentive can dramatically increase the number of emergency department physicians trained to prescribe a potentially life-saving medication that prevents patients from fatal opioid overdose.

Led by researchers in Emergency Medicine at the Perelman School of Medicine at the University of Pennsylvania (Penn Medicine), the study showed that, at its start, just 6 percent of eligible physicians across three different emergency departments (EDs) had the proper training to prescribe the medication buprenorphine. But by offering reimbursement for training and a $750 incentive, 89 percent of physicians in those EDs were fully trained six weeks later. The study was published this month in Annals of Emergency Medicine.

"This study shows how enthusiastically emergency physicians embraced the opportunity to obtain this certification, which speaks to the shifting national conversation surrounding opioid use disorder and the importance of meeting patients where they are," said Sean Foster, MD, an assistant professor of Emergency Medicine and the director of Quality Improvement in Emergency Medicine at Penn Presbyterian Medical Center. "This also gives a 'playbook' of sorts to any leaders and administrators who may be looking for ways to get their group trained."

Buprenorphine is an "agonist" drug, meaning that it soothes the brain's cravings for opioids and has a ceiling effect on their toxic effects, preventing fatal overdose. By prescribing buprenorphine, ED doctors provide a "bridge" from acute care to longer term care that can include everything from counseling to continuing medications that will better support recovery.

A post-intervention survey for the study and actual buprenorphine prescribing data showed that in addition to having such a high rate of those trained, which is called getting an "X waiver," the physicians used their certification fairly quickly. Roughly 65 percent of respondents reported that they either administered or prescribed buprenorphine within the five months of their training.

"Buprenorphine is underutilized because of a lack of X waivered providers and the stigma associated with taking this medication, with some suggesting it's 'replacing one drug with another,'" said Jeanmarie Perrone, MD, a professor of Emergency Medicine and the director of the new Center for Addiction Medicine and Policy at Penn Medicine. "'However, buprenorphine has been shown to unequivocally decrease opioid overdose deaths and decrease the transmission of infections such as hepatitis C or HIV."

To get their X waiver, physicians must devote an entire day to training, which can be difficult to schedule amid their many responsibilities. It also wasn't very common until recently for the emergency department to be the venue for buprenorphine prescription. The incentive and reimbursement ($750 and $200, respectively, in this case) as well as changing attitudes toward the medication seem to make the decision to get an X waiver much easier for the 67 physicians it was offered to.

Of the three emergency department locations, two actually achieved a 100 percent X waiver rate. This included one site that went from zero X waivers to all of its ED doctors having one., and another site that went from just three of its physicians having X waivers to 26.

The variation in X waiver rates by site was not directly studied, but Foster thinks he knows why one site did particularly well.

"That particular site has the most readily available access to certified recovery specialists, who are absolutely essential in making the bridge from the emergency department to the doctor's office," Foster explained. "They are also incredible advocates for the patients while in the emergency department, and can help patients work through any hesitation they may have about participating in these treatments."

A related project at Penn Medicine called CORE that utilized both certified recovery specialists and the promotion of X waiver training resulted in 7 out of 10 patients being in active recovery a month after visiting the emergency department. Typical national numbers without buprenorphine prescriptions hover around 1 in 10.

While $750 could be seen as steep for some health systems, the post-intervention survey in this study revealed that two-thirds of respondents would have felt moved to get their X waiver even if the incentive was $500 or less.

Moving forward, to explore more ways to introduce buprenorphine use, the study team hopes to explore the effectiveness of "mini X waivers," a shorter training course.

"This study targets emergency physicians to ensure that they better understand the way buprenorphine works in order to administer it for opioid withdrawal symptoms in the emergency department," Perrone said. "In this setting, the X waiver certification is not required but it can still be a bridge to getting patients into treatment."

Around the Globe and in the US there is currently an ongoing debate on "reopening" or, more to the point, when and how to end the Lockdown.

Unfortunately, there is no standard or accepted definition as to what a Lockdown constitutes. More importantly, we have not asked the critical question as to the very effectiveness of a spectrum of Public Health interventions, nor assess the socio-economic costs of individual measures.

What is obvious is that an extreme Lockdown that leads to socio-economic damage is very costly in terms of both economic and Public Health consequences. Comparing the epidemiological curves of Nations with 5,000 or more cases of COVID-19 against the spectrum of interventions in those countries shows no consistent advantage to extreme versus more limited social distancing measures.

AURORA, Colo. (May 5, 2020) - Health screenings can catch conditions early, helping patients avoid a condition's worst consequences or even preventing it from developing altogether. Think of mammograms to catch breast cancer early or high blood pressure screening before a person has a stroke. Screening helps pre-symptomatic patients take actions to reduce their risk of a catastrophic outcome.

