Friday, July 09, 2021

 

Women with recurrent UTIs voice 'fear and frustration' over treatment options

WOLTERS KLUWER HEALTH

Research News

July 8, 2021 - Women with recurrent urinary tract infections (UTIs) experience frustration related to their treatment - particularly the risks from repeated use of antibiotics, according to a focus group study in The Journal of Urology®, Official Journal of the American Urological Association (AUA). The journal is published in the Lippincott portfolio by Wolters Kluwer.

"This study was prompted by our experience treating countless women with recurrent UTIs referred to our specialized Female Pelvic Medicine and Reconstructive Surgery center," comments senior author Ja-Hong Kim, MD, of UCLA Center of Women's Pelvic Health. "The vast majority were understandably dissatisfied with their care pathway, which was primarily antibiotic-focused with minimal effort spent on patient education and prevention strategies."

Lead author Victoria C.S. Scott, MD, of Cedars-Sinai Medical Center, Beverly Hills, Calif adds, "It's important for patients with this chronic condition to feel empowered in sharing their concerns with physicians regarding their health, quality of life and medical treatment and for physicians to respond to these concerns."

New strategies needed 'to minimize and target antibiotic use'

More than half of women will develop a UTI sometime during their lives, and about one-fourth experience recurrent UTIs. Episodes of UTI have a major impact on patients' lives - including pain and other symptoms, reduced quality of life, and repeated courses of antibiotics for prevention and treatment.

"In our experience, many patients labelled with recurrent UTI are either misdiagnosed or mistreated without following the guidelines set forth by specialty societies," says Dr. Kim. "It became clear that a paradigm shift in recurrent UTI management was needed, starting with patient-centered research to assess gaps in the current UTI treatment algorithm." The researchers performed a series of focus groups, with a total of 29 patients participating.

Analysis of the discussions identified several themes related to negative effects associated with antibiotic use. The women were well aware of the risks of developing antibiotic resistance and collateral damage from overuse or inappropriate use of antibiotics. Some patients developed infection with antibiotic-resistant C. difficile bacteria, in one case leading to hospitalization.

The patients also voiced concern about taking antibiotics when they didn't have an infection. Many believed they had been given antibiotics for other causes of urinary symptoms - particularly overactive bladder, which commonly occurs in women with recurrent UTIs but causes less-severe symptoms.

Other themes centered on resentment of the medical profession. The women expressed irritation with physicians for "throwing antibiotics" at them without presenting other, non-antibiotic options for treating recurrent UTIs. They also felt the medical profession underestimated the impact of recurrent UTIs on their lives. The women felt an urgent need for more research on non-antibiotic options, with a special interest in "natural" or "alternative" treatments for prevention of recurrent UTIs.

However, some women shared they were satisfied with their care - particularly those treated by a physician specializing in Female Pelvic Medicine and Reconstructive Surgery. Patients were more likely to be satisfied if they felt their doctor understood their problems and had a system for rapid diagnosis and treatment when UTI episodes occurred.

"Physicians must investigate patients' recurrent UTI experiences and their perceptions of antibiotics during counseling to address their concern over antibiotic overuse," says Dr. Scott. The researchers follow and recommend a strategy of delaying antibiotics until urine culture results are available - as endorsed by the American Urological Association (AUA) and other specialty societies.

Dr. Kim concludes: "There are exciting research developments underway, including the utilization of point-of-care rapid diagnostic assays to accurately and selectively treat UTIs as well as studies to understand the impact of vaginal microbiome on voiding dysfunction. We hope these efforts will pave the way to improved patient experience."

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Click here to read "Fear and Frustration among Women with Recurrent Urinary Tract Infections: Findings from Patient Focus Groups."

DOI: 10.1097/JU.0000000000001843

About The Journal of Urology®

The Official Journal of the American Urological Association (AUA), and the most widely read and highly cited journal in the field, The Journal of Urology® brings solid coverage of the clinically relevant content needed to stay at the forefront of the dynamic field of urology. This premier journal presents investigative studies on critical areas of research and practice, survey articles providing brief editorial comments on the best and most important urology literature worldwide and practice-oriented reports on significant clinical observations. The Journal of Urology® covers the wide scope of urology, including pediatric urology, urologic cancers, renal transplantation, male infertility, urinary tract stones, female urology and neurourology.

About the American Urological Association

Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is a leading advocate for the specialty of urology, and has nearly 24,000 members throughout the world. The AUA is a premier urologic association, providing invaluable support to the urologic community as it pursues its mission of fostering the highest standards of urologic care through education, research and the formulation of health care policy. To learn more about the AUA visit: http://www.auanet.org.

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 2020 annual revenues of €4.6 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,200 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 in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.

For more information, visit http://www.wolterskluwer.com, follow us on TwitterFacebookLinkedIn, and YouTube.

 

High risk of divorce after TBI? Not necessarily, study suggests

WOLTERS KLUWER HEALT

Research News

July 6, 2021 - Traumatic brain injury (TBI) has a major impact on the lives of affected patients and families. But it doesn't necessarily lead to an increased risk of marital instability, as two-thirds of patients with TBI are still married to the same partner 10 years after their injury, reports a study in the July/August issue of the Journal of Head Trauma Rehabilitation (JHTR). The official journal of the Brain Injury Association of America, JHTR is published in the Lippincott portfolio by Wolters Kluwer.

For marriages that do end, divorce most often occurs within the first year after TBI, according to the new research by Flora M. Hammond, MD, of Indiana University School of Medicine, Indianapolis, and colleagues. "Our data dispel myths about risk of divorce after TBI and suggest a message of hope," the researchers write.

Findings may help in assessing risk and targeting timing marital interventions after TBI

Dr. Hammond and colleagues analyzed long-term follow-up data on 1,423 patients with TBI, all of whom were married at the time of their injury. Patients were drawn from the Traumatic Brain Injury Model Systems (TBIMS) database enrolling persons hospitalized with TBI. Average age at the time of injury was 44 years; about three-fourths of patients were men.

