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Hannah Stower

Nature Medicine, Published online: 11 February 2020; doi:10.1038/s41591-020-0776-9AI for breast-cancer screening…

Hannah Stower

Nature Medicine, Published online: 11 February 2020; doi:10.1038/s41591-020-0779-6Smoking cessation and type 2 diabetes…

Hannah Stower

Nature Medicine, Published online: 11 February 2020; doi:10.1038/s41591-020-0780-0Snake venom–producing organoids…

Gregory J. Dore, Marianne Martinello, Maryam Alavi, Jason Grebely

Nature Medicine, Published online: 11 February 2020; doi:10.1038/s41591-019-0706-xThe World Health Organization’s targets for eliminating hepatitis C virus by 2030 have been deemed ambitious by many. However, we believe they are achievable, provided they are supported by global commitment.

Hannah Stower

Nature Medicine, Published online: 11 February 2020; doi:10.1038/s41591-020-0777-8A successful phase 3 trial for lupus…

Muzlifah Haniffa

Nature Medicine, Published online: 11 February 2020; doi:10.1038/s41591-020-0767-xMuzlifah Haniffa is a dermatologist working at Newcastle University and Wellcome Sanger Institute. Her achievements were recognized by the 2019 Foulkes Foundation Medal awarded by the Academy of Medical Sciences. She also plays a pioneering role in the Human Cell Atlas initiative.

Abstract Malaria is major public health concerns which continues to claim the lives of more than 435,000 people each year. The challenges with anti-malarial drug resistance and detection of low parasitaemia forms an immediate barrier to achieve the fast-approaching United Nations Sustainable Development Goals of ending malaria epidemics by 2030. In this Opinion article, focusing on the recent published technologies, in particularly the nuclear magnetic resonance (NMR)-based diagnostic technologies, the authors offer their perspectives and highlight ways to bring these point-of-care technologies towards personalized medicine. To this end, they advocate an open sourcing initiative to rapidly close the gap between technological innovations and field implementation.…

Abstract Background Day 7 plasma lumefantrine concentration is suggested as a predictor for malaria treatment outcomes and a cut-off of ≥ 200 ng/ml is associated with day 28 cure rate in the general population. However, day 7 lumefantrine plasma concentration can be affected by age, the extent of fever, baseline parasitaemia, and bodyweight. Therefore, this study assessed the usefulness of day 7 lumefantrine plasma concentration as a predictor of malaria treatment outcome in under-fives children treated with generic or innovator drug-containing artemether-lumefantrine (ALu) in Tanzania. Methods This study was nested in an equivalence prospective study that aimed at determining the effectiveness of a generic ALu (Artefan®) in comparison with the innovator’s product (Coartem®). Children with uncomplicated malaria aged 6–59 months were recruited and randomized to receive either generic or innovator’s product. Children were treated with ALu as per World Health Organization recommendations. The clinical and parasitological outcomes were assessed after 28 days of follow up. PCR was performed to distinguish recrudescence and re-infections among children with recurrent malaria. Analysis of day 7 lumefantrine plasma concentration was carried out using a high-performance liquid chromatographic method with UV detection. Results The PCR corrected cure rates were 98.7% for children treated with generic and 98.6% for those treated with the innovator product (p = 1.00). The geometric mean (± SD) of day 7 plasma lumefantrine concentration was 159.3 (± 2.4) ng/ml for the generic and 164 (± 2.5) ng/ml for the innovator groups, p = 0.87. Geometric mean (± SD) day 7 lumefantrine plasma concentration between cured and recurrent malaria was not statistically different in both treatment arms [158.5 (± 2.4) vs 100.0 (± 1.5) ng/ml, (p = 0.28) for generic arm and 158.5 (± 2.3) vs 251.2 (± 4.2) ng/ml, (p = 0.24) for innovator arm]. Nutritional status was found to be a determinant of recurrent malaria (adjusted hazardous ratio (95% confidence interval) = 3(1.1–8.2), p = 0.029. Conclusion Using the recommended cut-off point of ≥ 200 ng/ml, day 7 plasma lumefantrine concentration failed to predict malaria treatment outcome in children treated with ALu in Tanzania. Further studies are recommended to establish the day 7 plasma lumefantrine concentration cut-off point to predict malaria treatment outcome in children.…

