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Neuroscience

Persistent protein pairing enables memories to last – The Transmitter: Neuroscience News and Perspectives

One question long plagued memory researcher Andr Fenton: How can memories last for years when a protein essential to maintaining them, called memory protein kinase Mzeta (PKMzeta), lasts for just days?

The answer, Fenton now says, may lie in PKMzetas interaction with another protein, called postsynaptic kidney and brain expressed adaptor protein (KIBRA). Complexes of the two molecules maintain memories in mice for at least one month, according to a new study co-led by Fenton, professor of neural science at New York University.

The bond between the two proteins protects each of them, Fenton says, from normal degradation in the cell.

KIBRA preferentially gloms onto potentiated synapses, the study shows. And it may help PKMzeta stick there, too, where the kinase acts as a molecular switch to help memories persist, Fenton says.

As Theseus Ship was sustained for generations by continually replacing worn planks with new timbers, long-term memory can be maintained by continual exchange of potentiating molecules at activated synapses, Fenton and his colleagues write in their paper, which was published last month in Science Advances.

Before this study, the PKMzeta mystery had two missing puzzle pieces, says Justin OHare, assistant professor of pharmacology at the University of Colorado Denver, who was not involved in the study.

One was how PKMzeta identifies potentiated synapses, part of the cellular mechanism underlying memory formation. The second was how memories persist despite the short lifetime of each PKMzeta molecule. This study essentially proposes KIBRA as a solution to both of thoseand the experiments themselves are pretty convincing and thorough. They do everything multiple ways.

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The controversy, Fenton says, forced his team to look for another molecule that might be involved in long-term potentiation. They focused on KIBRA because the scaffolding protein is found in neurons and has been shown to interact with similar kinases in the sea slug.

In a common benchtop experiment of memory persistence, electrical stimulation of the CA3 region in mouse hippocampal slices induced complexes of KIBRA and PKMzeta to form in the synapses of the downstream CA1 stratum radiatum region, Fentons team found, confirming their suspicions.

Not only did [KIBRA and PKMzeta] interact, but they interacted in the right places for storing a memory or maintaining [long-term potentiation], Fenton says.

The excitatory postsynaptic potentials, a proxy for long-term potentiation, across CA1 neurons in the slices remained high three hours after stimulation, the researchers found, but then dipped back down to baseline after treatment with two moleculeszeta-stat and K-ZAPthat block the interaction between KIBRA and PKMzeta.

The two inhibitors also caused wildtype mice to forget their training in two different foot-shock experiments when administered either three days or one montha time frame longer than the kinases typical turnoverafter the animals had learned the task.

This result suggests that the KIBRA-PKMzeta complex is crucial for long-term potentiation and for memory maintenance, Fenton says.

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That ruled out the possibility that other factorssuch as off-target effects of the two inhibitory moleculescaused the depotentiation or memory erasure in the mice. But it raised another question, Fenton says: So if PKMzeta is so important, and you delete it and you have normal memory and you have normal [long-term potentiation], like, what gives?

Another kinase, PKCiota/lambda, may step in and bind to KIBRA when PKMzeta is not around, Fenton says. Past work by Fenton and his colleagues has shown that PKCiota/lambda binds to KIBRA at a 10-fold lower rate than PKMzeta does.

This weaker interaction might explain why PKMzeta-null mice did maintain memories, but the memory is not as good, Fenton says. For example, in one experiment type, the PKMzeta-null mice re-enter an area where they previously received a mild foot shock more quickly than do their wildtype peers that did not receive the inhibitory molecules,but more slowly than the wildtype mice that received inhibitors,the study showed.

This result answers a question about another inhibitory molecule, the zeta inhibitor protein. ZIP, a 2020 study showed, interrupts long-term potentiation in mice that lack PKMzeta, indicating that memory relies on a completely different mechanism of action than PKMzeta, says Rami Yaka, professor of psychopharmacology at the Hebrew University of Jerusalem, who led the 2020 work but was not involved in the current study.

But ZIP is known to broadly target both PKMzeta and PKCiota/lambda, Fenton says. The inhibitors in the current study were specific to PKMzeta and so did not affect PKCiota/lambda.

There needed to be an explanation for why knocking out PKMzeta allowed memories to persist or [long-term potentiation] to persist, Fenton says.

How KIBRA becomes primed to capture PKMzeta and how KIBRA is attracted to the potentiated synapses remain open questions, says study investigator Panayiotis Tsokas, assistant professor in anesthesiology, physiology and pharmacology at SUNY Downstate Health Sciences University.

The answer might lie in calcium signaling in NMDA channels, which Tsokas says the team is exploring next.

