RACIST MEDICINE U$A

Individuals with sickle cell disease face long delays to pain care in emergency department

Emergency department triage at lesser severity levels does not follow established guidelines in majority of cases

American Society of Hematology

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(WASHINGTON — October 8, 2025) – Most individuals living with sickle cell disease who presented to the emergency department with a pain crisis, known as vaso-occlusive crisis (VOC), were not triaged appropriately according to established national guidelines, reveals a study published today in Blood Advances. Patients triaged with a less severe category waited nearly three times as long for their first dose of pain medication when compared to individuals with sickle cell disease who were triaged appropriately.

“Pain is a significant burden in the day-to-day lives of those living with sickle cell disease, with VOC being the number one reason these patients present to the emergency department,” said the study’s lead author, Abdulaziz Abu Haimed, MD, who was an internal medicine resident at the University of Maryland Medical Center at the time of the study. “When these patients arrive, they really need help, and as soon as possible. Our study shows that assigning them an appropriate emergency severity index (ESI) score substantially impacts the length of time it takes for them to receive their first dose of pain medication.”

Sickle cell disease is the most common inherited red blood cell disorder in the United States, affecting an estimated 100,000 people and one out of every 365 Black or African American births. The disorder is characterized by abnormally shaped blood cells that can become lodged in the blood vessels, blocking blood flow and leading to organ damage, infection, and episodes of severe pain, frequently referred to as VOC.

In their study, the researchers analyzed the impact of ESI assignment (the scoring tool used to triage a patient in the emergency department) on the time it takes for a patient with sickle cell disease to receive their first dose of pain medication for VOC. The ESI ranges from a score of 1 (most urgent) to 5 (least urgent), with National Heart, Lung, and Blood Institute (NHLBI) guidelines recommending an assignment of 2 to patients with sickle cell disease. Guidelines from the American Society of Hematology further recommend these patients wait no more than 60 minutes from arrival to receive their first dose of pain medication, with reassessment and re-administration of medication every 30 to 60 minutes, as needed.

“Many patients describe VOC as the worst pain of their lives,” said study author Jennie Law, MD, a hematologist-oncologist and associate professor of medicine at the University of Maryland School of Medicine. “They sometimes compare it to the feeling you’d get from taking a tourniquet to your limb and tightening it.”

The researchers retrospectively identified 125 sickle cell disease-related visits to the University of Maryland Medical Center’s emergency department over a six-month period in response to a change in their organization’s emergency department triage policy that aimed to align with available guidelines. After excluding visits for VOC complicated by other diagnoses that necessitated an ESI 2 and visits for other acute sickle cell disease complications, the study included 66 emergency department visits by 41 patients. The majority of these patients (63.4%) had the most severe variant of sickle cell disease, HbSS, and most patients (58%) were female, with a median age of 33. On a ten-point scale, the median pain score patients reported at triage was nine.

Of these emergency department visits, ESI 2 was assigned to 23 patients (34.8%) and ESI 3 to 43 patients (65.2%). There was no significant difference in gender, pain score, sickle cell disease variant, or age group between patients assigned an ESI 2 or 3.

The median time to first dose of pain medication for individuals assigned ESI 2 was 65 minutes, and the median time for those assigned ESI 3 was 178 minutes, with four such patients leaving the emergency department without receiving pain medication after a median wait of 349 minutes. No patients fell within the recommended time range outlined by NHLBI guidelines.

“A patient with sickle cell disease assigned an ESI 2 compared to 3 is about six times more likely to receive pain medication quicker,” said Dr. Abu Haimed. “Ensuring we assign patients the recommended ESI is one small intervention that can significantly improve the quality of care and overall experience in the emergency department.”

The study has some limitations, mainly due to being retrospective and conducted at a single center. As the study took place in a busy emergency department at a major urban hospital, it may not be representative of other emergency departments across the country. Additionally, to isolate the impact of triage, the researchers defined time to first dose of pain medication as time from triage to receipt of pain medication rather than time from arrival at the emergency department to receipt of medication (as employed by ASH guidelines), which may underestimate overall delays.

The researchers plan to replicate the study’s results with a larger sample size. Additionally, they hope to conduct studies examining the impact of ESI assignment on patients’ overall satisfaction with their experience in the emergency department, as well as how ESI influences the likelihood and duration of hospitalization.

In partnership with the Health Services Advisory Group, ASH developed two facility-level quality measures to improve time to pain management for individuals living with sickle cell disease presenting to the emergency department with VOC, which the Partnership for Quality Measurement recommended to CMS, but was not included in the FY 2025 Hospital Inpatient PPS proposed rule. ASH is continuing to identify pathways to implementing these measures for individuals living with sickle cell disease.

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Blood Advances (bloodadvances.org) is an online, open-access journal publishing more peer-reviewed hematology research than any other academic journal worldwide. Blood Advances is part of the Blood journals portfolio (bloodjournals.org) from the American Society of Hematology (ASH) (hematology.org).