Recently, researchers have begun exploring the feasibility of general population screening to identify children and youth at risk for developing type 1 diabetes, where the autoimmune destruction of insulin producing cells can be detected years before onset of extreme hyperglycemia and a life-long dependency on insulin injections.

Led by Marian Rewers, MD, PhD, at the Barbara Davis Center for Diabetes at the University of Colorado School of Medicine, the Autoimmunity Screening for Kids (ASK) study has screened 25,000 children between 1-17 years old in the Denver metro area. Results are promising and show that screening can greatly reduce the incidence of diabetic ketoacidosis (DKA), a life-threatening complication of diabetes that is present in more than half of newly diagnosed children in Colorado.

The challenge has been that it takes thousands of screening tests to prevent just one DKA. For many insurance companies, it can seem as if the cost outweighs the benefit. However, researchers reported last week in Diabetes Care that the screening benefits go far beyond simply preventing DKA events, suggesting that screening may be more cost-effective than previously thought.

"When people think of value in health screening, they think it's straightforward - you catch these people early and avoid the health and economic impacts of letting the condition progress. With pre-symptomatic type 1 diabetes screening, avoiding DKA events is important not only now but potentially well into the future, even beyond preventing one life-threatening event. Knowing you are at risk for type 1 diabetes can potentially change the whole course of your life," says the study's lead author, Brett McQueen, PhD, assistant professor in the CU Skaggs School of Pharmacy and Pharmaceutical Sciences and its Center for Pharmaceutical Outcomes Research.

Generally, the study shows that if screening leads to 20 percent reduction in DKA events along with a significantly better diabetes control after diagnosis the cost of screening would be more than offset by cost savings due to fewer diabetes complications. In addition to the long-term benefits of avoiding DKA, the study also highlights the ability of screening to improve overall quality of life through better disease control.

"Even modest improvements in glycemic control over time can make a big difference in long term health," McQueen says.

And according to McQueen, the awareness created by screening can initiate behaviors that improve this glycemic control.

"There are tradeoffs in health as in life: Should I spend extra time, money, and effort to be healthy? Maybe if I know I'm at risk for type 1 diabetes, I do a little more than I might otherwise," says McQueen.

Another way to increase the value of screening is to decrease its cost, for example by instituting screening in areas with existing screening infrastructure or reducing screening prices.

"Our work isn't about saying it's 'worth it' or 'not worth it,' but about displaying to providers how to make screening more cost effective - showing what do we need to do as clinicians and providers to make this high value," McQueen says. "If you can show these benefits and use screening in the right areas with the right populations, our study shows it can be high value in the long run."

Now with a better picture of factors that influence the value of type 1 diabetes screening, the team's future work will include defining screening practices that could increase this value, including setting an age schedule for optimal screening and perhaps genetic pre-screening to test primarily in the most at-risk populations.

"If you're not on top of your diabetes, both the quality and quantity of your life is going to suffer," McQueen says. "The earlier you know you're at risk, the more you can do to live longer and better."

DALLAS, May 5, 2020 -- A new genetic risk score based on 29 mutations in the blood identified more men at increased risk for an abdominal aortic aneurysm and who could benefit from screening to detect it prior to rupture, according to preliminary research presented at the American Heart Association's Vascular Discovery: From Genes to Medicine Scientific Sessions 2020. The meeting is a virtual event in 2020, to be held May 5-7, and is a premier global exchange of the latest advances in new and emerging scientific research in arteriosclerosis, thrombosis, vascular biology, peripheral vascular disease, vascular surgery and functional genomics.

"I think this is the future of precision medicine - to use someone's genetics to identify those at high risk and to screen and potentially treat them before it becomes a problem," said Derek Klarin, M.D., lead author of the study and a vascular surgery fellow at the University of Florida College of Medicine in Gainesville, Florida.

Abdominal aortic aneurysm occurs when there is enlargement or a weakening of the wall of the large blood vessel that supplies blood to the abdomen and lower body. The condition is found most often in men over the age of 60 who have a family history of aneurysm, have been smokers or have other heart disease risk factors. If the aneurysm weakens the vessel wall to the point that it ruptures, it is a life-threatening medical emergency with a survival rate of about 20%.

In order to detect more abdominal aortic aneurysms before it is an emergency, in December 2019, the United States Preventive Services Task Force (USPSTF) announced updated recommendations for a one-time ultrasound screening of men between 65 and 75 years of age who have ever smoked. If an aneurysm is detected, it can be monitored to determine if it is small, can be surgically repaired and allow for treatment if it grows large enough to raise concerns about rupture (more than 5.5 cm or 2-1/6 inches).

