Culture

Trifarotene is a drug for the external treatment of acne vulgaris of the face and trunk. It is suitable for affected people with many comedones, papules and pustules, i.e. with moderate acne for which systemic therapy is not yet an option. The Federal Joint Committee (G-BA) now commissioned the German Institute for Quality and Efficiency in Health Care (IQWiG) to investigate whether the drug offers these patients aged twelve years and older an added benefit in comparison with combination therapy of adapalene and benzoyl peroxide or of clindamycin and benzoyl peroxide, which is also applied externally.

As the drug manufacturer's dossier did not contain any study data suitable for a direct or indirect comparison with this appropriate comparator therapy, it was concluded that an added benefit of trifarotene is not proven.

Placebo-controlled approval studies

The manufacturer cited two randomized controlled trials from the approval process in which trifarotene was compared with placebo, so they cannot be used for comparison with an established treatment alternative. In addition, the treatment phases of 12 weeks were very short. For a chronic condition like acne vulgaris, a minimum of 24 weeks is needed for a benefit assessment. The dossier contained supplementary information on a 1-year study, but this study had no control arm.

Enough affected people for good comparative studies

According to the manufacturer, there are about one to two million people with moderate acne vulgaris in Germany alone. Katharina Biester from IQWiG's Drug Assessment Department is critical of the fact that, even in such a widespread therapeutic indication, the approval studies were again only carried out in comparison with placebo: "There is a declared political will in Europe to generate evidence for comparisons between drugs. One wonders, therefore, why development programmes for new drugs are not aimed at answering both the questions of the approval and those of the benefit assessment."

G-BA decides on the extent of added benefit

The dossier assessment is part of the early benefit assessment according to the Act on the Reform of the Market for Medicinal Products (AMNOG) supervised by the G-BA. After publication of the dossier assessment, the G-BA conducts a commenting procedure and makes a final decision on the extent of the added benefit.

The stress and anxiety experienced by the general population during Israel's first lockdown brought about a significant rise in orofacial and jaw pain, as well as jaw-clenching in the daytime and teeth-grinding at night, according to a new study from Tel Aviv University (TAU).

The research also found that women suffered more from these symptoms more than men, and that 35- to 55-year-olds suffered most.

"We believe that our findings reflect the distress felt by the middle generation, who were cooped up at home with young children, without the usual help from grandparents, while also worrying about their elderly parents, facing financial problems and often required to work from home under trying conditions," the researchers say.

The study was led by Dr. Alona Emodi-Perlman and Prof. Ilana Eli of TAU's Goldschleger School of Dental Medicine at TAU's Sackler Faculty of Medicine. The paper was published in the Journal of Clinical Medicine on October 12, 2020.

The study examined questionnaires that assessed the presence and possible worsening of these symptoms in the general population during the first COVID-19 lockdown, due to the national emergency and rise in anxiety levels. The questionnaire was answered by a total of 1,800 respondents in Israel and Poland.

During Israel's first lockdown, the general population exhibited a considerable rise in orofacial pain, as well as jaw-clenching in the daytime and teeth-grinding at night - physical symptoms often caused by stress and anxiety. The prevalence of symptoms rose from about 35% pre-pandemic to 47%; the prevalence of jaw-clenching in the daytime rose from about 17% to 32%; and teeth-grinding at night rose from about 10% to 36%. People who had suffered from these symptoms before the pandemic exhibited a rise of about 15% in their severity.

Altogether a rise of 10%-25% was recorded in these symptoms, which often reflect emotional stress.

In addition, comparing findings in Israel to results in Poland, the researchers found that probability of TMD and Bruxism was much higher among respondents in Poland.

DALLAS, Nov. 15, 2020 -- A daily dose of omega-3 fatty acids did not reduce the risk of cardiac events, including secondary heart attack, stroke, bypass surgery or death, among elderly people who had survived a recent heart attack, according to late-breaking research presented today at the American Heart Association's Scientific Sessions 2020. The virtual meeting is Friday, November 13 - Tuesday, November 17, 2020, and is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science for health care worldwide. The manuscript of this study is simultaneously published today in Circulation, journal of the American Heart Association.

Some studies have found that a high intake of fish-oil-derived omega-3 fatty acids is associated with reduced risk of cardiovascular events. However, some recent studies have shown the therapy to have no effect on overall cardiovascular health. The OMEMI Trial (OMega-3 fatty acids in Elderly patients with Myocardial Infarction) was conducted in Norway and investigated whether adding 1.8 grams of omega-3 fatty acids to standard treatment after a heart attack in elderly patients prevented new cardiac events.

