Variations in Processes of Care and Outcomes for Hospitalized General Medicine Patients Treated by Female vs Male Physicians

Anjali Sergeant, BASc¹; Sudipta Saha, SM²; Saeha Shin, MPH³; et alAdina Weinerman, MD⁴; Janice L. Kwan, MD, MPH⁵; Lauren Lapointe-Shaw, MD, PhD⁵; Terence Tang, MD⁵; Gillian Hawker, MD, MSc⁵; Paula A. Rochon, MD, MPH⁶; Amol A. Verma, MD, MPhil⁵; Fahad Razak, MD, MSc⁵

Author Affiliations Article Information

JAMA Health Forum. 2021;2(7):e211615. doi:10.1001/jamahealthforum.2021.1615

Key Points

Question  Is physician gender associated with mortality and other patient outcomes in a general internal medicine inpatient setting?

Findings  In this cross-sectional study of 171 625 hospitalized patients, patients cared for by female physicians had lower in-hospital mortality after adjustment for hospital and for patient characteristics, but this was no longer statistically different after adjustment for physician characteristics.

Meaning  The lower mortality rate in patients cared for by female physicians may be partially explained by differences in physician characteristics.

Abstract

Importance  Hospitalized medical patients cared for by female physicians may have decreased mortality rates compared with patients of male physicians. However, this association has yet to be assessed outside of the US, and little is known about factors that may explain this difference.

Objective  To determine whether mortality, other hospital outcomes, and processes of care differed between the patients cared for by female and male physicians.

Design, Setting, and Participants  This retrospective cross-sectional study included patients admitted to general medical wards at 7 hospitals in Ontario, Canada, between April 1, 2010, and October 31, 2017. The association of physician gender with patient outcomes was examined while adjusting for hospital fixed effects, patient characteristics, physician characteristics, and processes of care. All patients were admitted to a general internal medicine service through the emergency department and were cared for by a general internist or family physician-hospitalist. Patients were excluded if length of stay was greater than 30 days or if the attending physician cared for less than 100 hospitalized general medicine patients over the study period. Statistical analyses were performed from October 15, 2020, to May 8, 2021.

Main Outcomes and Measures  In-hospital mortality, length of stay, intensive care unit admission, 30-day readmissions, and process-of-care measures (blood tests, medications, imaging, endoscopy, and interventional radiology services).

Results  A total of 171 625 hospitalized patients with a median age of 73 years (interquartile range, 56-84 years) were included (84 221 men [49.1%], 87 402 women [50.9%], and 2 patients with unspecified sex). Patients were cared for by 172 attending physicians (54 female physicians [31.4%] and 118 male physicians [68.6%]). In fully adjusted models, female physicians ordered more imaging tests, including computed tomography (adjusted difference, −1.70%; 95% CI, −2.78% to −0.61%; P = .002), magnetic resonance imaging (−0.88%; 95% CI, −1.37% to −0.38%; P = .001), and ultrasonography (−1.90%; 95% CI, −3.21% to −0.59%; P = .005). Patients treated by female physicians had lower in-hospital mortality (2256 of 46 772 patients [4.8%] vs 6452 of 124 853 patients [5.2%]). This difference persisted after adjustment for patient characteristics but was no longer statistically different after adjustment for other physician characteristics (adjusted difference, 0.29%; 95% CI, −0.08% to 0.65%; P = .12). The difference was similar after further adjustment for processes of care.

Conclusions and Relevance  In this cross-sectional study of patients admitted to general medical units in Canada, patients cared for by female physicians had lower mortality rates than those treated by male physicians, adjusting for patient characteristics. This finding was nonsignificant after adjustment for other physician characteristics.

