New study in JNCCN presents evidence for ‘tough conversations’ around racism in access to cancer Care

Research led by Duke University School of Medicine found that Non-Hispanic Black patients were less likely to receive guideline-appropriate treatment for ovarian cancer compared to Non-Hispanic White patients

Peer-Reviewed Publication

NATIONAL COMPREHENSIVE CANCER NETWORK

 

IMAGE: MARY KATHERINE MONTES DE OCA, MD, DUKE UNIVERSITY SCHOOL OF MEDICINE view more 

CREDIT: NCCN

PLYMOUTH MEETING, PA [November 9, 2022] — New research in the November 2022 issue of JNCCN—Journal of the National Comprehensive Cancer Network examined whether people with ovarian cancer were being treated based on very specific recommendations regarding comprehensive staging surgery and the recommended minimum cycles of systemic therapy from evidence-based, expert consensus NCCN Guidelines. The findings showed clear disparities based on patients’ race, ability to pay, and the availability of specialists/cancer centers in their area—significantly impacting treatment course, which can affect survival. Out of 6,632 patients studied, 23.8% of non-Hispanic White patients received fully guideline-concordant surgery and chemotherapy compared to only 14.2% of non-Hispanic Black patients. Racial disparities remained after adjusting for the assessed healthcare access issues, including the ability to pay for care and having access to local specialists.

“While the ability to pay and the number of hospitals and specialists in the area impacts a patient's cancer care, these do not completely explain racial disparities in ovarian cancer treatment. More work needs to be done to determine what other factors are contributing to these inequities,” said lead author Mary Katherine Montes de Oca, MD, Duke University School of Medicine.

“The reasons are complex and multifaceted,” agreed senior author Tomi F. Akinyemiju, PhD, with the Department of Population Health Sciences and the Duke Cancer Institute at Duke University School of Medicine. “For many reasons, including the legacy of structural racism, Black patients have poorer access to healthcare. This is related to employment patterns, which predict quality insurance coverage and residential patterns, and in turn, the availability and quality of healthcare resources in predominantly Black neighborhoods. As our study shows, these are significant contributors to receiving guideline-concordant care. There is also an aspect of the quality of interactions between patients and providers, which is an area of ongoing research by our group─these additional dimensions of accommodation and acceptability need to be further addressed.”

Dr. Akinyemiju continued: “As a society, we need to have tough conversations about access to quality care, and collectively come up with solutions so that having a cancer diagnosis does not become a death sentence for the most vulnerable members of our society.”

The researchers used a SEER-Medicare linked dataset to examine the treatment received by patients who had at least 12 months of continuous enrollment in Medicare fee-for-service before and after being diagnosed with ovarian cancer. The findings also reference previous studies that illustrate worse outcomes, including increased mortality, for ovarian cancer patients who did not receive guideline-concordant treatment—based on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Ovarian Cancer recommendations for surgery and chemotherapy cycles. According to their cited research, guideline-adherent treatment has been associated with substantially improved outcomes in both Black and White patients, but some racial disparities in survival still remain, possibly due to later diagnosis or higher comorbidity burden.

“We know that the best outcomes for ovarian cancer are achieved when affected patients are treated according to NCCN Guidelines,” commented Ronald D. Alvarez, MD, MBA, Professor, Chairman, and Clinical Service Chief, Vanderbilt-Ingram Cancer Center, who was not involved in this research. “This study demonstrated, similar to many other studies, that non-Hispanic Black ovarian cancer patients were less likely than non-Hispanic White ovarian cancer patients to receive NCCN Guidelines-based care. This study specifically pointed out that non-Hispanic Black patients were less likely to undergo guideline-based surgery or initiate/complete chemotherapy and that this was predominantly related to lower affordability and availability of quality ovarian cancer services.”

Dr. Alvarez—who serves as Vice-Chair for the NCCN Guidelines® Panel for Ovarian Cancer—continued: “Improving the affordability and availability of such services should help improve adherence to guidelines and improve ovarian cancer outcomes in non-Hispanic Black patients. Interestingly, this study suggests that outcomes for this population would still fall short of those achieved for non-Hispanic White patients, even if affordability and availability issues were overcome.”

To read the entire study, visit JNCCN.org. Complimentary access to “Healthcare Access Dimensions and Guideline-Concordant Ovarian Cancer Treatment: SEER-Medicare Analysis of the ORCHiD Study” is available until February 10, 2023.