"This study focused on a particularly vulnerable patient group, in this case elderly patients with recent cardiovascular disease and a high load of risk factors, where the effects of preventive measures are usually the most prominent," said Are A. Kalstad, M.D., a principal investigator of the study, and a researcher at the Center for Clinical Research at Oslo University Hospital in Oslo, Norway. "The fact that no indication of any impact from the omega-3 fatty acids were found in this group, along with the results of other recent neutral trials, suggests that omega-3 supplements are ineffective for cardiovascular prevention."

The study included more than 1,000 patients (ages 70 to 82, mostly white, 29% women) who had all been hospitalized due to a heart attack within the previous two months. Most participants (97%) were taking cholesterol-lowering medications (statins), and most (86%) were on two blood thinner medications. Researchers randomly assigned half of the participants to receive an omega-3 fatty acids oral supplement daily and half to receive a placebo capsule of corn oil daily.

After 2 years of follow-up, researchers analyzed the number of cardiac events in each group, including heart attacks, strokes, revascularization (bypass surgery or angioplasty), hospitalizations for heart failure or deaths. The data indicates no difference in the rate of cardiac events between the two groups - about 20% for both groups.

Additionally, the researchers found no statistical differences between the omega-3 group and the patients taking the placebo when they examined subgroups of patients divided by age, gender, diabetes status, kidney function and triglyceride levels. Furthermore, the secondary endpoint of the study was new atrial fibrillation, which occurred in almost twice as many in the study's omega-3 group compared to the placebo group, 7.2 % vs 4.0 %, respectively, although the numbers were too small to be of statistical significance.

The brain encodes information collected by our senses. However, to perceive our environment and to constructively interact with it, these sensory signals need to be interpreted in the context of our previous experiences and current aims. In the latest issue of Science, a team of scientists led by Dr. Johannes Letzkus, Research Group Leader at the Max Planck Institute for Brain Research, has identified a key source of this experience-dependent top-down information.

The neocortex is the largest area of the human brain. It has expanded and differentiated enormously during mammalian evolution, and is thought to mediate many of the capacities that distinguish humans from their closest relatives. Moreover, dysfunctions of this area also play a central role in many psychiatric disorders. All higher cognitive functions of the neocortex are enabled by bringing together two distinct streams of information: a 'bottom-up' stream carrying signals from the surrounding environment, and a 'top-down' stream that transmits internally-generated information encoding our previous experiences and current aims.

"Decades of investigation have elucidated how sensory inputs from the environment are processed. However, our knowledge of internally-generated information is still in its infancy. This is one of the biggest gaps in our understanding of higher brain functions like sensory perception," says Letzkus. This motivated the team to search for the sources of these top-down signals. "Previous work by us and many other scientists had suggested that the top-most layer of neocortex is likely a key site that receives inputs carrying top-down information. Taking this as a starting point allowed us to identify a region of the thalamus - a brain area embedded deep within the forebrain - as a key candidate source of such internal information."

Motivated by these observations Dr. M. Belén Pardi, the first author of the study and postdoctoral researcher in the Letzkus lab, devised an innovative approach that enabled her to measure the responses of single thalamic synapses in mouse neocortex before and after a learning paradigm. "The results were very clear," Pardi remembers. "Whereas neutral stimuli without relevance were encoded by small and transient responses in this pathway, learning strongly boosted their activity and made the signals both faster and more sustained over time." This suggests that the thalamic synapses in neocortex encode the previous experience of the animal. "We were really convinced that this is the case when we compared the strength of the acquired memory with the change in thalamic activity: This revealed a strong positive correlation, indicating that inputs from the thalamus prominently encode the learned behavioral relevance of stimuli," says Letzkus.

But is this mechanism selective for these top-down memory-related signals? Sensory stimuli can be relevant because of what we have learned to associate with them, but also merely due to their physical properties. For instance, the louder sounds are the more readily they recruit attention in both humans and animals. However, this is a low-level function that has little to do with previous experience. "Intriguingly, we found very different, indeed opposite, encoding mechanisms for this bottom-up form of relevance" says Pardi.

Given their central importance, the scientists speculated that the way these signals are received in the neocortex must be tightly regulated. Pardi and co-workers addressed this in further experiments, combined with computational modeling in collaboration with the laboratory of Dr. Henning Sprekeler and his team at Technische Universität Berlin. The results indeed identified a previously unknown mechanism that can finely tune the information along this pathway, identifying a specialized type of neuron in the top-most layer of neocortex as a dynamic gatekeeper of these top-down signals.

"These results reveal the thalamic inputs to sensory neocortex as a key source of information about the past experiences that have been associated with sensory stimuli. Such top-down signals are perturbed in a number of brain disorders like autism and schizophrenia, and our hope is that the present findings will also enable a deeper understanding of the maladaptive changes that underlie these severe conditions," concludes Letzkus.

Features of the SARS-CoV-2 virus causing COVID-19, which could be useful for developing vaccines and treatment strategies, were identified using a nonhuman primate model developed at the Korea Research Institute of Bioscience and Biotechnology (KRIBB).