Excerpt from:
Persistent protein pairing enables memories to last - The Transmitter: Neuroscience News and Perspectives

Neuroscience

AI Enhances Story Creativity but Risks Reducing Novelty – Neuroscience News

Summary: A new study shows that AI helps make stories more creative, engaging, and well-written, especially for less creative writers. The research found that AI assistance boosts novelty and usefulness, making stories more enjoyable and less boring.

However, it also warns that the widespread use of AI may reduce the diversity and uniqueness of creative works. The findings highlight both the potential and risks of using AI in creative writing.

Key Facts:

Source: University of Exeter

Stories written with AI assistance have been deemed to be more creative, better written and more enjoyable.

A new study published in the journalScience Advancesfinds that AI enhances creativity by boosting the novelty of story ideas as well as the usefulness of stories their ability to engage the target audience and potential for publication.

It finds that AI professionalizes stories, making them more enjoyable, more likely to have plot twists, better written and less boring.

In a study in which 300 participants were tasked with writing a short, eight-sentence micro story for a target audience of young adults, researchers found that AI made those deemed less creative produce work that was up to 26.6% better written and 15.2% less boring.

However, AI was not judged to enhance the work produced by more creative writers.

The study also warns that while AI may enhance individual creativity it may also result in a loss of collective novelty, as AI-assisted stories were found to contain more similarities to each other and were less varied and diverse.

The researchers, from the University of Exeter Business School and Institute for Data Science and Artificial Intelligence as well as the UCL School of Management, assigned the 300 study participants to three groups: one group was allowed no AI help, a second group could use ChatGPT to provide a single three-sentence starting idea, and writers in the third group could choose from up to five AI-generated ideas for their inspiration.

They then recruited 600 people to judge how good the stories were, assessing them for novelty whether the stories did something new or unexpected and usefulness how appropriate they were for the target audience, and whether the ideas could be developed and potentially published.

They found that writers with the most access to AI experienced the greatest gains to their creativity, their stories scoring 8.1% higher for novelty and 9% higher for novelty compared with stories written without AI.

Writers who used up to five AI-generated ideas also scored higher for emotional characteristics, producing stories that were better written, more enjoyable, less boring and funnier.

The researchers evaluated the writers inherent creativity using a Divergent Association Task (DAT) and found that more creative writers those with the highest DAT scores benefitted least from generative AI ideas.

Less creative writers conversely saw a greater increase in creativity: access to five AI ideas improved novelty by 10.7% and usefulness by 11.5% compared with those who used no AI ideas. Their stories were judged to be up to 26.6% better written, up to 22.6%, more enjoyable and up to 15.2% less boring.

These improvements put writers with low DAT scores on a par with those with high DAT scores, effectively equalising creativity across the less and more creative writers.

The researchers also used OpenAIs embeddings application programming interface (API) to calculate how similar the stories were to each other.

They found a 10.7% increase in similarity between writers whose stories used one generative AI-idea, compared with the group that didnt use AI.

Oliver Hauser, Professor of Economics at the University of Exeter Business School and Deputy Director of the Institute for Data Science and Artificial Intelligence, said: This is a first step in studying a question fundamental to all human behaviour: how does generative AI affect human creativity?

Our results provide insight into how generative AI can enhance creativity, and removes any disadvantage or advantage based on the writers inherent creativity.

Anil Doshi, Assistant Professor at the UCL School of Management added: While these results point to an increase inindividualcreativity, there is risk of losingcollectivenovelty. Ifthe publishing industry were to embrace more generative AI-inspired stories, our findings suggest that the stories would become less unique in aggregate and moresimilar to each other.

Professor Hauser cautioned: This downward spiral shows parallels to an emerging social dilemma:if individual writers find out that their generative AI-inspired writing is evaluated as more creative,they have an incentive to use generative AI more in the future, but by doing so the collectivenovelty of stories may be reduced further.

In short, our results suggest that despite theenhancement effect that generative AI had on individual creativity, there may be a cautionary noteif generative AI were adopted more widely for creative tasks.

Author: Louise Vennells Source: University of Exeter Contact: Louise Vennells University of Exeter Image: The image is credited to Neuroscience News

Original Research: Open access. AI found to boost individual creativity at the expense of less varied content by Oliver Hauser et al. Science Advances

Abstract

AI found to boost individual creativity at the expense of less varied content

Creativity is core to being human. Generative artificial intelligence (AI)including powerful large language models (LLMs)holds promise for humans to be more creative by offering new ideas, or less creative by anchoring on generative AI ideas.

We study the causal impact of generative AI ideas on the production of short stories in an online experiment where some writers obtained story ideas from an LLM. We find that access to generative AI ideas causes stories to be evaluated as more creative, better written, and more enjoyable, especially among less creative writers.

