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A new blood test demonstrated remarkable promise in discriminating between persons with and without Alzheimer's disease and in persons at known genetic risk may be able to detect the disease as early as 20 years before the onset of cognitive impairment, according to a large international study published today in the Journal of the American Medical Association (JAMA) and simultaneously presented at the Alzheimer's Association International Conference.

For many years, the diagnosis of Alzheimer's has been based on the characterization of amyloid plaques and tau tangles in the brain, typically after a person dies. An inexpensive and widely available blood test for the presence of plaques and tangles would have a profound impact on Alzheimer's research and care. According to the new study, measurements of phospho-tau217 (p-tau217), one of the tau proteins found in tangles, could provide a relatively sensitive and accurate indicator of both plaques and tangles--corresponding to the diagnosis of Alzheimer's--in living people.

"The p-tau217 blood test has great promise in the diagnosis, early detection, and study of Alzheimer's," said Oskar Hansson, MD, PhD, Professor of Clinical Memory Research at Lund University, Sweden, who leads the Swedish BioFINDER Study and senior author on the study who spearheaded the international collaborative effort. "While more work is needed to optimize the assay and test it in other people before it becomes available in the clinic, the blood test might become especially useful to improve the recognition, diagnosis, and care of people in the primary care setting."

Researchers evaluated a new p-tau217 blood test in 1,402 cognitively impaired and unimpaired research participants from well-known studies in Arizona, Sweden, and Colombia. The study, which was coordinated from Lund University in Sweden, included 81 Arizona participants in Banner Sun Health Research Institute's Brain Donation program who had clinical assessments and provided blood samples in their last years of life and then had neuropathological assessments after they died; 699 participants in the Swedish BioFINDER Study who had clinical, brain imaging, cerebrospinal fluid (CSF), and blood-based biomarker assessments; and 522 Colombian autosomal dominant Alzheimer's disease (ADAD)-causing mutation carriers and non-carriers from the world's largest ADAD cohort.

In the Arizona (Banner Sun Health Research Institute) Brain Donation Cohort, the plasma p-tau217 assay discriminated between Arizona Brain donors with and without the subsequent neuropathological diagnosis of "intermediate or high likelihood Alzheimer's" (i.e., characterized by plaques, as well as tangles that have at least spread to temporal lobe memory areas or beyond) with 89% accuracy; it distinguished between those with and without a diagnosis of "high likelihood Alzheimer's" with 98% accuracy; and higher ptau217 measurements were correlated with higher brain tangle counts only in those persons who also had amyloid plaques.

In the Swedish BioFINDER Study, the assay discriminated between persons with the clinical diagnoses of Alzheimer's and other neurodegenerative diseases with 96% accuracy, similar to tau PET scans and CSF biomarkers and better than several other blood tests and MRI measurements; and it distinguished between those with and without an abnormal tau PET scan with 93% accuracy.

In the Colombia Cohort, the assay began to distinguish between mutation carriers and non-carriers 20 years before their estimated age at the onset of mild cognitive impairment.

In each of these analyses, p-tau217 (a major component of Alzheimer's disease-related tau tangles) performed better than p-tau181 (another component of tau tangles and a blood test recently found to have promise in the diagnosis of Alzheimer's) and several other studied blood tests.

Other study leaders include Jeffrey Dage, PhD, from Eli Lilly and Company, who developed the p-tau217 assay, co-first authors Sebastian Palmqvist, MD, PhD, and Shorena Janelidz, PhD, from Lund University, and Eric Reiman, MD, Banner Alzheimer's Institute, who organized the analysis of Arizona and Colombian cohort data.

In the last two years, researchers have made great progress in the development of amyloid blood tests, providing valuable information about one of the two cardinal features of Alzheimer's. While more work is needed before the test is ready for use in the clinic, a p-tau217 blood test has the potential to provide information about both plaques and tangles, corresponding to the diagnosis of Alzheimer's. It has the potential to advance the disease's research and care in other important ways.

"Blood tests like p-tau217 have the potential to revolutionize Alzheimer's research, treatment and prevention trials, and clinical care," said Eric Reiman, MD, Executive Director of Banner Alzheimer's Institute in Phoenix and a senior author on the study.

"While there's more work to do, I anticipate that their impact in both the research and clinical setting will become readily apparent within the next two years."

Alzheimer's is a debilitating and incurable disease that affects an estimated 5.8 million Americans age 65 and older. Without the discovery of successful prevention therapies, the number of U.S. cases is projected to reach nearly 14 million by 2050.

COLUMBUS, Ohio - A new study shows the surprising way that many American taxpayers adjust their standard of living when they owe money to the IRS versus when they receive tax refunds.

Researchers found that when households received tax refunds, they immediately started spending that new money. But those same households didn't cut their spending in years when they owed taxes to the IRS.

The findings contradict economic theories that suggest people spend their tax refunds only because they need the money to buy necessities, said Itzhak Ben-David, co-author of the study and professor of finance at The Ohio State University's Fisher College of Business.

If that were true, then these households would have had to cut spending in years when they owed taxes.

"What we found is that owing money to the IRS did not disrupt normal consumption in our sample of American households," Ben-David said.

The sample in this study used a personal finance website, so they were more financially sophisticated than average consumers, he noted. But even those in the study who had had the least savings and the most credit-card debt did not reduce their spending when they owed money.

"They found ways to use money from savings accounts or other reserves to keep up their spending in years when they had to pay the IRS. They didn't cancel their vacations," Ben-David said.

The study has been conditionally accepted for publication in the American Economic Review and is currently online at the SSRN preprint server.

Ben-David's co-authors were Jonathan Parker, professor of finance at the Massachusetts Institute of Technology, and two former Ohio State doctoral students: Brian Baugh, assistant professor of finance at the University of Nebraska, and Hoonsuk Park, assistant professor of banking and finance at Nanyang Technological University in Singapore.

