New weight-loss hope for highest obesity risk: Underserved, low-income

Low-income Louisiana patients enrolled in a tailored obesity intervention program lost much more weight than counterparts receiving usual care. Study results were published this week in The New England Journal of Medicine. This population, who traditionally face the most barriers to weight loss and the highest levels of obesity, found success in a coaching program delivered directly through their primary care clinics.

“It’s hard to lose weight for anyone. Adding any obstacle to treatment, especially poverty, makes that task much more difficult. We wanted to remove as many barriers as possible so we brought an effective program to people where they are, in the primary care clinics where they’re comfortable, and it works,” said Peter Katzmarzyk, Ph.D., Associate Executive Director of Population and Public Health Sciences at Pennington Biomedical Research Center.

Over the past decade, several studies failed to achieve meaningful weight loss among people with obesity through lifestyle modification, or diet and exercise, Dr. Katzmarzyk said. The results from the Promoting Successful Weight Loss in Primary Care in Louisiana (PROPEL) study demonstrate the importance of making the program as convenient for the patient as possible.

The PROPEL study enrolled 803 patients from 18 primary care clinics in rural and urban parts of the state. The two-year program randomly divided the patients into two groups:

• 452 took part in an “intensive lifestyle intervention.” For six months, patients had weekly in-person or phone sessions with a health coach. The coaches demonstrated appropriate portion sizes and identified portion-controlled foods such as fruits, soups and frozen entrees. The coaches also worked with patients on coping with stress and increasing physical activity. The patients were given electronic scales and encouraged to weigh themselves every day. For the remaining 18 months, the patients had monthly in-person or phone sessions.
• 351 patients received “usual care,” routine primary care services and three newsletters per year with articles on the importance of being active, getting enough sleep, household money management, family coping skills, and not smoking.

The lifestyle group lost 5 percent of their body weight, compared to 0.5 percent in the usual care group.

Pennington Biomedical Executive Director John Kirwan, Ph.D., said the study has important health implications in the effort to slow the global obesity epidemic.

“The significance of this study cannot be overstated. Obesity has been linked to at least 13 deadly cancers and lies at the root of type 2 diabetes and heart disease and stroke. People with obesity who contract COVID-19 are at much greater risk for serious illness or death,” Dr. Kirwan said. “A weight loss of 3 percent to 5 percent can generate significant health benefits.”

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The full study is available here.

This research is supported by award OB-1402-10977 from the Patient-Centered Outcomes Research Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Patient-Centered Outcomes Research Institute.

https://www.eurekalert.org/pub_releases/2020-09/pbrc-nwh090320.php

California (Quietly) Limits Unpopular Law That Restricted Freelancers

California Gov. Gavin Newsom quietly signed a law on Sept. 4 repealing parts of an unpopular law that put independent contractors in the state out of work and limited the earnings of freelancers, including visual artists, musicians, writers, translators, and film support crews by classifying them as employees.

The enactment of the new measure, which came after months of political and legal pressure from the trucking industry, companies such as Uber and Postmates, and groups such as the American Society of Journalists and Authors Inc. and the National Press Photographers Association, is a rare defeat for the labor movement in solidly progressive California.

The new law, known as AB 2257, passed both chambers of the state legislature unanimously on Aug. 31.

The Democratic governor announced on his website Sept. 4 that he had signed the measure but offered no explanation for why he had done so. The governor’s office could not immediately be reached for comment.

The new law took effect immediately upon signing.

AB 2257 amended AB 5, which attempted to determine who is a contractor and who is an employee and forced companies to reclassify their freelancers as employees. The new law provides greater flexibility to freelancers.

When AB 5 took effect Jan. 1, that law made it hard for so-called gig-economy companies to classify people who work for them as independent contractors instead of employees. The idea being the measure was to prevent freelancers from being unfairly exploited by employers.

Assemblywoman Lorena Gonzalez, a San Diego Democrat, wrote AB5 to implement a 2018 California Supreme Court decision known as Dynamex Operations West Inc. v. Superior Court, that deemed many freelancers to be employees, a status that entitled them to the minimum wage, overtime pay, unemployment insurance, and health benefits.

