Increased traffic injuries are a surprising result of restricting older drivers

If older drivers with cognitive impairment are no longer permitted behind the wheel, then accident rates should fall. That seems like common sense, but it turns out that the logic isn’t so simple. Since 2009, when Japan added cognitive tests to its license renewal process for those aged 75+, traffic injuries have actually increased.

Researchers have discovered that when older drivers lose their licenses, they often have to resort to bicycling or walking to get around. They become what’s known as unprotected road users. A new study by researchers centered at the University of Tsukuba in Japan found increased traffic injuries among such older people, who lack the protection of a motor vehicle. The findings were published in the journal Accident Analysis and Prevention.
Motor vehicle collisions are increasing among older drivers; this has triggered stricter licensing rules. Cognitive tests in Japan aim to identify drivers with possible dementia and require that they see a physician. Other countries such as Denmark and Canada have introduced similar tests. However, the overall success of such programs remains unclear.
“Some studies found increased injury rates as older drivers were forced into a modal shift from driving to walking or biking,” study first author Professor Masao Ichikawa says. “We wanted to see if this was true in Japan, and we wanted a more accurate picture. Rather than just look at pre- and post-test numbers, we used interrupted time-series analysis, which offsets factors that may have confounded the results over the years.”
Using reliable national data, they found significant increases in traffic deaths and injuries among unprotected road users aged 75 and up in the period after this same age group became subject to testing.
The increases generally occurred at a later age in men. The researchers suggested this may be because women are more anxious about their driving skills and give up their licenses earlier. The study did, however, find decreases in deaths and injuries for motor vehicle passengers aged 75–79 after cognitive tests began. This may owe to friends and family being more reluctant to ride with drivers after seeing their discouraging test results.
“Our findings suggest that Japan’s licensing policies may not adequately consider the dangers facing those who become unprotected when they must start walking or biking after losing their license,” Professor Ichikawa says.
The study implies a need to reconsider how cognitive testing is implemented. While the tests aim to remove potentially dangerous drivers from the roads, older people’s loss of a main mode of transport may expose them to new risks.

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When do problems with memory and decision-making affect older adults’ ability to drive?

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More information: Masao Ichikawa et al. Increased traffic injuries among older unprotected road users following the introduction of an age-based cognitive test to the driver’s license renewal procedure in Japan, Accident Analysis & Prevention (2020). DOI: 10.1016/j.aap.2020.105440

https://medicalxpress.com/news/2020-02-traffic-injuries-result-restricting-older.html

Built in 10 days, China’s virus hospital takes 1st patients

The first patients arrived Monday at a 1,000-bed hospital built in 10 days as part of China’s sweeping efforts to fight a new virus that is causing global alarm.

Huoshenshan Hospital and a second 1,500-bed facility due to open this week were built by construction crews who are working around the clock in Wuhan, the central city where the outbreak was first detected in December. Some 50 million people are barred from leaving Wuhan and surrounding cities.
The Wuhan treatment centers mark the second time Chinese leaders have responded to a new disease by building specialized hospitals almost overnight. As severe acute respiratory syndrome, or SARS, spread in 2003, a facility in Beijing for patients with that viral disease was constructed in a week.
The first patients arrived at Huoshenshan Hospital at 10 a.m. on Monday, according to state media. They gave no details of the patients’ identities or conditions.
The ruling Communist Party’s military wing, the People’s Liberation Army, sent 1,400 doctors, nurses and other personnel to staff the Wuhan hospital, the official Xinhua News Agency said. The government said earlier that some have experience fighting SARS and other outbreaks.

The state newspaper Beijing Daily applauded construction workers and suppliers who cut short their Lunar New Year holiday. It hailed the rapid construction as a political triumph, despite complaints leaders in Wuhan endangered the public by failing to respond fast enough to reports of a dangerous new disease.
“Today’s Chinese people are more deeply aware: where I stand is my China,” the newspaper said. “When this national sense of ownership is awakened, our mentality in the face of disasters becomes more mature.”
Authorities have cut most road, rail and air access to Wuhan and surrounding cities, isolating some 50 million people, in efforts to contain the viral outbreak that has sickened more than 17,000 people and killed more than 360.
Before this week’s addition of 2,500 new beds, Wuhan had 6,754 in hospitals designated for virus patients, according to the website TMTpost.com. It said authorities were considering assigning another 2,183 beds to virus cases at the city’s other hospitals.

