News

Newswise — PHILADELPHIA – Since the introduction of the Affordable Care Act, which provided access to health insurance to millions of previously uninsured adults in the United States, the availability of appointments with primary care physicians has improved for patients with Medicaid and remains unchanged for patients with private coverage, according to new research led by the Perelman School of Medicine and the Leonard Davis Institute of Health Economics at the University of Pennsylvania. The study, which compared new patient appointment availability in 10 states between 2012/13 (before the Affordable Care Act came into effect) and 2016, is published today in JAMA Internal Medicine. The study found appointment availability for Medicaid enrollees jumped from 57.9 percent to 63.2 percent between 2012/2013 and 2016. “Results of our study should ease concerns that the Affordable Care Act would aggravate access to primary care,” said lead author Daniel Polsky, PhD, a professor of Medicine at the Perelman School of Medicine and Health Care Management in the Wharton School at the University of Pennsylvania, and the executive director of Penn’s Leonard Davis Institute of Health Economics. “The finding that more doctors are accepting patients with Medicaid, not fewer, is particularly timely given the active health care reform debate as offers evidence contradicting that the stated criticism of Medicaid that ‘more and more doctors just won’t take Medicaid.” The study included two waves of data collection, from November 2012 to April 2013 and from February to June 2016. Simulated patients differing in age, sex, race, and ethnicity were randomized to an insurance type (Medicaid or private coverage) and clinical scenario (hypertension or check-up). Participants called in-network primary care practices in Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas, then requested the earliest available appointment with a randomly selected primary care provider. Researchers compared results of the two time periods to determine changes in appointment availability. They also estimated changes in the probability of short wait times (seven days or less) and long wait times (more than 30 days). In addition to an increase in appointment availability, patients with Medicaid and private coverage experienced somewhat longer wait times. Medicaid callers faced a 6.7 percentage point decrease in short wait times and, among privately insured callers, the share of short wait times decreased 4.1 percentage points and the share of long wait times increased 3.3 percentage points. The authors say the absorption of new patients may explain the increase in wait times, which was similarly observed in Massachusetts after it expanded Medicaid in 2006. Some initiatives to strengthen primary care delivery, such as raising Medicaid reimbursement rates to Medicare levels for some primary care providers in 2013 and 2014, increasing funds for federally qualified health centers, and expanding the penetration of Medicaid managed care, may explain the findings. Additionally, the authors suggest changes beyond Affordable Care Act initiatives, including team-based clinics, retail clinics, and data sharing, may have expanded capacity in some practices. Since this study focused solely on new patient appointment requests at in-network offices, further research is needed to determine how health system changes have affected established patients. Additionally, though the 10 states were selected specifically for their diversity along a number of dimensions, the results may not be generalizable to other settings. Additional authors on the study include Molly Candon from Penn’s Leonard Davis Institute of Health Economics, Brendan Saloner from the Johns Hopkins Bloomberg School of Public Health, Katherine Hempstead from the Robert Wood Johnson Foundation, Douglas Wissoker and Genevieve M. Kenney from the Urban Institute, and Karin Rhodes from the Hofstra Northwell School of Medicine. The study was funded by the Robert Wood Johnson Foundation. ###

Newswise — La Jolla, Calif., February 27, 2016 (embargoed until 11:00 A.M. EST) — Scientists at Sanford Burnham Prebys Medical Discovery Institute (SBP) have identified a new regulator of the innate immune response—the immediate, natural immune response to foreign invaders. The study, published recently in Nature Microbiology, suggests that therapeutics that modulate the regulator—an immune checkpoint—may represent the next generation of antiviral drugs, vaccine adjuvants, cancer immunotherapies, and treatments for autoimmune disease. “We discovered that a protein called K-homology splicing regulatory protein (KHSRP) weakens the immune response to viral RNA,” says Sumit Chanda, Ph.D., director of the Immunity and Pathogenesis Program at SBP, and senior author of the study. “Depleting KHSRP improved immune signaling and reduced viral replication in cell culture and in vivo, suggesting that drugs inhibiting the protein may have therapeutic value.” The innate immune response is the first line of defense against pathogens—a one-size-fits-all attack on viruses, bacteria, and pretty much anything that looks like an invader. But innate immunity must be carefully regulated. If the response is too slow or too weak, infections can run rampant, and if the trigger is