The work was initiated in February this year by the research team led by Dr. Jung Joo Hong at the KRIBB National Primate Research Center, and resulted in successful development of a nonhuman primate model of COVID-19 infection, the fourth model reported worldwide, following China, the Netherlands, and the US. The results of the study were part of a larger research project aiming to identify key features of severe acute respiratory syndrome coronavirus-2(SARS-CoV-2), the virus causing COVID-19, and to test for the efficacies of COVID-19 vaccines and treatments using the primate model.

In the primate study, vascular abnormalities due to the infection, reasons underlying fatality of COVID-19 infection, particularly in immunocompromised patients, sites of SARS-CoV-2 multiplication inside human body, and the time-course and were investigated.

The research team showed, for the first time, that SARS-CoV-2 caused vascular inflammation and that the endotheliitis persisted even 3 days after the infection. Further, they confirmed immunosuppression, which is typically observed in patients with immunodeficiency, when the viral load increased precipitously during COVID-19 infection(first 2 days after getting infected).

This study was featured on the cover of the Journal of Infectious Diseases, a world-class academic journal in the field of infectious diseases. The issue's online edition became available on August 3, 2020 and the article will be printed the November 15 issue.

The research team observed that the virus multiplied rapidly in the upper and lower respiratory tracts of the experimental primates in first 2 days after the viral infection. Subsequently, the viral load decreased quickly, and the viral activity was not detected 7 days after the infection.

These findings are expected to provide novel insights regarding the diagnostic challenges associated with a false positive test, i.e., a positive result of the reverse transcriptase polymerase chain reaction(RT-PCR) test for an asymptomatic.

DALLAS, Nov. 14, 2020 -- The use of the more potent antiplatelet medication ticagrelor was not superior to clopidogrel in the reduction of the rate of heart attack or severe complications among people undergoing an elective procedure to open a blocked artery, according to late-breaking research presented today at the American Heart Association's Scientific Sessions 2020. The virtual meeting is Friday, November 13-Tuesday, November 17, 2020, and is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science for health care worldwide. The manuscript of this study is simultaneously published today in Lancet.

The randomized, international, multi-center ALPHEUS trial enrolled 1,833 adults (average age 67% male ) at 49 centers in two European countries (France and the Czech Republic). The participants had heart disease and elected to undergo percutaneous coronary intervention (also known as PCI or angioplasty) to open a narrow or blocked blood vessel supplying blood to the heart.

The trial examined whether ticagrelor, a more potent antiplatelet medication than the standard of care (clopidogrel), may reduce the rate heart attack and complications around the time of the procedure for patients who are considered high-risk due to at least one additional underlying condition, such as renal insufficiency, diabetes, overweight, prior acute coronary syndome or heart failure, or because of a high risk procedure (multiple stents needed, bifurcation stenting, left main, etc.).

"While ticagrelor has been shown in previous studies to be beneficial in reducing blood clots among people who experienced a sudden blockage in a coronary artery, it has never been evaluated in patients undergoing elective percutaneous coronary intervention with more stable heart conditions," said Johanne Silvain, M.D., Ph.D., lead study author, and an interventional cardiologist and director of the Coronary Intensive Care Unit at the Institut de Cardiologie of the Hospital Pitié-Salpêtrière in Paris.

Percutaneous coronary intervention (PCI) is a common, non-surgical procedure that uses an inflatable balloon to open a blocked heart artery. Artery-clogging plaque is pushed against the blood vessel wall to restore blood flow through the artery. A small mesh tube called a stent is sometimes placed in the artery to keep it open.

The risk of severe complications, including stent clots, stroke and death, during percutaneous coronary intervention is less than 1% (the rate was 0.5% in the ALPHEUS trial). However, some patients experience heart attacks provoked by the PCI procedure itself.

In this study, a control group of patients received clopidogrel plus aspirin before PCI and for 30 days after the procedure. The experimental group received ticagrelor plus aspirin before PCI and for 30 days after.

The study, which was conducted over more than three years, found:

The rate of periprocedural heart attack and severe complications, including stent clots, stroke and death, was similar between the control group and the experimental group.

There was no increase in excessive bleeding 48-hours after PCI among the patients treated with ticagrelor compared to the control group.

"These results show there is no scientific data to support a change in the standard of care," Silvain said. "The use of ticagrelor should be reserved for treating patients who experienced a sudden blockage in a coronary artery (acute coronary syndrome), not those who have stable heart conditions and elect PCI."

Study limitations include that "it was an open label trial, myocardial infarction and injury were used as the clinical outcome as hard clinical endpoint which are rare in elective PCI. Patients under chronic clopidogrel therapy were included, and all troponin assays were allowed to reflect real-life but may have brought heterogeneity," he explained.