Ten years after TBI, 66 percent of patients with TBI remained married to the same person, without separation or divorce. Of marriages that ended, 68 percent did so within five years after TBI, including 39 percent within the first year.

The study also looked at factors associated with a higher or lower risk of divorce or separation. "Marital stability over the 10-year period was higher for those who were older, were female, and had no problematic substance use history," the researchers write. The risk of a breakup didn't seem to be related to race/ethnicity, education, cause of injury, or injury severity.

Marital stability has a major impact on the ability to resume normal life and functioning in persons with TBI. Some reports have suggested high divorce rates after TBI. However, in previous studies, reported rates of marital instability after TBI varied widely: from 22 to 85 percent. Long-term follow-up in a large sample of patients with TBI are major strengths of the new study.

The results question previous studies suggesting a high divorce rate among patients who are married at the time they sustain a TBI. The study also provides insights into risk factors for a marital breakup after TBI. The findings are consistent with the known bidirectional link between TBI and substance use. "While substance use itself may not cause marital instability, a spouse's perception that substance use is problematic may contribute to marital instability," Dr. Hammond and coauthors write.

The high risk of marital loss within the first few years after TBI suggests that early education and support might be helpful. The researchers note some important limitations of their study - including the lack of information on the quality of the marital relationship before TBI.

The findings may help to identify couples who may be at high risk of marital instability after TBI, and to guide patient and family education, relationship counseling, and other marital interventions, Dr. Hammond and colleagues believe. They conclude, "Interventions aimed at substance use prevention and functional improvement may also have relevance to facilitating marital stability."

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Click here to read "Marital Stability Over 10 Years Following Traumatic Brain Injury."

DOI: 10.1097/HTR.0000000000000674

About The Journal of Head Trauma Rehabilitation

The Journal of Head Trauma Rehabilitation is a leading, peer-reviewed resource that provides up-to-date information on the clinical management and rehabilitation of persons with traumatic brain injuries. Six issues each year aspire to the vision of "knowledge informing care" and include a wide range of articles, topical issues, commentaries and special features. It is the official journal of the Brain Injury Association of America.

About the Brain Injury Association of America

The Brain Injury Association of America is the country's oldest and largest nationwide brain injury advocacy organization. Our mission is to advance awareness, research, treatment and education and to improve the quality of life for all individuals impacted by brain injury. Through advocacy, we bring help, hope and healing to millions of individuals living with brain injury, their families and the professionals who serve them.

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 2020 annual revenues of €4.6 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,200 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 in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.

For more information, visit http://www.wolterskluwer.com, follow us on TwitterFacebookLinkedIn, and YouTube.


NYU Abu Dhabi researchers unlock secrets behind liver regrowth and regenerative medicine

New insight into the liver's unique ability to regenerate holds promise for developing treatments for the lung, heart, and other organs that currently must be replaced by transplants

NEW YORK UNIVERSITY

Research New

IMAGE

IMAGE: DR. KIRSTEN SADLER EDEPLI view more 

CREDIT: NYU ABU DHABIAbu Dhabi, UAE, July 5, 2021: NYU Abu Dhabi (NYUAD) researchers uncovered a code that sets the genome of the liver to account for the remarkable ability for this organ to regenerate. This finding offers new insight into how the specific genes that promote regeneration can be activated when part of the liver is removed. These findings have the potential to inform the development of a new form of regenerative medicine that could help non-regenerative organs regrow in mice and humans.

While other animals can regenerate most organs, humans, mice, and other mammals can only regenerate their liver in response to an injury or when a piece is removed. NYUAD researchers hypothesized that the genes that drive regeneration in the liver would be controlled by a specific code that allows them to be activated in response to injury or resection. They hone in on the epigenome, which is the modifications on the DNA that alter the gene expression, as opposed to changing the genetic code itself.

Using a mouse liver model, the team of NYUAD researchers, led by Professor of Biology Kirsten Sadler Edepli, identified the elements of the epigenetic code present in quiescent liver cells - cells that are currently not replicating but have the ability to proliferate under the right conditions - that activate specific genes to regenerate. Genes involved in liver cell proliferation are silenced in livers that are not regenerating, but the surprising finding was that they reside in parts of the genome where most genes are active. The researchers found that these pro-regenerative genes were marked with a specific modification - H3K27me3. During regeneration, H3K27me3 is depleted from these genes, enabling their dynamic expression and driving proliferation.

In the paper Chromatin states shaped by an epigenetic code confer regenerative potential to the mouse liver published in the journal Nature Communications, Sadler and the lead research scientist on her team, Chi Zhang, present the discovery that the mouse liver contains elements of the epigenetic code that allow pro-regenerative genes to activate when signaled. Epigenetic patterns are a well-established mechanism that coordinate gene expression. However, the way epigenetic patterns contribute to gene expression in the liver or how they impact liver regeneration was previously unknown. Their research uncovered six distinct chromatin states in the mouse liver corresponding to specific epigenetic marks, providing the first chromatin map of this important organ and showing that the elements of this map are essential for liver regeneration. This finding provides a mechanism that keeps cells in the liver in a "ready-set-go" state, in preparation for the signal to regenerate.

"The secret to regeneration is locked in a code in the liver epigenome. We are now studying the 'writers' of the epigenetic code -- the enzymes that create the epigenetic marks -- to see how this epigenetic code responds to aging, as the liver's ability to regenerate declines in older animals - including humans," said Sadler. "The continued study of the liver's remarkable ability to regenerate provides promise for the development of regenerative medicine; perhaps we can even try to write the code that allows regeneration in the young liver to cells in older animals, or even to tweak this code in other organs that don't regenerate and currently can only be replaced using complex, high-risk transplants."

