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New research to help manage excessive weight gain in patients being treated with antipsychotics
New research led by Dr Gurkiran Birdi and Dr Ian Maidment in the College of Health and Life Sciences at Aston University will explore ways of managing excessive weight gain in patients being treated with antipsychotics for mental health illnesses such as schizophrenia. The project, known as RESOLVE and funded by the National Institute for Health Research (NIHR), will study non-pharmacological interventions for antipsychotic-induced weight gain in people living with severe mental illness (SMI) by working directly with patients to understand and explain how, why, for whom, and in what contexts non-pharmacological interventions could help service users to manage antipsychotic-induced weight gain. Antipsychotics are widely used in the treatment of schizophrenia and other severe mental illnesses (SMI). Over the last 20 years, the first generation of antipsychotics has been replaced by the newer second generation of antipsychotics. There are over 220,000 people being treated for schizophrenia in the UK at any one point in time. Up to 80% of people with schizophrenia or bipolar disorder are overweight or obese. Weight gains of up to 33kg have been reported with antipsychotics. This weight gain has devastating consequences: life expectancy is reduced by 20 years in people with schizophrenia, partly related to the consequences of this weight gain. Diabetes has been reported to be a major issue with second-generation antipsychotics. In RESOLVE - which includes partners from University of East Anglia, Oxford, Cambridge, Birmingham Universities, the NHS and the McPin Foundation - the researchers will combine literature what has been written about the subject. The team will also interview volunteers, both people who have suffered from the weight and healthcare staff involved to understand their lived experience of weight gain. We also want to find out what works to help manage weight. At the end of the project, the team plans to develop guidance for service users and practitioners on the best ways to treat and manage weight gain. Dr Ian Maidment, reader in clinical pharmacy and lead researcher, said: “Prior to moving to academia, I spent 20 years working in mental health services. This is a really important issue, I have seen patients literally “balloon” weight with their weight increasing from 80 to 120kg. We need to find better ways to help them.” One member of the RESOLVE Lived Experience Advisory Group said: “The RESOLVE study could provide a tailored solution to my antipsychotic weight gain, that could benefit my unique needs as an individual. I have found that weight gain from taking anti-psychotics has been a real health problem. I find that this is often ignored or stigmatized by friends, family and healthcare professionals. Added to which there seems to be no currently available solution that works”.
Vitamin D2 and D3: what’s the difference and which should you take?
Both vitamins D2 and D3 are essentially inactive until they go through two processes in the body. First, the liver changes their chemical structure to form a molecule known as calcidiol. This is the form in which vitamin D is stored in the body. Calcidiol is then further altered in the kidneys to form calcitriol, the active form of the hormone. It is calcitriol that is responsible for the biological actions of vitamin D, including helping bones to form, metabolising calcium and supporting how our immune system works. Technically, vitamin D isn’t a vitamin at all, but a pro-hormone. This means the body converts it into an active hormone. All hormones have receptors (on bone cells, muscle cells, white blood cells) that they bind to and activate, like a key unlocking a lock. Vitamin D2 has the same affinity for the vitamin D receptor as vitamin D3, meaning neither form is better at binding to its receptor. Different effects on the immune system A recent study found that vitamin D2 and D3 supplementation had different effects on genes important for immune function. These findings are significant, as most previous research has failed to find much difference in the effect of supplementation with either vitamin D2 or D3. Most of the research published to date has suggested that the main difference between vitamin D2 and D3 supplementation is the effect on circulating vitamin D levels in the bloodstream. Studies have repeatedly shown that vitamin D3 is superior at raising levels of vitamin D in the body. These findings were supported by a recent review of the evidence which found that vitamin D3 supplementation increased vitamin D levels in the body better than vitamin D2. But not all studies agree. Very few studies support vitamin D2 supplementation being superior to vitamin D3. One trial showed that vitamin D2 was better at treating immune issues in patients who were on steroid therapy. However, other than increasing vitamin D levels in the body, there is not much evidence that vitamin D3 supplements are better than vitamin D2 supplements. One study found that vitamin D3 improved calcium levels more than vitamin D2. But we need more research to provide definitive answers. So which should I take? Vitamin D deficiency is now more prevalent than ever, with around a billion people worldwide being vitamin D deficient. It is important that people at risk of vitamin D deficiency – older adults, people living in less sunny climates and people with darker skin – take vitamin D supplements. Health professionals recommend that most people take 10 micrograms of vitamin D a day, especially in winter. It would appear that vitamin D3 supplements are the superior option for maintaining vitamin D levels, but short exposure of the skin to the sun, even on a cloudy day, will also help you keep healthy vitamin D levels.