The researchers used anonymized data from a personal finance website that included details of spending habits of 196,565 American households from July 2010 to May 2015. The researchers included only households that had both received tax refunds and paid the IRS in different years to ensure the findings weren't simply the result of separate households behaving in different ways.

All households - from the most to the least wealthy - increased their spending immediately after receiving the refund, the study showed.

People consumed about 8 percent of the refunds during the month after they received them, which rose to about 15 percent over the following three months.

"We found that the spending increases the exact day on which the refund arrives," Ben-David said. "Even though they know the refund is coming, most Americans don't start spending until they have it in their account."

Even the wealthiest people in the sample spent a good portion of their refund, despite the fact that they had the money to spend without the refund.

"When they received the refund, people in our sample consumed more or less the same fraction of it regardless of the amount. People who received a big refund spent about the same fraction as those with a smaller refund - just a bigger dollar amount," he said.

The results suggest that people treat a tax refund like they would a cash bonus from work - they spend some and save some.

When households owed money to the IRS, the researchers found that they increased transfers among their accounts in the month before making their payment. For example, some moved money from savings to checking before writing a check to the government.

What they didn't do is spend less on dining out, clothing, recreation or other items in their budget.

"Americans in our sample viewed tax payments as a necessary cost like a car repair or new appliance that can come out of their savings," Baugh said.

"It is not something they had to change their usual spending for."

The findings suggest that people's behavior involving money may not follow traditional economic theories, Parker said.

If people's spending responds primarily to how much money they have available, as some prominent theories predict, consumers should spend less when they owe the IRS, which this study didn't find. Furthermore, they also shouldn't spend their refund if they already have plenty of money - but this study showed that even the wealthiest households spent a portion of their refunds.

Instead, this research supports the theory that people use very general rules of thumb to determine how they spend money. According to this "mental accounting" theory, households think of themselves as having three accounts: current income, current assets and future incomes.

These are not real accounts, but how people track their money in their minds, Park said. In this theory, people try not to touch their current assets (like retirement savings) and future income (like inheritances they expect to receive).

All their spending comes from current income. That means when their income increases - as it does from a tax refund - they treat it like a bonus from work and spend some of it and save some of it.

If they owe money, that is outside of the usual income and spending cycle, so they use other sources of funds, if available, to pay it without reducing their usual spending - just like other unexpected costs.

"This is one of the few studies that has been able to show that mental accounting does explain how people behave in real life," Ben-David said.

Taking a few minutes to get that periodic cup of joe might not be such a bad idea.

When working at home, it's good to have a break, possibly every 30 minutes, to stay healthy and minimize injury to your back, shoulders and arms, says Kermit Davis, PhD, an expert in office ergonomics at the University of Cincinnati College of Medicine.

"The body doesn't like static postures continually," says Davis, a professor in the UC Department of Environmental and Public Health Sciences. "You don't want to do all sitting or all standing all the time. You want to alter your position and change it up throughout the day."

Workers across the nation have converted their basements, spare rooms, dining room tables or bedrooms into makeshift offices in the midst of the coronavirus pandemic. But few have much guidance when it comes to making these new spaces ergonomically safe, says Davis, who runs both UC's graduate industrial hygiene and occupational ergonomics programs.

"You can go home but you aren't allowed to take the monitor, chair and most office equipment," explains Davis. "You can use your laptop from home, but it is designed to be a short-term option. It should be used for a few hours while traveling. It is not meant to be used for eight or nine hours each day."

The screen and keyboard on laptops are smaller than a standard office computer, says Davis. As a result the user oftentimes looks downward since the smaller screen is well below eye height.

Davis conducted an ergonomic assessment of employees at the University of Cincinnati sending out an email survey to 4,500 faculty and staff after the coronavirus pandemic prompted the university to join many other employers across the nation in sending workers home to continue operations. The survey had 843 people complete it. As part of the study, 41 employees sent Davis photos of workers at home workstations for ergonomic review. This subset showed some trends and offered a glimpse into what many who work from home are encountering.

The survey's findings were recently published in the scholarly journal Ergonomics in Design.

Davis says the ergonomic evaluations of the home workstations identified many issues that could be adversely affecting the workers. Many chairs were the wrong height with about 41% too low and 2% too high. Fifty-three percent of workers had armrests on their chairs, but 32% did not use them and for 18% of workers the armrests were improperly adjusted, the study found.

Davis says not using the armrests causes contact stress on forearms when rested on the hard front edge of work surfaces and strain across the upper back as the arms need support. Also, support of the back of the chair was not used by 69% and often without any lumbar support for 73% of survey participants. That meant many individuals did not have proper support of their lower back, maintaining the lumbar curvature.

The position of a computer monitor was often too low or off to the side. Three quarters of monitors were laptops, which were too low relative to the workers' eye height, the study found.

External monitors were also routinely set up too low in 52% of participants or too high in 4%. Another common issue with the monitors was the lack of the primary screens centered in front of the workers occurring in 31% of workers and resulting in twisting of the neck and/or back to view the monitor, according to the study.

Davis says not everyone can spend hundreds of dollars on a new chair or other equipment when working from home. He says there are some cheap and easy fixes that will go a long way in improving the ergonomic well-being of office workers.

Here are a few tips that might be helpful for the homebound office worker:

Place a pillow on your seat to elevate the seat height.

Place a pillow or rolled up towel behind your back to provide lumbar and back support.

Wrap armrests when they are low and not adjustable.

Move your chair closer to the desk or table to encourage having the back against the back of the seat.

If a laptop is too low, place a lap desk or large pillow under the laptop to raise the monitor when using it on the lap.

Use an external keyboard and mouse, along with raising the laptop monitor by placing a stack of books or a box under the laptop when using a laptop on a desk.

An appropriate standing workstation should have the top of the monitor at eye height and directly in front, keyboard at a height so that forearms are parallel to the ground (approximately 90° elbow angle), and a soft or rounded front edge to the working surface.