DALLAS, Nov. 14, 2020 -- The primary results from the RIVER Trial, Rivaroxaban for Valvular Heart disease and Atrial Fibrillation, show that rivaroxaban is comparable to warfarin, which is currently the standard of care anticoagulant prescribed for patients with bioprosthetic mitral valves, according to late-breaking research presented today at the American Heart Association's Scientific Sessions 2020. The meeting is virtual, Friday, November 13-Tuesday, November 17, 2020, and is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science for health care worldwide.

Researchers say clinicians have used direct oral anticoagulants (DOACs) such as rivaroxaban off-label for patients with bioprosthetic mitral valves who have atrial fibrillation or flutter.

The RIVER trial followed 1,005 patients from 49 sites in Brazil who had a bioprosthetic mitral valve and atrial fibrillation or flutter for 12 months. Patients were randomized to rivaroxaban 20 mg once daily or the vitamin K antagonist anticoagulant warfarin (dose-adjusted to an international normalized ratio (INR) between 2.0-3.0). The primary endpoint was a composite of death, major cardiovascular events (stroke, transient ischemic attack, systemic embolism, valve thrombosis or hospitalization for heart failure) or major bleeding over 12 months.

"This is the largest trial designed to evaluate the safety and efficacy of direct oral anticoagulants in patients with bioprosthetic mitral valves and atrial fibrillation or flutter. Earlier trials of direct oral anticoagulants vs. warfarin for atrial fibrillation or flutter together included fewer than 200 patients with bioprosthetic mitral valves," said lead study author Otavio Berwanger, M.D., Ph. D., a cardiologist and epidemiologist, and the director of the Research Institute Hcor, Heart Hospital (Hospital de Coracao) in Sao Paulo, Brazil.

Patients who received rivaroxaban had an average of almost one year (347.5 days) free from the primary endpoint, similar to those treated with warfarin (340.1 days).

"Additionally, our confidence interval likely excluded an effect size larger than 1.4 days free from events favoring warfarin, clearly demonstrating the non-inferiority effect of rivaroxaban in this clinical setting," Berwanger said. "There was a similarly nonsignificant numeric trend favoring rivaroxaban for most secondary endpoints, however, the incidence of stroke was lower in the rivaroxaban than in the warfarin group. Importantly, safety events such as valve thrombosis, major/non-major clinically relevant and total bleeding were not statistically different between the rivaroxaban and warfarin groups."

A subgroup analysis of 18.8% of RIVER patients with bioprosthetic mitral valve implantation within the prior three months showed a mean of 35.1 days longer without evidence of the primary outcome compared to patients treated with warfarin.

"The results from the RIVER Trial are consistent with previous research, including ROCKET and other pivotal trials of DOACs, and can inform clinical practice for patients with bioprosthetic mitral valves," Berwanger said. "For a subgroup of patients with a mitral valve replacement within the last three months, rivaroxaban was statistically and clinically superior to warfarin."

The main study limitations are the open-label design, and the fact that the findings cannot be extrapolated to patients with a bioprosthetic aortic valve in the aortic position, or for patients with mitral stenosis or with mechanical valves. Trials in these populations are ongoing.

The agricultural industry relies heavily on chemical fungicides to protect crops. Many of these products have a detrimental effect on human and animal health. As a result, some of the most effective fungicides are considered to be banned in a number of geographies, especially in Europe.

"Despite efforts to develop natural protection, very few efficient solutions have been commercialized," explained Sylvain Dubey, a plant pathologist based in Switzerland. "And there are still no effective environmentally friendly methods of combatting the fungal pathogens that infect large groups of crops."

Dubey and colleagues were inspired by earlier research in which they showed that compounds with antifungal activities can be found in various organisms from prokaryotes to eukaryotes such as plants, with oil mixtures containing terpenes, phenols and alcohols, glycosides, alkaloids, and recently discovered glucosinolate derivatives. These latter compounds are primarily present in the Brassicaceae family.

"Because of these results, we investigated the fungitoxic activity of natural isothiocyanate derivatives of glucosinolates as well as semi-synthetic derivatives and their synergy."

In a recent study published in PhytoFrontiers journal, they confirmed that 13 natural and semi-synthetic glucosinolate derivatives are efficient fungicides alone or when used in combination against widespread genetically distant species of fungal plant pathogens. Combinations of these compounds showed strong synergistic fungitoxic effects.

"Interestingly, physico-chemical characteristics of fungitoxic glucosinolate derivatives differ from those showing no activities or from those that are known for their insecticidal or insect attractive properties," explained Dubey. "Indeed, fungitoxic compounds exhibit significantly higher bioaccumulation potential and are more lipophilic than compounds with no fungitoxic activities. It is therefore possible to anticipate the potential function of glucosinolate derivatives based on their physico-chemical properties and the differences in the way compounds will interact with the surrounding environment and hence organisms."