However, generative AIenabled stories are more similar to each other than stories by humans alone. These results point to an increase in individual creativity at the risk of losing collective novelty. This dynamic resembles a social dilemma: With generative AI, writers are individually better off, but collectively a narrower scope of novel content is produced.

Our results have implications for researchers, policy-makers, and practitioners interested in bolstering creativity.

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AI Enhances Story Creativity but Risks Reducing Novelty - Neuroscience News

Neuroscience

Infection Brain Inflammation Triggers Muscle Weakness – Neuroscience News

Summary: A new study reveals how brain inflammation from infections and neurodegenerative diseases causes muscle weakness by releasing the IL-6 protein. Researchers found that IL-6 travels from the brain to muscles, reducing their energy production and function.

This discovery could lead to treatments for muscle wasting in diseases like Alzheimers and long COVID. Blocking the IL-6 pathway may prevent muscle weakness associated with brain inflammation.

Key Facts:

Source: WUSTL

Infections and neurodegenerative diseases cause inflammation in the brain. But for unknown reasons, patients with brain inflammation often develop muscle problems that seem to be independent of the central nervous system.

Now, researchers at Washington University School of Medicine in St. Louis have revealed how brain inflammation releases a specific protein that travels from the brain to the muscles and causes a loss of muscle function.

The study, in fruit flies and mice, also identified ways to block this process, which could have implications for treating or preventing the muscle wasting sometimes associated with inflammatory diseases, including bacterial infections, Alzheimers disease and long COVID.

The study is published July 12 in the journalScience Immunology.

We are interested in understanding the very deep muscle fatigue that is associated with some common illnesses, said senior authorAaron Johnson, PhD, an associate professor of developmental biology.

Our study suggests that when we get sick, messenger proteins from the brain travel through the bloodstream and reduce energy levels in skeletal muscle. This is more than a lack of motivation to move because we dont feel well. These processes reduce energy levels in skeletal muscle, decreasing the capacity to move and function normally.

To investigate the effects of brain inflammation on muscle function, the researchers modeled three different types of diseases anE. colibacterial infection, a SARS-CoV-2 viral infection and Alzheimers. When the brain is exposed to inflammatory proteins characteristic of these diseases, damaging chemicals called reactive oxygen species build up.

The reactive oxygen species cause brain cells to produce an immune-related molecule called interleukin-6 (IL-6), which travels throughout the body via the bloodstream. The researchers found that IL-6 in mice and the corresponding protein in fruit flies reduced energy production in muscles mitochondria, the energy factories of cells.

Flies and mice that had COVID-associated proteins in the brain showed reduced motor function the flies didnt climb as well as they should have, and the mice didnt run as well or as much as control mice, Johnson said.

We saw similar effects on muscle function when the brain was exposed to bacterial-associated proteins and the Alzheimers protein amyloid beta. We also see evidence that this effect can become chronic. Even if an infection is cleared quickly, the reduced muscle performance remains many days longer in our experiments.

Johnson, along with collaborators at the University of Florida and first author Shuo Yang, PhD who did this work as a postdoctoral researcher in Johnsons lab make the case that the same processes are likely relevant in people. The bacterial brain infection meningitis is known to increase IL-6 levels and can be associated with muscle issues in some patients, for instance.

Among COVID-19 patients, inflammatory SARS-CoV-2 proteins have been found in the brain during autopsy, and many long COVID patients report extreme fatigue and muscle weakness even long after the initial infection has cleared. Patients with Alzheimers disease also show increased levels of IL-6 in the blood as well as muscle weakness.

The study pinpoints potential targets for preventing or treating muscle weakness related to brain inflammation. The researchers found that IL-6 activates what is called the JAK-STAT pathway in muscle, and this is what causes the reduced energy production of mitochondria.

Several therapeutics already approved by the Food and Drug Administration for other diseases can block this pathway. JAK inhibitors as well as several monoclonal antibodies against IL-6 are approved to treat various types of arthritis and manage other inflammatory conditions.

Were not sure why the brain produces a protein signal that is so damaging to muscle function across so many different disease categories, Johnson said.

If we want to speculate about possible reasons this process has stayed with us over the course of human evolution, despite the damage it does, it could be a way for the brain to reallocate resources to itself as it fights off disease. We need more research to better understand this process and its consequences throughout the body.

In the meantime, we hope our study encourages more clinical research into this pathway and whether existing treatments that block various parts of it can help the many patients who experience this type of debilitating muscle fatigue, he said.