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About NYU Abu Dhabi

http://www.nyuad.nyu.edu

NYU Abu Dhabi is the first comprehensive liberal arts and research campus in the Middle East to be operated abroad by a major American research university. NYU Abu Dhabi has integrated a highly selective undergraduate curriculum across the disciplines with a world center for advanced research and scholarship. The university enables its students in the sciences, engineering, social sciences, humanities, and arts to succeed in an increasingly interdependent world and advance cooperation and progress on humanity's shared challenges. NYU Abu Dhabi's high-achieving students have come from over 115 countries and speak over 115 languages. Together, NYU's campuses in New York, Abu Dhabi, and Shanghai form the backbone of a unique global university, giving faculty and students opportunities to experience varied learning environments and immersion in other cultures at one or more of the numerous study-abroad sites NYU maintains on six continents.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news

Not enough women and minorities apply for a job? Change the recruitment committee

UH study suggest practical steps to increase applicant pool diversity

UNIVERSITY OF HOUSTON

Research News

Amid calls for racial and social justice nationwide, businesses and educational institutions are grappling with how to adopt more inclusive organizational practices, including more diversified hiring. However, recruitment teams and strategic leaders often blame their lack of a diverse workforce on a lack of diverse applicants. A large study of recruitment data suggests a simple and efficient way of increasing diversity in applicant pools: have more diverse recruitment committees and leadership teams.

The study, led by researchers at the University of Houston's Center for ADVANCING Faculty Success and published online in the Journal of Applied Psychology, found that when the search committee chair for a job is a woman, 23% more women apply for the job than when the search committee is led by a man. What is more, over 100% more underrepresented minorities (URM), such as Hispanics and Blacks, apply for the job when the recruitment is led by a URM chair as opposed to a non-URM.    

In the context of workplace diversity, the concept of homophily - an affinity for similar others - has developed a bad reputation for furthering systemic barriers to opportunity for minority groups. In fact, homophily, if utilized wisely, can be leveraged to increase the representation of women and underrepresented minorities, according to Maryam A. Kazmi, a Ph.D. candidate at UH and the study's first author.    

"There is something that women and URM recruiters are doing differently than men and majority group members that encourages more women and URM applicants to apply for a job," she said. 

The study, an analysis of three years of recruitment data for tenure-track faculty jobs at a large, public research university, shows that one of the ways in which women and URM recruitment leaders are affecting applicant pools is by appointing more women and URM to participate on the search committees they lead. These women and URM search committee members, together with the leads of recruitment teams, disseminate job ads more widely, specifically to more women and URM potential applicants who then apply in greater numbers. But what motivates them to do so? 

Christiane Spitzmueller, professor of psychology at UH and a study co-author, said that women and URM recruitment leads and team members rely on their own experiences in developing applicant pools. 

"Women and underrepresented minority recruiters have likely experienced the same structural barriers to entry and career progress that the potential applicants may face. Their own experiences of inequity may make them likely to have a soft spot for similar others facing similar issues. This might motivate women and minority recruiters to work harder to ensure that they do what they can to ensure that more women and URM are made aware of the job opening and are encouraged to apply," she said. 

The researchers make a number of policy recommendations for human resource professionals, supervisors and other company executives to ensure more diverse applicant pools, which include: 

  • Posting the job ad on women/minority-specific websites
  • Cooperating with the organization/institution's diversity and inclusion offices to develop a diverse list of candidates to contact
  • Posting the position ad through department chair listservs
  • Calling women or colleagues from historically underrepresented backgrounds to get possible candidate names/recommendations on who to recruit
  • Using personal networks to recruit
  • Including language in the job ads promoting the diversity of the department and university to prospective candidates

The study found that women and URM recruiters tend to use different strategies to affect applicant pool diversity, says Juan Madera, study co-author and professor at the Conrad N. Hilton College of Hotel and Restaurant Management at UH. 

"We found preliminary evidence that women recruiters are more likely to use personal networks to identify and target women/URM applicants, whereas URM recruiters are more likely to use more formal strategies of increasing applicant pool diversity. For example, cooperating with the institution's diversity and inclusion offices to develop a diverse list of candidates to contact and posting the job ad on women and minority-specific websites," he said.   

"Women and URM continue to be underrepresented in workplaces. The diversification of applicant pools constitutes an important step for broadening the participation of women and URM in the workforce," says Paula Paula Myrick Short, senior vice president for academic affairs and provost at the University of Houston. "This study provides evidence of practical steps that organizations can take to increase their applicant pool diversity."

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Cancer screenings rebounded in 2020 after COVID but racial disparities remain

DANA-FARBER CANCER INSTITUTE

Research News

BOSTON - The numbers of cancer screening tests rebounded sharply in the last quarter of 2020, following a dramatic decline in the first months of the COVID-19 pandemic, at one large hospital system in the Northeastern United States. These findings were released in a study published in Cancer Cell. The research also found an increase in racial and socioeconomic disparities among users of some screening tests during the pandemic.

Study co-senior author Toni K. Choueiri, MD, director of the Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute, said following a dramatic decline during the first pandemic peak, there was a "substantial increase in screening procedures during the more recent periods with numbers exceeding those seen before the pandemic. However, racial disparities appear to differ between screening procedures, and are more marked in patients undergoing mammography."

"Early screening and diagnosis provide patients with the best chance for cancer cure--a widened racial gap in cancer screening due to COVID-19 will exacerbate existing racial disparities in cancer mortality," adds Quoc-Dien Trinh, MD, co-director of the Dana-Farber/Brigham and Women's Prostate Cancer Center, co-leader of the Mass General Brigham United Against Racism prostate cancer outreach clinic, and co-senior author on the study.

During September to December 2020, cancer screening rates for breast, prostate cervical, and lung cancer recovered and exceeded numbers seen before the pandemic, the study authors said. However, the recovery was not seen in colonoscopy screening to detect colorectal cancer.

"Colonoscopy did not get back to normal levels," said Chris Labaki, MD, of Dana-Farber, co-first author of the study. One reason may be that it is the most invasive of the tests, requiring hospital and anesthesia services, the authors suggested. The investigators also noted that some patients who would have undergone colonoscopies to screen for colorectal cancer may have opted for alternative, home-based methods such as tests for occult blood in stool.

In addition to the pandemic's temporary stifling of routine cancer screening, the researchers also found an increase in racial and socioeconomic disparities with some screening tests. Significant shifts in the racial distribution of patients undergoing mammography were revealed in the decreased numbers of Non-Hispanic Black and Hispanic patients having mammographies during the period September to December 2020 compared to the three months preceding the pandemic. This contrasted with an increase in mammography tests in the whole group of patients during the last quarter of 2020, according to the study. "These findings are concerning and suggest the pandemic may accentuate racial disparities related to cancer screening," the authors noted.

