Thursday, May 01, 2025

 

New study highlights success of financial toxicity tumor board in reducing cancer treatment costs 



Atrium Health Levine Cancer researchers conducted a five-year analysis of its Financial Toxicity Tumor Board, which was designed to alleviate financial burden on patients 



Atrium Health Wake Forest Baptist





CHARLOTTE, N.C. – April 29, 2025 – Financial toxicity, the financial distress linked to cancer treatment, significantly impacts patient outcomes. To combat this, the Atrium Health Levine Cancer Institute established a Financial Toxicity Tumor Board in 2019. 

The board is the first known institutional-level intervention of its kind, functioning like a traditional disease-focused multidisciplinary tumor board, but with a singular focus on financial distress. It includes participants from all areas of the cancer center including clinical, supportive and administrative domains. 

A new study published online in the Journal of the National Comprehensive Cancer Network analyzes the board’s impact over the past five years. 

“Financial toxicity significantly impacts the quality of life and overall well-being of cancer patients. It has also been linked to reduced treatment effectiveness and an increased risk of death,” said Thomas G. Knight, M.D., chair of the Financial Toxicity Tumor Board, oncologist at Atrium Health Levine Cancer, and clinical associate professor in the division of hematology and oncology at Wake Forest University School of Medicine

The board consists of two main parts. The first involves participant referrals, made by patients, family members, caregivers, physicians, nurses, social workers, financial counselors, pharmacists and staff.  The second part involves the Patient Assistance Program, which was created to systematically review each new treatment plan to see if patients qualify for free medication or help with copays. Pharmacy technicians also assist with this process.  

Key findings from the study include: 

  • Over 70 cases were presented to the tumor board with over 90% resulting in immediate solutions for individual patients and systemic changes. 

  • 9,321 patients were assisted with copay assistance, totaling over $10 million in savings to the patients. 

  • 16,495 patients received free drugs, valued at nearly $393 million.

The board established a process for patients to apply for grants from various foundations and nonprofits. Financial navigators kept records of available grants and assisted patients with applications, providing financial relief to many struggling to afford treatments. 

The board also addressed denied health insurance claims, investigating reasons for denials and advocating for patients. This led to many claims being approved, ensuring necessary coverage without financial hardship. 

"To show the uniqueness of our model, consider a patient who loses their employer-based insurance because they are unable to work. There’s difficulty paying for treatment, transportation and household expenses,” Knight said. “After the case is presented, the board obtains transportation, food and expense grants, in addition to COBRA.” 

Knight also highlighted how helping one patient can help others. 

“The real value of this model is that all stakeholders are in the room together and can recognize this is a foreseeable problem for other patients with a similar circumstance,” Knight said. “We can then form a workgroup to identify patients in those similar circumstances and intervene before they get into a crisis.” 

Knight said that the out-of-pocket cost savings for patients justify the need for other cancer centers to explore this same approach. 

“Our analysis shows that focused systemic intervention on financial toxicity can lead to substantial improvements,” Knight said. “This model should become a new standard of care to improve the financial well-being of cancer patients.” 

 

Missed school is an overlooked consequence of climate change




Stanford UniversityFacebook





In brief:

·  Exposure to tropical cyclones during early childhood significantly reduces school enrollment.

·  The effect is greater in areas unaccustomed to frequent storms.

·  Girls shoulder an uneven share of the burden.

·  Possible solutions include increased investment in disaster preparedness, resilient infrastructure, and community-based adaptation programs.


New Stanford-led research sheds light on an overlooked climate consequence: the impact of tropical cyclones on schooling opportunities and education in low- and middle-income countries. The study, published April 29 in Proceedings of the National Academy of Sciences, reveals how children in the path of hurricanes are set back in their schooling, particularly in areas unaccustomed to frequent storms, with girls shouldering an uneven share of the burden. The findings identify a new pathway by hurricanes and tropical storms – which together are called “tropical cyclones” – get in the way of social development. It also identifies where and to whom efforts should be directed to mitigate those harms.

“There’s a sweet spot – or maybe I should say a sour spot – where cyclones are intense enough but also rare enough to wreak havoc that causes children to lose out on the opportunity to attend school,” said study senior author Eran Bendavid, a professor of medicine and health policy in the Stanford School of Medicine and a senior fellow at the Stanford Woods Institute for the Environment. 