The Huoshenshan Hospital was built by a 7,000-member crew of carpenters, plumbers, electricians and other specialists, according to Xinhua.
About half of the two-story, 60,000-square meter (600,000-square foot) building is isolation wards, according to the government newspaper Yangtze Daily. It has 30 intensive care units.
The name Huoshenshan means God of Fire Mountain. The second hospital, Leishenshan, means God of Thunder Mountain.
Newspapers published day-by-day accounts of crews clearing a riverside plot, laying the foundation, installing sewage and electrical equipment and assembling prefabricated rooms that were shipped to the site.
Photos in state media showed workers in winter clothing, safety helmets and the surgical-style masks worn by millions of Chinese in an attempt to avoid contracting the virus. Trucks were shown arriving in the middle of the night carrying rolls of insulation and other materials.
Doctors can talk with outside experts over a video system that links them to Beijing’s PLA General Hospital, according to the Yangtze Daily. It said the system was installed in less than 12 hours by a 20-member “commando team” from Wuhan Telecom Ltd.
The building has specialized ventilation systems and double-sided cabinets that connect patient rooms to hallways and allow hospital staff to deliver supplies without entering the rooms. It is equipped with infrared scanners to warn if any employees show signs of the disease’s distinctive fever, the website Economy Net reported, citing the company that provided the technology.
A Chinese company donated “medical robots” to deliver medicines and carry test samples, according to the Shanghai newspaper The Paper.
In other cities, the government has designated hospitals to handle cases of the new virus. In Beijing, the Xiaotangshan Hospital built in 2003 for SARS is being renovated by construction workers. The government has yet to say whether it might be used for patients with the new disease.
https://medicalxpress.com/news/2020-02-built-days-china-virus-hospital.html

‘No clear rationale’ for 45% of Medicaid patients’ antibiotic prescriptions

A new Northwestern Medicine study has found alarmingly high rates of inappropriate antibiotic prescribing for patients on Medicaid, the public health insurance program for those with lower incomes.

Using Medicaid insurance claims between 2004 and 2013, the study evaluated 298 million antibiotic prescriptions filled by 53 million patients on Medicaid, the largest source of health care coverage in the U.S. It found 45% of Medicaid antibiotics were prescribed without any clear rationale: 17% of antibiotics were prescribed at an office visit during which no infection-related diagnosis was made, and 28% of antibiotic prescriptions were not associated with an office visit at all.
Prior to this study, antibiotic prescribing for Medicaid patients in the U.S. had not been comprehensively measured. It will be published Feb. 3 in the February issue of the journal Health Affairs.
The researchers used Medicaid data to determine whether patients made a clinic visit in the seven days prior to filling the antibiotic prescription and, when there was a visit, they checked whether the billing diagnosis specified an infection as the cause for the visit.
Antibiotics treat bacterial infections, and are used to prevent infection in organ transplants, surgery and the treatment of cancer. However, they also expose patients to adverse drug events like nausea, diarrhea—including the life-threatening Clostridioides difficile, or “C. diff”—rashes, yeast infections and life-threatening allergic reactions.
“Indiscriminate use of antibiotics is increasing the prevalence of antibiotic-resistant bacteria and rendering them ineffective,” said senior study author Dr. Jeffrey Linder, chief of general internal medicine and geriatrics in the department of medicine at Northwestern University Feinberg School of Medicine.
“It’s concerning that nearly half of antibiotics are prescribed without a visit or without a clear rationale,” Linder said. “We are not keeping track of and do not have a system to ensure high-quality antibiotic prescribing in the U.S.”
The study raises questions about the effectiveness of efforts to curb inappropriate antibiotic prescribing. Clinical policies are in place to help decrease the rate of antibiotic prescribing in the U.S., which is about double that of many other countries, but those policies are limited, Linder said.
Ambulatory antibiotic stewardship policies, which focus on prescribing decisions made when patients tell doctors about possible infections, don’t capture antibiotics prescribed outside of a doctor visit or without clear indications for use. The study found current ambulatory antibiotic stewardship policies missed 45% of antibiotic prescriptions.
“If we’re thinking about how to improve antibiotic use, we need to understand the context in which antibiotics are being prescribed,” said lead author Dr. Michael Fischer, a physician in the Brigham’s Division of Pharmacoepidemiology and Pharmacoeconomics and an associate professor of Medicine at Harvard Medical School. “If prescribing is taking place outside of an office visit, most of the approaches we’re taking to combat antibiotic overuse will miss those completely.”
The study authors acknowledge a critical question remains: What occurred clinically in the many cases when antibiotic prescriptions were dispensed without an office visit?
“Since our analyses were based on claims data, we don’t have access to medical records to determine what interactions took place between patients and prescribing clinicians,” Fischer said. “We assume that most of these prescriptions were associated with a telephone interaction, although some communication may have occurred over email, via web portals or in informal, uncaptured visits. Most of these encounters would be blind spots for the interventions designed to improve antibiotic use.”

