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Never mind toys, it’s time to ask Santa for crutches and catheters

Jacob Scott

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America’s hospitals, strained by nearly two years of fighting the covid-19 pandemic, are now scrounging for basic medical supplies.


In another consequence of the global supply chain crisis, hospitals managing holiday covid surges and all their other patients are running short of many necessities of care: crutches, syringes, needles, tubing, gloves, catheters, drapes for surgery, suction canisters for medical waste and even urine cups.


After the difficulties that health care workers faced in securing personal protective equipment in 2020, supply chain managers and other experts say shortages and delays of other common supplies escalated this year.


President Joe Biden’s promises to speed supplies into the country have repeatedly focused on ensuring that holiday gifts fill U.S. store shelves. “Only Santa Claus” can make sure they arrive on time, Biden said in a Dec. 1 speech about his administration’s efforts. Medical supplies received a passing reference.


In the meantime, clinicians describe making do, which sometimes requires piecing together what’s needed with odds and ends. And while they play MacGyver, their attention can be diverted from patient care.


In late November, executives at CentraCare in Minnesota said a lack of the urine collection kits the health system uses forced them to secure four alternatives and even order individual parts to make their own. Some of the cups can’t be transported through normal hospital tube systems, so workers must walk samples to the lab instead of tending to patients.


Dr. George Morris, CentraCare’s physician incident commander for covid response, worries about higher risk of harm for patients: “Now our supply shortage is actually affecting our ability to do the care.”


“When you throw in all these variations — four different types of collection kits, an infinite number of different types of crutches — there’s always that little slight chance of error,” Morris said. “And that’s unfortunate, but that’s the reality.”


“We just can’t get enough volume,” said Kelsey Ochsner, CentraCare’s manager of procurement. Federal emergency medical teams were dispatched to Minnesota in late November to help hospitals — including CentraCare’s St. Cloud Hospital, the system’s largest — manage a spike in covid infections.


The scarcity of supplies is driven by raw material shortages, port backlogs, shipping delays and a dearth of truck drivers for transporting goods. Another factor making things worse for hospitals in general: staff shortages.


“If you don’t have health care workers, you can’t do the work,” said Debbie White, a registered nurse and president of Health Professionals and Allied Employees, a union in New Jersey. “Whatever supplies you have are kind of a moot point if you can’t even take care of your patients.”


A global aluminum shortage has left hospitals short on crutches, so clinicians have organized donation drives for gently used items. “Imagine trying to get around after hip surgery or after breaking your leg without the aid of these devices,” read one recent call for walkers, canes and crutches from Utah hospitals, including Intermountain Healthcare and University of Utah Health.


The campaign, called Lean on Utah, collected items on three Saturdays this fall, bringing in 963 sets of crutches, 652 walkers, 333 canes and 153 nonmotorized wheelchairs.


Gordon Slade, Intermountain’s senior director of supply chain logistics, said lead times are so long that the health system has paid for expedited shipping, pushing costs ever higher.


“In some cases, you’re paying more for freight than the product,” he said.


Microchip and metals shortages have slowed the production of wheelchairs and other medical equipment. Also scarce are resin and silicone, used for canisters, catheters and the kits used to insert them in patients.


“Anything plastic-wise has been a little bit slowed down,” said Mark Welch, senior vice president of supply chain for North Carolina-based Novant Health. Among the items delayed are catheters, syringes, gauze and medical tape. As of early December, about 6.5% of items in Novant Health’s inventory were delayed, compared with 1% or less during normal operations.


The hospital has urged clinicians to conserve supplies like tape and gauze. “We’re asking them to really think before you use,” Welch said. “If you happen to just grab extra things to take to the room because you think you might use it, a lot of times it gets wasted.”


“This degree of disruption for this period of time is unusual,” said Melanie Fisher, a senior vice president for Beaumont Health, which operates hospitals in Michigan.


“To have 100 back orders a day is much different than traditionally having 25,” she said. “And to have back orders with either no substitutes available or having to make the kits ourselves when we’re already short-staffed — these are the complexities of what we’re working through now.”