too sensitive or the response is too strong, excessive inflammation or autoimmune diseases can arise. “That’s where KHSRP comes in,” explains Chanda. “It physically interacts with a protein called retinoic acid-inducible gene I (RIG-I) to apply the brakes to the innate immune response.” RIG-I receptors initiate antiviral immunity by detecting viral RNA in the cytoplasm of cells. When they bind viral RNA, they turn on signaling that leads to the production of interferon, a strong inflammatory signal that helps kill viruses, as well as the induction of other antiviral responses. RIG-I receptors also coordinate signaling with other immune factors to modulate the adaptive immune response—the acquired, specialized response that develops after the innate response and provides long-term immunity. “We identified KHSRP by systematically testing every human proteins to identify those that impact RIG-I signaling,” says Stephen Soonthornvacharin, a recent Ph.D. graduate from the Chanda lab. “We found about 240 proteins, but we focused on KHSRP because it was the only one of the 240 that was found to inhibit the very early steps of RIG-I signaling.” “Molecules that block KHSRP’s actions could serve as adjuvants—components that heighten the immune response—to vaccines against influenza or hepatitis C, as antiviral drugs, or even next-generation cancer immunotherapies,” Soonthornvacharin adds. “Also, among the 240 RIG-I regulators we identified, 125 appear to activate RIG-I, so finding drugs that inhibit these proteins may be a way to treat autoimmune conditions involving too much interferon, like type 1 diabetes or lupus. Figuring out which ones are promising requires further investigation.” “We think KHSRP protects against autoimmunity,” adds Chanda. “RIG-I normally recognizes RNA molecules that arise during viral infections, but it can also mistakenly sense RNA present in normal cells. Without KHSRP, the innate immune response could be erroneously turned on when there’s no virus. Increasing the activity of KHSRP might therefore be a way to treat autoimmunity.”“Next, we plan to figure out more of the details of how KHSRP regulates RIG-I,” says Sunnie Yoh, Ph.D., staff scientist in the Chanda lab and a key contributor to the research. “That’s the information that will move us in the direction of developing therapies.” This research was performed in collaboration with scientists at the Novartis Research Foundation, the Icahn School of Medicine at Mount Sinai, Oregon State University Corvallis, the Paul Ehrlich Institute in Langen, Germany, and the University of California San Francisco. Financial support was provided by the National Institutes of Health and the James B. Pendleton Charitable Trust. # # # #

Newswise — NEW BRUNSWICK, N.J. - Robert Wood Johnson University Hospital (RWJUH) is the first hospital in New Jersey to offer the Leksell Gamma Knife Icon, the most precise stereotactic radiosurgery system (SRS) currently available to patients diagnosed with primary and secondary brain tumors, vascular disorders, refractory pain, and movement disorders. Treatments using the new Icon System are available at the hospital's New Brunswick campus and can now be planned and guided by a frameless approach, when appropriate. The frameless mask solution is one of several new features of Icon and is integrated with a high-definition motion management system. “Increasing the precision of cranial stereotactic radiosurgery (SRS) is essential for effectively targeting tumor tissue while protecting healthy brain tissue from damage,” said Shabbar Danish, MD, FAANS, Chief of Neurosurgery for Rutgers Cancer Institute of New Jersey; Director of Stereotactic and Functional Neurosurgery Director at Rutgers Robert Wood Johnson Medical School and Director of the Gamma Knife Center at RWJUH. “The new Gamma Knife Icon System now provides the most accurate motion tracking during treatment. Additionally with Gamma Knife, there is a two-to-four fold improvement in sparing normal brain tissue compared to other linear accelerator technologies.” Nearly 78,000 new cases of primary brain tumors (including cancerous and non-cancerous tumors) were diagnosed in 2015, and today nearly 700,000 people in the U.S. alone are living with primary brain and CNS tumors including malignant tumors, benign tumors, functional disorders (such as essential tremor and severe facial pain (trigeminal neuralgia) vascular disorders and ocular disorders. Primary and metastatic brain tumors are challenging to treat. While surgery is an effective option, great care must be taken to minimize damage to normal surrounding brain tissue, and patients are at risk for surgical complications such as infection, post-surgical bleeding, and complications due to anesthesia. Traditional radiation therapy delivered to the brain may cause damage to healthy tissue within the brain and other parts of the body, leading to side effects such as hair loss, skin problems, neurocognitive decline and fatigue. Stereotactic radiosurgery (SRS) is a non-invasive treatment that focuses multiple beams of radiation to specific areas within the brain, destroying diseased tissue with precision while minimizing damage to surrounding healthy tissue. The procedure typically involves a single, outpatient session of radiation. “As a major academic