# # #

About JNCCN—Journal of the National Comprehensive Cancer Network

More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about innovation in translational medicine, and scientific studies related to oncology health services research, including quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit NCCN.org/jnccn/subscribe. Follow JNCCN on Twitter @JNCCN.

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, equitable, and accessible cancer care so all patients can live better lives. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) provide transparent, evidence-based, expert consensus recommendations for cancer treatment, prevention, and supportive services; they are the recognized standard for clinical direction and policy in cancer management and the most thorough and frequently-updated clinical practice guidelines available in any area of medicine. The NCCN Guidelines for Patients® provide expert cancer treatment information to inform and empower patients and caregivers, through support from the NCCN Foundation®. NCCN also advances continuing education, global initiatives, policy, and research collaboration and publication in oncology. Visit NCCN.org for more information and follow NCCN on Facebook @NCCNorg, Instagram @NCCNorg, and Twitter @NCCN.

Tomi F. Akinyemiju, PhD, with the Department of Population Health Sciences and the Duke Cancer Institute at Duke University School of Medicine

JNCCN Cover, November 2022

CREDIT

NCCN

JOURNAL

Journal of the National Comprehensive Cancer Network

DOI

10.6004/jnccn.2022.7055 

ARTICLE TITLE

Healthcare Access Dimensions and Guideline-Concordant Ovarian Cancer Treatment: SEER-Medicare Analysis of the ORCHiD Study

ARTICLE PUBLICATION DATE

9-Nov-2022

COI STATEMENT

Dr. Wilson has disclosed receiving grant/research support from AstraZeneca. Dr. Previs has disclosed serving on an advisory board for Myriad Genetics and Natera. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation analysis, results, or discussion of this article.

How has Medicaid expansion impacted health disparities nationwide?

Grant and Award Announcement

UNIVERSITY OF OKLAHOMA

 

IMAGE: A STUDY LED BY J. TOM MUELLER, PH.D., RESEARCH ASSISTANT PROFESSOR IN THE DEPARTMENT OF GEOGRAPHY AND ENVIRONMENTAL SUSTAINABILITY IN THE COLLEGE OF ATMOSPHERIC AND GEOGRAPHIC SCIENCES, AND THE DEPARTMENT OF SOCIOLOGY IN THE DODGE FAMILY COLLEGE OF ARTS AND SCIENCES, WILL EXAMINE THE IMPACT OF MEDICAID EXPANSION ACROSS THE UNITED STATES TO DETERMINE WHETHER REDUCED MORTALITY RATES BEAR OUT ACROSS RURAL AND URBAN COMMUNITIES AS WELL AS ACROSS ETHNIC OR RACIAL GROUPS. view more 

CREDIT: IMAGE PROVIDED BY THE UNIVERSITY OF OKLAHOMA

A study led by J. Tom Mueller, Ph.D., a research assistant professor at the University of Oklahoma, will examine the impact of Medicaid expansion across the United States to determine whether reduced mortality rates bear out across rural and urban communities as well as across ethnic or racial groups.

An estimated 82.8 million Americans currently receive health coverage through Medicaid. Jointly funded by states and the federal government, Medicaid provides health coverage to eligible low-income adults, children, pregnant women, elderly adults and people with disabilities.

The passage of the Affordable Care Act, signed into law in 2010, called for the expansion of Medicaid nationwide. After a Supreme Court ruling in 2012 determined that the decision to expand Medicaid benefits would be left to the states, participation in the expanded Medicaid program has grown slowly from 26 states participating in 2014 to 38 states and the District of Columbia participating by 2022.

Through the ACA, states participating in the Medicaid expansion program have the option to expand Medicaid coverage to adults with household incomes up to 138% of the federal poverty level.

Research has shown that from 2014-2018, mortality rates were reduced 3.6% more in states that expanded Medicaid than in states that did not. However, the impact of Medicaid expansion on health disparities remained underexamined.

“Medicaid expansion basically means that people at different income thresholds are eligible for Medicaid, which opens up a whole suite of health care options to people who otherwise wouldn't have been able to afford it,” Mueller said. “We have evidence that Medicaid expansion has reduced poverty and we have evidence that it has impacted health, but we don’t really have this kind of understanding on how it has related to disparities.”