"We focused on whether we could use a series of genetic mutations to develop a score that could stratify who is at higher risk of developing an abdominal aortic aneurysm," Klarin said.

Researchers identified genetic variants that raise the risk of abdominal aortic aneurysm by comparing more than 7,600 veterans with abdominal aortic aneurysm and more than 172,000 without the condition who were genotyped as part of the Million Veteran Program of the U.S. Department of Veteran Affairs.

"We identified 29 genetic mutations related to abdominal aortic aneurysm risk that are relatively common in the population and created a polygenic risk score - basically a way to add them all up to quantify how much risk you have based on your genetics," said Klarin.

In the study, among veterans 50 years of age and older who scored in the top 5% of genetic risk, 7.8% had been diagnosed with abdominal aortic aneurysm.

"This is a slightly higher risk than the 6-7% occurrence in men 65 and over who would be screened under the USPSTF's recommendations," Klarin said.

"Currently, this type of screening is not available from your doctor. Our results suggest current screening recommendations should be extended to include testing for those with high polygenic risk scores to allow for early intervention and prevention of abdominal aortic aneurysm," Klarin said.

Although the study involved only veterans, the researchers obtained the same results when they repeated the analysis in a sample of Mayo Clinic patients and participants from two other biobanks. Because the database included primarily white men, the results may not be applicable to women and men from other ethnic groups.

"We still need to do more work in understanding how best to identify women who will develop an abdominal aortic aneurysm. We have some data on African-American veterans, who in general are at lower risk; however, the genetics of the disease are not the same, so more data are needed," Klarin concluded.

Bottom Line: JAMA is commemorating 40 years of publishing A Piece of My Mind essays with this theme issue of 40 favorite essays from the past 10 years. The essays are often personal vignettes in which physicians discuss the human side of medicine. This editorial highlights some of the topics in the essays. More than 1,300 essays have been published over 40 years.

DALLAS, May 5, 2020 -- Higher alcohol consumption was shown to be associated with an increased risk of having a stroke or developing peripheral artery disease, according to new research published today in Circulation: Genomic and Precision Medicine, an American Heart Association journal.

While observational studies have consistently shown that heavy alcohol consumption is associated with an increased risk of certain cardiovascular diseases, they often use self-reported data and are unable to determine cause. Researchers in this study used a different technique called Mendelian randomization that identifies genetic variants with a known association to potential risk factors to determine the potential degree of disease risk.

"Since genetic variants are determined at conception and cannot be affected by subsequent environmental factors, this technique allows us to better determine whether a risk factor -- in this case, heavy alcohol consumption -- is the cause of a disease, or if it is simply associated,"

said Susanna Larsson, Ph.D., senior researcher and associate professor of cardiovascular and nutritional epidemiology at Karolinska Institutet in Stockholm, Sweden. "To our knowledge, this is the first Mendelian randomization study on alcohol consumption and several cardiovascular diseases."

Researchers analyzed the genetic data from several large-scale consortia and the UK Biobank, which follows the health and well-being of 500,000 United Kingdom residents. Results indicate that with higher alcohol consumption:

a three-fold increase of peripheral artery disease, a narrowing of arteries that results in reduced blood flow, usually to the legs;

a 27% increase in stroke incidence; and

some evidence for a positive association of coronary artery disease, atrial fibrillation and aortic aneurysm.

"Higher alcohol consumption is a known cause of death and disability, yet it was previously unclear if alcohol consumption is also a cause of cardiovascular disease. Considering that many people consume alcohol regularly, it is important to disentangle any risks or benefits," Larsson said.

Researchers noted that this study suggested the mechanism by which higher consumption was associated with the risk of stroke and PAD may be blood pressure.

According to a statement on dietary health, the American Heart Association believes that alcohol intake can be a component of a healthy diet if consumed in moderation (no more than one alcoholic drink per day for women and 2 alcohol drinks per day for men) and only by nonpregnant women and adults when there is no risk to existing health conditions, medication-alcohol interaction, or personal safety and work situations. One drink is equivalent to 12 ounces of beer (5% alcohol); 5 ounces of wine (12% alcohol); or 1.5 ounces of 80-proof distilled spirits (40% alcohol).

The study has some limitations. According to Dr. Larsson, the prevalence of heavy drinking in the UK Biobank was low, and it is unlikely that the burden of increased risk of cardiovascular disease is restricted to heavy drinkers alone. Also, the exact amount and frequency of alcohol consumed could not be quantified for this study. The researchers said the causal role of alcohol consumption on cardiovascular diseases other than stroke and peripheral artery disease requires further research.