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JAMA Health Forum – Health Policy, Health Care Reform, Health Affairs | JAMA Health Forum | JAMA Network

 PRIVATIZED MEDICINE USA

Association Between Primary Care Payment Model and Telemedicine Use for Medicare Advantage Enrollees During the COVID-19 Pandemic

Brian W. Powers, MD¹; Dana Drzayich Antol, MS¹; Yongming Zhao, PhD¹; et alGilbert S. Haugh, MS¹; Oraida Roman, MHA¹; William H. Shrank, MD¹; Niteesh K. Choudhry, MD, PhD²

Author Affiliations Article Information

JAMA Health Forum. 2021;2(7):e211597. doi:10.1001/jamahealthforum.2021.1597

COVID-19 Resource Center

Introduction

Patterns of outpatient care shifted dramatically during the early stages of the COVID-19 pandemic,¹ with deferred in-person care leading to substantial revenue losses for primary care organizations.² This shift created a strong financial incentive to move visits to telemedicine, especially among organizations reimbursed under fee-for-service payment models. Primary care organizations reimbursed under value-based payment models did not experience the same near-term financial incentives but may have found it easier to expand telemedicine access given underlying technology and infrastructure investments.³ To better understand these dynamics, we examined the association between the primary care payment model and telemedicine use for Medicare Advantage enrollees during the COVID-19 pandemic.

Methods

For this cohort study, we identified beneficiaries continuously enrolled in Medicare Advantage health maintenance organization (HMO) plans offered by Humana, Inc, from January 1, 2019, to September 30, 2020. Enrollees in HMO plans are required to select a primary care clinician, which we used to attribute patients to a primary care organization. We then used contract data to identify the payment model under which the organization was reimbursed for the patients’ care and classified those payment models according to the following taxonomy: fee-for-service; shared savings with upside-only financial risk; shared savings with downside financial risk; or capitation, as described in the eMethods of the Supplement. We considered shared savings with downside financial risk and capitation to represent advanced value-based payment models.

Next, we identified audiovisual and audio-only telemedicine visits with the attributed primary care organization from January 1, 2020, to September 30, 2020, using paid outpatient claims, as described in the eMethods of the Supplement. We then assessed changes in weekly rates of telemedicine utilization, stratified by primary care payment model. Finally, we estimated the association between telemedicine use and primary care payment model using a patient-level negative binomial regression model that adjusted for patient age, sex, race/ethnicity, Medicare eligibility criteria, comorbidity,⁴ and practice size, and included hospital referral region fixed effects. Race/ethnicity was assessed according to the Centers for Medicare & Medicaid Services beneficiary race code, which reflects data self-reported to the Social Security Administration.

An Advarra institutional review board deemed the study exempt and waived informed consent because it used only retrospective deidentified data and did not meet the criteria found in the Regulations for the Protection of Human Subjects (45 CFR §46). Data analyses were performed from December 30, 2020, to May 14, 2021, using SAS Enterprise Guide, version 8.2 (SAS Inc). P values were 2-tailed and statistical significance was defined as P < .05. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

Results

The study population of 1 125 946 patients (mean [SD] age, 74.7 [6.7] years; 645 489 [57.3%] women) comprised 28 508 (2.5%) Asian, 228 105 (20.3%) Black, 121 016 (10.8%) Hispanic, 1732 (0.2%) Native American, and 733 803 (65.2%) White individuals. Telemedicine use rose faster and reached higher absolute levels among those patients attributed to primary care organizations reimbursed via advanced value-based payment models compared with those reimbursed via fee-for-service (Figure). In multivariable analyses of cumulative telemedicine visits from March 1, 2020, to September 30, 2020, primary care payment model was significantly associated with telemedicine utilization (Table). Compared with patients attributed to organizations reimbursed under fee-for-service, the marginal effects of primary care payment model on telemedicine visits per 1000 patients were −12.9 (95% CI, −17.4 to −8.4) for shared savings with upside-only financial risk, 71.5 (95% CI, 66.9 to 76.1) for shared savings with downside financial risk, and 105.6 (95% CI, 96.1 to 115.1) for capitation.

Discussion

In this cohort study of Medicare Advantage enrollees during the COVID-19 pandemic, we found that the primary care payment model was significantly associated with telemedicine use. The patients attributed to the primary care organizations reimbursed under advanced value-based payment models used telemedicine services at the highest rates. Rates of telemedicine utilization were lower among patients attributed to organizations reimbursed under fee-for-service, despite those organizations facing the strongest near-term financial incentive to increase telemedicine utilization.² This suggests that accountability for cost, quality, and disease management under value-based payment models—and the infrastructure, technology, and management systems of organizations engaging in these models—may have been a stronger catalyst for telemedicine adoption than recouping revenue from deferred in-person visits.