“This project is looking at the impact of Medicaid expansion on disparities in mortality between rural and urban areas, and also then between different ethnic and racial populations within those areas, with the idea being that Medicaid expansion should have reduced mortality disparities,” he added. “Since poverty is such a dramatic social determinant of health, poverty reduction should be working as a mechanism for disparity reduction.”

The researchers will use data sets for the entire United States dating from before the ACA Medicaid expansion, 2008 through 2019, to reduce variables influenced by the COVID-19 pandemic. They plan to report their findings at the county level.

Mueller said in addition to insights on how Medicaid expansion may have impacted health disparities, “(the data) could also tell us information about the possible impacts of more broad scale universal health care options in the United States.”

Mueller, who holds faculty positions in the Department of Geography and Environmental Sustainability in the College of Atmospheric and Geographic Sciences, and the Department of Sociology in the Dodge Family College of Arts and Sciences, is working with collaborators at the University of Pennsylvania, McGill University and U.S. Census Bureau, as well as a board of consultants. The five-year project, “The Effect of Medicaid Expansion on Mortality Disparities and Poverty,” is funded by an estimated $1.5 million grant from the National Center on Minority Health and Health Disparities of the National Institutes of Health. Mueller is also a research fellow with OU’s Institute for Resilient Environmental and Energy Systems.

 

About the University of Oklahoma Office of the Vice President for Research and Partnerships 

The University of Oklahoma is a leading research university classified by the Carnegie Foundation in the highest tier of research universities in the nation. Faculty, staff and students at OU are tackling global challenges and accelerating the delivery of practical solutions that impact society in direct and tangible ways through research and creative activities. OU researchers expand foundational knowledge while moving beyond traditional academic boundaries, collaborating across disciplines and globally with other research institutions as well as decision makers and practitioners from industry, government and civil society to create and apply solutions for a better world. Find out more at ou.edu/research.

About the University of Oklahoma

Founded in 1890, the University of Oklahoma is a public research university located in Norman, Oklahoma. OU serves the educational, cultural, economic and health care needs of the state, region and nation. For more information visit www.ou.edu

Global COVID-19 infection rates may be higher than previously reported

Study suggests two-thirds of the global population may have antibodies from vaccination or infection

Peer-Reviewed Publication

PLOS

 

IMAGE: A PHLEBOTOMIST COLLECTS BLOOD IN THE HAY FIELD IN THE SELENGE AIMAG (PROVINCE) IN MONGOLIA FOR THE THIRD ROUND OF THE SARS-COV-2 POPULATION-BASED SEROEPIDEMIOLOGIC INVESTIGATION IN MAY 2021. view more 

CREDIT: MONGOLIAN SARS-COV-2 POPULATION-BASED SEROEPIDEMIOLOGICAL INVESTIGATION PROJECT TEAM (CC BY 4.0, HTTPS://CREATIVECOMMONS.ORG/LICENSES/BY/4.0/)

Serosurveillance provides estimates of antibody levels against infectious diseases and is considered the gold standard for measuring population immunity due to past infection or vaccination. A study publishing November 10th in the open access journal PLOS Medicine jointly authored by the World Health Organization’s (WHO) Unity Studies and SeroTracker and colleagues suggests that based on seroprevalence, global COVID-19 infection rates are likely to be higher than previously reported.

The global scale of COVID-19 infections is not well understood. Routine surveillance data underestimates infection and cannot infer population immunity due to asymptomatic infections and uneven access to diagnostics. In order to ascertain the true rates of infection and indicators of immunity in the population against SARS-CoV-2 over time, researchers conducted a systematic review and meta-analysis of seroprevalence studies published from January 1, 2020 to May 20, 2022. From their search parameters, the authors identified 965 distinct seroprevalence studies sampling 5,346,069 participants between January 2020 and April 2022, with 43% of these studies being from low-middle income countries. They analyzed seroprevalence by country and month, estimating regional and global seroprevalence over time, and estimated seropositivity rates from infection versus infection or vaccination.

The researchers found that global seroprevalence has risen from 7.7% in June 2020 to 59.2% in September 2021, suggesting two-thirds of the global population may be SARS-CoV-2 seropositive from either vaccination or infection. Estimates of COVID-19 infections based on seroprevalence data far exceed reported cases, suggesting a bigger global impact of COVID-19 than previously known. The study did have limits, such as underrepresentation of some countries in the data, and overrepresentation of others.