Yang S, Tian M, Dai Y, Wang R, Yamada S, Feng S, Wang Y, Chhangani D, Ou T, Li W, Guo X, McAdow J, Rincon-Limas DE, Yin X, Tai W, Cheng G, Johnson A. Infection and chronic disease activate a systemic brain-muscle signaling axis that regulates muscle function.Science Immunology. July 12, 2024.

Funding: This work is supported by the National Institutes of Health (NIH), grant numbers R01 AR070299 and R01AG059871; the National Key Research and Development Plan of China, grant numbers 2021YFC2302405, 2021YFC2300200, 2022YFC2303200, 2022YFC2303400 and 2022YFE0140700; the National Natural Science Foundation of China, grant numbers 32188101, 82271872, 32100755, 32172940 and 82341046; the Shenzhen San-Ming Project for Prevention and Research on Vector-borne Diseases, grant number SZSM202211023; the Yunnan Provincial Science and Technology Project at Southwest United Graduate School, grant number 202302AO370010; the New Cornerstone Science Foundation through the New Cornerstone Investigator Program; the Xplorer Prize from Tencent Foundation; the Natural Science Foundation of Heilongjiang Province, grant number JQ2021C005; the Science Fund Program for Distinguished Young Scholars (Overseas); and the Shenzhen Bay Laboratory Startup Fund, grant number 2133011.

Author: Jessica Church Source: WUSTL Contact: Jessica Church WUSTL Image: The image is credited to Neuroscience News

Original Research: Closed access. Infection and chronic disease activate a systemic brain-muscle signaling axis by Aaron Johnson et al. Science Immunology

Abstract

Infection and chronic disease activate a systemic brain-muscle signaling axis

Infections and neurodegenerative diseases induce neuroinflammation, but affected individuals often show nonneural symptoms including muscle pain and muscle fatigue. The molecular pathways by which neuroinflammation causes pathologies outside the central nervous system (CNS) are poorly understood.

We developed multiple models to investigate the impact of CNS stressors on motor function and found thatEscherichia coliinfections and SARS-CoV-2 protein expression caused reactive oxygen species (ROS) to accumulate in the brain. ROS induced expression of the cytokine Unpaired 3 (Upd3) inDrosophilaand its ortholog, IL-6, in mice.

CNS-derived Upd3/IL-6 activated the JAK-STAT pathway in skeletal muscle, which caused muscle mitochondrial dysfunction and impaired motor function. We observed similar phenotypes after expressing toxic amyloid- (A42) in the CNS.

Infection and chronic disease therefore activate a systemic brain-muscle signaling axis in which CNS-derived cytokines bypass the connectome and directly regulate muscle physiology, highlighting IL-6 as a therapeutic target to treat disease-associated muscle dysfunction.

See the article here:
Infection Brain Inflammation Triggers Muscle Weakness - Neuroscience News

Neuroscience

Alto Neuroscience, Inc. (NYSE:ANRO) Receives Average Rating of Buy from Analysts – Defense World

Alto Neuroscience, Inc. (NYSE:ANRO Get Free Report) has been given a consensus recommendation of Buy by the six research firms that are currently covering the stock, Marketbeat Ratings reports. Six equities research analysts have rated the stock with a buy rating. The average 1 year price target among brokers that have issued a report on the stock in the last year is $35.00.

Several equities research analysts have weighed in on the stock. Rodman & Renshaw assumed coverage on shares of Alto Neuroscience in a research report on Friday, June 21st. They issued a buy rating and a $43.00 price objective for the company. Stifel Nicolaus restated a buy rating and issued a $32.00 price objective on shares of Alto Neuroscience in a research report on Monday, March 25th. Finally, William Blair restated an outperform rating on shares of Alto Neuroscience in a research report on Wednesday, June 12th.

Get Our Latest Stock Report on Alto Neuroscience

Large investors have recently modified their holdings of the stock. University of Texas Texas AM Investment Managment Co. bought a new position in Alto Neuroscience during the first quarter worth about $340,000. Zimmer Partners LP bought a new position in Alto Neuroscience during the first quarter worth about $1,151,000. AWM Investment Company Inc. bought a new position in Alto Neuroscience during the first quarter worth about $4,592,000. Artal Group S.A. bought a new position in Alto Neuroscience during the first quarter worth about $5,372,000. Finally, Jennison Associates LLC bought a new position in Alto Neuroscience during the first quarter worth about $7,039,000.

NYSE ANRO opened at $14.50 on Tuesday. The company has a quick ratio of 26.02, a current ratio of 26.02 and a debt-to-equity ratio of 0.05. The businesss fifty day moving average price is $12.21. Alto Neuroscience has a 1 year low of $9.40 and a 1 year high of $24.00.