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Journal

Blood Advances

DOI

10.1182/bloodadvances.2025016538 

Article Title

Use of Emergency Severity Index 2 Reduces Time to First Analgesia in Sickle Cell Disease Vaso-occlusive Crisis

Article Publication Date

8-Oct-2025

 

Discovery into how breastfeeding impacts immunity in babies

Murdoch Childrens Research Institute

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Breastfeeding until at least six months helps babies to fight off infections and reduces chronic inflammation, according to a new study. And better understanding the way specific nutrients in breast milk impact the immune system will improve health outcomes for all infants including those not breastfed.

The study, led by Murdoch Children’s Research Institute (MCRI) and the Baker Heart and Diabetes Institute (Baker Institute), discovered more clues as to why infants who were breastfed to at least six months of age had fewer infections and less chronic inflammation. Preventing these infections could reduce the rates of many childhood conditions, such as allergies, diabetes and asthma.

Published in BMC Medicine, the researchers identified several types of lipids (essential nutrients) in blood samples from breastfed babies that help reduce inflammation, which may reflect the unique nutritional composition of breastmilk.

MCRI’s Dr Toby Mansell said plasmalogens, a unique type of lipid abundant in breastmilk, appeared key to lowering inflammation. 

“Plasmalogens are only found in breastmilk and are generally absent in formula milk, so a better understanding of how plasmalogens and other lipids unique to breastmilk protect against chronic inflammation will help pave the way for new treatments for infants who don’t receive breastmilk,” he said.

The study involved almost 900 infants from the Barwon Infant Study, a collaboration between MCRI, Barwon Health and Deakin University.

The study explored about 800 different lipids and other metabolic markers in babies up until 12 months of age. It found breastfeeding was associated with broad effects on different classes of lipids and metabolic markers.

Baker Institute’s Dr Satvika Burugupalli said the findings would lead to a new understanding of how breastfeeding and specific components of breast milk could benefit infants.

“Breast milk performs a central role in supporting a newborn's immune system,” she said. “It’s loaded with essential nutrients, including lipids, as well as antibodies and white blood cells.

“This study has identified key biological pathways for how breastfeeding improves immune health and reduces inflammation that can lead to many childhood conditions, such as allergies and asthma, and the risk of adult cardiovascular disease and diabetes.” 

Researchers from the University of Melbourne, Deakin University, Barwon Health, Northwestern University and the Florey Institute of Neuroscience and Mental Health also contributed to the study.

GenV (Generation Victoria), led by MCRI, will also be a key resource to track additional health outcomes of children who are breastfed. The GenV Breast Milk Collection, with almost 7,000 breast milk samples, alongside 10,500 infant stool samples, has the unique ability to investigate the relationship between early life nutrition, gut microbiome development and childhood health.  

Publication: Satvika Burugupalli, Toby Mansell, Tingting Wang, Alexandra D. George, Sudip Paul, Richard Saffery, Mimi L.K. Tang, Thomas W. McDade, Habtamu B. Beyene, Thy Duong, Peter Vuillermin, Anne-Louise Ponsonby, Barwon Infant Study Investigator Group, David P. Burgner, Peter J. Meikle. ‘The protective effect of breastfeeding on infant inflammation: a mediation analysis of the plasma lipidome and metabolome,’ BMC Medicine. DOI: 10.1186/s12916-025-04343-0

*The content of this communication is the sole responsibility of MCRI and does not reflect the views of the NHMRC.

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Journal

BMC Medicine

DOI

10.1186/s12916-025-04343-0 

Method of Research

Observational study

Subject of Research

People

UMD researchers create first system to track near-real time changes to global land cover

The DIST-ALERT system uses five satellites to receive more images of global land surfaces, more often

University of Maryland

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The DIST-ALERT system uses five satellites to receive more images of global land surfaces, more often

Scientists can now receive near-real-time alerts about the world’s lands as their surfaces change, thanks to a new satellite-based monitoring system described today in Nature Communications.

Known as the OPERA Land Surface Disturbance Alert (DIST-ALERT), the system is the first to globally track lands that are being changed by human activity, weather events, fires and other causes. Previously, only particular areas of the globe were being carefully monitored for changes to their land cover, like areas around the equator where rainforests are concentrated, and only for specific types of changes, like forest loss or fire.

DIST-ALERT also produces this information more quickly than other monitoring systems. Whereas most monitoring systems utilize imagery from one satellite system, DIST-ALERT obtains images from two systems, Landsat 8/9 and Sentinel-2A/B/C, that have five total satellites. Since it takes multiple days for a single satellite to return to an area to take a second image—a span of days described as a satellite's “revisit rate”—DIST-ALERT’s use of five satellites shortens its revisit rate to 1-4 days, giving scientists access to information in a shorter time frame.

“These satellites are affected by cloud cover, and if we don’t see the ground, we don’t know whether disturbances have happened. So with more observations we get more opportunities to get a cloud-free observation, and each observation can matter so much, particularly in cloudy areas,” explains Amy Pickens, an assistant research professor in the University of Maryland’s Department of Geographical Sciences (GEOG).