According to the authors, “This study on global seroprevalence of SARS-CoV-2 antibodies found that while seroprevalence has increased over time, a third of the global population tested negative for antibodies against the virus as of September 2021 estimates. It was also found that compared to seroprevalence estimates, routine testing for COVID-19 has largely underestimated the number of global infections.”

Bergeri, Whelan, Ware, Subissi and colleagues add, “As we enter the third year of the COVID-19 pandemic, implementation of a global system or network for targeted, multi-pathogen, high-quality and standardized collaborative serosurveillance is a crucial next step to monitor the COVID-19 pandemic and contribute to preparedness for other emerging respiratory pathogens.”

#####

In your coverage, please use this URL to provide access to the freely available paper in PLOS Medicine: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004107

Citation: Bergeri I, Whelan M, Ware H, Subissi L, Nardone A, Lewis HC, et al. (2022) Global SARS-CoV-2 seroprevalence from January 2020 to April 2022: A systematic review and meta-analysis of standardized population-based studies. PLoS Med 19(11): e1004107. https://doi.org/10.1371/journal.pmed.1004107

Author Countries: Switzerland, Canada, France, Congo, Egypt, India, Philippines, Denmark, United States, United Kingdom

Funding: see manuscript

---

JOURNAL

PLoS Medicine

DOI

10.1371/journal.pmed.1004107 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

COI STATEMENT

Competing Interests: see manuscript

COVID testing programs may increase risky behavior

Peer-Reviewed Publication

UNIVERSITY OF WYOMING

Frequent, mandatory surveillance testing was one of the techniques deployed in some jurisdictions in an attempt to control COVID-19, but new research shows that such testing may have the unintended consequence of riskier behavior by those enrolled in the testing.

Based on a false sense of security, students who participated in frequent COVID-19 testing at two universities engaged in more behavior known to increase the risk of spreading the virus than they might have otherwise, according to results of surveys led by University of Wyoming economists.

“Recent research provides some evidence that people increase risky behavior in response to facemask wearing and vaccines, but this is the first study to examine the behavioral responses to mandatory testing,” wrote researchers Chian Jones Ritten, Linda Thunstrom and Todd Cherry, of UW, and J.D. Wulfhorst, of the University of Idaho. “Overall, (our) results suggest that students perceived that the mandatory testing policy decreased their risk of contracting COVID-19, and that this perception led to higher participation in COVID-risky events.”

The research findings were published Friday in PNAS Nexus, the open access sister journal of the prestigious Proceedings of the National Academy of Sciences.

During the fall 2020 semester, UW required all on-campus undergraduate students to be tested for COVID twice weekly, while the University of Idaho tested a small random sample of students weekly. Both universities required masks for all indoor events on campus.

The researchers surveyed students at both universities and found that, in both cases, respondents who were tested more frequently perceived that they were at a reduced risk of contracting the virus. Those individuals also more frequently attended “risky” events such as large and small indoor gatherings and frequented restaurants and bars.

From a public health standpoint, such behavior is problematic because inaccurate and delayed test results can result in people who believe they’re not infected carrying the virus and infecting others. Although perhaps unlikely, it is possible that the benefits of testing programs could be entirely offset by increased viral transmission, the researchers say.

While other research shows that, in other contexts, this type of risk compensation behavior is generally small in magnitude, small behavioral changes may lead to meaningful increases in disease spread.

“These unintended consequences may pose a particularly large threat to public health when incubation times are short, the virus is highly transmissible and the risk of false negatives is high, such as with the Omicron variant of the coronavirus,” the researchers wrote.

Interestingly, the surveys found that women, more than men, perceive that increased testing reduces the risk of contracting the virus -- and are, thus, more likely to increase risky behavior than men.

Overall, the research shows that mandatory testing programs should be accompanied by mitigation measures to reduce the unintended consequence of people engaging in riskier behavior, the researchers say.

“Our findings suggest that programs with frequent testing may unintentionally increase behavior known to contribute to virus spread -- the potential consequences of which are amplified by the exponential nature of viral spread,” the researchers concluded. “Thus, when implementing mandatory testing programs to manage a pathogen, it is important to communicate the programs’ limitations in protecting against infection and highlight the potential for unintended behavioral responses.”