Abstract Background Documentation of the species composition of Anopheles mosquitoes and characterization of larval breeding sites is of major importance for the implementation of larval control as part of malaria vector control interventions in Ethiopia. The aims of this study were to determine the Anopheles larval species composition, larval density, available habitat types and the effects of related environmental and physico-chemical parameters of habitats in the Ghibe River basin of southwestern Ethiopia. Methods Anopheles larvae were sampled from November 2014 to October 2016 on a monthly basis and 3rd and 4th instars were identified microscopically to species. The larval habitats were characterized based on habitat perimeter, water depth, intensity of light, water current, water temperature, water pH, water turbidity, distance to the nearest house, vegetation coverage, permanence of the habitat, surface debris coverage, emergent plant coverage, habitat type and substrate type. Results In total, 9277 larvae of Anopheles mosquitoes and 494 pupae were sampled from borrow pits, hoof prints, rain pools, pools at river edges, pools in drying river beds, rock pools, tire tracks and swamps. Anopheles larval density was highest in pools in drying river beds (35.2 larvae per dip) and lowest in swamps (2.1 larvae per dip) at Darge, but highest in rain pools (11.9 larvae per dip), borrow pits (11.2 larvae per dip) and pools at river edges (7.9 larvae per dip), and lowest in swamps (0.5 larvae per dip) at Ghibe. A total of 3485 late instar Anopheles mosquito larvae were morphologically identified. Anopheles gambiae sensu lato was the primary Anopheles mosquito found in all larval habitats except in swamps. Temperature at the time of sampling and emergent vegetation, were the most important variables for Anopheles mosquito larval density. Anopheles gambiae density was significantly associated with habitats that had smaller perimeters, were sunlit, had low vegetation cover, and a lack of emergent plants. Generally, Anopheles mosquito larval density was not significantly associated with water pH, water temperature, water turbidity, algal content, and larval habitat depth. Conclusion Different species of Anopheles larvae were identified including An. gambiae s.l., the main malaria vector in Ethiopia. Anopheles gambiae s.l. is the most abundant species that bred in most of the larval habitat types identified in the study area. The density of this species was high in sunlit habitat, absence of emergent plants, lack of vegetation near habitat and habitats closer to human habitation. Rainfall plays a great role in determining the availability of breeding habitats. The presence of rain enable to create some of the habitat types, but alter the habitats formed at the edge of the rivers due to over flooding. Controlling the occurrence of mosquito larvae through larval source management during the dry season, targeting the pools in drying river bed and pools formed at the edge of the rivers as the water receded can be very crucial to interrupt the re-emergence of malaria vectors on the onset of rainy season.…

Abstract Background The effort to reduce the burden of malaria should target transmission in the community by accurate identification of asymptomatic infections. In malaria-endemic areas, asymptomatic malaria infection is still associated with complications. Malaria during pregnancy is characterized by anaemia and placental malaria, leading to low birth weight and perinatal morbidity and mortality. This study aimed to provide reliable data on the burden of asymptomatic malaria among pregnant women in malaria endemic areas of North-Shoa, Ethiopia. Methods Cross-sectional study was carried out to assess the prevalence and predictors of asymptomatic malaria in pregnant women from November 2018 to January 2019. Multistage sampling technique was employed to include 263 study participants. Data were analysed using SPSS version 20.0 statistical software. In all comparisons, p-values ≤ 0.05 was considered as statistically significant. Results The prevalence of asymptomatic malaria infection was 5.7% (15/263) and 3.4% (9/263) by using microscopy and RDTs, respectively. Plasmodium falciparum was a dominant species 9 (3.4%) and Plasmodium vivax accounted for 6 (2.3%) of Plasmodium infections as detected by microscopy. Multivariate analysis showed that ITN usage and haemoglobin level had a statistically significant association with Plasmodium infection after adjusting other possible factors. Compared to those who were using ITN always, the odds of Plasmodium infection was 18.16 times higher (95% CI 1.84–179.07) in pregnant women who were not using ITN, and 5.19 times higher (95% CI 0.55–49.21) in pregnant women who were using ITN sometimes. Asymptomatic malaria infected pregnant women were 3.78 times (95% CI 0.98–14.58) more likely to be anaemic compared to non-infected pregnant women. Conclusion The present study showed asymptomatic malaria is prevalent in pregnant women and it has statistically significance association with the haemoglobin level of pregnant women. This indicates pregnant women have to be screened for asymptomatic malaria to avoid health consequences of malaria infection during pregnancy for the mother and fetus.…

Ramanan Laxminarayan, Thomas Van Boeckel, Isabel Frost, Samuel Kariuki, Ejaz Ahmed Khan, Direk Limmathurotsakul, D G Joakim Larsson, Gabriel Levy-Hara, Marc Mendelson, Kevin Outterson, Sharon J Peacock, Yong-Guan Zhu

In 2013, a Lancet Infectious Diseases Commission described the state of antimicrobial resistance worldwide. Since then, greater awareness of the public health ramifications of antimicrobial resistance has led to national actions and global initiatives, including a resolution at the high-level meeting of the UN General Assembly in 2016. Progress in addressing this issue has ranged from a ban on irrational drug combinations in India to commitments to ban colistin as a growth promoter in animals, improve hospital infection control, and implement better antimicrobial stewardship.

