Telehealth through the pandemic at a safety net hospital: observations and next steps for cancer care delivery

The COVID-19 pandemic revolutionized cancer care delivery leading to rapid adoption of digital technology for telehealth in the United States. In this study, we describe telehealth utilization trends across the three largest waves of the pandemic at a safety net academic center. We also provide a perspective on lessons learnt and our vision for cancer care delivery using digital technology in the near future. The integration of interpreter services within the video platform and its integration within the electronic medical record system is crucial for safety net institutes that service a diverse patient population. Pay-parity for telehealth, especially ongoing support for audio-only visits, will be critical in overcoming health disparities for patients without access to smartphone technology. Use of telehealth in clinical trials, widespread adoption of hospital at home programs, electronic consults for rapid access, and structured telehealth slots in clinic templates will be crucial in making cancer care more equitable and efficient

Specific loss of adipocyte CD248 improves metabolic health via reduced white adipose tissue hypoxia, fibrosis and inflammation

Background: A positive energy balance promotes white adipose tissue (WAT) expansion which is characterized by activation of a repertoire of events including hypoxia, inflammation and extracellular matrix remodelling. The transmembrane glycoprotein CD248 has been implicated in all these processes in different malignant and inflammatory diseases but its potential impact in WAT and metabolic disease has not been explored.Methods: The role of CD248 in adipocyte function and glucose metabolism was evaluated by omits analyses in human WAT, gene knockdowns in human in vitro differentiated adipocytes and by adipocyte-specific and inducible Cd248 gene knockout studies in mice.Findings: CD248 is upregulated in white but not brown adipose tissue of obese and insulin-resistant individuals. Gene ontology analyses showed that CD248 expression associated positively with pro-inflammatory/pro-fibrotic pathways. By combining data from several human cohorts with gene knockdown experiments in human adipocytes, our results indicate that CD248 acts as a microenvironmental sensor which mediates part of the adipose tissue response to hypoxia and is specifically perturbed in white adipocytes in the obese state. Adipocytespecific and inducible Cd248 knockouts in mice, both before and after diet-induced obesity and insulin resistance/glucose intolerance, resulted in increased microvascular density as well as attenuated hypoxia, inflammation and fibrosis without affecting fat cell volume. This was accompanied by significant improvements in insulin sensitivity and glucose tolerance.Interpretation: CD248 exerts detrimental effects on WAT phenotype and systemic glucose homeostasis which may be reversed by suppression of adipocyte CD248. Therefore, CD248 may constitute a target to treat obesity-associated co-morbidities. (C) 2019 The Authors. Published by Elsevier B.V.</p

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic.

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world

Substance use among college women with disordered eating attitudes and behaviors [abstract]

Abstract only availableDisordered eating (e.g., binge eating, purging, fasting) is associated with high rates of psychiatric comorbidity and serious medical complications including death (Herzog et al., 2006). Past research has found substance-related disorders to be among the most common co-occurring problems for individuals with significant eating pathology (Fischer, Anderson, & Smith, 2004; Granner, Black, & Abood, 2002; Krahn, Kurth, Gomberg, & Drewnowski, 2005; Piran & Robinson, 2006). The existing research in this area shows some inconsistencies in whether this increased risk for substance abuse is common to all types of disordered eating, or is specific to one particular pattern of disordered eating. The present study examines the relationship between substance use (SU) and disordered eating habits and weight concerns (DE); specifically whether different DE behaviors (binging, purging, restricting, and dieting) lead to use of different substances and different usage rates. The study also examines potential mechanisms for this relationship, including weight control, reduction of anxiety or tension, emotion enhancement, and psychological characteristics common to individuals with DE including body dissatisfaction, perfectionism, and maturity fears. Female undergraduate participants completed an online survey with items drawn from several measures of eating habits, weight concerns, substance use and expectancies for substance use. In analysis, it is expected that substance use (SU) will be more prevalent among women with disordered eating habits and weight concerns (DE) than among women without DE. Among women with DE, rates of stimulant use will be similar for those with and without bingeing and purging behaviors. Additionally, among women with DE, alcohol and non-stimulant drug use will be more prevalent among those with bingeing and purging behavior than those who show only dieting and food restriction.McNair Scholars Progra

Enhanced inactivation of Escherichia coli and Listeria monocytogenes by exposure to 405 nm light under sub-lethal temperature, salt and acid stress conditions