Employees in California are entitled to benefits not available to contractors, such as the minimum wage, health insurance, and paid time off. AB 5 was strongly backed by labor organizations critical of hard-to-unionize freelance jobs. Unions hoped the law would give them an edge in recruiting new members.

AB 5 was enacted ostensibly to help workers by preventing their “misclassification” as non-employees.

It adopted the so-called “ABC” test to determine employee status, according to the Economic Policy Institute (EPI). The test stipulates that workers may only be considered independent contractors when a business proves the workers:

“a. Are free from control and direction by the hiring company;

b. Perform work outside the usual course of business of the hiring entity;

and c. Are independently established in that trade, occupation, or business.”

But mere weeks after the enactment of AB 5, which is still being challenged in the courts, the law ran into headwinds as freelance workers and others in a state with many independent contractors suddenly found themselves out of work or with their ability to earn a living severely restricted.

It stopped freelance writers from accepting more than 35 assignments from a single publisher and hindered the ability of musicians to accept regular paying gigs. Companies outside California stopped using freelancers in the state as they feared financial penalties for violating the law.

Gonzalez admitted there were problems back in February.

Gonzalez wrote in a Feb. 6 tweet that she was willing to consider easing the restriction affecting journalists. “Based on dozens of meetings with freelance journalists & photographers, we have submitted language to legislative counsel that … will cut out the 35 [articles] submission cap & instead more clearly define freelancer journalism,” she wrote.

Later in the month she reported progress on writing what turned out to be AB 2257.

“Having heard additional feedback from a variety of freelance writers, photographers and journalists, we are making changes to Assembly Bill 5 that accommodate their needs and still provide protections from misclassification,” she said February 27.

AB 2257 abolishes the 35 item submission limit for writers and photographers contained in AB 5. It also exempts translators, appraisers, and registered foresters from the restrictions.

Gig-economy companies are supporting a state ballot initiative this Nov. 3, Proposition 22, that would treat app-based drivers as independent contractors, not as employees.

https://www.zerohedge.com/political/california-quietly-limits-unpopular-law-restricted-freelancers

First ‘plug and play’ brain prosthesis demoed in paralyzed person

In a significant advance, UC San Francisco Weill Institute for Neurosciences researchers working towards a brain-controlled prosthetic limb have shown that machine learning techniques helped an individual with paralysis learn to control a computer cursor using their brain activity without requiring extensive daily retraining, which has been a requirement of all past brain-computer interface (BCI) efforts.

“The BCI field has made great progress in recent years, but because existing systems have had to be reset and recalibrated each day, they haven’t been able to tap into the brain‘s natural learning processes. It’s like asking someone to learn to ride a bike over and over again from scratch,” said study senior author Karunesh Ganguly, MD, Ph.D., an associate professor in the UCSF Department of Neurology. “Adapting an artificial learning system to work smoothly with the brain’s sophisticated long-term learning schemas is something that’s never been shown before in a person with paralysis.”

The achievement of “plug and play” performance demonstrates the value of so-called ECoG electrode arrays for BCI applicartions. An ECoG array comprises a pad of electrodes about the size of a post-it note that is surgically placed on the surface of the brain. They allow long-term, stable recordings of neural activity and have been approved for seizure monitoring in epilepsy patients. In contrast, past BCI efforts have used “pin-cushion” style arrays of sharp electrodes that penetrate the brain tissue for more sensitive recordings but tend to shift or lose signal over time. In this case, the authors obtained investigational device approval for long-term chronic implantation of ECoG arrays in paralyzed subjects to test their safety and efficacy as long-term, stable BCI implants.

In their new paper, published September 7, 2020 in Nature Biotechnology , Ganguly’s team documents the use of an ECoG electrode array in an individual with paralysis of all four limbs (tetraplegia). The participant is also enrolled in a clinical trial designed to test the use of ECoG arrays to allow paralyzed patients to control a prosthetic arm and hand, but in the new paper, the participant used the implant to control a computer cursor on a screen.

The researchers developed a BCI algorithm that uses machine learning to match brain activity recorded by the ECoG electrodes to the user’s desired cursor movements. Initially, the researchers followed the standard practice of resetting the algorithm each day. The participant would begin by imagining specific neck and wrist movements while watching the cursor move across the screen. Gradually the computer algorithm would update itself to match the cursor’s movements to the brain activity this generated, effective passing control of the cursor over to the user. However, starting this process over every day put a severe limit on the level of control that could be achieved. It could take hours to master control of the device, and some days the participant had to give up altogether.