A growing threat to education

Tropical cyclones are rotating systems of clouds and thunderstorms that produce strong winds and heavy rain. Estimates of impacts of tropical cyclones are often regional rather than global and do not consider population vulnerabilities. 

As the climate continues to warm, the frequency of stronger tropical cyclones is expected to rise, amplifying their already significant impact on vulnerable populations. These powerful storms can damage school buildings and roads leading to them, as well as dwellings, displacing children or making it necessary for them to help out with home repairs.

The research team analyzed schooling records of over 5.4 million people across 13 low- and middle-income countries hit by tropical cyclones between 1954 and 2010. The findings are stark: exposure to any cyclone at preschool age (around 5 or 6 years old) is associated with a 2.5% decrease in the likelihood of starting primary school, and as much as an 8.8% decrease after intense storms in communities less accustomed to such events. In the past 20 years, tropical cyclones have prevented more than 79,000 children in the study’s 13 low- and middle-income countries from ever starting school, according to the study. Across all affected students, these storms have resulted in a total loss of 1.1 million years of school.

The findings show that girls are disproportionately affected. This gender disparity further exacerbates educational disparities in low- and middle-income countries, and may reflect mechanisms such as being kept away from school to help with household needs in the wake of a storm.

Communities with low schooling rates, where education is often given less priority, also suffer more. In these areas, the study found significant decreases in enrollment, further widening the gap in educational attainment between populations where education is prioritized and those where it is not.

“Education is key to personal development, but tropical cyclones are depriving vulnerable populations of the opportunity to go to school,” said study lead author Renzhi Jing, a postdoctoral scholar in the Stanford School of Medicine and an affiliated researcher at the Stanford Woods Institute for the Environment. 

Consequences and solutions

Children who were exposed to tropical cyclones are less likely to complete primary school, enroll in secondary school, and are more likely to experience reduced years of schooling, the researchers point out. This not only limits their future economic opportunities but also perpetuates cycles of poverty and inequality in regions already struggling with these issues.

Interestingly, the study revealed that regions more frequently exposed to tropical cyclones tend to have smaller declines in school enrollment. This suggests that communities with regular cyclone exposure may have developed some level of adaptation, whether through improved infrastructure, better preparedness, or more resilient social systems. However, in regions where cyclones are rare, the lack of such adaptive measures makes the impact of these storms much more severe, highlighting the need for targeted disaster risk reduction and adaptation strategies.

The study’s findings underscore the urgent need to address the educational impacts of climate change, particularly in the world's poorest regions. As the frequency and severity of tropical cyclones increase, so too will the number of children whose education is disrupted. Policymakers and international organizations need to prioritize the protection of educational infrastructure and support systems, particularly for girls, according to the study’s authors.


Stanford co-authors also include Sam Heft-Neal, a research scholar at the Stanford Center on Food Security and the Environment, and Minghao Qiu a postdoctoral scholar affiliated with the Stanford Center for Innovation in Global Health and the Stanford Doerr School of Sustainability. Additional co-authors are from the Rand Corporation and Princeton University. Bendavid is also a member of Stanford Bio-X and the Maternal & Child Health Research Institute, and a faculty affiliate of the Institute for Human-Centered Artificial Intelligence.

The research was funded by the National Institutes of Health, the Katharine McCormick Advanced Postdoctoral Scholar Fellowship, and the Planetary Health Postdoctoral Fellowship

 

New method precisely calculates how mangroves protect coasts against strong waves



Royal Netherlands Institute for Sea Research



Imagine a natural fortress standing strong against raging storms. That’s what mangroves and other forested wetlands do for our coastlines. But how well do they protect us, and against which storms? Researchers from Sun Yat-Sen University, China and the Royal Netherlands Institute for Sea Research (NIOZ) have uncovered a new and easy method to predict the effectiveness of these natural barriers during extreme weather events. This is an important new insight and tool for coastal managers and policymakers.

We have long known that mangroves and other forested wetlands can act as natural shields against floods. But when it comes to extreme storms, we haven’t had a clear picture of just how well they work. The available models for predicting how much these forests can reduce wave heights are often too complicated for many coastal managers to use. Plus, figuring out the right numbers to plug into these models—especially in extreme conditions—is a tough nut to crack. 