The antimicrobial effects of 405 nm light have generated interest in its use as an emerging disinfection technology with potential food-related applications. The aim of this study was to assess the bactericidal efficacy of 405 nm light for inactivation of Escherichia coli and Listeria monocytogenes under sub-lethally stressed environmental conditions. Bacteria were exposed to 405 nm light from a light emitting diode (LED) array under various temperature, salt (NaCl) and acid conditions to determine if bacterial susceptibility to 405 nm light inactivation is affected when exposed under these conditions. Non-stressed bacterial populations (105 CFU/mL) were exposed to increasing doses of 405 nm light (~ 70 mW/cm2) and the inactivation results were compared with those generated under stress conditions. Bacteria were held at various temperatures (4 °C, 22 °C and 45 °C), acid concentrations (pH 3, 3.5 and 7) and salt concentrations (0%, 0.8%, 10% and 15% NaCl), and simultaneously exposed to 405 nm light. Enhanced inactivation of both E. coli and L. monocytogenes was achieved when light exposure was combined with each of the sub-lethal stresses, with significantly increased inactivation rates compared to non-stressed populations (P ≤ 0.05). One exception was with L. monocytogenes when light-exposed in the presence of 15% salt, as this combination reduced bacterial inactivation. The greatest enhancement of 405 nm light inactivation for both bacterial species was achieved when light exposure was combined with sub-lethal acid stress conditions at pH 3. This was demonstrated by a 5-log10 reduction of E. coli following a 405 nm light dose of 84 J/cm2 compared to 378 J/cm2 for non-stressed populations (77% reduction in dose) and by a 5-log10 reduction of L. monocytogenes achieved with a dose of 42 J/cm2 which corresponded to 50% of the dose required for the equivalent reduction of non-stressed populations. This acid-enhanced 405 nm light inactivation effect was demonstrated with E. coli and L. monocytogenes when dispersed in liquid suspension and when deposited on a test surface. Overall, results from this study have shown that sub-lethally stressed bacteria have increased susceptibility to 405 nm light inactivation, thereby providing a synergistic inactivation effect, findings which increase the potential of this new light-based decontamination technology for food related applications

Optimal KI Prophylactic Dose Determination for Thyroid Radiation Protection After a Single Administration in Adult Rats

A dose–response study was performed in adult rats to select an optimal stable potassium iodide (KI) dose which could be implemented in repeated prophylaxis, in case of prolonged exposure to radioactive iodine. Increasing doses of KI were given orally to rats 1 hour before internal exposure simulated by I-125 injection. I-125 incorporation in the thyroid was measured by γ-spectrometry, and KI protection effect was modeled by pharmacological functions. The measurement method by inductively coupled plasma mass spectrometry previously developed for the quantification of stable iodine in urine was adapted to correlate KI effect with its distribution in the thyroid. More than 75% blockade of iodine I-125 incorporation in the thyroid was achieved for KI single doses above 0.5 to 0.7 mg/kg. Stable iodine content in the thyroid 24 hours after KI administration displayed a biphasic response, with a maximum level for a dose around 1 mg/kg. Besides, the urinary excretion of stable iodine is described by a sigmoid function. The change in the rate of iodine excretion for doses above 1 mg/kg KI suggests a body overload in iodine and corroborates a possible saturation of the thyroid. The results show that 1 mg/kg KI could be regarded as an optimal dose for thyroid protection

Expansion of Functionally Anergic CD21 −/low Marginal Zone-like B Cell Clones in Hepatitis C Virus Infection-Related Autoimmunity

International audienceHomeostasis of peripheral B cell subsets is disturbed during chronic hepatitis C virus (HCV) infection, leading to the occurrence of autoimmunity and B cell lymphoproliferation. However, mechanisms by which HCV causes lymphoproliferation remain controversial. We report in this article on the elevated number of clonal CD21(-/low)IgM(+)CD27(+) marginal zone (MZ)-like B cells, which correlates with autoimmunity and lymphoproliferation in HCV patients. We found an increase in autoreactive BCRs using V(H)1-69 and V(H)4-34 genes in CD21(-/low) MZ B cells. CD21(-/low) MZ B cells showed impaired calcium-mediated signaling, did not upregulate activation markers, and did not proliferate in response to BCR triggering. CD21(-/low) MZ B cells also were prone to dying faster than their CD21(+) counterparts, suggesting that these B cells were anergic. CD21(-/low) MZ B cells, in contrast, remained responsive to TLR9 stimulation. Gene array analyses revealed the critical role of Early growth response 2 and Cbl-b in the induction of anergy. Therefore, HCV patients who display high frequencies of unresponsive CD21(-/low) MZ B cells are more susceptible to developing autoimmunity and/or lymphoproliferation. These cells remain in peripheral blood controlled by functional anergy instead of being eliminated, and chronic antigenic stimulation through TLR stimulation may create a favorable environment for breaking tolerance and activating these cells