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Region, Race, and Age Linked With Likelihood of Cancer Patients Using Telehealth Services

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Key takeaways

Cancer centers in the west were more than six times as likely to offer telehealth visits than other regions in the country.
Race, older age, and income level linked to use of telehealth services at cancer centers.
Each 10-year increase in patient age decreased the odds of a telehealth video visit by nearly 20 percent in cancer patients. Together, Black race and older age decreased the chances of a video visit by an additional 12 percent.

CHICAGO: Two studies improve understanding of how video and telephone telehealth services are used by patients and cancer centers across the country, identifying factors that could lead to more or less use of these services and guide efforts to improve access for patients who might otherwise be shut out. Research findings were presented at the virtual American College of Surgeons (ACS) Clinical Congress 2021.

To improve access to care during the COVID-19 pandemic, many medical centers shifted to telehealth services. In fact, telehealth visits increased by 50 percent during the first quarter of 2020, compared with the same period in 2019, according to the CDC.*

Telehealth appointments are more efficient than traditional face-to-face encounters, eliminating the need for long travel and wait times, plus many patients prefer the convenience of remote visits. However, challenges for patients such as technical difficulties, internet connection issues, and limited access to smart devices can prevent patients from using this approach.

“Because of COVID, centers across the country had to ramp up telehealth services, and that begs the question, is it feasible for these centers to make this shift long-term?” said Harry Doernberg, a medical student at Yale School of Medicine, New Haven, Connecticut.

Telehealth use among Commission on Cancer-accredited centers

For the first study, Mr. Doernberg and colleagues addressed this question by conducting a secret shopper study on 371 ACS Commission on Cancer (CoC)-accredited centers across the U.S. The objective was to identify factors associated with the centers who offered telehealth services and those who did not. Between June and September 2020, researchers called the centers anonymously to find out if they had the capacity to offer telehealth appointments to breast cancer patients.

Among the study’s key findings:

The vast majority of CoC-accredited centers (316 of 371) offered telehealth visits for breast cancer patients.
After controlling for facility type (Comprehensive Community Cancer Program, Community Cancer Program, and more), teaching hospital status, and hospital size, geographic location was the only independent factor associated with telehealth access.
Centers located in the west were over six times (OR: 6.38) more likely to offer telehealth visits than other regions, including the northeast.

“Overall, this analysis highlights the fact that different regions of the country were more or less prepared to shift to telehealth during the pandemic,” said study coauthor Anees Chagpar, MD, MBA, MPH, FACS, FRCS (C), professor of surgery, Yale School of Medicine, and a member of Yale Cancer Center. “The next questions are: What happens going forward? How many of these centers will continue to offer telehealth? What percentage of patients will opt for telehealth visits? How these questions play out in the future remains to be seen.”

Telehealth use among a diverse population

For the second study, Connie Shao, MD, a general surgery resident at the University of Alabama Birmingham, and her colleagues looked at telehealth use between March and December 2020 among a diverse population of patients receiving care at a Commission on Cancer-accredited National Cancer Institute-designated cancer center in Birmingham.

Using billing data, researchers compared patient socioecological factors for outpatient clinic visits (in-person versus telehealth and within telehealth, telephone-only versus video). The analysis adjusted for factors such as zip code, household income, race, and sex to identify factors associated with telehealth use.

Among the key findings:

Of the 60,718 clinic visits, 84.4 percent (51,260) were in-person and 15.6 percent (9,458) were via telehealth, including video (41.7 percent) and telephone-only (58.3 percent) visits.
Telehealth visits were primarily used by patients who were white (70.3 percent), female (63.7 percent), and had private insurance (47.5 percent). Average age was 60.
Compared with video visits, telephone visits were used more by patients who are Black (25.8 percent vs. 18.4 percent), older (62 vs. 57), from lower income zip codes ($52,297 vs. $56,343), and publicly insured (52 percent vs. 41.4 percent).
For each decade of advancing patient age, the likelihood of having a video visit decreased by 18 percent. This was even more pronounced in Black patients where the likelihood of a video visit dropped by 40 percent for every decade. When Black race and older age were combined, the odds of having a video visit dropped by another 12 percent. This finding was despite increased video telehealth use over the study period.

“Telemedicine is here to stay,” Dr. Shao said. “The issue is how do we make sure patients are accessing it equitably? Unfortunately, some of our sickest patients are not able to access telemedicine that most benefits their health care needs. We want to offer patients, those who are far from the hospital and have a difficult time connecting with us, care with us, even as the COVID pandemic hopefully ends.”

Although telemedicine has been available for decades, COVID has accelerated its widespread use very quickly. Together, these two studies deepen understanding of how vulnerable patients are not reaping the benefits of its use, paving the way for additional research and improved access.