New way to measure protection
To tackle this, a team of international researchers gathered data from some of the biggest waves ever recorded in forested wetlands. They looked at waves during a typhoon in China, as well as data from labs and other field studies around the world. What they found is remarkable: mangrove forests of about 100 m width can half the storm wave height. That’s a significant lowering of the waves, giving quite some protection to the coast line behind the mangrove forest. 

But that’s not all. The team tested 20 different ways to calculate the drag that trees create against water wavy motions. Most of these methods couldn’t predict wave attenuation in storm events. So, they came up with a new, easy-to-use method they called the HU method. “This method doesn’t need complicated numbers or detailed tree measurements,” says lead researcher Zhan Hu. “It’s simple enough that coastal practitioners or volunteers with a few existing measurements can use it to figure out how well their local forested wetlands can protect against waves.”

Saving coasts as well as money
“This study is a big deal for coastal protection” says Tjeerd Bouma, researcher at the Royal Netherlands Institute for Sea Research (NIOZ) who also worked on the project. “The HU method gives coastal managers and scientists a practical tool to assess how well their local forests can reduce wave heights during storms. This can help in designing natural coastal defenses, potentially saving billions of dollars worldwide.”
“Plus, the study reminds us how important it is to protect and restore mangroves and other forested wetlands like willows,” Bouma adds. “They’re not just wave-blockers; they also capture carbon, provide habitats for wildlife, and clean our water.”

Wave non-linearity
“No, the method is not named after me”, laughs Prof. Zhan Hu. “The name rather reflects the approach that is based on the relation between wave height ‘H’ and Ursell number U, which is an index for wave nonlinearity”. In a nutshell, this method works as the wave attenuation is closely linked to the nonlinear wave effect, which is depicted by the HU relations. And the same HU relation can be applied for both calm and storm weather conditions. The novel methods use the same HU relation in calm weather (but highly nonlinear) to predict the wave height attenuation during storm events, and bypassing the need of quantifying drag. 

Other wetlands and coastal areas
While the HU method is a great start, the researchers know it’s not perfect. It works best for specific types of rigid, above-ground forests. Future work will focus on making the HU method work for different kinds of wetlands and coastal areas. They also want to explore what happens when trees start to sway in the wind and how much wave reduction is possible.

“In short, this research is a huge step forward in understanding how nature can protect our coasts,” concludes Hu. “The HU method offers a new way to predict wave reduction during extreme storms, opening the door to more sustainable coastal management.”

The full paper was published in journal PNAS, and can be read at: https://doi.org/10.1073/pnas.2410883122

 

How baby pigs are shaping science




University of Illinois College of Agricultural, Consumer and Environmental Sciences

Feeding style affects growth in baby pigs 

image: 

University of Illinois Urbana-Champaign researchers Kaitlyn Sommer (left) and Ryan Dilger (right) studied the effect of feeding style on growth of piglets, leading to insights for both production agriculture and biomedical studies using the pig model.

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Credit: University of Illinois Urbana-Champaign





URBANA, Ill. -- When piglets don’t get enough milk in the first weeks of life, the chances of them thriving dramatically decline. In the U.S. pork production system, piglets with limited access to their mothers’ milk are typically “cross-fostered” with other sows. But in the E.U., a different solution is gaining ground. In certain circumstances, underfed piglets are artificially reared with milk replacer, mimicking feeding setups used in biomedical research.

A new study at the University of Illinois Urbana-Champaign asks a deceptively simple question: what is the best way to feed artificially reared pigs? The answer has implications not just for agriculture, but for biomedical research where pigs are used to study different aspects of human medicine. 

“The main driving factor for this study was to bridge the gap between the agriculture and biomedical worlds,” said lead study author Kaitlyn Sommer, a doctoral researcher in the Department of Animal Sciences, part of the College of Agricultural, Consumer and Environmental Sciences at Illinois. By testing different feeding strategies, researchers can better understand how nutrition early in a pig’s life can affect their growth, metabolism, behavior, and overall welfare. 

