McLean hospital study examines the cost-effectiveness of esketamine

Researchers find this nasal spray for treatment-resistant depression is currently too expensive for widespread use

MCLEAN HOSPITAL

 

IMAGE: STUDY DETERMINED THAT ESKETAMINE COST MUST REDUCE IN ORDER TO BE BENEFICIAL TO PATIENTS WITH DEPRESSION view more 

CREDIT: MCLEAN HOSPITAL

Highlights: * Study estimated the cost-effectiveness of esketamine, a novel intranasally dosed antidepressant for patients with treatment-resistant depression * Researchers employed a decision-analytic model to simulate the effects of treatment with esketamine versus oral antidepressants from both societal and health care sector perspectives * Study concluded that the price of esketamine must fall by more than 40% to be cost-effective for management of treatment-resistant depression in the United States

A paper authored by researchers from McLean Hospital has determined that esketamine, a nasal spray to treat severe depression, is currently too expensive for widespread use. Titled "Cost-Effectiveness of Esketamine Nasal Spray for Patients With Treatment-Resistant Depression in the United States," the paper was published on July 7 in Psychiatric Services.

The study compared the costs and benefits of esketamine, an antidepressant approved by the U.S. Food and Drug Administration (FDA) last year for use in treatment-resistant major depressive disorder. Unlike ketamine, a drug delivered intravenously to treat severe depression, esketamine is a nasal spray.

Lead author Eric L. Ross, MD, reported that "most medications don't work as well for people with treatment-resistant depression." However, he said, "Esketamine has been effective in a population where many other treatments haven't worked."

Ross said, "I want people to use esketamine, but it's important that it be cost-effective. I don't want it to put a real strain on our mental health care system."

To estimate the cost-effectiveness of the drug, Ross and his colleagues used a "decision-analytic model" to simulate the effects of treatment with esketamine versus oral antidepressants over five years. The model looked at both societal and health care sector perspectives of using the drug.

Ross explained that the study built on previous investigations of esketamine but added information about cost. Also, he said, the model accounted for issues such as "How much does it cost to have uncontrolled depression?" and "How much does it impact your quality of life?"

The simulations found that, over five years, esketamine was projected to improve quality of life by increasing time in remission for patients. Societal costs and health care sector costs, however, were projected to go up substantially. The authors estimated a greater than 95% likelihood that intranasal esketamine would not be cost-effective in the United States, according to commonly applied standards. Also, they concluded that the price of esketamine must fall by more than 40% from its current price of approximately $240 per dose to be cost-effective for the management of treatment-resistant depression in the U.S.

"Esketamine is too expensive, but it does work," Ross asserted. "The question now is 'How do we get the price down?'"

Ross said that he hopes the paper will encourage policymakers, insurers, and health care leaders to work to reduce the price of esketamine and make it more available to those in need. "At the end of the day, it's not about saving money," he said. "The goal is to make sure we're getting the most clinical benefit we can for the money we spend."

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FUNDING: This study was supported by Research Training and Career Development grant R25-MH-094612 from the National Institute of Mental Health to Dr. Ross. The National Institute of Mental Health did not participate in the design of the study, the analysis and interpretation of the data, or the preparation and submission of the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

ABOUT McLEAN HOSPITAL: McLean Hospital has a continuous commitment to put people first in patient care, innovation and discovery, and shared knowledge related to mental health. In 2017 and 2018, it was named the #1 hospital for psychiatric care in the United States by U.S. News & World Report. McLean Hospital is the largest psychiatric affiliate of Harvard Medical School and a member of Mass General Brigham. For more information, please visit https://www.mcleanhospital.org/ or follow us on Facebook or Twitter.

Mental health units in correctional facilities: Scarce data but promising outcomes

WOLTERS KLUWER HEALTH

 

July 13, 2020 - Specialized mental health units (MHUs) may be critical to managing the high rates of serious mental illness in incarcerated populations. But research data on unit characteristics, services provided, and outcomes achieved by MHUs in correctional facilities are scarce, according to a report in the July/August issue of Harvard Review of Psychiatry. The journal is published in the Lippincott portfolio by Wolters Kluwer.

With the scarcity of formal, peer-reviewed studies, Clinical Psychology PhD student Talia Cohen, Rakesh Karmacharya, MD, PhD, and colleagues of McLean Hospital, Belmont, Mass., took a different approach to gathering further information on MHUs in US correctional facilities: they Googled it. "Our gathering and collating the published and publicly available information on these 317 units will help bridge the gap in the literature on MHUs and help facilitate the development of additional MHUs," the researchers write.