The racial proportions of patients undergoing screening during the pandemic remained stable for PSA, colonoscopy, Pap test, and CT scanning for lung cancer, compared to the pre-pandemic periods.

The study was based on records of the Mass General Brigham system, a large healthcare system in the Northeast -- a region that had experienced a sharp decline in screening during the early months of the pandemic. A decrease in numbers of screening tests during March to June 2020 and June to September 2020 ranged from minus 65% to minus 82% and minus 4% to minus 44%, respectively, depending on screening type.

The reduction in tests initially in 2020 and the resurgence in the last quarter of 2020 was accompanied by changes in diagnoses of cancer: only 1,985 positive tests were reported during the early pandemic (March-June 2020) compared to 3,476 positive tests in the September-December period.

Statisticians calculated that 1,187 diagnoses were "missed" from March to June 2020 because of reduced use of screening. Of those, 323 were "recovered" from September to December 2020, although the study did not note whether the cancers were found at later stages. For colonoscopy, no diagnoses were "recovered" and 38 positive diagnoses were "missed" across the three pandemic periods analyzed.

"The increase in screening tests that was identified from September to December 2020 helped to recover some of the "missed" cancer diagnoses from earlier time periods," Labaki added. "However, more efforts are still needed to ensure the implementation of large screening campaigns as a significant proportion of cancers remains undiagnosed." The delays in diagnosis are expected to cause adverse oncologic outcomes, the researchers say.

"We don't want to miss out on cancer screenings," Choueiri emphasized. "We would want patients to come back to discuss with us and their primary care providers and to embark on screening following the national COVID-19 pandemic guidelines."

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The co-first authors of the study with Labaki are Ziad Bakouny, MD, MSc, and Andrew Schmidt, MD, of Dana-Farber. Co-authors are Stuart Lipsitz, ScD, of Brigham and Women's Hospital, and Timothy R. Rebbeck, PhD, of Dana-Farber and Harvard TH Chan School of Public Health.

About Dana-Farber/Brigham and Women's Cancer Center

Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) brings together specialists from two world-class medical centers. DF/BWCC has a singular focus on conquering cancer and improving the way that cancer care is delivered throughout the world. Through our 12 specialized disease treatment centers, experts from one of the world's leading cancer institutes and one of the world's leading hospitals work together as one team to offer the most advanced treatments with the compassion and care that makes all the difference.

 

Mapping dengue hot spots pinpoints risk for Zika and chikungunya

A risk-stratification method to more effectively control mosquito-borne diseases

EMORY HEALTH SCIENCES

Research News

Data from nine cities in Mexico confirms that identifying dengue fever “hot spots” can provide a predictive map for future outbreaks of Zika and chikungunya. All three of these viral diseases are spread by the Aedes aegypti mosquito. 

Lancet Planetary Health published the research, led by Gonzalo Vazquez-Prokopec, associate professor in Emory University’s Department of Environmental Sciences. The study provides a risk-stratification method to more effectively guide the control of diseases spread by Aedes aegypti

“Our results can help public health officials to do targeted, proactive interventions for emerging Aedes-borne diseases,” Vazquez-Prokopec says. “We’re providing them with statistical frameworks in the form of maps to guide their actions.” 

The study encompassed data for 2008 through 2020 from cities in southern Mexico with a high burden of dengue fever cases during that period, along with cases of the more recently emerged diseases of Zika and chikungunya. The cities included Acapulco, Merida, Veracruz, Cancun, Tapachula, Villahermosa, Campeche, Iguala and Coatzacoalcos. 

The results found a 62 percent overlap of hot spots for dengue and Zika and 53 percent overlap for cases of dengue and chikungunya. In addition, dengue hot spots between 2008 and 2016 were significantly associated with dengue hotspots detected between 2017 and 2020 in five of the nine cities. 

The work builds on a previous study of the spatial-temporal overlap of the three diseases, focused on Merida, a city of one million located in the Yucatan Peninsula. That study showed that nearly half of Merida’s dengue cases from 2008 to 2015 were clustered in 27 percent of the city. These dengue hot spots contained 75 percent of the first chikungunya cases reported during the outbreak of that disease in 2015 and 100 percent of the first Zika cases reported during the Zika outbreak of 2016. 

“In this latest paper, we’ve expanded our analysis in scope and geography and shown that the findings are consistent across these nine cities of different sizes and in different regions,” Vazquez-Prokopec says. “We’ve confirmed that dengue, Zika and chikungunya outbreaks tend to concentrate in small areas of a city, and that these hot spots are predictive of where future cases will concentrate.” 

Mosquito control efforts generally involve outdoor spraying that covers broad swaths of a city, but the Aedes aegypti mosquito has adapted to live inside houses. Work by Vazquez-Prokopec and collaborators has shown that the best way to control these mosquitos and the diseases they spread is by spraying a long-lasting pesticide indoors — on the ceilings, along the bases of walls, and in other areas of homes where the mosquitos tend to cluster.

This approach — known as targeted indoor residual spraying — is too expensive and time-consuming to apply across a city. 

The statistical framework in the current paper, however, allows public health officials to concentrate their efforts on previous hot spots for Aedes-borne diseases to better control — and even prevent — outbreaks. 

“The ultimate goal is to give public health officials the power to harness big data and do more effective and efficient mosquito control — even before an epidemic begins,” Vazquez-Prokopec says. 

Vazquez-Prokopec is currently leading a consortium in a randomized clinical trial in Merida to test targeted indoor residual spraying as an intervention against Aedes-borne diseases. The five-year trial, launched in 2020, is funded by a $6.5 million grant from the National Institutes of Health. 

Dengue fever is sometimes called “break-bone fever” due to the excruciating pain that is among its symptoms. More than one third of the world’s population lives in areas at high risk for infection with the dengue virus, a leading cause of illness and death in the tropics and subtropics.