medical center, we are proud to make the latest generation of this technology available to our patients,” explains Kimyatta Washington, MHSA, Assistant Vice President of Oncology Services for RWJUH. “Adoption of this latest advance in SRS technology is consistent with our mission to offer our patients the highest level of care for neurological disorders. Adding Gamma Knife Icon to our multi-disciplinary approach to treating brain cancer and complex neurological disorders in partnership with Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School and our other highly advanced cancer treatment centers within RWJBarnabas Health System, will allow us to offer the benefits of cranial SRS to a broader population of patients with brain disease, and to provide these patients with the most precise targeting technology available.” About Robert Wood Johnson University Hospital Robert Wood Johnson University Hospital (RWJUH) is a 965-bed academic medical center with campuses in New Brunswick and Somerville, NJ. Its Centers of Excellence include cardiovascular care from minimally invasive heart surgery to transplantation, cancer care, stroke care, neuroscience, joint replacement, and women’s and children’s care including The Bristol-Myers Squibb Children’s Hospital at Robert Wood Johnson University Hospital (www.bmsch.org). As the flagship Cancer Hospital of Rutgers Cancer Institute of New Jersey and the principal teaching hospital of Rutgers Robert Wood Johnson Medical School in New Brunswick, RWJUH is an innovative leader in advancing state-of-the-art care. A Level 1 Trauma Center and the first Pediatric Trauma Center in the state, RWJUH’s New Brunswick campus serves as a national resource in its ground-breaking approaches to emergency preparedness. RWJUH has been ranked among the best hospitals in America by U.S. News & World Report seven times and has been selected by the publication as a high performing hospital in numerous specialties. The Bristol-Myers Squibb Children’s Hospital has been ranked among the best hospitals in America by U.S. News & World Report three times. In addition, RWJUH was named among the best places to work in health care by Modern Healthcare magazine and received the Equity Care of Award as Top Hospital for Healthcare Diversity and Inclusion from the American Hospital Association. Both the New Brunswick and Somerset campuses have earned significant national recognition for clinical quality and patient safety, including the prestigious Magnet® Award for Nursing Excellence and “Most Wired” designation by Hospitals and Health Networks Magazine. The Joint Commission and the New Jersey Department of Health and Senior Services have designated the New Brunswick Campus as a Comprehensive Stroke Center and the Somerset Campus as a Primary Stroke Center. The American College of Surgeons’ Commission on Cancer has rated RWJUH New Brunswick among the nation’s best comprehensive cancer centers and designated the Steeplechase Cancer Center at RWJ Somerset as a Comprehensive Community Cancer Center. The Joint Surgery Center at Robert Wood Johnson University Hospital Somerset has earned the Joint Commission’s Gold Seal of Approval for total knee and total hip replacement surgery.

Newswise — Two drugs used to treat asthma and allergies may offer a way to prevent a form of pneumonia that can kill up to 40 percent of people who contract it, researchers at the University of Virginia School of Medicine have found. Influenza pneumonia results when a flu infection spreads to alveolar air sacs deep within the lungs. Normally, a flu infection does not progress that far into the lower respiratory tract, but when it does, the results can be deadly. “If infection is severe enough, and the immune response is potent enough, you get injury to these cells and are no longer able to get sufficient oxygen exchange,” explained UVA researcher Thomas J. Braciale, MD, PhD. “As a result of the infection of the cells, you can develop lethal pneumonia and die.” But early administration of the two asthma drugs, Accolate and Singulair, could prevent the infection of the alveolar cells deep in the lower respiratory tract, Braciale’s research suggests. “The excitement of this is the possibility of someone coming to see the physician with influenza that looks a little more severe than usual and treating them with the drugs Singulair or Accolate and preventing them from getting severe pneumonia,” he said. “The fatality rate from influenza pneumonia can be pretty high, even with all modern techniques to support these patients. Up to 40 percent. So it’s a very serious problem when it occurs.” Ounce of prevention Unlike bacterial pneumonia, influenza pneumonia is caused by a virus. That makes it very difficult to treat – and makes the possibility of prevention all the more tantalizing. “When we look at pandemic strains of influenza that have high mortality rates, one of the best adaptations of those pandemic viruses is their ability to infect these alveolar epithelial cells,” explained researcher Amber Cardani, PhD. “It’s one of the hallmarks for certain strains that cause the lethality in these pandemics.” Once influenza spreads deep into the lungs, the body’s own immune response can prove harmful, resulting in severe damage to the alveolar air sacs. “It’s an important observation