The researchers then switched to allow the algorithm to continue updating to match the participant’s brain activity without resetting it each day. They found that the continued interplay between brain signals and the machine learning-enhanced algorithm resulted in continuous improvements in performance over many days. Initially there was a little lost ground to make up each day, but soon the participant was able to immediately achieve top level performance.

“We found that we could further improve learning by making sure that the algorithm wasn’t updating faster than the brain could follow—a rate of about once every 10 seconds,” said Ganguly, a practicing neurologist with UCSF Health and the San Francisco Veterans Administration Medical Center’s Neurology & Rehabilitation Service. “We see this as trying to build a partnership between two learning systems—brain and computer—that ultimately lets the artificial interface become an extension of the user, like their own hand or arm.”

Over time, the participant’s brain was able to amplify patterns of neural activity it could use to most effectively drive the artificial interface via the ECoG array, while eliminating less effective signals—a pruning process much like how the brain is thought to learn any complex task, the researcher say. They observed that the participant’s brain activity seemed to develop an ingrained and consistent mental “model” for controlling the BCI interface, something that had never occurred with daily resetting and recalibration. When the interface was reset after several weeks of continuous learning, the participant rapidly re-established the same patterns of neural activity for controlling the device—effectively retraining the algorithm to its former state.

“Once the user has established an enduring memory of the solution for controlling the interface, there’s no need for resetting,” Ganguly said. “The brain just rapidly convergences back to the same solution.”

Eventually, once expertise was established, the researchers showed they could turn off the algorithm’s need to update itself altogether, and the participant could simply begin using the interface each day without any need for retraining or recalibration. Performance did not decline over 44 days in the absence of retraining, and the participant could even go days without practicing and see little decline in performance. The establishment of stable expertise in one form of BCI control (moving the cursor) also allowed researchers to begin “stacking” additional learned skills—such as “clicking” a virtual button—without loss of performance.

Such immediate “plug and play” BCI performance has long been a goal in the field, but has been out of reach because the “pincushion-style” electrodes used by most researchers tend to move over time, changing the signals seen by each electrode. Also, because these electrodes penetrate brain tissue, the immune system tends to reject them, gradually impairing their signal. ECoG arrays are less sensitive than these traditional implants, but their long-term stability appears to compensate for this shortcoming. The stability of ECoG recordings may be even more important for long-term control of more complex robotic systems such as artificial limbs, a key goal of the next phase of Ganguly’s research.

“We’ve always been mindful of the need to design technology that doesn’t end up in a drawer, so to speak, but which will actually improve the day-to-day lives of paralyzed patients,” Ganguly said. “These data show that ECoG-based BCIs could be the foundation for such a technology.”

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Explore furtherMind over body: Improving brain-computer interfaces

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More information: Plug-and-play control of a brain–computer interface through neural map stabilization, Nature Biotechnology (2020). DOI: 10.1038/s41587-020-0662-5 , www.nature.com/articles/s41587-020-0662-5

https://medicalxpress.com/news/2020-09-brain-prosthesis-demoed-paralyzed-person.html

China’s Sinovac covid vaccine candidate looks safe, slightly weaker in elderly

Chinese firm Sinovac Biotech Ltd said on Monday its coronavirus vaccine candidate appeared to be safe for older people, according to preliminary results from an early to mid-stage trial, while the immune responses triggered by the vaccine were slightly weaker than younger adults.

Health officials have been concerned about whether experimental vaccines could safely protect the elderly, whose immune systems usually react less robustly to vaccines, against the virus that has led to nearly 890,000 deaths worldwide.

Sinovac’s candidate CoronaVac did not cause severe side effects in a combined Phase 1 and Phase 2 trials launched in May involving 421 participants aged at least 60, Liu Peicheng, Sinovac’s media representative, told Reuters. The complete results have not been published and were not made available to Reuters.

Four of the world’s eight vaccines that are in the third phase of trials are from China.