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Review shows 2% of providers account for 25% of pediatric antibiotic prescriptions

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More information: Health Affairs (2020). DOI: 10.1377/hlthaff.2019.00545

https://medicalxpress.com/news/2020-02-rationale-medicaid-patients-antibiotic-prescriptions.html

Qiagen launches new breast cancer test in Europe

QIAGEN N.V. (NYSE:QGEN) announces CE Mark certification of its therascreen PIK3CA RGQ PCR kit as an aid in identifying breast cancer patients with a PIK3CA mutation. Market launch is underway.

The FDA approved the test last year. It is used as a companion diagnostic for Novartis’ Piqray (alpelisib).

https://seekingalpha.com/news/3537588-qiagen-launches-new-breast-cancer-test-in-europe

US NIH cancels trial after finding vaccine doesn’t prevent HIV

• The National Institutes of Health on Monday discontinued a South African trial of an HIV vaccine regimen after data monitors concluded the treatment hadn’t prevented new infections.
• The HTVN 702 study stopped dosing following an interim analysis that was conducted when at least 60% of patients had been in the trial for 18 months. In the group given the vaccine, 129 patients were infected with HIV, while 123 were infected in the trial’s placebo arm.
• “We hoped this vaccine candidate would work. Regrettably, it does not,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in a statement.

Worldwide, 38 million people are infected with HIV and nearly 2 million new infections happen every year. While effective treatments have been developed that prevent infections from progressing to AIDS, more than 700,000 people died from AIDS-related diseases in 2018.
Researchers hope a vaccine could prevent new infections, but the regimen tested in the Phase 2b/3 study, also known as Uhambo, did not live up to those hopes. The interim analysis consisted of data from 2,694 patients who received the active treatment and 2,689 patients who had been given a placebo, allowing the trial’s data safety and monitoring board to draw its conclusion.
The board did not find any safety signals.
When the NIH initiated the trial in 2016, it said the vaccine regimen was the only one ever shown to provide some protection against HIV, citing results from a Thai study.
Researchers based the regimen used in the trial on work conducted by the U.S. Military HIV Research Program and the Thai Ministry of Health in a trial called RV144. In the South African study, the vaccine was adapted to protect against the virus most common there, an HIV subtype called Clade C.
The regimen consisted of a Sanofi Pasteur-supplied, canarypox-based vaccine, dubbed ALVAC-HIV, and a GlaxoSmithKline gp120 protein subunit vaccine with an immunity-boosting adjuvant, both modified to be specific to subtype C. Those two shots were followed with boosters at 12 and 18 months.
An earlier trial of this regimen had shown that it stimulated antibodies to several HIV strains. However, that biomarker finding was not confirmed as having a benefit in preventing infections.
Johnson & Johnson and NIH have initiated a Phase 3 trial of another two-vaccine regimen that aims to cover a number of HIV subtypes. Called MOSAICO, that trial will also use HIV infection rates as its primary measure and is scheduled to yield final results in 2023.
https://www.biopharmadive.com/news/nih-stop-hiv-vaccine-study-uhambo/571594/

High-Tech Machines Are Being Used To Contain The Wuhan Coronavirus

When doctors in a Washington hospital sought to treat the first confirmed case of the Wuhan coronavirus in the United States on Wednesday, they tapped a device called Vici that allowed them to interact with their patient not in person, but through a screen.