Google Search Yields Valuable Data on MHUs in Correctional Facilities

Estimates suggest that 20 percent of inmates in jails and 15 percent of inmates in state prisons may have serious mental illness. Many patients, especially those with psychotic disorders, first receive psychiatric treatment after being incarcerated.

"The incarceration of mentally ill patients, who are often imprisoned due to issues related to untreated mental illness, is a major public health issue," the authors write. They set out to perform the first comprehensive compilation and description of MHUs in US correctional facilities.

But a preliminary review of health and criminal justice databases found "scant data": just 11 peer-reviewed articles were identified. To bridge the gap, Ms. Cohen, Dr. Karmacharya and colleagues performed a methodical, in-depth Google search of publicly available sources, including government websites, newspaper articles, and legal reports that led to the identification of 317 MHUs across the United States.

Although the available data varied, the authors analyzed the characteristics of the identified US MHUs:

• About 80 percent of units were located in prisons, rather than jails or other settings. About three-fourths served male inmates only.
• About half of units offered groups or programs to inmates, one-third provided individual therapy, and less than one-fourth provided both group and individual services.
• Just over half of MHUs had dedicated mental health staff, while about one-fourth provided mental health training to correctional officers.
• Some units were developed in partnership with other government agencies, nonprofit organizations, or universities. Funding for MHUs came from a variety of sources, most often state budgets or legislation.
• Information on the outcomes of mental health care was available for 38 MHUs, most of which reported reductions in violence and injuries. "The reports from these units show promising results for the benefits of implementing MHUs but also demonstrate the urgent need to conduct implementation and effectiveness trials for them," the researchers write.

Based on their experience, the authors make recommendations for creating a successful therapeutic environment at MHUs. They believe that units should be small, serving no more than 40 inmates. For the MHUs identified in the review, average unit size was 73 beds.

Units should offer groups and programming plus individual therapy, should have a trained and dedicated clinical staff, and should provide mental health training to correctional officers, the researchers believe. Only 12 (3.8%)of the MHUs identified in the review met all of these criteria.

While acknowledging the limitations of the evidence in their wide-ranging review, including the use of largely non-peer-reviewed sources, the researchers hope the findings will provide useful descriptive information on MHUs in the United States. The authors conclude: "Future research should collect systematized data from correctional facilities with MHUs in order to get a more comprehensive picture of the programs and to evaluate the effectiveness and feasibility of these treatment units."

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Click here to read "Mental Health Units in Correctional Facilities in the United States."
DOI: 10.1097/HRP.0000000000000267

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About the Harvard Review of Psychiatry

The Harvard Review of Psychiatry is the authoritative source for scholarly reviews and perspectives on a diverse range of important topics in psychiatry. Founded by the Harvard Medical School Department of Psychiatry, the journal is peer reviewed and not industry sponsored. It is the property of Harvard University and is affiliated with all of the Departments of Psychiatry at the Harvard teaching hospitals. Articles encompass major issues in contemporary psychiatry, including neuroscience, epidemiology, psychopharmacology, psychotherapy, history of psychiatry, and ethics.

About Wolters Kluwer

Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.

Wolters Kluwer reported 2019 annual revenues of €4.6 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students with advanced clinical decision support, learning and research and clinical intelligence. For more information about our solutions, visit http://healthclarity.wolterskluwer.com and follow us on LinkedIn and Twitter @WKHealth.

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Autoclaving, alcohol not the best options for disinfecting, reusing face masks

UC aerosol expert says efficiency of face masks and respirators drop with sterilization treatment for reuse

UNIVERSITY OF CINCINNATI

 

IMAGE: SERGEY GRINSHPUN, PHD, SHOWN IN THE UC COLLEGE OF MEDICINE. view more 

CREDIT: COLLEEN KELLEY/UNIVERSITY OF CINCINNATI CREATIVE + BRAND

A University of Cincinnati researcher is advising against using two widely available sterilization methods to clean disposable surgical masks and N95 respirators for reuse in the midst of the coronavirus pandemic.

Scarcity of personal protection equipment in medical settings has led many health systems to consider sterilizing and reusing masks developed initially as disposable items, says Sergey Grinshpun, PhD, director of the University of Cincinnati Center for Health-Related Aerosol Studies and professor in the UC Department of Environmental and Public Health Sciences.