In this study, 85 piglets were weaned at two days of age and reared individually with a nutritionally complete milk replacer. Half of the piglets were able to drink milk freely (known as ad libitum or free choice feeding), while the other half received carefully measured doses based on body weight, mimicking the frequency and quantity a piglet would get from a sow. Over the 15-day feeding study, the team tracked everything from the piglets’ body weight, insulin concentration, behavior, and even soft tissue composition.

The results were striking. “Ad libitum pigs drank more milk overall and gained more weight,” Sommer said. However, there were no significant differences in the soft tissue composition between the two groups at the conclusion of the study. Researchers found that the body fat and muscle protein content were comparable between the ad libitum and “prescribed feeding” piglets. The main distinction was in how quickly they grew. 

“When we compare how much milk they consumed relative to their body weight, both the ad libitum and prescribed feeding groups consumed similar amounts,” Sommer said. “This suggests that ad libitum pigs are simply growing faster, possibly due to differences in insulin production.”

One important measurement during this study was the insulin concentration in the piglets’ bloodstream. “Insulin is a big part of directing amino acids, which are the building blocks of protein,” said Ryan Dilger, senior study author and professor in animal sciences at Illinois. “Piglets ingest amino acids in the form of protein, and insulin is responsible for directing these amino acids toward building skeletal muscle.” 

Sommer explained that piglets in the ad libitum group ate larger, less frequent meals. This led to prolonged periods where their insulin levels were above the threshold needed to trigger muscle growth. In contrast, the pigs on the prescribed feeding schedule ate more frequent meals, but they consumed smaller volumes of milk every hour. While this schedule more closely resembles milk letdown from the sow, the insulin concentration in these piglets did not always reach the anabolic threshold, which is where the muscle building takes place. 

In addition to muscle growth and insulin concentration, the team also tracked how the pigs moved around their enclosures. Using high-tech cameras and automated tracking systems, researchers were able to analyze the preferred location of the piglets. “The prescribed-feeding pigs spent more time near the milk bowl and showed more feeding-related behaviors,” Sommer said. “This suggests that the extra time artificially-reared pigs spend near the feeding bowl, and display behaviors like rooting or nosing, might be driven by their natural instinct to nose and suckle at the sow’s teat – an action known to encourage milk production.”

And yes, there were toys. In the second trial, piglets were provided enrichment including toys and towels, and they grew particularly attached to them. “They’d snuggle up with them, and get upset when we took them out for cleaning,” Sommer said. 

While the image of a piglet curled up in a towel may sound adorable, the science is both practical and applicable. In production agriculture, understanding how milk access affects behavior could help reduce piglet crushing risk. Hungrier piglets may stay closer to the sow, increasing their likelihood of getting hurt. In the lab, these findings can help researchers fine-tune artificial feeding protocols for pigs being raised to improve biomedical research. This is increasingly important, as pigs are often used as a model for studying human nutrition and health. Due to their genetic similarities to humans, pigs offer insights that mice and other species cannot. “We particularly use pigs to study parts of the gastrointestinal tract, parts of the immune system, and in our lab specifically, brain function,” Dilger said. 

“Every study opens the door to new questions. What really stood out in this work is just how much the way we feed pigs can influence everything else we’re trying to measure,” Dilger said.

The goal is to continue to bridge the gap between the agricultural and biomedical applications of raising piglets. With future studies exploring additional behavioral and physiological outcomes, the team hopes to continue to refine piglet-rearing strategies. “There is still so much to learn,” Sommer said. “But, every piece brings us closer to understanding how management practices early in life can help piglets thrive, and get them started in the right direction.” 

The study, “Feeding style alters the growth and behavior of artificially-reared pigs,” is published in the Journal of Animal Science [DOI:10.1093/jas/skaf098]. Authors include Kaitlyn M. Sommer, Loretta Sutkus, Pradeep Senthil, and Ryan N. Dilger. 

Dilger is also affiliated with the Division of Nutritional Sciences, the Neuroscience Program, the Beckman Institute for Advanced Science and Technology, the Center for Digital Agriculture, the National Center for Supercomputing Applications (NCSA)the Carl R. Woese Institute for Genomic Biology, the Illinois Institutional Animal Care and Use Committee (IACUC), and the Office of the Vice Chancellor for Research and Innovation.  

Disclaimer: AAAS and Eurek

 

Electroactive biofiltration dynamic membrane: A new hope for wastewater treatment


Higher Education Press
Graphical abstract 

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Graphical abstract

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Credit: Chengxin Niu et al.