If obtaining a new chair or identifying an appropriate sitting workstation at home is not possible, rotating between a poor sitting workstation and a standing workstation would be the next best practice. There are many simple, makeshift standing workstations available in the home, including implementing the use of an ironing board, a kitchen counter, the top of a piano, a clothes basket placed upside down on a table or desk or a large box under the laptop.

Davis says he worries that workers' discomfort levels are increasing after more than five months of working remotely. "It's not just ergonomics changing but also other factors: isolation, teamwork changes and work-life balance is distorted and changes in the stress level that people have," he says.

Giving birth in the United States is a radically different experience based on race and income, illustrated most brutally by the Black and Indigenous maternal mortality crisis.

Now, a new study from the Boston University School of Public Health (BUSPH) and the National Partnership for Women & Families finds insurance type itself also plays a role in how mothers are treated, and how much agency they have in maternity decisions.

Published in the journal PLOS ONE, the first-of-its-kind study is part of Listening to Mothers in California, which examined women's experiences giving birth in California hospitals in 2016.

The study finds that, after adjusting for demographics and health conditions, a mother on Medicaid is three times less likely than a mother on private insurance to feel she had a choice about whether she had a vaginal or cesarean birth, or an episiotomy. Compared to private coverage, coverage by Medi-Cal (California's Medicaid program) was also associated with being about half as likely to have a choice of prenatal provider or to be encouraged by maternity care staff to make one's own decisions about labor and birth.

"This study is the largest to date using women's voices to examine their maternity experiences in births funded by Medicaid," says study lead author Dr. Eugene Declercq, professor of community health sciences at BUSPH and a member of the Listening to Mothers team.

"It documents the limitations on their ability to share in decisions about their own care, and is a call for clinicians and policymakers to make changes that ensure equitable rights for all mothers, regardless of insurance status," he says.

"Every indictor of disrespect and limit on choice that we examined was worse for women with Medi-Cal versus private insurance," says Carol Sakala, director of maternal health at the National Partnership for Women & Families and the survey's principal investigator. "This suggests women with Medi-Cal systemically receive substandard quality of care. Our results sound alarm bells about missed opportunities for mitigating the maternal health crisis within the Medi-Cal program.

For their analysis, the researchers used survey data from 1,087 women with commercial private insurance and 1,231 women enrolled in Medi-Cal. The sample was demographically representative of all live births in California that year.

The researchers then analyzed the relationships between the different insurance types and the women's experiences around maternal agency, including decision-making about interventions such as vaginal birth after cesarean and episiotomy, feeling pressured to have interventions, and their sense of fair treatment. The researchers then adjusted for the women's demographics, including income, as well as attitudes toward birth, type of prenatal care provider, type of birth attendant, and pregnancy complications, to identify how much of the difference in experiences was associated with insurance type.

Of course, the authors note, demographics and conditions are rarely equal for mothers on private and public insurance: In this sample, over half of non-Latina Black women and over two-thirds of Latina women were on Medi-Cal, compared to just over a quarter of non-Latina white women and just under a quarter of non-Latina Asian and Pacific Islander women; the majority of women born outside of the U.S. were on Medi-Cal; and 85% of women who spoke Spanish at home were on Medi-Cal. Before accounting for these and other demographic differences, many of the gaps between privately- and publicly-insured mothers' experiences were twice as large.

However, the researchers also found that insurance type may also influence other forms of discrimination: After adjusting for demographics and other factors, women with Medi-Cal were twice as likely to report that they were treated unfairly because of their race/ethnicity (particularly Asian and Pacific Islander women), and four times as likely because of the language they spoke.

With Medicaid covering 42% of childbearing women in the United States, the authors write, the program has huge potential to improve maternal health, and better treatment for Medicaid enrollees would have a profound effect on overall equity in maternal health.

"It is critical that maternity care providers--and really any gatekeepers to care--are made aware of these inequities," says study co-author Dr. Candice Belanoff, clinical associate professor of community health sciences at BUSPH, "and that they take steps to ensure equitable treatment and access regardless of insurer."

San Francisco (July 28, 2020) -- As part of Juul Labs' ongoing engagement with the public health community, the company today announced findings from a new study at the AcademyHealth 2020 Annual Research Meeting linking the JUUL System's market entry to decreased cigarette sales in Canada. The conference, which took place virtually, focuses on the intersection of health, health care, and policy.

The study, conducted and presented by Dr. Shivaani Prakash, Juul Labs' Director of Health Economics and Policy Research, found that the JUUL System's market entry in Canada likely decreased combustible cigarette sales, especially in urban markets. Using city-level data on cigarette and JUUL System sales in Canada and variation in timing of the JUUL System's market entry in a study, researchers ran econometric difference-in-difference models. They found that within the first 12 months of market entry, market entry and availability of the JUUL System likely led to a 1.5% decrease on average in store-level cigarette sales volume, within one large retailer chain. Overall, this could translate to over 400 million fewer cigarettes sold in Canada within the first year of the JUUL System's market entry.

They also found that the decline in cigarette sales magnified as the JUUL System's market share increased in stores, suggesting that local tobacco market competition plays a strong role in uptake and purchase of vaping products. For every 1% increase in the JUUL System's market share at the store-level, there was an associated 0.5% reduction in cigarette sales.

“This work provides strong evidence that the availability of vaping products could reduce cigarette sales, and suggests that providing alternative nicotine products to adult smokers could drive down combustible cigarette consumption,” said Rasmus Wissmann, Vice President of Data at Juul Labs. “Further research is needed to determine the long-term impact of vapor products on cigarette sales, and the net population health impact of such products.”

Identifying the impact of vaping products in global markets can help policymakers understand the role of alternative nicotine products in the commercial tobacco product market, and better evaluate the impact of such products.

As part of the Premarket Tobacco Product Application (PMTA) process in the United States, Juul Labs has built a comprehensive research program focused on examining the public health impact of the JUUL System. This includes research on the JUUL System's impact on the individual user, their ability to convert adult smokers from combustible cigarettes, and the net-population impact on public health.