the field is coming to,” Cardani said. “We really need to limit the infection of these lower respiratory airways.” Stopping the flu virus The researchers determined that the alveolar epithelial cells are typically protected from influenza infection by immune cells called alveolar macrophages. In some instances, however, the flu virus can prevent the macrophages from carrying out their protective function, allowing the epithelial cells to become vulnerable to infection. “It’s not as though they lack alveolar macrophages, it’s just that their alveolar macrophages don’t work right when they get exposed to the flu,” Braciale said. “And those are the types of patients, who potentially would eventually go to the intensive care unit, that we think could be treated early in infection with Accolate or Singulair to prevent infection of these epithelial cells and prevent lethal infection.” For their next steps, the researchers are consulting with colleagues to determine if patients being treated with Accolate and Singulair are less likely to develop influenza pneumonia during flu outbreaks. “This was a totally unexpected observation,” Braciale said. “When I told multiple colleagues who are infectious disease or pulmonary physicians, they were absolutely flabbergasted.” Findings published The findings have been published online by the scientific journal PLOS Pathogens. It was written by Cardani, Adam Boulton, Taeg S. Kim and Braciale. Braciale and Cardani are both part of UVA’s Department of Microbiology, Immunology and Cancer Biology and UVA’s Beirne B. Carter Center for Immunology Research. Braciale’s primary appointment is with the Department of Pathology. The work was supported by the National Institutes of Health, grant R01AI015608-35, and the NIH’s National Institute of General Medical Sciences, grants T32 GM007055 and T32 GM007055.   SEE ORIGINAL STUDY

Newswise — Research Triangle Park, NC— Pot brownies may be a thing of the past as there are new edible marijuana products, or edibles, on the market, including chocolates, candies, and cookies. These products are legally sold in Colorado and Washington, and according to a new study conducted by RTI International, changes to their labels are needed to ensure people know what they are consuming and that they are safely consuming the products. The new study published in the International Journal of Drug Policy, found that many of the adults who participated in the study are not reading labels, and if they are, information is often hard to decipher. “We discovered that people think there is too much information listed on the labels of edibles, thus potentially overlooking important information on consumption advice” said Sheryl C. Cates, corresponding author of the study and senior research policy analyst at RTI. “Our study also determined that labels often do not make it clear that the product contains marijuana, which can lead to accidental ingestion.” Researchers conducted four focus groups in Denver and Seattle with 94 adult consumers and nonconsumers. Participants revealed concerns with edible labels, and suggested that more needs to be done to inform and educate consumers and nonconsumers about the possible risks of edibles. In 2012, Colorado and Washington became the first two states in the United States to legalize marijuana for recreational use with retail sales starting in 2014. According to the Colorado Department of Revenue, edibles accounted for nearly half of total marijuana sales in the state for 2014. In Washington, edibles accounted for about 40 percent of marijuana sales according to Washington State Liquor and Cannabis Board (reported in 2016). “As the popularity of edibles grow, it is important that labels clearly and concisely provide consumers important information,” Cates said. “Web- and video-based education and using graphics on labels may be easy, cost-effective ways to inform buyers and the public.” Since conducting this research, the states of Colorado and Washington have changed some of the requirements for labeling of edibles based on increasing public concern. Lessons learned from Colorado and Washington, can help inform the labeling of edibles as additional states allow the sale of edibles for recreational use. To learn about RTI’s marijuana research, visit our Emerging Issues page. SEE ORIGINAL STUDY

Newswise — There are neurons in your skin that are wired for one purpose and one purpose only: to sense itchy things. These neurons are separate from the ones that detect pain, and yet, chemical-induced itch is often accompanied by mild pain, such as burning and stinging sensations. But when it comes to sending signals toward your brain through your spinal cord, itch and mild pain can go through the same set of spinal cord neurons, researchers report Feb. 22 in Neuron. This finding explains why pain often accompanies intense, chemical-induced itch. “To our surprise, we found the spinal cord neurons receiving the peripheral pain and itch inputs are not separate. They can receive signals from itch fibers and also pain fibers,” says Xinzhong Dong, Ph.D., professor of neuroscience at the Johns Hopkins University School of Medicine and Howard Hughes Medical Institute investigator, who led the study. These neurons, called the GRP neurons, are a way station for pain and itch