A limitation of this study was the inability to observe practice characteristics beyond payment model and size that may be associated with telemedicine adoption. Further research is needed to better understand the specific drivers of telemedicine adoption within physician organizations, especially as payers and policy makers consider approaches to ensure adequate, equitable, and sustainable access to telemedicine in the postpandemic era.

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Article Information

Accepted for Publication: May 17, 2021.

Published: July 16, 2021. doi:10.1001/jamahealthforum.2021.1597

Open Access: This is an open access article distributed under the terms of the CC-BY-NC-ND License. © 2021 Powers BW et al. JAMA Health Forum.

Corresponding Author: Brian W. Powers, MD, MBA, Humana Inc, 500 W Main St, Louisville, KY 40202 (bpowers5@humana.com).

Author Contributions: Dr Powers had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Powers, Drzayich Antol, Zhao, Haugh, Shrank, Choudhry.

Drafting of the manuscript: Powers, Shrank.

Critical revision of the manuscript for important intellectual content: Powers, Drzayich Antol, Zhao, Haugh, Roman, Choudhry.

Statistical analysis: Zhao, Haugh, Shrank.

Administrative, technical, or material support: Powers, Drzayich Antol, Roman, Shrank.

Supervision: Powers, Haugh, Shrank.

Conflict of Interest Disclosures: Dr Powers, Ms Drzayich Antol, and Ms Roman report equity in Humana, outside of the submitted work. Dr Shrank reports equity in Humana and serving as a Director at GetWellNetwork, outside the submitted work. Dr Choudhry reports grants from Humana, outside the submitted work. No other disclosures were reported.

Additional Contributions: We would like to thank Yong Li, PhD, Humana Inc, and Adrianne Casebeer, PhD, Humana Inc, for their contributions to the study design, data analysis, and results interpretation. They were not compensated beyond their regular salaries.

References

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Patel  SY, Mehrotra  A, Huskamp  HA, Uscher-Pines  L, Ganguli  I, Barnett  ML.  Trends in outpatient care delivery and telemedicine during the COVID-19 pandemic in the US.   JAMA Intern Med. 2021;181(3):388-391. doi:10.1001/jamainternmed.2020.5928
ArticlePubMedGoogle ScholarCrossref

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Basu  S, Phillips  RS, Phillips  R, Peterson  LE, Landon  BE.  Primary care practice finances in the United States amid the COVID-19 pandemic.   Health Aff (Millwood). 2020;39(9):1605-1614. doi:10.1377/hlthaff.2020.00794PubMedGoogle ScholarCrossref

3.

American Academy of Family Physicians. Value-based payment study. Accessed March 1, 2021. https://valuebasedcare.humana.com/wp-content/uploads/2018/02/2017-Value-Based-Payment-Study-External.pdf

4.

Quan  H, Sundararajan  V, Halfon  P,  et al.  Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.   Med Care. 2005;43(11):1130-1139. doi:10.1097/01.mlr.0000182534.19832.83PubMedGoogle ScholarCrossref

No sign of COVID-19 vaccine in breast milk

Small UCSF study indicates vaccine safety for pregnant and lactating women

UNIVERSITY OF CALIFORNIA - SAN FRANCISCO

Research News

Messenger RNA vaccines against COVID-19 were not detected in human milk, according to a small study by UC San Francisco, providing early evidence that the vaccine mRNA is not transferred to the infant.

The study, which analyzed the breast milk of seven women after they received the mRNA vaccines and found no trace of the vaccine, offers the first direct data of vaccine safety during breastfeeding and could allay concerns among those who have declined vaccination or discontinued breastfeeding due to concern that vaccination might alter human milk. The paper appears in JAMA Pediatrics.

Research has demonstrated that vaccines with mRNA inhibit transmission of the virus that causes COVID-19. The study analyzed the Pfizer and Moderna vaccines, both of which contain mRNA.

The World Health Organization recommends that breastfeeding people be vaccinated, and the Academy of Breastfeeding Medicine has said there is little risk of vaccine nanoparticles or mRNA entering breast tissue or being transferred to milk, which theoretically could affect infant immunity.