---

JOURNAL

PNAS Nexus

DOI

10.1093/pnasnexus/pgac247 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Frequent mandatory COVID-19 testing may increase risky behavior

ARTICLE PUBLICATION DATE

10-Nov-2022

Investigating COVID-19 deaths for children and young people

Study confirms death rates remain low and fatalities are often linked to underlying conditions

Peer-Reviewed Publication

PLOS

 

IMAGE: COVID-19 INFECTION RATES BY AGE GROUP AND NUMBER OF DEATHS BY CAUSE OF DEATH IN CYP <20 YEARS (PREDOMINANT CIRCULATING VARIANT SHOWN BY COLOURED CHEVRONS; ERROR BARS INDICATE 95% CONFIDENCE INTERVALS). view more 

CREDIT: BERTRAN M, ET AL., 2022, PLOS MEDICINE, CC-BY 4.0 (HTTPS://CREATIVECOMMONS.ORG/LICENSES/BY/4.0/)

A new study conducted in England shows that the risk of death due to COVID-19 remains very low for children and young people, and most deaths occur in those with underlying health conditions. Marta Bertran of the UK Health Security Agency, London, and colleagues present these findings November 8th in the open access journal PLOS Medicine.

Pediatric deaths due to COVID-19 are rare, and because infection tends to be mild in children and young people compared to adults, it can be challenging to assess COVID-19 severity and cause of death for those with serious underlying health conditions. In addition, because death due to COVID-19 is so uncommon for children, limited data exist to examine such fatalities at the population level.

To improve our understanding of pediatric COVID-19 deaths—and which factors might be linked to an increased risk of death—Bertran and colleagues analyzed detailed data on everyone aged less than 20 years in England who died within 100 days of a confirmed COVID-19 infection between March 2020 and December 2021.

The analysis showed that, of 185 total deaths that occurred, 81 were due to COVID-19. Of those who died from COVID-19, 75 percent had underlying health conditions, primarily severe neurodisability and conditions involving a compromised immune system. Half of COVID-19 deaths occurred within seven days of infection and the majority within 30 days of infection.

These findings confirm that death due to COVID-19 remained rare in children and young people even as new variants of the SARS-Cov-2 virus emerged during the study period. They also highlight which children might be at greater risk of COVID-19 death, which could help inform parents, clinicians, and policymakers about prevention through vaccination, for example, and seeking early treatment.

The authors note that this study emphasizes the need for detailed review of individual cases in order to collaboratively monitor rare COVID-19 outcomes in children. They also note that the study period occurred prior to the rise of the Omicron variant, which now dominates cases worldwide.

Coauthor Shamez Ladhani adds, “Our national surveillance in England continues to show a very very low risk of death due to COVID-19 in children and teenagers, with most fatalities occurring in those with multiple and life-limiting underlying conditions.”

#####

In your coverage, please use this URL to provide access to the freely available paper in PLOS Medicine: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004118

Citation: Bertran M, Amin-Chowdhury Z, Davies HG, Allen H, Clare T, Davison C, et al. (2022) COVID-19 deaths in children and young people in England, March 2020 to December 2021: An active prospective national surveillance study. PLoS Med 19(11): e1004118. https://doi.org/10.1371/journal.pmed.1004118

Author Countries: United Kingdom

Funding: The author(s) received no specific funding for this work.

---

JOURNAL

PLoS Medicine

DOI

10.1371/journal.pmed.1004118 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

Forensics used to reverse the decline of biodiversity in Europe

Staffordshire University is contributing forensic intelligence to an ambitious project which aims to protect endangered species like wolf, bear, lynx, and sturgeon in remote areas of Europe

Business Announcement

STAFFORDSHIRE UNIVERSITY

Staffordshire University is contributing forensic intelligence to an ambitious project which aims to protect endangered species like wolf, bear, lynx, and sturgeon in remote areas of Europe.

Funded by Horizon Europe, NATURE FIRST brings together 12 global partners to improve biodiversity and protect the habitats of many species which are being threatened by human activity.

Over the next three years, the project will develop predictive, proactive and preventative capabilities for nature conservation and law enforcement by combining forensic intelligence and remote sensing technologies into one system.

This new approach will draw on real-time data from satellites, drones, cameras and other sources to monitor protected locations affected by human activity.

Spanning Romania, Ukraine, Bulgaria, Serbia and Spain, the project will focus on biogeographical regions including the Carpathians, the Danube Delta, the Stara Planina mountains, the Os Ancares and O Courel.