Whole body diffusion-weighted magnetic resonance imaging (DW MRI) may aid in the assessment of cancer treatment response in children and youth at much lower levels of radiation than current approaches, suggests a small study funded by the National Institutes of Health. The results appear in Radiology.

Researchers compared DW MRI, which measures the density of tumors by tracking the movement of water molecules in tissue, to an established technique, fluorine 18 fluorodeoxyglucose positron emission tomography (FDG PET). FDG PET is typically used with computed tomography (CT) scans and measures tumor metabolism after an injection of radioactive glucose.

Both techniques showed significant agreement in tracking tumor response to therapy, raising the possibility that DW MRI might one day be used in place of CT scanning, either together with FDG PET or alone, without the need to inject radioactive glucose. This new approach could reduce radiation exposure by 80% for combined FDG PET/DW MRI and fully eliminate radiation exposure for tumors that can be evaluated with DW MRI only.

"Advances in pediatric cancer treatment have led to more survivors, but radiation exposure from current imaging techniques raises the risk of new cancers later in life," said George P. Giacoia, M.D., of the Obstetric and Pediatric Pharmacology and Therapeutics Branch at NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), which provided funding for the study. "These initial results on DW MRI are promising, but they need to be confirmed by additional studies."

In the current study, 56 children and youth (ages 6 to 22 years old) completed 112 DW MRI and FDG PET scans. Participants had either lymphoma (cancer that begins in the lymphatic system) or sarcoma (cancer that starts in bone, muscles and other soft tissues). The authors explained that the study included only two tumor types because pediatric cancers are rare. They added, however, that they believe their study encompasses the largest number of PET/MRI scans obtained in a pediatric population to date.

Researchers simultaneously performed the two scans on the study participants before their treatment began and then after the first few weeks of chemotherapy. Evaluating the therapy response early allows clinicians to switch to a potentially more effective treatment if the tumor continues to grow. The authors found that the two methods yielded similar results, though in some patients FDG PET detected therapy response sooner than DW MRI. They concluded that more studies are needed to confirm their results in a larger number of patients and for different tumor types.

BOSTON- Massachusetts Eye and Ear and Massachusetts General Hospital (MGH), members of Mass General Brigham, today announced progress towards the testing and development of an experimental vaccine called AAVCOVID, a novel gene-based vaccine candidate against SARS-CoV2, the virus that causes COVID-19.

The AAVCOVID vaccine program was developed in the laboratory of Luk H. Vandenberghe, PhD, director of the Grousbeck Gene Therapy Center at Massachusetts Eye and Ear and Associate Professor of Ophthalmology at Harvard Medical School. It is currently in preclinical development with a plan to begin clinical testing in humans later this year. Mason Freeman, MD, director and founder of the MGH Translational Research Center is leading the efforts to develop the clinical studies intended to establish safety and efficacy of the experimental vaccine.

The AAVCOVID Vaccine Program is a unique, gene-based vaccine strategy that uses adeno-associated viral (AAV) vector, a clinically established gene transfer technology leveraging the properties of a harmless viral carrier. AAV is used to deliver genetic sequences of the SARS-CoV-2 Spike antigen so the body can develop an immune response to the coronavirus. AAV technology has been used extensively in the field of gene therapy, and substantial experience and capacity exists for manufacturing and clinical use of AAV-based medicines. Two AAV-based drugs have been approved by U.S. Food and Drug Administration in recent years.

The AAVCOVID vaccine candidate will be administered by an intramuscular injection. Currently, tests are underway in animal models, and initial manufacturing activities have begun. Based on the preclinical findings, one or more candidates will advance into the clinical phase of testing in humans.

While several types of COVID-19 vaccines are in development worldwide, AAV technology offers several distinct advantages, including its adaptability and potential to elicit a beneficial immune response in people. In addition, other versions of AAV technology have been tested in the clinic for more than two decades with a favorable safety record.

"AAV is a superior technology for safe and efficient gene delivery, and the unique technologies we are applying in AAVCOVID support the potential for a potent immunity to be induced to SARS-CoV-2 from a single injection," said Dr. Vandenberghe. "In a crisis, we can harness the power of molecular biology and develop a draft of a vaccine in weeks, and that's what was done here. Now, clinical studies are needed to establish safety and efficacy of our novel approach," he said.

"While many organizations are engaged in generating vaccine candidates to prevent COVID-19 disease, it is very far from certain what the best approach will be," said Dr. Freeman. "Dr. Vandenberghe's unique vaccine method brings an elegant, novel and extremely creative approach to meeting our goal: to protect our most vulnerable patients as well as the healthcare workers who care for them during this and future viral outbreaks."