"The results strengthen current recommendations that the mRNA vaccines are safe in lactation, and that lactating individuals who receive the COVID vaccine should not stop breastfeeding," said corresponding author Stephanie L. Gaw, MD, PhD, assistant professor of Maternal-Fetal Medicine at UCSF.

"We didn't detect the vaccine associated mRNA in any of the milk samples tested," said lead author Yarden Golan, PhD, a postdoctoral fellow at UCSF. "These findings provide an experimental evidence regarding the safety of the use of mRNA-based vaccines during lactation."

The study was conducted from December 2020 to February 2021. The mothers' mean age was 37.8 years and their children ranged in age from one month to three years. Milk samples were collected prior to vaccination and at various times up to 48 hours after vaccination.

Researchers found that none of the samples showed detectable levels of vaccine mRNA in any component of the milk.

The authors noted that the study was limited by the small sample size and said that further clinical data from larger populations were needed to better estimate the effect of the vaccines on lactation outcomes.

###

Co-authors are Mary Prahl, MD; Arianna Cassidy, MD; Christine Y. Lin, BA; Nadav Ahituv, PhD; and Valerie J. Flaherman, MD, MPH, all of UCSF.

The study was supported by the Marino Family Foundation; the National Institutes of Health (grant numbers K23AI127886 and K08AI141728); the Weizmann Institute of Science-National Postdoctoral Award Program for Advancing Women in Science; the International Society for Research in Human Milk and Lactation Trainee Bridge Fund; and the Human Frontier Science Program. Disclosures can be found in the paper.

About UCSF Health: UCSF Health is recognized worldwide for its innovative patient care, reflecting the latest medical knowledge, advanced technologies and pioneering research. It includes the flagship UCSF Medical Center, which is ranked among the top 10 hospitals nationwide, as well as UCSF Benioff Children's Hospitals, with campuses in San Francisco and Oakland, Langley Porter Psychiatric Hospital and Clinics, UCSF Benioff Children's Physicians and the UCSF Faculty Practice. These hospitals serve as the academic medical center of the University of California, San Francisco, which is world-renowned for its graduate-level health sciences education and biomedical research. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area. Visit http://www.ucsfhealth.org/. Follow UCSF Health on Facebook or on Twitter

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Watching the ultrafast dance moves of a laser plasma

TATA INSTITUTE OF FUNDAMENTAL RESEARCH

VIDEO: THE MOTION OF A HOT, DENSE PLASMA CREATED ON A SOLID TARGET SURFACE BY AN ULTRAHIGH INTENSITY LASER. THE MOVIE SHOWS DIFFERENT REGIONS OF A PLASMA MOVING IN AND OUT... view more 

CREDIT: ANKIT DULAT

Great leaps in science and technology have been propelled by recent advances in seeing fast evolving physical phenomena, as they happen. Femtosecond lasers from the infrared to the X-ray region have enabled us to 'watch', in real time, atoms dance in molecules and solids on femtosecond and picosecond timescales. Watching such fascinating motions not just in real time but at the spatial locations where they happen, is a bigger challenge.

It is precisely this advance that has been made by a team of researchers at the Tata Institute of Fundamental Research, Mumbai, York University and the Rutherford Appleton Laboratories, UK [1]. They exploded a solid surface with an ultrahigh intensity (10^19 W/sq.cm), 25 femtosecond laser pulse (pump) creating a hot, dense plasma and monitored its ultra-rapid motion by reflecting a weak second femtosecond pulse (probe). The Doppler shifts in the wavelength imposed on the reflected probe pulse by the fast evolving plasma give away the outward (blue shift) and inward (red shift) motions of the plasma.

No previous study captured the motion on the entire plasma surface -- the 'dance floor' -- in a single experiment. This team coupled femtosecond time resolution with micrometre space resolution, thereby capturing the ultra-rapid twists and turns of the plasma at different transverse locations.