The Centers for Disease Control and Prevention (CDC) has allowed reuse of N95 facepiece respirators as a crisis capacity strategy.

Grinshpun tested two brands of N95 respirators along with two types of surgical masks -- one with high filtration and one with low-filtration abilities -- using an autoclave, an apparatus that works similar to a pressure cooker to sterilize items by using steam, heat and pressure during a specific time frame.

"The question for us was, what will happen with the performance of these N95 respirators and the surgical masks after they have spent minutes or longer in the autoclave and to what extent will the heat or steam destroy the structure of the filter making the items less useful," says Grinshpun.

Grinshpun also used another decontamination method which employed soaking the respirators and surgical masks in a 70% ethanol treatment for two hours and then drying the devices before their reuse. Alcohol is readily available in hospital settings and utilized for instrument sterilization.

Tests were conducted with disinfection treatments applied up to five times to simulate reusage that might occur in a healthcare setting.

"It almost didn't matter how often we decontaminated the protective devices-- once, twice or five times -- since the major damage inflicted on the performance characteristics of the items followed the first test," explains Grinshpun. "You are going to lose in performance if these masks or respirators are sterilized using either of these treatments. Of course, quantitatively, the effect differs for different devices."

The findings of the study are available online in the Journal of Hospital Infection. Co-authors of the study include Michael Yermakov, MD, senior research associate in the UC Department of Environmental and Public Health Sciences, and Marat Khodoun, PhD, research associate professor in the UC Department of Internal Medicine.

The study found that neither sterilization in an autoclave nor alcohol treatment caused visible damages to the surgical masks. The 3M 8210 N95 respirator revealed physical damages after implementing a single autoclave disinfection such as partial disintegration of the soft sealing material around the nose clip, and, importantly, loss of strap elasticity, which made this respiratory protective device not reusable.

Meanwhile, testing of the remaining 3M 1870 N95 respirator produced notable, but moderate damage and some detachment along with a minor deformation of the nose foam after a single and multiple autoclaving.

Experimental design of the study included testing each protective device by mounting it on a frame designed to utilize the entire effective filtration area. An air flow rate through the system was chosen to mimic breathing of a health care worker under a moderate and a strenuous workload. To simulate contamination of the test protective devices the items were soiled with protein.

"When multiple sterilizations were applied, facepieces were soiled before each autoclave treatment to mimic the device usage in air environments contaminated with protein that may be associated with emission of pathogenic virions by infected persons," according to the study. Researchers chose to perform five soil and sterilization cycles to simulate a daily reuse of the filtering facepiece over a period of five days.

Grinshpun also says that N95 respirators and some surgical masks rely on fibers that have an electrostatic charge which allows them to capture small particles and protect the wearer. Autoclaving and alcohol treatment weaken this electrostatic charge.

"What happens when you subject something to alcohol, heat or steam?" asks Grinshpun. "These fibers will lose, maybe not entirely, but at least some of their electric charge. This has a detrimental effect on the filter performance so that these protective devices may not be able to capture aerosol participles, including coronaviruses, as efficiently anymore."

For some N95 respirators their collection efficiency can drop below their certification level of 95% for the most penetrating particle sizes, says Grinshpun.

He adds that performance of surgical masks changes as a result of autoclaving, whether the mask is soiled or not, with the effect being more pronounced for devices which had poor initial filtration capabilities.

He says instead of using autoclaving or ethanol alcohol to disinfect face masks and N95 respirator facepieces, alternative options such as ultraviolet light may be explored. Grinshpun's study did not look at UV primarily because the investigators intended first to examine methods that are readily available in hospitals.

"We anticipated that UV-based and probably other techniques may be almost as efficient as autoclaving and ethanol treatment in inactivating pathogens but at the same time would not damage the fibers of protective detectives so that the particle collection efficiency will not suffer," says Grinshpun. "Similar studies can and should be conducted with alternative decontamination methods."

"The question of how the disinfection treatments impact the performance and integrity of respiratory protective devices remains important for as long as healthcare workers have to reuse these devices due to their shortage of personal protective equipment," says Grinshpun.

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WHY THE COOPERATIVE COMMONWEALTH IS THE IDEAL

Study shows humans are optimists for most of life

MICHIGAN STATE UNIVERSITY

 

Is middle age really the "golden age" when people are the most optimistic in life? Researchers from Michigan State University led the largest study of its kind to determine how optimistic people are in life and when, as well as how major life events affect how optimistic they are about the future.