Dengue is endemic through most of Mexico, where between 75,000 and 355,000 cases occur annually, translating into an economic cost of between about U.S. $150 million and $257 million annually. 

Chikungunya is rarely fatal but the symptoms can be severe and debilitating. Zika can cause symptoms similar to those of dengue and chikungunya, such as joint pains and fever. While Zika tends to be less debilitating, or even asymptomatic, if a pregnant woman contracts the virus it can have a catastrophic impact on her unborn child, including severe brain defects. 

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Co-authors of the Lancet Planetary Health paper include researchers from Mexico’s Ministry of Health; the Autonomous University of the Yucatan; the Autonomous University of Nuevo Leon; Yucatan Health Services; the Mexican Society of Public Health; the National Institute of Public Health in Cuernavaca; the Undersecretary of Prevention and Health Promotion in Mexico City; the Pan American Health Organization; and the U.S. Centers for Disease Control and Prevention. 

The work was funded by USAID, the U.S. Centers for Disease Control and Prevention, the Canadian Institute of Public Health, the state of Yucatan, the National Institutes of Health and Emory University.

Related:

Zeroing in on a mosquito menace

When taste and healthfulness compete, taste has a hidden advantage

New research describes what goes on in your brain when you reach for a candy bar instead of an apple

DUKE UNIVERSITY

Research News

DURHAM, N.C. -- You dash into a convenience store for a quick snack, spot an apple and reach for a candy bar instead. Poor self-control may not be the only factor behind your choice, new research suggests. That's because our brains process taste information first, before factoring in health information, according to new research from Duke University.

"We spend billions of dollars every year on diet products, yet most people fail when they attempt to diet," said study co-author Scott Huettel, a professor of psychology and neuroscience at Duke. "Taste seems to have an advantage that sets us up for failure."

"For many individuals, health information enters the decision process too late (relative to taste information) to drive choices toward the healthier option."

The new paper, which appears July 5 in Nature Human Behaviour, describes the advantage taste has over healthfulness in the decision-making process.

"We've always assumed people make unhealthy choices because that's their preference or because they aren't good at self-control," said study co-author Nicolette Sullivan. "It turns out it's not just a matter of self-control. Health is slower for your brain to estimate - it takes longer for you to include that information into the process of choosing between options."

The research was undertaken when Sullivan was a postdoctoral associate at Duke. She is now an assistant professor of marketing at the London School of Economics and Political Science.

For the study, Sullivan and Huettel recruited 79 young adults of a median age of 24.4 years. Study participants were asked to fast for four hours before the experiment to ensure they arrived hungry.

Participants were asked to rate snack foods on their tastiness, healthfulness and desirability. They were then presented with pairs of foods and asked to choose between them - and the researchers timed their choices.

At the end of the experiment, participants were offered one of the foods they had chosen.

Study participants registered taste information early in their decision process - taking about 400 milliseconds on average to incorporate taste information. Participants took twice as long to incorporate information about a snack's healthfulness into their decisions.

That may not sound like much time. In many cases though, it's enough to alter the choice we make.

"Not every decision is made quickly - house purchases, going to college - people take time to make those choices," Huettel said. "But many decisions we make in the world are fast - people reach for something in the grocery store or click on something online."

The authors say their findings could apply to other choices, not just food. For instance, some financial decisions, such as saving and spending choices, may also be affected by how - and when - the brain processes different types of information.

Meanwhile, all is not lost in the war against junk food cravings.

Half of study participants received a blurb before the experiment, stressing the importance of eating healthy. Those participants were less likely to choose an unhealthy snack.

The authors also identified something simple that can help people with their food choices: slowing down the decision-making process.

When study participants took longer to consider their options, they tended to pick healthier ones.

"There may be ways to set up environments so people have an easier time making healthy choices," Huettel said. "You want to make it easy for people to think about the healthfulness of foods, which would help nudge people toward better decisions."

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CITATION: "Healthful choices depend on the latency and rate of information accumulation," Nicolette J. Sullivan and Scott A. Huettel, July 5, 2021, Nature Human Behaviour. DOI: 10.1038/s41562-021-01154-0

 

Why insisting you're not racist may backfire

Experimental study finds white people often send the opposite message when they explain why they're not prejudiced

UNIVERSITY OF CALIFORNIA - BERKELEY HAAS SCHOOL OF BUSINESS

Research News

When you insist you're not racist, you may unwittingly be sending the opposite message.

That's the conclusion of a new study* by three Berkeley Haas researchers who conducted experiments with white participants claiming to hold egalitarian views. After asking them to write statements explaining why they weren't prejudiced against Black people, they found that other white people could nevertheless gauge the writers' underlying prejudice.

"Americans almost universally espouse egalitarianism and wish to see themselves as non-biased, yet racial prejudice persists," says Berkeley Haas Asst. Prof. Drew Jacoby Senghor, one of the authors. "Our results suggest that the explicit goal of appearing egalitarian might blind people to the possibility that they could be communicating, and perpetuating, prejudicial attitudes."

Co-authored by Derek Brown, PhD 24, and Michael Rosenblum, PhD 20--a post-doctoral scholar at NYU Stern School of Business--the study builds on past research finding people's racial prejudice "leaks out" through nonverbal behavior, such as facial expressions or physical distance. In a series of experiments published in the Journal of Experimental Social Psychology, the researchers looked at perceptions based solely on written content.

They selected a group of white participants, screening out the small percentage who expressed overt prejudice, and scored subjects' racial attitudes with two widely used assessments. The subjects were then asked: "Do you believe that all people are equal and should have equality of opportunity? Why or why not?," and "Are you prejudiced toward Black people? Why or why not?" A second group of white participants, asked to read the written responses, accurately estimated how the writers had scored on the prejudice scale.

Linguistic cues

In a second experiment to parse out whether people were signaling racial attitudes intentionally or inadvertently, they asked one group to answer as honestly as possible and another group to answer "in the least prejudiced way possible." There was no difference to the readers, who accurately scored both groups' answers.

"That gave us some confidence that people are naturally trying to come across as egalitarian, but something about the language they choose is betraying them," Rosenblum said.