Pickens is the first author of the Nature Communications paper, which also includes new findings, using DIST-ALERT data, on how much land around the world changed in 2023 compared to 2020, 2021 and 2022.

Looking at how lands changed compared to the same month in the previous three years, the researchers found that the largest share of land change in 2023 was caused by natural climatic variations resulting either in plants dying back from extra hot or dry conditions, or more plant cover from extra rainfall.

The second-largest driver of land surface changes was shifts in human-led management, primarily actions like planting a different kind of crop or harvesting at different times.

Accounting for all the ways that humans might convert land surfaces—plant new farms, cut down forests, add new buildings, etc.—the researchers found that the sum of human-led land conversion in 2023 totaled 28.6±7.6 Mha, which is greater than the area of Ecuador or Colorado. Half of that converted land was long-lived forests, shrublands, grasslands, or wetlands.

“The conversion of natural lands to land use is a significant contributor to climate warming,” said GEOG Professor Matthew Hansen, one of the paper’s coauthors. “The result is increasing anomalous weather at the global scale, often seen in our data as large-scale vegetation loss due to fire, drought, floods, and windthrow events.”

DIST-ALERT data can be accessed by the public via the Land Processes Distributed Active Archive Center. Some organizations are adding DIST-ALERT data to existing systems that send out email, text message or mobile app notifications about land changes that are of interest to their audiences. Global Forest Watch—which offers the latest data, technology and tools that empower people everywhere to better protect forests—used to only be able to provide users with alerts about changes to tropical forests, but now provides updates for users concerning changes to all kinds of forests.

“There are a lot of aspirations to protect land and a lot of need to manage land, to make sure it is being used in the most valuable ways. But you can’t do that unless you have data about what’s going on,” says Pickens. “DIST-ALERT monitoring in such a low latency mode enables that data to be more actionable; not just for policymaking, but for actually responding to individual events.”

Other paper coauthors include fellow GEOG researchers Assistant Research Professor Zhen Song, Faculty Specialist Andrew Poulson, Assistant Research Professor Anna Komarova, Faculty Specialist Antoine Baggett, Faculty Specialist Theodore Kerr, Research Graduate Assistant Aleksandra Mikus, Faculty Specialist Carolina Ortiz Dominguez, Associate Research Professor Alexandra Tyukavina, and Assistant Research Professor André Lima.

Read “Rapid monitoring of global land change”

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Journal

Nature Communications

DOI

10.1038/s41467-025-64014-9 

Article Title

Rapid monitoring of global land change

Article Publication Date

8-Oct-2025

 

Political views, not sex and violence, now drive literary censorship

Cornell University

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ITHACA, N.Y. — Liberals and conservatives both oppose censorship of children’s literature — unless the writing offends their own ideology, new Cornell research finds.

Studying a representative U.S. population, a team of scholars in literature, sociology and information science found competing cancel cultures in which widespread opposition to literary censorship masked offsetting disagreements between left- and right-wing values.

Those attitudes highlight the polarization of an issue once governed by bipartisan consensus over the need to protect children from inappropriate violent or sexual content.

“Both sides are willing to let children read books that reflect their own values but not those that might expose children to ideological contamination,” the researchers wrote in “The Polarization of Literary Censorship in the U.S.,” published in PLOS One. “Both liberals and conservatives support the censorship of some children’s books – just not the same ones.”

In one study measuring attitudes about censorship, a representative sample of more than 800 participants responded to 15 statements: five that liberals would be more likely to agree with (e.g., “Public elementary schools should not assign a history book about the important contributions of famous white men who owned slaves”); five that conservatives would be more likely to agree with (“Public elementary schools should not assign a book about a transgender character who inspires children to celebrate all gender identities”); and five that were ideologically neutral (“Censorship of children’s books is a serious problem in the U.S.”).

Conservatives were more likely than liberals to support censorship on the neutral questions. But the results overall showed the two sides held surprisingly similar views about censorship.

A second study tested people’s willingness to censor based on ideological criticism. More than 800 participants read four poems with content deemed non-ideological in pre-tests, with an experimental group also reading accusations that the poems were either racist, sexist, homophobic or antisemitic (offending the left) or anti-family, anti-male, unpatriotic or anti-Christian (offending the right).

Results showed liberals were more likely than conservatives to agree with criticism that aligned with their ideology, while conservatives were more likely than liberals to censor material in the absence of exposure to criticism.

The growing role of partisan ideology in shaping literary censorship, warned the researchers, threatens free speech as a core value.

“When each side attacks cancel culture on the other side, the attacks do not cancel out — they additively contribute to the restriction of freedom of expression,” said Michael Macy, professor of sociology, director of the Social Dynamics Laboratory, and senior author of the paper.

For additional information, see this Cornell Chronicle story.

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Journal

PLOS One

DOI

10.1371/journal.pone.0332240 

Article Title

The polarization of literary censorship in the U.S