Still, “this is very different from the shortages we saw last year” related to PPE, said Tinglong Dai, a professor of operations management and business analytics at Johns Hopkins University. With those, Dai said, the danger was grave: “People were actually infected, in certain cases actually died.”


Hospital executives were split on whether actions taken by the Biden administration — forcing major ports to operate round-the-clock, lowering container fees and allowing truck drivers to work longer hours — were improving the situations in their facilities. Some, like Welch of Novant Health, haven’t seen meaningful differences. Still, Fisher of Beaumont Health said, it’s hard to imagine what would have happened without them.


Hospital workers hope for some improvement after the holiday season. Industry reports, however, are “predicting another 18 to 24 months of supply chain challenges,” said Alyssa Kangas, CentraCare’s senior director of contracting and procurement.


Many hospitals contract with group-purchasing organizations to secure discounts from vendors. Managers said the contracts have offered protection against price gouging. But with the supply logjam, they might have to go off-contract to lock down goods — and risk escalating prices.


“At that point, we’re kind of at the mercy of the market,” said Slade of Intermountain Healthcare, adding that he’s concerned about price gouging when contracts come up for renewal. Oxygen tanks, he said, cost 600% more than they did a year ago. “I do see an avalanche of price increases in the future.”



This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Unraveling How Strigoractone Hormone Regulates Massive Gene Networks Controlling Plant Growth

Jacob Scott

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As sessile organisms, plants have to continually adapt their growth and architecture to the ever-changing environment. To do so, plants have evolved distinct molecular mechanisms to sense and respond to the environment and integrate the signals from outside with endogenous developmental programs.

New research from Nitzan Shabek’s laboratory at the UC Davis College of Biological Sciences, published in Nature Plants, unravels the underlying mechanism of protein targeting and destruction in a specific plant hormone signaling pathway.

Our lab aims at deciphering sensing mechanisms in plants and understanding how specific enzymes function can be regulated at the molecular levels. We have been studying a new plant hormone signal, strigolactone, that governs numerous processes of growth and development including branching and root architecture.”

Nitzan Shabek, assistant professor of biochemistry and structural biology, Department of Plant Biology

The work stems from a study by Shabek, published in Nature in 2018, unravelling molecular and structural changes in an enzyme, MAX2 (or D3) ubiquitin ligase. MAX2 was found in locked or unlocked forms that can recruit a strigolactone sensor, D14, and target for destruction a DNA transcriptional repressor complex, D53. Ubiquitins are small proteins, found in all eukaryotes, that “tag” other proteins for destruction within a cell.

To find the key to unlock MAX2 and to better understand its molecular dynamics in plants, postdoctoral fellows Lior Tal and Malathy Palayam, with junior specialist Aleczander Young, used an approach that integrated advanced structural biology, biochemistry, and plant genetics.

“We leveraged structure-guided approaches to systemically mutate MAX2 enzyme in Arabidopsis and created a MAX2 stuck in an unlocked form”, said Shabek, “some of these mutations were made by guiding CRISPR/Cas9 genome editing thus providing us a discovery platform to study and analyze the different signaling outputs and illuminate the role of MAX2 dynamics.”


They found that in the unlocked conformation, MAX2 can target the repressor proteins and biochemically decorate them with small ubiquitin proteins, tagging them for destruction. Removing these repressors allows other genes to be expressed – activating a massive gene network that governs shoot branching, root architecture, leaf senescence, and symbiosis with fungi, Shabek said.

Sending these repressors to the proteasome disposal complexes requires the enzyme to relock again. The team also showed that MAX2 not only target the repressors proteins, but once it is locked the strigolactone sensor itself gets destroyed, returning the system to its original state.

Finally, the study uncovered the key to the lock, an organic acid metabolite that can directly trigger the conformational switch.

“Beyond the implication in plants signaling, this is the first work that placed a primary metabolite as a direct new regulator of this type of ubiquitin ligase enzymes and will open new avenues of study in this direction,” Shabek said.

Additional coauthors on the paper are specialist Mily Ron and Professor Anne Britt, Department of Plant Biology. The study was supported by NSF CAREER and EAGER grants to Shabek. X-ray crystallography data was obtained at the Advanced Light Source, Lawrence Berkeley National Laboratory, a U.S. Department of Energy user facility.