The team is advised by experts at Massachusetts General Hospital and the Mass General Brigham Innovation Fund and includes deep involvement of experts from industry with experience in vaccine development, regulatory affairs, and manufacturing. The research is funded by philanthropic support led by Wyc Grousbeck, Boston Celtics lead owner and CEO and Mass. Eye and Ear Chairman, his wife Emilia Fazzalari, CEO of Cinco Spirits Group LLC, the Grousbeck family, and others.

"This is what innovation looks like. It is a combination of both the scientific insight of Dr. Vandenberghe and his team as well as the nimble and collaborative spirit of the institutions and donors who have come together to move this program from idea to promising vaccine candidate at lightning speed," said Joan W. Miller, MD, Chief of Ophthalmology at Mass. Eye and Ear, Massachusetts General Hospital, and Brigham and Women's Hospital, and Chair of Ophthalmology and David Glendenning Cogan Professor of Ophthalmology at Harvard Medical School.

"We are deeply grateful to all involved in this collaboration, and especially to the donors who generously stepped up to spearhead the initial funding of this program," said John Fernandez, President of Mass. Eye and Ear.

"The unprecedented coronavirus pandemic has challenged us all, and overcoming it demands the best thinking and the most creative ideas from our scientific and clinical teams supported and strengthened by our philanthropic communities," said Peter L. Slavin, MD, President of MGH. "This collective spirit of innovation, resolve and generosity is the most powerful weapon we have to fight this formidable virus."

About the AAVCOVID Technology

The AAVCOVID Vaccine Program is a gene-based vaccine strategy that seeks to deliver genetic sequences of the SARS-CoV-2 using an adeno-associated virus (AAV) vector, a harmless virus that serves as a delivery vehicle into the body.

Vaccination with AAVCOVID delivers the gene code for antigens from the SARS-CoV-2 Spike protein following a low dose intramuscular injection, which is designed to elicit an immune response to prevent infection. This approach is supported by extensive experience with the safety of the AAV technology platform in other diseases, including the use of AAVs in two FDA-approved medicines, and preclinical studies on immunogenicity.

Dr. Vandenberghe and his laboratory began work on the vaccine in mid-January following the Wuhan outbreak and the first publication of genetic sequences of the new coronavirus. Using a specific AAV with desirable vaccine properties, the program seeks to induce immunity to prevent infection and or disease in healthy populations.

AAV is also a rapidly adaptable technology. If a new strain of the SARS-CoV-2 virus emerges, the genetic code inside the AAVCOVID vaccine can be exchanged for an updated genetic code and processed into an updated vaccine in weeks, according to the researchers.

This multi-institutional program is led by principal investigator Luk H. Vandenberghe, PhD, the Grousbeck Family Chair in Gene Therapy at Mass. Eye and Ear, who is a world-renowned leader and pioneer of viral gene transfer and therapeutic gene transfer. Dr. Vandenberghe is working in conjunction with Mason Freeman, MD, who serves as Director of the Translational Medicine Group of the MGH Center for Computational and Integrative Biology and is Professor of Medicine at Harvard Medical School.

Having abnormally small red blood cells - a condition known as microcytosis - could indicate cancer, according to new research led by a University of Exeter student working with a world-leading team.

Medical Sciences student Rhain Hopkins was lead author of the study of more than 12,000 UK patients aged over 40, which found that the cancer risk in males was 6.2 per cent, compared to 2.7 per cent in those without microcytosis.

The research, funded by Cancer Research UK and NIHR and published in BJGP, found that in females, the risk of cancer was 2.7 per cent in those with microcytosis, compared to 1.4 per cent without.

Of more than 108,000 followed within the Clinical Practice Research Datalink records, 12,289 patients with microcytosis were followed up. Of those, 497 developed cancer within a year.

Microcytosis is related to iron deficiency and with genetic conditions which affect haemaglobn in the blood. Similarly, iron deficiency has been identified as a feature of some cancers, particularly colorectal. Microcytosis is easily identified in a routine blood test.

Rhian Hopkins was working with Exeter's cancer diagnosis team as part of her Professional Training Year, which gives Medical Sciences students practical experience of research. As lead author of the paper, she said: "Research targeted at diagnosing cancer earlier is so important in reducing the burden of this devastating disease. The identification of risk markers, such as microcytosis, that are relevant to a range of cancers, can have a real impact in primary care. Being part of this research has been a very rewarding experience and getting my first paper published is such a massive achievement."