Aston University psychologists to take part in major study to improve concussion prognosis
Researchers from the Aston Institute of Heath and Neurodevelopment, in the College of Health and Life Sciences at Aston University, are taking part in a major multiple partner study to identify new ways to accurately predict whether patients will develop long-term complications as a consequence of concussion. Experts from the University of Birmingham and the Defence Medical Rehabilitation Centre, in collaboration with Defence Medical Services, are to lead the UK consortium carrying out the study. With year one funded by the Ministry of Defence (£2m) and projected to run over eight years, the multi-faceted study will include a trial involving 400 civilians and 400 military personnel aged over 18 with a new diagnosis of concussion (also known as a mild traumatic brain injury or mTBI) which has resulted in them needing hospital treatment or rehabilitation. At specific time intervals over two years, the participants will take part in nine different areas of research using a variety of medical techniques and assessments to establish if these can be used routinely by medics as ‘biomarkers’ to indicate prognosis and long term impact of concussion. Medical techniques and assessments being trialled include brain imaging and function, analysis of blood and saliva samples, and headache measures, as well as mental health, vision, balance, and cognitive performance. mTBI is common and has been declared a major global public health problem, with 1.4 million hospital visits due to head injury annually in England and Wales - 85% of which are classified as mTBI. It is also estimated that up to 9.5% of UK military personnel with a combat role are diagnosed with mTBI annually. The research will involve 20 University of Birmingham experts working across disciplines, including neurology, psychology, sports medicine, mathematics and academics within the University’s Centre for Human Brain Health, and will be coordinated by Birmingham Clinical Trials Unit. It will also be driven by experts at the Defence Medical Rehabilitation Centre Stanford Hall; Imperial College London; University of Westminster; University of Nottingham; Royal Centre for Defence Medicine; and University Hospitals Coventry & Warwickshire. Dr Caroline Witton, reader in psychology and scientific lead for magnetoencephalography (MEG) at the Aston Institute for Health and Neurodevelopment (IHN), Aston University said: "I am very excited to be part of this landmark study of traumatic brain injury. At IHN we are focussed on improving lives through brain imaging and this work has the potential to help the thousands of people each year who suffer long term disability following a concussion." Dr Jan Novak, lecturer in psychology and MRI lead at Aston University said: "It is outstanding that this prestigious work is being conducted at Aston University’s Institute of Health and Neurodevelopment. We will provide our expertise in brain imaging, prediction of outcomes in patient groups, and credentials in mTBI research to enrich the study. It is hoped that it will build upon existing collaborations with other local institutions and government bodies such as the Ministry of Defence." Alex Sinclair, professor of Neurology at the University of Birmingham and chief investigator of the mTBI-Predict project explained: “Although classified as mild, and many recover, the consequences of concussion can be profound with many patients suffering long-term disability due to persistent headaches, fatigue, imbalance, memory disturbance, and poor mental health including post-traumatic stress disorder, while it can have a significant impact on the economy through loss of working hours and demand on the health system. Identifying those patients most at risk of these disabling consequences is not currently possible. There is therefore a pressing need to develop accurate, reproducible biomarkers of mTBI that are practical for use in a clinical setting and can predict long-term complications. "Our programme of research will deliver a step change in the care of patients with mTBI, enabling a personalised medicine approach to target early intervention for those most in need but also identifying those with a good prognosis who can return rapidly to activities of daily living.” Co-Chief Investigator, Air Vice-Marshall Rich Withnall QHS Director of Defence Healthcare, UK Ministry of Defence said: “I am delighted that the Defence Medical Services, including the Defence Medical Rehabilitation Centre at Stanford Hall, will be working hand-in-glove with class-leading civilian colleagues and the National Rehabilitation Centre Programme. I fully support this ground-breaking research which I am confident will lead to significant clinical innovation to benefit military and civilian patients and have a translational positive impact for sporting activities from grass-roots to elite levels.” Chief Executive of Headway, Peter McCabe said: “We know that even a seemingly minor head injury can have a major impact on a person’s life – and often the lives of those closest to them. This is particularly the case if the brain injury goes undiagnosed or its effects are mistaken for other conditions. The frustration of not having an accurate diagnosis or receiving the right support can be compounded by the lack of a clear recovery pathway or timeline. We therefore welcome this study in the hope that it can advance our understanding of concussion and mTBI.”
Sweeteners may be linked to increased cancer risk – new research
Sweeteners have long been suggested to be bad for our health. Studies have linked consuming too many sweeteners with conditions such as obesity, type 2 diabetes and cardiovascular disease. But links with cancer have been less certain. An artificial sweetener, called cyclamate, that was sold in the US in the 1970s was shown to increase bladder cancer in rats. However, human physiology is very different from rats, and observational studies failed to find a link between the sweetener and cancer risk in humans. Despite this, the media continued to report a link between sweeteners and cancer. But now, a study published in PLOS Medicine which looked at over 100,000 people, has shown that those who consume high levels of some sweeteners have a small increase in their risk of developing certain types of cancer. To assess their intake of artificial sweeteners, the researchers asked the participants to keep a food diary. Around half of the participants were followed for more than eight years. The study reported that aspartame and acesulfame K, in particular, were associated with increased cancer risk – especially breast and obesity-related cancers, such as colorectal, stomach and prostate cancers. This suggests that removing some types of sweeteners from your diet may reduce the risk of cancer. Cancer risk Many common foods contain sweeteners. These food additives mimic the effect of sugar on our taste receptors, providing intense sweetness with no or very few calories. Some sweeteners occur naturally (such as stevia or yacon syrup). Others, such as aspartame, are artificial. Although they have few or no calories, sweeteners still have an effect on our health. For example, aspartame turns into formaldehyde (a known carcinogen) when the body digests it. This could potentially see it accumulate in cells and cause them to become