Alto Neuroscience (NYSE:ANRO Get Free Report) last issued its quarterly earnings results on Tuesday, May 14th. The company reported ($0.76) earnings per share for the quarter, missing analysts consensus estimates of ($0.46) by ($0.30). On average, sell-side analysts expect that Alto Neuroscience will post -2.93 earnings per share for the current fiscal year.

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Alto Neuroscience, Inc operates as a clinical-stage biopharmaceutical company in the United States. Its product pipeline comprising ALTO-100, which is in phase 2b clinical trial for the treatment of patients with major depressive disorder (MDD); and which is in phase 2a clinical trial for the treatment of post-traumatic stress disorder.

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Alto Neuroscience, Inc. (NYSE:ANRO) Receives Average Rating of Buy from Analysts - Defense World

Anesthesiology

Chief resident spotlight: Jane Goodson, MD – University of Nebraska Medical Center

Jane Goodson, MD, is a resident physician with the UNMC Department of Anesthesiology.

Name:Janie Goodson, MD

Hometown:Saint Paul, Minnesota

Title and department at UNMC:Resident physician, UNMC Department of Anesthesiology

Education: MD, University of Minnesota

What drew you to a career in anesthesiology?I never considered anesthesiology as a specialty until my general surgery rotation as a third-year medical student in Minnesota. I initially loved the mix of pharmacology and physiology happening on the other side of the drape. I also liked the spectrum of patients from healthy to critically ill. Most importantly, I felt like I fit in personality-wise with all the anesthesiologists I met in medical school.

Why I chose UNMC:I chose UNMC because of the vast clinical experiences offered here and the reputation of the program for being welcoming and family friendly. I also appreciate that UNMC is both the academic institution and major trauma center for the area.

Do you have any specific goals as chief resident?As chief residents, Paul and I hope to continue to foster a positive culture in the program. Creating the resident schedule is a big part of the chief job. We want to make it as fair and equitable as possible while maximizing residents ability to attend important events like weddings and family trips. I hope our co-residents will find us approachable and willing to solve problems.

What do you consider your greatest achievement? So far, my greatest achievement is having a baby during residency. Its such an honor to take care of patients and my little buddy.

What is your life like outside of work? Outside of work, youll find me hanging out with my baby (almost 8 months old!) and my husband when were both off work. I look forward to having hobbies again one day (haha.) We love taking our dog on walks and occasionally arranging doggy playdates with my co-residents.

Three things people may not know about me:

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Chief resident spotlight: Jane Goodson, MD - University of Nebraska Medical Center

Anesthesiology

2,400 people in Oregon potentially exposed to HIV, hepatitis through botched anesthesia – Livescience.com

Around 2,400 people treated in Oregon hospitals may have been exposed to HIV, hepatitis or other blood-borne infections due to an anesthesiologist's improper administration of drugs.

Providence, a health care system that operates in several states, notified the public of the exposure risk in a statement Thursday (July 11).

"We recently learned that Providence's comprehensive infection control practices may not have been followed by a physician during some procedures at Portland-area hospitals," the statement reads. These hospitals include Providence Willamette Falls Medical Center and Providence Portland Medical Center. Providence is notifying "approximately 2,200 patients" seen at the former facility and two seen at the latter medical center of this potential risk.

In addition, the same physician practiced at a Legacy Health hospital called Legacy Mount Hood Medical Center. "We are in the process of sending letters notifying 221 patients who may have been impacted," a Legacy spokesperson shared in a statement emailed to Live Science.

Related: Nearly 450 hospital patients in Massachusetts may have been exposed to hepatitis and HIV

The physician was an anesthesiologist employed by Oregon Anesthesiology Group (OAG), which partners with hospitals and ambulatory surgery centers in western Oregon.

"When we learned that the physician had violated infection control practices, we suspended him, informed our partners Legacy Health and Providence, and then began an investigation that resulted in the physician's termination," an OAG spokesperson told Live Science in an email. "Even though the risk of infection was low, new protocols and procedures have been put in place to prevent similar incidents in the future."

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The physician's name has not been disclosed, the Associated Press (AP) reported.

The actions of this anesthesiologist put patients "at low risk" of being exposed to various blood-borne diseases, including HIV and hepatitis B and C, Providence representatives said. According to the AP report, the provider worked with Providence between 2017 and 2023.

"Out of an abundance of caution, we are encouraging these patients to get a blood test to screen for the aforementioned infections, at no cost," Providence said. Any patients that test positive will be notified and then informed of possible next steps.

Legacy Health emphasized that "this was an isolated situation involving a single provider." The anesthesiologist was contracted to work at the Legacy facility for about six months, starting in December 2023.