The experiments devised a novel 2-D Doppler monitor with sixteen independent, single shot, high resolution spectrometers all triggered by the pump laser pulse and capturing the instantaneous velocity of the plasma at different spatial locations. They show that different portions of the plasma move in and out at different times, contrary to the usual expectation of a somewhat uniform motion. This new method can prove very useful for tracking the flow of heat and energy along the surface and watching the growth of plasma instabilities, very important for understanding laser plasma science and pushing forward applications of high intensity, femtosecond laser driven laser plasmas in imaging and laser fusion.

CAPTION

A two-dimensional Doppler spectrometer captures the motions of a high intensity, femtosecond laser induced hot, dense plasma at different locations on a solid surface.

CREDIT

K. Jana and Amit Lad

[1] Femtosecond, two-dimensional spatial Doppler mapping of ultraintense laser-solid target interaction, PHYSICAL REVIEW RESEARCH 3, 033034 (2021)

Researchers surprised to find bacterial parasites behind rise of 'super bugs'

UNIVERSITY OF PITTSBURGH

Research News

IMAGE: PROFESSOR OF MICROBIOLOGY AND MOLECULAR GENETICS, UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE. view more 

CREDIT: VAUGHN COOPER

PITTSBURGH, July 16, 2021 - For the first time ever, researchers from the University of Pittsburgh School of Medicine discovered that phages--tiny viruses that attack bacteria--are key to initiating rapid bacterial evolution leading to the emergence of treatment-resistant "superbugs." The findings were published today in Science Advances.

The researchers showed that, contrary to a dominant theory in the field of evolutionary microbiology, the process of adaptation and diversification in bacterial colonies doesn't start from a homogenous clonal population. They were shocked to discover that the cause of much of the early adaptation wasn't random point mutations. Instead, they found that phages, which we normally think of as bacterial parasites, are what gave the winning strains the evolutionary advantage early on.

"Essentially, a parasite became a weapon," said senior author Vaughn Cooper, Ph.D., professor of microbiology and molecular genetics at Pitt. "Phages endowed the victors with the means of winning. What killed off more sensitive bugs gave the advantage to others."

When it comes to bacteria, a careful observer can track evolution in the span of a few days. Because of how quickly bacteria grow, it only takes days for bacterial strains to acquire new traits or develop resistance to antimicrobial drugs.

The researchers liken the way bacterial infections present in the clinic to a movie played from the middle. Just as late-arriving moviegoers struggle to mentally reconstruct events that led to a scene unfolding in front of their eyes, physicians are forced to make treatment decisions based on a static snapshot of when a patient presents at a hospital. And just like at a movie theater, there is no way to rewind the film and check if their guess about the plot or the origin of the infection was right or wrong.

The new study shows that bacterial and phage evolution often go hand in hand, especially in the early stages of bacterial infection. This is a multilayered process in which phages and bacteria are joined in a chaotic dance, constantly interacting and co-evolving.

When the scientists tracked changes in genetic sequences of six bacterial strains in a skin wound infection in pigs, they found that jumping of phages from one bacterial host to another was rampant--even clones that didn't gain an evolutionary advantage had phages incorporated in their genomes. Most clones had more than one phage integrated in their genetic material--often there were two, three or even four phages in one bug.

"It showed us just how much phages interact with one another and with new hosts," said Cooper. "Characterizing diversity in early bacterial infections can allow us to reconstruct history and retrace complex paths of evolution to a clinical advantage. And, with growing interest in using phages to treat highly resistant infections, we are learning how to harness their potency for good."

###

Other authors of the study include Christopher Marshall, Ph.D., and Christina Lim, Ph.D., of Marquette University; and Erin Gloag, Ph.D., and Daniel Wozniak, Ph.D., of The Ohio State University.

This work was supported by National Institutes of Health grants R01AI134895, R01AI143916, U01AI124302 and R33HL137077, and the American Heart Association Career Development Award (19CDA34630005).

To read this release online or share it, visit https://www.upmc.com/media/news/071621-cooper-phages [when embargo lifts].

About the University of Pittsburgh School of Medicine

As one of the nation's leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top 10 recipients of funding from the National Institutes of Health since 1998. In rankings recently released by the National Science Foundation, Pitt ranked fifth among all American universities in total federal science and engineering research and development support.

Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region's economy. For more information about the School of Medicine, see http://www.medschool.pitt.edu.