Claire Gwinnett, Professor of Forensic and Environmental Science, explained: “The overall aim is to halt and reverse the decline of biodiversity in Europe. We want to improve natural habitats where certain species are an incredibly important part of the ecosystem. To achieve this, we need a better understanding of why and where biodiversity is declining and what the key triggers are.

“As most of the threats and pressures on biodiversity are man-induced, this project will combine ecology and forensic science. This novel approach will use remote sensing technologies, machine learning and wildlife forensic methods to detect and recognise traces of human activities that negatively affect the environment.”

Biodiversity is under severe pressure due to a myriad of problems, including habitat fragmentation, overexploitation, hunting, climate change, pollution and invasive species.

 

The exploitation of natural resources also brings with it illegal activities such as poaching of species of flora and fauna that have a high value on the black market, trafficking and trading of rare and exotic animals and plants and setting fire to forestry and natural areas to force land-use designation changes to agriculture or commercial uses.

NATURE FIRST’s continuous, model-driven form of ecosystem monitoring will help to find cause-effect relationships and better understand changes in the environment. The models, also called Digital Twins, will help to translate environmental data into facts and actionable information for site managers and policy makers.

Professor Gwinnett said: “The regions we are looking at cover vast land masses which can’t easily be monitored manually on the ground. The Digital Twins system will make use of digital technologies to detect wildlife crime and other threats to facilitate rangers or law enforcement officers so that they respond more effectively.

“We will also be looking at how people who use the area legitimately can report through the Digital Twins system to help trigger a response to any changes in the environment or illegal activity.”

Professor Gwinnett added: “The aim of the EU Biodiversity Strategy for 2030 is to ensure that ecosystems are healthy, resilient to climate change and rich in biodiversity so that they can keep delivering the range of services essential to the prosperity and well-being of all of us. We are excited to be taking positive steps to help achieve this by working with such a fantastic group of global partners.”

The NATURE FIRST consortium members are 3EDATA INGENIERIA AMBIENTAL SL, Bulgarian Academy of Sciences, the Danube Delta National Institute for Research and Development, DotSpace, Semantic Web Company (SWC), Sensing Clues (coordinator), Staffordshire University, Sustainable Scale-up Foundation, Wageningen University & Research, Wildlife Forensic Academy, and WWF.

Deforestation and grassland conversion are the biggest causes of biodiversity loss

Researchers rank drivers of global biodiversity change

Peer-Reviewed Publication

GERMAN CENTRE FOR INTEGRATIVE BIODIVERSITY RESEARCH (IDIV) HALLE-JENA-LEIPZIG

 

IMAGE: LAND USE CHANGES SUCH AS DEFORESTATION AND GRASSLAND CONVERSION ARE NOT ONLY THE MAIN CAUSE OF GLOBAL BIODIVERSITY LOSS, THEY ARE ALSO RESPONSIBLE FOR ABOUT A QUARTER OF GLOBAL GREENHOUSE GAS EMISSIONS. view more 

CREDIT: ADOBE STOCKS

Whilst climate change has rightly attracted attention for its catastrophic consequences for the natural world, it is currently only the fourth largest driver of biodiversity loss on land, followed by invasive alien species in fifth place. “This major new study, published during the COP27 climate summit, demonstrates clearly that fighting climate change alone will not be enough to prevent the further loss of biodiversity, and with it our future”, says Dr Nicolas Titeux, one of the two first authors. “The various direct drivers should be addressed with similar ambition as the climate crisis and as a whole.” Titeux currently works at the Luxembourg Institute of Science and Technology but conducted the biggest part of the study at the UFZ with funding from iDiv.

Greenhouse gasses have been known to be the leading cause of the climate crisis for decades but just as important is understanding what is behind the enormous and rapid decline in species. A million species of animal and plant are threatened with extinction within the next few decades without significant countermeasures. Ecosystems worldwide are changing away from their natural condition, which means that they are increasingly unable to provide crucial ecosystem services for human well-being.

The authors of the study, led by Dr Pedro Jaureguiberry from UNC in Argentina and Dr Nicolas Titeux, also found that climate change is already in second place as a direct driver of species loss in the oceans. Here, the exploitation of fish stocks plays the biggest role. However, based on current developments, the authors assume that the importance of climate change for species loss and the decline of ecosystem services will increase in the coming years and decades and move up in the ranking of direct drivers.