Juul Labs will continue to share results from its science and research program with the public health communities as it works to support the scientific basis for the category, as well as future regulatory filings.

Pharmavite LLC, the makers of Nature Made vitamins, minerals and supplements, announced the publication of a research article in the journal PLoS ONE, which examines inadequate nutrient intake and its relationship to poor bone health, specifically risk of osteoporosis. The research was a cross sectional analysis of the U.S population [from National Health and Nutrition Examination Survey (NHANES) data], with a specific focus on those below the poverty line with food insecurities.

Poverty can be a barrier to routinely acquiring adequate nutrient intakes, specifically for calcium and vitamin D, to ensure bone health with the ultimate goal of preventing of osteoporosis. Age, gender and dietary intake are major factors that contribute to osteoporosis prevalence. This study examined the relationship between markers of poverty with calcium and vitamin D intake and osteoporosis in Americans, 50 years and older.

"This study continues to demonstrate how prevalent nutrient deficiency is among the U.S. population, and even more so, among lower income individuals and those with food insecurities. Yet, we know that nutrient adequacy is imperative in supporting overall health and wellness, including immune health, at a time when that is heavy on everyone's mind," said Susan Hazels Mitmesser, PhD, Vice President of Science & Technology at Pharmavite.

In the U.S., 25% of older Americans live below the poverty line. Within this population, 68% have inadequate calcium intakes, and 46% have inadequate vitamin D intakes. Gender, ethnic, and socio-economic differences impact overall risk for inadequate calcium and vitamin D intakes and subsequent osteoporosis risk, as seen in some of the study key findings:

American women over the age of 50 consistently have inadequate calcium intake regardless of their economic status.

Inadequate intake of calcium and vitamin D affects poverty-stricken men more than women with respect to osteoporosis risk.

Non-Hispanic Black men with a low income have two times greater risk for developing osteoporosis.

"Improving the consumption of nutrient-rich and fortified foods among individuals that live in poverty can help to decrease their chances of developing osteoporosis. Additionally, dietary supplements can play a critical role in helping any underserved population meet their nutrition needs --including making supplements readily available through programs like SNAP, for example," adds Mitmesser. "Our research demonstrates that participants with SNAP benefits and more access to food, have fewer nutrient inadequacies which helps them meet their nutrition needs."

It has been estimated in the U.S. population age 50 and older, about 10.2 million suffer from osteoporosis, and 80% of these affected cases are females. In addition, there are potentially 43.4 million people, or 44% of the population with osteopenia, which is a bone condition that often leads to osteoporosis. More than two million osteoporosis-related fractures occur annually, leading to more than 19 billion dollars in health care costs in the US.

An international team of volcanologists working on remote islands in the Galápagos Archipelago has found that volcanoes which reliably produce small basaltic lava eruptions hide chemically diverse magmas in their underground plumbing systems - including some with the potential to generate explosive activity.

Many volcanoes produce similar types of eruption over millions of years. For example, volcanoes in Iceland, Hawai'i and the Galápagos Islands consistently erupt lava flows - comprised of molten basaltic rock - which form long rivers of fire down their flanks. Although these lava flows are potentially damaging to houses close to the volcano, they generally move at a walking pace and do not pose the same risk to life as larger explosive eruptions, like those at Vesuvius or Mt. St. Helens. This long-term consistency in a volcano's eruptive behaviour informs hazard planning by local authorities.

The research team, led by Dr Michael Stock from Trinity College Dublin and comprising scientists from the US, UK and Ecuador, studied two Galápagos volcanoes, which have only erupted compositionally uniform basaltic lava flows at the Earth's surface for their entire lifetimes. By deciphering the compositions of microscopic crystals in the lavas, the team was able to reconstruct the chemical and physical characteristics of magmas stored underground beneath the volcanoes.

The results of the study show that - in contrast with the monotonous basaltic lavas erupted at the Earth's surface - magmas beneath the volcanoes are extremely diverse and include compositions similar to those erupted at Mt. St. Helens.

The team believes that volcanoes consistently erupt compositionally uniform basaltic lavas when the amount of magma flushing through the ground beneath the edifice is high enough to "overprint" any chemical diversity. This can occur when volcanoes are located close to a "hot spot" - a plume of hot magma rising towards the surface from deep within the Earth.

However, the chemically diverse magmas which the team discovered could become mobile and ascend towards the surface under certain circumstances. In this case, volcanoes that have reliably produced basaltic lava eruptions for millennia might undergo unexpected changes to more explosive activity in the future.

Dr Stock, from Trinity's School of Natural Sciences, and lead author on the paper, said:

"This was really unexpected. We started the study wanting to know why these volcanoes were so boring and what process caused the erupted lava compositions to remain constant over long timescales. Instead we found that they aren't boring at all - they just hide these secret magmas under the ground."

"Although there's no sign that these Galápagos volcanoes will undergo a transition in eruption style any time soon, our results show why other volcanoes might have changed their eruptive behaviour in the past. The study will also help us to better understand the risks posed by volcanoes in other parts of the world - just because they've always erupted a particular way in the past doesn't mean you can rely on them to continue doing the same thing indefinitely into the future."

Dr Benjamin Bernard, a volcanologist involved in monitoring Galápagos volcanoes at Instituto Geofísico and co-author on the paper, added:

"This discovery is a game-changer because it allows us to reconcile apparently divergent observations, such as the presence of explosive deposits at several Galápagos volcanoes. It also allows us to better understand the behaviour of these volcanoes, which is essential for volcano monitoring and hazard assessment."