The telehealth device, which looks like a tablet on wheels that doctors can use to talk to patients and perform basic diagnostic functions, like taking their temperature, is one of a handful of high-tech machines that doctors, airport workers, and hotel staff are using to help contain the outbreak that has been sweeping the world since it was discovered in Wuhan, China in late December.
“Caregivers provide care within the isolation unit, but technology is allowing us to reduce the number of up-close interactions,” says Dr. Amy Compton-Phillips, chief clinical officer at Providence Regional Medical Center in Everett, Washington, where the patient is being treated. Vici, made by Santa Barbara, California-based InTouch Health, resembles a tablet on wheels, and can protect caregivers from infection.

“Minimizing the spread of this new virus is especially important because we have not yet built up any immunity to it,” Compton-Phillips says. During the SARS coronavirus outbreak in 2003, a large portion of those affected were healthcare workers, highlighting the difficulties of remaining safe while providing treatment.
China’s national health commission and the Centers for Disease Control and Prevention say that the infection can spread from person-to-person, making telehealth devices and robots that minimize human contact in hospitals potentially life-saving.

“If it’s not essential for certain supporting staff to be in the patient areas, it’s best for them to avoid it. The fewer people who are in contact with infected patients, the better,” says Peter Seiff, an executive at Aethon, a Pittsburgh-based private company that sells a robot called TUG that autonomously ferries medical supplies throughout hospitals.

The Vici telehealth device and TUG robot are being used in hospitals across the United States.

Courtesy of InTouch Health and Aethon

Aethon’s TUG robots are deployed at over 140 sites, though the company wouldn’t comment on whether the device is being used at any of the U.S. hospitals where more than 240 patients have been investigated for the novel coronavirus that has so far killed at least 200 people in China.
There, robots are delivering both food and medical supplies to people suspected of having the virus, according to Chinese news reports. A robot named Little Peanut is delivering meals to people in quarantined in a hotel, while a hospital in southern China has rolled out bots to deliver medicine and collect bed sheets and rubbish.
Beyond delivery and telehealth, there’s surging demand for cleaning and disinfecting robots. Xenex, a San Antonio, Texas-based company that sells robots that use pulsed xenon UV-C light to wipe out pathogens, says its devices are currently being used to clean rooms at facilities with suspected cases of the Wuhan coronavirus.
“Our science team has been on the phone non-stop with hospitals to discuss protocols for disinfecting rooms and areas where suspect patients have been and are being treated,” says spokesperson Melinda Hart. “We’ve also been in contact with government contacts in China and the U.S. to explore how quickly we could export robots to China.”
The devices, which cost about $100,000, have been shown to decrease health care-associated infections —those which are contracted while a person is receiving care for something else — in several individual hospital studies, done in collaboration with the company.
Meanwhile, a Los Angeles-based company called Dimer has offered one of its germ-killing machines to an airline at the city’s international airport for free. Normally, the “GermFalcon” devices sell for $100,000 per unit.

Dimer’s GermFalcon in action on an airplane at LAX.

Courtesy of Dimer

“We have been disinfecting inbound planes from China at LAX the last several days,” says president Elliot M. Kreitenberg. “Our machine fits in the interior of a plane like a puzzle piece and delivers high doses of ultraviolet light to the surfaces that you are most in contact with in a long haul flight.”
While machines to help contain a virus’s spread are much more common now than they were during the 2003 SARS epidemic, the Wuhan coronavirus has already spread faster.
https://www.forbes.com/sites/jilliandonfro/2020/02/02/robots-to-the-rescue-how-high-tech-machines-are-being-used-to-contain-the-wuhan-coronavirus/#3a70f1c81779

No, The Wuhan Virus Was Not Genetically Engineered To Put Pieces Of HIV In It

The Wuhan coronavirus has saturated news, social media and conversations around the world for the past few weeks. And people understandably have questions such as; masks to wear or not to wear? Or, will the flu shot protect you from coronavirus? No. Is the coronavirus anything to do with Corona beer? No, come on. But with so much focus on the topic and new information about the outbreak coming out constantly, inevitably a slew of spurious information is also flooding the internet and coronavirus has resulted in several, well…viral news stories with little scientific merit.