"We found that optimism continued to increase throughout young adulthood, seemed to steadily plateau and then decline into older adulthood," said William Chopik, MSU assistant professor of psychology at MSU and lead author. "Even people with fairly bad circumstances, who have had tough things happen in their lives, look to their futures and life ahead and felt optimistic."

The study, published in the Journal of Research in Personality, surveyed 75,000 American, German and Dutch people between the ages of 16 and 101 to measure optimism and their outlook about the future. Chopik said the researchers looked at life events such as: marriage, divorce, a new job, retirement, changes in health and loss of a partner, a parent or a child.

"Counterintuitively -- and most surprising -- we found that really hard things like deaths and divorce really didn't change a person's outlook to the future," Chopik said. "This shows that a lot of people likely subscribe to the 'life is short' mantra and realize they should focus on things that make them happy and maintain emotional balance."

Chopik explained that regardless of life's good and bad circumstances, from the time people are 15 to almost 60 or 70, they become more and more optimistic.

"There's a massive stretch of life during which you keep consistently looking forward to things and the future," Chopik said. "Part of that has to do with experiencing success both in work and life. You find a job, you meet your significant other, you achieve your goals and so on. You become more autonomous and you are somewhat in control of your future; so, you tend to expect things to turn out well."

As people age into the elderly phase of life, the study showed a shift to declines in optimism, likely driven by health-related concerns and knowing that the bulk of life is behind you. While the elderly aren't full-fledge pessimists, Chopik said, there is still a noticeable change.

"Retirement age is when people can stop working, have time to travel and to pursue their hobbies," Chopik said. "But very surprisingly, people didn't really think that it would change the outlook of their lives for the better."

Chopik said one of the most profound conclusions in the study was showing how resilient people are in life.

"We oftentimes think that the really sad or tragic things that happen in life completely alter us as people, but that's not really the case," Chopik said. "You don't fundamentally change as a result of terrible things; people diagnosed with an illness or those who go through another crisis still felt positive about the future and what life had ahead for them on the other side."

https://www.sciencedirect.com/science/article/abs/pii/S0092656620300738

Scientists evaluated the perspectives of zinc intake for COVID-19 prevention

SECHENOV UNIVERSITY

Researchers from Sechenov University in collaboration with colleagues from Germany, Greece and Russia reviewed scientific articles on the role of zinc in the prevention and treatment of viral infections and pneumonia, with projections on those caused by SARS-CoV-2. The results were published in the International Journal of Molecular Medicine.

Zinc is necessary for normal metabolism and functioning of the reproductive, cardiovascular and nervous systems, but it is also important for the immune system, in particular for the proliferation and maturation of white blood cells (some of them are able to capture and digest microorganisms, and others - to produce antibodies). In addition, zinc is involved in the regulation of inflammation. Thus, normal levels of zinc support human resistance to inflammatory and infectious diseases.

'According to the current estimates, the risk of zinc deficiency is observed in more than 1.5 billion people in the world. In Russia, deficiency of this element occurs in 20-40% of the population; in some regions it reaches 60%. Given the crucial role of zinc in regulation of immunity, one can propose that its insufficiency may be considered as a risk factor for infectious diseases,' said the research leader, head of the Laboratory of Molecular Dietetics at Sechenov University, Professor Anatoly Skalny.

The scientists reviewed the results of studies on the use of zinc-containing drugs for increasing immunity and preventing viral infections, including SARS-CoV-2 that caused COVID-19 outbreak this year. Previous studies showed that zinc and its binding substances can slow down the work of RNA polymerase (an enzyme that synthesises viral RNA molecules) of coronaviruses and suppress their spread in the body. One of the substances that stimulate the cellular zinc uptake, chloroquine, has already been tested on patients with SARS-CoV-2, but its strong side effects make it necessary to look for other compounds with a similar effect or use zinc separately. However, both options have not been sufficiently studied or tested yet.

Observations of the development of other viruses, such as rhinoviruses (this family includes pathogens of acute respiratory diseases), show that an increase in the level of zinc in cells suppresses replication (reproduction) of the virus and stimulates production of interferon alpha, which has an antiviral activity.

In addition, zinc deficiency is considered as one of the risk factors for the development of pneumonia: it increases the susceptibility to infectious agents and the disease duration. Several studies show the effectiveness of zinc-containing drugs in decreasing severity and duration of symptoms and reducing the prevalence of pneumonia. However, in general, data on the use of zinc as a therapy, rather than prevention, are contradictory.