A rover expected to explore below the surface of Mars in 2022 has the potential to provide more insights

The findings published in Scientific Reports, Springer Nature suggests the presence of traces of water on Mars, raising the question of the possibility of a life-supporting environment

Abu Dhabi, UAE - July 28, 2020: Although no life has been detected on the Martian surface, a new study from astrophysicist and research scientist at the Center for Space Science at NYU Abu Dhabi, Dimitra Atri finds that conditions below the surface could potentially support it. The subsurface - which is less harsh and has traces of water - has never been explored. According to Atri, the steady bombardment of penetrating Galactic Cosmic Rays (GCRs) might provide the energy needed to catalyze organic activity there.

Atri's findings are reported in the study Investigating the biological potential of galactic cosmic ray-induced radiation-driven chemical disequilibrium in the Martian subsurface environment in the journal Scientific Reports, Springer Nature.

There is growing evidence suggesting the presence of an aqueous environment on ancient Mars, raising the question of the possibility of a life-supporting environment. The erosion of the Martian atmosphere resulted in drastic changes in its climate, surface water disappeared, shrinking habitable spaces on the planet, with only a limited amount of water remaining near the surface in form of brines and water-ice deposits. Life, if it ever existed, would have had to adapt to harsh modern conditions, which include low temperatures and surface pressure, and high radiation dose.

The subsurface of Mars has traces of water in the form of water-ice and brines, and undergoes radiation-driven redox chemistry. Using a combination of numerical models, space mission data, and studies of deep-cave ecosystems on Earth for his research, Atri proposes mechanisms through which life, if it ever existed on Mars, could survive and be detected with the upcoming ExoMars mission (2022) by the European Space Agency and Roscosmos. He hypothesizes that galactic cosmic radiation, which can penetrate several meters below the surface, will induce chemical reactions that can be used for metabolic energy by extant life, and host organisms using mechanisms seen in similar chemical and radiation environments on Earth.

"It is exciting to contemplate that life could survive in such a harsh environment, as few as two meters below the surface of Mars," said Atri. "When the Rosalind Franklin rover on board the ExoMars mission (ESA and Roscosmos), equipped with a subsurface drill, is launched in 2022, it will be well-suited to detect extant microbial life and hopefully provide some important insights."

PHILADELPHIA - To answer medical questions that can be applied to a wide patient population, machine learning models rely on large, diverse datasets from a variety of institutions. However, health systems and hospitals are often resistant to sharing patient data, due to legal, privacy, and cultural challenges.

An emerging technique called federated learning is a solution to this dilemma, according to a study published Tuesday in the journal Scientific Reports, led by senior author Spyridon Bakas, PhD, an instructor of Radiology and Pathology & Laboratory Medicine in the Perelman School of Medicine at the University of Pennsylvania.

Federated learning -- an approach first implemented by Google for keyboards' autocorrect functionality -- trains an algorithm across multiple decentralized devices or servers holding local data samples, without exchanging them. While the approach could potentially be used to answer many different medical questions, Penn Medicine researchers have shown that federated learning is successful specifically in the context of brain imaging, by being able to analyze magnetic resonance imaging (MRI) scans of brain tumor patients and distinguish healthy brain tissue from cancerous regions.

A model trained at Penn Medicine, for example, can be distributed to hospitals around the world. Doctors can then train on top of this shared model, by inputting their own patient brain scans. Their new model will then be transferred to a centralized server. The models will eventually be reconciled into a consensus model that has gained knowledge from each of the hospitals, and is therefore clinically useful.

"The more data the computational model sees, the better it learns the problem, and the better it can address the question that it was designed to answer," Bakas said. "Traditionally, machine learning has used data from a single institution, and then it became apparent that those models do not perform or generalize well on data from other institutions."

The federated learning model will need to be validated and approved by the U.S. Food and Drug Administration before it can be licensed and commercialized as a clinical tool for physicians. But if and when the model is commercialized, it would help radiologists, radiation oncologists, and neurosurgeons make important decisions about patient care, Bakas said. Nearly 80,000 people will be diagnosed with a brain tumor this year, according to the American Brain Tumor Association.

"Studies have shown that, when it comes to tumor boundaries, not only can different physicians have different opinions, but the same physician assessing the same scan can see different tumor boundary definition on one day of the week versus the next," he said. "Artificial Intelligence allows a physician to have more precise information about where a tumor ends, which directly affects a patient's treatment and prognosis."

To test the effectiveness of federated learning and compare it to other machine learning methods, Bakas collaborated with researchers from the University of Texas MD Anderson Cancer Center, Washington University, and the Hillman Cancer Center at the University of Pittsburgh, while Intel Corporation contributed privacy-protecting software to the project.

The study began with a model that was pre-trained on multi-institutional data from an open-source repository known as the International Brain Tumor Segmentation, or BraTS, challenge. BraTS currently provides a dataset that includes more than 2,600 brain scans captured with magnetic resonance imaging (MRI) from 660 patients. Next, 10 hospitals participated in the study by training AI models with their own patient data. The federated learning technique was then used to aggregate the data and create the consensus model.

The researchers compared federated learning to models trained by single institutions, as well as to other collaborative-learning approaches. The effectiveness of each method was measured by testing them against scans that were annotated manually by neurologists. When compared to a model trained with centralized data that did not protect patient privacy, federated learning was able to perform almost (99 percent) identically. The findings also indicated that increased access to data through data private, multi-institutional collaborations can benefit model performance.

The findings from this study have paved the way for a much larger, ambitious collaboration between Penn Medicine, Intel, and 30 partner institutions, supported by a $1.2 million grant from the National Cancer Institute of the National Institutes of Health that was awarded to Bakas earlier this year. Intel announced in May that Bakas will lead the project, in which the 30 institutions, across nine countries, will use the federated learning approach to train a consensus AI model on brain tumor data. The final goal of the project will be to create an open-source tool for any clinician at any hospital to use. The development of the tool in Penn's Center for Biomedical Image Computing & Analytics (CBICA) is being led by senior software developer Sarthak Pati, MS.

Study co-author Rivka Colen, MD, an associate professor of Radiology at the University of Pittsburgh School of Medicine, said that this paper and the larger federated learning project open up possibilities for even more uses of Artificial Intelligence in health care.