signals on their way to the brain. However, GRP neurons are not passive conduits, the researchers found. “When we eliminate this population of neurons in mice, the itch response is reduced. They scratch less,” says first author Shuohao Sun, a graduate student at Johns Hopkins. “But at the same time, the pain response is actually increased.” Mice without GRP neurons spent more time rubbing and licking to alleviate their pain, induced, for example, by exposing their tails to hot water. Further experiments that tracked electrical signaling through the neurons corroborated the result. Even though the GRP neurons seemed to be forwarding mild pain signals to the next neural relay station, they also seemed to mitigate intense pain signals. “It might sound counterintuitive, but we suggest that this small group of cells actually functions like a braking system for pain,” says Sun. “This brake is not always triggered by the painful stimuli; it’s only triggered by the strong pain stimuli. When the brake is on, the signal doesn’t go through. But when you have a weak pain signal, it doesn’t trigger the brake, and the signal can go through.” The researchers have named this hypothesis “the leaky gate” model. When the mice’s GRP neurons have been destroyed, the brake lines have essentially been cut, resulting in an uncontrolled cascade of pain. The braking system may be a way for animals to detect mild pains — like the kinds associated with itchy substances — without becoming overwhelmed by the pain, the researchers say. Built-in pain management would likely be a helpful adaptation for escaping from predators while injured. At the same time, GRP neurons are not the only group of spinal cord neurons that receive and forward pain signals to the brain, and the brain itself plays a central role in translating signals from peripheral neurons into experienced sensation. Questions remain about what happens to the signals from GRP neurons after they’re transported up the spinal cord. Chronic pain and itch affect about one in 10 Americans, the authors say. A better understanding of pain and itch signals’ journey to the brain may eventually lead to new treatment options. “The next step is moving even further into the central nervous system and seeing how the signal from the secondary neuron is getting to the next relay station,” says Dong. “We go one step at a time.” Other authors on the paper are Qian Xu and Yun Guan of the Johns Hopkins University School of Medicine, and Changxiong Guo and Qin Liu of Washington University School of Medicine. This work was supported by the National Institute of Dental and Craniofacial Research (grant number R01DE022750) and the National Institute of Neurological Disorders and Stroke (grant number R01NS054791).

Newswise — The implementation of state laws legalizing same-sex marriage was associated with a significant reduction in the rate of suicide attempts among high school students – and an even greater reduction among gay, lesbian and bisexual adolescents, new Johns Hopkins Bloomberg School of Public Health research suggests. The researchers, publishing Feb. 20 in JAMA Pediatrics, estimate that state-level, same-sex marriage policies were associated with more than 134,000 fewer adolescent suicide attempts per year. The study compared states that passed laws allowing same-sex marriage through Jan. 2015 to states that did not enact state-level legalization. A Supreme Court decision made same-sex marriage federal law in June of 2015. The findings show the effect that social policies can have on behavior, the researchers say. “These are high school students so they aren’t getting married any time soon, for the most part,” says study leader Julia Raifman, ScD, a post-doctoral fellow in the Department of Epidemiology at the Bloomberg School. “Still, permitting same-sex marriage reduces structural stigma associated with sexual orientation. There may be something about having equal rights – even if they have no immediate plans to take advantage of them – that makes students feel less stigmatized and more hopeful for the future.” Suicide is the second most common cause of death among people ages 15 to 24 in the United States (behind unintentional injury). Suicide rates have been rising in the U.S., and data indicate that rates of suicide attempts requiring medical attention among adolescents increased 47 percent between 2009 and 2015. Gay, lesbian and bisexual high school students are at particular risk. In the new study, 29 percent of gay, lesbian and bisexual high school students reported attempting suicide in the previous year as compared to six percent of heterosexual teens. For the study, Raifman and her colleagues analyzed data from the Youth Risk Behavior Surveillance System, a survey supported by the Centers for Disease Control and Prevention. The data included 32 of the 35 states that enacted same-sex marriage policies between Jan. 1, 2004 and Jan. 1, 2015. The researchers used data from Jan. 1, 1999 to Dec. 31, 2015 to capture trends in suicide attempts five years before the first same-sex marriage policy went into effect in Massachusetts. They were also able to compare data with states that did not enact same-sex marriage laws. They conducted state-by-state analyses, comparing, for example, suicide attempt rates in a state like