Dubey and colleagues hope that their findings will pave the way for parties looking to develop environmentally friendly methods of combating fungal pathogens. Their research mirrors other research that has shown that biological compounds can be used to replace environmentally damaging pesticides. For more information, read "Isothiocyanate Derivatives of Glucosinolates as Efficient Natural Fungicides" published in PhytoFrontiers journal.

During the height of the pandemic, researchers at Children's National Hospital discovered that as many as one half of children diagnosed with multisystem inflammatory disease in children (MIS-C) at the hospital developed cardiac complications including coronary artery abnormalities, even when diagnosed and treated promptly.

The data was shared as part of a poster presentation at the American Heart Association Scientific Sessions in November 2020. Though analysis was limited to the data from one institution's confirmed MIS-C cases, the findings are significant enough to warrant further study.

Interestingly, the authors noted that the high rate of cardiac complications far exceeds the rate of similar issues in children with Kawasaki disease -- another pediatric inflammatory syndrome that shares many common symptoms with MIS-C. The two are so similar that immunomodulation therapies successfully deployed in children with MIS-C were based on those developed to treat Kawasaki disease.

Knowledge of common cardiac complications in Kawasaki disease also flagged the need for routine echocardiograms in patients with MIS-C, which helped identify the higher rates of cardiac complications seen in the MIS-C patient population.

"This finding, however, is another data point that shows how MIS-C and Kawasaki disease have some specific differences needing further study," says Ashraf Harahsheh, M.D., a pediatric cardiologist at Children's National Hospital who studies Kawasaki disease and the first author on the new study.

"Previous clinical advancements made in Kawasaki disease set the stage for our response to MIS-C early on," he said. "Now we also need to understand MIS-C as its own syndrome so we can better address what we are seeing in this patient population," he says.

While most of the cardiac findings resolved during follow up, long-term studies are needed to determine if the cardiac abnormalities are associated with major cardiac events later.

"This work will help inform the community of the importance of diagnosing children with MIS-C promptly and following clinical guidelines for necessary tests and treatments once MIS-C is diagnosed," Harahsheh concludes.

Next, the research team plans to take a deep dive into patient demographics as well as findings from clinical, laboratory and electrocardiogram data for children who developed cardiac complications with MIS-C. The goal will be to refine treatment algorithms and potentially identify a subgroup of patients who may require different or more intense therapy to prevent cardiac complications.

New research from the University of Southern California measured the use of Medicaid's annual wellness visits and the receipt of structured cognitive assessments among Medicaid beneficiaries.

Lead author Mireille Jacobson, an economist and associate professor at the USC Leonard Davis School of Gerontology, and colleagues surveyed a sample of adults with either Medicare Advantage (MA) or fee-for service Medicare. Among the findings, approximately one-half of beneficiaries reported having an annual wellness visit, but only about a quarter of total respondents reported receiving a structured cognitive assessment at an annual wellness visit, even though, under the Affordable Care Act (ACA), detection of cognitive impairment is a required component of the visit.

The study, Cognitive Assessment at Medicare's Annual Wellness Visit In Fee-For-Service And Medicare Advantage Plans appears in the November issue of the journal Health Affairs and provides new insights - the self-reports of survey respondents - into cognitive assessments at annual wellness visits, an area that has been somewhat hidden from view.

"Until now there has been little clarity on whether any assessments actually take place because providers bill for the visit not the services," said Jacobson, who is also co-director of the Aging and Cognition Program at the USC Leonard D. Schaeffer Center for Health Policy & Economics. "In addition, because Medicare offers limited policy guidance on how to perform an assessment, it has been unclear who, if anyone, receives a structured cognitive assessment versus direct observation, in which the clinician might be looking at them and talking to a caregiver or a spouse but not actually doing much formal testing."

The researchers say variations in wellness visits and cognitive assessments by Medicare coverage type are even less understood. According to the study, Medicare Advantage (MA) enrollees were nearly 20 percentage points more likely to report that they had an annual wellness visit and more than eight percentage points more likely than those in fee-for-service Medicare to report a structured cognitive assessment at an annual wellness visit, primarily because of their higher likelihood of receiving such a visit. MA beneficiaries were also more likely to have a cognitive screen at any health care visit. The team states that the differences suggest that the rate of structured cognitive assessment in fee-for-service Medicare might be increased if incentives for take-up were similar to those in Medicare Advantage, but they say more research is needed to validate these differences and understand what accounts for them.