For three groups of participants who respectively took two shots of low, medium and high-dose CoronaVac, over 90% of them experienced significant increase in antibody levels, while the levels were slightly lower than those seen in younger subjects but in line with expectation, Liu said in a statement.

CoronaVac, being tested in Brazil and Indonesia in the final-stage human trials to evaluate whether it is effective and safe enough to obtain regulatory approvals for mass use, has already been given to tens of thousands of people, including about 90% of Sinovac employees and their families, as part of China’s emergency inoculation scheme to protect people facing high infection risk.

The potential vaccine could remain stable for up to three years in storage, Liu said, which might offer Sinovac some advantage in vaccine distribution to regions where cold-chain storage is not an option.

Such estimation is extrapolated from the fact that vaccines readings stayed within acceptable ranges for 42 days at 25 Celsius (77 Fahrenheit), 28 days at 37C (98.6 F), and five months for 2-8C (35.6-46.4 F), Liu said, without disclosing complete data.

https://www.marketscreener.com/quote/stock/SINOVAC-BIOTECH-LTD-5714593/news/Sinovac-Biotech-China-s-Sinovac-coronavirus-vaccine-candidate-appears-safe-slightly-weaker-in-eld-31246485/

Britain working to reduce travel quarantine through testing

Britain is working to reduce the 14-day quarantine period for arrivals from countries including Spain and France, offering the chance of some respite to a travel industry reeling from the impact of COVID-19.

Health Secretary Matt Hancock said a simple test when travelers land at an airport would not be effective, but the government was looking at ideas such as testing eight days after arrival.

Airline and tour companies have pleaded for a change to the 14-day quarantine rules.

“We are working to find a way that would allow for the quarantine to be reduced, but done in a way that also keeps people safe,” Hancock said on LBC radio on Monday.

But he said one test at the airport was not the answer.

“The reason it doesn’t work is because this virus can incubate for a period inside your body without a test being able to pick it up,” he said.

A test eight days after arrival was one option being considered, he said.

“It is one of the things we’d like to bring in as soon as it’s practical to do it,” he said.

“It is something that we are working on, but it isn’t something that is as straightforward as simply testing people when they get off a plane because of the number of people for whom that wouldn’t catch.”

https://www.reuters.com/article/us-health-coronavirus-britain-quarantine/britain-working-to-reduce-quarantine-through-testing-hancock-says-idUSKBN25Y0ZP

WHO says working with China on requirements for COVID vaccine approval

The World Health Organization is working with China on requirements for international approval of any Chinese COVID-19 vaccine, a senior official said on Monday.

“WHO’s office in China and WHO headquarters has been working with the regulatory authorities in China,” assistant director-general Mariangela Simao told a briefing in Geneva. “We are in direct contact, we have been sharing information and the requirements for international approval of vaccines.”

The chief executive of Sinovac Biotech Ltd said on Sunday about 90% of the Chinese firm’s employees and their families have taken an experimental vaccine it has developed under the country’s emergency use program.

The extent of inoculations under the emergency program, which China launched in July but has released few details about, points to how actively it is using experimental vaccines in the hopes of protecting essential workers against a potential COVID-19 resurgence, even as trials are still under way.

https://www.reuters.com/article/us-health-coronavirus-who-china/who-says-working-with-china-on-requirements-for-covid-vaccine-approval-idUSKBN25Y1MC

More investment bankers head back to the office

JPMorgan Chase (NYSE:JPM) asked that 50% of its investment bankers based in New York and London work from the firm’s offices on any given workday, Bloomberg reports, citing a person familiar with the matter.

That’s up from the 25% level it had set previously.

The increase starts today in London and tomorrow in New York, the person told Bloomberg News.

The bankers will work from home or the office on alternating weeks, according to the plan.

Meanwhile, Citigroup’s (NYSE:C) Europe markets chief Leonardo Arduini outlined plans for more workers to return to the bank’s Canary Wharf location in London, people familiar with the matter told Bloomberg. At present, ~20% of the markets staff is working from the London office, they said.

Previously: Goldman invites hundreds of senior London staff to return to office – FN (Aug. 27)

https://seekingalpha.com/news/3611950-jpmorgan-investment-bankers-head-back-to-office-bloomberg