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Study identifies monoclonal antibodies that may neutralize many norovirus variants

VANDERBILT UNIVERSITY MEDICAL CENTER

Research News

IMAGE: JAMES CROWE JR., MD, DIRECTOR OF THE VANDERBILT VACCINE CENTER view more 

CREDIT: VANDERBILT UNIVERSITY MEDICAL CENTER

Researchers at Vanderbilt University Medical Center (VUMC) and the Baylor College of Medicine in Houston, Texas, have taken a big step toward developing targeted treatments and vaccines against a family of viruses that attacks the gastrointestinal tract.

Each year in the United States circulating strains of the human norovirus are responsible for approximately 20 million cases of acute gastroenteritis. Hallmark symptoms include severe abdominal cramping, diarrhea and vomiting.

Several vaccine candidates are in clinical trials, but it is unclear how effective they will be, given the periodic emergence of novel norovirus variants. Developing broadly effective vaccines will require an understanding of the genetic diversity of the virus and the mechanisms by which the immune system can neutralize it.

Reporting this week in the journal Nature Communications, the researchers isolated a panel of human monoclonal antibodies from subjects with a history of acute gastroenteritis that are cross-reactive and which neutralize a broad range of norovirus variants in laboratory tests.

They describe a conserved, antigenic site on the norovirus that could be used to reformulate vaccine candidates so that they are broadly effective against circulating viral strains. The monoclonal antibodies also could be used to treat or prevent norovirus infection directly or as diagnostic reagents, they added.

Leading the research were the paper's corresponding authors, James Crowe Jr., MD, director of the Vanderbilt Vaccine Center, and B.V. Venkataram Prasad, PhD, the Alvin Romansky Chair in Biochemistry, in collaboration with Mary Estes, PhD, the Cullen Chair and professor of virology at Baylor College of Medicine.

First authors of the paper were Gabriela Alvarado, PhD, formerly of the Crowe lab, now at the National Institute of Allergy and Infectious Diseases, and Wilhelm Salmen, a graduate student in the Prasad lab.

"We were surprised to find naturally occurring antibodies that recognized so many different noroviruses," said Crowe, the Ann Scott Carell Chair and professor of Pediatrics and Pathology, Microbiology & Immunology at VUMC.

"Previously, many experts thought that this would not be possible because of the extreme sequence diversity in the various groups and types of noroviruses in circulation," he said. "The human immune system continues to surprise us in its capacity to recognize diverse virus variants."

"One of the fascinating aspects of this study was the unexpected finding of where the human antibody attacks the virus for neutralization," Prasad said.

"It is exciting to now have human monoclonal antibodies that neutralize many norovirus variants," added Estes.

###

Also contributing to the work were Khalil Ettayebi and Liya Hu, PhD, Baylor College of Medicine, and Banumathi Sankaran, PhD, from the Lawrence Berkeley National Laboratory in Berkeley, California.

The research was supported in part by the National Institutes of Health and the Welch Foundation of Houston, Texas.

RUDN University biologists prove the anticancer potential of macrophages

RUDN UNIVERSITY

Research News

IMAGE: RUDN UNIVERSITY BIOLOGISTS DISCOVERED THE WAY HOW MACROPHAGES (THE CELLS OF THE "FIRST LINE " IMMUNE RESPONSE) RESPOND TO INFLAMMATION AND IDENTIFIED HOW THE IMMUNE RESPONSE DEPENDS ON THEIR ORIGIN. IT... view more 

CREDIT: RUDN UNVIERSITY

RUDN University biologists discovered the way how macrophages (the cells of the "first line" immune response) respond to inflammation and identified how the immune response depends on their origin. It turned out that when exposed to an inflammatory stimulus, two opposing mechanisms are activated in macrophages simultaneously -- inducing and inhibiting inflammation. These data can potentially be useful in the treatment of cancer, as targeted activation of macrophages will strengthen the immune response of the organism in the fight against a tumor. The results were published in the journal Biomedicine & Pharmacotherapy.