Currently, Dr. Shao and colleagues are implementing a process at their center where patient navigators screen patients to figure out who needs telehealth support. The patient navigators instruct patients on how to set up a video-based telemedicine visit. This gives patients the skill and confidence to use telehealth video visits now and for future appointments.

“We are currently collaborating with a group to roll out this program even more and to analyze the strength of the program and eliminate the barriers. We want to know what can be improved to achieve successful telemedicine visits,” Dr. Shao said. “As COVID wanes, the fear of coming into the hospital decreases. Moving forward, our concern is finding ways to help those patients better engage with us, often and remotely. A lot of these patients are rural and live hours away from a major hospital.”

Coauthors for the Yale University School of Medicine study are Walter Hsiang, BS, MBA; Victoria Marks, BS; Irene Pak; Dana Kim; Bayan Galal; Waez Umer; and Afash Haleem.

Authors have no disclosures to mention.

CITATION: Doernberg H, et al. Factors Affecting Telehealth Availability Amongst Breast Centers During the Pandemic. Scientific Forum Presentation. American College of Surgeons Clinical Congress 2021.

Dr. Shao’s coauthors for the University of Alabama study are Marshall C. McLeod, PhD; Isabel C. dos Santos Marques, MD; Lauren Theiss, MD; Gregory D. Kennedy, MD, PhD, FACS; Mona N. Fouad, MD, MPH; Eric Wallace, MD; Daniel I. Chu, MD, FACS; and Sushanth Reddy, MD, FACS.

An American College of Surgeons resident research award and an AHRQ Grant for Health Services funded the study.

CITATION: Shao C, et al. Age Exacerbates Inequity in Telemedicine Use During the Covid-19 Pandemic for Cancer Patients in the Deep South. Scientific Forum Presentation. American College of Surgeons Clinical Congress 2021.

“FACS” designates that a surgeon is a Fellow of the American College of Surgeons.

_______________________

* https://www.cdc.gov/mmwr/volumes/69/wr/mm6943a3.htm.

# # #

About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.

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Original Source: bioengineer.org

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Earliest Evidence of Humans Decorating Jewellery in Eurasia

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Upon their dispersals in Central and Western Europe by around 42,000 years ago, groups of Homo sapiens started to manipulate mammoth tusks for the production of pendants and mobiliary objects, like carved statuettes, at times decorated with geometric motifs. In addition to lines, crosses and hashtags, a new type of decoration – the alignment of punctuations – appeared in some ornaments in south-western France and figurines in Swabian Jura in Germany. Until now, most of these adornments were discovered from older excavations, and their chronological attributions remain uncertain. Hence, questions regarding the emergence of human body augmentation and the diffusion of mobiliary art in Europe remained strongly debated.

Upon their dispersals in Central and Western Europe by around 42,000 years ago, groups of Homo sapiens started to manipulate mammoth tusks for the production of pendants and mobiliary objects, like carved statuettes, at times decorated with geometric motifs. In addition to lines, crosses and hashtags, a new type of decoration – the alignment of punctuations – appeared in some ornaments in south-western France and figurines in Swabian Jura in Germany. Until now, most of these adornments were discovered from older excavations, and their chronological attributions remain uncertain. Hence, questions regarding the emergence of human body augmentation and the diffusion of mobiliary art in Europe remained strongly debated.

A new study, led by researchers of the Max Planck Institute for Evolutionary Anthropology in Germany, the University of Bologna in Italy, Wroclaw University in Poland, the Polish Geological Institute-National Research Institute, Warsaw, Poland, and the Institute of Systematics and Evolution of Animals Polish Academy of Sciences, reports the oldest known punctate ivory pendant found in Eurasia. Its age of 41,500 years places this personal ornament from Stajnia Cave within the record of the earliest dispersals of Homo sapiens in Europe.

Methodological advances in radiocarbon dating

“Determining the exact age of this jewellery was fundamental for its cultural attribution, and we are thrilled of the result. This work demonstrates that using the most recent methodological advances in the radiocarbon method enables us to minimise the amount of sampling and achieve highly precise dates with a very small error range. If we want to seriously solve the debate on when mobiliary art emerged in Palaeolithic groups, we need to radiocarbon date these ornaments, especially those found during past fieldwork or in complex stratigraphic sequences”, says Sahra Talamo, lead author of the study and director of the BRAVHO radiocarbon lab at the Department of Chemistry G. Ciamician of Bologna University.

The study of the pendant and the awl was also carried out through digital methodologies starting from the micro-tomographic scans of the finds. “Through 3D modeling techniques, the finds were virtually reconstructed and the pendant appropriately restored, allowing detailed measurements and supporting the description of the decorations,” notes co-author Stefano Benazzi, director of the Osteoarchaeology and Paleoanthropology Laboratory (BONES Lab) at the Department of Cultural Heritage, University of Bologna.