The Medicare annual wellness visit and required cognitive screening are part of efforts to promote early detection of dementia and have been available since 2011. According to data from study co-author, Julie Zissimopoulos, co-director of the Aging and Cognition program at the USC Schaeffer Center, around one in 12 Americans age 65 and older is estimated to be living with dementia, with costs of medical and long term care approaching $3 trillion. Costs associated with Alzheimer's disease, the most common form of dementia, are expected to exceed $1.5 trillion by 2050.

"Increases in the number of people living with dementia and in the financial and nonfinancial costs of care are major policy concerns," said Zissimopoulos, who is also an associate professor at the USC Price School. "Early detection of cognitive impairment can have benefits that include the identification of treatment or improvement in quality of life."

The researchers note that the ACA does not specify that screenings for cognitive impairment need to be structured assessments - and that there has not yet been a direct analysis comparing the two methods. The Alzheimer's Association developed a toolkit that includes recommendations for when to administer structured tests, along with specific five-minute tests to choose from; these ask people to perform tasks like drawing a clock, identifying a picture or recalling words.

"Despite unanswered questions about the benefits of screening for patients and caregivers and the accuracy of tools, our survey data indicate that structured cognitive assessment is valued by older people," said Zissimopoulos. "Combined with randomized controlled trial evidence that screening in the primary care setting does not increase depressive symptoms or anxiety, these data provide further evidence to support the use of structured cognitive assessments
at the annual wellness visit."

The US Preventive Services Task Force also refrains from recommending structured assessments, stating, "there is insufficient evidence to sasses the balance of benefits and harms of screening for cognitive impairment in older adults." However, Jacobson warns about the issue of leaving assessment to direct observation when findings from other settings suggest that our own observations are subject to overconfidence, confirmation, and other psychological biases.

"The current assessment requirements are quite vague, and I hope this study can prompt some discussion and new research around what the costs and benefits are in leaving this evaluation up to physician observation versus doing more structured assessments," she said.

Bottom Line: Deaths from cancer accounted for more than 4 million potential years of life lost in 2017. While the cancer types with the highest death rates per capita accounted for the greatest number of years lost, cancers that typically occur at younger ages bore a disproportionate share of the burden.

Journal in Which the Study was Published: Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research

Author: Minkyo Song, MD, PhD, a research fellow at the National Cancer institute, part of the National Institutes of Health.

Background: "Potential years of life lost (PYLL) is an estimate of the average years a person would have lived if he or she had not died prematurely. Given that cancer is the leading cause of death in those younger than 80 years old, it is important to study the effect of cancer death rates among younger people," Song explained.

In 2017, there were 599,099 cancer deaths in the United States, according to death certificate data from the National Center for Health Statistics.

How the Study was Conducted: Song and colleagues used national mortality data from the U.S. National Center for Health Statistics, coupled with a commonly used definition of PYLL as the number of years lost prior to age 75, to quantify how many years of life were prematurely lost.

Results: The researchers calculated that 4,280,128 years of life were prematurely lost due to cancer in 2017.

For the most part, PYLL mirrored overall U.S. cancer mortality trends. For example, lung cancer, the cancer type that causes the largest number of deaths, accounted for approximately 24.3 percent of U.S. cancer deaths and 20.8 percent of PYLL. Colon/rectum cancer accounted for 8.8 percent of deaths and 9.6 percent of PYLL. Pancreatic cancer accounted for 7.3 percent of deaths and 6.6 percent of PYLL, while breast cancer accounted for 7.1 percent of deaths and 9.4 percent of PYLL.

One exception to this pattern was prostate cancer, which causes about 5.1 percent of U.S. cancer deaths but only 2 percent of PYLL. "Many of the deaths caused by this cancer occurred at older ages, resulting in fewer PYLL," Song noted.

Another metric, PYLL per death, provided a useful tool to measure the burden from several rare cancers that typically affect younger people, Song said. For example, testicular cancer accounted for 0.1 percent of cancer deaths in 2017, and 0.3 percent of PYLL. Bone cancer accounted for 0.3 percent of deaths, but 0.7 percent of PYLL. Although these cancers did not contribute dramatically to overall cancer mortality, they caused the highest numbers of life years lost per death: Testicular cancer had the highest PYLL per death, with an average of 34 years lost, followed by bone cancer, with an average of 26.4 years lost, and endocrine cancers including thymus cancer, with an average of 25.2 years lost.

The total number of PYLL increased slightly from 1990, despite an overall decrease in cancer deaths. In 1990, there were 4,262,397 PYLL, compared with the 4,280,128 recorded in 2017. During this time, overall cancer mortality dropped from 214.9 per 100,000 in 1990 to 152.7 per 100,000 in 2017. The researchers found that the increase in PYLL was due to the growth of the U.S. population.

