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Q&A: Closing in on ‘truly personalized medicine’

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Q&A: Closing in on ‘truly personalized medicine’


The 3D community has been busy during the pandemic. How have you kept your creativity flowing while working so much this past year?
This year certainly kept the team and me busy. We have been working around the clock, developing 3D-printed nasal swabs and pipettes for COVID-19 testing and converting BiPap machines to ventilators. To date we have 3D-printed more than 200,000 items to help combat the virus and aid our front-line workers. It was hard to find those spare moments, but every morning I made an effort to wake up early, make a cappuccino and sit out on the balcony of my New York City apartment overlooking the East River. Besides the amazing view, it felt surreal to soak in the morning calm, only to be interrupted by the concert of ambulances, reminding me that the world was so upside down. In those stolen moments, I did my best to reflect, think about the work we were doing and how we could help innovate even more.
 
How did you choose this line of work?
While I was a Ph.D. student, Northwell started its annual Innovation Challenge, pushing all team members in the health system to tackle problems creatively. Tasked with helping a patient in a car accident, we fired up our 3D printers and designed the first medical model and surgical guide for Northwell. The model and guide were for bone cement to help repair the patient’s elbow, which was severely damaged. We took top honors in the challenge and used the awarded $100,000 to fund the 3D lab we have today.
 
What’s the most important thing you do to encourage innovation within your team?
I encourage my team to chase down their ideas even if they may not be the most conventional. The beauty and excitement of 3D design is that there is no rule that you have to follow the XYZ protocol to achieve results. I don’t tell my team how to solve a problem; instead, I present the team with the issue, then we can brainstorm together and let them do what they do best.
 
Who was your role model or sponsor?
My principal investigator during my Ph.D. program was Daniel Grande of the Feinstein Institutes for Medical Research at Northwell. He has always been there to guide and mentor me. He was the first person to show me how a Ph.D. could navigate the clinical world, converting research into the practice of healthcare. He taught me to think differently and look at challenges from all angles.
 
What do you see as future big innovations?
Technology is improving how we can collect and analyze data, allowing us to adjust patient care in real time—on the fly. Machine learning, AI, automation, and 3D design are having a significant positive change for patient care. Combine the technology with things like individual genetic profiles and we are leaps and bounds closer to truly personalized medicine.



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Meat Production Is Polluting the Air You Breathe

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Meat Production Is Polluting the Air You Breathe


By Amy Norton
HealthDay Reporter

TUESDAY, May 11, 2021 (HealthDay News) — Steaks and burgers could be killing thousands of Americans each year, but in a way most people wouldn’t expect — via air pollution.

That’s the conclusion of a new study estimating that airborne particles generated by food production kill nearly 16,000 Americans each year. Pollution related to animal products — most notably beef — accounts for 80% of those deaths.

“What we eat affects not only our own health, but the health of others,” said researcher Jason Hill, a professor of bioproducts and biosystems engineering at the University of Minnesota in St. Paul.

Farming generates pollutants in numerous ways, but Hill’s team focused specifically on its role in fine-particle pollution — tiny substances suspended in the air that can be inhaled deeply into the lungs.

That can be especially dangerous for people with existing heart or lung conditions, and the World Health Organization says exposure to dirty air kills roughly 7 million people worldwide each year.

Continued

Farming activities like plowing fields, fertilizing crops and spreading and storing manure all help generate fine-particle pollution.

Growing plant foods creates some pollutants, but not at the level of animal products. There’s not only the livestock themselves — think manure — but the crops grown to feed them, Hill said.

Raising cattle requires the most resources and churns out the most pollution.

Accordingly, the study found, air pollution related to red-meat production caused the most harm: Per serving, its impact on deaths was seven times that of poultry, 10 times that of nuts and seeds, and at least 15 times that of other plant foods.

“Red meat has such a large impact that reducing our intake of that alone could make a big difference,” Hill said.

Gidon Eshel, a researcher not involved in the study, agreed.

Beef production “exerts, by far, the most environmental and health consequences,” said Eshel, a research professor at Bard College in Annandale-on-Hudson, N.Y.

It’s been well known that agriculture contributes to air pollution, Eshel said, and that air pollution contributes to deaths.

But the new findings, he said, show “crisply and numerically” how the nation’s collective diet contributes to deaths in the population.

Continued

The study — published May 10 in the Proceedings of the National Academy of Sciences — was partly funded by the U.S. Environmental Protection Agency (EPA) and U.S. Department of Agriculture.