Macrophages are the cells responsible for phagocytosis -- they capture bacteria, the dead cells remains and other foreign particles. This is the first line of defense of immune system. Most macrophages are formed from blood monocytes, which in turn differ in the level of two proteins on their surface: CD14 and CD16. Until now, it was not known how macrophages derived from the two most polar types of monocytes -- called CD14+monocytes and CD16+monocytes-respond to inflammation. RUDN University biologists have identified these differences.

"Surprisingly, among the published data, there is practically no information about the activation of macrophages obtained from CD14+monocytes and CD16+monocytes. There have only been several published works devoted to the pro-inflammatory polarization of human macrophages with varying monocytic origin. Most data derived from mouse models. We decided to fill this gap and discover how macrophages obtained from CD14+ and CD16+monocytes are activated", said Polina Vishnyakova, PhD, researcher at Medical Biotechnology Laboratory at RUDN University.

The receptors on the surface of macrophages react, for example, to lipopolysaccharides (LPS) -- the main component of bacterial membranes. RUDN University biologists used blood samples from six healthy women aged 26 to 34 years and isolated CD14+monocytes and CD16+monocytes from the blood using magnetic separation. Then the monocytes were "turned" into macrophages - by cultivation with special differentiation factors. Macrophages obtained from different types of monocytes were subjected to LPS and analyzed using flow cytometry, secretome, transcriptomic and proteomic analysis.

The results demonstrated that, firstly, the traditional division of macrophages into pro-inflammatory and anti-inflammatory is not quite correct -- they switch their functions depending on the surrounding conditions. RUDN University biologists also found out that macrophages derived from CD14+monocytes are more prone to a pro-inflammatory response. Flow cytometry showed that these macrophages synthesize more CD86 protein, which is responsible for the activation of T-lymphocytes -- other cells of the immune response. At the same time, secretome analysis showed that macrophages derived from CD14+monocytes secrete more pro-inflammatory and anti-inflammatory cytokine molecules.

These results can be used in the future for the treatment of oncological diseases. The fact is that pro-inflammatory macrophages are able to fight tumors. Picking the most suitable monocytes of the patient (CD14 or CD16), turning them into pro-inflammatory macrophages and transplanting them back to the tumor, one can stimulate the organism's fight against cancer cells.

"The key issue is the choice of monocyte subset for further therapeutic application of macrophages. Thus, macrophages obtained from different populations of human monocytes are potentially relevant for cell therapy in case of malignant oncological diseases", said Polina Vishnyakova, PhD, researcher at Medical Biotechnology Laboratory at RUDN University.

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New discoveries and insights into the glass transition

TOHOKU UNIVERSITY

Research News 

IMAGE: DSC TRACES OF THE LA(CE)NIAL SYSTEM, THE ARROWS INDICATE THE CALORIMETRIC GLASS-TRANSITION TEMPERATURE (TG) (LEFT). THE TEMPERATURE DEPENDENCE OF THE LOSS MODULUS OF THE LA(CE)NIAL SYSTEM NORMALIZED BY THE MAXIMUM... view more 

CREDIT: KATO LABORATORY, IMR, TOHOKU UNIVERSITY

A collaborative group from Tohoku University and Johns Hopkins University have provided valuable insights into the glass transition.

When a liquid is cooled rapidly, it gains viscosity and eventually becomes a rigid solid glass. The point at which it does so is known as the glass transition.

But the exact physics behind the glass transition, and the nature of glass in general, still pose many questions for scientists.

Metallic Glasses (MGs) are highly sought after since they combine the flexibility of plastic with the strength of steel. They are amorphous materials with a disordered atomic structure and exhibit unique and divergent thermodynamic and dynamic characteristics, especially when approaching the glass-transition temperature.

The glass transition in MGs is usually determined by calorimetric and dynamical measurements. The calorimetric glass transition detects the temperature at which specific heat has an abrupt jump, whereas dynamical transition looks at the diverse relaxation responses that emerge with increasing temperature forms.

Generally, the calorimetric glass-transition temperature follows the same trend as the dynamic α-relaxation temperature.

However, the collaborative group discovered that high configuration entropy significantly influences the glass transition of MGs and leads to the decoupling between calorimetric and dynamical glass transitions of high entropy metallic glasses.

The results of their research were published in the journal Nature Communication on June 22, 2021.