The study also showed that ethnic and racial minority groups account for a disproportionate share of the burden of premature cancer death. In 2017, 78 percent of all cancer deaths occurred in non-Hispanic whites, but only 70 percent of PYLL occurred in this group. By contrast, Hispanics accounted for 7 percent of cancer deaths and 10 percent of PYLL, while Blacks accounted for 12 percent of cancer deaths and 15 percent of PYLL.

Author's Comments: Overall, Song said, "PYLL is a useful 'complementary measure' to cancer mortality rates. Together, they provide a more detailed picture of the social and economic toll of cancer. PYLL can be used to estimate the impact of cancer death in younger populations. This metric highlights the enormous loss of life due to certain cancers that occur at younger ages, even if they occur infrequently."

Study Limitations: As a limitation, the researchers noted that the study relied on the cause of death reported on death certificates, which are subject to error. They also pointed out that other studies have used different definitions of PYLL, contributing to some differences across the body of research on this topic.

Funding & Disclosures: This study was funded by the Intramural Research Program at the National Cancer Institute. Song declares no conflicts of interest.

ARLINGTON HEIGHTS, Ill (November 13, 2020) - Throughout the course of the COVID-19 pandemic, those able to wear a face mask have been encouraged to do so to prevent transmission of the virus. For some people with skin allergies, wearing a mask can cause further problems. A medically challenging case presented at this year's virtual American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting revealed that for a man with several skin allergies, mask-wearing triggered his contact dermatitis.

"We treated a 60-year-old Black man with adult-onset eczema, contact dermatitis and chronic nasal allergies in our clinic after he presented three times to our hospital emergency room (ER) because of an uncomfortable face rash," says allergist Yashu Dhamija, MD, ACAAI member and lead author of the paper. "Up until April 2020, his skin conditions had been under control, but with mask-wearing, his symptoms began occurring in areas that providers were not yet accustomed to."

The ER doctors who first saw the patient prescribed prednisone for the rash. When his symptoms were not relieved, the patient underwent a follow up telehealth visit with the hospital's allergy clinic. Further investigation revealed his skin allergies had begun to flare in April 2020, coinciding with the pandemic and his mask-wearing.

"We realized that his rash appeared right where the elastic parts of a mask would rest," said allergist Kristin Schmidlin, MD, ACAAI member and co-author of the paper. "We tapered down the prednisone and advised him to use a topical steroid and a topical immunosuppressant until the rash resolved. We also told him to use cotton-based, dye-free masks without elastic. At a follow up telephone visit one week later, the patient said his rash continued to improve."

The authors note common allergens that can affect contact dermatitis are found in masks, elastic bands, and other components of face masks. People with existing skin allergies should work with their allergist. Your board-certified allergist can perform patch testing to help identify specific components in masks which may be triggering symptoms.

Religion hampered the diffusion of knowledge and economic development in France during the Second Industrial Revolution (1870-1914), according to research by Mara Squicciarini of Bocconi University recently published in the American Economic Review.

By opposing the introduction of technical education in primary schools, the Catholic Church in fact prevented the accumulation of human capital in the most religious areas of the country. Higher levels of religious education translated into significant lower industrial employment 10 to 15 years later, when schoolchildren entered the labor market.

"And these findings have important implications for economic development today," says Professor Squicciarini, "since many developing countries - where religion plays a primary role in the personal and public spheres - are experiencing large-scale technological progress, similar to that of Western Europe during the Second Industrial Revolution."

"The more sophisticated industrial machinery of the Second Industrial Revolution required a technically skilled workforce. Consequently, the French state took an active role in promoting a more technical curriculum to form a skilled labor force," Professor Squicciarini explains. But the Church was promoting a conservative, antiscientific program, hindering the introduction of the technical curriculum and pushing for religious education, while secular schools became increasingly modern and professional, the study shows.

The religious intensity of an area is associated with the diffusion of religious education and this, in turn, is associated with lower industrial development. The effect is sizeable: moving from the tenth to the ninetieth percentile of the share of Catholic schools distribution would decrease the share of industrial employment by 6.2 percentage points, relative to a mean of 28%.

The economic development of areas with a high or low religiosity did not start to diverge, though, until the Second Industrial Revolution, when the school curricula and the accumulation of human capital among the population began to count for industrial development. These results suggest that the relationship between religion and economic development is not inherently negative. Rather, it varies over time, and it becomes negative when religion hinders the adoption of economically useful knowledge.

WEST LAFAYETTE, Ind. - Pearls have long been favored as objects of beauty. Now, Purdue University innovators are using the gem to provide potential new opportunities for spectral information processing that can be applied to spectroscopy in biomedical and military applications.

The Purdue team demonstrated light transport-assisted information processing by creating a pearl spectrometer.

Spectrometers probe interactions of matter and light as a function of the electromagnetic spectrum and are commonly used in biomedical and military applications. For example, they have been used for diagnostics of various types of cancer and for military gas sensing.