cancerous. Our cells are hard-wired to self-destruct when they become cancerous. But aspartame has been shown to “switch off” the genes that tell cancer cells to do this. Other sweeteners, including sucralose and saccharin, have also been shown to damage DNA, which can lead to cancer. But this has only been shown in cells in a dish rather than in a living organism. Sweeteners can also have a profound effect on the bacteria that live in our gut. Changing the bacteria in the gut can impair the immune system, which could mean they no longer identify and remove cancerous cells. But it’s still unclear from these animal and cell-based experiments precisely how sweeteners initiate or support cancerous changes to cells. Many of these experiments would also be difficult to apply to humans because the amount of sweetener was given at much higher doses than a human would ever consume. The results from previous research studies are limited, largely because most studies on this subject have only observed the effect of consuming sweeteners without comparing against a group that hasn’t consumed any sweeteners. A recent systematic review of almost 600,000 participants even concluded there was limited evidence to suggest heavy consumption of artificial sweeteners may increase the risk of certain cancers. A review in the BMJ came to a similar conclusion. Although the findings of this recent study certainly warrant further research, it’s important to acknowledge the study’s limitations. First, food diaries can be unreliable because people aren’t always honest about what they eat or they may forget what they have consumed. Although this study collected food diaries every six months, there’s still a risk people weren’t always accurately recording what they were eating and drinking. Though the researchers partially mitigated this risk by having participants take photos of the food they ate, people still might not have included all the foods they ate. Based on current evidence, it’s generally agreed that using artificial sweeteners is associated with increased body weight – though researchers aren’t quite certain whether sweeteners directly cause this to happen. Although this recent study took people’s body mass index into account, it’s possible that changes in body fat may have contributed to the development of many of these types of cancers – not necessarily the sweeteners themselves. Finally, the risk of developing cancer in those who consumed the highest levels of artificial sweeteners compared with those who consumed the lowest amounts was modest – with only at 13% higher relative risk of developing cancer in the study period. So although people who consumed the highest amounts of sweetener had an increased risk of developing cancer, this was still only slightly higher than those with the lowest intake. While the link between sweetener use and diseases, including cancer, is still controversial, it’s important to note that not all sweeteners are equal. While sweeteners such as aspartame and saccharin may be associated with ill health, not all sweeteners are. Stevia, produced from the Stevia rebaudiana plant, has been reported to be useful in controlling diabetes and body weight, and may also lower blood pressure. The naturally occurring sugar alcohol, xylitol, may also support the immune system and digestion. Both stevia and xylitol have also been shown to protect from tooth decay, possibly because they kill bad oral bacteria. So the important choice may be not the amount of sweetener you eat but the type you use.
Questions about colon cancer? Our experts are here to help with your coverage
Every year, National Colorectal (colon) Cancer Awareness Month is observed during the month of March in an effort to raise awareness of the importance for colon cancer screenings. The recognition offers health care providers the opportunity to educate the general public about a disease that can be preventable, but can sometimes be seen as difficult for patients to discuss with their doctors. In the spirit of education, one of Augusta University’s experts has provided some insight into the subject of colon cancer. Dr. Asha Nayak-Kapoor is an associate professor of medicine in the Division of Hematology/Oncology in the Department of Medicine at the Medical College of Georgia at Augusta University. Nayak is certified by the American Board of Internal Medicine in Hematology and Oncology Specialties. Q: What are the primary risk factors for colon cancer? “Risk factors for colon cancer include: being overweight or obese, not being physically active, certain types of diets, smoking, alcohol use, being older, a personal history of colorectal polyps or colorectal cancer, a personal history of inflammatory bowel disease, a family history of colorectal cancer or adenomatous polyps, having an inherited syndrome. Common symptoms of colorectal cancer include: bloody stool or rectal bleeding, an ongoing change in bowel habits (diarrhea, constipation, chance in stool consistency), abdominal pain or cramping, gas or persistent abdominal discomfort, you feel like your bowels are not voiding completely, weakness, fatigue, or unexplained weight loss.” Q: How can a person protect themselves from the risks of colon cancer? “Colon cancer is largely preventable if patients undergo screening tests, like a surveillance colonoscopy starting at 45 years or earlier depending on family history. Many lifestyle-related factors have been linked to colorectal cancer. In fact, the links between diet, weight, and exercise and colorectal cancer risk are some of the strongest for any type of cancer. Getting to and staying at a healthy weight may help lower your risk. A diet that's high in red meats (such as beef, pork, lamb, or liver) and processed meats (like hot dogs and some luncheon meats) raises your colorectal cancer risk. Cooking meats at very high temperatures (frying, broiling, or grilling) creates chemicals that might raise your cancer risk. It’s not clear how much this might increase your colorectal cancer risk. Stop smoking. It is best not to drink alcohol. People with a history of colorectal cancer in a first-degree relative (parent, sibling, or child) are at increased risk. The risk is even higher if that relative was diagnosed with cancer when they were younger than 50, or if more than one first-degree relative is affected.” Q: It sometimes seems that colon cancer prevention is aimed more towards men compared to women, but cancer.org lists the risks at 1 in 23 (4.3%) for men and 1 in 25 (4.0%) for women. Is there a reason why perhaps a stigma about colon cancer affecting men more has been created? “According to focus group studies, it can be seen as a taboo topic that is uncomfortable to discuss, and it is not discussed as openly in public as prostate and breast cancer screenings. It can seem embarrassing or humiliating, and can be seen as distasteful dealing with prolonged bowel preparation.” Nayak is a member of several committees, including Onyx and Bayer Speaker Bureau for Nexavar, MCG Cancer Center Molecular Oncology Programme, and MCG Cancer Center Gastrointestinal Tumor Board Committee. If you are a journalist looking to know more about colorectal cancer and would like to speak with an expert for your stories, then let us help. Nayak is available to speak with media about this important subject. Simply click on her icon now to arrange an interview today.