A recent study published in Engineering presents a novel approach to wastewater treatment and membrane fouling mitigation. The research, led by Zhiwei Wang from Tongji University, focuses on the development of an electroactive biofiltration dynamic membrane (EBDM).

The increasing scarcity of freshwater resources and the need for more efficient wastewater treatment have driven the search for innovative solutions. Anaerobic membrane bioreactors (AnMBRs) have shown promise, but membrane fouling remains a significant challenge. Dynamic membranes (DMs) can help, but their fouling layer growth needs to be better managed. The EBDM aims to address these issues by integrating an electric field into the DM system.

The researchers established an anaerobic conductive dynamic membrane bioreactor to study the EBDM system. They compared an electrochemical anaerobic dynamic membrane bioreactor (E-AnDMBR) with a control anaerobic dynamic membrane bioreactor (C-AnDMBR) over a 240-day period. The E-AnDMBR was operated with an applied voltage, while the C-AnDMBR functioned without voltage.

The results were remarkable. The EBDM in the E-AnDMBR exhibited an ultralow fouling rate, with a transmembrane pressure of less than 2.5 kPa throughout the operation. It achieved a high COD removal efficiency of over 93% and maintained a turbidity of around 2 NTU in the effluent. Moreover, the methane productivity in the E-AnDMBR was 7.2% higher than that in the C-AnDMBR.

Morphological analysis revealed that the EBDM acted as an efficient biofilter with an ordered-clogging and step-filtered structure. The electric field modified the physicochemical properties of the biomass, reducing the fouling potential. For example, it decreased the zeta potential of the sludge, increased the floc size, and reduced the viscosity and EPS concentration.

The EBDM also had a significant impact on the microbial metabolism. Metagenomic sequencing showed that continuous electrical stimulation promoted the development of an electroactive fouling layer with enhanced microbial metabolic functionality. It increased the relative abundance of Geobacter on the anode, which facilitated extracellular electron transfer and methane production.

This study demonstrates that the EBDM system is a promising technology for wastewater treatment. It effectively controls membrane fouling, enhances effluent quality, and improves methane productivity. The findings contribute to a better understanding of the interactions between electric fields and electroactive biofilms, providing a new option for enhancing membrane performance in wastewater treatment systems.

The paper “Development of Electroactive Biofiltration Dynamic Membrane (EBDM) for Enhanced Wastewater Treatment and Fouling Mitigation: Unraveling the Growth Equilibrium Mechanisms of Fouling Layer,” is authored by Chengxin Niu, Wei Shi, Zhouyan Li, Zhiwei Qiu, Yun Guo, Zhiwei Wang. Full text of the open access paper: https://doi.org/10.1016/j.eng.2025.02.003. For more information about Engineering, visit the website at https://www.sciencedirect.com/journal/engineering.

 

Pediatric investigation review discusses the challenges, innovations, and future directions in dengue vaccine development


The review details the historical and current status of dengue vaccine development, underscoring key themes of future research


Pediatric Investigation





Dengue fever caused by a flavivirus named DENV is a major global health challenge, risking almost half of the world’s population. Since the early 20th century, the scientific community has faced multiple challenges to develop effective dengue vaccines. This spanned a variety of techniques – from the use of ox bile to weaken DENV to the chemical processing of DENV-infected mosquitoes! However, the limitations of these techniques and the urgent need to save millions of people from the infection in its endemic regions, led to the development of more sophisticated dengue vaccines.

In a recent review published in Pediatric Investigation on 15 April 2025, lead authors Professor Kevin C. Kain from the University of Toronto, Canada, and Dr. Ran Wang, Associate Professor at the Capital Medical University, China, discuss the current status and implications of dengue vaccines like CYD-TDV, TAK-003, and Butantan-DV while exploring the challenges in Dengue vaccine development like ADE, and proposes future directions in this field.

DENV has four serotypes (DENV-1 to DENV-4) and triggers both protective and pathogenic immune responses. Serotype-specific immune responses are typical when infected for the first time, whereas secondary infection may lead to more severe dengue due to ADE. “ADE is initiated when immune complexes of DENV and IgG antibodies bind to Fcγ receptors (FcγR) on myeloid cells. This suppresses antiviral defenses and enhances viral replication,” explains Professor Kain. This is an important aspect to consider while designing vaccines for dengue.