Another possible application of zinc is modulation of inflammation. Existing data show that zinc ions have an anti-inflammatory effect, reducing damage to lung tissue in pneumonia. Zinc also helps the body resist bacteria, and bacterial pneumonia frequently occurs in patients with secondary viral infections.

'A recent study conducted by scientists from the USA confirmed our assumptions, demonstrating the effect of zinc intake on the risk of a severe course and the need for artificial ventilation in patients with COVID-19,' said Alexey Tinkov, coauthor of the article, a leading researcher at the Laboratory of Molecular Dietetics at Sechenov University.

Therefore, according to current research, adequate zinc status can bring down the likelihood of infectious respiratory diseases, pneumonia and its complications. There are also indirect indications that zinc intake may be effective in the fight against coronavirus disease (COVID-19), but there is still insufficient data for recommendations.

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Study finds weight loss surgery cost disparity

As bariatric surgeries grow, low-income patients are paying more

UNIVERSITY OF GEORGIA

 

A new study from the University of Georgia finds that users of public insurance are paying more for bariatric weight loss surgery compared to private insurance patients.

The study, which published recently in Clinical Obesity, is the first to break down surgeries by insurance payer type - public versus private insurance - to better understand the economic burden on patients and U.S. health care system overall.

"Bariatric surgery is becoming more common, but there's increasing evidence that bariatric surgery is not happening consistently across all payer types, and there might be cost differences by payer type," said lead study author Janani Thapa, an assistant professor of health policy and management in UGA's College of Public Health.

These differences could point to inequities in health care access that make it more difficult for patients who have Medicaid or Medicare to qualify or pay for bariatric surgery when they need it.

Obesity rates are highest among low-income Americans; this also tends to be a group with less access to obesity treatment options, including bariatric surgery.

"The hoops that they have to jump through may be more [than others] to access the surgery," said Thapa, "and that was our motivation to look into this."

The team analyzed a national dataset of hospitalized patients from 2011 to 2014, looking for trends in bariatric surgery use, costs across insurance types and other demographic factors.

They found obesity diagnoses and surgeries grew among all patients over that time. This could explain why they also found that average national costs associated with bariatric surgery increased, said Thapa.

But they also found that while on average individual patients are paying less for the surgery, the overall cost burden was highest for publicly insured patients. The average cost per surgery was highest among Medicare patients.

Thapa says they can't say why that is, but "as soon as we talk about public insurance, it is taxpayer money that is paying for the surgery," she said.

The next step, the authors said, is to investigate the long-term health outcomes and medical costs of the weight loss surgery.

Despite the study's focus on one clinical intervention, Thapa and her co-authors still advocate for prevention as the best way to reduce the burden of obesity on individuals and the system.

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The study, "Inpatient Obesity Diagnosis, Use of Surgical Treatment and Associated Costs by Payer Type in the United States: Analysis of the National," published in July.

College of Public Health co-authors include Donglan "Stacy" Zhang, Justin Ingles, Kiran Thapa and Zhuo "Adam" Chen, and Sae R. Chung with UGA's College of Family and Consumer Sciences.

Partnerships with health systems can provide support to nursing homes during pandemic

Regenstrief, IU experts call for enhanced collaboration in Journal of the American Geriatrics Society editorial

REGENSTRIEF INSTITUTE

 

IMAGE: REGENSTRIEF INSTITUTE RESEARCH SCIENTISTS KATHLEEN UNROE, M.D., MHA AND JOSHUA VEST, PHD, MPH ARE THE AUTHORS OF A JOURNAL OF THE AMERICAN GERIATRICS SOCIETY EDITORIAL, "TIME TO LEVERAGE HEALTH SYSTEM... view more 

CREDIT: REGENSTRIEF INSTITUTE

Nursing homes are facing extreme challenges in the midst of the COVID-19 pandemic. Two Regenstrief Institute and Indiana University -- including IUPUI -- faculty members lay out their case that meaningful partnerships between acute care hospitals and nursing facilities can support better quality of care for people who live in the facilities.

Regenstrief research scientist and Indiana University School of Medicine Associate Professor of Medicine, Kathleen T. Unroe, M.D., MHA, and Regenstrief research scientist and Professor at IU Richard M. Fairbanks School of Public Health at IUPUI, Joshua Vest, PhD, MPH, wrote an editorial published in the Journal of the American Geriatrics Society. In it, they stated the benefits of collaboration between health systems and nursing facilities.