Source:
Journal reference:

Tal, L., et al. (2022) A conformational switch in the SCF-D3/MAX2 ubiquitin ligase facilitates strigolactone signalling. Nature Plants. doi.org/10.1038/s41477-022-01145-7.

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UrFU Sociologists Identify Digital Fears Among Young People

Jacob Scott

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Sociologists at the Ural Federal University (UrFU) have identified digital fears among young people. According to experts, these are additional fears that do not replace, but complement and reinforce traditional ones. They emerged against the background of uncertainty, the growth of forces beyond human control. Developed emotional intelligence, creativity, and the ability to collaborate help to overcome them.

In the study, sociologists interviewed 1,050 people aged 18-30. Respondents were asked to assess which digital risks concern them most. The study was launched in 2020 and the results were published in April 2022 in the Changing Societies & Personalities journal.

The first group of fears is influence and control. It touches on the problem of interference with privacy by technical means. This category is the most significant for young people: 55.8% are afraid of total control by means of video-surveillance and monitoring software on their mobile devices. 48.5% of respondents believe they are at risk of wiretapping, tracking content in social networks, and inability to keep correspondence secret.”

Natalia Antonova, Professor, Department of Applied Sociology, UrFU

45.8% of young people fear the manipulative influence of the media and an increase in fake news. At the same time, only 27.8% and 18.1% of respondents are concerned about microchipping and genetic manipulation, respectively. It is likely that these threats seem more controllable, both from the individual (through control of food choices, medical procedures, etc.) and from government programs, the researchers believe.

The second group of concerns is crime and security. Here young people are wary of illegal actions using digital technology.

“One of the main fears of 56% of young people is the security of personal data. This is related both to the growth of personal information in social networks and messengers, and to the growth of hacker attacks and viruses. 42.9% of young citizens are afraid of Internet fraudsters, and 25.8% are afraid of losing important information, including smashing their phones, not saving data, forgetting their passwords, or being without an Internet connection,” explains Sofia Abramova, Associate Professor at the Department of Applied Sociology at UrFU.

The third group of fears is based on changes in the way and pace of life, ways of interaction. Thus, 28.4% of respondents indicate a constant lack of time, the acceleration of communications, and worries about not being able to complete all tasks in time. Respondents are also concerned about the growth of online communications and communications with electronic systems (bots, autoresponders, product systems, etc.).

“As a result, 15.3% of young people raise problems related to increasing social distrust against the background of increasing dependence of human life and health on other people and electronic systems: in public transport, planes, elevators, medical intervention,” explains Sofia Abramova.

Respondents also fear the negative consequences of technological development. For example, 22.2% of young citizens fear the robotization of labor processes and the displacement of humans by robots. 14.6% speak directly about negative emotions in relation to the expansion of artificial intelligence.

The fifth type of fear is social inequality. Young people negatively assess the growth of inequality in access to information resources and technology, the exclusion of citizens from the economy depending on the level of digital competence and education, and age. As a result, they fear that benefits will be distributed more and more unequally, both among the inhabitants of the country and between countries.

“It is noteworthy that young people are simultaneously afraid of total surveillance via phone and afraid of being left without mobile devices. Fears shape the irrational behavior of the digital generation, entailing serious transformations in everyday life,” says Natalia Antonova.

Source:
Journal reference:

Abramova, S.B., et al. (2022) Digital Fears Experienced by Young People in the Age of Technoscience. Changing Societies & Personalities. doi.org/10.15826/csp.2022.6.1.163.

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Study demonstrates increased incidence of SARS-CoV-2 Omicron breakthrough infection in cancer patients

Jacob Scott

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In a recently published article in the journal Cancer Cell, scientists have demonstrated the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in cancer patients residing in Austria and Italy. The study reveals an induction in Omicron breakthrough infections in patients with hematologic and solid cancers.