Massachusetts before same-sex marriage was legalized to the period right after. State same-sex marriage legalization policies were associated with a seven percent reduction in suicide attempts among high school students generally. The association was concentrated in sexual minorities, with a 14 percent reduction in suicide attempts among gay, lesbian and bisexual adolescents. The effects persisted for at least two years. The states that did not implement same-sex marriage saw no reduction in suicide attempts among high school students. It’s unclear whether the political campaigns surrounding same-sex marriage legalization were behind the reduction in suicide attempts or the laws themselves. Still, they found that the reduction in suicide attempts wasn’t realized until after a law was enacted. In a state that would go on to pass a law two years in the future – when there was likely to be much conversation in the public about it – suicide attempts remained flat before passage. Healthy People 2020, a program run by the U.S. Department of Health and Human Services (HHS), has a goal of reducing adolescent suicide rates by 10 percent by 2020. The new research suggests that the legalization of same-sex marriage has been very effective in making progress toward that goal. Despite the large reduction in suicide attempts among gay, lesbian and bisexual high school students, this population still attempts suicide at higher rates than their straight peers. “It’s not easy to be an adolescent, and for adolescents who are just realizing they are sexual minorities, it can be even harder – that’s what the data on disparities affecting gay, lesbian, and bisexual adolescents tell us,” Raifman says. She says gay, lesbian, and bisexual adolescents are also at increased risk of substance abuse, depression and HIV. Despite evidence of disparities, she says there are no population-level programs aimed at reducing suicide attempts in gay, lesbian and bisexual students. She says schools and medical providers must understand that students who are sexual minorities are at higher risk and be on high alert. While Raifman found that legalizing same-sex marriage appears to be positively associated with reducing suicide attempts, policies that take away rights or add to stigma could have the opposite effect. “We can all agree that reducing adolescent suicide attempts is a good thing, regardless of our political views,” Raifman says. “Policymakers need to be aware that policies on sexual minority rights can have a real effect on the mental health of adolescents. The policies at the top can dictate in ways both positive and negative what happens further down.” “Difference-in-Differences Analysis of the Association Between State Same-Sex Marriage Policies and Adolescent Suicide Attempts” was written by Julia Raifman, Ellen Moscoe, Bryn Austin and Margaret McConnell. The research was supported by grants from the National Institutes of Health’s National Institute on Aging (T32AI102623) and National Institute of Mental Health (R25MH083620) as well as the Maternal and Child Health Bureau, Health Resources and Services Administration at HHS (T71-MC-00009 and T76-MC-00001).

Newswise — LOS ANGELES – Cedars-Sinai neuroscientists have uncovered processes involved in how the human brain creates and maintains short-term memories. “This study is the first clear demonstration of precisely how human brain cells work to create and recall short-term memories,” said Ueli Rutishauser, PhD, associate professor of Neurosurgery in the Cedars-Sinai Department of Neurosurgery and the study’s senior author. “Confirmation of this process and the specific brain regions involved is a critical step in developing meaningful treatments for memory disorders that affect millions of Americans.” The study’s findings, published online Feb. 20 and in the April print edition of Nature Neuroscience, involve a type of brain cell, called a persistently active neuron, that is vital for supporting short-term memory. Results indicate that this specific type of neurons remain active for several seconds when a person is required to memorize an object or image and recall it at a later time. The findings reveal critical new information on how the human brain stores and maintains short-term memories – the ability to remember ideas, thoughts, images and objects during a time frame of seconds to minutes. Short-term memory is essential for making decisions and mental calculations. “Because impaired short-term memory severely weakens someone’s ability to complete everyday tasks, it is essential to develop a better understanding of this process so new treatments for memory disorders can be developed,” said Jan Kamiński, PhD, a neuroscientist at Cedars-Sinai and lead author of the study. Researchers found persistently active neurons in the medial frontal lobe as well as the medial temporal lobe. The neurons remained active even after the patient stopped looking at an image or object. Until now, the medial temporal lobe was thought to be involved only in the formation of new long-term memories. Now, however, the new findings show that both areas of the brain are critical for maintaining short-term memory and rely upon the ongoing activity of the neurons for memorization. During the study, a team of Cedars-Sinai neurosurgeons implanted