What were those linguistic cues? The most powerful indicator, they found, was language that dehumanized or objectified African Americans--for example, "I have a great relationship with the Blacks." Other characteristics such as defensiveness, references to personal responsibility, or a belief that equal opportunity exists were strongly associated with higher levels of prejudice, and cues such as focus on equity or an acknowledgement that inequality exists were associated with lower levels of prejudice. Interestingly, references to being colorblind or mentions of personal contact with Black people weren't indicative of the white participants' attitudes.

"This demonstrates that peoples' use of the cues are meaningful not only for how prejudice is expressed, but also how egalitarianism is perceived," said Brown.

Contagion effect

A third experiment had a sobering result. The researchers found that white participants reported greater prejudice towards Black people after reading statements from the self-avowed white egalitarians who scored high on underlying prejudice. In other words, the readers mirrored the attitudes of the writers, even when they identified themselves as ideologically dissimilar (conservative vs liberal).

"We don't know reading other people's views gave them permission to express more prejudice, or whether they thought that this is the norm and their actual prejudice level changed, but there seemed to be a contagion effect," Rosenblum said. "One of the lessons here is that words carry weight. It does seem that this is one way that prejudice is unwittingly spread."

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*This study was first made available online in February 2021 ahead of publication in the May 2021 issue of the Journal of Experimental Social Psychology.

 

For neuroscientists and researchers in general, a checklist for eliminating gender bias

Changing mindsets is key, so that everyone, including men, are vocal advocates for women

UNIVERSITY OF CALIFORNIA - BERKELEY

Research News

In 2019, Anaïs Llorens and Athina Tzovara -- one a current, the other a former University of California, Berkeley, postdoctoral scholar at the Helen Wills Neuroscience Institute (HWNI) -- were attending a scientific meeting and pleased that one session, on gender bias in academia, attracted nearly a full house. The problem: The audience of some 300 was almost all women.

Where were the men, they wondered? More than 75% of all tenured faculty in Ph.D. programs around the world are men, making their participation key to solving the problem of gender bias, which negatively impacts the careers, work-life balance and mental health of all women in science, and even more so for minority women and members of the LGBTQ+ community.

"If they are not on board, and they don't feel that this is also their fight, then nothing will change," Llorens said.

That was only one of the incidents that led the two women to round up 45 men and women from 40 institutions across 10 countries and 18 nationalities, divide them into small groups and task them with scouring the literature for practical tips -- proven and unproven -- on how best to counteract all aspects of gender bias in academia. The study, with Llorens and Tzovara as first authors, appears today in the journal Neuron, and provides a comprehensive summary of the many forms that gender bias takes, along with a checklist that individuals, lab leaders, university administrators, journal editors and grant reviewers at funding agencies can use to remedy them.

Both women thank their mentor, Bob Knight, a UC Berkeley professor of psychology and neuroscience in the HWNI, for his enthusiastic support of women researchers and of their project, which they admit was substantially different from their main fields of research: how the brain deals with language and conscious perception of the environment. But as the two women transition to the next stages of their careers -- Tzovara, originally from Greece, left two years ago to become an assistant professor at the University of Bern in Switzerland, while Llorens, who is French, is finishing up her postdoctoral research at UC Berkeley -- they wanted to leave a legacy for women who follow them in neuroscience.

In a Q&A, Llorens and Tzovara talk about their motivations and the problem of gender bias in the ivied halls.

What drove you to undertake this year-long project?

Llorens: The starting point was at the end of 2019, when we went to a neuroscience conference, a big one, and we talked with many of our women colleagues and realized how many of us were struggling to find a correct balance between having a family, a life, and also finding a permanent position. In science, you often have to move abroad, for most of us in Europe, especially, and it is a long process before you can settle down and find a permanent position.

Then, at this very same conference, we attended a workshop on how to strive as a woman in neuroscience, and we really felt the discrepancy between what we were actually living as scientists and what the panelists were telling us. There were five successful women who managed to have a perfectly balanced life, with 300 women listening. When we came out of the room, we felt like we were the issue, because, obviously, they made it. Maybe we are the problem?

Tzovara: There is this notion of survivorship bias -- often we look at people who have made it, and we forget all the people who did not have a straightforward career path and are not there yet. That helped us to identify this gap between what others described, and what we experienced ourselves, and realize that the more we talk about bias, the more interest we find from men and women. That is why we wanted to give voice to all these discussions that we had among ourselves and write them down, hoping that these will be the beginning of a bigger conversation.

Llorens: After that workshop, I felt that had I wasted my time, because nothing will change by simply listening to successful women, if I may say so; we need more than that to actually see some improvements. That is why, for us, it was important to have as many men on board in this project who felt concerned and also wanted to fight for equity. It is something we need to discuss together.

Hasn't the situation improved for women in STEM fields over the past generation?

Llorens: Absolutely. We can really see improvement in many aspects of science. In many countries, between 20% and 25% of women are professors. We can also see progress in preventing sexual harassment. It is better, but we are far from equity. It is still not safe enough and still not equal enough.

Tzovara: I've observed improvements even in the last five or 10 years. These days, if there are conferences that have men-only panels, they will be called out. If there are journals where the editorial board is composed exclusively of men, they will be called out. So, there is concrete change compared to some years ago. I think it might be like a cascade effect -- the more we talk about bias, the more people are aware of it, the more we can realize that we need to take action. All this together has the power to bring positive change.

Llorens: But now some people think, "Ok, there is some improvement, so maybe we don't need to work as hard to make things better." And that is a problem, because equity won't just come magically; we need to keep working on it. And that is also an issue when we talk to people and they say, "It's better, it is just a matter of time." No, it isn't, actually. It is a matter of people making that change. We still need actions to make things right. There is progress, for sure. We are moving in the right direction. But we need to keep making the effort.

You provide many suggestions, but one is having a gender target in grants to improve equity, which some people -- women, as well as men -- might object to in the same way that people have objected to affirmative action for people of color.