Kuehn B.

Using a mercury-tainted skin-lightening cream obtained in Mexico left a California woman unable to speak or care for herself, according to a CDC report.

Kuehn B.

Nearly 5% of US adults reported driving under the influence of marijuana in 2018, according to a CDC report.

Armstrong MJ, Okun MS.

This narrative review summarizes the clinical manifestations of Parkinson disease, proposes an algorithm for diagnosing and classifying subtypes of the disease, and discusses pharmacologic and nonpharmacologic approaches for managing its most troublesome signs and symptoms including tremor, dyskinesias, gait disturbance, and cognitive impairment.

Newman H.

In this narrative medicine essay, a general pediatrics resident recalls the doubt and fear surrounding her high school diagnosis of ideopathic bone marrow suppression syndrome, her slow journey to recovery, and her how her family and physicians who cared for her nurtured her ambition to become a pediatric oncologist.

McFall G.

Late March, the afternoon light falls cold and bright as an operating room. Sparrows are prepping for spring, bathing their wings in the loose dirt. They find the hollows of steel lamp posts…

Hill KP.

This JAMA Patient Page describes use of preparations of the cannabis plant to treat medical conditions, the strength of evidence supporting such use, and the risks involved.

Tong SC, Lye DC, Yahav D, et al.

This randomized trial compares the effect of combining standard antibiotic therapy (intravenous vancomycin or daptomycin) with an antistaphylococcal β-lactam (intravenous flucloxacillin, cloxacillin, or cefazolin) vs standard therapy alone on a composite outcome of mortality, bacteremia, relapse, or treatment failure in adults with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia.

Costa ML, Achten J, Knight R, et al.

This randomized clinical trial compares the effects of incisional negative pressure wound therapy vs standard wound dressing on deep surgical site infection (SSI) at 30 days among patients undergoing surgery for major trauma–related lower limb fractures.

Chhabra KR, Sheetz KH, Nuliyalu U, et al.

This study uses claims data from a large US health insurer to describe the proportion of times patients who had undergone elective surgery at in-network facilities with in-network primary surgeons received out-of-network bills between 2012 and 2017.

Thiel C, Horwitz LI.

In Reply Mr Cahan and colleagues comment on our Viewpoint on the importance of supply optimization in improving the value of health care delivery. We agree with the authors that reducing variability in surgical utilization can be accomplished through consolidating device vendors and integrating purchasing decisions in a way that does not inappropriately drive practice patterns. We only add a caveat that too much consolidation, for example to a single vendor, can increase risk of supply shortages and reduce the opportunity for effective price negotiations.

Gondi S, Song Z.

In Reply Regarding our Viewpoint, Dr Young argues that the main reason increased investments in primary care have often failed to reduce total health care spending is that such investments have focused on expanding care teams. Young asserts that increasing the supply of family medicine physicians is the key for better health outcomes at lower costs and recommends that future efforts should abandon teams in favor of investing in family medicine physicians.

Cahan EM, Chawla A, Shea KG.

To the Editor Drs Thiel and Horwitz described the importance of supply chain optimization to improve value in health care, focusing on medical waste minimization. Of particular interest was the discussion on physician variation in utilization. Studies have previously demonstrated that physician utilization is a major driver of low-value services: variability in utilization of surgical supplies can lead to 20-fold variation across cost categories for identical procedures.

Young RA.

To the Editor Dr Song and Mr Gondi described the failure of recent efforts to increase total primary care spending to reduce total health care costs of the population. However, they did not explain why the studies they reviewed failed.

Han B, Volkow ND, Compton WM, et al.

This study uses National Surveys on Drug Use and Health data to characterize trends in heroin use, heroin use disorder, and heroin injection overall and by age, race, and geographic region.

Cagle JG, McPherson M, Frey JJ, et al.

This study uses a random survey of US hospice agencies to estimate rates of confirmed and suspected cases of medication diversion away from patients in hospice and association of diversion rates with agency characteristics and state opioid death rates.