electrodes to precisely locate the source of seizures in 13 epilepsy patients. Investigators then studied the electrical activity of individual neurons while patients performed a memory test. During the test, patients viewed a sequence of three images, followed by a two-to-three-second delay. Then patients were shown another image and were asked to decide whether they had previously seen the image. “A surprising finding of this new study is that some of the persistently active neurons were only active if the patient memorized a specific image,” Kamiński said. “For example, the researchers discovered a neuron that reacted every time the patient memorized an image of Han Solo, a character in the movie Star Wars, but not any other memory.” Another key finding of the study was a correlation between the strength of the neurons’ activity and the ability to later make use of the memory. “We noticed that the larger the increase in activity, the more likely the patient was to remember the image. In contrast, if the neuron’s activity was weak, the patient forgot the image and thus lost the memory,” said Adam N. Mamelak, MD, professor of Neurosurgery, director of Functional Neurosurgery at Cedars-Sinai and a co-author of the study. Keith L. Black, MD, chair of the Department of Neurosurgery at Cedars-Sinai, said the breakthrough can be credited to the partnership between neurosurgery and neurology clinicians working with neuroscientists. “This unique collaboration allows us to discover the mechanisms of memory in the human brain,” Black said. “This is key for moving closer to finding treatments for memory disorders, epilepsy and other diseases.” Rutishauser said a next step is understanding how multiple areas of the brain work together to support short-term memory. “Now that specific neurons that support short-term memory have been discovered, we have a way to study their interaction systematically,” he said. Other Cedars-Sinai study contributors included Jeffrey Chung, MD, director of the Epilepsy Program and the Neurophysiology Laboratory; and Shannon Sullivan, research associate. Ian Ross, MD, a neurosurgeon at Huntington Memorial Hospital also contributed. This work was supported by National Science Foundation grant 1554105, National Institute of Mental Health grant R01MH110831, the McKnight Endowment Fund for Neuroscience, a NARSAD Young Investigator grant from the Brain & Behavior Research Foundation (23502), and the Pfeiffer Foundation. # # #

Newswise — PHILADELPHIA— Cervical cancer is the leading cause of cancer deaths for women low- and middle-income countries, including Botswana, where 75 percent of cervical cancer patients suffer from advanced forms of the disease. These patients can face wait times as long as five months after diagnosis before receiving lifesaving treatment. A new, multidisciplinary model of cervical cancer care developed by a University of Pennsylvania team based in Botswana cut the delay between diagnosis and treatment by more than 50 percent, according to research published this month in the Journal of Global Oncology. Limited access to preventive screenings combined with the HIV epidemic are driving the high rate of cervical cancer in Botswana, which has the second highest HIV prevalence in the world. The risk of developing cervical cancer in women infected with HIV is three- to six–fold higher than those who are HIV-negative. In Botswana, more than two-thirds of all cervical cancer cases occur among women who are also living with HIV. However, radiation therapy is not available at in public clinics in Botswana, requiring patients to seek care at private hospitals, which can be a cumbersome process with wait times as long as five months. “With so many women suffering from advanced cervical cancer in Botswana, long delays between treatment and diagnosis can mean the difference between life and death,” said Surbhi Grover, MD, MPH, director of Global Radiation Oncology in the Perelman School of Medicine at the University of Pennsylvania and head of Oncology at Princess Marina Hospital in Botswana. “We saw an urgent need to develop a care program that gives cervical cancer patients the treatment they need as quickly as possible.” Grover and her fellow researchers at Princess Marina Hospital developed a multidisciplinary team (MDT) approach to streamline care and communication between providers and get patients to treatment facilities faster. Weekly care team meetings were established across providers, including radiation oncologists, clinical oncologists, gynecologists, nurse coordinators, and palliative care specialists to discuss patient cases and develop treatment plans. The teams also worked to together to submit paperwork and other documentation, further reducing delays in treatment and simplifying the overall process. “While this type of model might seem common in the United States or other developed countries, it’s actually a quite complicated process that lacks a global standard of guidelines,” Grover said. “We saw many different models across the world, but no published outcomes on how to successfully implement an MDT approach for cervical cancer care.” Over a six-month period, the team saw 135 patients, 60 percent of whom were diagnosed with cervical cancer and 42 percent had locally advanced cancer the required