Their study presents a new glass-forming system that uses high configurational entropy, named high entropy metallic glasses (HEMGs).

The group featured Specially Appointed Professor Jing Jiang and Professor Hidemi Kato from the Institute for Materials Research at Tohoku University and Professor Mingwei Chen from Johns Hopkins University.

"We are excited about this discovery and believe this work furthers our understanding of the fundamental mechanism behind the glass transition," said members of the research group.

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Individual protected areas in Amazonia differ greatly in how effectively they help to fight deforestation and carbon emissions

UNIVERSITY OF TURKU

Research News

IMAGE: INDIVIDUAL PROTECTED AREAS SHOWED SUBSTANTIAL VARIATION IN THEIR IMPACT, I.E. ESTIMATED AMOUNT OF PREVENTED DEFORESTATION. THE AVERAGE IMPACT OVER ALL AREAS, AND ALSO WITHIN EACH PROTECTION CATEGORY, WAS POSITIVE. view more 

CREDIT: TEEMU KOSKIMÄKI ET AL.

While tropical forests remain threatened and their future is uncertain, the importance of understanding how well individual protected areas avoid deforestation increases. Researchers from the University of Turku and University of Helsinki, Finland, have investigated this question in a newly published study that focuses on the State of Acre in Brazilian Amazonia.

Tropical forests are unique environments that have huge species diversity and also act as important reservoirs of organic carbon, thereby counteracting climate change. However, their area is diminishing due to deforestation, which gives reason to worry both about the survival of their biodiversity and about the increasing carbon emissions. To help to optimise conservation efforts, it is important to understand how well conservation areas succeed in safeguarding tropical forests.

A group of researchers from the Amazon Research Team of the University of Turku and from the University of Helsinki have now compared deforestation rates between protected and environmentally similar non-protected areas in the Acre state of Amazonian Brazil.

- We found that most protected areas have been effective against deforestation and the associated carbon emissions. In total, we estimated that each year the network of protected areas in Acre helps to avoid the same amount of carbon emissions that is produced by more than 120,000 Europeans, explains the lead author of the study, Doctoral Candidate Teemu Koskimäki.

Carrying out this kind of analyses is based on massive amounts of data and requires sophisticated analytical methods. The computer software needed to do this was developed by Postdoctoral Researcher Johanna Eklund and colleagues in an earlier project.

- To quantify the effect of protection, we had to take into account many other variables to find and match protected and non-protected areas that are similar in terms of deforestation threat. For example, the closer an area is to a big city and the easier it is to reach, the more deforestation pressure it faces whether it is protected or not, explains Eklund.

CAPTION

One of the main threats to Amazonian biodiversity is beef production for export. The biomass (and therefore carbon content) of the intact forest is many times larger than the biomass of the pasture and cattle together. Therefore, forest conversion releases significant amounts of carbon dioxide into the atmosphere.

CREDIT

Hanna Tuomiston

Identifying Differences Helps to Plan Future Conservation Actions

Interestingly, the researchers discovered significant variation among the protected areas.

- Some of the protected areas were very effective, whereas others seemed to suffer from even more severe deforestation than similar non-protected forests. Recognising these differences and their causes could make the management of protected areas more efficient and help to allocate resources to areas where they are most needed, Koskimäki says.

In the case of indigenous lands, the primary objective is to safeguard space for the local traditional peoples to live in rather than to protect nature. Nevertheless, these areas were found to be at least as effective in preventing deforestation as other categories of protected area. It seems that indigenous peoples have not been called guardians of the forest without good reason.

- We are now starting a new project to assess how climate change is affecting biodiversity and the livelihoods of indigenous communities in central Amazonia. This is done in collaboration with the local people. They are worried, because the seasonal patterns of rains and river floods seem to be changing and becoming less predictable, says Professor Hanna Tuomisto.

In the future, it would be interesting to clarify what the components of a successful protected area are in order to identify and spread the good practices. The results of this new study could be used to identify potential study subjects for future on-the-ground research at the local level. Such research could also focus on other factors that contribute to conservation success than prevention of deforestation, such as how well protected areas prevent selective logging or unsustainable levels of hunting.

The research article has been published in the journal Environmental Conservation.

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