The health care systems' statements don't note exactly how their safety protocols were violated. However, the Oregon Health Authority told the AP that the investigation centered around an anesthesiologist who delivered intravenous anesthesia and practiced "unacceptable" infection control while doing so.

Generally speaking, health care facilities have strict standards for how to sanitize needles, syringes and other equipment before they're used on a given patient, and a single needle and syringe should never be used for multiple people.

Ever wonder why some people build muscle more easily than others or why freckles come out in the sun? Send us your questions about how the human body works to community@livescience.com with the subject line "Health Desk Q," and you may see your question answered on the website!

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2,400 people in Oregon potentially exposed to HIV, hepatitis through botched anesthesia - Livescience.com

Anesthesiology

Providence, Legacy warn thousands of patients of possible exposure to hepatitis, HIV – The Lund Report

A former Oregon Anesthesiology Group physician is suspected of having violated infection control standards, but so far the allegations have not been linked to any patient infections, authorities say

Roughly 2,400 patients may have been exposed to hepatitis B and C as well as HIV as a result of a physician not following safety practices during medical procedures.

Providence Health & Services and Legacy Health are contacting patients who may have acquired infections while receiving care at three hospitals: Legacy Mount Hood Medical Center in Gresham, Providence Willamette Falls Medical Center in Oregon City and Providence Portland Medical Center.

A provider who previously worked for the Oregon Anesthesiology Group, an independent company that contracts with hospitals to provide anesthesiologists, is suspected of not adhering to infection control procedures, according to the health systems, who issued statements about the situation Thursday.

Patients are at alow risk of exposure to bloodborne infections, according to Providence. The hospital systems are conducting investigations in consultation with the Oregon Health Authoritys program on hospital-acquired infections, according to the agency.

Thus far, neither (Oregon Health Authority) nor the hospitals are aware of any reports of illness associated with this infection control breach, according to a statement issued by the agency.

The Oregon Anesthesiology Group issued its own statement:The safety of our patients is our top priority. When we learned that the physician had violated infection control practices, we suspended him, informed our partners Legacy Health and Providence, and then began an investigation that resulted in the physicians termination. Even though the risk of infection was low, new protocols and procedures have been put in place to prevent similar incidents in the future.

The provider thought to be responsible has not been identified. The hospital systems investigations center around a health care provider who provided care during medical and surgical procedures requiring intravenous (IV) anesthesia at the hospitals during different periods with unacceptable infection control practices, which put patients at risk of infections, according to the health authority.

The suspected provider worked at Legacy Mount Hood Medical Center for approximately six months beginning in December of 2023 according to Legacys statement. Legacy is sending letters to 221 patients who may have been exposed, and the hospital system immediately suspended the provider and launched a comprehensive investigation in accordance with regulations and with our policies and procedures after becoming aware of the situation.

According to Providence, the physician thought to be involved provided care at the health systems facilities between 2017 and 2023, and is no longer employed by the Oregon Anesthesiology Group.

The hospital system is sending letters and using the MyChart patient portal to notify approximately 2,200 patients seen at Providence Willamette Falls Medical Center as well as two patients seen at Providence Portland Medical Center.

Out of an abundance of caution, we are encouraging these patients to get a blood test to screen for the aforementioned infections, at no cost. If a patient tests positive, Providence will reach out to discuss their test results and next steps, according to the Providence statement. Patient safety is our number one priority, and our patients have our full commitment to a thorough review of this issue and appropriate action.

Providence cut ties with the Oregon Anesthesiology Group last year after having contracted with the physician-owned professional corporation since 1989.

Province instead hired Sound Physicians, a Tacoma, Washington-based staffing firm with a national presence and backing from private investors, to provide anesthesiologists. The health system faced criticism after Sound Physicians struggled to secure enough anesthesiologists, leading to numerous delayed and canceled surgeries.

About one in 31 hospital patients in the U.S. has at least one hospital-acquired infection on any given day, according to the state.

State health officials press release acknowledged that news of the safety violations may be distressing for some people. It added that highly qualified professionals are employed in Oregon to try to minimize hospital-acquired infections.

The health authoritys Health Facility Licensing & Certification Program accepts complaints and can launch investigations against hospitals for potential violations of state and federal requirements.

So far, state officials reportedly are not conducting their own investigation at Legacy Mt. Hood Medical Center or Providence Willamette Falls Medical Center.

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Providence, Legacy warn thousands of patients of possible exposure to hepatitis, HIV - The Lund Report

Pediatrics

Finding the Signal in the Noise on Pediatric Gender-Affirming Care – The Hastings Center

Bioethics Forum Essay

The Cass Review of gender identity services for children and young people, a recent report in the U.K., has spurred many headlines and much debate, most of which tout the finding of weak evidence for gender-affirming care for children and teenagers. Advocates of such care reject the report as anti-trans, while critics hail it for finally outing such care as pseudoscience. However, much of the noise around gender-affirming care in pediatrics, and this report, is misleading and takes away from the substantive improvements needed to provide the best care for transgender youth, something noted in the reports thoughtful foreword.