It drew on EPA emissions data to gauge the impact of different farming activities on U.S. counties’ air quality. The researchers then used statistical models to estimate the effects of fine-particle pollution, from various agriculture sources, on annual deaths nationwide.

The verdict: Agriculture generates enough dirty air to kill about 18,000 Americans each year. Specifically, ammonia from livestock waste and fertilizer was a major culprit, the researchers said.

Of those deaths, the vast majority — almost 16,000 — were related to food production, mainly meat, poultry and dairy.

To take a more positive view, Hill’s team also estimated the impact of potential solutions.

They found that certain farming measures — such as improving fertilizer application — could prevent some deaths.

But changes to the American diet would reap far greater benefits: If veganism and vegetarianism swept the nation, most of the described deaths could be avoided, the researchers found.

Continued

However, Hill stressed, “you don’t have to become an absolutist.”

His team projected that “flexitarian” eating would prevent a large number of deaths, too. That refers to diets that are largely plant-based but allow some animal products in moderation.

Given the large effects of red meat, Hill noted, even declaring “meatless Mondays” could make a difference.

But would there be ill health effects from eschewing animal protein?

Eshel said there’s “not a shred of evidence” that people need animal protein to be healthy — but a “mountain of evidence” supporting the benefits of plant-based diets.

In a 2019 study, Eshel estimated that if all Americans traded in meat for plant alternatives, it would make a big dent in greenhouse gas emissions, and use of crop lands and nitrogen fertilizers.

And with sources like soy and buckwheat supplying protein, the study found, there would be no skimping on nutrients, either.

But Eshel also acknowledged that a national embracing of veganism is unlikely. He said that “jettisoning” beef, and replacing it with healthy plant foods, would be a good step in itself.

Continued

More information

The Academy of Nutrition and Dietetics has advice on building healthy vegetarian diets.

SOURCES: Jason Hill, PhD, professor, bioproducts and biosystems engineering, University of Minnesota, St. Paul; Gidon Eshel, PhD, research professor, environmental and urban studies, Bard College, Annandale-on-Hudson, N.Y.; Proceedings of the National Academy of Sciences, online, May 10, 2021



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Poll: Most in US who remain unvaccinated need convincing

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Poll: Most in US who remain unvaccinated need convincing


Fewer Americans are reluctant to get a COVID-19 vaccine than just a few months ago, but questions about side effects and how the shots were tested still hold some back, according to a new poll that highlights the challenges at a pivotal moment in the U.S. vaccination campaign.

Just 11% of people who remain unvaccinated say they definitely will get the shot, while 34% say they definitely won’t, according to the poll by The Associated Press-NORC Center for Public Affairs Research.

That leaves a large swath of Americans in the middle who might still roll up their sleeves — including 27% who say they probably will and 27% who say they probably won’t — if someone credible addressed their concerns. That’s where National Institutes of Health immunologist Kizzmekia Corbett comes in.

Corbett helped lead development of the Moderna shot, and she spends hours giving plain-spoken answers to questions from Americans — especially Black Americans like her — to counter misinformation about the three vaccines used in the U.S.

No, COVID-19 vaccines won’t cause infertility: “Whoever started that rumor, shame on you.”

No, the shots’ speedy development doesn’t mean corners were cut: “We worked our butts off for the last six years” hunting vaccines for earlier cousins of COVID-19 — a head start that made the difference, Corbett recently told the AP.

Getting as many people vaccinated as fast as possible is critical to returning the country to normal. More than 150 million people — about 58% of all adults — have received at least one dose, according to the Centers for Disease Control and Prevention.

As that number grows, reluctance is inching down. Overall, the AP-NORC poll found about 1 in 5 American adults say they probably or definitely won’t get vaccinated, compared to about a third in January, when the shots were just rolling out.

Black Americans likewise are becoming more open to the shots, with 26% now saying they definitely or probably won’t get vaccinated compared with 41% in January. That’s similar to the 22% of Hispanic Americans and white Americans the poll found unlikely to get vaccinated. Among Asian Americans, just 9% say they definitely or probably won’t get the shots.

Holdouts are from all over American society — fueling experts’ advice that there is no one-size-fits-all vaccine message and that people need to hear from trusted sources, whether that’s scientists like Corbett or their own doctors. Adults under 45, rural Americans and Republicans are especially likely to say they will avoid vaccination, the poll found. But again, attitudes are changing: 32% of Republicans now say they probably or definitely won’t get vaccinated, down from 44% in January.