Technical training, exposure to multiple industries and an open and inclusive culture help IT Associates innovate across CCG. They are often the quiet contributors to a project, taking a business idea from concept to delivery to allow strategic business endeavours to get off the ground. What they do and how they do it can be mysterious to many, with technical jargon, architectural details and complex processes at play. To succeed in IT requires incredible technical knowledge, a solid understanding of business processes, and innovative mindset with a natural curiosity to understand how multiple industry business systems all work together. Most importantly what’s needed is the desire for continuous learning. The IT department at CCG has enjoyed an incredible period of growth and development over recent years. In the last decade alone, CCG has undergone a major technology transformation, replacing every major business system required to support the different lines of business under the CCG umbrella including CAA Insurance, Orion Travel Insurance, CAA Travel, Membership and Emergency Roadside Services, while also implementing industry-leading innovations like CAA MyPace. We spoke to three tenured Associates to uncover their secret to success working in IT. What drives the culture of a team that often works behind the scenes but is vital to the success of all organizational projects? Lindsay Lamothe Typically, IT Associates have exposure to many business areas, giving them a well-rounded view of the various industries in which CCG operates. At first glance, one might think that this kind of exposure helps drive innovation and growth. But, while this is true for many, Lindsay Lamothe, Senior Business Systems Analyst for CCG’s Roadside Product Management, explains it’s more nuanced. “I think working in multiple lines of business at the organization led me down the path towards IT. I have no formal training in IT but having exposure to the business side of things gave me insights that continue to be valuable now that I work in a business enablement area,” shared Lamothe. “Being exposed to multiple industries while working in IT is a valuable opportunity to grow knowledge, but I think anyone who can learn more about the multiple industries we operate in would be well-positioned to do well in IT.” Lamothe started at CCG as a summer student to pay for university and eventually came on full-time working in auto travel, helping Members with TripTiks. She worked on the frontlines for ten years before shifting into IT and roadside assistance and has now been at the company full-time for 18 years. Her sense of purpose comes through very clearly when you speak to her about the impact of her work. “I am proud to work in IT at CCG because I am passionate about roadside operations. What we do saves lives,” said Lamothe. “If each code fix or enhancement that we work on gets us to the Member even five seconds sooner, that could be a matter of life or death. I know that we are making a difference in people's lives.” Voytek Bialkowski Voytek Bialkowski, just accepted a promotion to a director position in Enterprise Resource Planning. He also started his career at CCG and credits the technical learning opportunities offered for his continued success. Next month he marks the impressive milestone of 15 years with the company. “CCG is unparalleled in the marketplace in terms of professional growth and learning opportunities,” shares Bialkowski. “Our senior leaders have created a true knowledge culture by encouraging and celebrating professional development, certification, and lifelong learning. In my time with the IT department, I have earned four SAP certifications that furthered my technical skillset. I have also leveraged many of the programs available for Associates, such as the Lean Six Sigma White Belt and the Queens mental health certificate.” What truly sets CCG’s IT department apart is the emphasis on technical training that many Associates can receive right out of school or with little prior knowledge. Bialkowski explains, “CCG has provided me with multiple avenues for technological growth. Working on best-in-class systems and learning their functional and technical components has allowed me to become intimately familiar with SAP’s software suite, Greenfield SAP strategies and methodologies, data quality and data migration, application management, software development and testing lifecycle, as well as SQL and other query languages.” It's clear through the experiences of Lamothe and Bialkowski that learning opportunities and a broad array of opportunities to contribute to different areas of the business are key drivers of the success of CCG’s IT Associates. While hard skills and insights are essential, equally important is the culture of a team and the people that one works with to get things done. John Zhao John Zhao, Manager Quality Assurance in IT App Development & Architecture, shared his take on CCG’s culture and how that plays a role in delivering exceptional service to CCG’s business areas. “Collaboration and mutual respect underpin everything we do in IT. This is a big part of how we continue to learn and support each other,” shares Zhao. “Beyond these two values, we are encouraged to apply innovation to our daily process and products.” Innovation, being care-driven, leading by example, and collaboration are values that define CCG’s corporate culture across departments. Still, it is evident in speaking to Zhao that with tight deadlines and often unexpected challenges, they are especially engrained in the culture and approach of the IT department. Zhao’s experience at CCG aligns with Bialkowski and Lamothe’s, showcasing how fostering and developing technical knowledge internally and maintaining a broad perspective that can connect the dots across multiple industries are standard features of our IT approach. All three Associates underscore how the innovative and best-in-class approach of our IT department starts at the top. From Jay Woo, our CEO, to Apra Sekhon, our Chief Innovation Officer and Kin Lee-Yow, our Chief Information Officer, and their leaders. Together, they set the bar on integrating technology and innovation to ensure everyone aligns on promoting growth and knowledge to drive success for CCG’s IT Associates. As technology and innovation continue to grow, it’s valuable for all Associates to understand how this hardworking group of individuals support the essential work we do at CCG.