The Cass report was commissioned by the U.K.s National Health Service to make recommendations on improving care for children and young people who are questioning their gender identity or experiencing gender dysphoria. The report made eight recommendations on treatment, two of them on medications: puberty blockers and hormones.

While gender-affirming care is not reducible to medications alone, they are the treatments most often singled out by critics. The report determined that the scientific evidence for puberty-blocking medications in youths needs improvement, expressing concern about the potential risks and questioning the benefits for most children. The report didnt say that puberty blockers should not be prescribed to children, but it concluded that they should only be prescribed as part of a clinical trial. The report said that masculinizing or feminizing hormones could be given to people starting at age 16, but it advised extreme caution.

I cant think of any other situation where we give life-altering treatments and dont have enough understanding about whats happening to those young people in adulthood, said Hillary Cass, the pediatrician who produced the report. This statement, and concerns raised in the report about lack of evidence, are misleading for two reasons.

First of all, most medications used in pediatrics lack long-term and pediatric-specific data, and so medicines for gender-affirming care are not exceptional in that regard. In fact, up to 38% of drugs used in pediatrics and 90% of those used for newborns are prescribed off-label and have had few studies performed on children. These off-label medications include antipsychotics, endocrine medications, and even some antibiotics.

Second, there is safety data on puberty blockers. They have been given to children for decades to treat conditions such as precocious puberty, in some cases for the indication of social distress related to early puberty. These drugs have been shown to be safe in prospective observational studies.

In looking for evidence Cass placed the greatest value on randomized controlled trials. In these studies, participants are randomly assigned to receive either an experimental treatment or a control treatment and then their outcomes are compared. RCTs are great when they are feasible and ethical. But they are not feasible for studying puberty blockers because the participants and researchers would know which group the participants were in when they either did or did not show pubertal changes. This knowledge could interfere with an unbiased scientific comparison of the outcomes.

Without RCTs on puberty blockers, Cass had to review other studies whose evidence she considered weak. But this does not mean a lack of benefit. Rather, it should prompt shared decision-making with clinicians, patients, and families discussing the proportionality of benefits and burdens.

Weighing the proportionality of benefit to burden from an intervention is a foundational calculus in ethical decision-making. It goes on every day in pediatrics without apparent controversy. Some arguments appeal to patient autonomythe rights and interests of the patient who wants a treatmentrather than to the treatments ability to reduce morbidity and mortality, as was discussed in an article in the current issue of the Hastings Center Report. Other arguments focus on what is in the best interest of the patient. But for many decisions in adolescent health, it is not a matter of choosing either/or but rather considering both the patients autonomy and best interest that is necessary. For example, life-and-death decisions involving serious illness in adolescents require respecting the adolescents autonomy and considering the medical teams and the parents assessments of the benefits and burdens, or beneficence and nonmaleficence, of those decisions.

Interestingly, in contrast to gender-affirming care, there seems to be relatively little public controversy over cosmetic surgery for teenagers. And yet in 2022 there were 23,527 cosmetic surgeries performed on teenagers in the U.S., including breast augmentation for both biologic cis males and females. These surgeries require the same decision-making process as other interventions for teenagers. But as far as we can tell, they receive less public scrutiny than gender-affirming care. There are no court cases against these surgeries or attempts by state governments to ban them despite legitimate questions about their benefits and burdens to adolescents and the fact that, unlike most gender-affirming interventions in youth, cosmetic surgeries are not reversible.

Issues around evidence in pediatrics are abundant, but gender-affirming care receives a disproportionate amount of public criticism. Resources are lacking for research that would provide more evidence on the safety and effectiveness of care in pediatrics, including gender-affirming care. The Cass report recognizes this problem and provides important guidance. The report does not support bans and criminalization of gender-affirming care, which has been the response by more than 20 U.S. states and is under review by the Supreme Court. On the contrary it calls for investment in and expansion of gender-affirming care: improved access, workforce education, and collaborative and coordinated services, along with infrastructure to ensure improved data collection and ongoing quality improvement to strengthen the evidence for various treatment options. While we disagree with the Cass reports assessment of the evidence for puberty blockers and hormone treatments, its overall recommendations should be heeded by critics of gender-affirming care if the goal of their critiques is truly to provide improved and beneficial care for young people.