The authors of this study thus confirm and specify the facts that the Global Assessment of the World Biodiversity Council IPBES had already indicated in 2019. “Our publication shows the depth of the work, which was performed in the Global Assessment of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES), where only the main results could be shown”, says Josef Settele from UFZ and Co-chair of the Global Assessment of IPBES. “It indicates the profoundness of the IPBES work”.

Need for nature-based solutions

This major study should be a game-changer for understanding how to tackle biodiversity loss. Jaureguiberry says: “Our study brings comprehensive and rigorous information on which drivers cause the most damage to biodiversity at multiple levels, from regions and realms to the different facets of biodiversity, highlighting the importance of each driver in particular contexts. Hopefully, this will contribute to a more holistic approach to generate more efficient policies to reverse biodiversity loss.”

In particular, the research demonstrates the need for a more holistic approach that will tackle the twin threats of climate and the biodiversity crisis together. Titeux points out that “The current global agreements such as the Convention on Biological Diversity and the UN Framework Convention on Climate Change can focus too narrowly on one driver, overlooking or, in the worst-case, undermining solutions for others”.

Professor Andy Purvis from the Natural History Museum in London explains: “Climate change and biodiversity loss have been tackled largely separately, by different policies that haven't always considered the other problem. For example, biofuels are proposed as one way to get to net zero, but the expansion of plantations into natural forest that could result would be terrible for nature.”

The paper also highlights some of the ‘nature-positive’ solutions that tackle both climate change and biodiversity loss such as large-scale restoration of natural forests and effective protection of coastal wetlands.

Andy Purvis adds:” I’d love for 'nature-positive' to get into the public consciousness as much as 'net zero' has. If future generations are going to have the same birthright we had of a liveable, supportive planet, then all parts of society will have to transition as quickly as possible to being both net zero and nature-positive.”

The research was financed inter alia by the Deutsche Forschungsgemeinschaft (DFG; FZT-118).

---

JOURNAL

Science Advances

DOI

10.1126/sciadv.abm9982 

METHOD OF RESEARCH

Meta-analysis

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

The direct drivers of recent global anthropogenic biodiversity loss.

ARTICLE PUBLICATION DATE

9-Nov-2022

Immune system reboot in MS patients

Peer-Reviewed Publication

UNIVERSITY OF ZURICH

Every day, one person in Switzerland is diagnosed with multiple sclerosis. MS is an autoimmune disease in which the body’s own immune system attacks the myelin sheath of the nerve cells in the brain and spinal cord. The disease leads to paralysis, pain and permanent fatigue, among other symptoms. Fortunately, there have been great advances in therapies in recent decades. A study by the Department of Neuroimmunology and MS Research at the University of Zurich (UZH) and the Department of Medical Oncology and Haematology Clinic at the University Hospital Zurich (USZ) has now pinpointed why the most effective currently available therapy – a stem cell transplant – works so well.

Wiping out unwanted immune cells

“80 percent of patients remain disease-free long-term or even forever following an autologous hematopoietic stem cell transplant,” says recently retired Professor Roland Martin, study lead and last author. The treatment is particularly suitable for younger people with aggressive forms of the disease. Four years ago, thanks to the high effectiveness of the treatment and the now low mortality rate, Martin’s department together with the USZ clinic were granted approval to administer the therapy. It is the only clinic in Switzerland approved for this treatment.

During the treatment, several chemotherapies completely destroy the patients’ immune system – including the subset of T cells which mistakenly attack their own nervous system. The patients then receive a transplant of their own blood stem cells, which were harvested before the chemotherapy. The body uses these cells to build a completely new immune system without any autoreactive cells.

Systematic analysis of immune cells

“Previous studies have shown the basic workings of the method, but many important details and questions remained open,” says Martin. Some unclear aspects were what exactly happens after the immune cells are eliminated, whether any of them survive the chemotherapy, and whether the autoreactive cells really do not return.

In the recently published study, Martin’s team systematically investigated these questions for the first time by analyzing the immune cells of 27 MS patients who received stem cell therapy in Zurich. The analysis was done before, during and up to two years after treatment. This allowed the researchers to track how quickly the different types of immune cells regenerated

Successful reset of immune system

Surprisingly, the cells known as memory T cells, which are responsible for ensuring the body remembers pathogens and can react quickly in case of a new infection, reappeared immediately after the transplant. Further analysis showed that these cells had not re-formed, but had survived the chemotherapy. These remnants of the original immune system nevertheless pose no risk for a return of MS: “They are pre-damaged due to the chemotherapy and therefore no longer able to trigger an autoimmune reaction,” explains Martin.