ChristianaCare MICU becomes first in United States to renew Beacon Award for Excellence for fifth-consecutive three-year cycle ChristianaCare’s Medical Intensive Care Unit (MICU) has earned an unprecedented honor from the American Association of Critical-Care Nurses. Among the thousands of intensive care units in the United States, ChristianaCare’s MICU is the first unit in history to earn a Beacon Award for Excellence from the association, also known as AACN, five times in a row. The Beacon Award is one of the highest achievements in nursing. The recognition lauds hospital units that employ evidence-based practices to improve patient and family outcomes. The award provides gold, silver and bronze levels of recognition to hospital units that exemplify excellence in professional practice, patient care and outcomes. Of the six Beacon Award-winning patient care units currently in the state of Delaware, five are at ChristianaCare: MICU (gold – five-time winner). Cardiovascular Critical Care Complex (gold – three-time winner). Transitional Medical Unit (silver). Surgical Critical Care Complex (silver). Transitional Surgical Unit (silver). ChristianaCare was one of 34 hospitals in the nation in 2021 with multiple units receiving Beacon Awards. Beacon Award designations are active for three years. “Through their relentless and uncompromising pursuit to deliver care that is nonpareil, the nurses of ChristianaCare’s MICU have become the paragon of what our profession can accomplish,” said Ric Cuming, EdD, MSN, RN, NEA-BC, FAAN, ChristianaCare’s chief nurse executive and president of ChristianaCare HomeHealth. “The success of our ChristianaCare MICU, even in the face of this pandemic, also has inspired our health system’s other intensive care units to achieve unprecedented gains in safety and quality that have been recognized with the AACN’s Beacon Award, the touchstone by which all critical care nursing excellence and quality are measured.” Success in caring for patients amidst COVID-19 ChristianaCare’s values of love and excellence are at the heart of the 24-bed MICU at Christiana Hospital, which holds the most Beacon Awards in Delaware. This year’s award is especially meaningful on the heels of yet another difficult surge of COVID-19. “It is a testament to our nurses and the entire care team that we continued to reach milestones in patient safety and satisfaction even during the COVID-19 pandemic,” said Carol Ritter, MSN, RN, CCRN-K, CNML, who has been nurse manager on the MICU for 10 years and a leader on the unit during all of its Beacon Award wins. “Everyone brings a level of expertise to the unit. We truly serve together.” Beacon awards celebrate the professional dedication that a nursing team demonstrates in going above and beyond to provide respectful, expert care. “Meaningful recognition takes on even greater relevance and importance as we continue to meet the challenges of the COVID-19 pandemic,” said AACN President Beth Wathen, MSN, RN, CCRN-K. “Being recognized as a Beacon unit underscores these teams’ ongoing commitment to providing safe, patient-centered and evidence-based care to patients and families. This achievement is a tremendous honor to those who have worked so hard to achieve excellence in patient care and positive patient outcomes.” ChristianaCare is one of only 152 health care institutions in the nation and the only in Delaware to have gold-level units. In 2008, the MICU was the first unit in the state to receive the Beacon Award. MICU’s culture of continuous improvement The MICU’s commitment to data-driven, evidence-based care proved especially valuable during the pandemic’s early days. Prone positioning, a technique to help patients with acute respiratory distress syndrome (ARDS) to breathe better, had been a longtime practice in ChristianaCare’s ICU. ChristianaCare critical care nurses Maureen Seckel, MSN, APRN, ACNS-BC, CCNS, FCCM, FCNS, and Dannette Mitchell, MSN, APRN, ACNS-BC, CCRN, published an article in AACN Advanced Critical Care that described ChristianaCare’s pioneering adoption of this technique, which ultimately became standard practice nationally in the treatment of patients with COVID-19 and ARDS. “On our unit, we empower the team to provide evidence-based care and have the tools to guide the practice,” Seckel said. “Because of this we were able to incorporate a highly effective, life-saving measure into COVID-19 care early in the pandemic.” Continuous improvement is a hallmark of the unit. The MICU has seven Comprehensive Unit-based Safety Program teams that follow data-collection processes to view trends and compare them to national standards to improve care and outcomes. “The whole unit is involved in collecting data to assess and make changes,” said MICU nurse Olivia Ross, BSN, RN, CCRN. Among the MICU’s accomplishments are excellent outcomes in preventing common hospital-acquired infections, even during the pandemic: Zero instances of catheter-associated urinary tract infections in three years. Zero instances of central line bloodstream infections in one year. The unit’s dedication to being exceptional today and even better tomorrow also focused inward during the pandemic. During a time of constant change, the team recognized the need for support to handle the unprecedented stress and strain of the pandemic. “To give the most vulnerable patients the highest levels of care on a consistent basis, we needed to take care of ourselves and one another too,” Ritter said. Ritter and team leaders committed to open-door policies throughout the pandemic, and they partnered with ChristianaCare’s Center for WorkLife Wellbeing to enable licensed psychologists to round on the unit, offering real-time check-ins with caregivers to provide support. The Beacon Award has been a resounding lift and reward for the MICU team members. “Having this recognition, especially during times of distress in the community and the world, signifies excellent nursing care,” said MICU nurse Paige Merring, MSN, RN, CCRN. “And to me it signifies an amazing team and great outcomes, which is the primary purpose of why we are all here.”