"I think it's a huge game changer," Colen said. "Radiomics is to radiology what genomics was to pathology. AI will revolutionize this field, because, right now, as a radiologist, most of what we do is descriptive. With deep learning, we're able to extract information that is hidden in this layer of digitized images."

A practicable and reliable therapeutic strategy to treat SARS-CoV-2 infection: absorbed plant MIR2911 in honeysuckle decoction inhibits SARS-CoV-2 replication and accelerates the negative conversion of infected patients

In a new study in Cell Discovery, Chen-Yu Zhang's group at Nanjing University and two other groups from Wuhan Institute of Virology and the Second Hospital of Nanjing present a novel finding that absorbed miRNA MIR2911 in honeysuckle decoction (HD) can directly target SARS-CoV-2 genes and inhibit viral replication. Drinking of HD accelerate the negative conversion of COVID-19 patients.

The search for clinically effective therapy for Covid-19 has not been successful to date. Many broad spectrum anti-viral agents have failed the test. In previous studies, Zhang's group has demonstrated that a plant microRNA, MIR2911, which is enriched in HD, could directly target influenza A viruses (IAV) including H1N1, H5N1 and H7N9. Drinking of HD can prevent IAV infection and reduce H5N1-induced mice death. They have also revealed that absorbed exogenous miRNAs (including MIR2911 in HD) can be packaged into exosomes, released to circulation, and then delivered into recipient cells as functional secreted miRNAs.

In the current study, they report that MIR2911 in HD can also suppress SARS-CoV-2 infection. The SARS-CoV-2 genome has up to 28 binding sites of MIR2911 which were confirmed by the classic luciferase assay. Cellular-exosomal-MIR2911 at 13.2 pM concentration (cellular exosomes were collected from culture medium of HEK293T cells transfected with synthetic MIR2911 or control ncRNA) inhibited 93% virus replication, indicating that exosomal MIR2911 directly and sufficiently inhibits SARS-CoV-2 replication.
The MIR2911 concentration in HD was about 52.5 pM (10.5 pmol/200 ml/30 g dried honeysuckle). Serum levels of MIR2911 in heathy volunteers two hours after drinking 200 ml HD were about 0.67 pM. The antiviral function of exosomes with/without MIR2911 collected from the same donor before and after drinking HD were assessed. Exosomes containing MIR2911 (MIR2911 levels: nondetectable before drinking; 57.9 fM after drinking) significantly inhibited virus replication.

A clinical study further confirmed the anti-viral effect of MIR2911 from HD. Patients who already received routine antiviral therapy were divided into two groups, one group received additionally MIR2911 in HD (10.5 pmol/200 ml/30 g dried honeysuckle/day, MIR2911+), the other group receive normal traditional Chinese medicine (TCM) mixture (sequenced to be free of MIR2911-). The time taken to become SARS-CoV-2 PCR-negative (TTN) significantly favored patients treated with HD-MIR2911 (median 4.0 vs 12.0 days, HR 0.11, 95% CI 0.025-0.46, P=0.0028), indicating that MIR2911 in HD accelerates the negative conversion of infected patients.

1) This study demonstrated that absorbed plant MIR2911 in honeysuckle decoction inhibits SARS-CoV-2 replication and accelerates the negative conversion of infected patients.

2) It provides a practicable and reliable therapeutic strategy to treat SARS-CoV-2 infection.

3) This is the first time that exosomes with/without MIR2911 collected from the same donor before and after drinking HD ware used to assess absorbed dietary miRNA function, further supporting that absorbed dietary miRNA plays the important role of cross-kingdom regulation in human consumer.

4) The data that MIR2911 (~60 fM) in exosomes significantly inhibits virus replication not only confirms the extra-high antiviral activity of MIR2911 (compared to that of remdesivir: 3.7 μM and Chloroquine: 10 μM) but also provides a novel and the most similar condition in vivo to assess the efficacy of potential drugs in vitro.

"We wished we could provide really useful information to help stop the pandemic in the darkest hour". Chen-Yu Zhang said. "The focus of this study is to demonstrate that absorbed plant MIR2911 in honeysuckle decoction inhibits SARS-CoV-2 replication sufficiently. On the other hand, in the study titled "Decreased HD-MIR2911 absorption in human subjects with the SIDT1 polymorphism fails to inhibit SARS-CoV-2 replication", we have shown that synthetic MIR2911, cellular-exosomal MIR2911 and serum-exosomal MIR2911 directly inhibited SARS-CoV-2 S-protein expression and SARS-CoV-2 replication. More importantly, decreased HD-MIR2911 absorption resulted in non-inhibitory effect on replication, indicating that MIR2911in HD is necessary to suppress SARS-CoV-2. Therefore, we propose medical doctors and scientists from all over the world to carry out HD-MIR2911 clinic trails in order to help treating SARS-CoV-2 infection." Zhang added.

Many LGBTQ youth continue to experience stigma and discrimination despite Canada's progress in protecting human rights. New research from UBC's school of nursing shows that supportive communities--and a progressive political climate--can help mitigate the effects of stigma on mental health.

The researchers combined data from the BC Adolescent Health Survey with an inventory of different LGBTQ events and youth supportive service in communities across B.C. They found that the greater the LGBTQ youth supports in a community, the less likely sexual minority youth, particularly lesbian and bisexual girls, were to have suicidal thoughts or attempts, or to self-harm, compared to their counterparts in communities with fewer supportive events, groups and services. The team also found that lesbian and bisexual girls in communities where more people voted BC NDP in the 2013 provincial general election were less likely to report suicidal thoughts or self-harm.

In their inventory, the researchers counted LGBTQ-youth drop-ins and LGBTQ-youth friendly health services, as well as positive events like Pride parades, anti-bullying days, and meetings for parents, families and friends of LGBTQ people. Community resources that show support for LGBTQ people more generally, such as rainbow crosswalks, supportive faith communities, and queer-friendly coffee houses, also made the list.