The personal ornament was discovered in 2010 during fieldwork directed by co-author Mikolaj Urbanowski among animal bones and a few Upper Palaeolithic stone tools. Separate short term occupations by Neanderthals and Homo sapiens groups have been identified from the cave’s archaeological record. The disposal of the pendant is probably occurred duringa hunting expedition into the Krakow-Czestochowa Upland where the pendant broke and was left behind in the cave.

Similar decorations appeared independently across Europe

“This piece of jewellery shows the great creativity and extraordinary manual skills of members of the group of Homo sapiens that occupied the site. The thickness of the plate is about 3.7 millimetres showing an astonishing precision on carving the punctures and the two holes for wearing it”, says co-author Wioletta Nowaczewska of Wroclaw University. “If the Stajnia pendant’s looping curve indicates a lunar analemma or kill scores will remain an open question. However, it is fascinating that similar decorations appeared independently across Europe”, remarks co-author Adam Nadachowski from the Institute of Systematics and Evolution of Animals Polish Academy of Sciences.

In broad-scale scenarios on the earliest expansion of Homo sapiens in Europe, the territory of Poland is often excluded suggesting that it remained deserted for several millennia after the demise of Neanderthals. “The ages of the ivory pendant and the bone awl found at Stajnia Cave finally demonstrate that the dispersal of Homo sapiens in Poland took place as early as in Central and Western Europe. This remarkable result will change the perspective on how adaptable these early groups were and call into question the monocentric model of diffusion of the artistic innovation in the Aurignacian”, says co-athor Andrea Picin from the Max Planck Institute for Evolutionary Anthropology in Leipzig.

Further detailed analyses on the ivory assemblages of Stajnia Cave and other sites in Poland are currently underway and promise to yield more insights into the strategies of production of personal ornaments in Central-Eastern Europe.

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Article: bioengineer.org

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Follow the Boat, Find the Bird — Free Food From Trawlers Helps Identify Important Areas for Seabird Conservation

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. Seabird populations under threat due to human activity
. University College Cork research could have implications for offshore developments
. Birds with tracking devices found to follow fishing vessels for food

. Seabird populations under threat due to human activity
. University College Cork research could have implications for offshore developments
. Birds with tracking devices found to follow fishing vessels for food

Studying fishing boats’ routes could assist better coastal planning and ultimately protect threatened seabirds, according to new research from University College Cork (UCC).

An international team, led by the Marine Ecology Group at MaREI, the SFI Research Centre for Energy, Climate and Marine hosted by UCC, equipped seabirds with the latest tracking technology and found that fishing vessels can help figure out where the birds go to feed.

Northern fulmars, a relative of the albatross, were shown to travel hundreds of kilometres in a matter of days for a meal before returning home, and their tracks revealed that up to half of the fulmars were following fishing vessels for food in the form of fishing waste thrown overboard.

The researchers then looked at the wider distribution of fulmars around Irish and UK waters and found that areas of the sea that fishing vessels spent the most time in were also where fulmars went to feed. Northern fulmars are an endangered species in Europe with markedly declining populations. This new understanding of their feeding grounds is vitally important for protecting them from the hazards they may face at sea at a time when most of the world’s seabird populations are threatened. Fulmars are often accidentally caught by vessels. Because fulmars can live to 50 years old, even occasional bycatch in fishing gear can have big implications for their population. This study highlights the need for best practice when fishing, including bird scaring lines when setting nets or trailing longlines.

Lead author Jamie Darby of MaREI at UCC said:

“Information about where seabirds go at sea is vital for making sure that new offshore developments, including windfarms, can be designed to do the least amount of harm. That’s why studies such as this one are so important.

“Humans have given seabirds a lot to contend with. They are sensitive to oil and plastic pollution; we accidentally catch them in commercial fishing gears; we’ve brought rats and other invasive species onto many of their breeding colonies over the last few centuries.”

Ireland has a huge expanse of marine territory and attracts fishing vessels from overseas because these fishing grounds are so productive. Ireland’s commitment to renewable energy means that windfarms will soon be a common fixture along the coasts. However given the islands and cliffs of Ireland are home to 24 species of seabird, proper planning of these energy generators is essential if these birds are to be protected.

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Original Article: bioengineer.org

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Unveiling the Hidden Cellular Logistics of Memory Storage in Neurons

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Exploring the mechanisms involved in sleep-dependent memory storage, a team of University of Michigan (U-M) cellular biologists found that RNAs associated with an understudied cell compartment in hippocampal neurons vary greatly between sleeping and sleep-deprived mice after learning.