Major study reveals the lasting impact of Covid lockdowns
New research from the University of East Anglia reveals first-hand the lasting impact that lockdowns may have had on people’s mental and physical health. The UK’s first Covid lockdown was announced by Prime Minister Boris Johnson exactly two years ago today. Just a few days later, researchers at UEA launched a major project to track the mental and physical health of the nation through lockdowns and beyond. More than 1,000 participants carried out daily surveys – with questions on a range of lifestyle behaviours including physical activity, diet, sleep, smoking, drinking, and drug use. Some of the participants were then interviewed by the research team, to try to understand what was happening for people from their own viewpoints. Listen to what they had to say in our oral history project Lockdown Voices. New findings published today show how people responded very differently to social restrictions depending on their existing circumstances. For those who were less well-off to start with, adapting to lockdown was more difficult, and health behaviours typically worsened to a greater extent. In contrast, those who were better off at the start of the pandemic demonstrated faster adaptation and were more able to respond positively to restrictions, for example by taking to online exercise classes. It is likely that any lasting impact to mental and physical health will therefore be much greater for those who were worse off to start with. Those with good social links and healthy behaviours already in place described in their interviews how they were able to adapt to lockdown and thrive, whereas some of the more vulnerable in our communities had fallen into unhealthy spirals. Prof Caitlin Notley, from UEA's Norwich Medical School, said: “When the first lockdown was announced back in 2020, we started surveying participants from around the UK daily. Our initial results showed that people were eating less fruit and veg, getting less exercise and drinking more alcohol. “It quickly became apparent that lockdown may have lasting consequences for the physical and mental health of the nation. “We wanted to see whether people’s lifestyles changed in the long-term so we continued the study by carrying out regular surveys with the participants, and interviewing some people to find out more.” Now, two years on, the team’s results show how health inequalities are likely to have widened. Prof Notley said: “Social restrictions imposed as a result of the coronavirus pandemic have had a significant impact on health behaviours at the individual and population level. “It’s fair to say that all of our participants’ lives were disrupted by lockdown and they were forced to adapt. “But people responded to the lockdowns very differently and their experiences of social restrictions varied considerably. “Fundamentally, people were hindered or helped by their existing support structures and resources, such as access to technology to engage with the outside world, or private outdoor space. “Those people who had good friends, community links and who were already health conscious, were able to respond positively and better able to cope. “They were able to adapt to the ‘new normal’, use technology to keep in touch with friends and relatives, order veg boxes, carry on with a healthy diet and take part in healthy pursuits in new and innovative ways such as online fitness classes or ‘doing Joe Wicks’. “But lockdowns are very likely to have caused a sustained widening of social and health inequalities. “Those who remained in work outside the home, or who were retired, were the least impacted overall. But those who were unemployed, younger, on a lower income, clinically unwell or told to fully shield were particularly impacted by strict restrictions. “For these more vulnerable people, supportive social factors were taken away or severely restricted. Anxiety and depression worsened, and unhealthy behaviours like exercising less, drinking more alcohol, and eating a poor diet increased. “As we work through the ‘roadmap to recovery’, emphasis needs to be placed on a collaborative, community-based approach, with a focus on what makes us well. “Encouraging membership of community exercise groups, for example, may help those most impacted to engage again with healthy behaviours to keep them well. We also need to pay attention to how those who are less well-off responded more negatively to the policy of lockdown, so that lessons can be learnt for the future,” she added. ‘Disruption and adaptation in response to the coronavirus pandemic – assets as contextual moderators of enactment of health behaviours’ is published in the British Journal of Health Psychology.
In new study in journal Gene Therapy, researchers at ChristianaCare’s Gene Editing Institute describe how the advance is validating the safety and efficacy of their novel approach for using CRISPR to improve lung cancer treatments A new study from scientists at ChristianaCare’s Gene Editing Institute is advancing the safety and efficacy of using CRISPR gene editing in patient treatments by demonstrating how to identify and evaluate the broad-based biological impact of gene editing on targeted tissues, where the edits are designed to fully disable or “knock out” a specific sequence of genetic code. The work, published today in the Nature journal Gene Therapy, supports the Institute’s efforts to improve lung cancer treatments by using CRISPR to disable or alter a master regulator gene to prevent it from producing a protein that blunts the impact of chemotherapy. “We found that when you use CRISPR, the edits sometimes end up altering rather than completely disabling the target gene, so we developed a process to gain a more complete understanding of what that means for patients,” said Eric Kmiec, Ph.D., executive director and chief scientific officer of ChristianaCare’s Gene Editing Institute and the principal author of the study. Dr. Kmiec said that for his team’s lung cancer work, “We discovered that even when our CRISPR-based genetic manipulation did not completely disable