Llorens: We advocate for a more equitable distribution of funding. Funding agencies should make an extra effort to insure a fairer distribution of the resources between genders. That said, during my career, I was hired through a grant promoting diversity by potentially hiring a woman, and I must admit when I read that I wondered, "Did I get the job because I was the best applicant or because I was a woman?" That is the tricky thing with positive actions: We still need them, as academia is still imbalanced for now, but we must somewhat force it. But I also had to work on my own self-esteem to understand that this is the way that things have to be done. It is not because I am not good, but it is just because we have to make things right.

Tzovara: Sometimes it is just about giving the right opportunities to people who are not traditionally represented in academia and then giving them some space. And that can often be enough by itself to let individuals that are traditionally underrepresented shine.

Do men suffer from the same pressures when trying to succeed in academia?

Tzovara: That reminds me of a discussion we had with one of our men co-authors who was trying to understand the way that women experience science. He, too, felt that he had experienced similar issues: difficulties moving abroad or difficulties with his family. But as women, we experience it much, much worse. Sometimes bias and discrimination or micro- and macro aggressions pile on top of the usual challenges associated with working in science.

Llorens: Biology is different. Men don't feel the same pressure as we do because, for us, literally, everything happens at the same time. In this window between 28 and 36 years of age, we need to find a position, but this is also when we have to be the most mobile, and it is the right age to build a family. For men, they can wait. It is challenging for everyone to keep relationships, but it is not the same pressure.

If you had to prioritize the most important interventions for reducing gender bias, where would you start?

Llorens: There are existing tools that people can use to mitigate bias pretty easily. For instance, regarding equitable citations in journal articles or in syllabi for teaching. These are easy actions that can be taken right now to make things better, and they are already known to be valuable.

For me, the biggest challenge, and I think the most impactful, would be to change mindsets. Everyone needs to be on board with this topic to make real change. If men are on board, then we will have allies at the top, because most of the leaders are men. We also need more action around sexual harassment. Stopping sexual harassment is everyone's job, of course, but the leaders need to be strict and clear with sexual harassment policies; they have to lead by example. Change has to come from the top. It is really important to make the working environment safe.

Tzovara: There are so many different things that we can do, and I think everybody should do both the smaller and the larger things. If they see injustice or bias, they should speak up. If someone is representing an institute, like a university or funding agency, they should make sure that the work of the institute represents equity. They should make sure that funding is equally distributed, that the institute doesn't only hire men, that promotions take gender bias into account, and so on. If someone has the power to change society and change mindsets, they should start working on that. And that is the message we tried to convey with this manuscript, where we split the suggested solutions into three levels of individual, institutional and societal to show that everybody has a responsibility, depending on their position and abilities.

Llorens: And also removing the burden that we have as women. On top of having to represent ourselves as women, we have to be part of committees and to add some extra work to represent women in science. If we can have everyone on board, meaning everyone advocates for underrepresented groups, even though they are not part of a one of those groups themselves, then the burden will be shared, and it will become easier for everyone. For me, that will be the most impactful action, for everyone to be more aware of these issues and take a stand and help us with that.

I also think that transparency is key. For instance, institutions must be transparent regarding negotiations, such as about the scale you can ask for salaries. The institution has to make things easier for everyone to navigate academia, to be honest. And because most of the biases are implicit, we need to call them out and make them explicit because many people think that they are not biased. I feel like I, too, am part of the problem. I have my own biases, everyone has their own bias. But I think acknowledging them, making them explicit, is also a step forward that people need to take.

How would you characterize UC Berkeley's response to gender bias?

Llorens: I think the way that they advertise now for positions -- making it mandatory to have women applicants -- is a good step forward. It means that the department has to actually do research when they are hiring for a position. When we talk now with students about gender bias, some of them are worried that if we do that, it means that we might need to go for someone who is not the best candidate. When I mentioned this to Bob Knight, who has been part of recruiting committees for many, many years, he said that the fact that you actually have to look for a broader pool of people you might not have thought of before was actually a good thing, that they never, ever chose someone that wasn't the top choice. For him, it didn't change the way he was recruiting people, it only diversified and increased the pool of subjects. The best candidate was offered the job. It just might not have been the best person they thought about before.

Also, in the past few years UC Berkeley has done a good job of increasing awareness of sexual assault and sexual harassment. The kinds of services and help offered by the university, including the Path to Care Center, for example, I found really interesting. Not all institutions have that. I also would add that UC Berkeley has really tried to raise awareness about women in science this year with the emphasis on 150 Years of Women at Berkeley. It is always important to try to raise awareness of this topic.

But UC Berkeley is a bubble.

Tzovara: And the lab we were in is a bubble within a bubble. I think I speak for a lot of people in the lab that we felt secure that, if something happened, Bob would have our backs. It is very important for members of any institution or individual lab to know that their mentors have their backs and speak up when they see injustice.

Llorens: You know the imposter syndrome -- it impacts women and men, but mostly women. When you have a PI who makes sure you are in a safe environment and makes you feel like you can do it, it helps a lot. It is not like that in many places, to be honest with you. Bob and Nina Dronkers (an adjunct professor of psychology who also is a co-senior author of the paper) were wonderful mentors.

How did you put together these checklists?

Tzovara: We wanted to base the paper on data. We read a lot -- we have almost 300 references in the paper -- and tried to back up everything with science and describe what worked and what didn't in remedying gender bias. We wanted to give examples of which of the proposed solutions can work and have been actually tested, and which are implemented in some parts of the world, but may still have uncertain results. The goal is to start from there and see what can be done to improve things on the individual, institutional and societal level.

What are your hopes for this paper?

Llorens: We want this paper to be disseminated widely and across different borders in academia. We are also now giving workshops at various scientific meetings and talking to undergraduate students.

Tzovara: Other activities that we plan to pursue include organizing mentoring seminars for women in science. One of the next steps is to also reach out to even younger ages. We would like to start talking about bias to young students in schools when their mindsets are still being shaped, in order to have an impact on the next generation.

Llorens: Gender bias is a sensitive topic, but we just want to get the discussion rolling. Hopefully, we can do a follow-up study in five years and say which suggestions worked to mitigate gender bias, and keep making progress on that topic so that we will end up with a checklist that each lab can refer to.