The review draws from insights and implications from three Dengue vaccines—CYD-TDV (Dengvaxia) was the first licensed dengue vaccine and showed efficacy in phase III clinical trials. However, it was found to have reduced protection against DENV-1, DENV-2, and DENV-3. Moreover, this vaccine was only recommended for individuals with confirmed prior DENV infection, limiting its practical application. Further, vaccination regime of three doses over 12 months, was particularly difficult to achieve in resource-limited settings. Due to these reasons, CYD-TDV was withdrawn from widespread use, although the WHO still recommends it for individuals aged 9-45 years with prior DENV infection.

The second vaccine—TAK-003 – was evaluated over a four-and-a-half-year-long Phase III trial across eight countries where Dengue is endemic. With an overall efficacy of 61.2% (against current dengue infection) and 84.1% (against hospitalized cases), it offered strong protection against DENV-1 and DENV-2 serotypes. But, due to the insufficient number of cases of the other two serotypes, TAK-003’s efficacy against these could not be evaluated. This vaccine has a two-dose regimen, presenting logistical challenges as in the case of CYD-TDV.

Contrary to the above cases, the Butantan-DV vaccine with its single-dose regimen proved to have an edge over the others in simplifying vaccination where healthcare facilities were limited. Dr. Wang explains further about this vaccine, “A 2-year analysis reported an overall efficacy of 73.6% in sero-naïve individuals and 89.2% in those with prior dengue exposure, with protection against DENV-1 (89.5%) and DENV-2 (69.6%)”. Also, in a study that spanned more than 3 years, Butantan-DV demonstrated an 89% decrease in severe dengue and dengue with warning signs. However, the efficacy of this vaccine against DENV-3 and DENV-4 is yet to be established. Although the current dengue vaccines exhibit effective reduction of severe and fatal dengue in clinical trials, their impact on individuals aged above 60 years is still unclear.

The possibility of severe dengue after vaccination has been a significant challenge, particularly thought to be driven by ADE. When non-neutralizing, cross-reactive antibodies recognize conserved epitopes on the DENV envelope protein, it triggers immune responses that weaken antiviral activity, leading to severe disease. “Understanding the role of conserved epitopes and FcγR signaling in ADE is crucial for dengue vaccine development, and ADE issues in real world may only be revealed through efficacy studies in phase IV clinical trials of vaccines”, comments Professor Kain.

Looking ahead, global collaboration among researchers, health agencies, and vaccine developers will be essential to advance dengue vaccine research. Future efforts should explore diverse platforms like mRNA vaccines and focus on avoiding ADE. Priorities include: 1) Phase IV trials to refine strategies, 2) vaccines adaptable across populations and serotypes, and 3) region-specific formulations targeting local DENV variants.

With global collaboration, advanced vaccine platforms, and a better understanding of ADE, we may finally be on the path toward eliminating dengue.

 

***

 

Reference

DOI: https://doi.org/10.1002/ped4.70005

 

About Professor Kevin C. Kain

Dr. Kain is a Professor of Medicine at the Department of Medicine, Tropical Disease Unit, University of Toronto, Canada, as well as the Director of the Sandra A. Rotman Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Canada. Dr. Kain has extensively worked in the tropics and sub-tropics on global health research and neglected tropical diseases like malaria and dengue. His research interests include new diagnostics for viral diseases, drugs and vaccines for prevention of malaria, and molecular mechanisms behind severe and cerebral malaria. He is widely regarded as an expert in tropical diseases, with over 500 publications to his credit having more 27,000 citations.

 

About Associate Professor Ran Wang

Dr. Ran Wang is an associate professor of infection and virology at the Beijing Children's Hospital, Capital Medical University, Beijing, China. Dr. Wang’s field of expertise includes research on the immune cross-reactivity across different types of flavivirus, such as Japanese encephalitis virus, Dengue virus, and Zika virus. He is also interested in the field of vaccination, focusing on viral immunology, T cell immunity, and infection. Dr. Wang is also engaged in Epstein–Barr virus-related research, focusing on immune regulation and disease pathogenesis.