Study: Enhanced SARS-CoV-2 breakthrough infections in patients with hematologic and solid cancers due to Omicron. Image Credit: Lightspring/Shutterstock

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen of the coronavirus disease 2019 (COVID-19) pandemic, has been found to cause severe infections in immunocompromised patients, including cancer patients. Moreover, a relatively lower level of neutralizing antibodies in response to COVID-19 vaccines has also been observed in cancer patients, especially those receiving B cell-targeting therapies.

The emergence of SARS-CoV-2 variants with improved immune fitness, such as delta and Omicron variants, has caused a sharp increase in breakthrough infections even in fully vaccinated individuals. However, the vaccines still show high protective efficacy against severe and fatal infections. COVID-19 vaccines have shown acceptable efficacy against severe disease, even in Omicron-infected cancer patients. However, the isolation and quarantine measures associated with SARS-CoV-2 infection may impair the routine administration of anticancer therapy, which can reduce the survival prognosis in cancer patients.

In the current study, the scientists have assessed the incidence of SARS-CoV-2 infection in cancer patients throughout the pandemic.

Study design

The study included 3,959 cancer patients, of whom 77% had solid cancer, and 23% had hematologic cancer. About 69% of the patients did not receive any anticancer treatment at the time of COVID-19 vaccination. Regarding vaccine coverage, about 85% of the patients had received at least one vaccine dose, and 15% remained unvaccinated. The incidence of SARS-CoV-2 infection in these patients was assessed between February 2020 and 2022.

Important observations

SARS-CoV-2 infection was detected in about 24% of the patients during the study period. During the delta-dominated wave, vaccine breakthrough infection was observed in 43% of the patients. In contrast, a significantly higher percentage of breakthrough infection (70%) was observed among the patients during the Omicron-dominated wave. During both delta and Omicron waves, cancer patients receiving systemic anticancer treatment showed a significantly higher percentage of breakthrough infection than those not receiving treatment (83% vs. 56%).

Regarding disease severity irrespective of vaccination status, a higher frequency of COVID-19-related hospitalization was observed during the delta wave compared to that during the Omicron wave. However, a relatively shorter duration of hospital stay was observed in vaccinated patients compared to that in unvaccinated patients. In addition, only 9% of patients with breakthrough infections were admitted to the intensive care unit (ICU). This highlights the protective efficacy of COVID-19 vaccines against severe disease.

Humoral immune response to vaccination

To determine vaccine-induced antibody response against delta and Omicron variants, the scientists measured blood levels of anti-delta and anti-Omicron spike receptor-binding domain (RBD) antibodies in a total of 78 cancer patients. In the analysis, they also included 25 healthcare workers as controls.

In response to vaccination, healthcare workers showed higher levels of total anti-spike antibodies compared to cancer patients. The lowest level of wildtype RBD-specific antibodies was observed in hematologic cancer patients receiving B cell-targeted treatment, followed by hematologic cancer patients not receiving B cell-targeted treatment and patients with solid tumors. A similar trend was observed for delta- and Omicron-specific spike RBD antibodies.

The serum samples collected from hematologic cancer patients without B cell-targeted treatment and solid tumor patients significantly inhibited the interaction between wildtype/delta RBD and angiotensin-converting enzyme 2 (ACE2; host cell receptor for viral entry). However, a significantly lower level of inhibition was observed for patients receiving B cell-targeted treatment. Importantly, a marked reduction in inhibition of Omicron RBD – ACE2 interaction was observed for all patients with solid tumors and hematologic cancer.

Study significance

The study demonstrates an increased incidence of vaccine breakthrough infections but a reduced disease severity among patients with solid tumors and hematologic cancer during the Omicron wave compared to the delta wave.

The study also highlights that COVID-19 vaccine-induced antibody response is lower in cancer patients than in healthy individuals. The reduction in antibody response is highest among hematologic patients receiving B cell-targeted treatment. Overall, a significant impairment in vaccine-induced Omicron neutralization has been observed in cancer patients.

Journal reference:
Mair, M. et al. (2022) “Enhanced SARS-CoV-2 breakthrough infections in patients with hematologic and solid cancers due to Omicron”, Cancer Cell. doi: 10.1016/j.ccell.2022.04.003. https://www.cell.com/cancer-cell/fulltext/S1535-6108(22)00165-9

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