Professor Willie Hamilton, at the University of Exeter Medical School, who oversaw the research, said: "Overall, the risk of cancer in patients with microcytosis was still low, however our research indicates a need to investigate cancer. In two patients with cancer out of three the possibility of cancer is fairly easy to identify. For the other third, symptoms are often vague, and don't clearly point to cancer. For these patients GPs have to use more subtle clues to recognise that cancer may be present. Small red cells have long been recognised with colon cancer, but this study shows that they are a much broader clue, alerting the doctor to the small possibility of one of several possible cancers."

Dr Elizabeth Shephard, who supervised Rhian, said: "Rhian was a dedicated, proactive and enthusiastic student and an absolute pleasure to work with. As part of her Professional Training Year (PTY), Rhian undertook this standalone project of investigating the role of microcytosis as a possible early marker of cancer. She taught herself to use Stata statistical analysis software, and with guidance learned how to build the database from which to run the analyses. She also analysed the data and wrote up the paper for publication, making a meaningful contribution to the potentially life-saving area of cancer diagnosis.

"The PTY placement is a fantastic opportunity for undergraduates to gain valuable research work experience - and for academics to work with bright students. I wouldn't hesitate to recommend the programme."

ORLANDO, May 5, 2020 - A new study co-authored by a University of Central Florida researcher shows that laws that punish substance use during pregnancy actually do more harm than good.

These unintended consequences include keeping women from getting the treatment they need and failing to reduce the number of babies addicted to drugs.

The study, which was published Monday in the journal Health Affairs, compared the effects of punitive polices in states that implemented them and those that didn't.

The findings are increasingly important as instances of opioid use disorder at delivery continue to rise.

"Opioid use during pregnancy can harm both the mother and baby, and rates of opioid use disorder at delivery increased over 300 percent between 1999 and 2014," said Danielle Atkins, an assistant professor in UCF's College of Community Innovation and Education and study co-author.

"States have taken various approaches to address prenatal substance use, including policies that consider prenatal substance use as equivalent to child abuse or neglect," Atkins said. "In our study, we did not find evidence that having a punitive prenatal-substance-use policy reduced rates of babies born with withdrawal symptoms or maternal narcotic exposure at birth."

"We found evidence, however, that punitive policies reduce substance use treatment admissions among pregnant women and that a smaller share of pregnant women are referred to treatment by health care providers in states with punitive policies," she said.

For the study, Atkins and co-author Christine Piette Durrance, an associate professor in the Department of Public Policy at the University of North Carolina at Chapel Hill, used data from the Healthcare Cost and Utilization Project's State Inpatient Databases, which has records for 95 percent of hospital discharges from 37 states.

From that data, they counted the number of babies born with withdrawal symptoms and affected by maternal narcotics exposure from 2000 to 2014.

They also used data from the Treatment Episode Data Set - Admissions, a national data system of annual admissions to substance abuse treatment facilities, to identify the number of pregnant women admitted to treatment by state and year.

For prenatal substance use policies implemented in different states, they used information from the Guttmacher Institute, State Policies in Brief, Substance Abuse During Pregnancy, bi-annual reports.

When they compared the proportion of pregnant women admitted to treatment before punitive policies were enacted to after, and with states that had those policies and those that didn't, they found that treatment admissions for pregnant women dropped by 29 percent and referrals to treatment by health care professionals decreased by 18 percent when punitive laws were put in place.

Furthermore, punitive policies were not statistically significantly related to the number of babies born with withdrawal symptoms or exposed to narcotics.

"These results provide population-based evidence of the effect of punitive prenatal substance use policies on birth outcomes and substance use treatment admissions," Atkins said. "Although proponents of punitive prenatal-substance-use policies often cite improved birth outcomes for infants as one policy aim, our results do not support this."

She said alternatives to punitive laws include improved access to medication-assisted treatment with methadone or buprenorphine, along with prenatal care and behavioral health counseling.

Atkins also noted the complex nature of prenatal substance abuse, such as whether prenatal opioid exposure was the result of a medically used prescription, and barriers to treatment, such as cost, availability and stigma.

A new study conducted in seven Front Range emergency departments demonstrated success in helping parents make their homes safer when a teen is distressed.

The study published in the Annals of Emergency Medicine showed that efforts by hospitals to counsel parents on safe storage of guns and medications were successful. For the study, investigators from the Program for Injury Prevention, Education and Research (PIPER) in the Colorado School of Public Health on the Anschutz Medical Campus collaborated with investigators from Northeastern and Harvard Universities.

The researchers worked with mental health providers at emergency departments to counsel parents of adolescents at risk of suicide. The counseling included advice on how to more safely store guns and medications, and parents received free locking devices.