Exploring the mechanisms involved in sleep-dependent memory storage, a team of University of Michigan (U-M) cellular biologists found that RNAs associated with an understudied cell compartment in hippocampal neurons vary greatly between sleeping and sleep-deprived mice after learning.

Sara Aton, Associate Professor in the Department of Molecular, Cellular, and Developmental Biology, and James Delorme, a recent U-M neuroscience graduate student, hypothesized that both a learning event and subsequent sleep (or sleep loss) would impact mRNA translation. Most prior work on the effects of sleep on mRNAs have focused on transcripts in the neuronal cytosol. However, Drs. Aton and Delorme found that after learning, major changes in RNAs are instead present –almost exclusively– on ribosomes associated with neuronal cell membranes. These results have been published in the Proceedings of the National Academy of Sciences, in November 30, 2021.*

The team first applied a commonly used biochemical method that homogenizes and centrifuges the hippocampal tissue, to separate the cytosol (the aqueous component of the cytoplasm of acell within which smaller organelles and particles are suspended) from other cellular components that are usually considered “debris” (endoplasmic reticulum, golgi apparatus, cell membrane, etc.). In this study, the authors found that RNA associated with ribosomes in the cytosol varied depending on whether the animals slept or not, confirming prior transcriptomic studies. However, cytosolic ribosomes showed almost no RNA changes depending on prior learning.

“If we had just stopped there, we wouldn’t have found anything that was novel or insightful. We strongly felt that we had to rethink our methodology,” explained Aton. Since it is well known that the endoplasmic reticulum is covered with ribosomes, the machinery that converts RNAs into proteins, Delorme and Aton decided to sequence the RNAs in the other parts of the cell, the “debris,” outside of the cytosol. It is in the less-well-studied membrane-containing cell fraction that they found that many transcripts were affected as a function of prior learning. These modified transcripts also differed significantly whether the animals had been allowed to sleep following the learning – allowing a new memory to be stored – or if they had been sleep-deprived. These unexpected results open the door to many more investigations.

“By looking in those other areas of the cell, we now have the capacity to generate many new hypotheses about what happens at the molecular level when memories are consolidated, and when consolidation is interrupted due to sleep deprivation,” said Aton.

For example, in the animals that slept following learning, Aton and Delorme observed an increase in the abundance of transcripts that encode components of protein synthesis machinery in the membrane fraction of hippocampal neurons. One hypothesis would be to test whether there is indeed an increase in protein production by membrane-associated ribosomes after post-learning sleep.

In addition to mRNAs, the authors also found that learning led to changes in long non-coding RNAs’ association with neuronal membrane-bound ribosomes. These could play a role in regulating the translation of other transcripts, which should be investigated. “The cells have developed very elegant mechanisms to fine tune the process from transcription to translation, and long non-coding RNAs could be one of them in this part of the brain,” said Aton.

She further explained by comparing neurons to a large warehouse, with complex logistics that are needed to respond quickly to needs for new proteins in distant cell processes, requiring preparedness and distribution adaptation processes. “Neurons have to deliver the ‘package’ within a reasonable time frame, when it’s needed, no matter how far away that location is. Neurons have evolved to do this, and it is a huge biological question to investigate. It is important to understand how this biology works because – in addition to storing new memories – it impacts regeneration, degeneration, and neurological diseases,” concluded Aton.

This is the second PNAS publication from the Delorme-Aton team’s research. In their first article** (see press release), the team found, in sleep-deprived mice, an inhibitory gating mechanism that could disrupt hippocampal activity and memory consolidation. In contrast, post-learning sleep suppressed the activity of inhibitory interneurons, increased activity among surrounding hippocampal neurons, and improved memory storage.

Papers cited:

* “Hippocampal neurons’ cytosolic and membrane-bound ribosomal transcript profiles are differentially regulated by learning and subsequent sleep,” James Delorme, Lijing Wang, Varna Kodoth, Yifan Wang, Jingqun Ma, Sha Jiang, Sara J. Aton, Proceedings of the National Academy of Sciences, November 30, 2021, https://doi.org/10.1073/pnas.2108534118

** “Sleep loss drives acetylcholine- and somatostatin interneuron-mediated gating of hippocampal activity, to inhibit memory consolidation,” James Delorme, Lijing Wang, Femke Roig Kuhn, Varna Kodoth, Jingqun Ma , Jessy D. Martinez, Frank Raven, Brandon A. Toth, Vinodh Balendran, Alexis Vega Medina, Sha Jiang, Sara J. Aton, PNAS, June 21, 2021, 10.1073/pnas.201931811

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Article: bioengineer.org

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