"The impact of stigma and discrimination continues to put the health of LGBTQ youth at risk, but this risk isn't equal everywhere in B.C.," said lead researcher Elizabeth Saewyc, a UBC nursing professor and director of Stigma and Resilience Among Vulnerable Youth Centre (SARAVYC). "Our research found that where lesbian, gay and bisexual youth live--their community environment, and the kind of LGBTQ-inclusive supports that are or aren't there--appears to play a role in their odds of suicidality and self-harm."

Saewyc says research shows that safe and inclusive schools, particularly those with gender and sexuality alliances, or GSAs, contribute to LGBTQ youth well-being, but this is among the first studies in Canada to look at the importance of the wider community at the same time.

"Even after accounting for school environments, our study found community supports and progressive political climates contribute to lesbian and bisexual girls' health. It's an important point for health care professionals and policymakers to consider - that LGBTQ visibility and support throughout communities can make a difference. We also need to recognize that the work is not yet done--we still have a long way to go to protect the health and well-being of all LGBTQ youth," said Saewyc.

Dozens of molecules may tangle up with rogue bundles of tau, a protein that normally gives nerve fibers structure, to cause brain cell damage that contributes to neurodegenerative diseases, a new study shows.

Neuroscientists have previously found that tau can become toxic when extra chemical molecules accumulate with its structure in the brain, causing it to form tangles of protein that destroy surrounding tissue.

Led by researchers from NYU Grossman School of Medicine, the new study analyzed the makeup of such tangles and found 12 proteins that they say have not before been tied to both tau and Alzheimer's disease. They also uncovered several dozen other proteins that appear in the latest stages of the disease as well as in the earliest phases of dementia.

"Our findings expand our understanding of the molecular interactions that drive Alzheimer's and other brain-damaging diseases related to misbehaving tau proteins," says study co-lead author Eleanor Drummond, PhD, a research assistant professor in the Department of Neurology at NYU Langone Health.

"Now that we have better insight into possible 'key players' in neurodegeneration, we may have clearer targets for potential therapies," says co-lead author Geoffrey Pires, a doctoral student in neurology at NYU Langone.

An estimated 5 million Americans are living with Alzheimer's, a progressive disease that affects mostly those over 65 and interferes with memory, language, and decision making. Currently, there are no effective treatments or prevention strategies for Alzheimer's. Experts have long linked it to a buildup of extra phosphate molecules on tau proteins. However, how these tangles damage neurons and what other proteins are involved in the development of Alzheimer's signature bundles have been poorly understood, says Drummond.

The new study, publishing online July 28 in the journal Brain, provides what Drummond and her colleagues say is the largest overview to date of proteins present in these tau tangles.

For the investigation, the research team analyzed donated brain tissue samples from 12 men and women with Alzheimer's disease. After separating the tau knots from the surrounding tissue, the researchers examined the bundles to identify the many proteins tangled within.

According to the findings, the tangles were composed of 542 different proteins in total, some of which are involved in essential processes within cells, such as energy production (vacuolar-ATPase subunit ATP6V0D1), the reading of genetic material (RNA binding protein HNRNPA1), and cell breakdown and digestion (PSMC 1 through 5). These results provide clues to how the tangles lead to neuron death, says Drummond.

"Alzheimer's has been studied for over a century, so it is eye opening that we are still uncovering dozens of proteins that we had no idea are associated with the disease," says study senior author Thomas Wisniewski, MD, the Gerald J. and Dorothy R. Friedman Professor in the Department of Neurology at NYU Langone.

Wisniewski, also a professor in the departments of Pathology and Psychiatry at NYU Langone, plans next to investigate the newly identified proteins in tissue samples of people with other tau-linked neurodegenerative diseases, such as Pick's disease and chronic traumatic encephalopathy, as well as other forms of dementia.

A new piece in Family Practice, published by Oxford University Press, indicates that tracking symptoms affiliated with the novel coronavirus through an app may not be a good predictor of the spread of the disease.

Over the course of 2020, as the novel coronavirus has spread across the globe causing extensive illness and economic havoc to communities everywhere, health care providers and the general public have been eager to find a way to identify the illness. In the absence of readily available tests, scientists have worked to identify clues to detect those who might have the illness as a way to combat the spread of the virus.

A recent study, "Real-time tracking of self-reported symptoms to predict potential COVID-19," published in Nature Medicine, suggested that a prediction score combining loss of smell and taste, fatigue, cough, and loss of appetite - collected through an app - was able to prospectively identify people at risk of COVID-19.

Researchers here compared the main features of the population involved in the Nature Medicine study, and the performance of their score, with data from a cross-sectional study conducted between March 24th and April 29th 2020, and applied the Nature Medicine model to these data.

Applying the probability threshold in the Nature Medicine study to these data indicated that 41% of positive tests were false positives, while 17% of negative tests were false negatives.

In the Family Practice piece, general practitioners referred most patients because they were complaining of COVID-like symptoms. It is likely that this population was symptomatic due to the triage performed by general practitioners prior to testing. Indeed, nearly half the patients in the sample reported fever (45.4%), reflecting the common reason for doctors to refer patients to testing at the time these data were collected.

Fever was registered in the app in the Nature Medicine study by only one-third of patients.

In conclusion, while real-time symptom collection through an app seems to be an attractive method to screen for potential infections, and the Nature Medicine study confirms the crucial value of specific symptoms such as loss of smell and taste, the score proposed in the study does not appear to perform well in a primary care population.

"These results confirm the crucial role of laboratory testing in COVID-19 and the need to support research on COVID-19 in primary care populations," said the letter's lead author, Benoit Tudrej.

Media coverage of the March 2019 Christchurch mosque shootings contributed to an increase in public support for gun control, a study by researchers at the University of Otago, Wellington has found.