"Unfortunately, widespread uses and practical adaptions of spectroscopy are often limited due to the need of conventional spectrometers," said Young Kim, an associate professor of biomedical engineering at Purdue. "The current spectrometers rely on complex device assembly, high-precision alignment and large physical size or dimension, all of which prevent rapid translation into practical applications."

The work, which was funded by the U.S. Air Force Research Laboratory, is published in Nano Letters.

"We discovered that pearls are an ideal natural object for Anderson localization of light, named after Nobel laureate Philip Anderson, whose concept has been extended to describe how light undergoes on and off resonances inside materials due to their strong scattering," Kim said.

Yunsang Kwak, a postdoctoral fellow in the lab at Purdue, said, "Anderson light localization offers high randomness that is extremely helpful for compressive sensing, in particular to conduct information processing with a thin and plat form factor, by simply attaching a pearl-like multispectral filter array on a conventional camera."

Kim said, "We do not think that the direct use of a pearl would be a good option for mass production of multispectral filter arrays. Instead, pearls teach us how to design disordered nanostructures of Anderson light localization to develop a new class of spectral information processing machine."

The Purdue researchers are looking to their new discovery to provide scientists with an idea of hybridizing material and digital properties, which could be useful for innovations in biomedical and defense applications.

Researchers from Nanjing University, Temple University, Fudan University, and Waseda University published a new paper in the Journal of Marketing that examines the double-edged effects of ECR ads on customer purchases.

The study, forthcoming in the the Journal of Marketing, is titled "The Double-Edged Effects of E-Commerce Cart Retargeting: Does Too Early Retargeting Backfire?" and is authored by Jing Li, Xueming Luo, Xianghua Lu, and Takeshi Moriguchi.

Because consumers often abandon e-commerce carts, companies are shifting their online advertising budgets to immediate e-commerce cart retargeting (ECR). They presume that early reminder ads, relative to late ones, generate more click-throughs and web revisits.

To test this presumption, the researchers developed a conceptual framework of the double-edged effects of ECR ads and empirically support it with a multi-study multi-setting design. In Study 1, they find that customers who received an early ECR ad within 30 minutes to one hour are less likely to make a purchase compared to those who did not receive it. In other words, delivering ECR ads too early can engender worse purchase rates than without delivering them, thus wasting online advertising budgets. By contrast, a late ECR ad after one to three days has a positive incremental impact on customer purchases. Study 2 replicates this double-edged impact of ECR ads delivered by mobile SMS and explores cart characteristics. Both the negative impact of early ECR and positive impact of late ECR can be amplified when the products in the retargeted carts are larger in quantity and at higher average prices.

Li says that "Given the prevalence of retargeting ads in practice, our findings provide managers with specific guidance on implementing ECR ads to boost ROI on retargeting campaigns. First, companies should not heedlessly follow the recency bump and shift all their online ad budgets to immediate retargeting. Delivering ECR ads too early can engender worse purchase rates than without delivering them. That is, too-soon reminder ads may annoy consumers and backfire, thus not only squandering ad budgets, but also likely hurting customers' long-term satisfaction." Prudent marketers should resist the temptation of immediate retargeting even though advanced digital e-commerce technologies can deliver retargeting ads within minutes after consumers abandon carts online. However, early ECR with price discounts or scarcity framing may allow managers to engender more purchase responses. But price discounts are not a panacea: When repeatedly used, they may train strategic customers who purposefully cart products and then wait for price discounts before purchasing.

"It is pivotal to scientifically gauge the causal impact of ECR ads. Firms should not rely on the absolute purchases as a measure of success, but rather adopt the relative purchase" adds Luo. "Without comparing the retargeting with the control, managers may mistakenly conclude that the early ECR is most effective."

The study also finds that a late ECR ad can be effective and win back potential customers with an increase in ROI on advertising. Moriguchi points out that "Firms can better deploy ECR ad campaigns with a delay after consumers abandon carts to minimize negative ad annoyance as well as maximize the positive ad reminder effects on customer purchases. Retargeting carts in e-commerce has enormous business potential because more than 69% of consumers abandon carts online, which amounts to more than $4.6 trillion each year." The right timing of ECR does not incur additional financial costs in retargeting, but can significantly lift customer purchases.

Finally, managerial actions call for an appropriate match between the timing of ECR ads and retargeted products. It is necessary to use ECR to cater to different types of cart abandonment. Different cases include carts with a high quantity of products versus carts with only one item or carts with an expensive product versus a cheap one. Thus, the researchers reveal a tactic e-commerce retailers can use to more accurately retarget customers with different digital carts. "Firms can strategically decide the time to turn on ECR, depending on its suitability for different types of carts, to maximize conversions" says Lu. For example, managers can win back more customers by implementing late ECR ads for carts with a larger quantity of products abandoned.