the targeted gene, it altered it in ways that appear to make lung cancer tumors more sensitive to chemotherapy. Validating lung cancer research using CRISPR “We were fortunate that our strategy for using CRISPR to improve lung cancer treatments has been validated once again,” he added. “But our commitment to conducting an unbiased assessment of our approach highlights the importance of examining all potential outcomes of an attempt to use CRISPR to knock out a specific gene. Specifically, anyone developing CRISPR therapies needs to be on the lookout for edits that don’t fully knock out a section of DNA code—and evaluate the potential impacts for patients. They could be positive, as they were in our case, negative or neutral, but they need to be known.” Much of the excitement around medical applications of CRISPR involves using the tool to disable harmful genes by editing or “knocking out” a specific sequence of DNA code. But there is increasing evidence that in the wake of a CRISPR edit, cells may remain that contain merely an altered form of the targeted code that allows the gene to continue to produce biologically active proteins. Scientists at the Gene Editing Institute are investigating the potential of using CRISPR to disable a gene called NRF2 to alter production of the protein that protects squamous cell carcinoma lung cancer tumors from the effects of chemotherapy or radiation. They already have shown, in studies with tumor cells and in animals, that they can selectively target the NRF2 gene without affecting normal cells, where the gene confers health benefits. In the present study they wanted to go further. They wanted to fully understand the implications of a CRISPR gene edit that allowed the NRF2 gene to retain enough DNA code to continue making a version of the protein, albeit in an altered or truncated form. The team is laying the groundwork for a clinical trial that would use CRISPR to improve the efficacy of conventional chemotherapy and radiation treatments. Dr. Kmiec said that before proceeding, he wanted his team to develop a clear process for identifying and evaluating all outcomes of CRISPR edits. Identifying and understanding the diversity of genetic outcomes produced by CRISPR-directed gene editing has been a centerpiece of the foundational research programs established by the Gene Editing Institute. Using CRISPR in a safe way “We carry out experiments in an unbiased fashion, not hoping for a particular outcome, but with patient safety and efficacy serving as the true north for our scientific endeavors,” Dr. Kmiec said. “No matter what we uncover or elucidate, the insights will help both ChristianaCare and the entire field use CRISPR in a safer and more efficacious manner.” The researchers found multiple cells where the targeted strand of DNA code in the NRF2 gene was not completely knocked out. Rather, following the CRISPR edit, cells emerged that had retained enough of the original code to continue producing a different form of the protein. Tests revealed that cancer tumor cells generating these altered proteins may be more vulnerable to chemotherapy drugs. "For the work we are doing with NRF2, the truncated proteins generated by the CRISPR edit appear to be beneficial for making tumors more sensitive to treatment,” said lead author Kelly Banas, Ph.D. “But the key point is these proteins were clearly biologically active. And that means we needed to determine their potential impact on the safety and efficacy of using CRISPR to treat lung cancer patients.” Dr. Banas noted that the study points to the limits of considering a CRISPR edit to be successful simply by testing for the absence of a targeted protein in its original form. She said by that standard, their edit was successful. The edited NRF2 genes were no longer producing the same protein. But she said if that’s all the ChristianaCare team had looked for, they would have missed the altered proteins coming from the NRF2 gene—and overlooked an important outcome that, in this case, strengthens the original hypothesis and experimental approach: that using CRISPR to target the NRF2 gene holds promise for improving outcomes for lung cancer patients. Importance of due diligence “The process we describe in this study is a template that should be followed in any effort to develop CRISPR as a medical treatment,” Dr. Kmiec said. “We’re part of a health care organization where patient safety is the top priority. We also are working at the vanguard of an exciting area of cutting-edge medicine, where a failure to conduct due diligence could cause tragic outcomes that would set back this field for decades. With this study, we have validated a process that can help this field move forward rapidly but safely.” CRISPR stands for “clustered regularly interspaced short palindromic repeats.” It is a defense mechanism found in bacteria that can recognize and slice up the DNA of invading viruses. Scientists have learned how to modify this mechanism so it can be directed to “edit” specific sequences of DNA code. About ChristianaCare’s Gene Editing Institute The Gene Editing Institute, a worldwide leader in CRISPR gene editing technology and the only institute of its kind based within a community health care system, takes a patient-first approach in all its research to improve the lives of people with life-threatening disease. Since 2015, researchers at the Gene Editing Institute have been involved in several ground-breaking firsts in the field, including the development of the first CRISPR gene editing tool to allow DNA repairs outside the human cell which will rapidly speed therapies to patients and the ExACT ™pathway of single-stranded DNA repair, which increased the on-target efficacy of CRISPR and paved the way for new CRISPR breakthroughs in precise DNA edits. Its researchers created CRISPR in a Box™, the leading educational toolkit to teach gene editing, DECODR™, recognized as the most user-friendly and precise analytical tool to understand the diversity of genetic outcomes of gene editing and are currently developing a patient trial for lung cancer using CRISPR.