The researchers studied print media coverage for the three months following the attacks, in which 51 people were killed while gathering to worship at two mosques in Christchurch. The attacks were livestreamed to Facebook by the shooter.

Dr Susanna Every-Palmer, the head of the Department of Psychological Medicine at the University of Otago, Wellington says one of the most notable features of media coverage was the refusal by most media outlets to name the shooter.

Of the 749 reports that focused on the mosque shootings, only 53 (7.1 per cent) mentioned his name, and only twice did it appear in the headlines.

She says this was likely influenced by the strong message delivered by Prime Minister Jacinda Ardern four days after the attack, in which she vowed never to speak the gunman's name and asked others to follow her lead.

Dr Every-Palmer says the media's decision to leave the perpetrator nameless and faceless meant New Zealanders were far more likely to support changes in government policy, rather than blaming the event on the actions of an individual.

"The New Zealand media's focus on the ease with which someone could legally obtain dangerous weapons and the environment in which terrorism can grow, rather than on the shooter himself, is important.

"There is also evidence that not naming the shooter may reduce the risk of copycat events," she says.

The New Zealand media's decision not to sensationalise the perpetrator and his views differed markedly from the approach to previous mass shootings with 85 per cent of print media articles naming the perpetrators of the mass shootings in Norway in 2011 and in Las Vegas in 2017 in the six months following the attacks.

The researchers analysed print-based media reports from major New Zealand newspapers covering the mass shooting between 15 March and 15 June, 2019. They identified 958 reports. Of these, 749 had the mosque shootings as a central focus.

Dr Every-Palmer says there were more articles on the mosque shooting than any other event in 2019, with the story dominating the headlines for three months.

"Several factors, including the scale of the Christchurch attacks - the worst in New Zealand's history - the media focus on the fact that the weapons had been legally obtained, and the fear of further violence all meant there was strong support for changes to gun laws, and a sense of urgency about implementing them."

Within a week of the mass shootings, the Government had announced a ban on military style semi-automatic weapons. The following month, legislation to restrict semi-automatic firearms and magazines with more than 10 rounds passed in Parliament with near unanimous support. The second tranche of gun control reforms, which includes a register for firearms, was passed by Parliament in June this year.

Dr Every-Palmer says the Government's rapid action on the first tranche of gun control measures coincided with the window of maximum support for legislative change.

"Opinion polls in the United States reveal peaks in public support for gun control that appeared to coincide with mass shootings such as that at Columbine High School in the United States in 1999, although such peaks quickly dissipated," she notes.

Dr Every-Palmer says bipartisan support for gun control in New Zealand was also likely generated by the shootings which acted as a 'focusing event'.

"This could reflect New Zealanders holding broadly similar attitudes towards gun ownership in a way that has not been observed in other countries such as the United States."

An Otago economist argues New Zealand should expand its trade agreements in the wake of COVID-19, as his new research shows the country benefited from the NZ-China free trade agreement.

University of Otago Economics Lecturer Dr Murat Ungor and his former Masters student, Sam Verevis collaborated on the paper What has New Zealand gained from the FTA with China: Two counterfactual analyses, which has just been published in the Scottish Journal of Political Economy.

It is one of the first systematic studies to analyse the effects of the historic 2008 NZ-China FTA on the economic performance of NZ, and found evidence it has contributed strongly to NZ's export growth.

Its release comes as NZ renegotiates and diversifies its trade agreements to maintain economic security as the COVID-19 pandemic continues.

Dr Ungor says China is still New Zealand's most important trade partner, and its emergence into the world market has caused unforeseen shifts in world trading patterns.

It has become NZ's top commodity export destination, with exports from NZ to China increasing from around US$90 million in 1979 to more than US$11 billion in 2019.

His co-authored paper with Mr Verevis sought to answer whether NZ's exports to China increased significantly due to the 2008 FTA, and how the agreement has affected NZ's per capita income.

"We find NZ exports to China were 200 per cent higher in 2014 than what they would have been, had the FTA never been signed," he says.

Food and live animal exports to China in 2014 were more than 180 per cent higher than the counterfactual model.

However, Dr Ungor says while NZ made substantial export gains, the research did not find a significant or robust impact on NZ's GDP per capita.

Globally, trade-exposed businesses have been among the hardest hit by the COVID-19 pandemic, and NZ has been very active to strengthen its economic ties.

China's economy was already showing signs of slowing down in 2019, and while it's plausible to expect it to continue to be NZ's major trading partner, there's no reason NZ can't diversify its trade agreements, Dr Ungor says.

"There is no reason to put all of your eggs in the same basket.

"Diversifying export partners and export goods, improving the current agreements and developing new strategic ties are very important."

Rather than NZ reducing its economic transactions with China, it should expand the size of current trade agreements or sign new bilateral and multilateral agreements, he says.

He notes a key item on the agenda at a video meeting of trade ministers from the Asia-Pacific Economic Cooperation (APEC) later this month will be the implementation of inclusive policy measures to ensure a fast-track regional recovery from COVID-19.

"The economic consequences of the negotiations and renegotiations of NZ's FTAs in the age of COVID-19 is another direction for future research," he says.

Dr Ungor suggests what could also be useful for policymakers is research on the spill over effect from a downturn in an economy of a large trading partner like China, on a smaller economy like NZ.

"It would be extremely interesting to examine how a small open economy is affected by trade with such a large open economy in terms of productivity, reallocation of capital, and labour," he says.

Mr Verevis and Dr Ungor's study used a synthetic control method commonly used in economics, political science and international relations.

As it would be impossible to know what would actually have happened to the NZ economy if it had not signed the China FTA, a 'synthetic' counterfactual model of an alternate reality had to be created, Dr Ungor says.

"We used a combination of 24 OECD countries to construct a 'synthetic' control NZ, which resembles relevant economic characteristics of the NZ economy before signing the FTA with China.

"This was our benchmark control group."

Countries used in the model had not signed FTAs with China.