The newest of these was a little unusual because it was based on a pre-print of a real scientific paper, (since removed just a few hours ago) uploaded to website bioRxiv, where scientists can present their completed, or near-completed studies, prior to peer-review by other scientists. The work, by a group based in India, was entitled “Uncanny similarity of unique inserts in the 2019-nCoV spike protein to HIV-1 gp120 and Gag.”
Seeing HIV and coronavirus in the same sentence is understandably a little startling, so what does it actually mean?
“Based on analysis of multiple, very short regions of proteins in the novel coronavirus, the bioRxiv paper claimed that the new coronavirus may have acquired these regions from HIV,” said Arinjay Banerjee, PhD, a postdoctoral fellow in virology at McMaster University in Ontario, Canada who has extensively studied coronaviruses.

Some types of viruses can swap pieces of their genetic code and in this case,the authors of the study say that the specific coronavirus which is involved in the most recent outbreak (2019-nCoV) has four small chunks of sequence in its genetic code which are not found in other, similar coronaviruses like SARS. According to the authors, these pieces bear some resemblance to bits of sequence also found in HIV.
However, the authors then speculated that this might not be a coincidence and perhaps the bits of genetic code were put there intentionally. The conspiracy theory was addressed today by a scientist from the Wuhan Institute of Virology at the Chinese Academy of Sciences, who rubbished the claims.

The wider scientific community, upon seeing the paper, were also less than impressed with these conclusions and speculations and swiftly set about not only voicing their concerns, but analyzing the data to double-check the results.
Essentially, the scientists found that yes, there are some additions in the nCoV coronavirus originating in Wuhan that other coronaviruses don’t have, which are similar to pieces of sequence found in HIV. But, the kicker here is that these pieces of genetic code are also found in countless other viruses and there’s no reason to believe they specifically came from HIV, at all.
“The authors compared very short regions of proteins in the novel coronavirus and concluded that the small segments of proteins were similar to segments in HIV proteins. Comparing very short segments can often generate false positives and it is difficult to make these conclusions using small protein segments,” said Banerjee.
The paper was withdrawn from bioRxiv on Sunday afternoon with one of the authors stating: “ it was not our intention to feed into the conspiracy theories and no such claims are made here.” The author further declares that the researchers will revise the paper and re-analyze the data before submitting it again.
But despite the removal, the pre-print paper has stimulated a heap of discussion about HIV and coronavirus. Many people have asked on social media why, if coronavirus does not have pieces of HIV in it, HIV drugs are being used in some cases to treat the virus, with preliminary evidence that they, and other anti-viral drugs appear to be working in some cases.
“Some antiviral drugs can work against fundamental and generic steps involved in RNA virus replication. Anti-HIV drugs that inhibit viral RNA (genome) replication or the process of making viral protein from viral RNA may also work against other RNA viruses. This depends on the mode of action of the drugs,” explains Banerjee.
Presumably in response to the rather critical attention that this paper received, bioRxiv has added a banner ‘warning’ to every new preprint on the website:
“bioRxiv is receiving many new papers on coronavirus 2019-nCoV. A reminder: these are preliminary reports that have not been peer-reviewed. They should not be regarded as conclusive, guide clinical practice/health-related behavior, or be reported in news media as established information,” read the statement.
Publishing scientific articles as pre-prints without any peer review beforehand is controversial and complex, with one valid question being whether media outlets should cover pre-print work and risk potentially misinforming the public if the original results are not quite up to scratch, as happened with the recent HIV/coronavirus paper. Has this recent incident tarnished the reputation of preprints?
“No. In fact, I believe that this why pre-prints were established. The scientific community can provide feedback prior to formal peer-review. Pre-prints offer the authors an opportunity to seek feedback from a wider scientific community, more than the 2-3 peer-reviewers in a formal review setting” said Banerjee, stating that this paper certainly would not have passed official peer review.
“It is unfortunate that multiple articles on pre-print servers were victims of viral social media posts, especially studies that were not robust or scientifically sound,” said Banerjee. “But I am impressed how quickly other researchers debunked the studies and reanalyzed the data,” he added.
Note: the authors of the bioRxiv paper were contacted for comment but had not replied at the time of publishing this article.
https://www.forbes.com/sites/victoriaforster/2020/02/02/no-coronavirus-was-not-bioengineered-to-put-pieces-of-hiv-in-it/#3f2944a556cb