The authors highlighted how health systems can support nursing home staffing, which is critical to delivering quality care and a constant challenge, even in normal situations. COVID-19 has exacerbated the challenges of maintaining staffing and, in some instances, created an additional need.

They also discussed how collaboration can facilitate the necessary virus testing within nursing homes and highlighted policy and economic drivers for better cooperation.

"Closer relationships can help reduce hospital readmissions and improve safety of transitions of care, which can have a detrimental impact on people living in long-term care facilities," said Dr. Unroe. "Health systems who have invested resources in developing relationships with nursing facilities are better able to ramp up and provide critical support during a crisis." Dr. Unroe led a Centers for Medicare and Medicaid demonstration project that successfully lowered the rate of avoidable hospitalizations in Indiana nursing homes.

"The pandemic is an opportunity to build on existing relationships between health systems and nursing facilities, as well as forge new ones," said Dr. Vest. "Access to testing, data sharing and leveraging of resources are all important to improve care during the COVID-19 crisis, and closer partnerships will provide facilitation and ultimately improve care for a population that is especially vulnerable during this time." Dr. Vest leads the Fairbanks School of Public Health's Center for Health policy, which conducts research and evaluates health system performance. His research focuses on technologies that enable the sharing of data between organizations.

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The editorial, "Time to Leverage Health System Collaborations: Supporting Nursing Facilities Through the COVID-19 Pandemic," was written in response to a paper published by a research team from the University of Washington. Drs. Unroe and Vest praise the work, which leveraged an existing university health system infrastructure to provide solutions and support to nursing homes during the outbreak. They believe the University of Washington's model demonstrates what is possible when investments are made in partnerships.

About Kathleen T. Unroe, M.D., MHA

In addition to being a research scientist at Regenstrief Institute, Kathleen Unroe, M.D., MHA, is an associate professor at Indiana University School of Medicine and a geriatrician practicing in the nursing home setting.

About Joshua R. Vest, PhD, MPH

In addition to being a research scientist with Regenstrief Institute, Joshua R. Vest, PhD, MPH, is the director of the Center for Health Policy and a professor of health policy and management at the IU Richard M. Fairbanks School of Public Health at IUPUI.

About Regenstrief Institute

Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.

Regenstrief Institute is celebrating 50 years of healthcare innovation. Sam Regenstrief, a successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute's research mission.

About IU Richard M. Fairbanks School of Public Health at IUPUI

Located on Indiana's premier research and health sciences campus, the IU Richard M. Fairbanks School of Public Health at IUPUI is committed to advancing the public's health and well-being through education, innovation and leadership. The Fairbanks School of Public Health is known for its expertise in biostatistics, epidemiology, cancer research, community health, environmental public health, health policy and health administration.

About IU School of Medicine

IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.

P3

University Research and the private sector

How a jelly ingredient factors in

UNIVERSITY OF ILLINOIS COLLEGE OF AGRICULTURAL, CONSUMER AND ENVIRONMENTAL SCIENCES

IMAGE: AN EXPERIMENT DEMONSTRATING THE SAFETY OF FOOD ADDITIVE PECTIN IN SPECIALTY INFANT FORMULAS EXEMPLIFIES HOW PUBLIC-PRIVATE PARTNERSHIPS CAN BENEFIT BOTH UNIVERSITY SCIENTISTS AND INDUSTRY. PICTURED ARE UNIVERSITY OF ILLINOIS PROFESSOR... view more 

CREDIT: LAUREN D. QUINN, UNIVERSITY OF ILLINOIS

URBANA, Ill. - Food additives get a bad rap, but a natural ingredient from orange peels and apple skins, pectin, is a thickener safely added to many food products, most notably jellies. The additive is also the subject of a University of Illinois experiment highlighting both the power and the challenges of public-private partnerships in university research.

The experiment, recently published in Regulatory Toxicology and Pharmacology, was pretty simple. It showed neonatal pigs tolerated milk replacer with pectin included at 0.2%. The research was done at the request of and with funding from formula manufacturer Mead Johnson Nutrition (now a division of RB), who hoped to prove the safety of the natural food additive for infants against a backdrop of new European standards.

Translating basic science into actionable industry and practitioner insights is part of the DNA of the College of Agricultural, Consumer and Environmental Sciences (ACES) at Illinois. From the college's perspective, public-private partnerships help industry and the public by providing unbiased, transparent science to back up or refute industry claims and practices. These partnerships also give ACES students opportunities to work within the industry landscape before entering the workforce.