$100K student scholarship pool available for 2022 summer courses in Ireland Six professors from Georgia Southern University’s College of Education (COE) recently broadened their horizons during a trip to Ireland as they learned from and shared insight with instructors and educational leaders in the Wexford County community. Led by Howard Keeley, Ph.D., director of the University’s Center for Irish Research and Teaching, COE faculty traveled to Georgia Southern’s learning center in Wexford, Ireland, to observe Irish educational settings and exchange ideas with local leaders just ahead of a summer study abroad program opportunity for Georgia Southern students in which $100,000 of scholarship funding is available. “The main thing we did was get in front of leaders in the education space in Ireland,” stated Keeley. “We spoke to a number of folks who are either principals or vice principals or, in some way, senior administrators in a variety of schools including all-boys, all-girls, religious, secular and mixed schools.” The group included Catherine Howerter, Ph.D., associate professor of elementary and special education; Kip Sorgen, Ph.D., assistant professor of leadership, technology and human development; Alex Reyes, Ph.D., assistant professor of middle grades and secondary education; Amanda Wall, Ph.D., associate professor of middle grades and secondary education; Betsy Barrow, Ed.D., assistant professor of middle grades and secondary education; and Dan Calhoun, Ph.D., professor of leadership, technology and human development. Reyes, who trains pre-service and in-service teachers to work with culturally and linguistically diverse students, was excited to travel to Wexford after a study abroad program in Czech Republic she spearheaded with Wall was canceled in March 2020 due to the pandemic. Intrigued by Ireland, a plurilingual country, she was curious to see how Wexford’s environment might benefit students culturally. “I thought it was really exciting,” said Reyes. “All of the street signs are in Irish, even though English is the main language spoken. That prioritizing of that cultural heritage is fascinating. It was great to learn that the students in their primary and secondary schools take Irish language and culture as a subject every year.” She was especially motivated by a field trip to an Irish-language school, Meanscoil Gharman, which serves middle and high school students. With the exception of one daily class in English, teachers and students conducted all lessons in Irish. “It was really interesting to see that perspective,” she said. “There has been a revitalization of that culture. I thought that was fascinating to see how that can be handled in school.” In addition, Reyes was duly impressed with the country’s prioritization of social and emotional literacy for children, and the mandated well-being hours that are incorporated into daily school routines as a result of the pandemic. A program that promotes hygiene and an anti-bullying campaign also fit into the wellness curriculum. “It really impressed me that as a nation they prioritize the wellness of students, and how language and cultures can really be supported in a meaningful way,” Reyes said. “It’s affirming to see a proactive approach that has positive outcomes. Now, thinking ahead, we can look at how we can create opportunities for our students to experience this kind of approach.” Sorgen, who teaches in the educational leadership program at Georgia Southern, was interested in Ireland’s professional preparation. “None of them had advanced degrees, like what we offer at Georgia Southern,” noted Sorgen. “Learning about how to be a principal in Ireland is on-the-job training. In Georgia, there are specific educational requirements for our school administrators guided by professional standards. In Ireland, they generally ascend through the ranks, which makes professional mentoring essential to their success. We are exploring ways our educational leadership students could learn from Irish administrators about their experience, specifically with mentoring.” He also foresees the international partnership as a two-way exchange. “Given educational leadership programs are not common in Ireland, our faculty are considering ways in which we could use our expertise to foster leadership development of principals and teachers in Wexford,” said Sorgen. “We would utilize the Georgia Southern Wexford campus to host some of these sessions, furthering Georgia Southern’s relationship within the Wexford community.” Keeley also arranged meetings with education policy makers, including an extended meeting with an Irish congressman who is a representative for the County of Wexford in the Irish national parliament and chairs the joint committee for the Irish equivalent of the House and Senate Committee on education and higher education. “That was a tremendous opportunity for our faculty to talk to somebody at the highest level of government in Ireland, creating Irish state policy on education,” said Keeley. “And I know from the feedback we got from our College of Education colleagues that particularly for those in higher education, that to them was a really useful, next-step experience.” The trip exceeded expectations. “It was a fantastic learning experience for everyone,” said Keeley. “We had lots of high-level and also very practical experiences, and I could see our College of Education team thinking, ‘How can I bring what I’m learning, what I’m experiencing in this moment, into my classroom, into my curriculum, into my prospective study abroad courses in a way to build student success for our Georgia Southern folks.’ I think it was a great visit.” Complementing the faculty’s trip, a COE Irish study abroad program on diverse education in Ireland was recently approved for Summer 2022 and will give education students the opportunity to take one or two courses with the study abroad component. This will be a part of a broader study abroad program in Wexford, presented by the Honors College and the Center for Irish Research and Teaching, with assistance from the Office of the Provost and the Office of Global Engagement. The costs for undergraduate students at Georgia Southern’s Wexford campus will be offset by a $100,000 scholarship fund with awards of $1,000 for each student accepted into the program. “For students traveling to Wexford, Ireland, this summer, we will be able to defray the cost of the program through a generous travel scholarship through the Georgia Southern University Foundation,” said Dustin Anderson, Ph.D., associate provost for Student Success. “The donation makes these the most affordable multi-week programs that we ever have been able to offer.” Keeley is thrilled the gifts from generous donors will enable a number of students to earn valuable global experiences. “For students to have an opportunity to have international lives is powerful, and it’s powerful in ways that sometimes we can’t even predict,” he said. “Just the very fact of being abroad is going to change any of us, right? It can have a really transformative effect to feel a sense that, you know, as a student, ‘I can do this,’ and then a sense after the fact, ‘I did this,’ and just that in itself is educational. Giving students a safe space in Wexford, Ireland, to grow and feel that they are in a sense global citizens and bring the best of America, bring the best of Georgia, bring the best of the states from Savannah to Ireland, and learn to be an ambassador. That’s wonderful.” In addition to the education courses, students will also be able to choose from a Wexford-Savannah honors inquiry and an interdisciplinary program open to all students on human migration with courses in geography, religious studies, public health and a CORE study abroad course. Students interested can learn more about the program by clicking here and can email Kristin Karam in the Office of Global Engagement for more information about the scholarships. Georgia Southern University-Wexford is a global hub for learning housed in a historic building constructed in 1812. The space now features state-of-the-art classrooms and student apartments. Georgia Southern is the first public university in the United States to open an outreach learning facility in Ireland. If you're a reporter looking to know more about this initiative, then let our experts help. Howard Keeley, Ph.D., is the director of the Center for Irish Research and Teaching at Georgia Southern University. He is available - simply click on his icon now to arrange an interview today.