References have been made in news media and elsewhere to the decline of personal attention in medical care. The physician-patient relationship that allows or prevents personalization includes, among other factors, the art of therapy.

To assist AMA members seeking information from the staff at AMA headquarters in Chicago, a new Member Service Unit has been established in the Circulation and Records Department. All telephone calls, letters, and telegrams not directed to specific individuals or departments will be referred to this unit for immediate response. Of course, if you already know whom you wish to contact, continue to address him or her by name.

Gostin LO.

Among all global health initiatives—such as the Global Polio Eradication Initiative, Roll Back Malaria (the RBM Partnership to End Malaria), and the Stop TB Partnership—universal health coverage (often abbreviated as UHC) has garnered the most political attention. The “sustainable development goals,” adopted by all United Nations (UN) member states in 2015, have a single health goal: to ensure healthy lives and promote well-being “for all at all ages.” Its most important target is to achieve universal health coverage by 2030.

Zaidan MF, Ameredes BT, Calhoun WJ.

This JAMA Insights Clinical Update reviews management of asthma exacerbations, including the use of inhaled corticosteroids (ICS), azithromycin, magnesium sulfate, and nebulized bronchodilators vs metered-dose inhalers (MDIs), and discusses the potential future role of benralizumab and other biological therapies.

Tripple JW, Ameredes BT, Calhoun WJ.

This JAMA Insights Clinical Update reviews recent evidence favoring use of inhaled corticosteroids (ICS)in all patients with asthma, regardless of frequency, and summarizes the SMART (single maintenance and reliever therapy) treatment approach, which uses an inhaler combining ICS and formoterol for control and relief of symptoms, and differences between SMART and symptom-driven therapy.

Pollitz K, Lopes L, Kearney A, et al.

Joynt Maddox KE, Livingston E.

“Surprise” billing occurs when patients with health insurance receive care from a clinician or facility included in their insurer’s network (“in-network”) but unexpectedly receive “surprise” bills from other clinicians involved in their care who are not in the patient’s insurer’s network (“out-of-network”) and therefore not covered by their insurance. In this issue of the JAMA, Chhabra and colleagues present a thorough analysis of out-of-network billing for elective operations and find the practice to be both common and potentially financially devastating. Based on their analysis of 347 356 patients who had undergone 1 of 7 common elective operations with in-network surgeons at in-network facilities, the authors report that 20.5% of these surgical episodes also had an associated out-of-network bill, with a mean potential financial liability of more than $2000. The most common sources of the out-of-network bills were surgical assistants and anesthesiologists.

Quatman CE, Villarreal ME, Cochran A.

Negative pressure wound therapy is commonly used for both acute and chronic wounds and involves applying either continuous or intermittent subatmospheric pressure to a wound that is beneath an occlusive dressing. Negative pressure wound therapy provides mechanical enhancement to wound healing by increasing blood flow to the wound, maintaining a moist environment, reducing tissue edema, and placing the wound under tension that enhances healing.

Gandhi TN, Malani PN.

Enhanced infection control efforts have helped reduce the rate of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia over the past decade, but the decline has stalled in recent years, and associated mortality remains steady at 20% to 25%. In terms of both clinical burden and absolute number of patients, MRSA bacteremia remains a common and highly morbid infection. While clinical practice guidelines, evidence-based management algorithms, and infectious diseases consultation can contribute to improved patient outcomes, a substantial proportion of patients still experience treatment failures. Vancomycin or daptomycin remain the preferred treatment for MRSA bacteremia, but the search for safer and more effective options continues.

Zoratti EM, O’Connor GT.

For more than 25 years, national and international guidelines have recommended standardized approaches to control the symptoms of asthma and reduce the risk of exacerbation using strategies that are relevant to the majority of patients with asthma. As new evidence emerges from randomized clinical trials, clinicians must modify treatment strategies to be consistent with new evidence. In this issue of JAMA, 2 JAMA Insights articles highlight new evidence that clinicians should consider when treating patients with asthma.

In the Editorials entitled “Waste in the US Health Care System” and “Toward Evidence-Based Policy Making to Reduce Wasteful Health Care Spending” published in the October 15, 2019, issue of JAMA, the upper end of the range of estimated potential savings should be $286 billion (instead of $282 billion) due to reclassification of one of the source studies in the related Special Communication. These articles have been corrected online.

In the Special Communication entitled “Waste in the US Health Care System: Estimated Costs and Potential for Savings” published in the October 15, 2019, issue of JAMA, one of the source studies was placed in the wrong category, with the result that the upper end of the range of estimated potential savings should be $286 billion (instead of $282 billion). As a result, the references have been renumbered, the Supplement has been updated (eTable 2 and eReferences), and the related video has been emended. All elements have been corrected online.