"What's beautiful about these public-private partnerships is their ability to more quickly create what's needed on the front lines of agriculture and other industries," says ACES Dean Kim Kidwell. "When industry is talking directly to our talented scientists and students, innovation is inevitable."

Ryan Dilger, study co-author and associate professor in the Department of Animal Sciences at Illinois acknowledges there can be a negative public perception about university scientists working with private companies. "It's tricky, but for us, it's always science first."

In 2015, Mead Johnson approached Dilger with a proposal that would fund construction of a new research center to study infant brain and gut development using the neonatal pig as a preclinical model. Within the scientific community, piglets are accepted as a more informative proxy for human infants than mice and rats. That's because, to a much greater degree than rodents, piglet digestive systems, behavioral responses, and brain development mirror those of human babies.

Dilger worked with neonatal piglets prior to 2015, but he knew having a dedicated building to conduct the research was a major boon with benefits that would go far beyond Mead Johnson's investment.

"We work with other partners using that same infrastructure. Every company we work with makes investments in the tools we need to do cutting-edge research, which then everybody gets access to," Dilger says. "We don't like exclusivity. Public-private investments build up our capacity as university scientists to be steadfast in an ever-changing world."

The partnership with Mead Johnson also led Stephen Fleming, a former doctoral student working with Dilger and co-author on the pectin study, to identify hurdles facing private companies who want to work with university scientists. To address the issue, Fleming and Dilger launched a startup company to help companies traverse the intricacies of the university research landscape. They call it Traverse Science.

"There was no service we knew of, especially in the biological sciences, connecting students and faculty with commercial presences who need help or expertise to perform and publish basic research. Traverse Science does that in the context of food and nutrition," Fleming says.

He points to a growing industry trend to downsize in-house research and development capacity, relying instead on university researchers or contract research organizations. Traverse Science, part of the EnterpriseWorks Incubator at the University of Illinois Research Park, connects companies with Illinois experts and offers project administration, data analysis, and publication services.

"We exist so scientists can focus on the science and business can keep moving forward," Fleming notes. "We think science should enable business, not slow it down."

Many university scientists working with industry are motivated to infuse more transparent, high-quality, peer-reviewed science into product claims, industry practice, and policy.

"Conducting practical research studies is something we want to continue to promote through ACES and Traverse. We want to hold industry to the high standards of our scientific training for the benefit of the public," Dilger says. "We'll always be scientists first."

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The article, "Dietary pectin at 0.2% in milk replacer did not inhibit growth, feed intake, or nutrient digestibility in a 3-week neonatal pig study," is published in Regulatory Toxicology and Pharmacology [DOI: 10.1016/j.yrtph.2020.104669]. Authors include Stephen Fleming, Jim Richards, Cris Bradley, Xiao Pan, Grace Li, and Ryan Di

Climate change will cause more extreme wet and dry seasons, researchers find

CLEMSON UNIVERSITY

 

The world can expect more rainfall as the climate changes, but it can also expect more water to evaporate, complicating efforts to manage reservoirs and irrigate crops in a growing world, according to a Clemson University researcher whose latest work has been published in the journal Nature Communications.

Ashok Mishra, who is the corresponding author on the new article, said that previous studies have focused mostly on how climate change will affect precipitation. But the key contribution of the new study is that it also examined the magnitude and variability of precipitation and evaporation and how much water will be available during the wettest and driest months of the year.

Researchers found that dry seasons will become drier, and wet seasons will become wetter, said Mishra, who is the Dean's Associate Professor in the Glenn Department of Civil Engineering.

Most of the Eastern United States, including all of South Carolina, has high precipitation that it is well distributed throughout the year, researchers found. The region and others like it can expect greater precipitation and evaporation in both wet and dry seasons, according to the study. The amount of water available will vary more widely than it does now, researchers found.

The greatest concern for such regions will be more flooding, Mishra said in an interview.

The regions that will be hardest hit by climate change are the ones that already get slammed with rain during wet seasons and struggle with drought during dry seasons, researchers found. They include much of India and its neighbors to the east, including Bangladesh and Myanmar, along with an inland swath of Brazil, two sections running east-west across Africa, and northern Australia, according to the study.

"The regions which already have more drought and flooding relative to other regions will further see an increase in these events," Mishra said.

As part of the study, researchers divided the world into nine land regions, or regimes. They looked at annual precipitation and how it fluctuates through the seasons for each region from 1971-2000.

Researchers then used that data to predict future water availability during each region's three wettest months and three driest months. They evaluated three scenarios based on multiple global climate models.