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'Fortunate accident' may yield immunity weapon against antibiotic-resistant bacteria

Johns Hopkins Medicine study uncovers enzyme inhibitor that boosts immune system to fight MRSA and other dangerous skin infections

JOHNS HOPKINS MEDICINE

Research News

IMAGE

IMAGE: SCANNING ELECTRON MICROGRAPH OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) BACTERIA BEING ENGULFED BY AN IMMUNE CELL KNOWN AS A NEUTROPHIL. JOHNS HOPKINS MEDICINE RESEARCHERS HAVE DISCOVERED THAT BLOCKING A SPECIFIC GROUP... view more 

CREDIT: NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES, NATIONAL INSTITUTES OF HEALTH

FOR IMMEDIATE RELEASE

In what turned out to be one of the most important accidents of all time, Scottish bacteriologist Alexander Fleming returned to his laboratory after a vacation in 1928 to find a clear zone surrounding a piece of mold that had infiltrated a petri dish full of Staphylococcus aureus (S. aureus), a common skin bacterium he was growing.

That region of no bacterial growth was the unplanned birth of a medical miracle, penicillin, and would lead to the era of antibiotics. Now, in a paper published today in the journal Science Translational Medicine, researchers at Johns Hopkins Medicine have announced another accidentally discovered, potentially game-changing treatment -- one that may one day provide an alternative immune-based solution to the danger of antibiotic-resistant bacterial infections.

And like Fleming's surprise finding, the bacterium of note is once again S. aureus -- but this time, methicillin-resistant Staphylococcus aureus, the life-threatening strain unharmed by methicillin and other antibiotics, and better known by its acronym, MRSA.

The paper's senior author, Lloyd Miller, M.D., Ph.D., former professor of dermatology, infectious diseases and orthopaedic surgery at the Johns Hopkins University School of Medicine, and now with Janssen Research and Development, says the research team was originally intending to study the mechanisms behind MRSA skin infections in mice with and without the ability to manufacture interleukin-1 beta (IL-1β). This protein, transformed into its active form by enzymes called caspases, enhances protective immunity by helping immune cells called neutrophils, monocytes and macrophages fight bacterial infections.

"We gave the mice a blocker of all caspases [pancaspase inhibitor], a compound known as Q-VD-OPH, thinking it would leave both sets of mice more vulnerable to MRSA infection," Miller says. "To our surprise, blocking caspases had the opposite effect, resulting in a rapid and remarkable clearing of the MRSA bacteria by keeping the immune cells alive and boosting their protective function."

Sensing they might have accidentally uncovered a means of fighting bacterial "superbugs," Miller and his colleagues conducted their latest study to confirm the unexpected finding was not a fluke.

The results were encouraging.

"A single oral dose of Q-VD-OPH decreased the size of MRSA skin lesions and rapidly cleared the bacteria compared with vehicle-treated [given the carrier solution without Q-VD-OPH] and untreated mice," says study lead author Martin Alphonse, Ph.D., a dermatology postdoctoral fellow at the Johns Hopkins University School of Medicine. "And surprisingly, the treatment worked whether IL-1β was present or not -- and without administering any antibiotics."

The researchers, says Alphonse, found that the pancaspase inhibitor reduces apoptosis -- one of three main methods the body uses to remove worn-out or damaged cells -- of neutrophils and monocytes, leaving them in plentiful numbers and better able to remove MRSA bacteria.

"It's like a fire department where older firetrucks are kept operating to help put out blazes, when otherwise, they would have been taken out of service," says Miller.

The researchers also saw enhanced necroptosis -- a second controlled cell death process similar to apoptosis -- of macrophages, which are mature monocytes.

"The destruction of macrophages by necroptosis releases large amount of tumor necrosis factor, or TNF, a protein that triggers bacteria-fighting immune cells to swarm into an infected area of skin," says Alphonse.

Finally, the researchers tested whether Q-VD-OPH in mice could have broader activity against two other dangerous skin bacteria, Streptococcus pyogenes (the cause of multiple diseases, including scarlet fever, necrotizing fasciitis and toxic shock syndrome) and Pseudomonas aeruginosa (often a threat to hospitalized patients on ventilators, with catheters or suffering wounds from surgery or burns). The targeting of the body's immune system against bacteria via pancaspase inhibition -- referred to as "host-directed immunotherapy" -- proved just as successful as it had been for MRSA.

"It was an accidental finding by Alexander Fleming that led to the golden age of antibiotics, but now that's nearing the end because of antibiotic-resistant bacteria," says Miller. "It seems fitting that another surprise in the lab could be the start of a second golden age, the use of host-directed immunotherapy," says Miller.

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Along with Miller and Alphonse, the Johns Hopkins Medicine research team includes Jessica Rubens, Roger Ortines, Nicholas Orlando, Aman Patel, Dustin Dikeman, Yu Wang, Ivan Vuong, Daniel Joyce, Jeffrey Zhang, Mohammed Mumtaz, Halyun Liu, Qi Liu, Christine Youn, Garrett Patrick, Advaitaa Ravipati, Robert Miller and Nathan Archer.

Data from this study were included earlier this year in a U.S. patent application (PCT/US2021/024889) through Johns Hopkins Technology Ventures for "caspase inhibition as a host-directed immunotherapy against bacterial infections."

The work was supported by grant T32AI052071 from the National Institute of Allergy and Infectious Diseases, and grants R01AR073665 and R01AR069502 from the National Institute of Arthritis, Musculoskeletal and Skin Diseases.

Miller is a full-time employee of Janssen Research and Development; has received grant support from AstraZeneca, Pfizer, Boehringer Ingelheim, Regeneron Pharmaceuticals, and Moderna Therapeutics; holds stock from Johnson & Johnson and Noveome Biotherapeutics; and was a paid consultant for AstraZeneca, Armirall and Janssen Research and Development, which are all developing therapeutics against S. aureus and other pathogens.

None of the other authors have financial disclosures or conflicts of interest related to this study.