Though conducted before the coronavirus crisis, the results are even more important now during this time of added stress when families are spending more time at home and gun sales are on the rise.

According to lead Colorado investigator, Carol Runyan, MDH, PhD, founding director of PIPER, "This is important because Colorado's teen suicide rate is the 8th highest in the nation and has increased nearly 70% over the last decade, with more than 1,135 Colorado youth dying from suicide between 2000 and 2018. Most of these happen at home. By storing medications and guns more safely, parents can save lives. That was the motivation behind the study."

Emmy Betz, MD, MDH, associate professor of emergency medicine at the University of Colorado School of Medicine, and study co-investigator, adds, "A visit to the emergency room is an important opportunity to reach parents to talk about in-home safety measures that can be effective. Until now, though, consistent counseling about firearm and medication safety has not always been routine."

Conducted over two years, the study demonstrated that a brief online training for counselors, coupled with free medication and firearm locking devices, helped parents make changes at home to improve safety. The research followed up with 575 parents who brought teens to the hospital with a mental health crisis. The results include:

The percentages of parents reporting safer storage practices after the counseling more than doubled, indicating that counseling can help change in-home practices.

The behavioral health counselors who participated in the study expressed enthusiasm for the changes, indicating that they found the online training very helpful and easy to deliver in a way acceptable to parents in a time of extreme stress.

The study documented that the percentages of counselors reported to have talked to parents about these topics improved during the study period, with 57% counseling about safe firearm storage after the study was implemented (versus just 19% at the start).

Counseling about medication storage also increased, to 80% from just 32%.

But, there is still room for improvement, noted Colorado School of Public Health investigator, Sara Brandspigel, MPH. "We are hopeful that these seven hospitals will continue to maintain their counseling efforts and that more hospitals will take advantage of the free training and increase their counseling on safe storage of firearms and medications." She also noted that when someone is at risk of suicide, the safest firearm storage location is outside the home. Working with Betz, as an outgrowth of the study Brandspigel initiated development of a web-based resource showing where in Colorado families can take their guns to store away from the home.

Sarah Brummett, Director of the Office of Suicide Prevention at the Colorado Department of Public Health and Environment, and a study consultant, notes that the training for hospital-based counselors is available for free online through Train.org/Colorado (ID 1076412 "Lethal Means Counseling: A Role for Colorado Emergency Departments to Reduce Youth Suicide") and urges all hospitals to build their capacity for collaborative safety counseling. She notes, in particular, that in this time of added stress during the COVID-19 response effort, that crisis hotlines such as the Colorado Crisis and Support line (1-844-493-8255) are providing support and resources to a greater number of clients and that safe storage of firearms and medications can protect not only young people, but all family members.

Researchers from McMaster University have found that the potato, primarily known as a starchy vegetable, can be a source of high-quality protein that helps to maintain muscle.

The findings, reported in the journal Nutrients, highlight the potential benefits of what is considered a non-traditional source of protein, particularly as dietary trends change and worldwide demand has increased for plant-based alternatives to animal-derived sources.

"While the amount of protein found in a potato is small, we grow lots of potatoes and the protein, when isolated, it can provide some measurable benefits," says Sara Oikawa, a former graduate student in the Department of Kinesiology at McMaster and lead author of the research paper.

The researchers recruited young women in their early twenties who consumed diets containing protein at the recommended dietary allowance (RDA) of 0.8 grams of protein/ per kilogram of weight/day, which would be approximately 60g of protein for the average woman or 70g for the average man.

One group of participants consumed additional potato protein isolate - in the form of a pudding--doubling their intake of the RDA to 1.6g/kg/d. Another group received a placebo.

Researchers found the women who consumed the additional potato protein increased the rate at which their muscles made new protein, while the placebo group did not.

"This was an interesting finding that we did not expect," says Oikawa. "But it is one that shows the recommended daily allowance is inadequate to support maintenance of muscle in these young women."

Perhaps more interesting, she says, was that a form of plant-derived protein, which has generally been thought to be of lower quality than animal-derived protein, can have such a beneficial effect.

To study the impact of weightlifting, the research team then instructed both groups of women to exercise only one of their legs.

"This method is a little unconventional but allows us to see the effect within the same person and not have to add more people who were exercising," said the study principal investigator Stuart Phillips, who is a professor in the Department of Kinesiology at McMaster and a leading researcher on protein and exercise.

In the leg the women exercised, scientists did not find any extra benefits from potato protein.

"That finding, which some may find disappointing, is in line with the rather small effect that protein has compared to exercise itself," explains Phillips. "In other words, exercise is just such a more potent stimulus for making new muscle proteins compared to protein."