The best case scenario for relatively stable water availability during wet and dry seasons is that the global temperature will stabilize at 2 degrees Celsius over pre-industrial levels, according to the study.

But researchers also looked at what would happen if the temperature were to rise to 3.5 degrees Celsius or 5 degrees Celsius over pre-industrial levels by the end of the century.

The higher the temperature, the more variation in water availability, researchers found.

Mishra said that his message to the world is that water is a very important resource.

"The availability of this resource is an issue everybody is facing," he said. "We need to take precautions to optimally use how much water we have. As the climate changes and population increases, we should be preparing for the future by improving the technology to efficiently use water for crops."

Jesus M. de la Garza, chair of the Glenn Department of Civil Engineering, congratulated Mishra on publication of the research.

"Dr. Mishra and his team have taken a novel approach to examining climate change," de la Garza said. "Their work is a step toward developing sustainable solutions ensuring the world has an adequate water supply. With this new article, Dr. Mishra is helping raise Clemson University's global reputation for high-quality research."

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The title of the article is, "Climate change will affect global water availability through compounding changes in seasonal precipitation and evaporation." You can read the full article it here.

Authors are Mishra; Goutam Konapala, who received a Ph.D. while studying under Mishra and was a postdoctoral researcher at Oak Ridge National Laboratory during the study; Yoshihide Wada of the International Institute for Applied Systems Analysis in Austria; and Michael E. Mann of Pennsylvania State University.

WHITE MALE SUPREMACY

Cost prevents one in five US women from using their preferred contraception

UNIVERSITY OF TEXAS AT AUSTIN

AUSTIN, Texas-- More than one in five women at risk of an unplanned pregnancy in the U.S. would use a different method of contraception if cost were not a factor, says a new study from the Texas Policy Evaluation Project (TxPEP) published in Contraception X. Uninsured women (one in three) and publicly insured women (one in four) were more likely to prefer a different method than privately insured women (one in five), indicating the importance of insurance coverage in ensuring access to the contraceptive methods women desire. The U.S. Supreme Court recently ruled in Little Sisters of the Poor v. Pennsylvania that employers can refuse to cover birth control for religious or moral reasons. Out-of-pocket costs for contraception will rise for many U.S. women, and they will be less likely to get the birth control they want.

"Whether people are able to afford the type of birth control they want to use is a strong indicator of the quality of reproductive healthcare in the U.S.," says Dr. Kari White, principal investigator of TxPEP and Associate Professor of Social Work and Sociology at The University of Texas at Austin. "The Supreme Court's ruling, along with other recent policies that have limited publicly funded services for low-income women, will likely reverse some of the gains in access and affordability we have seen in recent years."

Affordable access to contraception in the U.S. improved over the last 7 years as a result of the Affordable Care Act (ACA) contraceptive coverage mandate, which made all Food and Drug Administration-approved contraceptive methods available for no charge to women enrolled in most private insurance plans. The Court's ruling will impact an estimated 70,500 - 126,400 women of childbearing age who will now need to pay out-of-pocket for their birth control, and some of the most effective methods, such as female sterilization, IUDs and implants, are very expensive in the U.S. Some women who lose coverage may look for a new provider at a publicly funded health center that offers low-cost contraception. These facilities, which receive federal Title X family planning funds or other federal and state funding to serve low-income women, will likely not be able to meet the demand of new patients, leaving more women with cost barriers to using the birth control method they desire.

The new TxPEP study, based on data collected after the implementation of the ACA, also showed that Black and Hispanic women and those of other races/ethnicities were less likely to be using the birth control they wanted compared with white women, reflecting the structural disadvantage women of color face in the U.S. healthcare system. "Black women can face additional barriers accessing affordable contraceptive care that is free of bias, and affording contraception may be especially challenging for recent and undocumented immigrants, many of whom are Hispanic, due to limited insurance coverage options," says Kristen Burke, a doctoral student in sociology and graduate research associate at TxPEP. "The COVID-19 pandemic has highlighted incredible racial disparities in health outcomes, including access to reproductive health services, and the Court's decision will likely exacerbate these gaps in care."

The study used data from the 2015-2017 National Survey of Family Growth, focusing on sexually active women of reproductive age in the United States who were neither pregnant nor trying to become pregnant. Previous studies by TxPEP have shown that women often prefer to use more effective methods such as the IUD, implant, and sterilization, which may not be readily available at publicly funded or private health care providers.

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