chemo-radiation. However, thanks to the MDT model, 62 percent of those patients required only one clinic visit to coordinate care, reducing the time between diagnosis and treatment initiation by more than 50 percent, with the median delay from biopsy to treatment initiation cut to 39 days from an average of 108 days before the new care model. “With this model, we’ve shown that the MDT approach works in a resource-limited setting and actually helps address several challenges providers face,” Grover said. “Many of our patients must travel long distances or face other barriers that prevent them from returning to the clinic for multiple visits. Offering patients a comprehensive treatment plan during one clinic visit is a game-changer.” Similar MDT models are being developed for head and neck cancer, breast cancer, and palliative care in Botswana. A follow-up clinic is also being piloted where patients with gynecological cancer receive continued follow-up care after chemotherapy and radiation are complete. All patients seen in the Penn MDT clinic will be linked to this new clinic and will receive regular communication about follow-up care. “What this approach really shows is the importance of integrated care and treatment models,” Grover said. “We hope our MDT model will be applied on a broad scale across many different illnesses and clinics in resource-limited settings worldwide.” ###

Newswise — Australia could save AUD $3.4 billion (USD $2.3 billion) in healthcare costs over the remaining lifetimes of all Australians alive in 2010 by instituting a combination of taxes on unhealthy foods and subsidies on fruits and vegetables, according to a new study published in PLOS Medicine by Linda Cobiac, from the University of Melbourne, Australia and colleagues. An increasing number of Western countries have implemented or proposed taxes on unhealthy foods and drinks in an attempt to curb rates of dietary-related diseases, however the cost-effectiveness of combining various taxes and subsidies is not well-understood. In the new study, researchers modeled the effect of taxes on saturated fat, salt, sugar, and sugar-sweetened beverages and a subsidy on fruits and vegetables on the Australian population of 22 million alive in 2010. They simulated how different combinations of these taxes and subsidies—designed so there would be less than a one percent change in total food expenditure for the average household—impacted the death and morbidity rates of Australians as well as healthcare spending over the remainder of their lives. The greatest impact, the researchers concluded, came from a sugar tax, which could avert 270,000 disability-adjusted life years (DALYs, or years of healthy lifespan across the population lost due to disease). “That is a gain of 1.2 years of healthy life for every 100 Australians alive in 2010,” the authors say. “Few other public health interventions could deliver such health gains on average across the whole population.” A salt tax was estimated to save 130,000 DALYS over the remainder of the lives of Australians alive in 2010, a saturated fat tax 97,000 DALYs, and a sugar-sweetened beverage tax 12,000 DALYs. Combined with taxes, the fruit and vegetable subsidies made for additional averted DALYs and reduced health sector spending, but on their own were not estimated to lead to a clear health benefit. Overall, when combined to maximize benefits, the taxes and subsidies could save an estimated 470,000 DALYs and reduce spending by AUD $3.4 billion (USD $2.3 billion). “Simulation studies, such as ours, have uncertainty. For example, we are reliant on other research estimating the responsiveness of the public to changes in food prices. There are also implementation issues for the food industry.” “Nevertheless, this study adds to the growing evidence of large health benefits and cost-effectiveness of using taxes and regulatory measures to influence the consumption of healthy foods,” the authors say. “We believe that with such large potential health benefits for the Australian population and large benefits in reducing health sector spending…the formulation of a tax and subsidy package should be given more prominent and serious consideration in public health nutrition strategy.” “Several countries have imposed taxes on sugary drinks, with the UK the latest to consider such a policy. Our research suggests that even bigger health gains and cost savings may be possible with food taxes and subsidies on a wider range of foods.” Research Article Funding: LJC was supported by a National Health and Medical Research Council Fellowship (Grant number 1036771; www.nhmrc.gov.au). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.   Competing Interests:LJC is a member of the Editorial Board of PLOS Medicine. Citation:Cobiac LJ, Tam K, Veerman L, Blakely T (2017) Taxes and Subsidies for Improving Diet and Population Health in Australia: A Cost-Effectiveness Modelling Study. PLoS Med 14(2): e1002232. doi:10.1371/journal.pmed.1002232   Author Affiliations:Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia School of Public Health, The University of Queensland, Herston, Queensland, Australia, Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, Department of Public Health, University of Otago, Wellington, Wellington, New Zealand     SEE ORIGINAL STUDY