In the months and years following the transplant, the body gradually recreates the different types of immune cells. The thymus gland plays an important role in this process. This is where the T cells go to school, so to speak, and learn to distinguish foreign structures, such as viruses, from the body’s own. “Adults have very little functioning tissue left in the thymus,” says Martin. “But after a transplant, the organ appears to resume its function and ensures the creation of a completely new repertoire of T cells which evidently do not trigger MS or cause it to return.”

Further studies needed for wider approval

These findings have enabled the researchers to understand why stem cell transplants are usually so successful. But lamentably, says Martin, the treatment is not approved in many countries, as phase III studies are lacking. “Phase III studies cost several hundred million euros, and pharmaceutical companies are only willing to conduct them if they will make money afterward.” This is not the case with stem cell therapy, as the drugs used are no longer patent-protected.

“I am therefore very pleased that we have succeeded in obtaining approval for the treatment from the Federal Office of Public Health and that health insurers are covering the costs,” Martin says. In the past, many MS sufferers from Switzerland had to travel to Moscow, Israel or Mexico to receive transplants.

---

JOURNAL

Science Translational Medicine

DOI

10.1126/scitranslmed.abq1693 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Dynamics of T cell repertoire renewal following autologous hematopoietic stem cell transplantation in multiple sclerosis

ARTICLE PUBLICATION DATE

10-Nov-2022

UK

Failing IT infrastructure is undermining safe healthcare in the NHS

Poorly functioning IT systems “a clear and present threat to patient safety,” warn experts

Peer-Reviewed Publication

BMJ

Joe Zhang at Imperial College London and colleagues point to a recent 10 day IT system outage at one of the largest hospital trusts in the NHS and warn that increasing digital transformation “means such failures are no longer mere inconvenience but fundamentally affect our ability to deliver safe and effective care.”

They argue that, unlike the procurement of electronic health records, for example, investment in IT infrastructure (which includes computers, servers, and networks) is rarely prioritised and easily viewed as a cost to keep down rather than an investment that increases productivity.

Yet the consequences are substantial, they write. A recent survey of NHS clinicians commissioned by NHS England shows that user experiences of electronic health records are generally poor, resulting from unreliable, slow IT.

The British Medical Association (BMA) estimates that a substantial proportion (27%) of NHS clinicians lose over four hours a week through inefficient IT systems. The BMA report also found deficiencies in investment and lack of clinician engagement in procurement.

Outdated infrastructure is a risk to data security, they add. It is unclear how many providers conform to national guidance by keeping multiple back-ups of data, including ‘off site.’

There is also a growing disconnect between government messaging promoting a digital future for healthcare (including artificial intelligence) and the lived experience of clinical staff coping daily with ongoing IT problems. 

“This digital future will not materialise without closer attention to crumbling IT infrastructure and poor user experiences,” they write.

There is no one-size-fits-all solution, but the NHS can learn from approaches taken elsewhere, they say. In the US, for example, the effect of health IT on end users is an active area of research, particularly on how functionality of IT systems affects clinician burnout and effectiveness, while federal oversight of healthcare IT infrastructure can identify problems and coordinate a response.

To facilitate a transformation of IT infrastructure in the NHS “we need to include systematic and transparent measurement of IT capabilities and functionality at the level of clinicians – the people actually using the systems” they explain, “as well as at the level of those procuring the systems.”

Armed with this understanding, quality improvement cycles must become routine in IT governance, as they are in clinical care, and government must provide the investment needed to identify and rectify poor performance but also demand accountability, with minimum standards for IT function and stability, they add. 

“We must not tolerate problems with IT infrastructure as normal,” they conclude. 

“Poorly functioning IT systems are a clear and present threat to patient safety that also limit the potential for future transformative investment in healthcare. Urgent improvement is an NHS priority.”

---

JOURNAL

The BMJ

DOI

10.1136/bmj-2022-073166 

METHOD OF RESEARCH

News article

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Failing IT infrastructure is undermining safe healthcare in the NHS

ARTICLE PUBLICATION DATE

9-Nov-2022