Ian D. Wolfe, PhD, MA, RN, HEC-C, is director of ethics at Childrens Minnesota and affiliate faculty in the University of Minnesotas Center for Bioethics.

Justin M Penny, DO, MA, HEC-C, is an assistant professor in the Department of Family Medicine and Community Health at the University of Minnesota and a clinical ethics assistant professor in the Center for Bioethics.

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Finding the Signal in the Noise on Pediatric Gender-Affirming Care - The Hastings Center

Pediatrics

Texas abortion law was followed by a rise in infant deaths: study | STAT – STAT

Since Texas ban on abortion went into effect, infant deaths in the state increased by nearly 13%, according to a new analysis published on Monday in JAMA Pediatrics. In the rest of the country, infant mortality increased less than 2% over the same period.

We had read the literature that was showing an association [of infant death increases] with prior abortion restrictions or states that are hostile to abortion, said lead author Alison Gemmill, a demographer and perinatal epidemiologist at Johns Hopkins Bloomberg School of Public Health. But they werent sure how strong the connection was.

In order to establish the bans potential impact on infant mortality, the researchers looked at deaths that occurred starting in March 2022. Babies born in that month were about 10 to 14 weeks along when the Texas abortion ban known as SB 8 went into effect on Sept. 1, 2021. The ban, one of the most restrictive in the country, prohibits abortions after about six weeks of pregnancy.

The researchers found that in 2022, 2,240 infants under the age of 1 died in Texas, more than half of whom died before 28 days of life. In 2021, there were 1,985 infant deaths, a statistically significant difference.

I actually dont think that it was obvious that there would be increases in infant deaths, and so just that there is itself an important finding, said Amanda Jean Stevenson, a professor of sociology at the University of Colorado Boulder, whose work focuses on the impact of abortion and family planning policy. There would be an argument to be made that we wouldnt expect to see statistically significant increases, because this is such a rare outcome, and abortion had already been restricted in Texas pretty substantially, said Stevenson, who was not involved in the study.

The findings, she said, show the huge impact that a restriction on abortion can have, even starting from low levels of access. Before SB 8 went into effect, abortion in Texas was essentially banned after 22 weeks, and the state imposed other restrictions, such as requiring hospital admitting privileges to provide an abortion and curtailing access for minors. We think its actually a causal effect, said Gemmill.

The study had limitations, including the fact that the gestational age was not included in infants death certificates. The low absolute number of deaths prevented more detailed demographic analyses, too. But the researchers focused on building apples-to-apples comparisons by accessing the same Centers for Disease Control and Prevention data for Texas and the rest of the country. They only included states where infant deaths exceeded 10 in any given month between 2018 and 2022, as data for smaller states didnt provide the same level of granularity.

Given the really substantial rigor that this article uses in its analysis, I am confident that this is something that happened exactly when SB 8 went into effect, said Stevenson. I think that its very strong evidence that SB 8 is the cause of the observed increase.

Among the causes of infant deaths, one increased the most: congenital abnormalities, which increased 22.9% in Texas in children between 2021 and 2022, while they decreased 2.9% in the rest of the country. That trend suggests that at least in some cases, parents were forced to carry a pregnancy to term while knowing their children had little to no chance of survival, said Gemmill.

What we know from the literature is that any infant death is a traumatic event to experience, she said. But I can imagine that carrying that fetus to term when you could have had the option to terminate is going to just add that additional trauma and heartbreak to the situation.

Significant increases were also found in babies who died because of maternal complications of pregnancy; in Texas, those deaths increased by 18.2% between 2021 and 2022, compared to 7.8% in the rest of the country. Infant deaths caused by unintentional injuries, which can be associated with unwanted pregnancies, also increased by 20.7%, compared to a 1.1% increase elsewhere in the U.S.

These numbers only paint a partial picture of the long-term impact of abortion bans, said Gemmill, who is planning to focus her research on infant morbidity. Babies born with congenital abnormalities can face extremely difficult life circumstances, and require immense practical and emotional investment from parents.

Deadly fetal abnormalities cant be corrected through medical intervention, leaving the prevention of these deaths to policy. The most effective way to prevent these unnecessary infant deaths is clearly to not restrict abortion, said Stevenson. The other thing that is possible is to support people leaving Texas and states that ban abortion to get abortion in other places. So there also is an opportunity for policy intervention in the form of facilitating people crossing state lines for care, she said.

In the short term, Gemmill said, stronger support is needed for the families facing the loss of an infant. Stevenson agrees: The grief that parents experience, the burden that caring for terminally ill infants places on families and health care providers there are a lot of ways that our society doesnt support people who are dealing with traumas like these.

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Texas abortion law was followed by a rise in infant deaths: study | STAT - STAT