Abbasi J.

Patients with probable Alzheimer disease (AD) had sustained memory improvements 3 months after ultrasound brain stimulation in a small pilot study. The noninvasive technique, called transcranial pulse stimulation (TPS), is designed to apply ultrashort ultrasound pulses to small brain areas.

Abbasi J.

An experimental gene therapy for hemophilia A remained effective up to 3 years after a single infusion, researchers recently reported in the New England Journal of Medicine. BioMarin Pharmaceutical’s valoctocogene roxaparvovec encodes factor VIII, the blood-clotting protein that’s missing or low in people with hemophilia A, the most common form of the disease.

Abbasi J.

An artificial intelligence (AI) system for breast cancer screening outperformed radiologists in a recent study in Nature. The technique spotted more cancers and raised fewer false alarms.

Slomski A.

This Medical News article discusses new international recommendations for female testosterone therapy.

McCoy MS, Joffe S, Emanuel EJ.

This Viewpoint uses the framework of exploitation, an unequal sharing of benefits and harms between parties in an agreement, to highlight the ethical risks inherent in data-sharing partnerships between health systems and for-profit technology companies and to explore potential strategies for addressing those risks.

Wachter RM, Cassel CK.

This Viewpoint proposes principles of security, transparency, and privacy to guide data-sharing agreements between clinical organizations and digital technology companies as both seek electronic health record (EHR) data to grow their business and improve health care delivery and outcomes.

Hammoud MM, Andrews J, Skochelak SE.

This Viewpoint proposes an early result match program for applicants to postgraduate training programs, much like early decision programs at undergraduate colleges, as a means to address the rise in number of residency applications and to ensure better fit between trainees and programs.

In the Special Communication entitled “FDA Approval and Regulation of Pharmaceuticals, 1983-2018” published in the January 14, 2020, issue of JAMA, a figure legend was missing. Figure 2 should have included a legend that read “Data are from annual Prescription Drug User Fee Act financial reports (1993-2018) and exclude data from other user fee acts. FDA indicates US Food and Drug Administration.” This article was corrected online.

Matheny ME, Whicher D, Thadaney Israni S.

This Viewpoint summarizes the 2019 AI in Healthcare report from the National Academy of Medicine (NAM), which reviews best practices for AI development, adoption, and maintenance and urges prioritization of equity, inclusion, and human rights in AI health system implementation.

Simon Zenke, Margriet M. Palm, Julia Braun, Alina Gavrilov, Philippa Meiser, Jan P. Böttcher, Niklas Beyersdorf, Stephan Ehl, Audrey Gerard, Tim Lämmermann, Ton N. Schumacher, Joost B. Beltman, Jan C. Rohr

Zenke et al. show that dynamics of activated CD8+ T lymphocytes are shaped by intercellular communication in a manner akin to quorum regulation. Specifically, a network of nested antagonistic feedback circuits functions to sustain or curtail T cell expansion based on cellular density, thereby promoting robustness of T cell population dynamics.

Yi Zhou, Mingjian Fei, Gu Zhang, Wei-Ching Liang, WeiYu Lin, Yan Wu, Robert Piskol, John Ridgway, Erin McNamara, Haochu Huang, Juan Zhang, Jaehak Oh, Jaina M. Patel, Diana Jakubiak, Jeff Lau, Beth Blackwood, Daniel D. Bravo, Yongchang Shi, Jianyong Wang, Hong-Ming Hu, Wyne P. Lee, Rajiv Jesudason, Dewakar Sangaraju, Zora Modrusan, Keith R. Anderson, Søren Warming, Merone Roose-Girma, Minhong Yan

Zhou et al. generate an antibody that selectively inhibits efferocytosis by the phagocytic receptor MerTK and show that MerTK blockade increases tumor immunogenicity and potentiates anti-tumor immunity via the transfer of tumor-derived cGAMP into tumor-associated macrophages (TAMs) through the ATP-gated channel P2X7R and subsequent STING activation.

Thomas Plum, Xi Wang, Mandy Rettel, Jeroen Krijgsveld, Thorsten B. Feyerabend, Hans-Reimer Rodewald

Mast cell functions beyond allergic diseases remain enigmatic. To provide structural information, Plum et al. performed comprehensive proteome analyses on primary human and mouse mast cells, revealing the cells' unique lineage within the immune system, putative roles in neuroimmune interactions, and targets for antibody-mediated mast cell ablation.