About three-fourths of those who say they are unlikely to get vaccinated have little to no confidence that the vaccines were properly tested, and 55% are very concerned about side effects, the poll found. Even among those who say they will probably get vaccinated but have not done so yet, concerns about proper testing are elevated compared with people who have received their shots already.

In forums hosted by colleges, Black pastors, doctors and even basketball great Kareem Abdul-Jabbar, Corbett says the best way to overcome distrust is to put the science in understandable terms for strangers just like she does for family. Later this spring, she’s moving from the NIH to Harvard’s School of Public Health to continue both her vaccine research and that outreach to communities, the school plans to announce on Tuesday.

The vaccines’ speedy development “is historic and it is brag-worthy,” said Corbett, whose NIH team was able to customize a shot that matched the new virus after spending six years developing vaccines against other dangerous coronaviruses such as MERS.

But “really, we should have started the conversations very early about what went into it,” she said, so the public understood that no steps were skipped.

A combination of huge studies and real-world data show the main side effects of the U.S. vaccines are temporary fevers or aches as the immune system revs up. The shots are undergoing unprecedented safety monitoring, which last month led to a temporary pause in Johnson & Johnson vaccinations to determine how to handle an incredibly rare risk of blood clots.

Even after that pause, overall confidence in the vaccines is up slightly compared with a few months ago, with 45% of all adults now very or extremely confident that the shots were properly tested for safety and effectiveness, compared with 39% in an AP-NORC poll in February.

But side effect myths persist. Corbett calls the fertility concern “completely absurd,” and in forum after forum explains why it’s biologically impossible for the vaccines to alter anyone’s DNA.

The repetition is OK: “People need to hear things multiple times,” she said.

Plus, many Americans have some of the same questions scientists are still trying to answer, such as whether or when people might need a booster dose.

“Those are things that even I can’t even answer. But what I can say is that we’re doing everything we can to make sure we can answer it as soon as possible,” Corbett said.



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CMS requires nursing homes offer COVID-19 vaccines, education

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CMS requires nursing homes offer COVID-19 vaccines, education


Long-term and intermediate care facilities will have to educate their residents, clients and staff about COVID-19 vaccines and offer such vaccines to those populations when available, according to a CMS interim final rule published Tuesday.

If those facilities don’t provide the required education and vaccinations, the agency could bar them from participating in Medicare or Medicaid. The rule also requires long-term and intermediate care facilities to report the COVID-19 vaccination status of their residents and staff to the Centers for Disease Control and Prevention.

“The new vaccination reporting requirement will not only assist in monitoring uptake amongst residents and staff, but will also aid in identifying facilities that may be in need of additional resources and/or assistance to respond to the COVID-19 pandemic,” CMS said in a statement.

The agency touted the move, saying it would advance health equity and combat vaccine hesitancy.

“These new requirements reinforce CMS’ commitment of ensuring equitable vaccine access for Medicare and Medicaid beneficiaries,” CMS Chief Medical Officer Dr. Lee Fleisher said in a statement. “Today’s announcement directly aids nursing home residents and people with intellectual or developmental disabilities who have been disproportionately affected by COVID-19. Our goal is to increase COVID-19 vaccine confidence and acceptance among these individuals and the staff who serve them.”

The changes follow recent CDC guidance that recommends prioritizing the vaccination of people living in congregate settings, which are also known as residential habilitation settings.

“People living and working in these living situations may have challenges with social distancing and other mitigation measures, like mask use and handwashing, that help to prevent the spread of SARS-CoV-2,” the rule said. “Some congregate living residents require close assistance and support from facility staff, which further reduces their ability to maintain physical distance.”

The interim final rule takes effect May 21. Comments on it are due in June.

CMS asked the public to comment on whether it could realistically carry out similar requirements for other congregate settings, including psychiatric residential treatment facilities, psychiatric hospitals, forensic hospitals and inpatient hospice facilities.

The agency considered extending the requirements to other facility types but decided not to because it didn’t think those requirements were workable now. Instead, CMS said it would focus on facilities with longer-term patient relationships because they’re better able to administer and track multi-dose vaccines.

“Individuals in psychiatric hospitals, for example, may only be inpatients for short periods, making appropriate provision of a two-dose vaccine series challenging,” the rule said. “Although a one-dose vaccine product is also now authorized … we are not able to guarantee sufficient availability of single-dose COVID-19 vaccines at this time, or in the near future.”



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