The demand for protein has risen dramatically to meet the increased demands from the rising global population and plant-based proteins could fill that gap.

"This study provides evidence that the quality of proteins from plants can support muscle," says Oikawa. "I think you'll see more work on plant-based protein sources being done."

University of Houston Hugh Roy and Lillie Cranz Cullen Endowed Professor of biomedical engineering, Chandra Mohan, and his team have discovered a difference in urinary biomarker proteins of lupus nephritis (LN) in patients according to race. He is reporting his findings in Nature Communications.

"Among African American patients, the most discriminatory biomarkers that distinguished active LN from inactive disease were urine ALCAM, PF-4, properdin, and VCAM-1," reports Mohan. Mohan is already collaborating with a biotech partner targeting the ALCAM protein with new therapeutics that can potentially block it in patients with LN. Yet other urine proteins were noted to be discriminatory among Caucasian and Asian patients.

"The best biomarkers lend themselves to be the best therapeutic targets because they tend to be disease drivers, and that is what is happening here with ALCAM," said Mohan, whose research was supported by the National Institutes of Health.

Systemic Lupus Erythematosus (SLE), also called lupus, is an autoimmune disease that occurs when the body attacks its own tissues and organs. Inflammation from the disease can impact many different parts of the body including joints, skin, kidneys, blood cells, brain and heart. Lupus nephritis is one of the most frequent and severe clinical manifestations of SLE, representing a leading cause of morbidity and mortality.

"While patient demographics are widely known to affect SLE disease manifestations and outcomes, there are virtually no studies investigating this phenomenon in the context of disease biomarkers," reports Mohan. "Most SLE biomarker studies focus on one demographic group or all ethnic groups combined, which yield results that may not be equally predictive in all demographic groups of SLE patients."

Mohan's team used an aptamer-based screen with the power to simultaneously interrogate over 1,100 unique proteins, rather than traditional biomarker discovery study designs, which are either based on prior understanding of established pathways underlying LN or analysis of proteins.

"In this assay, streptavidin-coated beads labelled with 1,129 unique aptamers are added to each urine sample to allow them to bind to their designated protein targets," said Mohan. Aptamers are synthetic, single-stranded DNA-based molecular recognition elements, which selectively recognize and quantify a wide spectrum of proteins in body fluids or cells.

"This is one of the largest, if not the largest, screening platforms currently available," said Mohan, who used the screening on 127 patients with inactive lupus, 107 patients with active lupus nephritis, 67 with active non-renal lupus and 74 healthy individuals.

Given the observed variation in urine biomarkers across ethnicities, Mohan's team is planning a longitudinal study which tracks patients for months or years, so that disease flares can be predicted before they actually happen.

WASHINGTON (May 5, 2020) - Enrollment in a supportive oncodermatology program is associated with a significantly improved quality of life score, according to a recent survey from the George Washington University (GW) Cancer Center. The results of the survey were published in the Journal of Drugs in Dermatology.

Supportive oncodermatology is a growing field that provides treatment and preventive care to oncology patients who experience adverse dermatologic events associated with their cancer treatments. While dermatologic health in cancer patients is gaining attention, the literature evaluating the impact of supportive oncodermatology clinics on patient quality of life is limited.

To identify the impact of these programs, the group at GW performed a cross-sectional survey of adult cancer patients enrolled at the Supportive Oncodermatology Clinic at GW Cancer Center. Those who met inclusion criteria were invited to complete an online survey with questions adapted from the Dermatology Life Quality Index and Patient Satisfaction Questionnaire.

"Our results show that patient quality of life benefited significantly from enrollment in the clinic's programs," said Adam Friedman, MD, director of the GW Supportive Oncodermatology Clinic, interim chair of the Department of Dermatology at the GW School of Medicine and Health Sciences, and senior author on the study. "The supportive oncodermatology field is a critical element of multidisciplinary cancer care that addresses dermatologic wellness in cancer patients."

The respondents reported satisfaction with the care they received at the GW Supportive Oncodermatology Clinic, especially in terms of providers' interpersonal manner and communication and would recommend this type of care to other cancer patients.

Prior to receiving care at the clinic, patients had an average quality of life score of 6.5, indicating a "moderate effect" dermatologic adverse events have on quality of life. On average, scores were significantly reduced by 2.7 points after joining the clinic.

While patients reported overall satisfaction with dermatologic care, many reported being unsure if those interventions aided in adherence to anticancer treatment. Because of this, the authors pointed out, it is necessary to develop evidence-based management systems for dermatologic adverse effects.